Learn About ACEs and Create a Healthier Future

This post is made possible with support from the American Academy of Pediatrics through a cooperative agreement with the Centers for Disease Control and Prevention. All opinions are my own.

In 2019, I read more than 1,500 articles about social work in my role as the editor of a nonprofit social work membership organization’s newsletter.

Here’s something that is emerging as a common thread more and more often as I choose stories each day: Adverse Childhood Experiences (ACEs for short). 

Each time I’ve read that acronym, it has registered in my brain in a “yes, that makes sense” kind of way, partially because my undergraduate degree is in child development and my graduate degree is in counseling. But college was a long time ago, and the amount of research on the topic has expanded a great deal. It’s time to learn more about the details behind the acronym. I hope you’ll join me. It’s something we all need to know.

What is an ACE?

ACEs happen to children between birth and age 17. These potentially traumatic occurrences include things such as experiencing abuse or violence; witnessing violence in the community or at home; and the death by suicide (or attempt) of a family member.

Environmental factors can also play a part in ACEs. The presence of a family member with mental health problems, substance abuse, or the type of instability that comes from having a parent incarcerated or a divorce or separation.

The long-term effects of ACEs sometimes don’t show up until years later. Adults who experienced ACEs as children have been shown to have higher rates of smoking, heart disease, death by suicide, and depression among other health issues. 

This article explains more about ACEs and how they can show up in adulthood. 

ACEs are not destiny, and we can be the ones to change things

All of us can help prevent ACEs and lead children toward a healthier adulthood. Preventing ACEs makes a huge difference. Intervening in situations causing ACEs can reduce the number of adults with depression by 44%.

Our involvement — by providing safe, stable and nurturing relationships and environments in childhood — can have so many beneficial long-term effects, such as more robust brain architecture and more consistent employment. 

That safety and stability can provide a sort of “reset” and keep the body’s stress system from succumbing to the health and behavior compromises that result from ACEs.

Learn About ACEs and Create a Healthier Future

The way women in prison have challenged my thinking

As I’ve been writing this post, I haven’t been able to stop thinking about the women I have met through my volunteer work at a prison. I think of them for two reasons. One is the way they talk about the direction their lives have taken and the experiences of their childhoods. Obviously, every story is different, and some people end up incarcerated who experienced no ACEs. 

Research, though, points to the disproportionate amount of ACEs experienced by incarcerated people in childhood. If those ACEs could be reduced, the outcome could be less crime and reduced spending on correctional facilities.

More than talking about themselves and their lives before prison, the absolute first thing every one of them who is a mother discusses is her children. They look forward to making their children’s upcoming visits meaningful; they think — hard — about how the networks of support back at home are helping their children navigate life. They want safety, stability and nurturing for their kids.

It takes reinforcements to provide safe, stable and nurturing environments

If there are children in your life, you can be a part of creating safety and stability while providing a nurturing environment. The way that plays out may be different if, unlike me, you still have children at home, but there are ways each one of us can make a difference for kids in our homes, in our lives, or both.

As I’ve learned more about ACEs, I’ve been thinking about three people who have helped strengthen me emotionally so I can be in a position to help lessen the chances that ACEs will occur for kids I know and love.

  1. Melanie. My therapist, Melanie Pelc of The Living Room, has made a difference for me. Before starting a more formal relationship, she was the social worker for our family when my father-in-law was in hospice. It helped to start our relationship at a place beyond “square one,” since she already knew a good bit about our family dynamics. Also, she comes to my house, which is *huge* because it makes it that much harder to back out of an appointment.        
  2. Sandy. My friend, Sandy P., would make the list anyway, but there’s a particular reason I think of her. We got to know each other through the running community. Although I’m not running anymore, she still makes a huge effort to stay in touch. The most important element that puts her on the list is that she organized volunteer opportunities for us after Hurricane Michael. Even though we like purely social occasions, something was different about volunteering together.
  3. Barb. My mother-in-law, Barb, passed away in 2013, but she was the type of person we all need in our lives. I remember my sister-in-law saying, “you can tell her anything, and she won’t look down on you for it but she’ll help you get perspective.” This is a bit of a paraphrase, not a direct quote, but it captures her spirit. She went through some excruciating trials (such as becoming blind in mid-life) that could have made her bitter or resigned, but she did quite the opposite. 

What are your three sources of support?

What are the three people or resources that will help you create safe, stable and nurturing relationships in your world? I’d love to hear about them in the comments! Or better yet, tweet them to social media with the hashtag #FindYour3.

My boring colonoscopy

With the exception of a bit of diverticulosis, there was absolutely nothing out of the ordinary about my Nov. 22 colonoscopy.

That’s why I want to share about my experience with the prep and the procedure itself (that part will be extremely brief (thank you, fentanyl and midazolam!)). One in every 20 people will be diagnosed with colon cancer at some point. I figure that would be totally out of the ordinary in every way — uncomfortable, expensive, frustrating and worrisome not to mention possibly fatal — that if I can reassure you regarding the colonoscopy process, I can help you avoid being among the 1 in 20 (or at least catch it early enough to have a better outcome).

I agreed to have a colonoscopy in alignment with the CDC recommendations that people ages 50-75 be screened for colorectal cancer and continue every 10 years after their first.

The prep

It’s absolutely true what they say – the prep is worse than the procedure. There are dietary restrictions for seven days prior to the procedure, as well as the need to adhere to a clear liquid diet the day before.

Here’s what happens when you give a grammar-lover unclear instructions.

My boring colonoscopy

I have to admit I was prepared to avoid seeds and nuts. I did not know about fruits and vegetables. Furthermore, does this mean no raw fruit and no raw vegetables, or does it mean “no vegetables” at all?

I read some other colonoscopy prep diets, which were all stricter than this one, so I decided it meant no raw vegetables. (I know I could have called to clarify — I guess I decided to live dangerously.)

I must have done OK, because my results said, “The quality of the bowel preparation was excellent.” Hooray.

via GIPHY

Seeing red

Another thing about the prep period is that you can’t have anything to drink that has red or purple dye.

I wasn’t thinking about that part (hadn’t read it, I don’t think), when I grabbed the bottle of magnesium citrate required as part of the day-prior preparation. Given a choice of “lemon” (clear), and “cherry” (red), I chose my favorite color and flavor. THEN I really reviewed the instructions. It was less than $2, but it’s the principle of the thing! If anyone needs some cherry-flavored magnesium citrate, it’s yours!

Chugging (and chugging and chugging) a gallon of prep drink

Starting at 6 p.m. the night before your colonoscopy (and two hours after drinking the non-red magnesium citrate), there’s the matter of drinking a gallon of GaviLyte-N. The instructions are to drink an 8-oz glass every 15 minutes — downing 2 quarts the night prior to the procedure and 2 more quarts the next day 6 hours before your exam.

My boring colonoscopy

I have to admit, I was down to the wire to finish this the morning of my procedure. The taste wasn’t unmanageable, but neither was it delightful to stuff my otherwise-empty stomach with two gallons of liquid at 5 a.m. I almost gagged getting the last down in time for the cut-off, but I did!

A friend of mine was given pills instead of gallons of solution for her prep, and I think that is worth exploring in the future.

Calories matter the day prior to the procedure

I did not plan nearly well enough to get enough calories during the “clear liquids” day. I had a full day of editing, which in a perfect world involves keeping your brain fueled well enough to put complete sentences together. I had consumed the Gatorades I had bought by around 1 p.m. I had to forgo the chicken broth I had bought because it turned out not to be fat-free. I went through plenty of other things, all zero-calories, and practically pounced on my husband when he arrived home with the calories I had requested (I couldn’t run out to the store because ^^^^ see above re: the gallon of laxative I had just consumed).

Take my advice: Stock up on caloric drinks and fat-free broths for the day prior to your procedure. Then you’ll be able to continue using subjects and verbs effortlessly.

The day of the procedure

There’s nothing remarkable to say about the day of the procedure. I didn’t take many pictures, mainly because I handed my phone over to my husband before getting onto the bed. I did capture this lovely wardrobe item (and I love the saying “you deserve the best”). The nonslip socks were pretty great too.

My boring colonoscopy

There was a funny moment when I approached the bed. It was set REALLY HIGH. It took a few gymnastics to get onto it. The nurse showed up and asked how I got there. I explained that I just figured it out and she said she could have lowered it. Well … yeah…

I did have a brief conversation with the physician, but after that discussion, the nurse upped the sleepytime meds and the next thing I know I was leaving with my husband. Apparently they explained everything to me four times.

I also had to ask Wayne later that night if I had indeed bought grapes when we went to Publix afterward.

Moral of the story: They’re not kidding when they require you to have a driver. Not at all!

The results

My results were pretty unremarkable. As I mentioned, I have some “diverticulosis in the sigmoid colon” but I don’t need to go back for this procedure for 10 (count ’em 10!) years.

Why it matters

Yes, it was inconvenient to do the food/liquid prep. No, I didn’t enjoy the trips to the bathroom that resulted from the prep. No, I don’t remember anything about the procedure itself.

What I do know is that a friend of Wayne’s and mine did not come out of her experience with such a nondescript story. Her colonoscopy resulted in a diagnosis of colon cancer, so she now has to deal with treatment protocols and uncertainty. Another friend had colon cancer in his early 40s. I imagine we all know about Katie Couric losing her first husband to colon cancer. She even went with Jimmy Kimmel for his first colonoscopy!

I doubt Katie Couric will show up at any of our colonoscopies, but I’ll be happy to send you a paper umbrella for your prep (as seen in the video) because this process should be as fun as possible.

I also want you around.

My boring colonoscopy

I’m linking up with Kat Bouska’s blog. The prompt is, “Tell us about something you’re procrastinating on.” I should have gotten my colonoscopy done five years ago when I was 50 — I wasn’t really procrastinating because of anxiety — I just let other things get in the way. Take it from me — there’s really not that much to say about it (unless you’re a blogger trying to make a point).

REACH (FMF31 2019 Day 13)

I am participating in 31 Days of Five Minute Free Writes 2019 (all of my submissions can be found here).

Today’s prompt is: REACH

What started as a tiny pain in my shoulder (I thought I had slept wrong) in February 2019 grew over a period of months to something much more painful and disturbing.

My range of motion became more and more restricted. I couldn’t reach a high shelf in the kitchen (or anything that involved something high above me). My whole arm hurt. My hand got numb. It got bad enough that I called the doctor (which says a lot!). I’m not doctor-averse, but I tend to shy away from taking the time. (I was also overdue for some basic physical-type stuff anyway.

Frozen Shoulder
Here’s an example of something I certainly couldn’t do when my frozen shoulder was at its worst. That and tying a bow behind my dress, turning my head to look behind me as backing up my car and anything that involved reaching high.

In the midst of all this, I ended up having this painful-yet-funny situation that I shared on Facebook.

My doctor’s appointment was on a Monday in July. He ordered an X-ray. I went and got the X-ray that afternoon, then waited for some diagnosis. Backing up, when I arrived at the doctor, all their phone numbers on me were outdated (owing, I guess, to the fact that I had not been in a while). I corrected them so they would have the correct number to get in touch with me.

About a week later, I got snail mail with a letter that said “we can’t reach you — call us.”

Turns out they had been calling the ancient numbers, not my new number.

The nurse read off the X-ray results: “Arthritis and a bone spur.” Well — that didn’t sound good.

Commence the lengthy wait (about a month) to get into the orthopedist. Interestingly enough, Dr. Thompson is the same orthopedist who set Tenley’s foot when she was 3 and broke it jumping off the bed 20 years ago.

**end of five minutes**

He did a few diagnostic activities with me and asked if I had ever heard of “frozen shoulder.”

It’s another name for adhesive capsulitis, and it means the shoulder joint tissues develop tightness and scarring that keeps the shoulder from rotating.

After a month of waiting, having convinced myself of the worst — that I would have to take time off work to have surgery — the solution (they said) was four stretches, twice a day.

Now, I’m a bit of a pessimist about being handed sheets of paper with stretches. It reminded me of the balance exercises we were supposed to do with my father-in-law, also disseminated when a medical professional handed over some sheets of paper and said “do this every day.” (To be fair, I am a bit more compliant as a patient than he was!).

The good news? THE STRETCHES WORK!

The situation isn’t perfect yet, but my range of motion is so much better and the pain has lessened a good bit. I read (and the doctor confirmed) that frozen shoulder does clear up on its own eventually (he also mentioned some people get it in both shoulders at once — I just can’t imagine how those people keep functioning!).

I’m glad I trusted the sheets of paper (and the doctor) this time. I also learned (yet again) a lesson about why catastrophizing without doing extensive research or waiting to hear a specialist’s opinion is so counterproductive.

31 Days of Five-Minute Free Writes

The Surprise of Early Menopause

What are some ways your body has surprised you? An unexpected zit the day you are scheduled to drop significant money on professional headshots? A stomach virus 24 hours before you depart on your anniversary cruise?

My body surprised me with periods that started when I was 9.

The date a woman’s first period started is important to cancer researchers, and I have been involved in the Cancer Prevention Study-3 for almost 15 years.

I signed up for the study (and allowed them to take blood) when I was participating in Relay for Life. As we left the tent where the signup was occurring, we were given postcards to self-address. The postcard reads: “When you enrolled at your local Relay for Life event, you were asked to record the start date of your last menstrual period. Understanding exactly where you were in your menstrual cycle at the time you gave blood is very important. For this reason, we need to know the exact date of your next menstrual period.

The prepaid postcard had a spot where I could record my next period and return to the study organizers.

I placed the card in a cabinet in my bathroom where I kept feminine protection products.

And it sat in that cabinet for approximately 14 years, until I took it out as I prepared to write this blog post.

I never had another period. I was 41.

The Surprise of Early Menopause
There it is, in all its upside down glory. Right behind some cough syrup that expired three years ago, some contraceptives that I clearly didn’t need either and some empty yeast infection treatment boxes. Also, maybe I should dust sometime.

The physical part of early menopause

Because I am 54, I have among my friends circle many women who are experiencing the classic symptoms often associated with menopause. Hot flashes are the most frequent occurrence.

Although I always empathize with my friends whose internal furnaces are on overdrive and who have to change their sheets often because of being so sweaty at night, I can’t personally relate. I never had hot flashes. Then again, I didn’t know I was menopausal.

I was 31 when I had my daughter and 34 when I had my son. Three years later, we began trying to conceive our third, and that didn’t go according to plan. During my third pregnancy, the doctor couldn’t find a heartbeat at around 10 weeks. I remember sitting in the exam room, reading some luxury magazine about travel to Spain, trying to reconcile the rapid change from expectation (literally) to loss.

The next time I got pregnant, it was just as sad but somehow not all that shocking when the doctor couldn’t find a heartbeat at around the 8-week point. It was around this time that the term “old eggs” got thrown into the mix. I insisted on genetic testing for the embryo, which did turn out to have a significant chromosomal defect that most likely caused it to stop developing.

Although we kept trying after that, I never got pregnant again. I made an appointment with my OB/GYN to discuss the situation. I really like this physician (he had been my OB during one of the pregnancies that did not remain viable), but the afternoon fell apart a bit. He was running way behind, and I had to pick up a child at afterschool. I think we may have had five minutes … maybe seven. It was long enough for him to say, “your bloodwork reflects that you’re in perimenopause.” I don’t recall asking if it was possible for me to conceive; my recollection is more that I knew this didn’t bode well (and being me I was freaking out about the $1-per-minute penalty at the afterschool program).

I had possessed a subtle fear of menopause for a long time. As a child, I had been told my mom’s depression was “menopause.” As an adult, I had a wise therapist who pointed out that menopause doesn’t last 10 years.

Although I look back on the time that I now realize I was headed toward early menopause and see some signs (my periods got erratic, I experienced some mood changes), none of it was what I had dreaded.

In addition, it is such a freeing sensation to not have to worry about birth control. No pads or tampons either. There’s one less thing to worry about (and buy).

The emotional part of early menopause

I have several friends who had “surprise babies” in their early 40s. I would be lying to tell you I haven’t struggled with that. Of course I’m happy for them, but it often takes me a few beats mentally to channel my thinking about this, even now. Usually these friends are *shocked* to find themselves pregnant. They have all turned out to be amazing parents to their “surprise babies,” but most of them talked about how this was not at all the plan. The part that is hard to reconcile is that, for us, a third child was in the plan.

The surprising joy of having bandwidth

I am not a fan of the word “bandwidth” in general. I think it is overused these days.

However, it is also exactly what I think of at this stage in my life. After leaving the job I held for almost 20 years, followed by a few rough years of caregiving while also freelancing, I have a job I love along with the mental and actual bandwidth to dig in to it.

I see the parents around me, juggling the heavy demands of raising children, building a career and trying to keep balls in the air, and I remember well the stress of never feeling I was giving any of it enough.

It feels like a luxury to be able to spend an extra few minutes getting a social media image just right for work. I can spend an additional hour on a project that is not strictly required.

I still need to make more time for the people in my life, and lately I’ve been craving fresh air and the outdoors.

But I have choices I didn’t have at any other stage of life and the time to pursue them. I have the gift of being able to disrupt aging.

Maybe it’s time to throw a particular postcard away too.

The Surprise of Early Menopause

This post is made possible with support from AARP’s Disrupt Aging. All opinions are my own.

4 Cardiac Health Stories Relevant to Women

My friend Lorraine has been posting recently about her medical journey. She almost went down a road that would have involved invasive surgery, a lengthy recovery and time lost on the things she loves most. However, she sought a second opinion and has a new plan that will hopefully resolve her issue while preserving her health and time.

Although Lorraine’s story doesn’t regard cardiac health, it dovetails with four different cardiac health stories I’ve heard this week. The topic is personally relevant for many reasons, and each story left me wishing we handled women’s cardiac health issues differently.

Sudden Death Due to Cardiac Arrhythmia

My friend Chris Russell shared a story this week about a young endurance runner who died suddenly due to a cardiac arrhythmia.

The information about cardiac arrhythmia accompanying the article says this:

Cardiac arrhythmia is a frequent cause of death during sleep. This is when the heartbeat is irregular and the heart may be beating too fast or too slowly. Although they can affect all age groups, it is more common in older people and drinking in excess or being overweight puts people at greater risk. Sudden cardiac death from an arrhythmia kills around 100,000 people every year.

Note: I believe the “100,000 people per year” figure applies to the UK. The Cleveland Clinic puts the figure for adults in the US at 325,000.

Whether it’s 100,000 or 325,000, the number is too high. Due to our family’s experience with Long QT Syndrome (we lost a family member who died in her sleep at age 30, leaving behind three young children), along with stories such as Christine Garwitz Puricelli’s regarding her daughter Emilie (here’s Emilie’s page for info and donations), I am a staunch advocate for awareness on the part of medical practitioners and self-advocacy by patients.

Women and Cardiac Health

Emilie Puricelli

Takeaway: Be persistent if you feel there is an issue even after doctors say things are okay. (My sister-in-law had been hospitalized a short time before her death, but the medical exploration focused on areas besides cardiac issues. How could a 30-year-old with a career and three little kids, appearing mostly healthy, have a cardiac problem?)

(Now that we know of the issue, most people in the family who share genetics with my sister-in-law have been tested and the ones who do have Long QT are on appropriate medication and know what precautions to take — this stands a significant chance of helping them normal lives with normal longevity, thank goodness.)

A Close Call Due to Sudden Cardiac Arrest

My friend Lisa posted this article about a man who went into sudden cardiac arrest during a workout and was revived by a truly serendipitous combination of events that included the presence of nurses (and easy access to an AED).

Lisa should know. I think it’s safe to say every single one of us in the Tallahassee running community who know and love Lisa said something like “you must not mean Lisa” when we first heard about her cardiac arrest and subsequent surgery a few years ago. (Lisa tells her story here in this older post from a time when we were trying to help her with a particular campaign.)

Takeaway:  While it would be unrealistic to say “never work out alone” or “always have a trained medical professional nearby,” do be cognizant of your workout conditions, especially if you have a family history (Lisa had a family history; I’m not sure about the cross fitter featured in the other article). I suppose the other takeaway is “don’t assume anyone is invincible.”

A New Cardiac Problem Along With a New Baby

My friend and former coworker Janet posted this article about a woman who developed postpartum cardiomyopathy shortly after her baby was born. Janet, who also came far too close to losing her life due to PPCM, feels that education is important (I agree).

More about PPCM (from My Heart Sisters):

In PPCM, heart cells become damaged through an inflammatory process, and a woman can go from healthy to complete heart failure in hours, days, weeks or months after giving birth and sometimes while pregnant. It is one pregnancy complication that is rarely spoken about and because no one talks about it, it continues to claim lives and cause incredible suffering.

Much like Serena Williams had to convince doctors that she was on the verge of a life-threatening condition right after she gave birth, many PPCM stories I hear have the same thread: “thank goodness a medical professional FINALLY listened.”

When Technology Helps Reveal An Underlying Issue

My friend Karen had serious open-heart surgery last year. I believe it’s safe to say everyone thought the major issues were resolved, and she returned to her taxing career as an elementary school teacher. I’m keeping this explanation concise, because it’s a developing situation and I respect her privacy.

But apparently she had an Internal Loop Recorder placed after her original surgery. It recently showed signs of a serious new issue. That led to a life-saving placement of a pacemaker/defibrillator. Without the loop recorder, it could have taken much longer for the new issue to arise, and her life would have been more at risk.

Takeaway: Technology can play a huge role in cardiac health. I have an IRL too (for a much less serious reason than Karen) and I am reassured that it is keeping track of my Multifocal Atrial Tachycardia so if an issue does arise, I can have it addressed immediately and my physician will have lots of useful information. By the same token, and I realize this contradicts what I just said, don’t depend solely on technology. It isn’t the only information that helps a doctor make a decision and it can be inaccurate.

How to Be Your Own Best Advocate

When I set out to write this post, I asked if I am really qualified to do that (this is a question I ask before writing most posts, but in general I believe in taking the first step and acknowledging that there is a wealth of information among my readers/followers — what I don’t know (or get wrong), they can fill in the blanks).

Based on the four scenarios and takeaways I shared above, here are 5 important tips (even if I don’t practice them perfectly myself).

  • Keep asking even if told you are okay
  • Modify your fitness routine to accommodate any potential cardiac issues
  • Do your own research
  • Document everything
  • Take advantage of technology

I also like much of what Trin Perkins has to say in 5 Ways to Be Your Own Health Advocate, including “view yourself as the client, not the patient.” She has a point.

I am happy some of the people mentioned in the stories I shared today survived, and sad that some lost their lives when I believe more awareness of women’s cardiac health issues could have led to a different outcome.

Speak up, friends. Your life may depend on it. (And please listen up, medical professionals. Our lives may depend on it.)

Women and Cardiac Health