Tag: Mental Health

It’s been a long year

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First things first; I haven’t posted since 6 April. I’m sorry about that. 2020 has been a bad year for me, as it has been for so many, and I really struggled with burnout during the lockdown. I was one of the lucky people who was able to keep working during the pandemic, as it was very easy to transition to working from home. However, the isolation, combined with some other factors, made for a severe lack of energy and motivation, and this blog was the first thing to fall by the wayside.

I can’t guarantee that won’t continue to happen over time. Research has indicated a genetic link between endo, gut issues and depression (tell us something we didn’t know!), and I’ll admit my usual positive mood does tend to take a blow when my endo is flaring. However, I’m feeling not too bad at the moment, and have some new content I really want to get out in the next little bit. Expect some updates about surgery, the implanon, and some commentary on the pandemic and disability.

I’ve been really happy to see that this blog has still had views even whilst I’ve been inactive. I hope it has been useful to some people!

I also hope that people have been coping alright during the pandemic. Let me know in the comments what you’ve been up to, and how you’ve been.

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Coronavirus

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Hi all,

I want to apologise for the delay in posting. I had a post mostly ready to go, but with coronavirus doing what it’s doing, it didn’t feel right to proceed with my planned schedule without addressing the pandemic first.

This is not a fun time. It feels like half the world is taking this whole thing too seriously, and hoarding loo roll as a result. It feels like the other half is not taking it seriously enough, and refusing to take sensible measures to flatten the curve.

I know I’m not likely to die if I get coronavirus. Despite having a shockingly poor immune system, I don’t have any lung issues. I can’t say the same for my grandmother with one lung, who lives in a nursing home, which are basically disease-boxes. Nor can I say the same for my asthmatic friends. I’m worried about my uncle, who is a doctor, and my aunt and cousin, who are nurses. I’m worried about my husband, whose work exposes him to people from so many different situations that it could come at him from anywhere. I’m worried about my teacher friends, surrounded by hundreds of children every day with no way to maintain distance.

I’m worried about my friends who earn their living as casual workers or performers as businesses reliant on large groups of people gathering in small spaces close, or reduce their workers’ hours. I’m worried about small businesses I have affection for and loyalty too having to close their doors.

I’m worried about separated couples having to navigate co-parenting and quarantine. I’m worried about victims who live with their abusers, trapped in homes with them. I’m worried about people with depression, anxiety, mental illness and chronic pain becoming even more socially isolated and afraid, and the toll this will take on their mental health.

I’m worried about hospitals being put under so much pressure that doctors are forced to chose who to save, or leave people in pain and distress as a half-measure because there isn’t enough to keep everyone pain-free or healed.

I just want everyone to take sensible measures. Act pre-emptively in areas where coronavirus is not yet widespread, and take all possible precautions in areas where it is. Don’t hoard. Help your neighbours out, particularly if they are elderly, sick, disabled or isolated. Help those struggling financially if you have a little extra cash. Keep supporting local business where you can. Look after your mental health and maintain social networks as far as possible. Don’t panic. Verify your sources of information and take proper advice. Wash your hands. Understand that you being healthy doesn’t mean you aren’t a vector. Understand that health is not the same as immunity. Know the symptoms, and get tested appropriately. Just be good people, and good members of the human community.

I hope all my readers are staying safe and looking after themselves. I know many of you will be vulnerable to this disease, and are probably scared and feeling hopeless as people continue to blow it off as ‘a bad flu’. I’m sorry if you get glib responses like that to your valid concerns. I hope you don’t catch the virus, and if you do, I hope your symptoms are mild and your recovery is swift.

I wish you all the best.

xxxx

Lifeline’s Response

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A few weeks ago I wrote a letter to Lifeline about one of their Australian ads (you can read it here).  They have now responded.

The email reads:

“Thank you for providing your feedback about the Lifeline HOPE billboards.  I am so sorry that they have made you feel the way they do, this is certainly not our intention.  We had aimed to provide a strong message of hope, which is the undercurrent of all our communication campaigns.  To date, I have received plenty of positive feedback about this campaign, your feedback is the first negative, but it has weighed on me heavily. Thank you for taking the time.

The intention behind the poster was that people would see the ad and be encouraged to hold on with HOPE for whatever the reason may be that they need it.  In doing so, I had hoped to encourage a more compassionate Australia. For those in chronic pain, I had hoped to impart hope in the continuing advancement in scientific discovery and the dedicated medical teams who are working in the field. The furthest thing from my intention is to cause anyone harm or to experience isolation.

Ella, this ad placement has been provided pro bono, so I am unable to change where it is placed or how often.  I can give you the undertaking though that the next iteration of  posters I am given the opportunity to post I will ensure there is a different hopeful message.

I am sorry for the distress this has caused you, I hope my response will give you some solace.

Kind regards

Ina”

Ina is the National Manager of Communications and Public Affairs for Lifeline.

Whilst I still think the ad is deeply insensitive and demonstrates a lack of thought, and I don’t buy the “continuing advancement in scientific discovery” thing (anyone with a chronic illness knows that waiting for medical advances is about as hopeful as waiting for a tsunami in the Gobi Desert), I am gratified to have received a reply.  I also very much appreciate the apology.  I do hope that they bear the message in mind and give thought to those of us with chronic pain in future ad campaigns.

I strongly encourage anyone with the spoons to call out ableism or exclusion when they see it.  People without intimate experience of disability or chronic pain don’t even think to double check on whether their language or actions are inclusive – goodness knows I rarely did prior to actually having endometriosis and working to educate myself.  Every time we point it out is hopefully a time the other person goes away to think about it and takes the time to educate themselves and change their behaviour in future, and hopefully become an advocate for us as well.

Keep on keeping on, endo warriors.

2019 Election: Health and Disability

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Unless you have been living under a rock for the past month, you are probably aware that we have a federal election happening on 18 May.

Now, I have my own views on who to vote for and on the policies of the major parties.  I definitely encourage everyone to read up one who is saying what about all the important matters.  However, there are two policies particularly relevant to those of us with endo that I want to summarise here: health and disability.  I’m going to outline the policies of Liberal, Labor, the Greens, One Nation and the United Australia Party (aka the Clive Palmer party).

This should not be treated as a how-to-vote guide.  A party may have great policies on health but terrible policies on another area that matters just as much.  It’s also not going to capture my views on the parties: this is literally just a summary of what their stated policies on health and disability are.  I also acknowledge that other issues directly impact women with endo, such as issues around homelessness and employment.  I’m only going to touch on those where I think they will have a very noticeable impact on people with chronic illness, rather than a general one.

If you are struggling with keeping up with all the different views of the many, many parties contesting, I encourage you to have a peek at Vote Compass.  It can be really helpful in figuring out how you align with the major parties on big issues.

Now, without further ado and in no particular order:-

The Liberal Party

The Liberal Party, for my non-Aussie readers, is our current government.  They fall to the right on the political spectrum, generally speaking.  So far in the election they have been running on an economic platform.

The Endometriosis Action Plan has come to be during the Liberal Party reign, although it received perhaps its strongest support for Labor Senator Gai Brodtmann, who has been a fierce advocate for people with endometriosis.  As far as I am aware, the plan received bipartisan support.  Although the Plan puts some money towards improving care, the majority of funding goes to education and awareness.

When it comes to welfare, the Liberal focus appears to be on those who can work, but are currently unemployed, rather than those who can’t.  Their website talks about initiatives such as cashless welfare cards and work the dole programmes.  I strongly encourage those with endometriosis or chronic illness to research these initiatives and determine whether they are likely to hurt or help.

In their health policy, Liberal pledges to:-

  • commit up to $29.1 billion to hospitals by 2025, including increasing funding to specialist care for chronic pain treatment;
  • continue funding Medicare and the PBS;
  • invest $308 million in reducing the cost of medication for people using multiple medications;
  • increase access to MRIs;
  • devote $4.8 billion to mental health care; and
  • Put an additional 3,000 nurses and allied health professionals in rural medical practices.

The page also talks about reforms made over the past 4 years, but it is not clear from the page whether that funding and policy will continue.  One assumes that that is the intention but I don’t want to put words in their mouths.

When comparing themselves to Labor they emphasise that they have committed greater funds during their term than Labor did during theirs, and that Labor once blocked 7 medications from being included on the PBS.

The Labor Party

The Labor Party website is a little less easy to navigate, with policies laid out singly rather than grouped by area, like “health”, but I’ve gleaned what I can and summarised below for you.

In disability, Labor pledges $10 million to disability advocacy (although it isn’t clear whether endometriosis or chronic illness more generally would be considered a disability).  They aim for a 6% disability quota in the APS by 2022.  They say they will reform the NDIS to close the gap between it and mainstream services.  They will also amend the Terms of Reference of the Royal Commission to include redress.  They will invest $300 million into students with a disability – again, it is unclear how disability is to be defined in this context.

Under Hospitals, Labor pledges to restore the $2.8 billion of funding to hospitals that they allege the Liberal Party is cutting.  They also pledge $500 million to reduce emergency room waiting times.  They state that they will close the gap in health care between rural and metropolitan areas.  They will increase staffing at Medicare and Centrelink, which would hopefully improve access and decrease wait times.

They state that they will reverse Liberal cuts to penalty rates.  I include this because many people with chronic illness find themselves working in casual positions due to the unpredictability of their illness making full- or part-time work impossible.

In the mental health area, Labor will invest $200 million in Headspace.

In reproductive rights, an area the Liberal Party doesn’t touch on at all, Labor will work to decriminalise abortion, and (significantly for those who use contraception to manage their endo) increase access to contraceptives, particularly long-acting ones such as the implanon and mirena.  They also directly mention endometriosis, saying that they will be

“Addressing specific reproductive health issues such as endometriosis, polycystic ovarian syndrome, transvaginal mesh and female genital mutilation.”

They have committed to continuing the Endometriosis Action Plan.

The Greens

The Greens have kindly collated all this information on just one page, which made accessing it nice and easy.  From this page you can download individual, more specific plans.  Say what you will about their policies – this website is very helpful.

The Greens say that they will fund a “truly universal” public health system, and reduce hospital waiting times (not clear if this is for surgery or emergency rooms or something else).  They will do this by funding Medicare – there is a big emphasis in their platform of ensuring that people don’t feel they have to pay for private insurance to access quality care.  It is worth reading that document – it includes details such as a $3.5 billion plan to increase care for people with chronic physical and mental illness, including $750 worth of care and a national framework for diagnosis and treatment.

They will increase mental health funding and work to destigmatise mental illness.

They pledge to raise Newstart and the New Parenting Payment by $75 per week, which will help those people with chronic illnesses who are too sick to work but can’t meet the very strict requirements for the DSP and so get stuck on Newstart long-term.

They will increase general accessibility for people with disabilities.  It’s worth noting that the Greens do have a Senator who uses a wheelchair (Jordon Steele-John), who would likely appreciate the systemic barriers people with a disability can face.

The United Australia Party

I love you, my readers, but I don’t love you enough to listen to all of Clive Palmer’s speeches in the hope one of them mentions health.  They don’t talk about them in the title.  You can do that here if you want to.

However, I have scoured his “Vision for Australia” document looking for policies.  Basically he keeps talking about boosting the economy through his various strategies, and mentions health only tangentially.  He will

  • build more hospitals;
  • reduce income tax (helpful for those sickies healthy enough to earn enough to pay tax but who are struggling financially);
  •   commit $80 billion in funding to health for the next three years;

and that’s all I could find.

I’m also not 100% clear when this document was published, as the URL includes “2015” and the stats all seem to be from around then.

In summary, the UAP is very much about the economy and getting the money – the details on how it will be spent may be available but if it is, it’s not easily found on the website.

One Nation

One Nation has a very pretty website, but not a lot of detail on health or disability.  There is definitely more of a focus on immigration, Islam and refugees.

All I could really find in the health sphere is support for sick people accessing medical cannabis, although they don’t outline specifics of how that support looks (legalisation, decriminalisation, licensing, etc).

In terms of accessing Centrelink, they want to introduce an identity card to fight against people rorting the system.

That’s all I could find on their website.  Really, that’s it.  If someone else finds more, please let me know, because this just seems lacking.

 

I hope that may have been helpful to those who didn’t want to sift through reams of election promises to find out how folks with endo would be effected from 19 May.  Please remember to vote properly and consider voting below the line to control where your preferences go, or research who is referencing whom to make sure you know what happens if your party doesn’t win.

Here’s hoping for a great future and ongoing support in the health arena.

Secondary Conditions: Polycystic Ovarian Syndrome

Published on by Bubbles in the Brain4 Comments

I’ve written a lot about endometriosis.  I’ve also written about some of the “side-effects ” people with endo often suffer, such as back pain, digestive issues, and gastritis.  Now I want to write a little series on other chronic conditions that often appear alongside endometriosis.  Today, it’s polycystic ovarian syndrome, aka PCOS.

What is PCOS? Well, it’s a condition whereby the ovaries become enlarged and prone to cysts. Tiny little follicles grow on the ovaries, containing partially formed eggs that rarely grow to maturity or become fertile. The body produces too much insulin and androgen (a male hormone).

PCOS can cause weight gain, excessive hair growth on the body, hair loss on the scalp, depression, sleep apnea, acne, pain, infertility , increased likelihood of diabetes, and irregular periods.  It’s a nasty disease and the side effects (wrongly) carry a lot of social stigma.

Like adeno and endo, no one is really 100% sure what causes PCOS. It does appear to run in families and is more likely to effect women who are overweight, but neither of these is a guarantee of getting it, nor are slender people with no family history automatically exempt. What we do know is estimates suggest it could effect as many as 20% of people with ovaries of reproductive age, and often goes undiagnosed.

As with any disease where weight increase is both a symptom and increases the risk of either contracting the disease or exacerbating the symptoms, doctors will urge sufferers to make healthy lifestyle choices, particularly around diet and exercise. Not for a moment will I pretend this is a bad idea.  Sufferers can achieve significant relief from symptoms with only a small amount of weight loss (which sounds a lot easier than it is when your own body is fighting you every step of the way).  However, I do urge people not to allow doctors to attribute everything to their weight and offer no other assistance. Hormonal treatments can also be an important part of dealing with PCOS, both to block and to raise different hormones.

It’s also a good idea to have a mental health professional as part of your treating team. Dealing with difficult symptoms that our society wrongly but consistently perceives as “gross” or symbolic of laziness is hard enough. Dealing with a disease that also can cause depression is an extra battle you shouldn’t have to fight alone.

Before you can start to be effectively treated, however, you need to be diagnosed. There is no 100% guaranteed method of diagnosis. Scans may show cysts on your ovaries, but you can have ovarian cysts without having PCOS. Likewise, you can have PCOS but not have anything visible on scans. You can also have blood tests that will look at hormone levels in your blood to see what, if anything, is elevated.  Like endo, though, it can just be a lot of guesswork and diagnoses are often based purely of reported symptoms.

Endometriosis and PCOS, unfortunately, often travel in packs, and it is relatively common to have both.  However, plenty of people only deal with one or the other.  I’m lucky enough not to have had to deal with PCOS. I have friends, acquaintances and possibly family members with it, and their experiences have ranged from annoying to devastating. Have any of my readers experienced PCOS? What was your path to diagnosis?  If anyone wants to write a guest post about how PCOS really feels on a day to day basis, I’d love to publish it.

The Selfishness of the Sick

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There’s a weird thing that you experience when you’re chronically ill that you just don’t feel when you are healthy.  That’s the sensation of feeling selfish for wanting to be healthy.

I’ll try and explain.

When you have a cold that won’t go away and its really bad, you go and see the doctor, because you expect, quite rightly, that a cold should clear up.  After all, healthy is your normal state and it is to that state that you would like to return.  You don’t feel selfish for wanting to be healthy again, and that is absolutely as it should be.  The doctor doesn’t imply that you should just learn to deal with being sick better, or suggest that maybe you should just settle for a less bad cold than what you have because after all, it could be worse.  They listen, they give you your antibiotics, and you generally don’t leave feeling that you are being silently judged for wanting to be rid of your cold.

However, when you are chronically ill, it’s a bit different.  First of all there is the adjustment stage, where you have to learn to accept the fact that you will never be healthy in its true sense again.  That’s a topic for another post, because it really deserves a proper article.  Even when you’ve adjusted your own expectations, though, you have to deal with the expectations of the medical profession.

When it comes to endometriosis, a lot of doctors (not all, but too many) leave you feeling like you are asking for too much.  Hospitals are the worst at this – they just want to get you to a point where they can turf you back out with a pocket full of endone and not be their problem anymore.  Contrary to what you see on House or Scrubs, there is rarely any follow-up, insistence on solving the problem or finding a miracle cure.  Hospitals won’t keep you til the pain has reduced enough for you to walk easily or return to work.  They just wait for you to say that the pain seems to be reducing slightly, and you’re gone.  I know that hospitals are underfunded and understaffed, but it really makes you feel like a massive burden rather than someone with a right to health, or even a life without constant pain.

Private gynaecologists don’t have that excuse, but they do it too.  I’ve been told that I should expect to live the rest of my life with a base level of pain at 4/10 every single day.  At my last gynaecologist, I raised an ongoing issue that was causing me pain and inconvenience and he just seemed utterly uninterested.  After all, I could walk, couldn’t I?  What is worst for me is the silent undercurrent that seems to say “Why can’t you settle for what you have?  Why isn’t this good enough for you?”  It makes you feel naive and worst of all, selfish.

It isn’t enough for me, though.  I’ve had a great experience lately with Zoladex, a subcutaneous implant that dissolves over time and puts you into artificial menopause.  It has effectively ended a three-month flareup during which I could barely work.  At my last consult with him, Dr Edi-Osagie asked me if simply staying on the implant and avoiding surgery was an option for me.

I did seriously consider it, but in the end, I decided to pursue surgery anyway.  This is for a few reasons:-

  1. Zoladex has been a big improvement on where I was, but my quality of life is still nowhere near what it was prior to my first surgery;
  2. As long as I’m on it, I can’t conceive, and whilst I’m not in any rush to have a baby I do want the option;
  3. If the surgery is successful, I can come off all of the artificial hormones I’m on and let my body go back to normal, which is something I haven’t had in ten years;
  4. Zoladex and the accompanying hormone replacement therapy is expensive (about $160 a month for both);
  5. Being in menopause does have some not-so-great side effects, such as hot flushes, an increase in peach fuzz all over my face, and messed up sleep patterns;
  6. If I don’t take the opportunity to have this surgery, I may never have the chance again, and I will regret that forever.

I felt rude, assertive, guilty and incredibly selfish saying to Dr Edi-Osagie that near enough just wasn’t good enough for me.  However, he acknowledged my concerns and was so supportive of my decision, just as he was in my first consult.  I cannot recommend him highly enough.

It is really hard, asking for more.  Previously being beaten down by the health profession and being socialised as a woman against being assertive, which society reads as bad and bossy, as well as against being selfish, makes it really hard.  Women are taught to be passive and self-sacrificing, and sick people are told to be patient and grateful for what we have.  However, the risk has totally paid off for me.  Even if this surgery achieves nothing, I can fall back on the Zoladex, something I wouldn’t have if I had settled for my previous gynae’s advice, just like I wouldn’t have had the improvements in my health that he gave me if I had stuck with the advice of the two before him.  I now have a specialist who is supportive, validating and proactive.

So, if I can give one piece of advice, it is this: be selfish.  Ask for more.  You should not have to settle for “good enough” when it comes to your health.  In the end, you may have to, but don’t stop trying as long as you have the resources to do so.  It is your health.  It is your quality of life.  You are allowed to be “selfish”.

The Problem with “Curing” Us

Published on by Bubbles in the Brain2 Comments

Today I had a really annoying and unsettling experience.  Like most such experiences, it happened on the internet.  I’m not going to post screenshots but I will talk about what happened, because people stepping over boundaries is a huge thing that most chronically ill/disabled people experience often.  I’ve touched on this before, but today I want to go into a bit more detail about why it is a real problem.

So, my friend posted a critique of Big Pharma, which simplistically stated that they create customers, not cures.  I agree that pharmaceutical companies, like every other organisation in a capitalist scheme, exist to make money, and that their pricing of necessary medication is totally unethical.  However, to suggest that they can’t provide cures at all is just misleading, as is the suggestion that the very act of creating customers by providing necessary drugs is bad.  It’s the way they do it that is the problem.  Anyway, that’s largely beside the point, although one gentleman did very kindly explain my own position to me.  How I could have understood what I thought without his assistance, I’ll never know.

What annoyed me equally as much as the above mansplainer, though, was the elderly fellow who decided to tell me – not ask, tell – to try natural hygiene.  Despite several rebuttals from me and him being shut down by our mutual friend when he implored her to tell me to contact him, he decided he was going to send me a PM about natural hygiene and offer his services again.

From my understanding of it, natural hygiene is a health movement that promotes eating clean, fasting sometimes, exercising, getting plenty of sunshine and sleeping well.  It’s based on the idea that we can help the body to heal itself.  That’s all fine and dandy and I totally support taking those steps for good mental and physical health, as I’ve outlined previously.

However, various proponents of natural hygiene also encourage rejecting all supplements and all but life-saving medical treatment or medication.  Quite frankly, I think that is incredibly dangerous and irresponsible, particularly as it is a “treatment” being marketed to desperately ill people who are often at the point of trying literally anything.  There are some diseases that the body simply cannot overcome alone, and endometriosis is one of them.

Now, giving this fellow the benefit of the doubt, let’s say he utterly believes in this system and truly believes that he can radically improve my quality of life.  Why is it still so problematic for him to contact me?

1)  It is really directive.  If someone is sick, don’t tell them what to do.  You are not a person with the authority to tell them what to do.  A far less irritating way to phrase this, rather than as a command, would be “have you tried X?” Even that is still problematic, though, because…

2) we probably have tried it, or at least looked into it.  If we haven’t, there is probably a good reason for it.  We don’t actually want to be sick.  There is nothing about endometriosis that makes it worth having, I promise you.  If it is something as basic as trying to eat healthy, sleep well, etc etc etc, we have definitely tried it, and it is very condescending to assume we aren’t already taking those basic steps.

3) It assumes that we are just half-arsing our treatment.  Every person I know with endo is seeking proper medical care for it.  I’ve gone through four gynaecologists because it is super important to me to ensure that I am getting the best medical care I can (weird, huh?).  Whatever we are doing, there’s a really good chance we are doing under proper medical advice and supervision, and that we are doing it thoroughly, because, as I said, we don’t actually want to be sick.

4) It is incredibly presumptive to assume that you hold the magic cure for endometriosis when literally legions of highly qualified doctors, surgeons and medical researchers do not.

5) It suggests that you know the disease better than we do.  Like most people with endo, I’ve spent the years since my diagnosis researching, learning, seeking treatment and reading every article about it I could get my hands on.  The fact that someone insists that they have a cure implies that they (in this case, an elderly man who is neither a gynaecologist or the possessor of a uterus, that I know of), know more about endo than I do after living with it for a decade and being diagnosed for two years.

6) It fails to notice the inherent barriers to such treatments.  Yes, I advocate eating well and living as healthily as possible.  That’s just good common sense that helps support the immune system and can (but doesn’t always) increase the body’s capacity to deal with flareups.  However, it is flipping hard.  If I can’t stand, I can’t buy healthy ingredients or prepare a meal.  If I can’t work, I can’t afford a varied diet.  If I am in horrible pain, I want – and need – quick, easy and convenient.  I certainly can’t exercise, I will probably suffer disrupted sleep, and I’m not going to put my tortured body through the rigours of a fast.

7) It crosses a line.  I told this man to stop.  I told him very clearly I wasn’t interested.  However, he not only PMed me, he also told his friend, on the main thread, to tell me to contact him.  He refused to take no for an answer.  It is incredibly disrespectful to do this, regardless of his motives.  My healthcare is my choice and when someone says “no thank you”, you need to leave them be.  There is already enough paternalism in medicine without it coming at us from randoms on the internet too.

There are ways to suggest alternative treatments to people, but generally speaking, unless you are either a doctor or actually have the disease, it’s not a good idea, because you are probably talking down to someone who a) hears this sort of thing all the time, and b) knows a lot more about it than you do.  If you absolutely cannot help yourself (please do, though), stop when you are asked to.  Respect our boundaries.  Respect that we know what we are saying when we say “no”.  Respect us.

 

Blue Knot: Vicarious Trauma

Published on by Bubbles in the Brain1 Comment

TW: suicide, mental health, violence, sexual assault

I know I promised I’d be back to endometriosis on Friday.  Apparently  I lied.  On Friday night I was feeling so well that I seized the moment and went to see my parents, and on Saturday my week of unhealthy living (i.e. drinking a litre of green tea on Friday to stay awake after an early morning and late night on Thursday) caught up with me and I was in too much pain to sit here and write.  And now today I’m not really talking about endo either.

Instead I want to write about vicarious trauma, which is fitting given what I wrote about RUOK Day.  RUOK Day encourages talking to people and listening to their issues.  Blue Knot instead provides services for those suffering trauma, or those experiencing vicarious trauma, which is where you are effected by experiencing something second-hand.  We had a training session by the Blue Knot foundation this week.

I’m a lawyer.  I hear traumatic stories all the time, including first-hand accounts from my clients about the serious violence they have faced.  Sometimes that includes viewing wounds, graphic images people have posted online, and reading some really sickening police and medical reports.  There are many professions that are equally high risk for various trauma, including medical, mental health, emergency services and support services.  Basically, anyone who hears or sees other people’s accounts of a traumatic event.  That can include when you follow the steps provided by RUOK to support someone having thoughts of suicide.

There is always the risk, when you agree to talk about issues someone is facing, that you will be taking on a seriously difficult topic that could leave its own scars on you.  It’s not something you should necessarily do unless you are in a sufficiently healthy headspace.  Even then, the effect it could have may surprise you.

Vicarious trauma is a sneaky beggar, too.  It can build slowly and you don’t even notice how badly you are being effected until you reach crisis point.  Alternatively, it can strike out of nowhere for apparently no reason at full power.  A few months ago, I was representing a woman to get an interim domestic violence order.  She told me her story, I drafted the application, and then about an hour later we were in front of the court and I was taking her through her evidence and giving submissions.  While I was making my submissions, this massive lump formed in my throat, tears flooded my eyes and I choked up.  I managed to stumble through my closing without (I think) being obvious upset, but my goodness, it was an intense feeling.  The strangest part?  I can’t even remember the woman’s story now.  I don’t think it was really different from anything I’d heard before and I cannot remember why that one in particular got to me.  It just did.  I was left feeling anxious and unsettled for the rest of the day.  I got the order, that much I do remember.

Anyway, that was vicarious trauma.  Something about her story triggered a very physical response in me.  And trauma is physical – it’s a reaction to stress that settles into the very tissue of your body.  But what can you do about it?

First, before you even notice symptoms, act protectively.  Dr John Arden recommends a technique called SEEDS – Social Connectivity, Exercise, Education, Diet and Sleep.  I’ll let you read more about what that means on that link, as he explains it in his own words, but the TL;DR is: be social, exercise regularly, keep your brain engaged, eat well and sleep well.

As usual, it is an unfortunately able-bodied technique that assumes people at risk of experiencing vicarious trauma are automatically capable of these things.  When I’m healthy and not in a flare-up I’m perfectly capable of taking each of the above precautions (except, apparently, when there are cakes to be made), but they are that much harder when you’re sick.  So for us, it becomes a case of “do what you can.” Unfortunately these factors don’t become any less important for us, so we have to find ways of doing them that work for us.  Maybe our social connection needs to happen by phone or in our house.  Our exercise might just be yoga or a couple of minutes on an exercise bike.  Education might be pausing our Netflix binge of unhappiness to do a Sudoku or logic puzzle, or switching to a documentary.  For diet, ensure that the meals buried in the freezer aren’t just chips and pies, or that your Deliveroo includes some vegetables.  If pain or medication is interfering with your sleep, talk to your doctor about counteracting that with sedatives, melatonin, or anti-insomnia techniques.  Practice good sleep hygiene as much as you can.  The more you do these things, the better able you will be to fight trauma when it comes, vicariously or otherwise (and the better you’ll be at dealing with flare-ups). However, if you aren’t achieving them, don’t beat yourself up – that’s really counter-productive.  Practise some self-compassion.

Second, learn to identify it in yourself and others.  It may be represented by changes in behaviour that are totally innocuous or even appear beneficial, such as a renewed dedication to work that even borders on or later becomes workaholism.  It may be a previously loud person becoming withdrawn, or a quiet one becoming overly loud.  It might be an increase in substance use or an inability to sleep resulting in exhaustion.  If it is you that is at risk, check in with yourself.  Take the time to see how you are feeling and compare that to other days.  It’s a weird thing to do, but analyse yourself and don’t give yourself a pass.  By that I mean, if you notice that you are tense and agitated, don’t just say, “oh, that’s just because work is busy.” Instead say, “I think that’s just because work is busy at the moment, but I’ll keep checking in on it.” If work calms down and you don’t, it might be time to speak to someone.

Finally, if you realise it that there is a problem, talk to someone.  If you have a supportive boss, discuss with them if perhaps you can take a short break from the thing that traumatised you – for example, I might ask if I can do a week of general civil law instead of domestic violence and help people with debt, tenancy and employment instead.  However, you may not have the option for that, so you may need to speak to someone outside of work.  If your work has an Employee Assistance Programme, utilise it.  If you need a starting point, try calling the Blue Knot helpline on 1300 657 380.  Talk to your GP about a mental health plan.  If you are a student, access the resources at your school or university.

I just want to finish by saying that the training provided was excellent.  The trainer was a psychologist and he was clear incredibly passionate about what he does.  If it is something that could benefit your workplace, I really recommend it.

Are you in an at risk job?  Have you ever noticed vicarious trauma symptoms in yourself?  How did you deal with it?  Let me know in the comments.

RUOK Day and the Cake of Doom

Published on by Bubbles in the Brain1 Comment

TW: Suicide, mental health

Yesterday I explained that I am engaged in a battle to the death over who at my workplace can make the best cake.  I will tell you the results of that epic showdown, but first I want to talk a bit about RUOK Day.

Did you know that 8 Australians take their own lives every single day?  Even higher numbers than that make attempts.  Rates of suicide are higher amongst men.

This is particularly relevant to people suffering from endometriosis, and chronic illness in general.  Why?  Because there are three main factors that make it more likely that someone will commit suicide: social isolation, feeling like a burden, and the means to follow through.  I’ve talked before about how easy it can be to become socially isolated when struggling through a flare-up, and that feeling like a burden is one of the many mental side-effects of physical pain.  With the amount of strong painkillers many of us have access to, means to follow through completes the endometriosis-suicide trifecta.  We are an at-risk group and today really brought that home to me.

RUOK Day focuses less on people at risk of suicide, though, and more on the rest of society and what ordinary Australians can do to help their friends, colleagues or loved ones through the power of asking a simple question, “Are you ok?”  It teaches listening without judgement, helping the person struggling to seek appropriate help, and continuing to check in with them (in my view the most important step of all).  It’s never going to be an easy conversation to have – it may be embarrassing and overly intimate for both parties, but they are right when they say it can save lives.  I encourage everyone to head over to their website, watch some of the informative videos they have on how their system works, and put it into practice.  Use this day as a chance to check in with friends and family.  That simple act of connection may pull someone back from the brink.  It may pull you back.  I’ve written before about the importance of maintaining social connection even when you feel like you can’t.  Take a step to do that right now.  Ask yourself, “Are you ok?”  If you aren’t, speak to someone.

On a lighter note, my workplace wisely decreed that the path to mental health is built on cake.  Ironically, I had to fight my way through crippling knee pain (my knees were swollen and aching from referred back pain) to make my cake, I literally lost sleep over it, I would have skipped dinner if not for my husband, and I shed real tears.  Not my proudest mental health moment.  However, the cake was a success!

I was attempting to recreate Anthea of Rainbow Nourishment’s glorious Golden Gaytime cake.  For those outside Australia going “um…what?” the Golden Gaytime is a popular and delicious ice-cream that is sadly not vegan.  I based my recipe partially on Anthea’s ice-cream bites of the same flavour, and improvised a whole lot.  I topped it with a bunch of things from her beautiful e-book, “Nourishing Treats”, including date-tahini-caramel swirls, hazelnut chocolate dough, and vegan Ferrero Rochers.  I also made some banana popsicles but the cake was so full of treats that it didn’t need it (and they also were just really unfortunately and inappropriately shaped).  On the plus side, they are safely in my freezer where I can eat them all.

Although it lacks the professional finish of Anthea’s cake, I was pretty proud of how it came out.

My cake 1.JPG
We had a crunchy chocolately base, a caramel ice-cream layer, a chocolate ice-cream layer, a vanilla ice-cream layer, chocolate drizzle, tahini-date caramel at the edge, chocolate hazelnut swirls, Ferrero Rocher bits, shards of chocolate, cacao nibs and cookie crumbs – all made from scratch!

I was up against some very stiff competition, though.  There were six cakes in all.

Banana and raspberry.JPG
I was tempted to try and steal that nice little chopping board.

Offering number one was this banana raspberry creation, vaguely reminiscent of an aeroplane.  This cute little number was a runner-up (ranked in the bottom three) and won a box of cake mix.

White chocolate and macademia.JPG
Does anyone else always try and spell macadamia as “macademia”, like some bizarre cross between nuts and university research?

Offering number two was this plate of delicious-looking white chocolate and macadamia cookies, which deserve special mention as the baker was sick with a sinus infection and still loved his colleagues and the promotion of healthy minds enough to bring in biscuits for us.  Despite his efforts, these biscuits also landed as a runner-up and also won some cake mix.

Hamburger.JPG
Doesn’t the “cheese” look disturbingly realistic?

Offering number three I found unbelievably odd.  This cake actually looked very much like a cheeseburger.  Now, don’t get me wrong, I love a good (vegan) cheeseburger, but there is something about seeing one in cake form that just does my head in.  However, it is very clever and landed a neat third place.

Chocolate and raspberry.JPG
Beautifully presented and it smelled AMAZING.

Offering number four was this decadent gluten-free chocolate-raspberry cake, which was apparently full of whiskey.  This was the one I was most sad about not being able to eat because it looked so good (mine was the only vegan cake so I couldn’t taste-test any of the others).  To my surprise this cake also only made it into the runner-up position – I think maybe not enough people tried it as it was on the smaller side.

Maltesers.JPG
The inside sponge was vegan so I did manage to nab a taste of that and it was admittedly delicious.  Why must I be surrounded by such talented women?

Finally, my main competition, made by my work bestie and towering over its competitors: the gravity-defying Malteser cake.  It is with a heavy heart that I admit that this cake beat mine to take out the main prize of a silicon muffin tray and loaf tin, and I walked away with second (a very nice glass tray).  Admittedly it was an excellent cake and the win was not undeserved.

Layers.JPG
A better look at the layers in my creation.

All in all, I was very happy to come second.  I had some stiff competition and although mine looked incredibly decadent, it wasn’t particularly sweet.  Barring the chocolate, it had no refined sugar and relied on date and a small amount of maple syrup in the Ferrero Rochers for sweetness.  However, I think the lack of sweetness may have worked in my favourite – it was cold and relatively refreshing and I think would have stood out because of that.  It also managed to be quite rich, thanks to being 90% coconut cream, and had all sorts of textures thanks to the crunchy base, nutty crumble, stiff chocolate and smooth creamy layers.

So, what’s the take-away from today?  Eat cake, but don’t hurt yourself to make it.  Perhaps more importantly, look after your mental health, and look out for your friends.

Talking to Children About Their Endometriosis

Published on by Bubbles in the BrainLeave a comment

According to modern medical wisdom, there’s a whole bunch of reasons why someone will get endometriosis.  Unfortunately, one of the factors seems to be genetics.  It can be inherited through either the paternal or maternal line, so don’t be too quick to blame your mother just because she’s got the requisite equipment, so to speak.

Anyway, if you’ve got it, there’s a good chance that any children or grandchildren of yours with the corresponding reproductive organs could develop it too.  Alternatively, you may be someone without the disease but have found out that your child has it.  Either way, your chat with them is going to have to be a little more comprehensive that the usual “talk”.

Now, I’m going to assume that this particular chat isn’t going to need to happen until your child starts to get their period, so this is mostly going to be aimed at 12-15 year-olds.  I know some children do get their periods younger than that, but even in those cases, it generally takes a few years for the symptoms to become obvious enough to start seeing a doctor about.  I think I got my period around 11 or 12, but I didn’t really become conscious of severe pain until several years later, at 14 or 15.  My experience isn’t universal, but it seems to be the age most young people become aware of it, so that’s the age that this post will be pitched at.

First and foremost, I think it is vital that young people understand how their own body works.  I also think they should get the anatomical breakdown of the bits they don’t have, because understanding the human body is useful and important.  Regardless, knowing their own internal workings will help them understand exactly what the disease is and how it is effecting them, save a lot of time in the doctor’s office, and make explanations from any treating specialists a lot more comprehensive.  Make sure your teenager knows the meaning of uterus, ovaries and Fallopian tubes and how they work together.  Make sure they understand the menstrual cycle, and not just the period.  Explain ovulation and how our hormone levels can fluctuate based on what stage of the cycle we are at.  Explain how the different stages of the cycle effect the body.  Most importantly, establish what is normal and what should be concerning.

Second, listen to them and believe their pain.  I’ve talked before about how we often aren’t believed.  Don’t be another person in a child’s life who assumes that they are exaggerating, hysterical or don’t know their own bodies.

Enquire.  If they say something is wrong, do a preliminary check.  If their periods are alarmingly heavy, ask about the frequency, whether they are having cramps, or if they are having bowel symptoms.  Encourage them to be open and honest with you or another adult they trust.

Get them medical attention, and fight for them if the doctors aren’t interested.  Young people tend to believe it when someone in authority tells them that they are wrong, and  I can say from bitter experience that it is pretty crushing and starts the cycle of having no confidence in your own assessment of your pain levels.  Talk them through their rights in the medical system and what to expect when visiting a specialist.

Give them autonomy over their own bodies.  The older they get, the more maturity they will be able to exercise in relation to their medical decisions.  Letting them have their opinions heard about particular options is important in helping them feel empowered.  I think it’s super risky to be forcing a teen into a particular course of treatment, particularly with a disease like this where everyone reacts so differently.  Give them the benefit of your experience and opinion, but my view would be that, if they are not happy with a proposed course, forcing them into it isn’t likely to be of much benefit, especially if they are an older teen.

Likewise, make sure they have a good relationship with their doctor.  I’ve changed had four specialists.  It’s important to find the one that is a good fit with you, particularly given that they are going to get up close and personal with your up-close-and-personals.  If they don’t have any confidence in their specialist, find them one that they can trust.  Ask what they want from a gynaecologist – they may want a particular age or gender, or to try someone recommended to them by someone else.

Encourage them to ask questions and do research.  Make sure that they have all possible information about their disease and whatever options they are pursuing, whether medical or surgical.  Link them up with a support group, particularly if you can find one of other young people.  Give them a place to share their experiences and chat with people their own age.  They might have questions that they don’t feel comfortable asking a parent or an adult doctor.

Be patient and understanding.  Of course you should encourage them to try their best and push through when they can.  It completely sucks, but it is the most unfortunate reality of endometriosis that we have to do stuff that it hurts to do.  However, if they say that they cannot do something because it is simply beyond their physical ability, don’t push them.  That does nothing but make us worse.  Let them rest and recover when they can.  I vividly remember being shamed out of sick bay during high school by unsympathetic nurses.  Don’t be that person.  We don’t like that person.

Facilitate them having as much of a normal life as possible.  Help them get to events with their friends and do extra-curricular stuff.  They might not be able to cope with the physical stresses of sporting classes, but perhaps they could do a painting or drama class.  If they can’t compete in the school athletics carnival, get them decked out in house colours so they can show their support.

Unfortunately, you may need to be a bit of a disciplinarian.  Teenagers make stupid decisions (actually, do we ever grow out of that?).  Even more than normal teens, young people with endometriosis need to safeguard their health.  That means a healthy diet, plenty of sleep, the right supplements, fresh air and sunshine, gentle exercise etc.  Many teenagers have the tendency to stay up super late and then sleep in for hours, things they can’t do during the school week and which messes with their circadian rhythms and whatnot.  I’m not saying they can never have a late night, but getting them to have a solid routine is really important because they have to go to school and school is full of germs which they are more likely than your average person to catch.  Likewise, if they would like to live off chips and pizza (wouldn’t we all) rather than a balanced diet, you may need to put a foot down.  Get them involved in making healthy meals that they will like, if you can.  My sister and I love making our own pizzas (although hers are mostly meat and cheese, so not a totally balanced diet there).

Ultimately, there’s no road map to parenting, and dealing with a child with a chronic illness will be even harder than raising a child in the pink of health.  How do you help your child with endo?  Any tips not included here?  Any difficult experiences you can share to help other parents avoid those situations?  Please let me know in the comments!