Eating For Endometriosis

If I could eat whatever I wanted I’d have my Dad’s oatmeal pancakes for breakfast (with chocolate chips), chicken cutlet sub or egg salad with lettuce and tomato on whole wheat for lunch, and spaghetti with meatballs for dinner or fettuccine alfredo with broccoli. Then maybe a chocolate chocolate chip ice cream with hot fudge and peanut butter.

Now if I actually ate all of that in a day I’d likely feel super shitty in every way the next day. Oh and probably throw in a glass or two of wine. Forgot about the alcohol!

Around the time I had my two surgeries, so roughly ten years ago, I was exploring every possible alternative treatment for endometriosis. I learned it was a chronic illness and actually would never really go away…I needed alternative means to try and take control.

I read a great book, which I still have, by Dian Shepperson Mills, called Endomestriosis: A Key to Healing Through Nutrition. She is British so there were recipes with “aubergines” in them and I didn’t know what the hell that was. She also talked about inflammatory foods which I had never learned about before. I had a degree in nursing at this point…no one ever taught us about inflammatory foods. We learned nutrition based on the food pyramid. Shaking my head now.

She advised cutting out dairy, wheat, meat, and sugar. So basically everything in my diet. And alcohol. Over the next ten years I would try all variations of these dietary changes. I did cut them all out at one point. I remember that month of pain from endo and withdrawal from every food I ever ate.

I’ve perfected gluten free baking. It only took about five years to get that down. I now have a great flour mix that allows me to enjoy baked goods.

I slowly learned that gluten free, dairy free, and mostly meat free (some times chicken), with fish included, and low sugar is the best to keep my symptoms controlled.

It totally sucks at times though to be so restrictive. I’ve had epic meltdowns in restaurants. Well not in, but in the car afterward. We scour the menu before we go anywhere now to make sure there are options for me. When people ask if I have a food allergy I just say Yes, because I am sick of explaining that no I don’t have an anaphylactic reaction but I will be in crippling pain for a few days after eating wheat or gluten or dairy.

This year off birth control and doing hot yoga I still couldn’t lose weight though. I also was having a lot of pain and realized my PCOS was back as I now had several cysts on my left ovary. I was eating too much sugar and meat. I was eating a lot of what the boys were eating which was not good for me.

I met with my OB and she confirmed the cyst diagnosis I already had given myself. She did it by ultrasound; I knew I had cysts based off thirty four years living in this body. She offered me a lot of pharmaceutical and surgical options. I shook my head and asked her to order some lab work and then I left to go back to my roots of nutrition for endometriosis and PCOS.

When I examined my eating habits and my lack of weight loss I realized I was eating healthy-ish but not a true anti-inflammatory diet.

So I prepared my wife. She’s been with me through many cleanses before. She knew what to expect. No alcohol. No sugar. No gluten. No dairy. Lots of kale smoothies and this time I was allowing myself seafood because it has specifically been linked to lower PCOS symptoms.

Off I went. Two eggs over easy in the morning usually over sweet potatoes or veggies from the night before. Or with cooked salmon or homemade sausage (Whole 30 recipe). Lunch- Smoothie. No snacks. Lots of water. In the smoothie- kale, avocado, banana, frozen strawberries or frozen peaches, maybe a tablespoon of peanut butter, and maybe unsweetened cocoa, and definitely unsweetened almond milk. I fill up a 32 oz nalgene bottle with it and that’s my lunch.

Dinner- Generally another smoothie. I always change up the fruit or greens but there’s always an avocado. If I have “real food” I have grilled squash or sweet potatoes and fish like salmon or haddock. Sometimes I throw scallops and frozen veggies into a pot on the stove with olive oil and Old Bay seasoning.

You get the picture. No snacks. Veggies. Fruit. Seafood. Eggs. Lots of water. No alcohol.

The first week sucks ass. The first two days I’m always hungry. The third-fifth day I want to kill some one. The sixth day it becomes more manageable. That’s where I screw myself sometimes. Just when it’s getting easier a weekend pops up and I think, hmmm, I’ll have a drink or a dessert because it’s my cheat day. But cheat days don’t work for this.

Because the super annoying part is I see results. I am losing weight. I also feel better. I hadn’t gotten my period for over a month as often happens with PCOS, five days into my crazy new diet plan I got my period. No pain either. So yeah. It’s infuriating because it works. It’s amazing because it works.

I feel better now that I’m not starving all the time because my stomach adjusted and now I actually crave smoothies and feel full after them. I feel better now that I’m not in nearly as much pain. The cysts are gone. I don’t need an ultrasound to tell me. That constant feeling of pressure and fullness is gone. So yeah. Kale. My new bestie.

It’s nothing I haven’t done before. I keep telling myself I’ve actually been more restrictive in the past. But sometimes I just want to toss the damn blender and eat some chicken nuggets and fries and chocolate cake. I just want my body to not be my enemy. But that’s all self pity.

Endometriosis and PCOS force me to actually treat my body better than I would without a chronic illness. Do I yearn for an egg salad sandwich on real bread? Yes. But I love living without pain more. Does it irritate me that I can’t eat what I want when I want? Yes. But I begrudgingly appreciate the accountability this disease forces me to take over my choices and my nutrition.

Not one doctor of the many I’ve visited has ever told me to read Mills’ book. Yet among Endo people it’s a well known valuable resource.

I practice Western medicine. But I know firsthand it’s limitations.

Here’s to my nutrition and to yours. If you think you can’t…make it past day six and seven…then you can. Promise.

What I’ve learned the most is not all restrictions were right for me. I really had to feel it out and figure out what foods aggravate and what foods heal. That is very individualized. Some people wouldn’t tolerate eggs or seafood. For me they work. Get to know your own body and yes restrict so you can add slowly back in to see what makes the pain worse. It’s a horrible experiment. But worth it.

Living With Endometriosis

I’ve written about endometriosis before and Mommying with a chronic painful illness. But I’m going to mention it again.

It’s been on my mind lately for a variety of reasons. The more I practice psychiatry the more I see how women are mistreated in our society. I mean I knew it before, having experienced it myself, but now I really see it.

It took me three years to be diagnosed with endometriosis. On average it takes about five in the United States, up to ten in England (I did my thesis on barriers to treatment and diagnosis of endometriosis, so trust me on the stats, but you can message me if you want the articles). The first diagnostic surgery was wrong in many ways- she used laser to supposedly get rid of the one endometrial spot she found, told me my ureter was malformed, and that I had minimal endo maybe stage I. There are IV stages- IV being the worst and most widespread.

Fast forward- my ureter was not malformed, I found a second surgeon because my pain quadrupled after laser and I educated myself that I needed excision not laser removal of endometrial lesions. We went for the second surgery and he diagnosed me with stage III endometriosis and excised several areas of lesions on my abdominal wall and my ovaries. He also found endometrial tissue on my uterosacral ligaments and colon.

When I woke up from that surgery I remember he told me what I had and how much he took out and I sobbed. I was so relieved. For three years I chased a diagnosis. I chased my pain.

I was sent to psychiatry at some point by my OB at the time- as many women with pain are sent to me- and was told my a therapist that I must have chronic abdominal and pelvic pain because I must have a history of sexual trauma even if I have no memory of it and no other signs or symptoms that I was a victim of sexual abuse.

I in fact do and did not have a history of sexual trauma.

I never returned to that therapist for obvious reasons including but not limited to misdiagnosis. But can we talk about how much that messed with my head?!

I would puke from the pain. I had hemorrhaging cysts and my hematocrit would drop to 23 and they would threaten blood transfusions as I lay curled in a ball and just wanted it to all go away. But of course, in that moment I remember thinking, and this is all because I have sexual trauma of which I have no memory or inkling? There are so many things wrong with those memories!

I mean the pain made it so I couldn’t think clearly. Then I had to deal with all these health care providers who were minimizing my pain because I was female. I must not have a high tolerance. I must be seeking opioids. I must have a psychiatric history that I am not even aware of. Until that surgeon who took me seriously, I literally thought I was losing my mind and making myself be in constant pain.

So he fixed me for awhile. But it never goes away. Not completely. Then I had the boys and all those pregnancy and nursing hormones kept it at bay. Then it came back. Hard. Then I went on birth control (OCP) because I thought I would give it another go. I hadn’t taken it since my early twenty’s and I really don’t want another surgery. I started it last Summer and it helped. I remembered the one of probably fifteen I tried that didn’t make me super angry and emotional.

But then I stopped losing weight, and gained some back. My blood pressure has been creeping up. I knew it was from the OCP. So I stopped it two weeks ago. The last two days have been horrible with the pain.

I read this piece once by someone with endometriosis, she wrote the “pain is like an old friend,” and I was annoyed and horrified by that ten years ago, but now I understand it. The hormones, the side effects to OCP, the pain meds, the surgeries: all of that crap is foreign and scary. The pain is familiar. I know what to expect with it. Crippling at times.

Like I stood up during yoga class today at hot yoga, and I instantly dropped back to my knees. The pain shot through me like fire from my leg to my abdomen. The boys have seen me drop down to the floor very suddenly when it hits like that. Jackson comes and rubs my head. Declan asks if I’m okay. I grit my teeth and smile at them, a smile that doesn’t quite reach my eyes, and tell them I’m fine, and within a few seconds to a minute it always passes and recedes into a duller pins and needles pain.

Pain meds don’t work. Advil and tylenol are like spritzing a wildfire with a little spray bottle. I can’t take narcotics because I’m a Mama and they don’t really work either. They just numb me out for a period of time.

I said to my wife, “So I’m fat and hypertensive or I’m in pain.” She told me to be fat. That she hates seeing me in pain.

But it’s not that easy for me to accept being overweight and hypertensive. It’s not good for me in the long run. I guess neither is being in pain. But like I said, the pain is like an old friend. Wrapping around me with fiery tendrils.

These days when it’s bad I can’t always focus on the boys. I can only focus on my next breath, my next step, my next move. I feel awful for that. That I’m not myself. I can get into my head about it and have quite the pity party. But then I’m a firm believer in the everything happens for a reason concept.

I think I wouldn’t be able to help the numerous women who end up in my office after a shoddy medical work-up because no one could see past her gender and take her complaints seriously, and truly try and get to the bottom of her presentation and symptoms.

I don’t tell them they must have sexual trauma if they have chronic pain. I tell them I want all of their records. Then I review them all, and I run labs for anything that possibly has been missed, and I refer them to specialists who may think differently then a primary care MD or an OB and who may do different work-ups.

When I offer them alternative work-up ideas and different diagnostic ideas and different doctors to see and alternative therapies to try…I always see something in them that I know all too well. Hope.

When that surgeon told me it was stage III endometriosis with the pathology report and surgical pictures to prove it I felt such relief. Such hope. I knew it was a chronic illness, but at least I had an answer. I had a name for the pain, and an understanding for the underlying cause.

I wasn’t crazy.

That we as healthcare providers are more comfortable telling women to seek psychiatric care then to do an adequate if not thorough work up for them disgusts me. I like to think in my small office, in my own way, I am giving back in a way that only one surgeon ever did for me.

So for now, I’ll embrace my old friend endo armed with my hot water bottle on the front and heating pad on the back. I’ll embrace the good days and not live through them by dreading the bad ones to come and I will take the bad days knowing there will be good days to follow.

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Mommy-ing with chronic illnesses

I often see clients who are suffering from depression/bipolar disorder/PTSD, etc who have young children. And their number one concern that brings them to tears is the thought that they are not the best Mom they can be because of their illness. Because sometimes they are short with their kids, or don’t feel like they have the energy to deal with them, or put them in preschool three days a week even though they are stay-at-home mom’s and feel guilty about it but need a break.

I’m not a big self-disclosure type of person. So I usually don’t disclose to clients that I literally know exactly how they feel. But I’m saying it here. I get you. I have severe and sadly in the past year uncontrolled asthma as well as endometriosis. The asthma, eh it’s okay, when I was on prednisone for six weeks and I turned into a lunatic then I felt bad for my kids. But I usually can power through the whole not breathing thing better than the endo. For those who are unfamiliar endometriosis is an autoimmune disease that causes growth of endometrial tissue in other parts of the body where it’s not supposed to be. Symptoms are generally pain, hemorrhagic cysts (bleeding cysts), infertility, bowel issues, and it’s even been found on people’s lungs which causes breathing issues obviously. So yeah it’s no picnic. There’s no cure. I’ve had two surgeries already and not looking to have a third.

Before I became a Mom I could take a nap. Cancel plans. Take a narcotic pain medication to ease symptoms to be able to sleep. Now…I power through. The pain’s still there. The fatigue that comes with it. The cysts that cause really freaking bad pain. Have I curled up on the couch in front of Moana with a heating pad and felt like the worst mom ever? Yes. Have I been brought to tears when one of them unknowingly kicked me in the abdomen right in that sweet spot where the endo pain lives as we were having a tickle fight? Yes. Have I grimaced when I bent to pick them up and fought back tears as I held them in my arms when they cried? Yes. Have I ever told my wife or kids that I am in pain? No. She knows, I mean, she’s know me for eleven years. She knows when I”m hurting. But I don’t want the boys to think I am anything less than their Mama. I want to protect them from this as much as anything.

Mommy-ing is hard. Mommy-ing while trying to battle your own demons. Girl Rock On. I tell my clients, “You are the best and most beautiful Mom your kids would ever want. So don’t beat yourself up about needing a break from them or taking your own space. You have to take care of you in order to take care of them,”

But I know from experience. It’s wicked hard taking care of me while also trying to take care of them. Naps? Ha. Pain meds? Not happening. I don’t even want them in the house in case the boys find them and take them by accident (former ED nurse paranoia I know). Just have to settle for Moana and a heating pad with the monster’s, I mean boys, running in and out of the room, yelling, occasionally hitting each other and crying, and some times just cuddling up against my side and pointing at the heating pad and saying “Mama boo boo?”