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Living With Crohn’s: My Daily Routine

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By Michelle Pickens, as told to Danny Bonvissuto

As early as I can remember, I’ve had issues with my health. When I was little, I had severe constipation, nausea, vomiting, and food sensitivities.

As I got older, those symptoms transitioned into diarrhea, irregular bowel movements, and pain. I was always very fatigued and my immune system was weak: The second someone in my class had the cold or flu, I’d get it, too. Looking back, it was a sign.

From a mental perspective, my anxiety was high. What if I need to find a bathroom? What if I’m nauseous? Doctors would say, “Oh, you’ll grow out of it. It’s just your anxiety.”

Finally, a Diagnosis

After years of misdiagnosis, I was finally diagnosed with Crohn’s disease in 2015. I was 23 and had just finished up college while working full time. My symptoms were getting worse. I had a lot of vomiting and pain. The fatigue was at the point where it was difficult for me to work or even get out of bed some days.

It was so bad it pushed me to seek additional care. I took a couple months off, looked for another job, and went through all the doctor appointments it took to get the diagnosis.

There’s no blood test for Crohn’s. No way to prove what you’re feeling. Eventually I saw the right doctor, who did a test with a pill camera called a small bowel capsule. (This is a pill-sized camera that you swallow, allowing doctors to see inside your digestive system.) It tracked my intestines and was able to get into a blind spot where neither a colonoscopy nor endoscopy can see inflammation. 

It was such a relief to get the diagnosis because it made me feel like I wasn’t crazy. For so many years I knew something was wrong and couldn’t name it. I also felt hopeful. Once I knew what I was dealing with, I knew I could work to get to a better place.

Sharing My Story

In 2016, I started a blog called Crohnically Blonde as an outlet to connect with people as I go through the stages of dealing with Crohn’s. When I first started to share, there weren’t as many people talking about it.

I’ve been able to form relationships in an online community through shared experiences. I hope someone can see my story and feel that, if they’re at the beginning of their journey, there’s a way to get through.

Managing My Medication

At first, I was on a lot of medication that wasn’t working well and was a huge imposition on my schedule. Now I get infusions of an immunosuppressive drug every 7 weeks.

It means being away from my family and job for 4-5 hours, and managing child-care coverage during the treatment and the weekend after, because I feel almost flu-like. The extra help allows me to rest and fuel back up after the treatment.

I have the option to be on more medications to control my symptoms. But I try to shy away from those and manage it on my own because I don’t want to be on medicine for every single thing.

Before I had my son, I was more willing to try different medications. But while I was pregnant, I could barely be on any of the Crohn’s medicines. After I had him, it didn’t make sense to be reliant on them.

Crohn’s, Pregnancy, and Motherhood

Crohn’s affected me throughout my pregnancy. I got very sick in my third trimester because I went off my immunosuppressive drug to avoid passing any on to the baby. I ended up having to be induced early so I could get back on the medication as soon as possible.

My son, Maddox, is 1 now. Crohn’s changed my expectation of what I thought motherhood would be.

I’ve learned that I’d rather be present and able to enjoy him in the good moments than push it when I’m sick. It’s been difficult. But if I’m not well, I can’t be there for my child. I try to be with him as much as I can, but there are times when I need to step back and take an hourlong nap.

I have a great support system: My husband, mom, or mother-in-law can step in and help out for a little while, and when I feel better, I can be a better mom. There are also days when I don’t have accessible help. In those situations, I’ll do lower-key activities that I can enjoy with him but that aren’t physically demanding on me.

Schedule and Adjust

Right now I’m in a pretty good spot. I work from home now, as a recruiter for a tech company, and that makes a huge difference. A lot of my anxiety in the past was around being in an office and being sick. Now that I can work remotely, it’s such a game changer.

But Crohn’s still affects my day-to-day. I have days where I’m feeling sick, and need to rest and change my plans so I’m home and not out somewhere.

No matter how planned-out I have my day or week, if I’m not feeling well that takes precedence. I like to be a very scheduled person. But I have to roll with the punches and have a plan B.

The biggest challenge is managing my sleep and stress. They’re both very influential in symptom flare-ups. I have to get at least 8 hours of sleep, no matter what. And I try to incorporate time to de-stress, like reading a book or relaxing at the end of the day.

Going to therapy helps offset stress as well, and is now part of my ingrained self-care schedule.

Social Life Strategies

My co-workers, family, and friends are very understanding. But that wasn’t the case at first. The more open I’ve been about Crohn’s, the more people understand that I’m not flaking out if I have to change plans; there’s an underlying reason.

I only have a certain amount of energy, so now I pick and choose. I know I need to work and be with my family, which means I have less energy to put into social situations.

I plan out what I’m comfortable doing, but have also become comfortable with changing plans. Even if I’m excited to go out to dinner with a friend, I don’t push it if I feel terrible that day.

Food in Flux

I’ve followed a gluten-free diet for years. I started with an elimination diet and realized that gluten was bothering me.

Other foods aren’t as black and white. I can eat a salad one day and it’s fine, and eat the same salad the next day and it makes me sick. I repeat the safe foods that don’t make me sick and stick to a general schedule of three meals a day that are pretty much all gluten free.

Sometimes the timing matters: I’ll wake up and feel nauseated and need a starchy food like dry cereal. If I’m going on a road trip, or have a big event, like a wedding, I plan it out and try to be careful about what I eat leading up to it because I don’t want to be sick. But it’s hard because you never really know. It’s kind of a gamble.

Flexibility Is Key

I’ve learned to be as flexible as possible. I never know what each day is going to bring, I just have to trust that my body is telling what it needs for that specific day. That’s my priority, and everything else can wait.

 



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The Future of Men’s Mental Health

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Part 3—Gender-Specific Healing and Man Therapy

            In Part 1, I addressed the questions, “Men and Mental Health, What Are We Missing?” Part 2 focused on the way that “Mental Health Crises Are Putting Everyone at Risk.” In Part 3, I will explore my own journey addressing issues that address the unique issues faced by men and how the emerging field of Gender-Specific Healing and Men’s Health is a key to the future of health care.

            I have become an expert in the field of Gender-Specific Healing and Men’s Mental Health due, in no small part, to the fact that my interest began more than 80 years ago. Prior to my much-anticipated birth, my parents were convinced that I would be a girl and had girl’s names picked out as well as an assortment of cuddly girls dolls that were popular in 1943, the year I was born. It took my parents several days to accept the reality of my little penis and to agree on a name for their new baby boy.

            At age three I announced that I no longer wanted to wear my white “baby shoes” and announced I wanted a change. My mother took me to the shoe store for my first pair of “big-boy shoes”. After perusing the store I found my shoes and jumped for joy when my eyes landed on a pair of red Keds. The salesman measured my feet and returned with a box which he opened carefully and good out a beautiful pair of blue shoes. I was crestfallen and didn’t understand the logic of his cheerful explanation. “Blue is for boys,” he told us smiling at my mother. “Red is for girls and we wouldn’t want our little man to get off on the wrong foot…chuckle, chuckle.”

            Bless her heart, my mother was not amused and told the clerk in no uncertain terms to give her son what he asked for and I danced out of the store wearing my beautiful red Keds. I reasoned since I was a boy and I liked the color red, then red was obviously a boy’s color.

            When I grew up and got married and our son, Jemal, was born on November 21, 1969 and our daughter, Angela, on March 22, 1972, my wife and I promised that we wouldn’t try to push our children into societal pigeon holes or gender-restricting boxes of what boys and girls must do and be. Yet, like most parents, it soon became apparent that each of our children were unique and different and that there were clearly some differences that seemed sex-specific beyond the obvious reality of a penis being part of Jemal’s anatomy and a vagina part of Angela’s body.

            After receiving a Master of Social Work degree (and later a PhD in International Health), I began specializing in work with men and their families. My first book, Inside Out: Becoming My Own Man was published in 1983, followed by Looking for Love in All the Wrong Places, and The Warrior’s Journey Home: Healing Men, Healing the Planet.

            My work gained international success with the publication of Male Menopause in 1997. After working with many mid-life men and their wives, it became clear to me that men also went through a biologically based “change of life” that had many similarities and differences from what women experienced. The book was translated into fourteen foreign languages and I spent the next seven years speaking around the world and offering trainings for professional working with issues of midlife and aging.

            In 2002, I met Marianne Legato, M.D., following the publication of her book, Eve’s Rib: The New Science of Gender-Specific Medicine and How It Can Save Your Life.

“Until now, we’ve acted as though men and women were essentially identical except for the differences in their reproductive function,”

said Dr. Legato.

“In fact, information we’ve been gathering over the past ten years tells us that this is anything but true, and that everywhere we look, the two sexes are startingly and unexpectedly different not only in their normal function but in the ways they experience illness.”

            The need for gender-specific health care is gaining increased support. According to David C. Page, M.D., professor of biology at the Massachusetts Institute of Technology (MIT),

“There are 10 trillion cells in the human body and every one of them is sex specific. We’ve had a unisex vision of the human genome, but men and women are not equal in our genome and men and women are not equal in the face of disease.”

            Dr. Page summarizes the importance of his research.

“We need to build a better tool kit for researchers that is XX and XY informed rather than our current gender-neutral stance.  We need a tool kit that recognizes the fundamental difference on a cellular, organ, system, and person level between XY and XX.  I believe that if we do this, we will arrive at a fundamentally new paradigm for understanding and treating human disease.”

Man Therapy: The Future of Gender-Specific Health Care for Men

            Although the research on gender-specific medicine was intended to be for men as well as women, Dr. Legato acknowledges that men’s health has been neglected. In a recent interview she told me that gender-specific medicine is not just about women’s health, but about the health of both sexes, the funding for our initial research came from companies that were focused on new health products and services for women.

            In an article, “Healer, Heal Thyself,”  Dr. Legato told me candidly,

“My physician father illustrated many of the biological and societal hazards of being male. My mother outlived him by a decade, mourning his absence every day. The premature death of men is the most important—and neglected—health issue of our time.”

            I first heard about the work of Man Therapy when I met its founder and creator, Joe Conrad in November 2021. I was impressed with the creative ways that Man Therapy addressed serious issues like male-type depression and suicide prevention. I invited Joe to join a new venture I called our Moonshot for Mankind and Humanity. Joe’s team helped us create a website and introductory video.

            The purpose of the Moonshot for Mankind is to bring together organizations and individuals who are doing positive and important work to help improve men’s mental, emotional, and relational health. Man Therapy is one of the best I’ve seen since it has been proven to be effective in preventing suicide and engaging men in improving their lives.

            “What began as a suicide prevention campaign has morphed into a men’s mental health campaign where the goal is to support all men before they are ever in crisis,” says Conrad. “We remind men that taking care of their mental health is the manliest things a man can do, that therapy comes in many forms and connect men and their loved ones to information, tools and resources. Our goals remain to bust through the stigma, increase help-seeking behavior and reduce suicide among working-age men.”

            In 2022, I interviewed Joe Conrad and wrote an article, “Man Therapy: Why Gender-Specific Health Care is Good for Men, Women, and The  World.”  Joe told me,

“Man Therapy was launched in 2010 and has had more than 1.5 million visits to the site. Visitors have completed 400,000 ‘head inspections’ and there have been 40,000 clicks to the crisis line.”

            That was impressive enough, but I also learned that the program had been evaluated by the Centers for Disease Control and Prevention (CDC). The study shows that men who access Man Therapy, as a digital mental health intervention, experience a decrease in depression and suicidal ideation, a reduction in poor mental health days, and an increase in help-seeking behavior. Additionally, the study shows that men in the Man Therapy control group reported statistically significant improved rates of engaging in formal help-seeking behaviors through tools like online treatment locator systems, making or attending a mental health treatment appointment, or attending a professionally led support group.

The Man Therapy Community and Provider Directory: You Can Join Now

            When I began working in the field of gender-specific healing and men’s health there was a huge need for services, but very few practitioners focused on the unique health issues facing men. The need continues to increase, but now there are many more health care providers. For the first time, Man Therapy is creating a Man Therapist’s Directory.

            Joe Conrad says,

“The Man Therapy team is excited to announce that their very own Man Therapist Provider Directory is officially live. Knowing that men face unique mental health challenges, our aim in building this tool is to create a first-of-its-kind network of therapists and providers that are uniquely qualified and passionate about working with men.”

            He goes on to say,

“By joining our Provider Directory, you can leverage Man Therapy’s thousands of unique site visits every day to promote your services directly to men who are actively seeking help. This listing includes your headshot or logo, a brief description of your services, and a link directly to your personal website for more information about working with you.”

            I was excited to join and I immediately signed up. You can see my listing here. Joe’s long-term goal, which I am excited to support, is to make Man Therapy the world’s leading mental health brand. If you are a mental health professional or know someone who is, you may want to learn more about Man Therapy.

            “Man Therapy formally invites you to be among the first to join our growing network,”

says Joe Conrad.

“Please click this link and follow the instructions for submitting your application. Once you get to the payment section, insert this discount code – mtlaunch50 – to receive 50% off an annual membership to our network as a thank you for all you do to support men.”

            This is a wonderful opportunity to get in on the ground floor and join this community of healers and those seeking to improve their own health. Stay tuned for more articles that will explore additional issues about the importance of men’s mental health. If you are not already receiving my free weekly newsletter you can sign up here.



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What’s Behind Major Rise in Heart Failure Deaths?

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May 3, 2024 — Americans are dying of heart failure today at a higher rate than they did in 1999, reversing years of progress in reducing the death rate. 

That is the stark message of a new JAMA Cardiology study, which finds that the current mortality rate from heart failure is 3% higher than it was 25 years ago. Based on data from death certificates, the study says, the mortality rate fell significantly from 1999 to 2009, then plateaued for a few years before sharply increasing from 2012 to 2019. During the pandemic years of 2020 and 2021, the latest year for which data is available, heart failure deaths accelerated.

“These data are striking,” said Veronique Roger, MD, MPH, chief of the epidemiology and community health branch of the National Heart, Lung, and Blood Institute. “They really constitute an urgent call for action to reverse this trend.”

Roger, who was not involved in the study, noted that during the 2000s, the mortality rate from cardiovascular disease declined and that now it has leveled off, largely because of the burst in deaths attributed to heart failure. “This paper shows that not only are we are not making progress, but our gains are being eroded. So it’s a major deal.”

According to the National Institutes of Health, about 6.7 million Americans have heart failure today. That’s just a snapshot in time, of course: About 1 in 4 Americans will develop heart failure during their lifetimes, the NIH said. About half of those with the condition die within 5 years after diagnosis.

People who are 65 or older have a far greater chance of dying of heart failure than younger people do. However, the relative increase in the death rate was most marked among younger Americans, according to the study. Among people younger than 45, there was a ninefold rise in heart failure deaths from 2012 to 2021, and there was almost a fourfold increase among people aged 45-64.

Comorbidities Lead to Heart Failure

In the view of study co-author Marat Fudim, MD, an associate professor of cardiology at Duke University in Durham, NC, the increase in heart failure deaths among younger people is probably related to the fact that obesity and diabetes have become more prevalent among young adults. It’s not surprising, he said, that an increasing number of people with these disorders develop heart failure in middle age.

Otherwise, he said, “the reversal of [heart failure mortality] trends seems to have hit men and women and the different races in a very similar fashion. It didn’t discriminate in that or in rural versus urban residents. While there were stark differences between racial groups and between rural and urban in heart failure mortality rates, the reversal trend is very similar among all these groups.” 

“What we see in practices is that comorbidities drive heart failure,” said Fudim, whose own cardiology practice specializes in this condition. “Heart failure is rarely a single disease problem. Usually, heart failure patients have obesity, diabetes, cardiac artery disease, hyperlipidemia — all these diseases are driving heart failure, which leads to mortality.”

The increase in heart failure mortality predated the COVID-19 pandemic, but COVID accelerated the increase in deaths from this condition. From 2012 to 2019, the average annual percentage change in mortality was 1.82%; during 2020 and 2021, it was 7.06%.

Fudim said there were two reasons for this. First, patients who were hospitalized for a COVID-related pneumonia had a roughly 20% higher chance of developing heart failure than did other people, after adjusting for their health status. In addition, COVID worsened health disparities related to race and income level, and it made the health system focus on COVID-related care rather than on heart failure prevention or management.

Factors in Mortality Rate Increase

A co-author of an earlier paper that showed an increase in the rate of heart failure deaths agreed that COVID was “like throwing fuel on the fire” of heart failure mortality. 

Sadiya S. Khan, MD, the Magerstadt Professor of Cardiovascular Epidemiology at the Feinberg School of Medicine at Northwestern University in Chicago, also agreed that the increase in the number of middle-aged people dying of this condition is probably related to comorbidities they developed earlier in life. Khan added kidney disease to the list of potential disorders related to death from heart failure. And, she said, she is also seeing earlier onset of heart failure. 

Khan’s research group published a paper showing that the mortality rate for heart disease from hardening of the arteries — known as ischemic heart disease, which often leads to heart attacks — declined even as the heart failure death rate rose. She attributes this mainly to there being better treatments for the underlying heart disease.

“For ischemic heart disease, there has been a lot of progress in effective therapies, particularly related to stenting and effective lipid-lowering therapies with statins and some new therapies. We haven’t seen the same progress for heart failure.”

Another factor that might have contributed to the increased mortality rate is the prevalence of heart failure. If more people develop heart failure, more of them will die of it. On the other hand, said Roger and Fudim, a higher death rate might result from patients with heart failure being sicker than they used to be, even without increased prevalence. Fudim said the data show the heart failure rate is fairly flat but gradually ticking up. 

Where Did We Go Wrong?

Khan’s 2019 study suggested that the earlier decline in cardiovascular disease deaths reflected the success of policies aimed at increasing control of blood pressure and cholesterol, along with higher rates of people quitting smoking and effective medication use. 

“However, the prevalence of obesity and diabetes has increased dramatically, the decline in overall CVD death rates has stalled, and heart failure-related CVD mortality rates are rising,” the paper said.

If so many of the right things were being done, why did the heart failure mortality trend reverse?

Roger doesn’t blame doctors, who continue to do the right things, in her view.

“What we haven’t done right is our failure to control obesity and diabetes. Diabetes travels with obesity, so if we focus solely on obesity, the choices that you and I and everyone make when we eat are not in the doctor’s office,” Roger said. 

“I think we’ve done the best we could with the things that are within our control,” she said. “But that’s offset by the trends in obesity, which are related to the consumption of ultra-processed foods, sugar-sweetened beverages, and so on.”

Fudim, in contrast, believes the health system is at least partly to blame for the reversal of the heart failure mortality trend. Partly because of the shortages in primary care, he said, access to care is limited in many areas, prevention and chronic care are being under-emphasized, and some heart failure patients are not getting the care they need.

Roger agreed. She cited the substantially higher heart failure death rate among Black people as evidence that “difficulties in accessing the health care system and the quality of health care both play a role.”

On the other hand, she said, health systems have placed a priority on improving the care of heart failure patients, partly because of Medicare incentives. The increase in the rate of heart failure deaths, despite all of these efforts, she said, should be “an urgent wake-up call. There are new avenues of research, prevention, and clinical practice that should be synergized to address or mitigate this trend because we can’t let it go on like this.”



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A 'Phenomenal' Garmin Smartwatch With a 'Fantastic Battery Life' Is Now $100 Off for a Limited Time

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Men’s Journal aims to feature only the best products and services.  If you buy something via one of our links, we may earn a commission.

REI has been host to hundreds of great deals on outdoor and camping gear over the last month, with markdowns of up to 60% off some of the best hiking shoes, tents, and e-bikes for spring and summer. At the same time, the retailer has had a trove of running equipment on sale, including bestselling shoes, lightweight shorts, and now a top-rated Garmin smartwatch with a battery life that rivals the best in the industry.

The Garmin Forerunner 255 is on sale at REI for $250 right now—a 28% discount on the normal $350 cost, which matches the list price on Amazon. This versatile smartwatch is a top-10 bestselling GPS sports watch at REI after earning over 200 five-star ratings from shoppers who say it’s a “phenomenal running watch with great features.” It’s currently on sale in dark gray and medium blue until Father’s Day, but it’s not guaranteed to stay in stock.

Garmin Forerunner 255 in Slate Gray, $250 (was $350) at REI

Courtesy of REI

Get It

This Garmin smartwatch was built for runners. It does all the basics, including counting steps, tracking heart rate, and acting as an extension of your smartphone, but it also has special features that were intended to make training for marathons more comprehensive. It has widgets that allow you to fully customize a training program that’ll get you up to speed for race day with the accuracy of Garmin’s GPS systems for precise tracking. Based on what it sees in your performance, it’ll even offer suggestions and help devise custom workouts to keep you on track to nail your next PR. And, to top it all off, it tells the time.

There are so many features crammed into this little smartwatch, but what makes the biggest impact, according to shoppers, is the battery life. “I thought [my watch] was joking when it said 11 days,” a shopper exclaimed. “Even with 60-plus-mile bike rides and 10-plus-mile runs, nine days of battery life is pretty legit. I also enjoy the ‘Morning Report’ I get every day as well as the accuracy of the GPS. I could go on about the activity options, as there are many. Let’s just keep it as the best watch I have purchased.”

Garmin Forerunner 255 in Tidal Blue, $250 (was $350) at REI

Courtesy of REI

Get It

Some who have bought this Garmin smartwatch have compared it to their Apple Watches, and many seem to prefer the former. “I want to say I ‘downgraded’ from the Apple Watch but, to be honest, this isn’t a downgrade at all,” a shopper said. “Fantastic battery life, very easy to start an activity, and great daily reminders and encouragement. I love that it syncs to my Edge 1030 for cycling and HR.”

The Garmin Forerunner 255 is already a popular smartwatch pick that’s just going to garner more attention now that it’s $100 off. If you’ve been thinking about adding one to your routine, make sure to pick it up soon before it goes back up in price. 



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