By Cheryl Oreglia

Preparation Is Key
 
I knew this chrysalis stage was going to be rough, as if tackling pubescence in your fifties, but I have to admit the unrelenting joy was a total surprise.
 
The caterpillar chooses the food the butterfly will need, chooses the exact space to later spread its wings, without the space, the wings would never fly writes Marion Woodman. She goes on to say the chrysalis is essential. It is the twilight zone, a precarious world between past and future, like living in a gap, it naturally defines all that is to be.
 
I’ve come to believe aging well is all about preparation. Did I sufficiently feed myself with rich experiences, capacitate deeply rooted relationships, situate myself in a space that not only allowed for failure but a graceful recovery? If so, am I prepared to rid myself of this interim shelter, spread my wings, and live without the encumbrances of youth?
 
This is my journey through menopause, the untarnished truth, the reality of aging in a modern world, and how this redefined my perception of beauty.
 
When the tsunami hit, it was powerful and unexpected. I found myself sweating profusely in front of my students, I couldn’t sleep for more than a two-hour stretch, or decide on a particular mood, and never mind the unwarranted belly fat. My hair, skin, muscles, and bones staged a coup and I’m afraid I was not dealing with it well.
 
I took walks, ate kale, drank lots of water, and like Jesus there was never enough wine.
 
Our Predecessors
 
It’s noteworthy to mention that aging female whales also experience a hormone imbalance during their twilight years. The interesting thing is whales become leaders in their pods, whereas humans go on hormone replacement, and start searching the yellow pages for a good therapist.
 
We have an odd response to aging in our society—tackle the symptoms, hide the evidence. It’s as if we’re disposable, past our expiration date, left unrefrigerated, fermenting on the counter, our essence soured, spoiled, and yet some would say cultured.
 
It must be said, I miss my waist. The part of my anatomy designed to clarify the top half of my body from the bottom. It not only defined my shoulders, but scaled beautifully with my derrière, allowed me to bend gracefully, wear fashionable belts, offer a place to rest a baby or my hands when angry. It’s no longer there, as if a soft-serve ice cream cone, I’m suddenly layered. This could be for practical purposes, such as stability because otherwise, my boobs would totally throw me off balance.
 
People age. It’s not a design flaw or cruel and unusual punishment for surviving our youth. It’s a reward. We are finally unburdened by cycling hormones, the demands of fertility, and our homemade fledglings. I’m what you call a recovering enabler, I used to spend my day running amuck, delivering late papers, forgotten lunches, art projects, and gym clothes to three different schools, acting as a buffer during conflicts, generously (at times begrudgingly) accommodating the demands of family and clan, bending like a pretzel to make life easier for anyone caught in the vortex of my life.
 
I don’t miss all the noise and confusion, the chaotic pace, picky eaters, or monthly menses.
 
Today, I’m graced with quiet, unmitigated time, and the leisure to pursue all those dreams I stuck on that vision board in my thirties but somehow ended up in the back of a disorganized closet. I have arrived, it’s time to dust off that old bulletin board, and start pinning new goals.
 
My husband and I are revving up the romance. He’s taken to courting his bride. We bought a tandem bike, joined a gourmet cooking club, and added wine tasting to our extracurricular activities. He’s improving his golf game; I’m developing my writing and together we are decluttering the garage. Our travel plans have been hampered by the restrictions of an unexpected pandemic but like all things in life, this too shall pass. My schedule is malleable, I wrap it around my needs. Now I consider it a good day when I find my car keys, a parking space, and remember why I landed in the Target parking lot.
 
Survival of the Fittest
 
But wait for it … in the middle of all this menopausal unrest, I stumbled on a fabulous theory! The most prevalent premise behind menopause is called the grandmother hypothesis. In short, it suggests females may stop breeding to help their children and grandchildren survive and reproduce.
 
Do you understand the implications here?
 
I didn’t either.
 
In a world where my value was based on the productivity of my womb, no wonder I had a meltdown when my ovaries died. As my temperature rose, and the perky parts fell, I became a mother again.
 
Yes, it’s true. With the birth of my daughter’s daughter, I’m no longer a detriment to the ecosystem, like reusable containers I’ve been repurposed, restored, and revitalized.
 
I can’t say it enough, motherhood the second time around is pretty damn sweet, nothing falls out of your honeypot, and no stretch marks.
 
The afternoon knows what the morning never suspected, says Robert Frost.
 
My granddaughter asked me the other day, “Do those hurt, Grammie?” She was referring to the wrinkles around my eyes. I said, “No sweetheart, not at all.” I’m relishing the freedom from those confining roles of parent, caregiver, volunteer extraordinaire, to newly winged senior citizen, glorious, light, wrinkled, and free.
 
I still hate kale.
 
Naomi Wolf says, a consequence of female self-love is that the woman grows convinced of social worth. Her love for her body will be unqualified, which is the basis of female identification. If a woman loves her own body, she doesn’t grudge what other women do with theirs; if she loves femaleness, she champions its rights.
 
“Aging is an extraordinary process where you become the person you should have always been,” says David Bowie. Writing has given me a place to spread my wings. I could not have anticipated the enormous endowment of this work. My concept of beauty has shifted over time. I believe there is nothing more beautiful than a confident, unencumbered woman, who understands not only her immeasurable worth, but her influence on the perpetuation of society. I appreciate the brevity of our existence, the precarious space between past and future in which we exist, and I’m ever so grateful for our latent ability to break through the chrysalis, take to the skies, endowed with wrinkles, and resplendent joy.
 
 
Cheryl Oreglia hosts a lifestyle blog called Living in the Gap, she claims the space between past and future, where one's potential is created or destroyed. With arresting humor Oreglia draws you into her cantankerous life, forty-year marriage, empty nest, and evolving faith. By cleaning out the things that clutter her life she illuminates our own in her popular memoir-style blog. Oreglia surrounds herself with a gaggle of intriguing friends who challenge her to live authentically in a rapidly changing world. Oreglia uses her experience to explore what matters most in life...the degree to which we love and are loved. 
 
 

In a previous post, I covered the main components of a total healthcare team that midlife women need begin building as they get serious about their long-term well-being. Just a few of those slots should be devoted to providers such as a primary care physician, a dentist, a gynecologist familiar treating women beyond the realm of fertility and pregnancy, and a dermatologist, among others.

These core practitioners should be able to fulfill and treat the most pressing and common healthcare needs we face going into middle age and beyond. These are the type of providers who are usually covered by your insurance within your networks, with the only payments rendered being whatever it takes to meet your deductibles and contribute your co-pays.

But what else is out there? What other tools should middle-aged women have in their well-being grab bag?

Well, there is more. This could be looked at negatively or positively, depending on your viewpoint. You may be thinking, “Great! At least there are all sorts of trained people out there to meet my needs.” Or you may instead be saying to yourself, “What kind of BS is this, and how expensive is this going to be.”

No matter your paradigm, the truth is that our holistic mind-body needs can be vast. And conventional doctors, even specialists, are not always the best, most comprehensive resources for information when it comes to things that cannot be prescribed and picked up at the pharmacy, or that are not necessarily part of a diagnosable condition, illness, disease or pathology.

Other types of wellness providers that may be discretionary (depending on your situation) and “nice to have” include:

Acupuncturist. Acupuncture has been indicated as being helpful for menopause symptoms. Some research has linked improvement in sleep problems, vasomotor symptoms and overall mood with acupuncture. For those who don’t know, acupuncture is a form of alternative medicine rooted in Chinese medicine. It involves superficially inserting small needs in the body. Ranges for the cost of acupuncture vary, often between $50-$95 per session.

Dietician. Despite their name, dieticians do much more than just put clients on diet. Dieticians are experts in nutrition who usually have an undergraduate degree from an accredited university or college with coursework that has been vetted by the Accreditation Council for Education in Nutrition and the Academy of Nutrition and Dietetics. Many dieticians have master’s degrees, have completed industry internships, have passed national examinations and are required to complete continuing education requirements. A dietician helps people focus on healthy eating habits and sound nutrition practices. These specialists can help women struggling with midlife weight loss or medical conditions that make weight loss or weight maintenance challenging.

Massage Therapist. Massage therapists are trained to understand bodily mechanics as they use touch to manipulate the muscles and soft tissues of the body. Massage therapy has been associated with stress reduction, circulation improvement, lymphatic system stimulation, recovery from injury and a general feeling of well-being. Medically, massage can help with nerve pain, fibromyalgia, anxiety and other physical pain syndromes or symptoms. According to national averages, the typical cost for a massage session is $50-$150.

Personal Trainer. Personal trainers are credentialed to provide custom workout plans and supervised exercise sessions for clients. They often serve individuals interested in specific goals, usually weight loss, muscle gain, injury recovery and foundational bodily function. Based on their training, the not only provide motivation, accountability and support, but they also know how to prevent injury during training and to develop modifications based on a client’s limitations. Personal trainers are usually certified by one of the prevailing industry bodies – NASM, ACE or ISSA.

Therapist. Therapists are not psychiatrists – they cannot prescribe medications. Sometimes a therapist may also be classified as a psychologist or social worker, but not always. Therapists help people deal with particular issues, such as addiction or marital challenges, but they also provide overall support for a variety of emotional, mental or physical health problems.

* Some insurance carriers will cover the cost of dieticians or nutritionists. 

Now that you’ve decided to finally get that long-delayed annual physical and have gathered an understanding of what to look for in a good doctor, it’s time to take things up a notch. Finding a quality physician and getting a yearly checkup provides a solid baseline for the fuller continuum of your personal healthcare portfolio.

And that broader picture requires building your total healthcare team. As you get older, having a complete medical squad ready to deploy in the backdrop of your ongoing wellness is vital. Sure, you’ll still see your core primary care physician (PCP) for routine office visits and once-a-year follow-ups to monitor your baseline health and get meds for things like sinus infections or UTIs. But creating a comprehensive care team goes beyond these minimums.

In some cases, it can be challenging to construct your healthcare team due to insurance red tape. For example, your internal medicine doctor may be the gatekeeper – the one you through which you must funnel most specialized medical requests. In such cases, the PCP largely holds the cards in determining whether, or when, you get that prized referral to see a specialist who focuses on a particular area of the body (e.g. a cardiologist for heart concerns, a neurologist for nerve-related issues). However, even if this is true for you, you can still build a go-to care team by doing the legwork now to determine precisely which doctors in what areas you want to see if or when circumstances dictate.

For those who have a primary care physician but who also have the autonomy to see other doctors without going through PCPs for a referral, you’re probably wondering, “What is a healthcare team? What kind of doctors need to be on it?”

A care team is akin to a team in sports: Everyone has a role, a position to play, with expectations of what that title conveys. Similarly, it is understood that most people who are 40+ years old currently need, or will need, more than the garden variety family medicine doctor to deal with all the medical concerns they face. Your PCP cannot be all things to all of your problems. So let’s call the other care providers “reinforcements,” though this is not intended to belittle the critical role they play.

Your body is unique, and the needs you have from a medical standpoint are, too. So these are simply recommendations, or considerations, of the various provider types who you’ll need to recruit as part of your total healthcare team.

Dentist. Oral health is important. People should visit their dentist twice a year for cleanings. Assuming no other issues are discovered, such as early stage periodontal disease or failing teeth, these two outings will be the only times you see your dentist annually. Though this may seem “low level” when it comes to overall health, it’s not: oral health is connected to diabetes, heart disease, oral cancer and stroke, according to many reputable health sources.

Dermatologist. Skin changes at midlife. You may start to see more moles, new wrinkles, a return of acne and changes in skin texture. Yes, in most cases these are more superficial, aesthetic considerations rather than medical needs. But feeling good about how you look is an important aspect of well-being. Dermatologists provide treatments and medications that can help women feel better about their changing selves at middle age without going under the knife.

Endocrinologist. With hormonal havoc happening during perimenopause, some women in the 40-and-over camp may find themselves visiting an endocrinologist for the first time. Most endocrinologists don’t treat perimenopause, but instead focus on diabetes, cholesterol issues, thyroid problems, adrenal disorders and hypoglycemia. The caveat to note is that reproductive endocrinologists are trained to deal with hormonal problems and can be well suited to manage hormone replacement therapy (HRT).

Gynecologist. This is perhaps the most obvious recommendation to have on your personal care team as a woman. Though we may not be entertaining the idea of reproduction at this stage, there are other elements of your reproductive health to maintain. It is now recommended to get Pap smears every three years (often along with HPV testing). Some women still opt to visit their GYN annually for an exam. It is important to find a doctor or practice skilled in, and attentive to, treating patients who are not obstetrical cases (in other words, women who are neither pregnant nor interested in being so).

Optometrist / Ophthalmologist. Most people’s vision changes around the age of 40, even for those who’ve never needed glasses before. Getting your eyes checked every year or two should be pretty customary for the 40+ set. This evaluates any changes to your vision and ensures you get the right prescription to see clearly, and also checks for any underlying eye diseases, like the beginnings of glaucoma.
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Orthopedist. The aches and pains of advancing stage start to hit many people going into their 40s or 50s. In many cases, the discomforts are short-lived and benign; other times, there is actually a structural and functional problem involving the musculoskeletal system. These problems could be degenerative in nature (think arthritis), acute (think runners knee) or require surgery (like bone spurs impinging on nerves). Achy necks, back pain, knee stiffness and the like are common symptoms that lead to orthopedic care.

Psychiatrist. A perimenopausal woman, or one going through the menopausal transition, has at least double the risk of first-time anxiety or depression than a pre-menopausal woman. The risk ratio is higher for women who’ve previously experienced postpartum depression or who’ve had prior depressive episodes. For many women, this will be the first time in their lives that they are offered or prescribed an antidepressant or anti-anxiety medication. Sometimes these medications have other benefits, such as treating hot flashes or reducing hormonal headaches. In any event, it’s probably better to have a professional trained in this pharmacology to manage this than a general medicine doctor. And this type of physician just happens to be a psychiatrist.

Your situation is as unique as your biology, and you may need other types of providers in your wheelhouse as you navigate the changes of age and time. Coming up soon in this series will be a list of the specialists and providers that are “nice to haves” in enhancing your total well-being and health.