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 (2^nd 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…

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!

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.

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!

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.