Aging can be tough physically, emotionally and mentally. Luckily, author Laurie Notaro is here to help us find the lighter side of middle age and beyond as she discusses her book "Excuse Me While I Disappear." Laurie paints vivid (and hilarious) pictures of all sorts of middle-aged health and social issues, and geriatrician Dr. Erum Jadoon chimes in with her medical insight on what to expect from our bodies as we age.
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Dr. Denise Millstine: Welcome to the “Read.Talk. Grow.” podcast, where we explore women’s health topics through books. In the same way that books can transport us to a different time, place or culture, “Read. Talk. Grow.” demonstrates how they can also give a new appreciation for health experiences and provide a platform from which women’s health can be discussed. At “Read. Talk. Grow.,” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives.
I’m your host, Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic, where I practice women’s health, internal medicine and integrative medicine. I am always reading and I love discussing books with my patients, my professional colleagues, my friends, and now with you.
Our topic today is about being a middle-aged and aging woman and looking honestly at the health challenges faced as women are in their 40s, 50s and beyond. We’re going to discuss some common, if not often discussed, happenings in the body as women age, and we’ll do that through the book by Laurie Notaro, “Excuse Me While I Disappear: Tales Of Midlife Mayhem.”
Laurie Notaro has been fired from seven jobs, laid off from three and voluntarily liberated from one. Despite all that, she’s managed to write a number of New York Times best-selling essay collections, including: “The Idiot Girls’ Action Adventure Club,” “Autobiography Of A Fat Bride” and “Housebroken.” She lives with her husband in Oregon. Her most recent book is“Excuse Me While I Disappear,” and it’s based on what happened when her husband started to receive AARP membership materials. Laurie, welcome to the show.
Laurie Notaro: Thank you so much. I’m delighted to be here.
Dr. Denise Millstine: Our second guest is Dr. Erum Jadoon. Dr. Jadoon is a geriatrician, internist and an assistant professor of medicine at Mayo Clinic in Arizona. Her interests include nutrition, bone health and geriatric medicine, with an emphasis on functional status, unintentional weight loss and frailty. She’s on the faculty with the Academy of Communication and Healthcare and teaches communication to Mayo Clinic, faculty, physicians and training and medical students. Erum, welcome to the show.
Dr. Erum Jadoon: Thank you for having me. A pleasure.
Dr. Denise Millstine: I do want to warn our listeners that the health issues faced by women who are middle aged are important and can be very serious. Today, we’re talking to the hilarious Laurie Notaro and the delightful Dr. Erum Jadoon. So we’ll be taking a lighter approach that is also often helpful and healing, which is not to say that we don’t understand the impact and distress these conditions, symptoms and experiences can have.
Laurie, I shared with you before we started recording that I have been in love with your work since “The Idiot Girls Action Adventure Guide.” You had me at that crazy cover. For our listeners who don’t know it, they should look at it right away. I’m ready to read any of your books any time. But when I saw that you wrote a book about my age bracket, the middle-aged women, I knew I was in. Unfortunately, I started reading your book while I was sitting in a Mayo Clinic patient waiting room as a patient, and I was laughing out loud, which I don’t think the other people appreciated very much.
I want to start with a quote from your book. It says, “We are not born old. We worked to get there. And it is such a surprise when you realize that your new body has been absorbed by a different one. Freckles aren’t where they used to be, and parts that were visible are now obstructed. It’s a jarring moment full of terror, anger and wonder. It happens to every single one of us who stays alive long enough. Laurie, it’s so important how you universalized this experience.
Laurie Notaro: Well, yesterday I was 27. Today I’m like, where did all these things come from? Why am I leaking during the middle of the day? I did not have children. Why do I have to run to the bathroom before I laugh at a joke? Or tell my husband, “Stop! I have to go to the bathroom first!”
So there’s so many things about getting older that no one prepared me for. I’m 58 now. I think I’m 57 going to be 58. My mom never talked about it. My grandmother never talked about it. My friends who were older never talked about it. It was such a taboo subject. Like, if we don’t mention it, no one’s going to notice that we’ve gone gray.
All of a sudden I’m here and I have all these questions and no one will say anything to me, so I’m just going to break it out into the open and see what happens. We’re going to crack the old lady egg and see how we scramble it up.
Dr. Erum Jadoon: Thank you for writing this book, Laurie. It’s been a pleasure to read it and so, so timely for so many of us. I’m glad that I got to read your book, and I agree with Denise. I was reading it and laughing out loud, and my son came up to me rather alarmed, “Mom, what’s going on? What are you reading? Can you share the joke?” I’m like, “Maybe not today.”
Dr. Denise Millstine: Maybe not at this age, honey.
Dr. Erum Jadoon: Not right now.
Dr. Denise Millstine: But in your clinical practice, Erum, you see a lot of women who are coming off of maybe the childbearing years or the years where their health didn’t have to be a top priority to them. But they’re coming into your office and saying, “I can feel myself aging.”
Dr. Erum Jadoon: Yes. Sometimes I notice it is difficult even to use the word aging. It is difficult to say that something is happening. It’s like, “Oh, I have a few things and I think I need to see somebody. I’m not sure. Maybe I should see an integrative medicine doctor or a functional medicine doctor or I should do something out of the box because I don’t think that you can really help me.”
It’s almost as if these things that they’re experiencing are not medical diagnoses, and it’s so select that they need help outside of what is a traditional meaning of Western medicine.
Dr. Denise Millstine: Yet there are a lot of strategies that you have in your toolbox that I do think can help these women. So the book is called“Excuse Me While I Disappear,” which is really a reference to middle-aged women becoming invisible. So, Laurie, instead of being distressed about this, you actually use this new super power feature to push your limits to see just what you can get away with once the world has stopped noticing you.But then later in the book you say this quote, “Sometimes it takes an invisible woman to get something done.” Talk to our listeners about the experience of being invisible.
Laurie Notaro: It doesn’t happen right away. I think it happens in dribbles and bits, but then one day it hits you. It’s like no one is spraying me with perfume when I go to the mall, no one’s really paying attention to me. At that time I worked on a college campus and it really hit me when the younger people were not giving me fliers for free pizza at the college joint down the street.
It’s like, “Oh, they don’t think I’m a student.” So it became very obvious to me that I was separate and apart and I had become old. I had become that person who doesn’t want a free pizza, even though I very much wanted a free pizza. So I started testing my limits, not really deliberately. One day, which really cemented everything for me, it was a complete accident. I walked out of Safeway and there were five pounds of potatoes in the bottom of my cart that I had not paid for. Not deliberately, it was a complete accident, and I thought, “I just stole potatoes.” Then I thought, “Well, of course I just stole potatoes. Who doesn’t trust a gray lady getting into a Prius? Who’s not going to trust her? Of course I stole potatoes.” No one noticed it, and I just thought to myself, “How far can I push it here? What can I really do? So I started exploring my boundaries and the thing of it was is that I found so many benefits to being gray and to being older and that I could get away with so much more.
Because I was so much of a non-threat, I was not really a sexual being anymore, and I know a lot of women complain about that. I don’t. I like not getting whistled at. It was a very comforting area where I was now free to be me because no one was watching. So if I wear something crazy no one pays attention. To me, it was a very, very liberating experience. I do think that I could walk out with a walk-in freezer at Costco just by waving an old Safeway receipt. I totally believe I could do that. I don’t encourage it, but I know I could do it.
Dr. Denise Millstine: You might put it on social if you get away with it, but you might not, because then Costco might figure it out.
Laurie Notaro: That would be a felony because they’re like over $1,000. So yeah.
Dr. Denise Millstine: Excellent point. Our listeners learn so much from our show. Well, your first chapter is actually about growing gray, about letting your hair go gray and the transition, and I loved this quote, “What was I so afraid of, looking my age? That’s ridiculous.” But we do this to ourselves. We think we have to maintain this younger, youthful, maybe healthy appearance because that’s what the world expects from us.
Laurie Notaro: Absolutely. It’s gotten to the point where I am proud that I’m still alive at this age. I shouldn’t be. Despite all odds, everything that I’ve done, all the risk because I’ve taken I should have been dead literally like 30 years ago. But I didn’t. I’m a survivor. Just from day to day, I’m just living and eating cheese out of a spray can and eating Twinkies and things that have expired out of jars.I will totally do all that stuff, and I’m still here. So every day I figured I learned something. I’m so much smarter now than I was at 27. I may not have the kind of butt. I can’t fit into the same clothes. But what would I rather have? Would I rather be smarter or wear a size six shoes? I think I’d rather be smarter. But I do want to know why it is that my butt got so big.
Dr. Denise Millstine: We’re going to talk about that. We’re going to talk about what happened to your butt and why did the belly change? But before we do, I want to talk a little bit with Erum about ageism and what happens as women enter into this middle age period.
Dr. Erum Jadoon: So I think when I hear the word ageism, it comes to my mind equivalent words of racism or sexism. So it’s almost as if ageism is a stereotype of what people think aging is. The moment you are old or you are considered having gray hair, there are certain assumptions that people will tag on to it. Some of them may be, “Oh, you know, your life is over, you have nothing to look forward to. There is nothing you can contribute to society for. You really shouldn’t be driving that hot sports car, or maybe not walking in the aisles of Safeway.” Ageism results in a type of social construct that causes us to doubt our own ability to be independent and do things that we like to do. Or it affects our mental as well as our physical health. Very similar to what happens with sexism, for example, or racism. So similar bad outcomes have been proven for people that actually start to feel and buy into the stereotype threat. I see it unfortunately a lot in my learners and one of the first things I have to do is to make sure that we know what ageism means and what is the effect of this on others.
Because I have young learners all the way from first year medical students to residents and fellows that want to teach geriatrics. I think talking about it and clarifying what this term means and the implications on healthcare are extremely important if we are to move forward as physicians, as caregivers in healthcare, and largely, as a society.
Dr. Denise Millstine: I think these are such important points because really it’s culturally that we’re treating people who are aging as if they are no longer of use. But there are so many people trying to change that narrative. We interviewed Kirsten Miller, who wrote the book “The Change,” where these women who go through menopause develop superpowers, and her argument, which our listeners will hear on that episode, is that this is not a shriveled up time of women’s life.This is a powerful time of women’s life. As a general statement, we are more resourced. We have the wisdom of our experiences, and for many of us we start to have fewer of those direct day to day responsibilities. If our kids have started to grow older, for example. So, Laurie, you’re part of changing that narrative because this is not the boo hoo, excuse me while I disappear, but you are literally laughing in the face of aging and even at one point death and bringing your spirit and your spunk to this topic.
Laurie Notaro: I think it’s important to address what we just said about ageism and being put into a category. I hadn’t worked in a job actually for 20 years and I needed to go back to work in order to get healthcare insurance because being of my age, I was 55 and my Blue Cross Blue Shield payments were going up.
I needed to get health insurance from a company. So I went back to work at the University of Oregon and where they sat me in a big room full of cubicles in what we came to term as death row. It was where all the old gray ladies sat and I sat there and I looked and I noticed that everyone else had gray hair, and I thought: “Well, no, I should be sitting over there with the young people.”
But then I started to get to know my neighbors, and Charlene was an old punk-rocker who was a single mom at the age of 19 and brought her kids up by herself. Marlette had designed Iron Maiden covers for albums, and Melody was a barrel racer. She was the first female broadcaster in the state of Oregon.
Now, those women were who I wanted to sit with. We had common experiences. We had broken down many barriers ourselves that the girls in the younger row had never known about our challenges. Some of them had never been the first woman to do anything. I was the first woman to do several things at ASU, and the time I remember fighting as a young person saying, I can be brash in my writing, even though it wasn’t ladylike and people didn’t want women to write things like that.
Because I was very honest with my writing when I was still in college and women were really not supposed to be like that and, again I find that age wise, older women aren’t supposed to talk like that. They’re not supposed to use foul language or say risqué things. But I didn’t just pass a mark in my life where all of a sudden that part of me disappeared. I’m still here, but I’m fading a little bit in the background so I can kind of mess with you in other ways. I’m still here. I’m stronger than ever. I’m smarter than ever, and I’m more myself than I’ve ever been before.
Dr. Erum Jadoon: Laurie, I would say that when I read your book, I felt that this was a celebration of life and a celebration of having gray hair. Because for me, as somebody who is a geriatrician, it’s my life’s mission to be the provider for older adults above age 65. I have often gotten comments like, “Oh, that’s such an awesome thing you’re doing. Well, it’s great that you’re practicing in Arizona,” or sometimes I’ll get comments like, “Oh wow, you’re a good soul. We need more of you.”
But if you actually take a step back and look at the word ageism, which was coined by Dr. Butler, who is the founder of the Institute on Aging, he’s passed away, but one of his students, Dr. Levy, who is a big time researcher at Yale, has studied ageism and talks about the longest running study on longevity out of Wisconsin.
The evidence that she has produced with her research, studying all these individuals, is that there is a difference of an average of seven years in the longevity and lifespan of individuals who remain positive and don’t let what are classic factors associated with ageism and stereotyping affect them.
So individuals who have better outcomes in their cardiovascular disease, they have better outcomes with socialization, they have better outcomes with staying independent in their own homes. So the stereotyping of ageism that unfortunately still is so prevalent in modern society actually results in poor health outcomes, and that’s important in this day and age where we are really trying to have a good life.
How do you remain productive and happy and not happy, I would say, but rather more content and satisfied with your life choices and trajectory well into the longest lifespan that you can have or a healthspan that you can have, so I thought that your book was spot on.
Laurie Notaro: Thank you so much. I’m really hoping that people, whether or not they read my book is irrelevant, but to embrace yourself where you’ve reached this point, and I feel so bad that I did not really utilize my grandparents because I didn’t know about their perspectives until I got to this age. They knew so much more than I gave them credit for.
They had experienced so much more, and I looked at them saying, “Oh, you’re from a different time.” They were, but they still lived in this time and lived in that time. Therefore the experience span, they had gained so much knowledge and had so much wisdom and perspective, much more so than an 18-year-old person that I was. I didn’t know anything, and so that’s my one great regret, and I hope that younger people listening to this will embrace that and talk to their elders and really respect what they’re saying because they’ve seen it all.
They’ve seen centuries, not centuries, but decades pass. Fads change, presidents change, presidents indicted, all kinds of stuff. They’re living testaments to history. So that is something to celebrate. I think that that is a terrific thing. It makes me sad to hear that when people experience ageism, they’re almost disregarded when instead we should really hold them in great esteem and in great affection.
Dr. Erum Jadoon: Absolutely. Absolutely.
Dr. Denise Millstine: Although I don’t think whether people read the book is irrelevant, because to summarize what Erum just said, I think she said, “If you read Laurie Notaro books and laugh, you probably could live many years longer.” So I’ll use that as a little plug for people to start reading and laughing at your work. I want to switch gears a little bit and focus on what you call in your book the user’s manual for your new old body.
What I’d like to do is just raise several of the topics that are in the book to have you tell us about them, Laurie, and then to have Erum give some comments from a medical standpoint. So the first one we’ve already raised, but let’s talk a little bit more about having a big belly, but a flat back side. So your quote from the book is: “You resemble an exhausted party balloon from behind and a snowman from the front.” Tell us about that.
Laurie Notaro: That’s true, and I started to notice when I got older, even though I’m wearing Spanx. I like some kind of foundation since I was 18 because I’m Catholic and Italian and American, and my mother told me to wear those things, that my tights would roll down over what I now call my “blap,” which is my belly and my lap together, roll down under the blap and kind of create a belly hammock as if it was Gilligan going to sleep.
That was one thing, and I don’t know how to get rid of it. I was talking to a friend of mine the other day and she’s just like: “I’ve tried everything for the last 20 years. I’ve lost 3 pounds.” I was like, “Teresa, the only thing that’s going to make that blap turn inside out is a scalpel and some needle and thread. I don’t know how it got there, but it’s not going anywhere. It’s staying.
It’s a part of me now. I should embrace it. So I would like to know, what is that? Why is it there? How can I suck it in?
Dr. Erum Jadoon: Laurie, I feel your pain. In many ways. More ways than one. The way I like to put it is based on human physiology. There is definitely a difference in the way women’s bodies are built when we compare it to men, for example. Women do have more fat percentage to start off, and it has a very real purpose in preserving life and making sure that it is a bank in case there are long months of starvation or for harvest.
We do have that to start with. Even in the best of times. The body composition is basically another term to basically talk about how much muscle, how much fat, how much water content is in the human body, and so women, to begin with, have more fat. But the reality is that for everybody, men or women, there is an average loss of total body muscle starting as young as 40.
This is why we see a lot of our Olympians, Olympic champions or sports athletes kind of retired around late 20s, early 30s because your muscle mass and your quick twitch fibers start to actually decline. When we hit around 30, they stabilize for a bit and then start declining after the age of 40, and if you are one of those individuals who has not been an athlete all your life and has been doing more desk work and things like that, you’re not starting off with a very high muscle mass to begin with.
Some of it, of course, is genetics, too. But when we hit our menopause, we don’t have our estrogen progesterone going around, and so that is another whammy, and by then we’ve already lost quite a critical amount of muscle mass. So that together with the low muscle mass results in our inability to efficiently use all the energy we get from our food because our eating habits are just the same. There are studies that show that women, when they get married for the first time, are sitting and eating with their husbands and suddenly they’re competing with their husbands for the steak and they’re matching the appetites.
There is a social construct there. So we eat according to whoever we are sitting next to. That influences how we eat. But our eating habits don’t change as we get older. We love that extra sweet. We like that extra bag of chips and there is also real physiology behind that because sweet flavor is one of those tastes that is the last to go.
So you will always have a sweet tooth. You may not appreciate any other flavor, so that together with the low muscle mass results in us just building up more fat. Correct me if I’m wrong, Denise, but with menopause and estrogen loss, there is a redistribution that happens with normal fat, so unfortunately we tend to accumulate more of it around that middle.
I mean, I have patients that go to great lengths to keep their size, but that’s with a very strict diet and muscle building exercises and things like that. It’s not that it cannot be done, but it is a very difficult battle.
Dr. Denise Millstine: Well, and you commented that many of them have the genetics that will keep it in that shape as well. Because one thing that also comes up in your book, Laurie, is talking about weight and talking about obesity. So let’s talk a little bit about that because we’ve touched on it somewhat in terms of this redistribution of the fat and the muscle.
The backside is really these big muscles and that’s why it gets flat. Right? But in terms of weight management, this has been a major issue for you in your life that you have actually had treated medically. And I’m going to give another quote too, actually from your book. The first is “obesity is caused by something we simply don’t understand yet, and the reason why people are still obese is that no one really cares that much to figure it out.”
So I love that call to action, Laurie, that comes again in the context of your humor that you’re really saying “Hey, healthcare system, let’s wake up and deal with this because of how people who are obese are treated in our society,” and here’s the second quote.
“Ask any chubby girl what people have said to her and it will be jaw-dropping and mortifying and soul-crushing.” And this is so true. You had bariatric surgery, which was brave, and of course, you treated it with some jokes. Tell us a little bit about your experience with that.
Laurie Notaro: I think I’m the only person in the history of bariatric surgery where it didn’t work.
Dr. Denise Millstine: Not at all.
Dr. Erum Jadoon: Not at all.
Laurie Notaro: The platform is I have polycystic ovarian syndrome and I had it since people knew what it was. That’s where those comments come in, where my gynecologist is pinching my belly and saying: “You eat too many Twinkies.” She was German, so she said it a little bit meaner than she probably should have, but it was me trying to explain to doctors over and over again, I don’t eat anything different than my sister is and she’s a 108 pounds, and at that point I was very physical and all of a sudden one day I just ballooned and no one could tell me why. It was always because of what I was eating. It wasn’t later on until we started discovering the human genome and these links about famine in our genetics. I was like: “Boy, I think The Notaros, Magazineos and the Gianandrias were really hungry for many, many centuries.
I should just go on “Survivor” or “Alone,” and I would win a million dollars for sitting in a tent and just tending a fire because that’s what my endocrinologist said. She said: “You need to understand that you need to take weight loss off the table for you. We have to manage it in a different way. It’s not going to happen to you.”
In a way that’s good for the apocalypse, I guess. But in another way, I’ve dealt with diabetes, I’ve dealt with insulin, all different kinds of things, and that’s why I had bariatric surgery and it reversed the diabetes, but it did not do anything really, I lost 20 pounds. It wasn’t like I lost 150. So it was good in that respect and it’s a really great treatment. I still deal with that all the time with doctors telling me it’s diet and exercise, diet and exercise, and I was like, “Last night I had broccoli. I had roasted eggplant. What do you want from me? I haven’t had a roll in like 17 years. I just want to chew a breadstick.”
There are still mysteries out there that we don’t know. I’m sure at Mayo Clinic you guys understand that. Hopefully one day I think it’ll take a fat, chubby lady scientist to understand how we can undo obesity and what really causes that. I’m just a layman. I don’t know what I’m talking about, but that’s my hope.
Dr. Denise Millstine: But you do know what you’re talking about, and you’ve had this lived experience, and when you say it didn’t work, it did work in that it cured your diabetes because weight in and of itself is unhealthy when it gives you these chronic conditions like the diabetes, the hypertension and 20 pounds is a lot. That was more than you had been able to lose before the surgery.
While it might not have given you back that svelte body that you were dreaming about, it did do some really positive things. Erum, talk a little bit about obesity, obesity management in this day and age.
Dr. Erum Jadoon: Laurie, you’ve touched on the most important, I believe, aspects of obesity. In your very sweet, personal narrative. My heart goes out to you for all the micro-aggressions and others that you’ve had to endure. It’s another stereotype that we as a society seem to shake. But obesity or weight gain is a combination of many different factors. In the most elementary of ways, it’s more calories in that count, but it’s not as simple as that at all, and we’re beginning to now understand that there are much more complicated factors that go into it. Very recently, we really did not have an effective treatment. It was either some sort of appetite suppressant or some kind of sort of quick medication to help not absorb fat and give you stomach cramps and bloating and diarrhea.
If you can’t go that route, then you just take the big guns out and go ahead and get bariatric surgery done. So there was nothing in the middle that we could give to our patients and say, this is your treatment, and you’re absolutely right. I think a lot of this has to do with what is in demand and where research is focused and you’re correct that we have not used our resources and energy into solving this awful epidemic of being overweight.
Being overweight in the simplest of terms, in some ways can be reversed with lifestyle changes and taking on muscle and all that. But if you are 70, 80 pounds overweight and you even average half a pound or 1 pound of weight loss, which is considered safe for a week, you can imagine how many weeks of your life without a single slip up it will take for you to lose that weight. It’s impossible.
I’m really glad that your endocrinologist talked to you. Your bariatric surgery was a success because even though you may not have dropped the weight or did not achieve whatever size you were thinking about, it actually reversed diabetes. The reason that medically we are so cautious and so careful with trying to manage this is because something like diabetes has implications on your overall life span as well as your propensity to go to the hospital, get repeat admissions or get sick because it puts you at a higher risk for infections, cancers, all sorts of liver-related problems, heart-related problems.
If you can reverse diabetes just with this and have a 20-pound weight loss, that’s a clear win. Weight is a difficult issue. Of course, other medical diagnoses will play a role, like the polycystic ovarian disease or even being on medications like I’m sure, Denise, both of us have patients that have to be on certain medications for, let’s say, certain autoimmune disorders, which cause redistribution, increased weight.
I could talk about this forever. I mean, I can tell you that one of the problems is fructose sugar. How we have fructose corn sugar in everything for shelf life. And unknown to me, it was in baby food which I fed to my kids. There have been studies showing that it’s more addictive than cocaine on mice. So if you give a mouse fructose sugar versus cocaine, it will go for the fructose sugar. That’s how addictive it is when you’re exposed to it early on in life. So it starts with your school and it starts with the vending machines. It goes on and on from there.
Dr. Denise Millstine: I think we should do some rapid-fire topics if we can. I was telling some friends last night that I’d be interviewing you, Laurie, and I mentioned what you call sneaker farts. One of them sai, : “What is it? When I was in my 20s, I could just fart, you know, only when I knew it was safe to fart.” So what’s going on with us? Can you give us some of your tips and tricks for the sneaker fart situation?
Laurie Notaro: Honestly I don’t have any tips and tricks, but it happened to me last week as I was getting out of a car. It happens when I get up, get out of the car. You have no control over it. It just happens. It was a lazy, unambitious kind of fart, and I did it in front of my friend Catherine.
And I said: “What can I do? She heard me do it. I did it,” and I said: “I’m sorry, it’s a sneaker fart. I didn’t mean to. It came out. Please forgive me.” And she was like: “You know what, happens to me all the time.” That’s what I mean. Stay with your people and they’ll totally understand you.
Dr. Denise Millstine: I think in the book you also suggested to go stand near a snow blower or a leaf blower that also camouflages, I guess. It was your suggestion.
Laurie Notaro: Or traffic. Traffic always works. Just run out to a street and… But sneaker farts, they will just happen. You cannot control them. It’s absolute anarchy with the lower half of your body. There’s nothing you can do about it. It will happen.
Dr. Denise Millstine: Okay. Why are middle-aged women farting more?
Dr. Erum Jadoon: I think they’re not farting more. It’s just that perhaps the farts are happening without conscious awareness. I think farting is a very healthy thing. It just tells me that your gastrointestinal system is working the way it should. When my patients tell me that they have belly aches, the first thing I ask them is: “When was the last time you farted? Are you farting?” They say, “Oh, yeah, I’m doing that.” I’m like: “Okay, good. You’re good to go. Almost.”
So I think losing control over bodily functions, such as having a bowel movement or passing gas or holding the urine in. All of that is pretty much related to the undercarriage, or the pelvic floor. What holds everything up. Just as there is loss of muscle elsewhere in our body, there is loss of muscle down there as well.
For women, again, it’s a double whammy because many of us have had pregnancies. We have carried a pretty large load in our belly where some of the parts down there which are not supposed to stretch under a lot of stress systems start to stretch, but systems that do stretch, once you have your ligaments stretched out, your body will begin getting back to what the original size was in lack of better terms. That together with a lot of loss of muscle, predisposes us to having problems where we can’t quite hold our urine or we can’t quite hold our gas, or we can’t quite hold the fecal matter.
These accidents do happen. There are very good modalities out there to help with this. But I think that there is so much pressure not to talk about it. It’s so embarrassing that you will not have a patient tell you that this is an issue.
It’s one of my teaching points in geriatrics and in my geriatric clinics particularly, but also with my outpatient practice, with my learners, is that please ask in a respectful manner, “Do you ever have an accident, or do you ever feel that you have soiled your clothes?” That would be the opening question to talking about it, because there are such good medical and surgical remedies for this.
Dr. Denise Millstine: The truth is that, yeah, people feel ashamed. They think that they’re the only ones who are going through this. But it is incredibly, incredibly common. Another thing that’s very common, Laurie, is vaginal dryness. I forget the quote from the book, something about it being a desert when it used to be a rainforest. I’m pretty sure I misquoted that, but tell us a little bit about your experience with that.
Laurie Notaro: The older you get, it just becomes like a little oyster that’s been out in the sun.
Dr. Denise Millstine: That’s right. That’s right.
Laurie Notaro: My best adviceis make sure, next to your nightstand, that you do not have your foot cream in the same kind of receptacle as you have your lubricant. Things can get really, really painful. You don’t want icy hot down there.
Dr. Denise Millstine: Oh, my gosh!
Dr. Erum Jadoon: Oh my God, Laurie!
Laurie Notaro: Just make sure in the dark you know what you’re grabbing for. There are things out there to help. Take advantage of them. My mother can never listen to this podcast now. What I would say, yes, is just make sure and responsible, you know, which is which.
Dr. Denise Millstine: Great tip.
Dr. Erum Jadoon: So I would say, Denise, that I have, for many different things, Laurie and actually when I was reading your book, it was very interesting to me because you bring up the cultural aspects of taboo subjects as well. I thought that was so good for anyone who’s reading that book. But it spoke to me personally.
One of the things that is important is to actually ask our patients if they are having urine infections more than two or three times in a year; if they are getting irritated down there, “Do you have burning down there? Do you feel that you have a loss of libido? If you are having intercourse, does that hurt?”
These are questions that are not your typical questions that our taught to our medical students in med school and we just don’t even talk about it, or we are uncomfortable talking about these even as providers.
The interesting thing is that I’ve had women as old as 80s coming to me with repeat urine infections and, with the single simple intervention of using local estrogen cream, they never ever have another urine infection, or talk about the difference between a lubricant and the vaginal moisturizer, how that can make the difference in someone’s quality of life. Such a simple measure.
It is unbelievable to me that we are still not at the point where this is the normal clinical encounter that everybody should have. One of my secrets is actually an open secret, a fun secret, is that I ask my patients about their libido and painful intercourse, and they’re like,: “Oh, you know, nobody ever asked me that, but yeah, that is a big issue, and it’s been affecting my relationship.” And I’m like, “How about this? What if I sent you to a consultant women’s clinic and they came back and gave me feedback and said, “You know, I got all this information. You can’t believe how it’s changed my life. And I talk to my girlfriends and they’re all doing the same thing and it’s like, awesome.”
I feel that as a society we like to make judgments and assumptions and I think that as women we are always, always targeted, for lack of better terms, and as we get in our middle-age and in the older years, some of those things are so much more difficult for us.
Dr. Denise Millstine: Just to reiterate that there are strategies for this. Vaginal dryness is very normal once you go through menopause, and if it’s not bothering you, it doesn’t have to be treated. But if you’re having recurrent UTIs, if you’re having any pain in the vaginal area, if you’re having pain with intercourse or with your sexual activity and intimacy, please, please talk to a doctor about it or a healthcare professional about it because there are many, many strategies out there.
Before we wrap up, I do want to talk about solutions. So you propose one, Laurie, to this invisible nature of the middle-age woman, being in the dark about what’s going to happen to our bodies, and that is to have “the talk.” So in the same way that young girls are taught how they’ll go through puberty and get their periods, you say as a culture, we prepare children for the next stage in their lives as they morph into adults, but where is the talk about moving from an adult to an elder? I love the solution.
Dr. Erum Jadoon: I loved it.
Laurie Notaro: I come from a Catholic background, so those sorts of things are very, very taboo. We did not talk about that, but I have broached the subject to my mother. Like what was your menopause like? Because I have heard that your menopause will be very similar to your mother’s, and she actually said, “You really want to know?” She was surprised that I would ask her about this.
She had not asked her mother and she went through all this stuff on her own, and I have been talking with my friends more as we morph into this age, texting back and forth, “Okay, Is this normal? Did you get your little hormone test yet? Where are you in the process?” and now we’ve started to have Meno Parties.
When you reach menopause on the day that you are declared, you have a Meno Party. I did have a Meno Party with a little pinata and the shape of the uterus, and we beat the crap out of it. And what fell out were a little M&Ms that I pretended were pills. You know, they were chill pills.
But in any case having that open dialog, that discourse with people around you and making such a subject that’s not so taboo, I think just does us all such a favor. When we talk about vaginal dryness or I send a text to my friend Amy that says, “I just pooped in my pants on my front porch because I couldn’t get my keys out of my purse fast enough.”
She’d be like, “Dude, me too.” You know? It’s like that kind of thing. We all have similarities and we need to acknowledge them in order to normalize what is happening here. Aging is normal. It’s just a normal process, and if you’re lucky enough, you get to go through it.
Dr. Denise Millstine: I think that’s a great place to end. If you’re lucky enough, you get to go through it. If listeners would like more tidbits on how to host a Meno Party and what type of balloons to buy, please read “Excuse Me While I Disappear” by Laurie Notaro. This has been such a fun discussion about middle-aged health conditions and being middle-aged and ageism. I want to thank you both for joining us on “Read Talk. Grow.”
Laurie Notaro: Thank you so much. It was such a delight to be here and to speak to everyone. I had the best time. Thank you.
Dr. Erum Jadoon: Thank you, Laurie. It’s been an absolute pleasure and honor to meet you. I loved your book. I loved it. Thank you, Denise, for having me.
Dr. Denise Millstine: Thank you for joining us to talk books and health today on “Read. Talk. Grow.” To continue the conversation and send comments, visit the show notes or email us at readtalkgrow@mayo.edu.
“Read. Talk. Grow.” is a production of Mayo Clinic Press. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
The podcast is for informational purposes only and is not designed to replace a physician’s medical assessment and judgment. Information presented is not intended as medical advice. Please contact a healthcare professional for medical assistance with specific questions pertaining to your own health if needed. Keep reading everyone.