Category Archives: Health and wellness

The Big O has new meaning as women age

Since being diagnosed in November, days before Thanksgiving, I have taken a chalky white pill with a full glass of water every Thursday morning, on an empty stomach. Then I have stood or sat upright for an hour before enjoying my customary coffee with microwaved milk, so the medicine can be absorbed and won’t irritate the esophagus (my “food pipe”).

Initially, I was angry:

  • At a healthcare system that didn’t warn me years ago that bone density could be an issue for a woman who is white, thin, of northern European heritage, with a small frame and a mother who took Fosomax herself for years.
  • At a nurse practitioner who had seen me before my 65th birthday in July and never mentioned it was time for another bone density scan. I discovered that on my own while clicking through MyChart months later to verify an appointment and saw a notice that my scan was “overdue.”
  • At a culture that pressured women to be model thin when I was young. Twiggy was a skinny, 16-year-old kid when the media started marketing her as the ideal body type for women. Even Gloria Steinem, for all her intellect and accomplishments, became the face of the 1970s-era women’s movement in part because she, too, was thin and pretty.

“I have to focus more on being strong than being thin,” I wrote on Facebook shortly after my diagnosis of thinning bones. Enough crowing about keeping a closet full of clothes from my 40s and 50s “because they still fit.” Or celebrating that I weigh less than I did when I got pregnant with my older son, who was born in 1990. Or preferencing cardio exercise, which gives me an emotional lift, over the tougher, more monotonous work of lifting weights.

One of my sisters was nurturing and supportive, texting or calling to offer tips about the benefits of Pilates or which calcium-rich foods to eat. (Who knew that ice cream, eggnog and fortified frozen waffles would make the list, alongside kale and broccoli?)

My oldest sister, the pragmatic one, issued a simple challenge: What are you going to do about it?

Name it, claim it

The word itself scares me. Osteoporosis conjures up images of an old, wizened woman whose upper back has curved into a question mark. My reluctance to name the disease, to say the word aloud, is both a symbol and a symptom of my denial. Just as I resisted the label alcoholic when I recognized in my early 40s that I needed to quit drinking, I now reference my “bone density issue.”

Osteoporosis is for old people; osteoporosis, like forgetfulness and a thickening middle, is for my late mother. Thinning bones don’t afflict people who are fit and who exercise as much as I do.

Or so I thought. Physically active throughout my life — a seasoned cyclist, a walker who averages 16,000 steps a day, a former aerobics instructor who still loves to take yoga classes — I was stunned that thinning bones could be a problem. When the nurse practitioner handed me a printout from Mayo Clinic at my follow-up appointment, I noted that none of the “lifestyle choices” that increase risk of osteoporosis apply to me:

  1. Sedentary lifestyle. I have a hard time sitting still. “You’re in fifth gear or asleep,” my husband likes to say.
  2. Excessive alcohol consumption. I haven’t had a drink since January 10, 2010.
  3. Tobacco use. I never could inhale.

“This is not your fault,” the nurse practitioner assured me after I told her I was scared. But the diagnosis, especially on the cusp of snow and ice season in Minnesota, felt like a slippery slide into old age — like “being suddenly Old and Fragile,” as one friend aptly put it.

How would I walk my dogs every morning when falling could more easily break my bones? Would I have to abandon biking come spring, a sport I have loved since I was 5, because a tumble could sideline me forever? Exercise and movement are my sanity, my way of coping with stress, my increasingly tenuous hold on independence, my illusion that I will be forever young.

As the shock has worn off, I have moved gradually toward acceptance, and into action. Do something now, or you’ll pay later. That much is clear.

Bone up

Watching my weight was something I could control in a world that (still) tries to control women’s bodies. Now, I apply that discipline to self-care for my bones.

One lesson I’ve learned already is to take charge of my own healthcare. In a system still exhausted and under-resourced from COVID, no doctor is going to walk me through this. Doing my own research and seeking support from friends and family members, including my weight-lifting sons, have pulled me out of the muck of fear and self-pity.

  • Thursday is Fosomax day, with a weekly reminder on my calendar. The hour of being upright and foregoing any nourishment but water is peaceful and productive quiet time.
  • I lift free weights two to three times a week and am relishing growing stronger.
  • I have started taking a Pilates Fusion class designed for people with arthritis and osteoporosis, with special emphasis on strengthening back, glute and abdominal muscles.
  • I no longer skip my daily calcium and Vitamin D3 supplements.

That my diagnosis came on the cusp of a major life change — a step away from a full-time career, and all the status and identity and financial security that brought me — has made osteoporosis seem both an indignity and oddly well timed, a gentle push into the next phase of life and a firm reminder to accept reality and deal with it.

“Everyone hopes to reach old age, but when it comes, most of us complain about it,” the Roman philosopher Cicero said. Had I not been searching the website for tips on healthy bones, I never would have stumbled upon “Lessons on Successful Aging,” derived from Cicero’s 2,000-year-old essay “On Old Age.”

Among the lessons relative to women at this later stage of life:

  1. A good old age begins in youth. I can wish that I had started lifting weights at a younger age, but I cannot change the habits or negligence of the past. All I can do is develop new patterns now.
  2. We can be active in old age, with limitations. Winter biking will never be a sport I’ll pursue, just as jogging outdoors in winter now seems foolhardy.
  3. Youth and old age differ. Longing for what was keeps us stuck in the past and blocks us from embracing the benefits of aging.

Osteoporosis, the Big O for older women, is my necessary reminder that good health is neither a given nor guaranteed.

Try this Antidote for Aging: Leave the Car at Home

I gave up my membership at CorePower Yoga in September, in anticipation of becoming eligible for Medicare. After nine years, I said a reluctant goodbye to the Colorado-based chain that brought fast-paced, fitness yoga to the masses, at least those of us who could afford it.

Now, my Blue Cross Blue Shield Advantage plan, which supplements the hospitalization and basic clinical coverage in Medicare Parts A and B, offers free membership at certain health clubs. The youth-oriented CorePower is not among them, and so I took another step down the path leading directly to old age and signed up at the YMCA a walkable distance from my house and Lifetime Fitness, a bus ride away.

Exciting, yes, but the busing and walking will benefit my aging mind and body more than any health club membership ever could.

Four reasons why:

  1. I will engage in active transportation — walking (with or without my dogs) or riding a bus or bike — far more often than I’ll get to BodyPump at the Y or the Gluteous MAXout class at Lifetime Fitness.
  2. I notice more about my community and the wider world when I get around in a way that de-prioritizes cars, which separate us from other people. Paying attention makes me aware of how the world has changed, keeping me current on social trends, and that’s good for older people.
  3. I am more likely to engage with others — greeting them on a sidewalk, chatting with them on a bike path — and social interaction sparks my aging brain.
  4. My imagination takes flight and my worries right-size when I am gazing out the window on a bus or train or moving freely outdoors. Speed no longer is the top priority.

Being a daily pedestrian, a regular transit rider and at least a two-season cyclist have become ingrained habits. Because I live in a city — in a neighborhood with sidewalks, bike paths and several bus routes an easy walk away — I can incorporate those practices more readily than someone who lives in a small town or a suburb. And yet a walk or a bike ride can happen almost anywhere.

Active transportation is an ideal way to exercise as we age, at a time of life when we’re more serene and less competitive. (At 65, my last timed run is a decade behind me, and I never bought a computer for my road bike.) I have been keeping a multimodal diary since July, jotting down why I was grateful on any given day to have made the counter-cultural choice to leave the car in the garage and move instead on my own power.

Communal transportation requires patience, flexibility and, at times, humility — having to explain, for example, that a late bus is beyond your control. But all three traits are invaluable to graceful aging.

Consider this:

  • If I hadn’t taken the bus to a volunteer shift at Planned Parenthood North Central States, I wouldn’t have gained 3,000 steps on a brisk and bracing day, warmed slightly by the sunshine, when I missed my bus and had to high tail it to a different route.
  • If I hadn’t walked to the bus stop for yoga on a Sunday morning in July, I wouldn’t have been able to greet a neighbor and introduce myself to another. I would have lost the chance to read an article in that morning’s Washington Post. Still, had I driven, I could have left home 30 minutes later. In a go-go society, that matters.
  • If I hadn’t bussed to a business meeting where I didn’t have the option of running late, I would not have recognized the luxury of having choices. I allowed myself five minutes to get to a bus stop three blocks away: Why did my dog choose this moment to escape from the back gate? But, of course, I could always use my car if I missed the bus. Privilege means having options — and less anxiety than the young man in the back of the bus shouting into his mobile phone about how he was short on rent because he spends too much money (“meals out, shin guards”) on his girlfriend’s kids.
  • If I hadn’t ridden my bike to meet a friend for coffee, I wouldn’t have discovered the private, pristine patio behind Cahoot’s Coffee Bar on a lovely autumn day. It was the safest place to park my new bike, and the barista kindly helped me get it back there.
  • If I had driven to a meeting where the bus did make me late, I would have missed the 12-minute walk to the bus stop and the reminder that I used to commute to work by foot — 17 minutes each way — and need to build that exercise into my new routine of at-home contract work.
  • If I hadn’t taken the Green Line train to a meeting in downtown St. Paul, I wouldn’t have figured out how to feel safe on a transit system wrestling with crime. I sat in the car closest to the conductor, looped one strap of my backpack around my arm, kept my smartphone out of sight and minded my own business.
  • If I hadn’t walked to a meeting at a favorite coffee shop just far enough away to contemplate driving, I wouldn’t have snagged the metal plant stand shaped like a tricycle from a neighborhood antique store just moments before they closed.

We can’t lecture or guilt people into driving less, even though we know it helps cut greenhouse gas emissions. Sure, we can cite climate change as an existential threat, but Americans know that — we’ve been whipsawed all summer by news of drought here, torrential rains there — and still, our self-defeating practices don’t change.

I used to work for a man who left his climate-controlled house in the suburbs, got into his climate-controlled vehicle in his attached garage, drove freeways to the campus where we both were employed and parked in a climate-controlled garage beneath the student center. Once upstairs, he walked the equivalent of half a city block outside to reach his climate-controlled office. That was the extent of his engagement with the outdoors.

I don’t have enough years left on the planet to spend them encased in air-conditioned structures that separate me from what is real, and essential. I want to be out there, amid it all, with the city and Mother Nature, as unpredictable and sometimes scary as they both may be.

Photo courtesy of Jan Huber on Unsplash

The ABCs (and Ds) of Medicare: Back to the Basics

Why do so few people in Medicare brochures wear glasses? (Sometimes the men do.) Why do so many of us aging Americans view 65 — the age at which we qualify for government-sponsored healthcare (thank you, LBJ) — as a natural end to our full-time working years? Who could have predicted that learning the ABCs would be a task not only for toddlers but for those of us toddling toward retirement, too?

“Don’t let the alphabet confuse you,” a BlueCross BlueShield Minnesota rep told me last January during the first of my phone calls to learn more about Medicare. Back then, I thought understanding the multi-pronged program would be child’s play.

“Parts A and B are original Medicare,” he explained patiently, while I pictured him holding up colored wooden blocks. “Part C is an advantage plan. Part D is prescription drugs.”

D is for drugs, I told myself: I can remember that!

The ABCs of old age

Turns out, there’s so much more. I have learned that the weightiest decisions about Medicare — whether to enroll in a Medigap or an Advantage plan, when to enroll in Parts B and D without facing a lifetime penalty, which private insurer to use — can all be delayed since I plan to keep working full time, with employer-provided healthcare, after I turn 65 in July.

Still, my months of research have changed my perception of where I am in life. Wrinkles flank my mouth and crease the bridge between my eyes. My right hip hurts from over-exercise. I feel the beginning twinges of arthritis in my hands. Or am I finally just acknowledging the obvious?

“I’m officially old,” I texted my lifelong friend, who turns 65 in May, six weeks ahead of me. “Just enrolled in Medicare Part A.” (That’s the part that covers most hospitalization expenses and is free at 65, provided you’ve worked long enough to qualify.)

“If I didn’t tell you today, I LOVE YOU!” she replied, reassuring me that I am really only “young-old.” Age reveals the importance of family and friends, the relationships we nurture because we need one another as we feel our way forward, toward the inevitable end time.

Marketing Madness

An unmarked white envelope fell out of my newspaper the other morning, an ad to join AARP. Did all subscribers get these, or is generational marketing that sophisticated? My mailbox hasn’t been so stuffed with ads —invitations to Medicare 101 classes, appeals from insurance companies whose chief executives earn multiple millions of dollars a year — since I aged out of the desirable demographic of 18 to 54 years old.

The first piece of Medicare mail has proven the most useful. A tall, laminated, two-sided flyer from UCare, it looks and functions like a large bookmark and has sat atop the growing pile of brochures for months. One side declares in oversized, old people–friendly type what steps to take six, four and three months before you turn 65; the other side urges you toward the research you should do anyway if you plan to keep working past age 65 and are fully insured.

Three key points that months of research has taught me:

First: Other than Part A (the standard hospitalization coverage), Medicare, contrary to assumptions, is not free. Nor is it the Bernie Sanders vision of a single-payer, government-sponsored program. A former colleague of mine retired nine months before turning 65. Despite careful budgeting and the blessing of her financial advisor to walk away from a six-figure salary before she qualified for Medicare, she said the monthly cost of post-retirement healthcare coverage surprised her: “It’s expensive!”

Second: If you have healthcare through your employer, and plan to keep working past 65, determine whether the prescription drug coverage is “creditable,” meaning it at least equals Medicare Part D; that’s the only way to delay Part D enrollment without a penalty once you have turned 65. (Given that a trusted neighbor contradicted the advice from a BlueCross salesman, I have fact-checked this several times.)

Third: “Original Medicare” — Parts A and B — covers only 80 percent of your expenses. That means you have to figure out the distinction between a Medigap supplemental plan and the relatively new (since 1997) Advantage plans, which are cheaper, more bound to a network of providers and recently have been in the news for denying claims. Heavily marketed, they appeal to healthy, young-old people like me because of their emphasis on fitness programs and coverage for fashionable eyewear.

We ego-driven Baby Boomers don’t feature ourselves ever sliding into decrepitude or suffering the indignities that a more expensive Medigap plan would cover.

Medicare’s Promise and Potential

Just as I started saving for retirement at age 27 and have counseled my grown sons to do the same, I have spent months now researching how Medicare works and what health coverage I may need heading into these years when the uncertainty of life has never looked more certain.

Key to keeping the fear at bay has been talking to people who have crossed the bridge:

  • My politically conservative confidant who favors UCare because he won’t buy health insurance from a for-profit company like United HealthCare.
  • My friend who thinks Advantage plans are overrated and overmarketed; she uses a more expensive Medigap supplemental plan because it serves her wherever she travels, including overseas.
  • My buddy who swears that the free services of a broker — who, of course, is getting compensated by insurance companies — bring clarity to the head-spinning confusion of Medicare options. He laughed at my insistence on doing my own research (“that’s so like you, Amy”).

For those of us who have earned enough and had the discipline to save throughout our working years, Medicare opens a door to the final active stage of life. However much I may mock the glossy brochures — color photos of women walking in the woods, a laughing couple out on bikes, a man lingering in a bookstore, two women talking over coffee — I have to concede that the calmer life they portray looks good.

Nothing in the stack of marketing materials tells me how to decide when to leave full-time employment. How I’ll fill my time or discover a new identity. How my husband and I will belt-tighten once a tidy sum of money no longer drops into our checking account every other Friday.

Most of us know that retirement requires a baseline of financial planning; but emotional and spiritual planning are just as important.

Connie Zweig, Ph.D.

What I do know — and what one of my older sisters predicted — is that my view of work is shifting, almost without bidding, as I edge closer to the time when healthcare coverage no longer ties me to a demanding full-time job. Allowing others to control my schedule, always carrying the worries with me, rarely getting a full night’s sleep: It’s all less appealing and less physically possible as I age.

“How we retire, and how we imagine retirement, may be more important than when we retire,” says Connie Zweig, Ph.D. in her 2021 book The Inner Work of Age: Shifting from Role to Soul. “All this emphasis on working and doing . . . stresses that purpose comes through productivity and doesn’t appear to include more service-oriented doing or more contemplative, spiritual development,” she writes.

Maybe the Medicare brochures with all their bicycles and coffee breaks are marketing more than overpriced health insurance, after all. Maybe it’s time to listen, to see the end of work-as-identity as a new beginning. As a time when I finally will be free.