Best Health

Field Guide: ILLUSTRATIONS BY
Perimenopause KA YOUNG LEE

BRAIN FOG:

You know,
the thing when you

try to remember
what's-her-name.

46 FEBRUARY/MARCH 2021

84% OF WOMEN SAID MENOPAUSAL SYMPTOMS
INTERFERED WITH THEIR LIVES.
— WOMEN'S HEALTH COLLECTIVE CANADA

PERI-WHAT-NOW?
YOUR COMPLETE GUIDE
TO A MAJOR LIFE
STAGE THAT NO ONE
TOLD YOU ABOUT

SUPER-PERIODS: THE SYMPTOMS ARE talked about in bewil- book and flying into an unexplained rage at
dered tones between friends, and tenta- the drop of a hat. “Is it...perimenopause?”
When your cycle tively broached with doctors. Mood swings. the friend asks. “No...no…no” the woman
Hulks out. Insomnia. Super-periods. Peeing when you says, not quite believing herself to be that
cough. The increasing inability to recall the old. “I wear a jean jacket. I still drink out of
BESTHEALTHMAG.CA name of your only child, or any word, really. a mason jar. But...is it?”
The general feeling that you, your body and
your mind are totally out of whack — also Women aren’t the only ones who feel
where the HELL are my keys? lost navigating this stage, says Dr. Renee
Morissette, a family physician and certi-
Maybe you’ve heard of perimenopause — fied menopause practitioner who works at
the sometimes decade-long life stage that the Women’s Mid-Life Health Program of
precedes menopause and messes with Saskatchewan. “I think, unfortunately, a
nearly every aspect of your life. But how do lot of healthcare professionals [are too].
you know if you are in it? The answer a lot Menopause just doesn’t get the attention it
of women seem to get is, “Who can say?” deserves, even in healthcare.”

Let’s get some facts out of the way. Fact: The Baroness sketch reflects this absurd
Menopause is diagnosed when you’ve gone reality too; it ends with the woman asking
12 straight months without a period. The her doctor “Is it perimenopause?” “I don’t
average age for a woman to go through it is know, is it?” he says. “It could be. There’s
52. Fact: Perimenopause encompasses the not really much research. I mean, who
years before menopause, when hormone really cares, right?”
shifts get increasingly wild, and general
chaos can ensue. Fact: Most women know The spot reflects an ugly truth: Women’s
very little about perimenopause, if they’ve health has a long history of being ignored.
heard about it at all. In the case of perimenopause, this can
mean silently suffering through symptoms,
This massive blindspot in women’s health for a number of years, without so much
was perfectly skewered recently on the as a pamphlet to get you through. “It’s a
hilarious Baroness von Sketch TV show. A huge part of your life that’s affected,” says
40ish woman and her friends nervously Morissette. “If you are lost, that can just
debate what could be behind symptoms be horrible.”
such as getting a bit flush in a restaurant,
not being able to recall whether she’s read a Here, then, is a primer on what is possi-
bly the least-discussed life stage ever.

47

Field Guide: ILLUSTRATIONS BY
Perimenopause KA YOUNG LEE

NINE THINGS YOU DIDN’T
KNOW (AND MIGHT FORGET)

ABOUT PERIMENOPAUSE

BY DANIELLE GROEN

MENOPAUSE IS IDENTIFIED in the rear-view NO.1 HOT GOSS PHOTOGRAPH (GOLDEN GIRLS) ALAMY STOCK PHOTOS
mirror: It’s only after a woman has gone a
full year without a period that she’s con- YOUR HORMONES WILL After 50 years
sidered menopausal. The time before that GO HAYWIRE of studying the
— stretching, on average, over four years physiology of hot
but potentially up to a decade — is the cha- Estrogen serves a bunch of different func- flashes, no one
otic and annoyingly unpredictable stage tions in our bodies: At normal levels, it has nailed down
known as perimenopause. That’s when keeps our heart healthy, our bones strong,
we can experience all the flushed, foggy, our minds sharp and our cholesterol in the cause.
oily, moody, sleep-sabotaging symptoms check. It also (no surprise!) plays an impor-
of menopause without the benefit of at tant role in our menstrual cycles. For most FEBRUARY/MARCH 2021
least getting to ditch our tampons. No two of our reproductive years, our ovaries pro-
women undergo perimenopause exactly duce estrogen to develop the uterine lining
the same way, but many of us will want to to support pregnancy, while progesterone,
strap in tight. Here’s a road map to what typically produced during ovulation, is
lies ahead. used to control that growth. No pregnancy?

48

”WOULDN'T IT BE WONDERFUL IF WE COULD HAVE THESE
CONVERSATIONS WITHOUT SHAME, SO WE DON'T FEEL LIKE
WE'RE GOING MAD OR INSANE?”— ACTOR GILLIAN ANDERSON

Estrogen and progesterone levels both drop, IT WAS ALL THE TALK
the lining sheds and you reach for a carton ON THE LANAI
of ice cream.
We feel you, Rose.
But as women age, our ovaries don’t
make estrogen or progesterone in the same
way. And that throws the whole delicate
system out of whack, causing estrogen to
spike at certain times and plummet at oth-
ers. “You get these f luctuations — some-
times higher, sometimes lower — as your
overall estrogen levels drop over the peri-
menopausal period,” says Dr. Lindsay
Shirreff, obstetrician and gynecologist at
Mount Sinai Hospital in Toronto. “And it’s
the fluctuation in estrogen that leads to all
those bothersome symptoms.”

NO.2

THINGS ARE GOING
TO GET DAMP

Here’s what we do know: A sudden onslaught An incomplete history of Workin' Moms
of sweatiness — known by sunrise as hot pop culture tackling “the References to
flashes and by sunset as night sweats — will change,” and the long, perimenopause in TV
be experienced by as many as 55 percent winding road to it, lovingly and film are rare, but
of perimenopausal women, making it one known as “the change actor Catherine Reitman
of the most common symptoms. We know before the change.” may win for the most
each episode tends to last between three creative use of the word
and 10 minutes, and can occur daily, even The Golden Girls — who else? — Oprah. in her CBC show, Workin’
hourly, for certain women but just occasion- Our favourite lanai-loving In 2002, she wrote about Moms, calling it the “sexy-
ally for others. Sometimes you might feel women made waves the lack of information pause.” “Peri-f—king-
a little warm, and sometimes you can be when they brought and preparation she got menopause” — possibly
left soaked. menopause talk to prime from her own doctors. more likely to be co-opted
time. In an episode “Of the five doctors I’d by the show’s fans — was
Here’s what we don’t know: what exactly called “The End of the visited, two were female. also used to great effect.
provokes these wretched spells. The best Curse,” a doctor has to Neither had asked
guess is that hormonal changes tell the inform Blanche that whether I, then age 47, Ada Calhoun
hypothalamus — that’s the part of the brain she isn't pregnant, might be nearing one The American writer
that helps control temperature — that the she’s just going through of the major markers has joined ranks with
body is too hot, which triggers copious menopause. Look on of a woman’s life.” One Caitlin Moran and
sweating, a trick to cool us down. But even the bright side, Dorothy doctor dismissed her others to become an
after roughly 50 years of studying the phys- says, no more cramps! symptoms completely. outspoken voice for
iology of menopausal hot flashes, no one The slam dunk comes “I asked him, could I be the perimenopausal
has nailed down the actual cause. courtesy of Sophia: entering menopause? masses. From her book,
“You just grow a beard.” ‘Well, if it’s menopause, Why We Can’t Sleep:
NO.3 ma’am,’ he said, Women’s New Midlife
Oprah chuckling, ‘you’re Crisis: “Sometimes my
THERE WILL BE BLOOD Many now- definitely in the wrong own perimenopausal
perimenopausal women place! I don’t know a moods are more rage
During perimenopause, your menstrual first heard tell of it via thing about that.’” than anxiety. I woke
cycle will likely become irregular. Some up the other day and
women might experience a spike in estro- noticed that my husband
gen, causing the uterine lining to become had placed a couple
thicker, and a drop in progesterone, which of champagne corks on
can lead to unrestrained lining growth. The top of a picture frame.
result? “So much heavy bleeding,” says Dr. It made me want to start
Nese Yuksel, a professor with the faculty breaking things. What
of pharmacy and pharmaceutical sciences is this, a goddamned
at the University of Alberta. Other women student house?”

BESTHEALTHMAG.CA 49

Field Guide: ILLUSTRATIONS BY
Perimenopause KA YOUNG LEE

might experience the opposite, with lighter NO.4 of anxiety saw their likelihood to feel high PHOTOGRAPH (BROWNE) MATT BARNES PHOTOGRAPHY
bleeding. More than a quarter of perimeno- anxiety triple (says a 10-year multi-ethnic
pausal women surveyed by the University of THERE COULD BE BABY study from SWAN). “Women who have a
Michigan in 2014 had at least three periods history of clinical or postpartum depres-
in six months that went on for — brace your- “Yes, women can still get pregnant in peri- sion are more predisposed to feeling
self — 10 days or more. A whopping 91 per- menopause,” Yuk sel says. The general depression at this time, but even women
cent of women had between one and three quality and number of our eggs may be without that history can feel out of con-
super periods over a span of three years. declining during this time, but there’s trol,” Yuksel says. In fact, an eight-year
For most women, the time between cycles always that unforeseen overachiever. If you study from the University of Pennsylva-
lengthens over perimenopause, giving the choose a hormonal contraceptive to avoid nia found that women who had never
lining a greater chance to build up before a surprise pregnancy, there is another experienced a depressive episode before
its dramatic exit. But some women will see bonus: Certain types of oral contraceptives were four times more likely to do so during
their periods get closer and closer together and progestin IUDs can also be treatments perimenopause.
as a result of that hormonal imbalance. for heavy periods.
Then there’s the acne: Falling estro-
HOT STUFF NO.5 gen levels can result in a rise in andro-
gens, which trigger excess sebum, causing
What to reach BUT THERE MIGHT pimples to erupt across your face. There’s
for when you feel NOT BE SEX also the listlessness: More than half of peri-
menopausal women are fighting fatigue.
the flush Maybe it’s a drop in the hormones that once And then there’s, god help us, the hair: The
upon a time caused us to feel frisky. Maybe Cleveland Clinic found increased facial hair
Is it a bit warm in here? it’s that perimenopausal women are 40 per- growth occurs. It’s the triumphant return of
Clary sage, grapefruit and peppermint in cent more likely than their younger selves puberty, only this time…
Saje’s roll-on aromatherapy stick deliver to experience frequent pain during sex,
most often as a result of vaginal dryness. NO.7
calming, soothing sensations when Maybe it’s — remember? — all that sweating.
applied to your throat, chest and neck. “There are lots of things that contribute to YOU WON’T SLEEP LIKE
a loss in women’s libido,” Shirreff says. “It’s A TEENAGER AGAIN
$20, saje.com definitely a common complaint.”
There’s a decent chance you don’t sleep
Yeah, it’s definitely warm in here But while 75 percent of women surveyed well already: At some point, one in four
A spritz of Pause’s cooling by the Study of Women’s Health Across the women will experience symptoms of
Nation (SWAN) say sex is moderately to insomnia. But during perimenopause,
mist refreshes and calms your skin extremely important to them, a collapsed that rate jumps as high as 42 percent —
while reducing redness and sex drive can be seen by society — and doc- after all, it’s hard to enjoy eight hours
evaporating sweat. tors — as inevitable at this time. “There’s of blissful slumber when you keep wak-
$40, pausewellaging.com this idea that you should have low libido, ing up sweaty in the middle of the night.
like, ‘Look at you: You’re so busy looking Decreasing estrogen makes it more difficult
Someone open a $#% window after everybody, your children, your par- to fall (and stay) asleep, and it’s also asso-
The Menopod delivers instant relief ents, your job,’” Yuksel says. “There can be ciated with sleep-disordered breathing. In
to the thermal receptors on the back of a lot of gender bias, unfortunately, toward fact, a 2018 study in the Nature and Sci-
your neck. It’s small, convenient and women’s health and sexualit y. Gener- ence of Sleep found that women transi-
portable — unlike a bag of frozen peas. ally, people don’t feel comfortable talking tioning into menopause are more likely to
about vaginas.” But it’s critical to steel your- suffer from serious sleep apnea.
$140, menopod.com self and have this conversation, she says,
because there are treatments available for NO.8
perimenopausal symptoms.
YOUR BLADDER AND
NO.6 ABDOMEN AND PELVIS MIGHT

YOU’LL FEEL LIKE START TO FEEL…WEIRD
A TEENAGER AGAIN
Look: There’s just going to be a lot more
Mood swings? Oh, very much so. Up to peeing. A University of California study
70 percent of perimenopausal women revealed that 34 percent of women age
confessed to being irritable (according to 40 and older get up once a night to use
researchers at McMaster University and the the bathroom, and one-third of that group
University of Toronto), while women who makes the trip a second time or more. And a
entered perimenopause with low levels University of Washington review found that
irritable bowel syndrome (IBS) symptoms

50 FEBRUARY/MARCH 2021

IT'S A “S**TSTORM” OF HORMONES, SAID SINGER
AL ANIS MORISSET TE, ABOUT BREASTFEEDING
HER BABY W HILE GOING THROUGH PERIMENOPAUSE.

— bloating, bowel discomfort, abdominal BARONESSES GET
pain — are more common in perimeno- PERIMENOPAUSE TOO
pausal women, regardless of whether they
actually have IBS.

You also might notice your pelvic floor
isn’t feeling its usual self. As muscles and
ligaments stretch and weaken, especially
in women who’ve given birth, over time
they no longer provide enough support for
the uterus, leading to pelvic organ prolapse.
Good news: Mild prolapse doesn’t require
treatment. Better news: A study of par-
ticipants in the Women’s Health Initiative
found that spontaneous regression is com-
mon, especially for mild prolapse.

NO.9

YOU’LL FORGET WHAT #9 IS

Start tying strings around your fingers — Three questions with surprise. I did not think
and maybe your phone, your keys and your Baroness Von Sketch’s I had that much juice
kid. “Brain fog is incredibly common dur- Aurora Browne: left in my baby-wanting
ing perimenopause,” Yuksel says. In the machine.
2016 Seattle Midlife Women’s Health Study, Why do you think have more kids. Last fall,
nearly three-quarters of women said they the Baroness Von when we were in pre- I’m also constantly
had problems summoning names, while Sketch spot about production for season surprised about the lustre
half struggled to remember where they put perimenopause felt so five, I was 47, and I think and thickness of the
things, what they just said, what they just iconic right away? my body was squeezing goatee hairs on my chin
heard and what they were, at that precise There was an extra out the last egg or and my moustache.
moment, meant to be doing. easiness to making something, because I
it, because nobody have NEVER had such You tweeted asking
“Forgetfulness and difficulty thinking makes sketches about an intense desire to be women to post their
clearly is related to a drop in estradiol perimenopause. There pregnant. For about a experience with
around the time of perimenopause,” Shirreff are so many weird, day and a half, it was perimenopausal periods
explains. Estradiol, the most potent of our “What am I? Where am like I was in love, staring in one GIF. Were
three estrogen hormones, is a crucial part I?” feelings you have starry-eyed into the you surprised by the
of memory formation and cognitive func- when you go through distance, thinking of enthusiastic response?
tion; as it goes, so too does our concentra- this — and it shouldn’t nothing else. I’ve always My followers tend
tion and recall. You might think that hot be weird. Half the people been aware of the sweet to be women in my
flashes, sleep disturbances, depression in the world go through whisper of ovulation, demographic. I was
and anxiety would compound these prob- this, but we don’t talk telling me everything will pretty sure they’d find
lems, but nope: A six-year analysis from about it. be fine, looking around at fun ways to express
SWAN found they don’t account for the fog how attractive everyone this experience. I was
of perimenopause. Our brain works in mys- Is there anything about is.… But it had never delighted. We often say
terious ways. perimenopause that been this intense. I was humour is what we use
still catches you by texting my husband, to show other people
Just as mysterious? Our brain’s ability to surprise? saying, “Look, we just they’re normal, but
bounce back. A separate four-year analysis I have a nine-year-old, have to have another there’s lots of times I use
from SWAN confirmed once women transi- and we never intended to baby.” So that was a humour to show myself
tion fully into menopause, brain function that there are other
rebounds to its premenopausal state. That’s people like me. That I
not to say, however, that we should all suffer am normal. This was a
through cognitive disturbances — or mood wonderful confirmation
swings, or super periods or pelvic organ that I’m okay.
prolapse — until perimenopause passes and —Christina Vardanis
order is restored. “More research and con-
versation is needed about perimenopause,
and one part of the misinformation is that
there aren’t options to help,” Yuksel says.
“There’s a physiological reason for all of
this, and there are evidence-based treat-
ments available too.”

BESTHEALTHMAG.CA 51

Field Guide: ILLUSTRATIONS BY
Perimenopause KA YOUNG LEE

HERE’S THE DEAL Is this the same thing as hormone
WITH HORMONE
replacement therapy?
THERAPY Many experts now use the term hormone
therapy instead of hormone replacement
BY CHRISTINA FRANGOU therapy. “The word replacement suggests
that something is gone that’s supposed to
be there,” says Mattatall. But perimeno-
pause and menopause are natural parts
of aging, even if they come with difficult
symptoms, she points out. “There was
a historical misogynist view that older
women are supposed to be hormonally
like they were in their 20s,” she says.
That’s unfair, she adds. “There’s noth-
ing wrong with you in menopause. If you
have these symptoms, we have therapies
that can help.”

Is it harmful?
It has risks and benefits, and these vary
from person to person. Hormone therapy
is safe and effective for some, but requires
in-depth discussions with a doctor.

In the past, many women took hormone
therapy as they got older, not for spe-
cific symptoms. But studies have shown
that hormone therapy is better suited for
women who have symptoms of perimeno-
pause or early menopause. Ideally, you
should use the lowest dose for the shortest
possible time, says Mattatall.

JUST LIKE THE symptoms it was designed about the risks and benefits of hormone Why is there so much confusion?
to cure, hormone replacement therapy’s therapy, there’s a lot of confusion and even Hormone therapy is complicated, and fig-
reputation has run hot and cold over the stigma. Is it safe? For whom? And how do uring out how and where it works best has
past eight decades. you know what will work best for you? been a long process.

Today, hormone therapy has settled into What is hormone therapy? Estrogen was initially prescribed to treat
a more temperate role — as a vital aid for It involves supplementing or mimicking menopause — not so much the symptoms
some women who are experiencing symp- the hormones that your body is no lon- but the aging process itself, says Dr. Wendy
toms of perimenopause and menopause. ger making consistently. During peri- Wolfman, the director of the Menopause
menopause, as ovarian function wanes, Clinic at Mount Sinai Hospital, a professor
“You don’t have to put up with symp- hormone levels f luctuate and decrease of obstetrics and gynecology at the Univer-
toms,” says Dr. Fiona Mattatall, an assis- slowly over time. Physicians often pre- sity of Toronto and the first clinical chair
tant professor in obstetrics and gynecology scribe estrogen and progestin to help with in mature women’s health. “The goal was
at the University of Calgary. “Hormone symptoms of menopause, perimenopause to make women feel younger and be more
therapy is often the most effective treat- and osteoporosis (progestin also reduces sexually responsive,” she says. Estrogen
ment for symptoms related to hormonal risk of uterine cancer). use began to increase in the 1970s.
f luctuations.”
Hormone therapy then briefly fell out of
But after decades of mixed messages favour after research showed that taking
estrogen alone increased rates of uterine
cancer. But scientists soon found that add-
ing progestin to hormone therapies miti-
gated that risk.

In the 1980s, a landmark analysis in the
United States called the Nurses’ Health
Study showed that women who took hor-
mone therapy had fewer instances of car-
diovascular disease — a major killer of
women after menopause. Over the next
two decades, hormone therapy use among
women soared.

But in 2002, results from the Women’s
Health Initiative, a U.S. study of more

52 FEBRUARY/MARCH 2021

“THERE WAS NO PHONE CALL,
TELLING ME W HAT WAS COMING.”
—ACTOR WHOOPIE GOLDBERG

than 160,000 post-menopausal women, THESE LOW-KEY
raised the alarm. An analysis showed that CHANGES CAN
post-menopausal women who’d been tak- ALSO HELP
ing hormone therapy for approximately
five years had an increased risk of heart Dr. Renee Morissette,
attacks, strokes, clots in the legs and breast a certified menopause
cancer. “Women came off the therapy in practitioner at the
droves,” says Wolfman. Women’s Mid-Life
Health Program of
We now know that the picture is more Saskatchewan, explains.
complex: Women 59 years old and younger
in the study did not have significant Consume strategically better, have a higher
increases in cardiovascular disease and “Adding more fruits and sex drive and have a
strokes, though there are lingering ques- vegetables into your better sense of well-
tions about breast cancer risk. At the same diet, making sure you being. High-intensity
time, younger women benefited the most in get adequate protein and interval training has a bit
terms of relief of symptoms from perimeno- optimizing your calcium more benefit than some
pause and menopause. But this history cre- and vitamin D intake help other forms of exercise,
ated a stigma around hormone therapy, promote a general sense especially for weight
says Wolfman. of well-being. Minimizing maintenance. Weight
caffeine and alcohol are training using light
What’s the current recommendation? huge for improving sleep, weights or resistance
Most major women’s health organizations mood, hot flashes and bands is especially
now recommend hormone therapy for incontinence. But listen, important for bone
women with symptoms of perimenopause, when you’re feeling health. But anything
as well as women in menopause who are bad because of your that gets your heart
in their 50s, or those whose menopause symptoms, it’s going rate up is good.”
ended within 10 years. It is not rec- to be more tempting
ommended for women with a history of not to abide by these Be mindful
breast cancer. guidelines. As with all “Stress can be a
these changes, it’s baby humongous trigger for
What are my options? steps. When you notice symptoms. But we’re
Talk to a doctor about your symptoms. that drinking one cup of seeing in studies that
Irregular bleeding should be investigated coffee a day instead of the meditation practice
to rule out other medical concerns, such three, for example, means of mindfulness is great
as cancer and fibroids, which both become you’re sleeping better for stress reduction, and
more common with age. or you have fewer hot practising mindfulness
flashes or you’re going has been linked to fewer
Certain types of birth control pills and to the bathroom less, it hot flashes and better
hormonal IUDs can be good first-line will help reinforce that sleep, which leads to
hormone therapies for many women in behaviour. It’s a bit of trial better mood and even
perimenopause to help with symptoms, and error, but knowing better sex.”
especially heavy or irregular menstrual what your triggers are is
cycles. There’s the added benefit of contra- a big first step.” Please, just moisturize
ception; women in their 40s are one of the your vagina
highest-risk groups for unintended preg- Make a move “More than 60 percent of
nancy, notes Wolfman. “At first, women might women in the later years
notice that when they’re of menopause experience
Hormones can also come in the form of more active, they get vaginal dryness. This is
oral tablets, patches or transdermal gels. more hot flashes. But something you can solve
For women whose main symptoms are studies do show that without ever talking to a
vaginal discomfort, there are localized women who get into a doctor! Drugstore vaginal
therapies specifically for the vagina, in regular exercise routine moisturizers can help
the form of creams, rings and tablets. For — let’s say, 150 minutes quite a bit — look for
those who have symptoms during certain per week, split up ones with hyaluronic acid,
points in their cycle, physicians might add however you like — have which are particularly
other medications or hormones for a few fewer hot flashes, sleep effective.”—Rebecca Philps
days a month on top of or instead of birth
control. If the symptoms are primarily 53
around mood, for example, other medi-
cations or cognitive behavioural therapy
may be helpful, says Wolfman. There’s no
one-size-fits-all approach. “It becomes an
individual decision based on a woman’s
personal risk, her family history and goals.
So it’s a long discussion.”

BESTHEALTHMAG.CA

Field Guide: ILLUSTRATIONS BY PHOTOGRAPH (UNDIES) COURTESY OF KNIX
Perimenopause KA YOUNG LEE

LET’S GO BACK IT’S EASY TO dismiss peeing, a little bit,
TO THE PEE THING some of the time (only when I sneeze…or
cough…or run), as a minor inconvenience,
FOR A SECOND but it’s a slippery slope, and no one likes
dealing with these kinds of surprises. So
BY K ATE RAE what’s really going on?

54 This kind of peeing falls under the
“stress urinary incontinence” umbrella
— and it can be a real bummer, especially
when you’re trying to amp up your exer-
cise to boost your mental and physical
health. It’s largely caused by a weak pelvic
floor, the hammock of muscles, ligaments
and fascia that hangs out just below your
bladder. Aging, past or current pregnan-
cies and being overweight can cause these
bungee cords to soften and slacken.

The problem can start with your ure-
thra, says Michele Fraser, a Toronto-based
pelvic floor physiotherapist. It has a muco-
sal lining that makes the tube’s sides stick
together. But a lack of estrogen — a factor
during perimenopause and menopause —
causes everything to dry up, including the
urethra, so it loses some of its Velcro ability
and leaves you with leaks.

Another cause is pelvic organ prolapse,
in which your bladder (cystocele prolapse),
rectum (rectocele prolapse) and/or uterus
(uterine prolapse) lose their footing and
collapse toward and into the vagina. If
your bladder prolapses, it will hang below
your urethra, not above it (think water in a
slumped balloon), and cause both leaking
and a feeling of never being empty.

So what to do? First, keep a diary of when
it’s happening. Then make an appointment
with a pelvic floor physiotherapist.

At your initial appointment, expect a
lot of awkward questions. “I always tell
new clients, ‘Listen, I talk about pee,
poo and sex all day,’” says Fraser. “Noth-
ing surprises me.” Next, there’s an inter-
nal exam, either inside the vagina or the
anus, or both, so the physiotherapist can
map out your pelvic f loor, identifying its
weakness and its tensions. (This won’t
happen, obviously, if your examination
is virtual, where the assessment will be
based on you sharing your symptoms.)
And then comes the Plan — the capital P is
intentional, because it involves more than
banging out a few simple “squeeze-like-
you’re-stopping-a-pee” Kegels at a traffic
light. One cue Fraser uses, for example, is,
“Imagine a flaxseed at the tip of your ure-
thra. Now imagine pulling it up inside, like
an elephant drinking water with its trunk.”

Doing these exercises, possibly in combi-
nation with other tools, such as using local-
ized estrogen to help improve the integrity
of the tissue, should help in most cases,
Fraser says.

FEBRUARY/MARCH 2021

WORTH A SHOT “THINK OF THE TRANSITION TO
PERIMENOPAUSE...LIK E PUBERT Y IN RE VERSE.”
Leak-free undies SAYS DR. JENNIFER GUNTER
perifmorenyoopuar use
YOU CAN STILL
survival kit WORK OUT. JUST
BE PEE-PARED

Knix Pelvic-floor physiotherapist
Frustrated by the lack of Michele Fraser is very clear
products to help women that there is no easy “do this,
don’t do that” solution when
manage post-partum it comes to working out. It’s
leakage, Toronto’s Joanna not the exercise necessarily,
Griffiths created Knix, the but how you’re doing it and
OG leak-proof underwear, whether your core and intra-
which absorbs up to eight abdominal muscles (which
teaspoons of liquid. From are intimately connected to
your pelvic floor) are being
$34, knix.ca used properly. That said…

Newex Sure, wear whatever Getting close to
This Quebec-based brand, Walking, swimming and
cycling are typically the danger zone
run by Fanny Maude considered “safe” Anything high-impact
Théberge and her partner, activities, as they put can cause trouble, as
very little strain on your can holding in your
Steve Leduc, makes bladder. But everyone breath (it creates
performance underwear is different, and any pressure in the intra-
(and shorts, capris and activity over time can abdominal space).
leggings) that can absorb cause your muscles to Lifting heavy weights
up to 10 teaspoons of fluid. weaken — and your overhead can also be
bladder to fill up too. tough, and sports that
From $35, newex.ca So while you may feel involve a lot of changes
great at the beginning in direction and stop-
Speax of the hike, you may be start movement (like
Undies from New York City- surprised by the end. hockey and tennis)
based Speax by Thinx come can overload your
Maybe take some pelvic floor too.
in four colours and cuts
(high-waist, hip-hugger, extra precautions Red alert!
bikini and thong), and hold Due to their lack As anyone who does
up to eight teaspoons of of bouncy, sudden CrossFit will tell
liquid. The company also movements, Pilates you, double unders
offers a 60-day money-back and yoga may seem (skipping rope, but
guarantee. $52 per pair or like innocuous forms of swinging the rope
3 for $138, shethinx.com exercise, but they can twice with every jump)
be troublemakers: If are the number one
While these can be you’re doing crunches or way to guarantee
life-savers, they’re not 100s, you can be putting you make a splash.
long-term solutions. pressure on your bladder, —Kate Rae
Consult your doctor if you’re while chaturanga (a yoga
experiencing leakage. push-up) and navasana
(boat pose) can cause
BESTHEALTHMAG.CA you to overgrip and spill.

55

5ċ$5ÄÀØӋԡ € $zԡPeĀԡeԡ€šÿ5ԡӤąeØZԡZ5ÄÍ5€Nӥ PHOTOGRAPH COURTESY OF SHEKEIDRA BOOKER/S.MARCHE’ PHOTOGRAPHY

WHTTVOEOOCI“FEWADWOBTWPOEHUETAENNEVRWDB’DUEGTLAAYLEOHKNSNWAOETNESNRDOORTTTRWOMWAPHOBLAEBHOANLNYEOENCG. .EWY”,

In this excerpt from her new book, Black Girl in Love (with Herself), Canadian
writer, playwright, life coach and television producer Trey Anthony

reflects on being a suddenly single mom in the pandemic economy, and
the incredible strength she discovered through vulnerability.

56 FEBRUARY/MARCH 2021



W 5ċ$5ÄÀØӋԡ € $zԡPeĀԡeԡ€šÿ5ԡӤąeØZԡZ5ÄÍ5€Nӥ

walls caving in on me. Thankfully I have some savings, but I’m
carefully monitoring my money, and I’m painfully aware that I’m
spending and not making any additional income. This begins to
stress me even more. Thank God I have the insight to take my own
advice and begin seeing a therapist. But it isn’t cheap. Each session
costs me $150 per hour, and as much as I know that I emotionally
need this, I cannot justify spending this amount on a weekly ses-
sion as I watch income I thought I could count on magically dis-

appear. The world is in shock, the economy is at a standstill, and

there is no end in sight. No one seems to know when things will

return to normal. As I start to scrutinize my budget, I know that

my weekly therapy sessions have to go. I compromise with myself,

saying that I will cut them down to one session every three weeks.

I know it’s a sacrifice that I have to make to stay afloat.

I’m on the phone with my dear friend Bea, who is doing her

weekly check-in sessions with me. She knows I’m still mourning

the loss of my relationship and I’m still feeling overwhelmed by

motherhood. She gently inquires how I am doing. Despite my best

efforts, I start crying. Bea calmly soothes me and asks how my new

weekly therapy sessions are going. I tell her that they are going

well, but due to my concerns about my income, I have cut them

down. Without skipping a beat, Bea says, “You are going through

WHEN I WAS nine years old and living in England, my mother left an awful breakup. You have just moved. You are a new mother.

my brother and me with our grandmother and moved to Canada We are in a pandemic. If a person were experiencing one of these

for a new job. My grandmother was now the primary caregiver of things, it would be stressful; you are experiencing all these things

two additional children while still taking care of several of her own simultaneously. You are going through extreme trauma. Please

children who still resided in the home. Money was tight, but my send me your account number, Janice [her partner], and I will

grandmother always ensured that we had food in the house. She pay for the extra sessions. You need them. We can’t afford to lose

made a big deal of always cooking a big pot of rice and peas and you—you’re too important to many people. And I know you would

chicken for Sunday dinner, complete with a freshly made apple have done the same for me.”

pie or blackberry pie with fresh custard that we washed down All of a sudden, I’m nine years old, back in my grandmother’s

with some carrot juice. To this day, I have a hard time eating alone kitchen. I feel her rage. I’m seeing her rip up the free lunch paper.

because I find myself mourning the loss of my big family dinners. I don’t want anyone feeling sorry for me, I’m not someone’s char-

Mealtime was very important to my grandmother, and she took ity case! I quickly refuse. Assuring Bea that I’m fine, I don’t need

great pride in always having her fridge overflowing with food and help. Bea is firm. She begs me to take some time to think about it

our bellies full. She would beam at the entire family as she saw us before saying no. I quickly get off the phone and then I sit with her

heap spoons of rice onto our already overflowing plates or argue offer. I feel shame. I cry. I think some more. This is more than gen-

about who was going to have the extra chicken leg. From her, erous. I’m blessed to have such amazing friends. I sit with my own

I grew up knowing that food was equated with love and family. shame, now alongside gratitude. What does this mean if I accept it?

However, one day before class, my teacher pulled me aside and Taking money from her makes me feel vulnerable. Taking money

expressed her concern about the growing stress being placed on for extra therapy confirms to that critical voice in my head that

my grandmother because of having “two extra mouths to feed.” I’m weak. How dare I take money for something as “frivolous” as

With a look of pity and concern, she handed me a form to take therapy. My poor granny must be rolling in her grave!

home to my grandmother that would qualify my brother and me I rock my newborn son in my arms as I think it over. I look

for free lunches. The teacher stressed that my grandmother would down at his innocent face. He has a blind trust and knows and

no longer have to give my brother and me weekly lunch money. understands that I will take care of him. I know he deserves to

I eagerly ran home with the form, and I thought my grandmother have a mother that is emotionally prepared to be a mother. He

would be as delighted as I was that she could save more money. deserves a mother who prioritizes her own well-being, and that

However, she was far from happy. My grandmother took one look means she can assess when she needs help. In my own child-

at the form and ripped it up. She was raging as she expressed, hood, I carried the burden of misplaced trauma and stress, such

“Tell your little so-called teacher to not feel sorry for me! We do as when the Black women in my family were overburdened, emo-

not need her handouts! We have more than enough! Dis family is tionally drained, and feeling unsupported, they took their frustra-

not a charity case!” tion out on me. I know what it feels like to be viewed as one more

My nine-year-old self could not understand why my grand- thing to do on their overflowing to-do list.

mother was so upset, but what I now understood is that it was unac- I smile down at my son. I’m not weak. I am not a charity case.

ceptable to her to take money from anyone and that she believed I deserve support. I deserve help. I deserve love. I need to do

you shouldn’t let people feel sorry for you. People offering you help this for my son and myself. I pick up my phone and text Bea my

was not a good thing. account details.

Fast forward 30 years, and I’m now in the biggest crisis of my Too many of us struggle with the facade we share with the pub-

life. I’m no longer in a high two-income household. I’m suddenly lic. And yet there are the realities of our lives. I had the pleasure of

single, dealing with a tremulous breakup. I have a newborn baby, interviewing Dr. LaShawn Da Pittman during my research for this

and my income seems to be rapidly decreasing by the minute book. She has a Ph.D. in Sociology and has conducted extensive

because the world is now in a global pandemic. My shows, work- research pertaining to Black women and vulnerability. Dr. Pitt-

shops, and talks are being canceled as the government informs us man shared how vulnerability showed up for many Black women

to stay home. I’m an emotional wreck, stressed, and feeling the when it comes to finances and how many of us do not share our

58 FEBRUARY/MARCH 2021

5ċ$5ÄÀØӋԡ € $zԡPeĀԡeԡ€šÿ5ԡӤąeØZԡZ5ÄÍ5€Nӥ VITALS

financial concerns due to shame. “As Black women, we would head home, driving for another two hours.
are more likely than our white counterparts to expe- During the ride home, she would barely say a word.
rience financial struggle, to be raising our children And I would instinctively know that my role was to be
alone. And although we work more than other white silent and only tell her when to change lanes. Once
women, we earn less than white women on average, we arrived home, my grandmother would warm up
not to mention all men. We are more likely to be family the pots on the stove. She would have Sunday din-
and community caregivers than other women.. . . .So, ner with the rest of the family, wash the dishes, and
essentially we are doing more with less.” then she would sleep for a short while and head to
her night shift.
During our interview, I could not help but think
about my poor grandmother doing more with less. Now, as a grown woman, I reflect on the emotional
toll of this Sunday morning journey for my grand-
Every Sunday she got up early to cook dinner, and mother. How it must have felt for her to see her youngest son
we would leave about 8 a.m. to visit my uncle who was in prison. behind bars and not being allowed to touch him. I think of her sac-
We would drive for nearly two hours, and my grandmother would rifice. How she expressed her love by bringing him food. How she
refer to me as “her little company.” She didn’t have her driver’s never cried, never showed any emotions. How she never brought
license—she had failed the driving test seven times, but that didn’t along another adult or family member for comfort. How she could
stop her! So, for all my life, my gangster granny was driving dirty! only trust and rely on her nine-year-old granddaughter for com-
I was her co-pilot, and I would tell her when it was safe for her to pany. How she risked driving every Sunday with no driver’s license
change lanes on the highway. We would sing along to the radio, to see her son. How, as Black women, we will find a way even when
and I would write songs and stories in my notebook and read them there seems to be none.
aloud to her, and my grandmother would add to the story plot. It Many of us are navigating less-than-ideal circumstances and
was truly our bonding time. harsh realities. Yet we still want to be viewed as strong, capable
women. We do not know how to be vulnerable. We do not know
At the jail, would sit in a big waiting room. Sometimes, my how to deal with the emotions that come up for us if we are vul-
uncle came out quickly; other times, we sat there for hours until nerable. We can watch all the Brené Brown videos on vulnerabil-
a prison officer led him and he swaggered toward us. He always ity, but we also have deep-rooted trust issues. Some of us have
seemed happy to see us. My grandmother would not make eye attempted to trust partners, friends, and loved ones and have
contact with her son. She was stoic and kissed her teeth as he sat found ourselves holding the huge pile of poop, otherwise known
down. She would shoot him a quick, disapproving look before as the letdown bag, when we had our vulnerability thrown in our
reaching into her big black handbag and handing my uncle a big face. When I was dumped by my ex, I couldn’t help but feel duped
plastic ice cream container that now served as Tupperware, filled for fully trusting someone and believing they would hold my trust
with rice and peas and stewed chicken and my grandmother’s sacred. I was mad at myself for walking into this relationship arms
famous coleslaw. My grateful uncle would gobble it down as my and heart wide open and believing her when she swore up and
grandmother intensely watched. I would fill in the awkward down that she would always be there for me. I battled with myself
silence by giving my uncle amusing play-by-play about what was for a long time about how much I would reveal in future relation-
happening at home or sharing all the family drama that my grand- ships, and I was tempted to start rebuilding the walls around my
mother had recently told me. I honestly feel this is how I learned heart because I never wanted to feel hurt like that again.
to literally keep an audience captive! During this time, my mother was quick to once again offer her
unsolicited advice, “Trey, your problem is you give too much.
Thirty minutes later, the visit would abruptly end. My grand- You give too much of yourself over to others.” In other words, my
mother, with her head held high, would pop the empty container mother thought I was too vulnerable and that vulnerability could
back in her handbag and silently motion for me to follow her. We only lead to tremendous hurt. And as tempting as it was to restart
the narrative in my head that people couldn’t be trusted, that lov-
KIIAASGIO’ODFMLNIRLTELDROYACENRO,ONNLHIBYFNN’DHETAEEFAMNCEWOYF.RKSOAREEUTRIENADNMHLATRDIEEMGNSER.EYGN’.S, ing someone could only lead to hurt, or that accepting money from
people could only lead to them later having something to throw in
my face, I decided that my ex was only one person. Yes, she had let
me down, and perhaps I had misplaced my trust. I had given too
much to the wrong person. I expressed my fears about love to a
close friend who simply stated, “Don’t this let experience change
you; people love you because you show up fully to love. You picked
wrong this time but trust that next time you will pick right.”
I knew there were people in my life who I could trust. I also
knew that to find the love I wanted, I needed to show up healed,
open, compassionate, and kind. Because we attract where we
are. So instead of shutting down my vulnerability, I worked on
becoming more vulnerable. Instead of telling people I was fine,
I shared my hurt, frustration, and disappointment. I decided to
write and share my biggest vulnerabilities in this book to also
help other Black women know that it is okay to take off your
Superwoman cape.

Excerpted from Black Girl in Love (with Herself): A Guide to Self-
Love, Healing, and Creating the Life You Truly Deserve by Trey
Anthony. Copyright © 2021 by Trey Anthony. Published by Hay House.
Reproduced by arrangement with the publisher. All rights reserved.

BESTHEALTHMAG.CA 59

Fig. 01

Do early birds
really get the
worm? Find out
on page 65

Subject 01

Canada's
Debunker-

In-Chief

WAKEIn his new book, Timothy Caulfield
takes the stress out of everyday
decision-making by doing what he
does best: examining the evidence.

UP By

Christina
Vardanis

AND Photographs By
Raina + Wilson

Prop Styling By

Leanne Kelly

Wardrobe By

STSMCHIEEENLLCETerriDacquisto

U where he’s one of the top policers of the For instance, I’m drinking my third cup
misinformation army. of coffee today and am not going to
sweat it.
He acknowledges that at times it feels Me too!
like a losing battle. But there’s a note of
hope in the dedication of Relax, Dam- You outline three main paradoxes
mit!: “To science. Hang in there.” Does that go into our decision-making
he believe the trend toward pseudo-sci- process: the knowledge-era paradox
ence may be losing some of its steam? (increased access to better informa-
“You have to be hopeful,” Caulfield, 57, tion does not necessarily lead to bet-
says over the phone. “Some people say, ter-informed decisions), the less-risk
‘What’s the point in fighting this — you paradox (our desire to avoid any kind of
can’t make a difference.’ Well, first of all, harm — enter fearmongering) and the
the evidence says you can make a differ- perfection paradox (the compulsion to
ence. But also, just think about what it chase what ultimately is an unachiev-
would be like if we didn’t fight — if the able ideal). Which one do you think
only voice out there was the noise.” contributes most to anxiety?
I’ll say that the less-risk paradox really
We talked to him about how science speaks to our time. It’s a cheat because it
can help de-stress modern life, what it’s goes hand in hand with the new informa-
been like to watch a global pandemic tion environment we have in social media,
unfold in real time and whether those the speed at which we get information and
paper toilet covers in public bathrooms the degree to which society is an amplifier
do any good.6 of risk. Society is becoming increasingly
structured in a way that brings together
UNIVERSITY OF ALBERTA professor Tim- The book walks the reader through forces that twist what we hear about sci-
othy Caulfield has been on the front lines a regular day and the multitude of ence, both more broadly and specifically
of the misinformation wars for years, choices we make — Should I have about our health. Yes, there often are
taking aim at the wellness industry, another cup of coffee?7 Should I let my entities that are focused on it — they want
anti-vaxxers and spreaders of pseudo- kid walk to school herself?8 — which to market a product to you, or they have
science (including, ahem, certain celeb- are influenced by a strange brew of some ideology they want to get across —
rities1 who suggest pushing certain jade science, pop culture and fear. Why did but it’s also a systemic problem. These
eggs into certain body parts). His latest you write it this way? things work together, and our cognitive
book brings the fight not just to your First, it’s just fun to go through what the biases fit into the way social media feeds
front door but inside your kitchen, living science says about these little decisions. us that information.
room, bedroom — even your bathroom, But I’ve always been interested in mis-
as you’re deciding, for the 1,346,687th information, fearmongering, the role You say perspective is impor tant
time, if you’re really going to floss. of ideology and how these forces affect when talking about risk. That got me
how science and health are represented. thinking about the past year — the
Relax, Dammit! A User’s Guide to the Age We often think about those issues in the way we’ve all been isolating makes it
of Anxiety 2 examines all the decisions we context of big things, like climate change hard to maintain a baseline level of per-
make throughout the day, between the or vaccination hesitancy. I thought if we spective. Do you think the impact of this
time we decide to wake up and the time structured the book around these little pandemic will exacerbate the less-risk
we decide to go to bed, and determines decisions we all make, it would bring it paradox in the future?
how many of them are guided by sci- home, because the same forces are at Yes. We’re all spending more time online.
ence versus misinformation. Should you play. It was a way of exploring and mak- There’s interesting research that looks
check your phone before getting out of ing relevant to people how these social at social media and how being online all
bed?3 Is it good or bad to weigh your- forces impact decision making. the time and being bombarded in a cha-
self?4 Unloading on your partner about otic information environment can stress
your workday is healthy, right? 5 Caul- I try not to say, “This is the way you us out. It makes it more difficult for us
field tackles these kinds of questions in must do it.” Instead, I try to paint a pic- to tease out what’s real and what’s not.
the same breezy style that’s earned him ture to show when the facts might be There’s also some research that suggests
more than 64,000 followers on Twitter, unclear and then show how other social it causes us to share misinformation more.
forces shape our thinking . Knowing this So we’re just getting this worst-case sce-
will perhaps be liberating, in the sense nario — this cycle of fear. We’re getting
that people won’t be as stressed out all this information about the pandemic
about their decision making. while being stuck at home, which creates a
tough situation with respect to not just fear
"There is evidence that just pausing to consider the and risk perception but also the spread of
truth of something and doing a brief check increases misinformation.

the likelihood of not sharing bad information" Another interesting thing about the
pandemic is that you get anti-maskers
62 and anti-vaxxers saying, “Oh, it’s not
risky to me.” Risk to the community is
another perspective that’s being lost,

FEBRUARY/MARCH 2021

Notes and increasingly so. So it is going to be esoteric, but they are good examples of little
very interesting to see how this plays out. things in our lives we get wrong, sometimes
1 cough just because we listen to intuition. I mean,
Gwyneth Paltrow On a more “glass half full” note: There’s who wants to sit on a common toilet seat?
cough a study that just came out that shows And ranting does feel like it should work.
people are taking the pandemic more
2 seriously, even in the United States. More And was there anything that, prior
people are wearing masks. Given the to writing the book, you felt pretty
3 No. When you first politics in the U.S. over the last while, relaxed about but then started taking
wake up, you’re in that’s a remarkable achievement. In Can- more seriously?
a state of decreased ada, we’re seeing trust in the vaccine tick How I handle my email. I joke that if you’re
cognitive function. up. And I think that’s partly because of downtown in a big city and you see a crowd
(Read: You’re more the efficacy and good research behind it of people, then you’re looking at a crowd of
likely to type but also because of the increase in sci- email answerers — that’s how dominant it
something you will ence communication. is in our lives. I learned how to manage my
regret later.) And email and not get too stressed out about it,
compulsive phone What’s the most useful tip you have for and it seems like a little thing, but it made
checking is someone who’s faced with a bunch of a big difference in my life. I could wake up
associated with unequivocal information? How do they in the morning and do nothing but answer
anxiety and stress, navigate that knowledge paradox on email for 10 hours.
Caulfield writes. their own?
Over the past couple of months, people Yes, I think that’s a common feeling.
4 This one is more have been saying we need to improve our Exactly. And if you realize you’re never
complicated. But there critical-thinking skills and our media lit- going to get on top of it, you’re never going
is research that shows eracy, and it creates the impression that to get to “inbox zero” — that’s the type of
watching the scale there are really difficult tools people have thing that lets me manage my life a little
can help people to learn…but it’s not difficult. There are bit better.
maintain their weight. fundamental, straightforward things peo-
ple can do that don’t take that much time. On a related note, you also call out the
5 We’ll come back to this One of them is checking the evidence that illusion of “time panic” — the idea that
one, but — spoiler exists to support a claim. If it’s a testimo- there’s just never enough time.12 Saying
alert — you may not nial, be suspicious. If it’s just one study, be that it just doesn’t exist completely blew
like the answer. suspicious. If it’s an animal study, be sus- my mind. How is it possible that it’s all
picious. If they’re trying to sell you some- in our heads?
6 They do not. thing, be suspicious. These are all things Honestly, I thought more people would be
you can look for that will give you a sense angry about that part of the book and say,
7 If you want! There of the quality and credibility of the evi- “But I am busy!” I think that’s because, in
is enough research, dence being used to support a claim. some ways, we all recognize life is just struc-
Caulfield writes, to tured to make us feel very busy. We carry
safely conclude that The good news is, there’s evidence that our office around in our pocket. We always
coffee is “probably if you teach these straightforward things could be doing something else. The other
reasonably good to people, they are better at discern- day I was sitting with my son and watching a
for you and almost ing what’s real and what’s not. In fact, football game, and my phone was with me,
certainly not bad even just pausing to consider the truth and I felt guilty that I could be answering an
for you.” of something and doing a brief check email. We live in this chaotic information
increases the likelihood of not sharing environment, where we’re always capable
8 Fear is at play in this bad information. of working all the time, and that creates the
decision. Caulfield feeling of being busy even if we’re not neces-
points to a 2015 out After doing all the research for this sarily so. Of course, there are people who
of the Pew Research book, is there anything you feel 100 are incredibly busy, but when you look at
Center in the U.S. that percent okay about saying, “You can the global data, it shows we really aren’t as
found parents’ third- stop worrying about this”? busy as we think we are.
biggest worry was their Sitting on a public toilet seat.9 The worry
kid getting kidnapped. people have about that is very common. About that office in your pocket… The
But the real risk of number of times a day we decide to
that happening is Anything else we can stop debating? check our smartphones is staggering.13
“astoundingly small.” The uselessness of meetings at work 10 is You raise the idea of how our phones
Caulfield also points pretty well documented. The other one — increase our capacity for “absent pres-
out that getting and I love this topic and could have written ence” — I admit that put a chill directly
harmed in a car a whole book on it — is how ranting isn’t
accident on the way to good for you.11 I know these might seem
school is more likely
than a child being 63
hurt by traffic while
walking to school.

BESTHEALTHMAG.CA

Fig. 02

Is breakfast
the most

important meal
of the day?

VITALS

9 The kitchen faucet into my heart. It’s a terrible truth to real- Journal of Medicine recently about men-
handle carries more ize about how you’re living your life. tal health issues stemming from the pan-
germs. Yeah. There’s that story I tell, where my son demic, and one of the recommendations
came in, all excited about his report card, was to take a break from all the chaotic and
10 Evidence shows this and I pulled out my damn phone. We all conflicting information we’re bombarded
is especially true do it. And even if you don’t pull out your with all the time. I think taking those steps
when it comes to phone, you’re thinking about it. will not only help with your stress but also
brainstorming. allow you to increase your critical think-
I think people are familiar with the det- ing. There’s actually a little bit of evidence
11 “Ranting is the rimental effect smartphone addiction to back that up as well — that if you can just
junk food of has on health, but it feels like too big a take a pause and reflect, you’re less likely to
emotional response,” problem to tackle. What is one change share misinformation, and you’ll be better
Caulfield writes. “It people can make that would have the at critically assessing the content circulating
provides immediate biggest payoff? on social media.
satisfaction,” but There are two things I try to do — though I
over time, we often admit I’ve gotten worse about this during What’s it been like to be Tim Caulfield
regret and even the pandemic. First, I put my phone away in — the guy ruled by science and rea-
feel sick about it. my office when I’m done work. So if I want son — over the past 10 months, as the
to check it, I have to get up and go into my world grapples with a global pandemic
12 Complaining about office. And then I try not to check it at all in real time?
being busy has become after 9 p.m. It’s not that my phone stressed It really has been bonkers. There have
a kind of cultural me out, but it did keep my mind active. been some days when it’s been incredibly
currency, Caulfield frustrating, and others when I’ve sympa-
writes. That, in Definitely don’t take your phone into thized with the public health authorities
concert with having your bedroom. A colleague I work with struggling with the uncertainty of the sci-
constant access to actually has a little bed she puts her phone ence. It’s a unique time, because people
email and the nature in, and she puts a little blanket over it. I are watching the science unfold and maybe
of work changing, love it. It may be a bit of an obvious thing, don’t like what they’re seeing as the sau-
results in the feeling but it makes such a huge difference, espe- sage gets made.
of being overwhelmed. cially in the quality of my sleep.
But for many, it’s There’s been a lot of confusion about the
an illusion. And the other thing I try to do is create science, but the spread and the embrace of
some blackout times throughout the day. misinformation — I’ve never seen anything
13 It’s been estimated When I first started doing this, I aimed for like this.
that the average only a half an hour — 30 minutes with no
person checks their email, no social media. It’s hard to do. The silver lining, if I can use that phrase,
phone more than given the time, is that there are people
100 times a day. There are pervasive beliefs that chronic who are taking misinformation more seri-
stress — the garden-variety kind that’s ously now than I’ve ever seen before — in
Fig. 01 not brought on by poverty or conflict — health organizations, and governments,
can make you sick. So then we stress at provincial levels and around the world.
Getting up early is often about not practising enough self-care. Hopefully that will have long-term implica-
cited as a “secret of Then the wellness industrial complex tions for how we deal with it in the future.
successful people” — but reinforces that anxiety. How stressed
research shows waking up we should be about stress itself? So many doctors and scientists have
at a consistent time every First of all, I just want to be clear that we’re become much more active, raising
day is more important to not talking about stress in terms of a men- their voices on Twitter and other plat-
maintaining good health. tal health issue. If people are feeling high forms to help explain the science, and
The fact that morning people levels of anxiety, they need to reach out to using it to challenge policy decisions.
often seem more successful, a doctor. But in general, being anxious and You’re right — we’re seeing the creation
Caulfield writes, may be the being stressed out, especially about some- of this wonderful community of scien-
result of society favouring thing like a pandemic, is a natural reaction. tists, clinicians, science communicators,
morningness in general. So how can we respond to it? One of the students, nurses, pharmacists, physical
themes in my work is that we should, as therapists, teachers and just people who
Fig. 02 much as possible, focus on evidence-based are passionate about battling misinfor-
fundamentals, and this is relevant when we mation. I really hope it becomes a bit of a
There’s no debating that talk about living a healthy lifestyle and how social movement that carries on — a legacy
breakfast has become the to deal with anxiety: Exercise. Get a good of the pandemic.
most venerated meal of the night’s sleep. Eat a healthy diet. And then
day. But the science on its step away from the noise when you can. This interview has been condensed
benefits, Caulfield points There was a great piece in the New England and edited for clarity.
out, is quite mixed. Most
evidence is generally pro 65
breakfast, but experts warn
of its importance being
“massively oversold.”

BESTHEALTHMAG.CA



WALLED IN

IT’S BEEN A YEAR OF STRESS,
AONNISDOOIULTAR’STMIDOEONNNTAEANALDNHGUERAMIELBTFE,HR.

POLITICAL SCIENCE PROFESSOR
AISHA AHMAD

ZLEOAWNYNEEOSSARROTKONITNHRHGAEEITFNRLWEDEXACISPSTAE, SOARTNNIEEDTNRHCEE
HOW TO MOVE AHEAD WHEN

THE TANK FEELS EMPTY.

Illustrations by Rachel Wada

IT’S BEEN ALMOST ONE YEAR SINCE THE CORONAVIRUS PANDEMIC

upended our lives, and its impact on our mental and emotional
health continues to spread. Some of us are grieving the loss of
loved ones; others are struggling with illness, job loss or crushing
isolation. But despite our respective struggles, we each now have
a year of experience in this crisis — and that counts for something.
We have navigated deadly threats, managed physical hardships,
adapted to rapidly changing conditions and responded to adversity
with creativity. The fact that we are still in the game is evidence of
deep personal strength and resilience.

But this journey hasn’t always been pretty. Survival never is.
Having spent months and years in disaster zones around the
world, I can attest that working through a sustained crisis is tough
business. I’ve spent many days hearing gunfire right outside my
window and worrying about cholera in my neighbourhood. Dur-
ing those periods of acute stress, my mind and body automati-
cally focused on the external threats, working on overdrive to
protect me. That was a normal, appropriate reaction to danger,
designed to keep me alive. Over time, however, this type of pro-
longed stress and arousal can produce a slew of emotional and
psychological side effects.

War and plague are different calamities, but there are many
notable similarities. The constant threat of serious bodily harm
or death. Crippling boredom and loneliness. Restrictions on mobil-
ity. Systemic fear and uncertainty. Bursts of activity and adrenalin
followed by a long, dreary grind. Family separation and loss of
loved ones. Severe economic hardships. Prolonged interruptions
to childhood education. Sure, no one is shooting bullets at us,

67

but this pandemic is a system-wide lethal your own home or you have been witness- PANDEMIC
threat that has invaded the most intimate ing them in your community, we have all DIARIES
parts of our lives: our bodies, our homes, been living with the constant hum of cri- CANADIAN
our relationships and our finances. sis in our heads. In my experience, I have WOMEN SHARE
learned it is perfectly normal to have this HOW THE
After a year in this pandemic pressure lead to emotional and psychological side PAST YEAR HAS
cooker, it is no surprise many folks are effects. Even for people who have a lot of AFFECTED THEIR
feeling the psychological burn of sus- experience with disasters, it takes effort to MENTAL HEALTH
tained crisis. Yes, we have relearned how maintain a state of inner calm and peace
to shop, connect, work and exercise under under these conditions. AS TOLD TO
these rough conditions. We have held the SADIYA ANSARI, KATE RAE
fort for our loved ones like champions and These mental health pressures are real
made enormous personal sacrifices for the and valid — but distress doesn’t have to be AND REBECCA PHILPS
greater good. But the tank is empty. Nerves our only speed over the next few months.
are shot. Anxiety, sleep disruption, work Even if we hit low points, there are ways ‘BY MAY, I WAS
fatigue and family pressures are all par for to pull ourselves back up. We can start by
the course. Some have avoided the worst abandoning the false assumption that if we BURNT OUT’
damage, but very few are fortunate enough feel bad, we must be doing badly. Everyone
to be unaffected and undisturbed. is going to have down days, and these emo- ց When the pandemic hit, I fortunately
tional fluctuations are not a judgment on could work from home. But my kids
But does struggling with the mental and our ability to handle this crisis well. were transitioning to online school at the
emotional toll of this chronic crisis mean same time. My husband works outside
you are failing at “pandemic living”? Abso- It would also be wise to reconsider what the home, and it was just chaotic every
lutely not. Discomfort and upset are nor- “doing well” in the middle of a pandemic single day. There were many nights I
mal and appropriate human reactions to even means. For example, perhaps you worked well past nine o’clock.
sustained crisis conditions. Whether it is went into this doing morning yoga, design-
a war, a famine, an earthquake or a pan- ing cute home workspaces and baking fresh By May, I was burnt out. I wasn’t
demic, no sane person feels great in the banana bread. While that may have felt like sleeping properly. I was snappy with ev-
middle of a deadly disaster. Tragedy and a strong start, chances are there was a bit erybody. My stress showed physically:
loss are not supposed to make us cheerful. of denial and inexperience behind your I started to have hair loss, and my eyes
It is perfectly normal for people to feel sad cheery mood. It is unreasonable to expect were consistently red, with bags under-
or angry when terrible things are happen- that you should remain chipper, like some neath them. I don’t think I was ever so
ing to folks around them. creepy smiling robot, while we’re still in happy to see June because it eased the
the midst of it. pressure of balancing the kids’ school
Now, some people have dismissed pan- with my work.
demic times as “just sitting at home,” thus So, if today you fought with your part-
minimizing the suffering others might be ner, missed a webinar and ate a party-sized The kids returned to school online in
experiencing. As someone who has been bag of Doritos, take a breath and forgive September. That’s when I was able to
to a lot of war zones, let me try to provide yourself. You are not failing or weak. These emerge from the dark space I had been
some perspective on this matter. To be are just normal human responses to sus- in because we had a better system in
clear, this is exactly what a systemic disaster tained crisis. place. Everyone is set up with Google
looks and feels like from the inside. Some- Home (to ask questions before asking
times horror strikes your own loved ones. The good news is that we are now me) and we’ve introduced boundaries
Other times, you sit in suffocating spaces approaching the final stretch of this mara- that allow me to work uninterrupted (the
while receiving news of calamity befall- thon disaster. Our world’s scientists have kids don’t bug me until the end of the
ing your neighbours. The reality — not the developed multiple vaccines in record- school day).
director’s cut movie edition — is full of dull, breaking time, and while there will likely
slow forms of everyday trauma. It is like a be delays and logistical challenges to dis- I’m feeling less overwhelmed — we’ve
monotonous, electric hum of anxiety con- tribution, the finish line is now in sight. learned how to make this work tempo-
stantly buzzing in your head, interrupted by According to the current trajectory, Canada rarily. But now my anxiety is focused
sporadic bursts of adrenalin and fear. aims to achieve nationwide vaccination by on the future: How long is this going to
September 2021. This is an astonishingly last? —Monifa, 36
The pandemic is not a war, but it is also fast timeline. Of course, at a personal level,
not a “lightweight” disaster to be dismissed that might still seem like a long time to
or scoffed at. Being unable to hold your wait. However, respite and relief can come
loved one’s hand before they die is devas- well before we receive a vaccine ourselves.
tating. Learning that you now have perma-
nent organ damage from coronavirus is a Even amid the harshest disaster con-
crushing personal blow. No hugs for a year ditions, I have always found moments of
is a recipe for psychological distress. With a peace, friendship and even the sublime.
spouse working double shifts in emergency There are bursts of colour and moments
or front-line service, the most stalwart part- of hilarity. I can’t explain why, but jokes
ner can have panic attacks. And frankly, I get funnier when you really need to laugh.
can say from experience that when a loved It’s like when you haven’t eaten all day and
one is trapped in a long-term-care home finally manage to get some fast food…some-
with a COVID-19 outbreak, it feels remark- how that cheap, greasy burger is hands-
ably similar to having them stuck in a city down the most delicious thing you’ve ever
with frequent suicide bombings. put in your mouth. Happiness amid hard-
ship is like that. Each day, we can look for
Whether these calamities have touched and capture these (continued on page 70)

68

‘I’VE DISCOVERED BATH SOBBING ‘LOCKDOWN MADE ME
AND CAR SCREAMING’ FEEL LESS ALONE’

ցԡWhen people ask how I’m doing, I say a rock — sturdy and totally uninterest- ց In December 2019, I had a
I’m pandemically parenting pubescents ing. Well, I’m perimenopausal, I’m barely panic attack, followed by
while perimenopausal. Our 15-year-old sleeping and my skin is really thin right several more. They were
is lovely and thoughtful and kind but now, so most of our interactions are like triggered by a sexual assault
also unbelievably depressed. And the a bristling porcupine standoff. that made me feel isolated
truth is, I don’t know how to throw a — I was extremely afraid of
rope down a well to someone when Through all this, I’ve discovered bath closeness, of other people’s
I’m even farther down it. Some nights, sobbing and car screaming. Those are touch. I went to a walk-in and
we just lie on the couch and watch TV my outlets. Not having access to my was given antidepressants.
and eat ice cream and feel sad together. coping strategies, like hanging out with
Maybe that’s okay? I worry about resil- friends or my sisters, is destroying me.   In late February I took a job
ience with kids — they don’t necessarily at a neighbourhood coffee
know that it gets better. But there’s also the intense guilt of shop. I went in for the first
feeling this way. I don’t use the term shift on a Thursday, and
I’ve suffered from anxiety and depres- “lucky,” because I know we’re actively by Sunday, everything was
sion in the past. I’m a recovered agora- benefiting from privilege. We can self- closed. Thanks to that five-
phobe. I’ve been through two extreme isolate safely at home. We’re financially hour shift, I got CERB, which
bouts where I couldn’t leave the house stable. Our kids are old enough to tackle saved my life.
for months. I pretty much crawled out online school on their own. I find my-
of it, thanks to cognitive behavioural self reverting to the hateful self-talk that In a weird way, lockdown
therapy. I feel remarkably healed from plagued me in my agoraphobia days: made me feel less alone.
that, but the pandemic has been offer- Suck it up, you pathetic loser. Before the pandemic,
ing me the perfect opportunity to sink my fear of touch made me
back into it. I’m not in a rush to socialize I saw a young woman in the drug- feel ashamed and different.
again, and I know that’s a red flag. store the other day with a tiny baby Now everyone was
strapped to her. I asked her how she experiencing the same
Our 13-year-old son acts like a parody was doing, and she started welling up. loneliness, lack of physical
of a moody teenager, with the gloom, Her first instinct was to say, “We’re touch and even fear of
the darkness, the bristling rage. I know lucky, we’re okay…but it’s hard.” I told closeness I felt after I
he’s as depressed as his sister and that her that both things can exist together was assaulted.
it’s just manifesting differently. The ad- and both things are true. I wish I could
vice books say you’re supposed to be like speak to myself with the same kind- In the fall, I didn’t get a job
ness. —Jenny,* 49 I really wanted, and after
that I was just sad. I was
also paying a lot in rent
and weighing my options.
Meanwhile, Morocco, where
I’m from, reopened its
borders. My brother paid for
the plane ticket, and I’m home
now. Here I’m in a house
with a small garden — I can go
outside, breathe fresh
air. I have my family, people
to talk to. And honestly, it’s
the best decision I made in
2020. —Leyla,* 29

*Names have been changed to protect privacy. 69

(continued from page 68) strange and beau- ‘I KEPT THINKING I SHOULD BE
tiful little moments. BETTER ABLE TO HANDLE IT ALL’

These bright spots are likely to become ց Life in March of last year was already time, of course, racing to the bathroom
even more abundant in the weeks ahead. super stressful. I was in charge of a mas- to vomit before calls. Panic attacks two
Long Canadian winters are always tough, sive account at work. I am also a single nights in a row made me feel like I was
and pandemic restrictions have made this a mom by choice to six-year-old twins, dying. My friend finally said, “Yeah…
particularly gruelling season. But we know so yeah — super stressful. Then the you’re not going home like this.” I called
how much the coming of spring lifts our pandemic hit. With the girls home from my doctor. She wrote me a note, saying
spirits, with brighter days and the smell of school, I quickly went from fun bristol- I was stopping work, effective immedi-
fresh grass and budding trees. That natu- board-schedule mom to demented-and- ately, due to stress leave.
ral relief is just on the horizon. One thing raging mom.
I can promise is that after a long bout of I didn’t feel relief. I felt guilty that oth-
sustained hardship, simple pleasures such By June, my days went like this: up at er people had to do my work, and I felt
as these always feel like heaven on earth. 6 a.m., when urgent texts started com- ashamed about not being able to man-
ing in, going flat out until dinner time age it all. But I started seeing a therapist,
And on the days that are darker, we can and then working again until midnight and I started taking an SSRI. Both have
choose to embrace ever more gentleness. or later. By August, I was vomiting blood helped a lot.
When external conditions are ruthless, from an ulcer, I hadn’t had a solid bowel
compassion is a revolutionary act. As we movement in weeks thanks to my steady I am now back at work — I really can’t
move into the final stretch of this mara- diet of coffee and panic attacks, and I afford not to be. My ulcer is better. My
thon, each of us can develop a merciful had constant headaches. I kept thinking sleep is better. I feel more supported at
vision of a good life. Not a perfect maga- I should be better able to handle it all. I work. I am trying to be okay with every-
zine cover, but a soft and nourishing life felt like a failure on all fronts. thing not being okay. I’m establishing
that works under sustained hardship con- some guardrails with my therapist. But I
ditions. So today is a great day to flush any My best friend convinced us to am so deeply aware that I am on my own
perfectionist expectations you have that come to her cottage, and that’s when when it comes to my kids, and it’s super
you must write a book, learn two languages I snapped. I was working the whole overwhelming. —Beth, 45
and get as fit as an Olympic athlete in the
next six months. It’s irrelevant that Becky
just posted staged photos of her flawless
home gym and kale salad with an #inspira-
tional quote. Unfollow. Save your energy to
capture real moments of the sublime that
touch your own authentic, messy, perfectly
imperfect world.

No one else gets to dictate what your
best life should look like over the next few
months. You do not have to do a single
CrossFit video in your living room. How-
ever you are able to care for your body in a
safe and respectful way is perfectly good.
If you only ate junk food today, you are
still a worthy and accepted human being.
Take a multivitamin and try again tomor-
row. And you may have just shouted at your
partner or best friend, but you can come
back with a peace offering and promise to
work together as a team in the days ahead.

The harsher the crisis conditions become,
the more merciful we can be, with ourselves
and with others. Everyone falters along the
way. No judgment. No shame. We just get
back up and move toward the light. That is a
true measure of successful living under sus-
tained disaster conditions.

Aisha Ahmad is an associate professor
of political science at the University
of Toronto and the chair of the board of
Women in International Security–Canada.
She is the author of the award-winning
book Jihad & Co.: Black Markets and
Islamist Power (Oxford University Press,
2017) and has conducted fieldwork in
Afghanistan, Pakistan, Somalia, Mali,
Iraq, Kenya and Lebanon.   

70

‘ALL THE LONELINESS ‘I MISS SO MANY THINGS ABOUT PRE-PANDEMIC LIFE’
I EXPERIENCED AS A NEW
IMMIGRANT RETURNED’

ց I moved to Toronto from Argentina in ց Anyone who has ever met Then I usually visit my
2001, and it was an unbearably lonely me knows how extroverted I granddaughter (we are in
time. There are the intensely confusing used to be. I was a server for a bubble). She is two and
and destabilizing cultural differences, of decades at some of Toronto’s incredible and joyful and
course (ah, so you don’t kiss the dentist busiest restaurants, and I loved charming and showers me with
hello here in Canada), but the lack of the chaos of it all. I also hosted love and kisses. I don’t know
touch and connection was just so des- and took part in storytelling and how I would get through this
perately isolating. In the ensuing years, I stand-up comedy events all over without that. And as soon as
started a career, got married and created the city. I absolutely loved it. I’m home, I reach for my weed.
a new community. I used to look at it as a fun
I miss so many things about distraction, used to love getting
And then COVID-19 hit, and all of the pre-pandemic life. I miss sex. a little bit high. Now I seek
loneliness I experienced as a new immi- I miss walking to the TIFF total annihilation. I smoke it all
grant returned. I am having those horri- Lightbox and watching films on evening, something I would
ble feelings again — the aching isolation, my own. I miss performing. have never done before. It
the confusion, the yearning. Another rea- helps me forget about what life
son this pandemic is hitting me so hard: Now, I walk — 12 kilometres used to be like — full of energy
We’ve been trying for years for a baby. every day. It’s what I did before, and possibility. —Elaine, 65
I’ve had a couple of pregnancies that but I was always walking to
didn’t hold, and finally my doctor discov- places. Now I just walk.
ered I have uterine polyps that need to
be removed. But my appointments keep ‘I WASN’T GOING TO GET THROUGH THIS
getting rescheduled because it’s consid- WITHOUT SOME HELP’
ered an elective surgery. There’s also a
requirement to quarantine for 15 days be- ց When the lockdown hit, my workplace I had seen a therapist in my twenties
forehand, even from my husband. Who closed. My husband does Internet repair for depression. That felt more traumat-
has that kind of space in their home? At for a telecom company, so he was still ic, while this felt more like an insidious
37, I feel like time is running out. very much in contact with people. We thing, that I would wake up in six months
just couldn’t imagine taking care of our and be in a real health crisis if I didn’t do
And so, I’ve decided to return to Ar- kids if we both got sick. We decided the anything about it. I started seeing some-
gentina for a few weeks to have the pro- best way to keep our family safe was one every few weeks — it was good to
cedure done. There, it’s day surgery. And for me and the kids to move in with my reset and find strategies to get out of
it’s easy to get tested for COVID-19 if you parents. Looking back, I’m not sure how it. She suggested medication would be
have money. It doesn’t feel great, taking we survived that. It’s hard to remember helpful, and I’m still considering it.
advantage of their two-tier system, but now why we were separated, because
it means I get to see my family. the numbers were low at that time. We I found a groove and stopped thera-
decided we would reconnect in late May. py in the fall. But I just made another
Some days I feel we won’t be able to appointment. I broke my foot, and the
recover from the damage of this. Hope- By the summer, everything felt hard. I recovery is slow. I use exercise to stabi-
fully people will feel more empathy. usually have nonstop energy — if I don’t lize myself — getting outdoors, taking
—Cecilia, 37 have anything planned for an evening, I’ll a walk at lunch — and I haven’t been
bake cookies or something. I just wasn’t able to do that. Working from home, it’s
doing that. The weather was glorious, hard to separate the mom from the other
and instead of going for a run after put- person I am.
ting the kids to bed, I’d just put on Netf-
lix. That raised warning flags for me — I I have such mixed feelings about
felt like I wasn’t going to get through this a winter in lockdown. I’m looking for-
without some help. ward to when everybody’s vaccinated.
—Valérie,* 37

*Names have been changed to protect privacy. 71

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֑

PHOTOGRAPH COURTESY OF AROUNNA KHOUNNORAJ/BOOKHOU

72 FEBRUARY/MARCH 2021