The Top 10 Things I HATE About Ageing...

-frenemies-

Well a very happy birthday it was..... Another year older - Check! Another year wiser - one would hope. Being in residency alone makes me feel like I've aged 9 years in the past 9 months, and not all for the worser (or whatever the opposite of better is); I do feel weathered, and tired, and out of shape...but I also feel like I've learned more about my field in the past 9 months than I ever thought possible. I owe it to my fellow goats, my seniors, my attendings, my nurses, my administration, and mostly my patients. So thanks. And thank you to all those who have supported me through this ageing process - again, my fellow goats, my seniors, my attendings, my nurses, my administration, my patients, and more than anything, my friends and family; never could have done it without any of you.

As I sit here, wishing that Coppola never invented such a delicious bottle of Malbec, I reflect on the things that truly make me feel old....at a ripe age of 31 (I know for all those older than me that I should quit my bitching, but lets be honest here - if you've never been in my position, you have no idea, and if you have been in my position, you know where I'm coming from.) As plush and delightful as my program may be, there are things that I wish the years did not bring me, and there are things about my younger years that I wish I could regain. Alas, the human body and the wonders of life have in store for us something that none of us want (that would be the whole ageing thing again), yet I long to embrace. So here's to another year older, and another year wiser....again, one would hope ;-)

My list of the top 10 things I absolutely despise about getting older (and I'm sure many can commiserate with me...for those with no idea, get ready, get set, cause game on!)

1. I'm Tired - As you age, you may get tired (and to those of you who don't....well....stuff you (j/k)!! Being tired is soooooo common a complaint among patients, and it is so non-specific (caused by many different things), that there's often no way to figure out what's causing it. We can check your thyroid, iron, hemoglobin and vitamin D levels (I find myself wishing that I have a thyroid problem, a vitamin D deficiency, whatever it may be that I can fix with the wonders of supplementation), but sometimes it's just getting older, not getting proper sleep, not eating right, not getting proper exercise, etc, etc, etc. I want to say that I'm tired all the time. It doesn't matter if I get a full 8 hours (a full what now??!), and even when I get 12-16 in a row (once in a blue moon)....I feel like I am always ready for a nap. As a resident, I'm just not getting enough sleep. It's not cause I work too much to sleep - for the most part, I almost never work 14-16 hours in a day, but on the days that I do, it's not like I come home and head strait to bed. I want to hang out, watch some Southpark, chill out and wind down. Which brings me (usually) to midnight or one in the morning, at which point I set my alarm to 6 or 6:30 (if I'm lucky enough), and try to lay down, wondering if I will wake up to said alarm. I've had a real problem lately with this, too often sleeping through it, or waking up in my sleep to turn it off.....bottom line, I can't decide if it's ageing or residency (or the accelerated former due to the latter) that makes me tired, but whichever way you cut it, I feel weathered....sleepy....exhausted....and I just want to stop and sleep for a month.

2. I'm Creaky and Stiff and Sore  - I'm only 31, but for whatever reason, I seem to wake up all sore and creaky in the mornings. And that's not the only time - on occasion my knees hurt when climbing the stairs, my feet hurt at the end of the day, I get stiff while reclining on my couch in the evenings. What did I do to deserve this? Oh yeah - years of not thinking it would ever happen to me. I've broken my share of bones (a couple wrists, a couple ankles, a knee, a couple metatarsals) - blame rugby, snowboarding and running on that, but I never thought that I would have any sort of arthritis this young. Well I do. I actually creak, and pop, and crackle....it's like a favorite breakfast cereal in my joints on a regular basis. The reason I hate this so much is that it's now come to the point that I can no longer run long distances (something I really did love to do.) What a fabulous way to release stress, by running though a lovely park, with some fabulous music flowing through my ipod, people watching and getting lost in my thoughts. I can only run a few kilometers (that's only a couple miles, for my American brethren) before I start to feel the pain. So I'm stuck cycling, ellipticalling, swimming, yogaing....nothing that I love as much as running, and nothing as easy as grabbing my shoes and running out the door. Oh how I wish I could be 16 and back on Vancouver Island running through the back-woods behind school once again..... So as you age, the wear an tear on your joints takes a toll on the cartilage within it; cartilage acts like a cushion, so to speak, between your joints. It prevents the oh-so-painful bone-on-bone feeling that you would have forever. It has your joints moving smoothly, and as you age, injury, wear and tear (like high-impact activity), and general inflammation around areas with cartilage will cause degeneration of it over time. When this happens, you get less and less cushion, until eventually your joints aren't moving so smoothly. You creak, crackle, get stiff and sore. See the back-pain section for further explanation for the lower body creaks. Supplementation may be in order - Boswellia, Glucosamine, Glycominoglycans.

3. My Back Hurts - Said to be the most common complaint in doctor's offices, a sore back can have many different causes. As you age, many things can affect your back, some of which are preventable. Here are a couple of my faves....

1. So remember those shoes that you love which have no arch support, and when you wear them you have sore feet at the end of the day? Well, they may inevitably cause a sore back one day! When you wear shoes that don't support your feet properly, your ankle joints don't align quite properly, or your knees, or your hips, and....yup, you guessed it - your back! Your body is designed to line up with itself, so that all your joints sit in a certain position; when you screw with one of those joints, you can cause pain in all the joints above it, and since there are so many joints below the back, it can end up in pain from any misalignment in the feet, ankles, knees or hips. Moral - get good shoes that have support specific to your foot type - if you're flat footed, get arch support, if you've got high arches, watch out for too much arch support. If you are a runner, go to one of those stores that lets you try on shoes, and then films your feet as you run - you can actually see the alignment of your step change with different shoes, and this can help you find shoes that will support and protect all your joints!

2. As you age, the cells in your body are just not as strong as they used to be. That combined with activity can lead to damage in the support system of the back itself; your back is a series of vertebral bones that are stacked on each other, with cushiony discs in between them to absorb shock. The discs can get worn down, so you lose that shock absorber, so any sort of 'shock' is absorbed by the vertebral bones themselves (degenerative disk disease); these bones are not designed to do this so when this happens, they can weaken and collapse on themselves, although this usually happens after some sort of  injury, and is more common in the much-more-elderly-than-myself....it can happen though, so don't pretend you're invincible. The disks between the bones can absorb enough shock that you can get a bulging, or even a herniated disc; your discs are like a jelly doughnut, except that the jelly is supposed to stay in...if it gets squeezed towards the outside of the doughnut, you may get a bulging disk, which can cause pain when that bulge pushes on nerves, and if the jelly gets squeezed out all over the place, you can end up in a world of pain where you have lots of pressure on the large nerves of the spinal  cord (ever heard of sciatica? Ouchie). Bulging discs can be quite common, and since they don't always cause pain, they are often found incidentally....ruptured/herniated discs, not commonly painless, and nerve pain sucks cause there's little you can do to stop it - you have to stop what is causing it. Stretch, take calcium-vitamin D supplements, exercise, eat a healthy diet. All the basics here... Booerns back pain, booerns.

3. When you think of what your back's job is, it is to hold up your body, and when that body has lots of extra pounds on it to hold up, you're going to end up with back pain. This can lead to what would seem like a catch-22 for many people, because they say they can't work out cause of back pain (and some will ask for disability and pain meds.....I want to hand them a salad and a swimsuit), but their back pain would be relieved if they would just work out and lose those pounds! Well, working out does not have to equal jogging. Go for a brisk walk , go swimming, do intensive yoga, whatever it is that will get your heart rate up for a half-an-hour several times a week (nudge, nudge, wink, wink), and that's a great start. I mean really, if the people on the biggest loser can go from panting while walking on the treadmill to running a marathon, I'm sure you can go for a swim. Supplementation in order - fruits, vegetables, lean protein, and less crap.

4. I'm Fat - Likely the part of ageing that I despise the most, cause my whole life I have struggled with my weight. Every now and then I will get to a healthy weight (usually for some goal....like a wedding for instance), and then something will snap, I will stop exercising, and start eating crap again. I remember back in the day when I could start working out, and within about a week I would start feeling great, start seeing results, and feel like my workouts were taking me somewhere. These days I do not feel so lucky, and there are several reasons for this (my lazy, fat-ass attitude one of them, but I am not going to go there.) As you age, your basal metabolism slows down it's pace. As well, in general, the amount of lean muscle that you have on your body decreases, so this even further decreases your metabolism; lean muscle increases your metabolism by increasing the number of little 'power stations' in your body that are using up your fuel (fat). Fat is just storage - no power stations there! So it makes sense that more lean muscle = more fat burned, even at rest. For whatever reason, my mind seems to be very 'black or white' on the subject of diet and exercise, and I either go at it like a madwoman, keeping the strictest diet ever, and working out like it's my job, or I eat anything I want and I sit on my couch. With all honesty, it's just easier to sit on my couch and eat crap food during residency. I've tried waking up early to work out (cause let me tell you the motivation and energy factor after a long day is nil), but I can talk myself out of this so easily....or sleepy-me just sabotages all efforts and turns off the alarm at 5am, for me only to wake up 5 minutes before clinic (see #1). So as you age, one of the most frustrating things that happens is your metabolism just sloooooooows doooooooown, which means that it takes longer to burn off that doughnut you had for breakfast, so think quick and put it down. Have a banana instead. Without your metabolism burning off the calories/fat you're eating, you're just going to end up with a muffin-top.

5. I'm Hungover - Well this one might only be relevant on certain days,  (note: I downed a couple glasses of wine last night to celebrate/commiserate my new older year, and feel like I drank a whole bottle of tequila) but nonetheless, I cannot help but notice that I cannot recover in the same ways I used to be able to after a couple of libations. Now I don't want to say I was a big partier, but I remember the days when I was working as a waitress at a little breakfast joint that opened at 6:45, when I could go out all night long, and still make it to work, manage to work efficiently, and look and feel great doing so. These days I find a glass of wine will have me waking up feeling like I got hit by a bus. My ability to recover has dwindled (and luckily so has my desire to put myself in the situation to need to recover in the first place.) As I mentioned above, your metabolism slows down as you age...now 'metabolism' goes not just refer to that which makes you fat or thin - it's all the chemical interactions and processes that are happening at the smallest level in the body, all required to keep you alive. Well, metabolizing alcohol is one of those little chemical equations; the process takes alcohol and works it through a couple enzymes (proteins that in this case change alcohol into other compounds, via a couple of reactions). The intermediate compounds (ones in the middle of the equation between alcohol, and fully metabolized alcohol) are toxic and can contribute to hangover symptoms (dehydration, alcohol-induced nausea, and other factors also contribute). When your metabolism slows down, so does the conversion of these compounds, and you can get a back-up of toxic chemicals (more than when you were younger). So voila, your body slowing down helps you have that headache that makes you physically slow down. I feel kinda sabotaged by myself. Water, anti-oxidants (vitamin C, vitamin B1, fruits and veggies in general) can help prevent these, and you'll definitely want to, for more than just hangover prevention - the 'oxidants' that the anti-oxidants are anti-ing do more damage than just the hangover headache.

6. I'm Wrinkly - I've aged. I can tell when I look in the mirror. Those creases in my forehead don't go away when I relax anymore. The crows feet in the corner's of my eyes can be seen in the light of day. I don't really have anything against wrinkles, or at least the ones that you've earned and that tell a happy story of your life....laugh lines, crows feet, cheek creases from smiling...I think they are a testament to how much you smile. But the ones that bother me are the ones on my forehead - the ones that I've gotten from furrowing my brow. They remind me of the hours in my life that I have spent bent over books, charts, EMR's (electronic medical records). And these creases are getting deep quick! I can't even tell you how many different wrinkle creams, refinishing serums, collagen masks and retinoid solutions I have purchased over the past 5 years....it's kinda ridiculous. Wrinkles are formed as you age due to skin, muscles, connective tissues (shocking surprise) getting weaker, more flaccid, less tense. Skin sags, creases form....sunlight, repetitive facial expressions, smoking, pollution, dehydration - these all contribute to wrinkles. There is more money put into wrinkle research every year than into cancer research (which is not such a shocking surprise, since sadly there is money in wrinkles, and none in Cancer....sad reality). The good news is that you can prevent wrinkles by drinking lots of fluids, eating healthily, exercising, using sunscreen, taking care of your skin, and quitting smoking. I'm feeling repetitive here...which makes me furrow my brow....

7. Cellulite - I love how people how to justify cellulite saying that "movie stars have it too!!" I don't care who all has it....I flipping hate it! Cottage-cheese thighs, orange-peel skin**....No thanks. It is true though that it is a relatively "normal" part of ageing (people are predisposed obviously, and the amount of fat you have can play a role in the development.) Cellulite is what it is because subcutaneous fat pushes through the fibrous connective tissue that lays over top of it; when you're young, that fibrous tissue is tight and fresh, but thanks to genes, body type, sex, race, inflammation, weight (the list goes on), those fibers get weak and flimsy, not being able to hold back the impending outpouches of fatty tissue. ....I vividly remember the first time I realized this in The Talented Mr. Ryan, a shot of Gwenyth Paltrow in a bathing suit where you see the back of her thighs, and she too (in her ever-perfect physique), had cellulite. This, of course, was before I developed mine...oh the naivety of it all, the unknowing of what wonders the years would bring me. Now sadly, there is no cure for cellulite...yes there are things to help smooth, firm, plump, etc, etc, etc. But nothing is every really going to tighten up that fibrous tissue again. Best bet (assuming you don't have too many of the genes, body-type, race points against you), is to exercise and eat well so that you can decrease the amount of fat that you're letting be there to poke through (yes...you are in-fact usually not blameless in this....admitting you have a problem is the first step towards recovery.) There is no pill, no cream, no smoothing serum, roller device, coffee mask, slimming wrap that will do more for you than diet, exercise and a healthy lifestyle. And I plan on implementing one of these just as soon as I get back from vacation (just over a weeks time....recently purchased "Metamorphosis....the body transformation system" via infomercial. Should make for an entertaining month of night float.)

(**sidenote - is it coincidence that we use food-related descriptions when describing body imperfections due to fat? Cottage-cheese thighs, orange-peel skin, jelly-belly, muffin-top...)

8. Everyone's Having Babies but Me - Residency is tough enough as it is, that I have no idea how people do it while getting pregnant and raising kids....I can't even keep a couple of house plants alive (Plants - 0, Me - 5). Props to you guys. That being said, my body YEARNS to have one for myself. I feel like every time I log onto facebook, I see yet another ultrasound pic, a baby belly or another picture of a brand new baby. Most of me is ecstatic for people, and the other part of me wants to....I'm not going to finish that sentence, cause no matter how I cut it, I sound like a horrible person. Really, I am happy for all of you, and it's not as if 'age' is getting in my way of having kids right now; it's the 1824 miles between Hubbs and I for the next 460 days (of course I have a countdown!) But it's ageing that makes our post-residency options narrow; I want to be a young Mum (yeah, I know...missed that boat, but I'm trying to prevent it from getting any more of a head-start than it already has.) I'm not saying there is anything wrong with having kids in your thirties (there are obviously more risks involved, but it's not like my eggs are shriveled up and useless), it's just not what I planned for myself. Honestly, I wanted to have at least one by now, but plans change. Med school happened later than originally planned, and I wouldn't have done anything differently, I just wish I could do it all at once (or do I when I think of the craziness??) I worry that since I already have to deal with numbers 1, 2, 3, 4, and 7 at age 31, what is adding pregnancy going to do to me a couple years from now? Yeah, yeah, I need to listen to my own advice about getting off my couch, exercising more, drinking more water, eating more healthily....but that bacon at the hospital is just so crispy and delicious....every morning. Again, "Metamorphosis"  ;-)

9. My Memory - Really this point should really be called "The Lack Thereof." Again, yeah....I'm only 31, but MAN has my memory declined since I was a teenager! Hubbs jokes about it, how I have early-onset dementia, and obviously he's kidding (obviously, right love?!), but there is no doubt in my mind that either my brain is full and every time I put something new in there, something else falls out, or as I age, some of the memories are fading. Take today as an example. I am (ever so clearly, eh?) a Canadian, so to live and work here, I have a green-card (yes older-sissy, now it's on the blog, so Mum and Dad will know that I am in fact still dealing with myself...at least I have the excuse of a busy life these days!!) So being the good Kiwi-Canadian that I am, I settled in for an episode of The Flight of the Conchords last night (S2E1 - Femodent Commercial), when Bret and Jemaine get into a pickle regarding getting paid for their recent work; up comes the topic of word-visas, green-cards, etc. So I think to myself (at 2am, post birthday-wine) "wait a moment...when does my green-card expire? I think the end of April some time." Having a feeling in the pit of my stomach, I hop out of bed, find my card and see "Expiry: April 6, 2012." Oh swizzle-sticks. So this flung me into a flurry of printing off forms, gathering bank statements, writing affidavits....luckily I have friends on Nightfloat to guide me through the ridiculous that is me, and luckily I remembered today, and not next week - I could have been deported! And do you know how many times I've thought to myself that I should check on that date and make sure I'm 'on top of things?' Too many times to count, but never at a time when I was anywhere near my card, and never did I write it down again in my daytimer (I actually had written it down for a couple months ago, and the page has so many scribbles and crossed out errands, it's a wonder I get anything done at all! So it's come to this....if I don't write it down, I could get totally screwed. I need a personal scribe to follow me around and remind me of things I think, and I don't even think Siri could help me here, cause she'd be constantly reminding me of things that I would just have her remind me of later. As I get older, these scatterbrained moments are becoming more common, but thanks to the horse-shoe I seem to have up my rear, I've managed to make it this far. Knock on wood that the good times keep on coming....

10. Real Life - Now not that I don't love doing what I'm doing....I really do! But don't you ever wish you could be like 6 or 7 again, where your 'job' in life was to go to school, play with toys and friends, go to camp in the summer, watch cartoons on Saturday mornings. I mean come on - doesn't that sound delightful? Have you ever seen a kid entertained by something like bubble wrap? Or if they're young enough, a box? Imagine being that easily entertained, and that happy about something so simple? A time when you didn't have to worry about work, bills, gas prices, insurance, diet, homework, laundry....I really could go on. Real life and being all growed up is fun, but man does it get old sometimes. I even miss the days when I was a waitress/bartender, and my 'work' was getting dressed up, serving food, entertaining people for 45 mins to a couple of hours, and charming every penny out of them that I could. It was great money, and when I was done work, I was done work. No charting about diners, pages about kitchen emergencies, consults on dishes. At most I had to learn what wines went with what dishes, and this was research and studying I was into! Being a responsible adult is great and all, but sometimes I long for the days when blowing bubbles, or remembering what kind of toast table 4 wanted with their eggs was the hardest thing I had to do in my day.

So there it is. Ageing can be great because you get to live like a big-person, having real money, your own apartment, whatever bed-time you want. But living like a big-person can suck, as 1-10 may demonstrate. I don't mean to complain, but it's been a long day.....I'm tired, creaky, dimpled, wrinkly, fat, with a sore back, a bad memory, a hangover, no baby, and the reality of a 'Real Life' awaiting me in the morning. Good night :-)