This week's Torah partion is about lepers...it is called Mezora.
It reminds me of a difficult and lonely time in my life when I was treated like a non-person, or less than a full member of the community. It was a period I was so eager to put behind me that I spent little time reflecting back upon it until years later, when I came back into the community and discovered an old acquaintance standing in the shoes I had once worn. I asked her about her experience and, as she described the way others were treating her, my memories of rejection and loneliness came rushing back and I knew I had to help her.
I immediately made plans to throw a party and I invited a bunch of the people who were ignoring this woman in their midst. When I explained to one of them what I was doing, she denied that it could be true. Ironically, this friend was one of the people who had ignored me when I had stood in my old shoes but became my friend when I returned wearing a new pair. I told her how I knew it was true, without mentioning that she had once treated me the same way.
The shoes I'm overstretching here are the metaphorical shoes of a divorced woman, or, as some people who haven't walked in them might put it, of a "single mother by choice".
The reason I mention this is because I wonder whether it's the perception that some women CHOOSE to become divorced that exempts them from the loving ministrations of the community, or if not, what is it that makes people behave the way they do?
It is marvelous that when a married woman becomes gravely ill, the community lines up to help - they visit, they bring meals and gifts, they offer to do errands, they drive the woman to and from doctor appointments, they cart her children around for her. It is absolutely a wonderful thing. It feels great to help people in their time of need, when they feel overwhelmed, when their life seems to be falling apart. It makes us grateful not to be in their shoes, faced with our own mortality.
But when a woman gets divorced, she is a pariah, very much like the lepers of the Torah. Generally speaking, a woman not only needs a whole new skill set, but also a whole new set of friends and support system, because she suddenly becomes persona non grata to a shockingly large portion of the community. I'm not sure it is even a conscious decison people make, and I'd certainly prefer to think that it is not, but every time it happens to a friend, I reach out to them, only I hear how rare my kindness is.
As beautiful as it is to witness the outreach to the wife whose physical health is slipping away from her, that is how ugly it can be to witness the phenomenon of people turning their backs on the divorcing woman as her world is crumbling.
I was divorced 15 years ago and since then I have counseled such a great number of people - both lifelong friends and those who were drawn to me just for that season of their lives - that I have become, quite accidentally, a bit of an expert.
I think this expertise obtained because I have so much compassion for women at this painful point in their lives. Admittedly, I simply love talking, helping, and giving advice, but it's more than that. Especailly when I meet a person who came to town in a relationship and now, bereft of that relationship, finds herself utterly alone, well, I really "get it" and evidently, that is rare. First of all, no woman becomes a single mother by choice. Either her husband leaves the marriage, or she leaves because she is on the verge of losing her mind. In the latter case, she leaves to save her life. She generally does not leave the marriage until there is no longer any viable choice. In all my years of becoming an expert on this subject, I only encountered one person who chose to leave her marriage to play the field because she was pretty sure she could score an upgrade. She traded up and then her second husband left her. In that instance, I had a bit less compassion, but as far as I can tell, her story is very unusual.
Because divorce sucks.
When I moved to Cincinnati married to a native son, I was embraced to some degree by the community of folks my husband had grown up with. When I divorced him, they turned their collective backs. One woman, whom I considered a friend because she kissed me whenever she saw me, invited us to parties, took me out to lunch, brought us a lovely baby gift, attended our son's bris, had us break the Yom Kippur fast at her parents' house, and invited me to faux finish her dining room in exchange for pizza, explained, when I went to her for comfort, that while she hadn't really been friends with my husband while growing up, so far as she could tell he had become a real mensch. So, if I was leaving him, well, we could no longer be friends.
Others were more subtle, leaving me to the conclusion that Cincinnati was just an extrmely cold and unfriendly place. I immersed myself in parenting my young son, accepting the fact that he and I were now two people "on our own", as my photo albums from that era are labelled. We had a lot of fun together, and we had an incredibly close, intense relationship, but we were constantly isolated and alone in the middle of a crowd. No invitations to playdates or shabbat lunch. No invitations to much of anything. I felt lucky if anyone spoke to me. On the playground with my son after school, the only adult who engaged with me was the grandmother of another preschooler. Ironically, she was a good friend of my former mother in law, but she was the only adult (other than the teachers) whom I remember talking to on a regular basis at my son's school. We took the kids for ice cream a couple of times and it was shocking treat for me to get to talk to another adult in this context. I wonder if she has any idea how much I appreciated her kindness. When I am done with this blog post, I plan to call and tell her.
I joined a new temple and attended services weekly, took a class at lunchtime, but nobody there reached out to me, not even the rabbi and his wife. My decorative painting clients were often quite friendly while I was in their home, but that was as far as it went. It was clear that I would have to create my own life. I was (if you know me, you know this) far from shy, but I had just two, very busy friends in town - one was my nanny, and the other, Gillian, a single friend from college, who had moved here to join the local symphony just as I was preparing to get divorced.
The scarcity of friends left me plenty of time for myself. When my son went to be with his father, I either exercised alone in my kitchen, did volunteer work, housework, filled photo albums with pictures I'd taken of my son, or hung out with the new gay friends I made through my work as a decorative painter.
The other thing I did was to go out on blind dates. These were either the result of an ad I placed in the newspaper or, later, when I became more selective, through an old fashioned Jewish matchmaker. Nobody in my "community" ever once asked me if I wanted to meet someone they knew. Early on in my divorced life, I met an older guy when I went to shabbat services elsewhere, and I went out with him only because (1) he was tall (2) I despaired of ever being introduced to anyone. I even auctioned myself off from a catwalk once when someone asked me to help the charity she worked for.
Eventually, one of those dates actually led somewhere. I became engaged, and when I did, there was a palpable shift. Actually, it was a bit more like an earthquake. Clients started acting like friends. One client made a bridal shower for me. Other clients attended, showering me with gifts and positive attention. Even though I felt like exactly the same person, no more or less atrractive or friendly, it was as though my "leprosy" had suddenly cleared up, my pariah status had been nullified. I didnt have any more money than before because I was marrying a graduate student earning his Phd and paying off student loans. But some of my clients - now our friends - even came to our wedding, even though it was hundreds of miles away, in Cleveland.
So, mezora. This is still how we treat the lepers. I hope it is clear that I am sharing my story not to complain, not to criticize, but merely to raise awareness and increase sensitivity. The town I once thought of as unfriendly when I was divorced has yielded up a great abundance of good neighbors and friends, a fun community orchestra and an incredibly supportive and loving yoga community. I have a wonderful husband, three of the best children in the world, and a temple community where people in all stages of life are genuinely included and embraced.
I recently started a new blog to open up conversations about certain female topics on which we tend to remain silent, and then this week's portion reminded me there is yet more silence that I feel should be broken. My hope is that you will now think of a divorced person in your community and reach out to her or to him. My dream is that you will read this and invite them, include them, or offer them a helping hand. You never know what sort of shoes you might be standing in someday. May you never walk alone.
Sunday, April 10, 2011
Saturday, March 26, 2011
running with the runs
Vaginologue has inspired many of us not only to become aware and comfortable with our bodies as women, but also to find strength in sharing these experiences with each other. I was chatting with Nancy, (Vaginologue's founder) laughing, of course, and also admiring her bravery in writing about her vagina and bladder “issues”. (I just LOVE the word “issues”)
In her first post, Nancy mentions that she will be discussing the anus, rectum, colon and so on. I mentioned (in jest) that when we she was ready for this area, I am an expert. So here we are…
I have had ulcerative colitis for over 12 years. I was diagnosed while pregnant with my twins, who are now 11. My main symptom at the time was bleeding when I went to the bathroom. This is of course was alarming to doctors, and so began the poking and prodding of my body which already had plenty going on in it while gestating two babies. The first guess was that is was a hemorrhoid. BTW, you can be sure of a post in the future devoted just to hemorrhoids!!
I was sent to a proctologist who actually had printed on the door to his office, “Diseases of the Anus and Rectum”. If you want to feel badly about yourself, go ahead and walk through that door. The problem with my trip to the proctologist was that in order to examine you, you have to lay face down on a table and my bulging tummy simply would not allow it. The rest of the time was spent with the doctor and his assistant positioning me every which way trying to figure out ways to access my asshole, only to find I did not in fact have a disease of the anus and rectum.
I purposely include this lengthy intro because it displays how the diagnosis process is sometimes the worst part in facing these issues with our bodies. Many people take years to finally follow through all the way because it is humiliating, expensive, painful, time consuming and very, very frustrating.
OK, back to ulcerative colitis (UC). To shorten the details, UC is basically ulcers and inflammation of the colon. It results in cramps, bleeding, urgency to go to the bathroom and when you do, it is often in vain because it leaves you with an entrance/exit the width of a piece of spaghetti. I don’t mean to trump bladder problems, but you cannot pass off shitting your pants with “spilling water on your pants”. There is a simple fact about people with UC: If you have it, you have had an accident!
At first you face a true fear about it (that never really goes away) but then if you are lucky, you do gain a sense of humor about it and realize that the human body, while miraculous, sometimes sucks!!!
What Vaginologue really illustrates for me is that these changes to our body are difficult for many reasons, but mostly because as we age we still feel young, strong, sexy, confident and busy as hell. These “issues” keep us from feeling like ourselves and doing the things we want to do. They show us that we are human and that we cannot control how our bodies change, no matter what healthy food we put into it or how many yoga classes we take. (Did I mention how much I hate not being able to control things??!!)
When I have a flare up (as we call them), I am usually sick in the morning. I will visit the toilet at least 1000 times, each time leaving very little stool behind (because my colon is so inflamed, nothing can pass through it) but what looks like a gallon of blood is all I have to show for myself. This process interrupts my life bigtime!! When I feel a cramp, I know I have 4.2 seconds to get my ass on the toilet, or else. This makes it challenging to get kids out of bed and dressed, make breakfast, enjoy a cup of coffee while reading the paper, and you can forget morning sex or any kind of interaction with your significant other.
As soon as I am certain that there is nothing left in my body and have wiped away the sweat, I try to get on with my life. For me that means being a mom, wife, daughter, friend, educator and runner. I get really pissed if any of this gets in the way of one of my runs (no pun intended)!
About 1 month into my new marriage (2nd one’s a charm!) my husband and I went for a run. I was in the middle of a terrible flare up, that started on my honeymoon (really God?!). I did have to stop a few times to breath through some cramping, but I did make it through the run….until we were at the house next door to our house (yes, that is 1 house away from my house). All I can say is that it happened fast. I looked longingly at my house, which simultaneously seemed so close and yet so far away. My 4.2 seconds simply wouldn’t allow me to get to my bathroom. Not knowing what to do I stood still and merely sat down on the curb and let it happen. My husband, Scott, looked at me with a blank stare as he saw the bloody diarrhea dripping down my legs. I looked up at him and simply asked him to please get me towel. I draped myself in the towel and went straight into the shower. Scott really was puzzled. He could not for the life of him understand why I would have chosen to shit my pants on our neighbors curb instead of in our bathroom. Um, hello!!
For many weeks after the incident, we could not pass the curb without snickering. And so, life and all that it entails goes on…
Thursday, March 24, 2011
multi-tasking
Multi tasking is the m.o. of all those of us blessed with ADHD, especially moms, since all moms multi-task, even the "normal" ones. So, you can only imagine my joy at having weights I can use while practicing the violin, doing laundry AND cleaning my oven.
The set of vaginal weights arrived on Tuesday and for a moment I dropped everything I was doing, which was practicing the violin. I had just picked up two of the pieces we would be reading the next night at rehearsal and I wanted to listen to them on you tube while flipping through my part and even trying to play along. I was practicing while sitting down because it's orchestral music and that's how I'll perform it when the time comes.
Anyway, as soon as I saw the delivery truck drive away, I ran outside. The package said it was from essential control (LOVE that name) so I tore it open and immediately assembled the essentially conical shaped weight (no, it's not a tiny barbell) so that it held the lightest of the 5 inserts, washed it in the ktichen sink and, with a casual glance at the instruction pamphlet, inserted it into my vagina.
Lovely.
Imagine a very heavy, slippery tampon. To keep it from falling right back out, you must contract the same muscles you would use to stop the flow of urine. You also should wear snug underwear, just in case your muscles tire out. The brochure recommends using the weight initially for just 15 minutes. Once that is achieved, it suggests adding various physical activities like walking, climbing stairs, deep lunges and eventually, jumping on and off a BOSU.
With the weight securely in place, I decided to practice Brandenburg 4, so that I was standing up...because that is how I will perform it.
The next thing I knew, it was time to pick the boys up from school so I just ran out of the house with the weight still in place. Before I knew it, I had been contracting my pelvic floor muscles for over two hours straight. My muscles were not twitching, but they were very fatigued. It was a stupid thing to do, but it's so typical of me to overdo something the first day.
The next day, I realised almost immediately upon re-inserting the weight that I would need at least a day to recover.
Today is the third day and I used the weight for just a short time this morning after getting the kids onto the school bus. I remarked to my husband, who was preparing to go to work, that I feel so frustrated by what is seemingly a long road ahead of me. To be at the first level of "competence", on the very lightest weight, rather than mastering it instantaneously, feels very discouraging.
His response was "um...HOW many days ago did you get the weights?"
And so, I smacked him in the back and said "shut up!" and "have you met me?" and we laughed.
I'm about to leave for New York with my teenage son, and the weights (as well as the violin) will be staying home without me. I will do core and pelvic floor exercises every day, though: on the airplane, on the subway, while waiting in line to buy tickets to a Broadway show, and presumably during the question and answer sessions at Columbia and NYU. I'll resume my full "workouts", my violin practice, and my visits with my lovely physical therapists, after Spring Break, and I'll check back in with you then.
Ciao!
The set of vaginal weights arrived on Tuesday and for a moment I dropped everything I was doing, which was practicing the violin. I had just picked up two of the pieces we would be reading the next night at rehearsal and I wanted to listen to them on you tube while flipping through my part and even trying to play along. I was practicing while sitting down because it's orchestral music and that's how I'll perform it when the time comes.
Anyway, as soon as I saw the delivery truck drive away, I ran outside. The package said it was from essential control (LOVE that name) so I tore it open and immediately assembled the essentially conical shaped weight (no, it's not a tiny barbell) so that it held the lightest of the 5 inserts, washed it in the ktichen sink and, with a casual glance at the instruction pamphlet, inserted it into my vagina.
Lovely.
Imagine a very heavy, slippery tampon. To keep it from falling right back out, you must contract the same muscles you would use to stop the flow of urine. You also should wear snug underwear, just in case your muscles tire out. The brochure recommends using the weight initially for just 15 minutes. Once that is achieved, it suggests adding various physical activities like walking, climbing stairs, deep lunges and eventually, jumping on and off a BOSU.
With the weight securely in place, I decided to practice Brandenburg 4, so that I was standing up...because that is how I will perform it.
The next thing I knew, it was time to pick the boys up from school so I just ran out of the house with the weight still in place. Before I knew it, I had been contracting my pelvic floor muscles for over two hours straight. My muscles were not twitching, but they were very fatigued. It was a stupid thing to do, but it's so typical of me to overdo something the first day.
The next day, I realised almost immediately upon re-inserting the weight that I would need at least a day to recover.
Today is the third day and I used the weight for just a short time this morning after getting the kids onto the school bus. I remarked to my husband, who was preparing to go to work, that I feel so frustrated by what is seemingly a long road ahead of me. To be at the first level of "competence", on the very lightest weight, rather than mastering it instantaneously, feels very discouraging.
His response was "um...HOW many days ago did you get the weights?"
And so, I smacked him in the back and said "shut up!" and "have you met me?" and we laughed.
I'm about to leave for New York with my teenage son, and the weights (as well as the violin) will be staying home without me. I will do core and pelvic floor exercises every day, though: on the airplane, on the subway, while waiting in line to buy tickets to a Broadway show, and presumably during the question and answer sessions at Columbia and NYU. I'll resume my full "workouts", my violin practice, and my visits with my lovely physical therapists, after Spring Break, and I'll check back in with you then.
Ciao!
Thursday, March 17, 2011
free weights, just for her!
OK, Ready? I can hardly believe this myself. I just ordered a set of free weights. For my vagina.
I don't know about you, but I am very amused by this. When Emily, my physical therapist saw me yesterday, first, she asked "How was your concert on Sunday?" because Victoria, my other therapist, had attended our concert with her fiance, Jason, but had not yet seen Emily to give her the full report.
But then, after hearing a bit about the concert, Emily was excited to tell me about some training equipment I can use at home to bulk up my pelvic floor muscles. Emily knows how much I love using various pieces of fitness equipment at the gym, so she was eager to tell me about a product called Step Free Vaginal Weights. She has a set in the office, still in its plastic wrap, just to give patients an idea of what they look like. (I had a busy evening yesterday after therapy, so I just ordered mine before writing this blog post.) The weights reminded me of a wireless electronic toy that is operated by remote control by one's partner, which Emily found intriguing, so she and I had a little nice conversation about that, and then she explained how the weights are used.
The point is that by using the weights regularly, as with any new strength building exercise, the muscles will change in shape and size in about four to six weeks. So, yes, this means the plan is that I am going to bulk up my vaginal muscles. Hmmm...
We can tell, from the areas that remain challenging for me, that this is what needs to be done. As I had hoped and predicted, I am currently on track to be the valedictorian of pf&c rehabilitation. My strength scores have improved consistently and dramatically from one week to the next, so that I am now hitting "above normal" levels on both the quick flicks and during the first half of the long holds. So, one challenge is that I still need to build stamina, but the good news is that I am well on my way. The other challenge is that if my legs are spread wide, as they are during triangle pose in yoga class, or while running down a snowy hill to retreive an errant sled, the slightest trip or wobble can result in leakage. The element of surprise continues to override the work I am doing by mindfully performing Kegel exercises while loading dishes and putting away clean laundry.
Legs Apart + Surprise = Leak
So, just as my strong muscular legs and arms are constantly prepared to stop me from falling or hurting myself when I am surprised by a false step, so must my vaginal muscles be constantly ready to keep the urethra supported when a sneeze or loss of balance threatens to allow urine to be released.
Our family went to Dick's (the sporting goods store) last night and while Sam was trying on baseball cleats, I played catch with Isaac using a 4 pound medicine ball, and then I bought a Bosu ball and a 36" foam roller. These are basic gym equipment for toning and strengthening your core, but which also can be very helpful in exercises I've learned to do to strengthen the muscles of the pelvic floor. I was delighted to have my very own equipment, and I was so busy trying it all out after the kids went to bed last night that I forgot to order my vaginal weights, but now I have, and they should soon be on their way to me.
Next week, I won't go to pf&c therapy because I have a full day field trip with Isaac, and then the following week is Spring Break, so I'll be busy doing mom stuff. So, I won't return for more therapy (and assessment) until April. I'm excited to see how much progrerss I can make by then. I continue to feel very optimistic. I'll let you know how goes with my new set of weights when they arrive.
I don't know about you, but I am very amused by this. When Emily, my physical therapist saw me yesterday, first, she asked "How was your concert on Sunday?" because Victoria, my other therapist, had attended our concert with her fiance, Jason, but had not yet seen Emily to give her the full report.
But then, after hearing a bit about the concert, Emily was excited to tell me about some training equipment I can use at home to bulk up my pelvic floor muscles. Emily knows how much I love using various pieces of fitness equipment at the gym, so she was eager to tell me about a product called Step Free Vaginal Weights. She has a set in the office, still in its plastic wrap, just to give patients an idea of what they look like. (I had a busy evening yesterday after therapy, so I just ordered mine before writing this blog post.) The weights reminded me of a wireless electronic toy that is operated by remote control by one's partner, which Emily found intriguing, so she and I had a little nice conversation about that, and then she explained how the weights are used.
The point is that by using the weights regularly, as with any new strength building exercise, the muscles will change in shape and size in about four to six weeks. So, yes, this means the plan is that I am going to bulk up my vaginal muscles. Hmmm...
We can tell, from the areas that remain challenging for me, that this is what needs to be done. As I had hoped and predicted, I am currently on track to be the valedictorian of pf&c rehabilitation. My strength scores have improved consistently and dramatically from one week to the next, so that I am now hitting "above normal" levels on both the quick flicks and during the first half of the long holds. So, one challenge is that I still need to build stamina, but the good news is that I am well on my way. The other challenge is that if my legs are spread wide, as they are during triangle pose in yoga class, or while running down a snowy hill to retreive an errant sled, the slightest trip or wobble can result in leakage. The element of surprise continues to override the work I am doing by mindfully performing Kegel exercises while loading dishes and putting away clean laundry.
Legs Apart + Surprise = Leak
So, just as my strong muscular legs and arms are constantly prepared to stop me from falling or hurting myself when I am surprised by a false step, so must my vaginal muscles be constantly ready to keep the urethra supported when a sneeze or loss of balance threatens to allow urine to be released.
Our family went to Dick's (the sporting goods store) last night and while Sam was trying on baseball cleats, I played catch with Isaac using a 4 pound medicine ball, and then I bought a Bosu ball and a 36" foam roller. These are basic gym equipment for toning and strengthening your core, but which also can be very helpful in exercises I've learned to do to strengthen the muscles of the pelvic floor. I was delighted to have my very own equipment, and I was so busy trying it all out after the kids went to bed last night that I forgot to order my vaginal weights, but now I have, and they should soon be on their way to me.
Next week, I won't go to pf&c therapy because I have a full day field trip with Isaac, and then the following week is Spring Break, so I'll be busy doing mom stuff. So, I won't return for more therapy (and assessment) until April. I'm excited to see how much progrerss I can make by then. I continue to feel very optimistic. I'll let you know how goes with my new set of weights when they arrive.
Friday, March 4, 2011
reporting on my second pelvic floor and core rehab session
First off, I want to mention that I am going to drink a huge glass of filtered tap water while I write this post. I highly recommend that you run to the sink and fill up a tall one with the same precious stuff before you read any further.
Coincidentally, I began my work in pelvic floor rehab smack in the middle of a set of 12 group personal training sessions I bought on livingsocial.com. So, on Wednesday, I went straight from an intense workout to therapy. I freshened up with a wet towel in between, so if you were just thinking "ew!" then, no, that was not the issue.
As the future valedictorian of pf&c rehab, I had done my homework well enough to advance to level two of therapy in just one week. Hold your applause, please. Full disclosure: I only leaked once at home during week one, at the end of a series of sneezes that caught me while I was loading the dishwasher. And yesterday, our gym workout included a series of jumps executed while simultaneously scissoring our legs, open and close, rather like a game of hopscotch, and I had to run the toilet as soon as I tried to do it. But the "issue" was - that is, the most frustrating thing for me as a type-A therapy patient was - that the core workout I had to do with Emily (my new pf&c therapist) this week was chock full of exercises that challenged the same groups of muscles I had just pushed to fatigue less than one hour earlier in the gym. Consequently, when Emily hooked up the the hand held video monitor to my pelvic floor and core muscles, she saw digital evidence of someone whose tummy was tired.
Emily immediately found a positive use for the workout that had just worn me out. We reviewed all the exercises I had done at the gym, from that day's workout as well as the previous one, and suggested how I might modify all of them to incorporate the contraction of pelvic floor muscles. Essentially, Emily gave me a lesson in adding kegels to many of the forms of physical activity I perform in the course of a cardio and weight training workout.
It seems obvious that the point of rehab is to enable me to defer urination during all the activities of my day, other than that of sitting on the toilet. But I hadn't thought about specifically incorporating pelvic floor work into a workout designed to target my quadriceps, biceps, deltoids and gluteus maximus, for example. What a revelation! It makes my trip to the gym doubly rewarding.
So, my homework this week is to continue the quick flicks and long holds from week one, and to do them while I am vacuuming, while I am unloading the diswasher, while I am in line at the grovery store, and while I am stooping to pick other people's wet towels off the carpet. But I also have several exercises to do while lying on my back, doing nothing but breathing and targeting my lower abdominals, and/or raising one leg at time. And when I do go to the gym, as I did today and yesterday, I concentrate on including pelvic floor contractions into each and every exercise the trainer asks me to do.
At a gym, you can see and feel how effectively you are targeting an externally visible muscle, like a bicep or tricep, simply by positioning that muscle to face the mirror while you execute the movement. And most people are gratified, while working out, to see the targeted muscle contract and relax in the mirror. Unless you want to position a gooseneck mirror in between your legs, a pelvic floor workout requires a bit more faith. But I know I am working the right muscles in a targeted way and I have to believe that I am going to see some results before too long.
When I went to the desk to schedule my third rehab session for next Wednesday, I felt optimistic enough to cancel my appointment for a cystoscopy, a surgical prerequisite procedure about which I know very little and hope it stays that way.
As always, I will keep you posted. Now, let's finish that drink of water and refill our glass. L'chaim!
Coincidentally, I began my work in pelvic floor rehab smack in the middle of a set of 12 group personal training sessions I bought on livingsocial.com. So, on Wednesday, I went straight from an intense workout to therapy. I freshened up with a wet towel in between, so if you were just thinking "ew!" then, no, that was not the issue.
As the future valedictorian of pf&c rehab, I had done my homework well enough to advance to level two of therapy in just one week. Hold your applause, please. Full disclosure: I only leaked once at home during week one, at the end of a series of sneezes that caught me while I was loading the dishwasher. And yesterday, our gym workout included a series of jumps executed while simultaneously scissoring our legs, open and close, rather like a game of hopscotch, and I had to run the toilet as soon as I tried to do it. But the "issue" was - that is, the most frustrating thing for me as a type-A therapy patient was - that the core workout I had to do with Emily (my new pf&c therapist) this week was chock full of exercises that challenged the same groups of muscles I had just pushed to fatigue less than one hour earlier in the gym. Consequently, when Emily hooked up the the hand held video monitor to my pelvic floor and core muscles, she saw digital evidence of someone whose tummy was tired.
Emily immediately found a positive use for the workout that had just worn me out. We reviewed all the exercises I had done at the gym, from that day's workout as well as the previous one, and suggested how I might modify all of them to incorporate the contraction of pelvic floor muscles. Essentially, Emily gave me a lesson in adding kegels to many of the forms of physical activity I perform in the course of a cardio and weight training workout.
It seems obvious that the point of rehab is to enable me to defer urination during all the activities of my day, other than that of sitting on the toilet. But I hadn't thought about specifically incorporating pelvic floor work into a workout designed to target my quadriceps, biceps, deltoids and gluteus maximus, for example. What a revelation! It makes my trip to the gym doubly rewarding.
So, my homework this week is to continue the quick flicks and long holds from week one, and to do them while I am vacuuming, while I am unloading the diswasher, while I am in line at the grovery store, and while I am stooping to pick other people's wet towels off the carpet. But I also have several exercises to do while lying on my back, doing nothing but breathing and targeting my lower abdominals, and/or raising one leg at time. And when I do go to the gym, as I did today and yesterday, I concentrate on including pelvic floor contractions into each and every exercise the trainer asks me to do.
At a gym, you can see and feel how effectively you are targeting an externally visible muscle, like a bicep or tricep, simply by positioning that muscle to face the mirror while you execute the movement. And most people are gratified, while working out, to see the targeted muscle contract and relax in the mirror. Unless you want to position a gooseneck mirror in between your legs, a pelvic floor workout requires a bit more faith. But I know I am working the right muscles in a targeted way and I have to believe that I am going to see some results before too long.
When I went to the desk to schedule my third rehab session for next Wednesday, I felt optimistic enough to cancel my appointment for a cystoscopy, a surgical prerequisite procedure about which I know very little and hope it stays that way.
As always, I will keep you posted. Now, let's finish that drink of water and refill our glass. L'chaim!
Tuesday, March 1, 2011
the nitty gritty of my first appointment
Tomorrow afternoon, I will have my second pelvic floor and core rehab appointment with Victoria. I'm a little nervous because I told her it was my goal to become the valedictorian of pelvic floor/core rehab and I'm not sure if I have worked hard enough this week to be on track toward achieving that goal. I learned a lot last week, and was gratified to hear that we covered more in my first session than most people do. Yes, I really am competitive in EVERYTHING I do. It's ridiculous, perhaps, but probably too late to change.
Victoria is a very lovely and articulate young woman and a virtual font of helpful knowledge about pelvic floor and core. She is so passionate about helping to improve women's lives through her work that she really inspired me to reach out to all of you.
First, Victoria told me that 6 out of 10 women do Kegels wrong. Uh oh. Pressure. She then hooked me up to several sensors attached to a handheld device with a screen. I got to hold the device and watch the display. Victoria said it was kind of like a video game. Whenever I contracted the muscles to which the electrodes were attached, the screen would show my level of contraction. She told me to listen to the machine and every 5seconds, when a voice prompted me to flick, I should quickly contract and release the muscles that control my urinary flow.
Well, the very first flick showed us that I was using too many of the muscles in the region, but I was immediately able to correct that and focus just on the tiny triangle of muscles around my urethra. Hooray! OK, back to the video game; Flick! 2 3 4 5 Flick! 2 3 4 5 Flick! I had to hand the device over to Victoria and just concentrate on following her instructions because as I watched the contractions register on the screen, I could not resist trying to beat my high score, and that is not good. The screen also showed that I was not relaxing my muscles enough between flicks. But I ask you, HOW does one completely relax when someone you have just met has hooked you up with electrodes all over your nether region? I rest my case.
If you are playing along at home and you want to find out if you are contracting your pelvic floor muscles correctly there is a way to do that all by yourself. Prop yourself up in a semi reclining position on your bed with your kneww bent and legs slightly apart. Place your fingertips in the space between your vagina and rectum. PLace your other hand on your lower abdomen.
Breathe in, allowing the abdomen to expand (your belly button should rise).
As you breath out, close or squeeze shut all openings of the vagina, urethra and rectum. In other words, suck in and up everything below your bellybutton, including lower abs and pelvic floor. If you feel anything pushing into your fingers, you are doing it wrong. The part of you under your first hand should move up into your pelvis and the part under your second hand should move down toward your back.
Quick flicks are when you perform this contraction quickly and then release it for several seconds.
Long holds are when you hold the contraction longer, thus activating other muscle fibers that make up 70 percent of the muscles in question.
The ultimate goal is to be able to perform this contraction every time you lift, push, pull, laugh, cough, sneeze or need to defer either urinating or passing gas.
Victoria also gave me a list of bladder irritants. Drinking too much coffee and soda irritate the bladder, but these fluids have to replaced, not just diminished. Drinking too little during the day can result in urine that is too concentrated and that can also be an irritant to the bladder. (Irritated bladders signal to us that they need emptying even when they are not full.) So, this leads to the same advice you will also get from every diet coach and dermatologist on the planet - drink more water! 48-64 ounces a day. You know there are flavored waters and cute water bottles out there, so load 'em up, keep it with you and keep chugging.
Before I left, I observed that Victoria wears her engagement ring around her neck on a chain the way I did when I was engaged to Paul and painting murals and faux finishes pretty much full time. Latex gloves going on and coming off all the time, ripping on the diamond, was no fun at all. After connecting on the ring on a chain issue, I learned that her fiance is the newest professional violinist in town without an opportunity to perform. He was on the road with Barrage for four years (check them out on you tube if you havent had the thrill of seeing them) until he realized it was time to propose and settle down. I immediately went home and friended Jason on facebook and invited him to check out our orchestra, something I might not have been comfortable doing if I hadn't already made the decision to be so "OUT" about my pelvic floor/core adventures.
I didn't tell Jason how I had met his lovely fiancee, but he made it clear in his friendly, postive response to my email message that she had at least filled him in that I was a patient. So, I am expecting Victoria and Jason at our next concert, on March 13. But before then, she and I have some more good work to do. I will be sure to keep you posted on our progress.
Victoria is a very lovely and articulate young woman and a virtual font of helpful knowledge about pelvic floor and core. She is so passionate about helping to improve women's lives through her work that she really inspired me to reach out to all of you.
First, Victoria told me that 6 out of 10 women do Kegels wrong. Uh oh. Pressure. She then hooked me up to several sensors attached to a handheld device with a screen. I got to hold the device and watch the display. Victoria said it was kind of like a video game. Whenever I contracted the muscles to which the electrodes were attached, the screen would show my level of contraction. She told me to listen to the machine and every 5seconds, when a voice prompted me to flick, I should quickly contract and release the muscles that control my urinary flow.
Well, the very first flick showed us that I was using too many of the muscles in the region, but I was immediately able to correct that and focus just on the tiny triangle of muscles around my urethra. Hooray! OK, back to the video game; Flick! 2 3 4 5 Flick! 2 3 4 5 Flick! I had to hand the device over to Victoria and just concentrate on following her instructions because as I watched the contractions register on the screen, I could not resist trying to beat my high score, and that is not good. The screen also showed that I was not relaxing my muscles enough between flicks. But I ask you, HOW does one completely relax when someone you have just met has hooked you up with electrodes all over your nether region? I rest my case.
If you are playing along at home and you want to find out if you are contracting your pelvic floor muscles correctly there is a way to do that all by yourself. Prop yourself up in a semi reclining position on your bed with your kneww bent and legs slightly apart. Place your fingertips in the space between your vagina and rectum. PLace your other hand on your lower abdomen.
Breathe in, allowing the abdomen to expand (your belly button should rise).
As you breath out, close or squeeze shut all openings of the vagina, urethra and rectum. In other words, suck in and up everything below your bellybutton, including lower abs and pelvic floor. If you feel anything pushing into your fingers, you are doing it wrong. The part of you under your first hand should move up into your pelvis and the part under your second hand should move down toward your back.
Quick flicks are when you perform this contraction quickly and then release it for several seconds.
Long holds are when you hold the contraction longer, thus activating other muscle fibers that make up 70 percent of the muscles in question.
The ultimate goal is to be able to perform this contraction every time you lift, push, pull, laugh, cough, sneeze or need to defer either urinating or passing gas.
Victoria also gave me a list of bladder irritants. Drinking too much coffee and soda irritate the bladder, but these fluids have to replaced, not just diminished. Drinking too little during the day can result in urine that is too concentrated and that can also be an irritant to the bladder. (Irritated bladders signal to us that they need emptying even when they are not full.) So, this leads to the same advice you will also get from every diet coach and dermatologist on the planet - drink more water! 48-64 ounces a day. You know there are flavored waters and cute water bottles out there, so load 'em up, keep it with you and keep chugging.
Before I left, I observed that Victoria wears her engagement ring around her neck on a chain the way I did when I was engaged to Paul and painting murals and faux finishes pretty much full time. Latex gloves going on and coming off all the time, ripping on the diamond, was no fun at all. After connecting on the ring on a chain issue, I learned that her fiance is the newest professional violinist in town without an opportunity to perform. He was on the road with Barrage for four years (check them out on you tube if you havent had the thrill of seeing them) until he realized it was time to propose and settle down. I immediately went home and friended Jason on facebook and invited him to check out our orchestra, something I might not have been comfortable doing if I hadn't already made the decision to be so "OUT" about my pelvic floor/core adventures.
I didn't tell Jason how I had met his lovely fiancee, but he made it clear in his friendly, postive response to my email message that she had at least filled him in that I was a patient. So, I am expecting Victoria and Jason at our next concert, on March 13. But before then, she and I have some more good work to do. I will be sure to keep you posted on our progress.
Saturday, February 26, 2011
The other "end" of my Pelvic Floor/Core rehabilitation
Okay, survey says:
Tell us specifically what you learned in physical therapy!
All right, all right! I'll tell you, I promise...
But first, you really should know that you still haven't read half of what's been bothering me. I didn't want to overwhelm you, but even I didn't even realize how many symptoms I had that could be addressed in Pelvic Floor/Core rehab until I was asked to sit down and fill out the new patient questionnaire.
I have already told you about my urinary issues, but not the um, my rectal difficulties. "Thank goodness!" I thought several times while checking boxes on the survey. I didn't have to check off a lot of the boxes next to any of the problems concerning sexual activity. I felt grateful not to have to admit to peeing on myself while sleeping or having sex, and thankful not to suffer from chronic pain of any kind, or to have parts of me hanging out that shouldn't be.
I had noticed that several things were not returning to "normal" after my third child was born, including some issues with my rectum. This is so uncomfortable for me to write about that I feel the need to indulge in a tangent before I proceed.
The baby himself was practically perfect in every way. Actually, his eyes were very bloodshot at birth and the pediatrician who saw him his first office appointment said it was because I had pushed him out so hard and fast. When I tell people I pushed my ten pound baby out very rapidly because I was very angry, they usually say something like "No doubt you were, honey!"
This is a misunderstanding I usually don't bother to correct. I hadn't been angry at the usual suspects: not at the baby for being so big, nor at myself for getting into this situation a third time, not at G-d, my husband, or life in general. No, it was a very specific anger directed at one D. Schwartz, M.D. who, 6 hours after I had checked into Christ Hospital in active labor, began his on-call duty by sticking two latex covered fingers into my vagina, first, to break my water and then, to measure how dilated I was: "only 8". Next, he palpated my belly to estimate the size of the baby I was about to deliver, and rather breezily announced that he was going to scrub up and would see me across the hall, because the baby was "too big" and he was going to perform a Caesarean section.
My birth plan was to deliver this baby naturally. I was a big fan of the Bradlee Method, having used it to deliver 9 pound, 12 ounce Sam two years previously, and I had been looking forward to a repeat performance. The two pregnancies had been virtually identical, and the babies had almost the same exact due date, just two years apart. The only differences I could detect were that this baby was a bit more vigorous in his movements in utero, and he seemed to be in much less of a hurry to come out. Sam had us racing to the hospital almost two weeks before my due date, and then he was born within two hours of our arrival there. Now, Isaac was four days past due, and so big and heavy that I had been going in for a check every other day for two weeks.
I had deliberately met with and been examined by everyone in the obstetrics office but Dr. Schwartz, so naturally the one doctor in the practice who was unfamilar with my pregnancy was the one to show up for the birth. Now, I was so upset by his casual dismissal of my birth plan that I became enraged. I announced my decision: I would stay put and continue to labor naturally. Then, a moment later, I said "I'm going to have this baby now," to which Paul and the nurse replied sweetly, almost in unison, "that a girl, yes, you are, now that's the spirit" or something to that effect. "No," I said, "I mean RIGHT NOW! I mean I have to push. Please, help me! Hold my legs! The baby's coming out right now!"
Someone was dispatched to tell Dr Schwartz to put on his catcher's mitt and get back to my room. Indignant, I decided I would have someone else catch this baby before he even had time to double back down the hallway. And then, in a sort of tantrum, I pushed with all my might and pop, out came the head of an angry, ten pound two ounce brand new baby boy. I only knew Dr. Schwartz was there because he said "this isn't a newborn, it's a three month old!", and I said "maybe in YOUR family, Dr. Schwartz, but in my family, that's what a newborn looks like." Then he told me that he had cut me "just a bit" to help the baby come out and that he was sewing me up and apologized if it hurt. "Believe me," I said "what you are doing is NOTHING compared to what just happened" which led to this part of my story being misundertstood for the first time.
When you first return home after having vaginally delivered a baby, you may have stitches, as I had. But whether or you not you have had a episiotomy or a tear, or simply stretched yourself to the limit and beyond, you are certainly going to be very tender. Passing the first bowel movement after childbirth is consequently a rather dreadful thing. Mine was no exception. It was not only scary; it was stuck. Very gingerly, I inserted a finger into my vagina and felt my bowel pressing against my vaginal wall. I pushed tentatively and was relieved to feel the obstruction give way, as the bowel movement continued in a proper, downward direction.
The next day, I repeated the same maneuver, helping to guide the bowel movement down and out of my body by gently applying pressure from inside my vagina.
Eventually, waste began passing out of my rectum without manual assistance. But now and then, by which I mean very often, the obstruction would reoccur, and no matter how much I strained, it seemed the stool would not pass through my rectum unless I stuck a finger into my vagina to help it along. It is almost unbelievable that I continued to utilize this "digital" system for so many years without telling a doctor about it. I think we generally have so much shame about our bowels that it is difficult to talk about them. Considering that I am one of those people who doesn't let my spouse enter or remain in the bathroom when I need to use the toilet, it makes sense that I would be reluctant to have a conversation about my toilet related activity with anyone.
Certainly, it is very odd and uncomfortable to be writing about this now, but I am inspired by the idea that I might help someone (or more than one) who is silently suffering as I recently was, unaware that this is a common condition called a rectocele.
When I returned home from seeing the urogynecologist, I didn't even know how to spell rectocele. I typed "rectoseal" into the search bar on my computer and eventually discovered the following definion on the Mayo Clinic website:
A rectocele occurs when the thin wall of fibrous tissue (fascia) separating the rectum from the vagina becomes weakened, allowing the front wall of the rectum to bulge into the vagina.
Reading more, I felt fortunate to understand that my rectosele was fairly mild. Some more severe rectoceles require surgery. In some cases, rectal tissue may obtrude from the vaginal opening, and some are quite painful. While I cannot entirely reverse or "cure" the damage caused by the tremendous pressure that was exerted on the fascia during childbirth, I hope to effect a significant improvement through my work in physical therapy. In addition to tightening and strengthening the muscles that control the sphincter of the bladder, I also hope that by doing repeated pelvic floor exercises, I will strengthen the pelvic floor muscles that wrap around the underside of my vagina and rectum, giving support to both.
I promise to tell you about the specifics of my first pelvic floor therapy appointment, and my homework assignment, in my very next post. Please stay tuned.
Tell us specifically what you learned in physical therapy!
All right, all right! I'll tell you, I promise...
But first, you really should know that you still haven't read half of what's been bothering me. I didn't want to overwhelm you, but even I didn't even realize how many symptoms I had that could be addressed in Pelvic Floor/Core rehab until I was asked to sit down and fill out the new patient questionnaire.
I have already told you about my urinary issues, but not the um, my rectal difficulties. "Thank goodness!" I thought several times while checking boxes on the survey. I didn't have to check off a lot of the boxes next to any of the problems concerning sexual activity. I felt grateful not to have to admit to peeing on myself while sleeping or having sex, and thankful not to suffer from chronic pain of any kind, or to have parts of me hanging out that shouldn't be.
I had noticed that several things were not returning to "normal" after my third child was born, including some issues with my rectum. This is so uncomfortable for me to write about that I feel the need to indulge in a tangent before I proceed.
The baby himself was practically perfect in every way. Actually, his eyes were very bloodshot at birth and the pediatrician who saw him his first office appointment said it was because I had pushed him out so hard and fast. When I tell people I pushed my ten pound baby out very rapidly because I was very angry, they usually say something like "No doubt you were, honey!"
This is a misunderstanding I usually don't bother to correct. I hadn't been angry at the usual suspects: not at the baby for being so big, nor at myself for getting into this situation a third time, not at G-d, my husband, or life in general. No, it was a very specific anger directed at one D. Schwartz, M.D. who, 6 hours after I had checked into Christ Hospital in active labor, began his on-call duty by sticking two latex covered fingers into my vagina, first, to break my water and then, to measure how dilated I was: "only 8". Next, he palpated my belly to estimate the size of the baby I was about to deliver, and rather breezily announced that he was going to scrub up and would see me across the hall, because the baby was "too big" and he was going to perform a Caesarean section.
My birth plan was to deliver this baby naturally. I was a big fan of the Bradlee Method, having used it to deliver 9 pound, 12 ounce Sam two years previously, and I had been looking forward to a repeat performance. The two pregnancies had been virtually identical, and the babies had almost the same exact due date, just two years apart. The only differences I could detect were that this baby was a bit more vigorous in his movements in utero, and he seemed to be in much less of a hurry to come out. Sam had us racing to the hospital almost two weeks before my due date, and then he was born within two hours of our arrival there. Now, Isaac was four days past due, and so big and heavy that I had been going in for a check every other day for two weeks.
I had deliberately met with and been examined by everyone in the obstetrics office but Dr. Schwartz, so naturally the one doctor in the practice who was unfamilar with my pregnancy was the one to show up for the birth. Now, I was so upset by his casual dismissal of my birth plan that I became enraged. I announced my decision: I would stay put and continue to labor naturally. Then, a moment later, I said "I'm going to have this baby now," to which Paul and the nurse replied sweetly, almost in unison, "that a girl, yes, you are, now that's the spirit" or something to that effect. "No," I said, "I mean RIGHT NOW! I mean I have to push. Please, help me! Hold my legs! The baby's coming out right now!"
Someone was dispatched to tell Dr Schwartz to put on his catcher's mitt and get back to my room. Indignant, I decided I would have someone else catch this baby before he even had time to double back down the hallway. And then, in a sort of tantrum, I pushed with all my might and pop, out came the head of an angry, ten pound two ounce brand new baby boy. I only knew Dr. Schwartz was there because he said "this isn't a newborn, it's a three month old!", and I said "maybe in YOUR family, Dr. Schwartz, but in my family, that's what a newborn looks like." Then he told me that he had cut me "just a bit" to help the baby come out and that he was sewing me up and apologized if it hurt. "Believe me," I said "what you are doing is NOTHING compared to what just happened" which led to this part of my story being misundertstood for the first time.
When you first return home after having vaginally delivered a baby, you may have stitches, as I had. But whether or you not you have had a episiotomy or a tear, or simply stretched yourself to the limit and beyond, you are certainly going to be very tender. Passing the first bowel movement after childbirth is consequently a rather dreadful thing. Mine was no exception. It was not only scary; it was stuck. Very gingerly, I inserted a finger into my vagina and felt my bowel pressing against my vaginal wall. I pushed tentatively and was relieved to feel the obstruction give way, as the bowel movement continued in a proper, downward direction.
The next day, I repeated the same maneuver, helping to guide the bowel movement down and out of my body by gently applying pressure from inside my vagina.
Eventually, waste began passing out of my rectum without manual assistance. But now and then, by which I mean very often, the obstruction would reoccur, and no matter how much I strained, it seemed the stool would not pass through my rectum unless I stuck a finger into my vagina to help it along. It is almost unbelievable that I continued to utilize this "digital" system for so many years without telling a doctor about it. I think we generally have so much shame about our bowels that it is difficult to talk about them. Considering that I am one of those people who doesn't let my spouse enter or remain in the bathroom when I need to use the toilet, it makes sense that I would be reluctant to have a conversation about my toilet related activity with anyone.
Certainly, it is very odd and uncomfortable to be writing about this now, but I am inspired by the idea that I might help someone (or more than one) who is silently suffering as I recently was, unaware that this is a common condition called a rectocele.
When I returned home from seeing the urogynecologist, I didn't even know how to spell rectocele. I typed "rectoseal" into the search bar on my computer and eventually discovered the following definion on the Mayo Clinic website:
A rectocele occurs when the thin wall of fibrous tissue (fascia) separating the rectum from the vagina becomes weakened, allowing the front wall of the rectum to bulge into the vagina.
Reading more, I felt fortunate to understand that my rectosele was fairly mild. Some more severe rectoceles require surgery. In some cases, rectal tissue may obtrude from the vaginal opening, and some are quite painful. While I cannot entirely reverse or "cure" the damage caused by the tremendous pressure that was exerted on the fascia during childbirth, I hope to effect a significant improvement through my work in physical therapy. In addition to tightening and strengthening the muscles that control the sphincter of the bladder, I also hope that by doing repeated pelvic floor exercises, I will strengthen the pelvic floor muscles that wrap around the underside of my vagina and rectum, giving support to both.
I promise to tell you about the specifics of my first pelvic floor therapy appointment, and my homework assignment, in my very next post. Please stay tuned.
Friday, February 25, 2011
Kegels, Pessaries and Slings
When I finally confessed and complained to my female gynocologist about my unfortunate tendency to pee when I sneeze, slip, trip, cough or laugh, I had been dealing with it for almost seven years. Out of a combination of denial, wishful thinking and indignation, I refused to wear a pad, so for me, that meant seven years of too many trips to the dry cleaners. Seven years of embarrassment, inconvenience and humiliation that could very closely approach self-loathing.
After an errant sneeze produces a leak, I feel a wet spot in my clothing, and I wait for an opportune moment to sneak a downward peek at my crotch and inner thighs. Does it show? Will people smell it? How soon can I get home to change my clothes?
I used to think incontinence was only a problem for old people. I have long known that people with Alzheimer's eventually lose control of their bladder and bowels. Television commercials for adult diapers (like Depends) do not, so far as I know, feature women riding horseback or playing tennis the way tampon commercials do. Consequently, I never thought it was something people had to deal with in the prime of their life, while they were still premenopausal, very active, and otherwise fit.
A lovely older woman, who is no longer among the living and whose name I will respectfully withhold, coached my string quartet at the Manhattan School of Music the year I turned fifteen. In her prime, she had been a glamorous and sought after virtuoso, whom I had seen photographed in sparkling gowns, cradling her violin in her arms and gazing confidently into the camera. We worked together in a practice room, where she would walk around the four of us as we sat and tried to make beautiful music. When she would pass by me, or stop to adjust my shoulder or hand, her hips were close enough to my face that I detected a strong odor of stale urine.
It broke my heart that this woman, whom I so loved and admired, smelled so much like the stairs in the subway station. I assumed that if she could not prevent this unfortunate condition, then there must not be anything that a person could do about it. I know that this sensory memory of my quartet coach negatively affected my expectations when faced with my own stress incontinence at age 36. I know it is one of the reasons I remained silent as long as I did. It is one of the reasons I had so little hope.
I knew from the "what to expect" books that the way to strengthen pelvic floor muscles was to do Kegels, the same contraction exercises we are taught to do in preparation for labor. I did Kegels on command at the end of every prenatal water aerobics class, which I took in both Michigan and Ohio, where my second and third babies were born.
This is what I remember:
Five or six of us stand in a wide circle, neck deep in cool water, our distended bellies challenging the remaining elasticity of our maternity bathing suits. We giggle self-consciously as the teacher instructs us to clench the muscles of our posterior, and we try to follow, desperately hoping that we are doing ourselves some good. She tells us we should tape an index card to our rear view mirror reminding us "to Kegel" at stop lights, so I know they are important to do.
Somehow, though, I remain unaware that there is any point to "Kegels" other than physically preparing you to push your baby's head more effectively through what will feel like a blazing wall of fire. I remember from my first childbirth experience how frightening and painful this stage of delivery is, and the memory is enough to motivate me. Somewhere along the way, I also hear that it's good to have strong "Kegel" muscles after childbirth, too, and that it feels good for both partners when a woman "Kegels" during intercourse. But even in a circle of women in almost the same exact circumstances, there is very little discussion, in either the pool or the locker room, about our incontinence, a humiliating and inconvenient part of our shared experience. We are focused on labor and delivery, on how many weeks of pregnancy we each have left, on our weight gain, on whether we will nurse or bottle feed, on our hope of taking home a healthy baby. Nobody ever once mentions anything about peeing on herself.
When I brushed off my doctor's suggestion, a year ago, that I undergo "simple, bladder sling" surgery to get better support for my urethra, she told me there was just one other thing that could help. She was reluctant to recommend a pessary for me because I am sexually active, preferring to give them to elderly widows. But I was insistent that I needed an alternative to surgery, and assured her that I was willing to deal with considerable incovenience in order to avoid it. Explaining that I would have to remove it before having sex, my doctor reluctantly fit me for my a pessary, which is rather like a diaphragm with several holes in it, inserted into the vagina and positioned so as to restrict the movement of the urethra.
As I left her office with my new pessary in place, I was hopeful that the device would improve the situation enough to resolve the matter and turn my focus to more pleasant things. On my way out, my doctor urged me again to consider sling surgery, emphasizing that it was not elective, like a breast lift, but rather, quality of life. I could appreciate the disctinction. My husband had just undergone knee surgery for quality of life reasons, and that had been the right decision for him, with great results. But every surgery, no matter how "simple", involves risk.
Also, the fact that a torn flap of cartilage is painfully getting in the way of a moving joint is a very different thing to explain to patient than the fact that her urethra is insufficiently supported by her tired, over stretched muscles. For one thing, we are already familiar with the relatively simple, accessible anatomy of the knee, and if we don't "get it" from looking at the x-ray, there are charts, models and brochures all over an orthopedist's office to help make it very clear.
By contrast, we don't grow up looking at models of vaginas and bladders in our grade school science classrooms. As an English major, I never had to locate or identify a urethra on any test. Most of us don't spend a lot of time looking at these parts of our own anatomy. It's inconvenient, for one thing, requiring a mirror and specially angled lighting. Peeing, for girls and women, is fairly mysterious, at least compared to peeing for boys and men. Most of us learn where and how to insert a tampon, but there is never any reason to help a girl locate her urethra. We don't teacher our daughters to aim their stream at m & m's floating in the toilet; we just tell them to sit down and let it flow.
This is already a long post, so I will pick this story up again another time. I am busy doing my new pelvic floor exercises frequently, both the "quick flicks" and the "long holds", and I am very hopeful. The knowledge I received in just one physical therapy appointment exceeds anything I was ever told previously about the physiological cause and nature of my condition. In my next post, I will tell you more about that appointment and why I walked out of it feeling so very optimistic.
After an errant sneeze produces a leak, I feel a wet spot in my clothing, and I wait for an opportune moment to sneak a downward peek at my crotch and inner thighs. Does it show? Will people smell it? How soon can I get home to change my clothes?
I used to think incontinence was only a problem for old people. I have long known that people with Alzheimer's eventually lose control of their bladder and bowels. Television commercials for adult diapers (like Depends) do not, so far as I know, feature women riding horseback or playing tennis the way tampon commercials do. Consequently, I never thought it was something people had to deal with in the prime of their life, while they were still premenopausal, very active, and otherwise fit.
A lovely older woman, who is no longer among the living and whose name I will respectfully withhold, coached my string quartet at the Manhattan School of Music the year I turned fifteen. In her prime, she had been a glamorous and sought after virtuoso, whom I had seen photographed in sparkling gowns, cradling her violin in her arms and gazing confidently into the camera. We worked together in a practice room, where she would walk around the four of us as we sat and tried to make beautiful music. When she would pass by me, or stop to adjust my shoulder or hand, her hips were close enough to my face that I detected a strong odor of stale urine.
It broke my heart that this woman, whom I so loved and admired, smelled so much like the stairs in the subway station. I assumed that if she could not prevent this unfortunate condition, then there must not be anything that a person could do about it. I know that this sensory memory of my quartet coach negatively affected my expectations when faced with my own stress incontinence at age 36. I know it is one of the reasons I remained silent as long as I did. It is one of the reasons I had so little hope.
I knew from the "what to expect" books that the way to strengthen pelvic floor muscles was to do Kegels, the same contraction exercises we are taught to do in preparation for labor. I did Kegels on command at the end of every prenatal water aerobics class, which I took in both Michigan and Ohio, where my second and third babies were born.
This is what I remember:
Five or six of us stand in a wide circle, neck deep in cool water, our distended bellies challenging the remaining elasticity of our maternity bathing suits. We giggle self-consciously as the teacher instructs us to clench the muscles of our posterior, and we try to follow, desperately hoping that we are doing ourselves some good. She tells us we should tape an index card to our rear view mirror reminding us "to Kegel" at stop lights, so I know they are important to do.
Somehow, though, I remain unaware that there is any point to "Kegels" other than physically preparing you to push your baby's head more effectively through what will feel like a blazing wall of fire. I remember from my first childbirth experience how frightening and painful this stage of delivery is, and the memory is enough to motivate me. Somewhere along the way, I also hear that it's good to have strong "Kegel" muscles after childbirth, too, and that it feels good for both partners when a woman "Kegels" during intercourse. But even in a circle of women in almost the same exact circumstances, there is very little discussion, in either the pool or the locker room, about our incontinence, a humiliating and inconvenient part of our shared experience. We are focused on labor and delivery, on how many weeks of pregnancy we each have left, on our weight gain, on whether we will nurse or bottle feed, on our hope of taking home a healthy baby. Nobody ever once mentions anything about peeing on herself.
When I brushed off my doctor's suggestion, a year ago, that I undergo "simple, bladder sling" surgery to get better support for my urethra, she told me there was just one other thing that could help. She was reluctant to recommend a pessary for me because I am sexually active, preferring to give them to elderly widows. But I was insistent that I needed an alternative to surgery, and assured her that I was willing to deal with considerable incovenience in order to avoid it. Explaining that I would have to remove it before having sex, my doctor reluctantly fit me for my a pessary, which is rather like a diaphragm with several holes in it, inserted into the vagina and positioned so as to restrict the movement of the urethra.
As I left her office with my new pessary in place, I was hopeful that the device would improve the situation enough to resolve the matter and turn my focus to more pleasant things. On my way out, my doctor urged me again to consider sling surgery, emphasizing that it was not elective, like a breast lift, but rather, quality of life. I could appreciate the disctinction. My husband had just undergone knee surgery for quality of life reasons, and that had been the right decision for him, with great results. But every surgery, no matter how "simple", involves risk.
Also, the fact that a torn flap of cartilage is painfully getting in the way of a moving joint is a very different thing to explain to patient than the fact that her urethra is insufficiently supported by her tired, over stretched muscles. For one thing, we are already familiar with the relatively simple, accessible anatomy of the knee, and if we don't "get it" from looking at the x-ray, there are charts, models and brochures all over an orthopedist's office to help make it very clear.
By contrast, we don't grow up looking at models of vaginas and bladders in our grade school science classrooms. As an English major, I never had to locate or identify a urethra on any test. Most of us don't spend a lot of time looking at these parts of our own anatomy. It's inconvenient, for one thing, requiring a mirror and specially angled lighting. Peeing, for girls and women, is fairly mysterious, at least compared to peeing for boys and men. Most of us learn where and how to insert a tampon, but there is never any reason to help a girl locate her urethra. We don't teacher our daughters to aim their stream at m & m's floating in the toilet; we just tell them to sit down and let it flow.
This is already a long post, so I will pick this story up again another time. I am busy doing my new pelvic floor exercises frequently, both the "quick flicks" and the "long holds", and I am very hopeful. The knowledge I received in just one physical therapy appointment exceeds anything I was ever told previously about the physiological cause and nature of my condition. In my next post, I will tell you more about that appointment and why I walked out of it feeling so very optimistic.
Acknowledgment
When I do a kind or generous thing for someone, I am rarely motivated by the hope of an acknowledgment, but it always feels so very good to receive it.
I am always delighted when an old-fashioned, handwritten thank you note appears in my mailbox, brightening up the stack of bills and solicitations. Yesterday, though, I was deeply grateful for digital technology and the speed of communication that it has made possible. I want you all to know that I was, quite frankly, blown away by the enthusiastic response to my first post here on Vaginologue.
People who have never responded to any post on Unburied Treasure chose to write to me yesterday for the first time. I received private messages through facebook from people who are generally so silent that I had honestly forgotten they were among my facebook friends. I realize that it is uncomfortable to post comments publicly of such a personal nature as this blog invites, and I don't want to push anyone beyond their comfort zone. But what I learned yesterday is that it's not just myriad faceless women who are dealing with these issues in silence, it is you: my friends and readers. As Kristin wrote, below yesterday's post, the more women who tell their story, the more "normal" it becomes, thus increasing the likelihood that other women will seek medical help and improve their lives. This is precisely my goal.
I never imagined that one blogpost, especially a first blogpost, would bring such an outpouring of feedback. After having struggled with the decision to blog about my "female issues", I cannot imagine clearer confirmation that I made the right choice. Thank you so much for your words of encouragement and appreciation. It means a great deal to me. Know that you have fueled my mission here and that, as a result, I am committed to continuing to do my best to share my story with you.
I am always delighted when an old-fashioned, handwritten thank you note appears in my mailbox, brightening up the stack of bills and solicitations. Yesterday, though, I was deeply grateful for digital technology and the speed of communication that it has made possible. I want you all to know that I was, quite frankly, blown away by the enthusiastic response to my first post here on Vaginologue.
People who have never responded to any post on Unburied Treasure chose to write to me yesterday for the first time. I received private messages through facebook from people who are generally so silent that I had honestly forgotten they were among my facebook friends. I realize that it is uncomfortable to post comments publicly of such a personal nature as this blog invites, and I don't want to push anyone beyond their comfort zone. But what I learned yesterday is that it's not just myriad faceless women who are dealing with these issues in silence, it is you: my friends and readers. As Kristin wrote, below yesterday's post, the more women who tell their story, the more "normal" it becomes, thus increasing the likelihood that other women will seek medical help and improve their lives. This is precisely my goal.
I never imagined that one blogpost, especially a first blogpost, would bring such an outpouring of feedback. After having struggled with the decision to blog about my "female issues", I cannot imagine clearer confirmation that I made the right choice. Thank you so much for your words of encouragement and appreciation. It means a great deal to me. Know that you have fueled my mission here and that, as a result, I am committed to continuing to do my best to share my story with you.
Thursday, February 24, 2011
In the Beginning
This story is not just about vagina.
But of course, vagina is the starting point for every woman's story. By this, I don't mean to conflict with the belief that life begins at birth; or in the uterus, at the point of viability; or in the fallopian tube, at the point of encounter between sperm and ovum. No matter what you believe, when we are born, we are announced to the world on the basis of our vagina:
"IT'S A GIRL!" someone invariably exclaims, upon seeing it. And thus, we begin.
As far as I can recall, nobody ever spoke to me about my vagina when I was little.
My mother did teach me that the part of my body that I kept in my underpants was called the vulva. I knew it was private because my sister and I weren't allowed to walk around with it uncovered, no matter what. We grew up wearing underpants under our nightgowns. When I asked my mother how to make a baby, I remember being very specifically concerned about whether it was necessary to remove your underwear. She told me you didn't have to if you didn't want to.
I first learned my vulva was interesting to boys when Craig Barash, who sat next to me in the very back row of Mrs. Brown's third grade classroom at Birch Lane Elementary School, asked me to show it to him.
Craig was clever enough to start by asking me just to let him see my panties. I knew this overt fascination with panties must run in his family, because his father drove a big fancy car with the first vanity plate I had ever seen: SKIRTS. Once, when we driving right behind them, I asked my parents about it, and they told me it was because his father manufactured skirts for a living; the plastic, see-through kind. I could tell that my parents did not approve of this kind of skirt, or of Craig's parents. Even though we went to the same temple and Hebrew school and lived just a block away from each other on Bay Drive, we did not carpool with the Barashes and I was instructed never to go into their house. There was consequently an air of mystery around all the Barash family that thrilled and baffled me. I knew instinctively not to ask my parents any further questions about the peculiar skirts that Mr. Barash made, and a few more years would pass before I knew anything about the type of women who wore them.
I wore short (but opaque) dresses from Florence Eisemann or Chemise Lacoste as my Mommy-imposed school uniform from age 2 1/2 until sometime in the fifth grade. By about age five, my legs had grown too long to fit into tights, so Mommy switched me to wearing knee socks with my Mary Janes, which I owned in both black and white patent leather, as well as buttery leather, in brown or maroon. When I was standing or walking, I looked very prim and proper in my dress, my color coordinated knee socks, and my long, straight, brown hair tied up with a matching bow. But when I sat down in my low, little desk chair at school, the hem of the skirt invariably rode up pretty close to panty level, exposing long, white thighs that just barely fit under my desk.
It was no big deal to spread my knees apart, twist sideways in my seat, and let Craig see my panties. They were Carter's panties, with a pattern of little flowers scattered across the white, cotton fabric and a delicate, colorful rick-rack sort of trim at the leg. It made sense to me that if Carter's bothered to make panties that pretty, people should want to see them. From there, it was a fairly simple matter to reach in and pull down my panties, when Craig asked me to. As the youngest kid in the third grade, I was very happy for the attention. I was six years old at the time.
I'll return to Vaginologue soon and often to tell you more of the story of my vagina and its neighbors: uterus, urethra, and rectum. I'm forty four years old now, and yesterday, I started physical therapy for what those in the business like to call my pelvic floor. It was a pretty big deal for me to admit, to myself and then, to a doctor, that I have been having a problem "down there" ever since my youngest child was born.
The problem is this: I have been accidentally peeing on myself for the last eight years; every time I slip on an oil puddle in the garage, trip on the sidewalk, sneeze while walking, dance while having cocktails, or run more than about six steps. It was difficult for me to come out of my cloud of denial and wishful thinking to confront the fact that this problem was not going to go away by itself, no matter how many kegels I might remember to do at stop lights. It was extremely difficult to show up at physical therapy yesterday and allow a stranger to help me begin to do something about it.
Having now taken those first steps, however, it is my lofty hope that with this blog, I can be of service to other women by sharing my experience in working to correct a problem from which I know so many of you also suffer. My personal goal is to strengthen the muscles that control urinary flow so that they do their job the way they used to, before I pushed three big babies out into the world through my vagina. I want to continue my very active lifestyle, but in such a way that the only thing I am soaked in is sweat, and in which I pee only when I consciously give myself permission to do so. I now have a list of daily exercises to perform as homework before my next appointment on Wednesday, so I'm going to go and get those done. I'll see you back here in a little while.
But of course, vagina is the starting point for every woman's story. By this, I don't mean to conflict with the belief that life begins at birth; or in the uterus, at the point of viability; or in the fallopian tube, at the point of encounter between sperm and ovum. No matter what you believe, when we are born, we are announced to the world on the basis of our vagina:
"IT'S A GIRL!" someone invariably exclaims, upon seeing it. And thus, we begin.
As far as I can recall, nobody ever spoke to me about my vagina when I was little.
My mother did teach me that the part of my body that I kept in my underpants was called the vulva. I knew it was private because my sister and I weren't allowed to walk around with it uncovered, no matter what. We grew up wearing underpants under our nightgowns. When I asked my mother how to make a baby, I remember being very specifically concerned about whether it was necessary to remove your underwear. She told me you didn't have to if you didn't want to.
I first learned my vulva was interesting to boys when Craig Barash, who sat next to me in the very back row of Mrs. Brown's third grade classroom at Birch Lane Elementary School, asked me to show it to him.
Craig was clever enough to start by asking me just to let him see my panties. I knew this overt fascination with panties must run in his family, because his father drove a big fancy car with the first vanity plate I had ever seen: SKIRTS. Once, when we driving right behind them, I asked my parents about it, and they told me it was because his father manufactured skirts for a living; the plastic, see-through kind. I could tell that my parents did not approve of this kind of skirt, or of Craig's parents. Even though we went to the same temple and Hebrew school and lived just a block away from each other on Bay Drive, we did not carpool with the Barashes and I was instructed never to go into their house. There was consequently an air of mystery around all the Barash family that thrilled and baffled me. I knew instinctively not to ask my parents any further questions about the peculiar skirts that Mr. Barash made, and a few more years would pass before I knew anything about the type of women who wore them.
I wore short (but opaque) dresses from Florence Eisemann or Chemise Lacoste as my Mommy-imposed school uniform from age 2 1/2 until sometime in the fifth grade. By about age five, my legs had grown too long to fit into tights, so Mommy switched me to wearing knee socks with my Mary Janes, which I owned in both black and white patent leather, as well as buttery leather, in brown or maroon. When I was standing or walking, I looked very prim and proper in my dress, my color coordinated knee socks, and my long, straight, brown hair tied up with a matching bow. But when I sat down in my low, little desk chair at school, the hem of the skirt invariably rode up pretty close to panty level, exposing long, white thighs that just barely fit under my desk.
It was no big deal to spread my knees apart, twist sideways in my seat, and let Craig see my panties. They were Carter's panties, with a pattern of little flowers scattered across the white, cotton fabric and a delicate, colorful rick-rack sort of trim at the leg. It made sense to me that if Carter's bothered to make panties that pretty, people should want to see them. From there, it was a fairly simple matter to reach in and pull down my panties, when Craig asked me to. As the youngest kid in the third grade, I was very happy for the attention. I was six years old at the time.
I'll return to Vaginologue soon and often to tell you more of the story of my vagina and its neighbors: uterus, urethra, and rectum. I'm forty four years old now, and yesterday, I started physical therapy for what those in the business like to call my pelvic floor. It was a pretty big deal for me to admit, to myself and then, to a doctor, that I have been having a problem "down there" ever since my youngest child was born.
The problem is this: I have been accidentally peeing on myself for the last eight years; every time I slip on an oil puddle in the garage, trip on the sidewalk, sneeze while walking, dance while having cocktails, or run more than about six steps. It was difficult for me to come out of my cloud of denial and wishful thinking to confront the fact that this problem was not going to go away by itself, no matter how many kegels I might remember to do at stop lights. It was extremely difficult to show up at physical therapy yesterday and allow a stranger to help me begin to do something about it.
Having now taken those first steps, however, it is my lofty hope that with this blog, I can be of service to other women by sharing my experience in working to correct a problem from which I know so many of you also suffer. My personal goal is to strengthen the muscles that control urinary flow so that they do their job the way they used to, before I pushed three big babies out into the world through my vagina. I want to continue my very active lifestyle, but in such a way that the only thing I am soaked in is sweat, and in which I pee only when I consciously give myself permission to do so. I now have a list of daily exercises to perform as homework before my next appointment on Wednesday, so I'm going to go and get those done. I'll see you back here in a little while.
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