Life is easier ...

Recovering from my surgery has been slow but steady.  Not there yet, but on the right track, which is good.  My husband has been good - with hardly a complaint (okay, a few complaints) - about doing things to help.  He is adamant that I shouldn't do too much too soon.  I think when it actually registered that my blood count had been dangerously low, requiring blood transfusions over about 14 hours across two days. he got a bit of a shock.  To be fair, we both did, though more in hindsight. So he is keen for my recovery to go smoothly.  He claims he's adding up all the favours I've asked of him, and is looking forward to me repaying them.  I said he has to put them in the bank as insurance against some time when he will get sick/need surgery, and I have to be the chief driver/cook/bottle-washer/errand runner/muscle.

So I've been doing very little.  The odd bit of cooking or making lunch, tidying up the kitchen a bit (though no bending allowed which makes it harder), walking around and around the living room to get some gentle exercise (if I go out I have to climb, and that puts too much pressure on the abdomen and pelvic floor), catching up on recorded TV (making my way through House of Cards Season 1), binge watching Season 2 of The Bridge, and ... an indulgence ... binge watching Season 1 of How I Met Your Mother (because I've never watched it before).  I will be watching the rest.

I thought recovery would be no problem, because I would have the internet, and I could use the time to write.  But sitting here at the computer in my office is not entirely comfortable, and I'm not supposed to do it for too long because of the pressure on my abdominal muscles.  And reading ... well, I didn't anticipate the severe brain fog from the anaesthetic (hence all the TV watching). Just this week it has lifted, and I've been at last able to read a couple of books, and may return even to The Luminaries.

And it made me realise how much harder it would have been if I had had children.  Being able to take it easy, concentrate on my recovery, and sleep when I need to sleep is, I suspect, something that many women in my position can only imagine.  That said, many women my age have adult children who can help out too, so I guess it goes both ways.  Still, I'm thankful that I am able to concentrate on me at this time.  I don't think it's selfish, I think I am lucky.  And right now, I need to see the advantages of my situation.

12 things I wish I'd been told about the Big M

I was going to title this “For Women of a Certain Age” but I realised that that was making assumptions, and the one thing we've learned about assumptions in the reproductive health sense is that we cannot make them.

I'm writing this nervously too, knowing that anyone googling my real name (potential employers, for example) could in fact find themselves here, men or women.  I hope that the fact that I'm writing under a pseudonym, and that I'm writing about intimate women’s issues, will let them know this is not for them, and turn them away now.  NOW!  Because this is a warning of TMI (Too Much Information) for pretty much everyone.  When I tell my husband what I'm about to tell you, he covers his ears and makes loud noises.  So hopefully, that warning will turn anyone else away too.  Though my husband isn't usually so lucky, as my response is “if I have to live it, you at least have to hear about it!”   These are things women share, privately, in the kitchens during dinner parties, or in cafes, or on the driveway after lunch, or in the bathrooms at work amongst other women of or approaching a certain age.  These are not things we share with men.  They know it happens.  But they don’t really want to know.  Consider yourself warned.

I know this isn't a No Kidding related post.  But I feel it sits better here, in a community that is predominantly women, that is knowledgeable about our reproductive systems, and that is accustomed to talking about things that are generally considered to be TMI.

Twelve things I wish someone had told me about the lead up to menopause:

1. Men don’t understand what you’re going through.  They’ll have a rough idea, based on general knowledge and bad jokes on American TV sitcoms.  And the truth is, they don’t want to know what you’re going through.  I try to tell my husband some of the TMI details, and he covers his ears and makes loud signs.  My response is “if I have to live it, you have to hear it.”  Don't get me wrong, he is sympathetic.  But until it happened to me, he had no idea.  And would rather not know.
   
   
2. Weight will arrive.  It will sneak up on you, and it is difficult to shift, even though I exercise regularly at the gym.  I always thought that was a cliché.  Um.  No, it’s not.  Don’t let it sneak up, and don’t assume you will be able to get rid of it in the way you did even a few years ago.
   
   
3. Emotions will go up and down like a yo-yo.  Again, because you’re feeling them, they sneak up and don't seem so unusual.  I - finally - managed to recognise the mood changes, and reel them in a little.  Fortunately, this aspect seems to have abated recently.  All I’ll say is that my husband’s a saint.  (Shh.  Sometimes.  Don’t tell him.)
   
   
4. Our reproductive parts, having already caused many of us such grief, might just quietly go to sleep and turn out the lights without a word.  But equally, as a dear friend commented to me recently, some of us might find that our parts are not dying down quietly, they're going out screaming. Loudly.
   
   
5. And this is the thing no-one ever tells you.  Well, no-one ever told me.  I wish women were warned, because I have tolerated this for too long.  I have been dealing with regular chainsaw massacre-like events.  The nine hour flight to Singapore was no fun, and I was nervous for weeks in advance that on our South African safari the lions would smell blood and attack!  (Fortunately, for once, timing was on my side and attacks were averted.)  Having googled a little, I tolerated this because I thought it was normal.  It is common.  But it is not necessarily normal.  And there are degrees.  So talk to your doctor, because …
   
   
6. There is medication that can reduce the carnage, and make your life more tolerable.   Actually, this is relevant for anyone, no matter what age, who might be similarly inflicted.  I am going to talk to my niece about it.  I don't think she knows.
   
   
7. Living in a hot climate might help.  When I was in Qatar and Jordan last year, at 40-plus Celsius, I didn't even notice if I was having hot flushes.  (OK, that’s not a serious one, but it was good not to notice them!) There are degrees of hot flushes too.  Sometimes they're just a gentle flush of heat.  Other times, it feels as if you're suddenly thrust into a sauna.
   
   
8. They estimate that up to 80% of women have fibroids by the time they reach menopause. Many women have them, but as they have no symptoms, they're not even aware of it. Fibroids can cause major problems - heavy bleeding, pain, frequent urination, etc.  We've all heard of the stories of people growing huge basketball-size fibroids.  But what I didn't know was that even one or two can do a lot of damage.  And they grow and multiply quickly in those last ten years before the Big M. That pregnant-looking belly may not just be down to mid-life weight gain.
   
   
9. Most importantly, if I was back in my early 40s now, I would do things differently.  In particular, I would get my FSH checked every year or two, to see where I was in the process.  I would certainly get it checked if I noticed disturbing changes.  Why didn't I? Because I didn't realise that it would help me know if my symptoms are normal, or whether further investigations are necessary.  My gynaecologist said that my FSH indicates that everything should be over by now.  Yet, up until about six months ago, I was still reasonably regular.  But apparently that wasn't normal.
   
   
10. Talking is good.  In fact, talk to your older female friends, your mother, your aunts, older sisters.  Find out what was normal for them, so you get an idea about what might or might not happen. Some of them will tell you just to wait and it will be over.  Don't listen to them.  Talk to your doctor instead.  It might be the case that you can just wait.  It might not.  (Not, in my case it turns out).
    
    
11. Listen to women who are going through this, understand, empathise, and learn.  But please don’t compare your own sterling health/regularity with theirs, even if you want to be over it too.  (I'm not sure if I did this myself or not, but I wish I'd thought about it).  If you’re not having difficulties, don't be pleased with yourself.  I've had a number of people do this and it makes me feel broken and judged and old before my time (even though it is not, apparently, "before my time") all over again.  (One woman's comments - about how "normal" (or the implication being, exceptional) she was because everything was continuing without change at a couple of years older than me - took me right back to the dinner table conversation we had had years ago when she and her husband were asking about my ectopic pregnancy, and he said proudly, smugly even, "my wife, she has no problems.")  The best reaction was from a friend who said "I want to hear it all.  I'm following you in a year or two, and want to be prepared."  She may not have any issues (she's not that much younger than me, and so far so good).  But she listened.
    
    
12. Remember that ultimately, it’s just another transition in life.  One I was not looking forward to, but one I realise now is no big deal.  One that will give us more freedom than we, as women, have ever had.  Think about that freedom, what it means, what we've put up for months, years, decades, and what we can - when we’re ready - cast aside, both physically and emotionally.  It is not an end, it is a beginning. I am now ready, and I am welcoming it. Nothing is ever simple though.  Changes for me, it seems, will come surgically next month. To be honest, I can't wait.

Ectopic Awareness Raising – Part 2

Warning:  This post may well contain TMI.

Just over a year after my first positive pregnancy test, I conceived again, but this time it took the help of a fertility specialist.

I had a strong, early, positive pregnancy test.  I had traditional pregnancy symptoms – fatigue, even nausea.  How I relished that nausea.  With a history of one ectopic pregnancy, my doctor wanted me to get blood tests and an early scan (at about 6 weeks pregnant).  In fact, she’d given me the forms for blood tests even before I got pregnant, and just said – use them.  The tests would tell if my hCG levels were rising appropriately.  They’re supposed to double every 2-3 days.  If they don’t, then the pregnancy is possibly an ectopic.  But I got my positive close to the end of the year, and I couldn’t get the tests done as we were travelling south for Christmas.  I figured I could wait and get that scan after the New Year.  After my experience a year earlier, I knew the symptoms of an ectopic, and I knew to get to the doctor if things weren’t right.  So I relaxed, we both relaxed, and enjoyed it. 

Until things started going wrong.  Bleeding.  Lots of it.  Too much.  None of the classic ectopic symptoms, though.  Pain, for example.  Any woman of child-bearing age who has abdominal pain should be tested for pregnancy, and an ectopic should be ruled out.  It saves lives.  But we don’t all get pain.  I hadn’t had any pain with my ectopic the previous year, so I knew that pain – whilst it is a common symptom – didn’t have to be present for my pregnancy to be ectopic. 

At the end of December, after I returned home, and things deteriorated, I began an interminable process of hospital visits, and blood tests.  This time though my hormone levels were high. The doctors treated me for a miscarriage, then an incomplete miscarriage.  But my levels continued to rise.  I ended up in hospital, having emergency exploratory surgery and a D&C.  “You’ve miscarried,” I was told.  “There was no sign of an ectopic.”  I went home, looking forward to recovering, then trying again.  But once again, the quality of the health care I received probably saved my life.  They continued to check my blood levels, and waited for histology results.  My levels continued to rise.  Obviously this was no miscarriage.  But it wasn’t a viable pregnancy either. Finally, after many more days, more scans, and many more long, boring, worrying hours waiting at the Women’s Health Assessment Unit, I was diagnosed with a second ectopic pregnancy.

To be more accurate, this one was a cornual ectopic pregnancy (now more accurately called an interstitial pregnancy).  Only about 1-2% of all ectopic pregnancies (themselves about 1-2% of all pregnancies) are cornual.  So they are rare.  This type of pregnancy almost makes it to the right place, but not quite, implanting in the area where the blood supply enters the uterus.  This was probably why my hormone levels were so high – compared to a fallopian tube, there was room (and a blood supply) here for the pregnancy to grow.  It is as a result one of the most dangerous types of ectopic pregnancy; if it ruptures, the outcome is potentially catastrophic, as you can bleed out within a very short time. 

Normal protocol for an ectopic pregnancy is to treat with surgery if your hCG levels are over 3-5,000.  Mine were at 14,000.  But surgery itself was too risky.  It could result in too much bleeding, and potential loss of some or all of my uterus.  So again I was treated with methotrexate.  But this time I wasn’t allowed to go home.  The risk was too great, they said.  The 30-40 minutes drive between home and hospital could make the difference between life and death.  I had to stay in hospital until my levels dropped – normally this takes about a week.  I was not happy about this.  But they didn’t drop.  They doubled.  The doctors were worried.  They were concerned I might have a molar pregnancy or more aggressive trophoblastic disease, when the pregnancy cells go rogue, and can metastasize throughout the body.  I was assigned a gynaecological oncologist.  I had a chest x-ray and a CT scan.  It seemed to take forever to get the results.  Finally they came in.  I was clear. 

And after a week, my hCG levels plateaued, and I was sent home.  It took another week for my levels to begin to fall.  I felt as if I was getting out of the woods.  But the nightmare wasn’t quite over yet.  It took another five-six months, two more hospital procedures/surgeries, numerous visits to the wards and WHAU, blood tests, stress and tears, before I was given the all clear to try to conceive again.