Leaning to skip and other attempts to address the lifespan/healthspan gap

It  was 10 years ago this month (February 2013) when my eardrum burst. I was 54 years old.  I'd had a cold and my ear began to ache on the way to work and then in the middle of a mid-morning meeting I, and the colleague in my office at the time, heard a loud pop. I held a tissue to my face as a clear, yet sticky liquid, began to run down my cheek on to my neck. An emergency appointment with my GP confirmed what was already obvious and I was sent away with a prescription for antibiotics and a reassurance that it shouldn't interfere with the anaesthetic for the minor operation I was due to have as a day patient a couple of weeks later. The investigative surgery went well and the uterine polyp was benign. I had a sore throat for a day or two but nothing worse.  Recovering from the trauma in my ear took longer as the medication gave me thrush resulting in several trips back to my general practitioner (and I’m left with minor hearing loss on my left side).  My blood pressure was also a concern at this time. First picked up in pre-op at the hospital I was monitored over several months and although the 24 hour blood pressure test averaged out as normal the 'spiking' at various times in the day wasn't considered healthy for a mid-life woman whose father had died at 55 of a heart attack.

I hadn't been to see a GP for years but some post-menopausal spotting five months before my second, more serious, cold of the winter (which led to the small explosion in my ear) seemed to start me on a treadmill of appointments. It didn't stop with the blood pressure. Urine and blood tests highlighted a way above average blood sugar count and the thrush and some recent untried for weight loss were now put down to type 2 diabetes (T2Diabetes).

As a child I was a skinny thing, all legs and sharp bones. But at eight years old following a road accident - my fault, I ran out in front of the car - I stated to get heavier, more solid looking. I'd suffered a head injury (and some other fairly minor cuts and bruises) and I understand now that I may have damaged my pituitary gland; which controls the thyroid and adrenal glands, responsible for our metabolism, stress and growth hormones as well as testosterone, the male sex hormone. Although I’ve never been formally diagnosed I’m fairly sure that I have PCOS (polycystic ovary syndrome) having learnt about the physical symptoms though a couple of research projects (I’m a sociologist and some of my work in on patients’ and healthcare professionals’ experience of medical encounters). Weight struggles, my T2Diabetes diagnosis and a couple of other symptoms – which I won’t share now, but maybe sometime  – all suggesting this. And yet my ‘diabescity’ diagnosis was hard to cope with at first, and still is at times. I like to be ‘in control’, to be organised, to have plans and enact on them; maybe even more so because of the reproductive disruption I’ve experienced and the lack of control I had over the health and illness experience of loved ones (see Reflections of Mother’s Day as a Motherless, Childless Woman | ABCtales for some related discussion). I felt some stigma too. To be fair nobody said anything negative to me but I worried that others might think badly of me, for not controlling my weight, for not eating healthily enough etc. and so on…. So not only did I not want to widely share my diagnosis with many people but I also felt the need to challenge this particular form of biographical disruption, this threat to my self-identity as a healthy person, head on. So I adopted a new regime which included a change of diet – which included eating as little sugar as possible – and a significant increase in exercise.

I began swimming at least three times a week and I also joined the gym at a local hotel; not to use the machines but to take part in spinning (cycle) and strength and cardio based classes. I’ve never been very good at sport. At school I was always amongst the last to be picked for a team and at one memorable sports day I threw the discus at the teachers’ table. But I’ve always swum, slowly and with little technique, but with much enjoyment, so I was happy to pick this up again. I was a little shy during my first visits to the group classes aware of myself, as I was, as an ageing, gendered being amongst the oldest in the female dominated classes (men were more likely to ‘work out’ in the adjacent gym space). But for a couple of years or so I enjoyed myself, becoming a little obsessed with getting stronger and fitter.

For quite a while I was successful. My blood sugar returned to within almost the ‘normal’ range and I lost some weight, even though I was still far from the ‘ideal ‘as directed by BMI guidelines. Asked by a colleague to reflect on my experience of weight loss a couple of years after my diabetes diagnosis I wrote a short article which included some personal details and a short piece of related fiction (Mixed Messages | M/C Journal (media-culture.org.au) By way of an introduction I began with a list of things that had been said to me, or about me (and reported back) following my weight loss and body toning. As you see the messages are mixed and even the compliments feel a tad tainted. Did I really look that bad before?

You look great.

You look amazing.

I didn’t recognise you.

You are looking 10 years younger.

Just how much weight have you lost? It really shows.

Isn’t Gayle looking great?

Have you done it just through diet and exercise [or surgery)?

Have you lost some more since I last saw you?

You don’t want to look scrawny.

You are not planning to lose any more are you?

Have you seen Gayle doesn’t she look drawn?

Of course you are still much heavier than the NHS recommendation.

I’m not of course stating anything new here with reference to gendered, and other, expectations regarding body image and identity, for who amongst us hasn’t at one time or another felt judged as lesser for our presentation of self? I’d be dishonest too if I didn’t admit to enjoying the compliments, but I was left feeling uneasy by them nevertheless. To add to my discomfort, and with reference specifically to my ‘diabescity’, my ‘success’ narrative remained determined by medical definitions and I was permitted only to speak of ‘remission’ rather than reversal or cure.

I can pinpoint when things began to change, when my motivation slipped. Late summer 2017 I started going to fewer classes (although I kept up with the swimming) and this coupled with a little less care about my diet (although I stayed off the sweet stuff) meant I began to put some weight back on (although I was still quite a bit lighter than when I started out). My health suffered and although I still felt ‘well enough’ my blood sugars and blood pressure began to mis-behaviour once more. Time for new medication and consequently new feelings of shame, of frustration at my lack of control.

Moving on a few years and the next big lifestyle disruption – affecting so many more than just me – was prompted by the directive to ‘stay at home to save lives’ as Covid-19 began to impact on all of us. During lockdown I didn’t eat any more but I did quite a bit less, going out hardly at all for at least a couple of months. When I did regularly start to wear outdoor clothes (rather than pjs and comfy round the house wear) again, first to walk, and walk, and walk on my own and then to meet up with my two close friends who made up my support bubble many old favourites didn’t fit. When the walking didn’t help that much my social bubble friends lent me their exercise bike but I found it hard to be interested in this form of exercise at this time. Lockdown(S) over, more swimming and another medication review helped and slowly I began to lose weight again and feel a little fitter. Winter 2021 my friends decided that they too needed to use the exercise bike so bought me a new one as part of my Christmas present so as not to deprive me of the fun!

Then came another change. A friend started visiting a personal trainer and suggested that I might like to too. She knew I’d enjoyed classes in the past and also that I was reluctant to return to a shared exercise space mostly populated by much younger and fitter individuals. I prevaricated for a while but eventually wrote an email and booked a time for a first visit. That was in August 2022. I enjoyed the session and soon began to look forward to my weekly sessions, more and more. It’s different from my earlier experience with strength and cardio exercises, not least because it’s usually just me and the PT in the studio. About three weeks in I was asked to put a large Pilates ball between my feet and lift my legs. Not only could I not do this at all, I could hardly lift my feet off the floor without the ball between them. Personal exercise obsession kicking in once more I practiced this and other exercises at home (the new exercise bike that I sat on about six times in total between January and September 2022 I now use between 10-20 minutes most days). The result? I can now lift my legs, a small (the smaller the more difficult) Pilates ball between my feet, vertically 90% (which might not sound like that much to some but feels like a miracle to me) and I feel fitter and stronger than I have for years. I’m even learning to skip. Not very well, but I get a bit better (with less hesitations and trip-ups) each time I try. This is something I could never do very well before, not even as a child.

My PT is a thinker and the chats we have about our personal lives, our work and our interests (as well as my fitness progression) make the time go all the faster and often give me much food for thought. Our discussion of the difference between lifespan and healthspan being one example. There are differences in definition here. For many healthspan is very crudely (I/we would argue) defined as the number of disease-free years lived. For example:

Having a long life span is indeed the same as having a long life. In other words, the life span is simply how long you live. The definition of healthspan, however, is how many healthy years you live. So, you may have a long life span and live until you are 100 years old, but if you spend 50 of those years being greatly affected by a chronic illness, your health span would only total 50 years.’ Healthspan Vs. Lifespan: What's The Difference? | Genflow (genflowbio.com)

According to this definition my healthspan ship has already long sailed. It is certainly unlikely that I’ll ever be able to reverse the chronic condition(s) I live with. But I feel good and once again people are telling me I look well and asking me if I’ve lost weight (with once again the same ambivalent emotional response in me). So, isn’t it better, as some do (including myself and the person helping me the most just now in my personal health quest) to focus on personal definitions and goals grounded in our own embodied and social, emotional and political identities, rather than narrow medically defined ideals? More to think about here I know…..