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MEDICINE : IN PRACTICE

Midlife need not be a crisis

As Gladys, who returned to college while in her 50s, proves, maturing age can be a time to reevaluate and change courses.

May 16, 2011|Yolanda Reid Chassiakos

"Fish out of water," Gladys said with pride as she took a seat in my office. "That's me."

No question, this full-figured, conservatively dressed woman in her 50s with salt-and-pepper hair was far different from most of her young and trendy screenwriting program classmates. Her past year had been a rough one: The unwelcome dissolution of her marriage of two decades and the departure of her adult children for higher education and work had fully emptied her nest. For the first time in more than 20 years, Gladys had no one to care for but herself.

And, despite appreciating that her odds of success in youth-focused Hollywood were long, Gladys decided to leave her career as a teacher and return to graduate school to get a degree in film.

Gladys' migraines had worsened in recent weeks, and the pre-headache auras she was experiencing frightened her -- some of the symptoms resembled mini-strokes. Gladys' mother, a heavy smoker, had had a fatal heart attack in her 60s, and though Gladys had quit smoking in her 30s, she was worried that she would tread down the same cardiovascular path.

For The Record
Los Angeles Times Friday, May 20, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 43 words Type of Material: Correction
Midlife crises: A doctor's essay in the May 16 Health section on the challenges people face in midlife referred to Judith Viorst, author of the book "Necessary Losses," as Miss Manners. The Miss Manners books and advice column are written by Judith Martin.
For The Record
Los Angeles Times Monday, May 23, 2011 Home Edition Health & Wellness Part E Page 4 Features Desk 1 inches; 43 words Type of Material: Correction
Midlife crises: A doctor's essay in the May 16 Health section on the challenges people face in midlife referred to Judith Viorst, author of the book "Necessary Losses," as Miss Manners. The Miss Manners books and advice column are written by Judith Martin.

We started her visit by acknowledging the vast changes and new challenges she was facing, and the high levels of stress to be expected. We also needed to ensure that there wasn't an organic problem that was undermining Gladys' health.

Gladys took a daily vitamin and some over-the-counter antihistamines, but she was not on any prescription medications. Her physical examination, neurologic examination, blood pressure, EKG, blood count, lipid panel and thyroid screens were normal.

She had already gone through menopause and had opted to forgo hormone support during the peri- and post-menopausal transition; her gynecologic exam was also normal for her age.

She did screen positive for symptoms of depression, including decreased appetite, sleep disturbances, fatigue, feelings of sadness and guilt, increased irritability, a sense of failure, and pessimism about the future.

Fortunately, unlike up to 11% of her undergraduate and graduate peers, surveyed by the National College Health Assessment in 2009, Gladys had not considered suicide.

We've labeled the earth-shaking shifts of middle age as a "midlife crisis." The media have promoted stereotypes of men buying flashy sports cars complete with trophy girlfriends and of women jetting off for passionate romance on Mediterranean isles, all guided by the cliched phrase often seen on inspirational coffee mugs and azure posters of soaring seagulls: "Today is the first day of the rest of your life." Having reached the midpoint of our vital journey, we often opt for reboots or course corrections so we can fully enjoy the second half.

But closer examination demonstrates that most folks are not, in fact, dealing with a "midlife" crisis but an "end of life" crisis. Just as Gladys' young classmates often see themselves as immortal (and often take unwise risks), it's in our 40s and 50s that many of us come to finally internalize the idea that life is finite and that death is a reality.

For some, middle age provides the stimulus to pursue unfulfilled dreams. For others, decisions made and actions taken don't reflect "new opportunities" as much as they do desperate "last chances."

The stresses of this phase of life can result in psychological as well as physical symptoms.

To ensure that we weren't missing a hidden brain tumor, I asked Gladys to get an MRI. We were both overjoyed when the results came back clear. I was able to prescribe an effective medication to abort a developing migraine and relieve Gladys' aura symptoms and pain.

At the same time, I referred Gladys to our counseling center for an evaluation for depression and to learn more about options for stress reduction, such as mindfulness and cognitive behavioral therapy. Encouraging her to work with our registered dietitian on an age-appropriate healthy diet and exercise program, and to take advantage of our massage and acupuncture clinics, also helped reduce her symptoms and stress.

Though most of the patients I care for are of traditional college age, our university has a significant group of courageous returning students like Gladys. With counseling and support, and a more balanced lifestyle, Gladys persisted in her academic program, and, in two years, was the gratified owner of both a marketable screenplay and a master of fine arts degree.

Judith (Miss Manners) Viorst's wise book "Necessary Losses" underscores the universal challenges we face as we are forced to accept that we are skiing faster and faster on the downhill slope of life's mountain. Mourning for what is lost, or what cannot be regained, is a stressful process.

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