Showing posts with label endometriosis. Show all posts
Showing posts with label endometriosis. Show all posts

Friday, 12 April 2013

I love the welfare state


kaberettPosted by kaberett

[Content notes: medical gatekeeping, current government policy, graphic medical details, cancer]

... I think the NHS is great
Forget about your worries and your strife:
We’ve got our - healthcare guaranteed
They will not charge us any fees
The welfare state’ll care for us for life!



And, do you know, I really do love the NHS. I really do love the welfare state. I love receiving DLA; I love my bus pass; I love my wheelchair. (Yes, my wheelchair? Is the NHS' fault.) I love all of the various ways in which the welfare state makes it easier to Exist While Me in our society; I am endlessly grateful that I can leave the house, that I have support to Get Stuff Done, and so on. I have wept grateful tears over being able to call NHS Direct and be told whether or not to go to hospital. I love being able to attend my GP once every couple of weeks in order to catch up on all the things that have gone wrong, tweak my doses, and so on. I love that my prescription medications - I'm on somewhere around 10 a day, ignoring my as-and-whens - only cost me one hundred pounds a year.



When they're ill in the US, their budget's blown,
Bankrupt by doctor's bills, not like at home
GPs and hospitals for free

For every slightest malady.
When you've fallen into the rocks and plants,
Or your kid's put ants into your pants,
Or maybe - tried a few...
The NHS is always there to care for you.



For nearly a year in there, I thought I was going to be moving to South California for grad school. Specifically, I thought I was going to be moving to LA - a country where one of my standard medications isn't FDA-approved, and a city that makes my lungs hate me for a good three months after I move somewhere with better air quality.


Thursday, 24 January 2013

The pursuit of life, liberty, and happiness


kaberettPosted by kaberett

If you've seen me perform with Lashings, you've almost certainly seen me take prescription medication while on stage. You've likely seen me on codeine. And here's what I can tell you for certain: you have never, ever seen me unmedicated.

Of course, I'm not the only one of us who takes meds on the regular: when my timer goes off in LashSpace I'm not the only one who reaches for tablets. But, well - it was noticeable that for the three-week Edinburgh run, the largest category by volume in my packing at the beginning of the trip was enough medication for three weeks. It's noticeable that in Lashings, as well as in my professional life, people tend to ask me for painkillers first - and that is 100% and entirely the reason that I carry ibuprofen with me at all times. (I'm continually maxing out on a different NSAID, so I can't take ibuprofen without serious health risks - but I like to be able to offer people something slightly weaker than neat opiates!)

Here's another anecdote for you: two weeks ago, I went to a GP at my surgery (never seen her before), and asked - among other things - about the possibility of sleeping pills to help with my insomnia. I was very, very careful to not request temazepam by name. She looked at the list of other things I'm taking - for the record, my daily meds are mefenamic acid, paracetamol, amitriptyline 25mg, citalopram 40mg, Buscopan, omeprazole, Fostair - sucked her teeth, and said that she didn't particularly want to prescribe it, because it can be awfully addictive, you know, and with everything else I'm on...

... and that, ladies & gents & everyone else, is when I had A Realisation.

Well, that's not quite true: it had been fermenting for a long time. But here it is: my approach to medication is not terribly common.

I'm reminded of this every time someone mentions that something is hurting, I offer them painkillers, and they demur: "Oh, no, it's not that bad," or "I'd rather wait to see if it clears up by itself," or any one of a number of other responses. It's not that I think there's anything wrong with that attitude - I used to be very, very good at it myself - but these days... well, I find it baffling (not least because ibuprofen has a rather milder side-effect profile than e.g. alcohol!).

I mean, of course, obviously - it's taught to us by the cultural expectations of a stiff upper lip, and of "musn't grumble"; by "the cure is worse than the disease"; by an ideal of self-sufficiency; and by a media that encourages us to mistrust medicine and medics, quite aside from all the people with good personal reasons to be mistrustful.

I know, intellectually, that I used to understand this at a deep and visceral level. I used to be so invested in the idea that I wasn't really in pain - that I was making it all up - that I'd skip my meds and put taking them off until I was on the floor and immobile with agony, and even then I wasn't sure I wasn't just an attention-seeker.

I know better than that these days.

These days, I know it's a lot easier to keep pain under control from the word go than it is to try to get a grip on it once it's unbearable. I know that for me, once I've started being in enough pain to notice, the vast majority of the time it's only going to get worse. And, importantly, I'm intimately familiar with drug side-effect profiles and the interaction of anything I'm asking for with everything I'm already on, and by the time I'm asking a doctor to prescribe me something I've definitely already made the cost-benefit analysis and I've probably already experimented with the drug in question. (Pro tip: people with chronic pain are often pretty relaxed about sharing meds with others they trust to act responsibly, in the general spirit of "try before you buy" and of "pay it forward".)

So I've put in all this work: on getting past my inhibitions about "making a fuss"; on researching my condition; on investigating plausible management regimes; on working out what might improve my situation.

Off I trot to the GP, and I say... "um, I'm having this problem, er, is there anything at all you might be able to do for that?" And if the GP sounds encouraging, I bimble on to "um, um, um, I've done some reading, um, it sounds like drug X might be useful? Maybe?"

Because here's the problem: I can't afford to be seen as "drug-seeking". I cannot afford the risk of doctors deciding that I don't actually need pain relief as pain relief, but what I do need is weaning off my addiction to the drugs that make my day-to-day life liveable. I can't be an effective self-advocate in medical settings in case gate-keepers decide that I'm a pushy patient - in case I seem too high-functioning, too well, to really need all those drugs.

And it was earlier this week that I worked out why this problem keeps arising.

(Before we go any further, I want to point out that my experiences as wheelchair-using crip are also my experiences as somebody who is thin, and white, and upper-middle class, and has access to medical journals and the education to make sense of the jargon, and covered by mummy's health insurance up to the age of 25. Most of the chronically ill people I interact with are either at (a) my university's Disabled Students' Campaign or (b) Diary of a Benefit Scrounger, i.e. heavily skewed towards activists; both have significant overlap with my areas of privilege. I can't - and don't - speak for all people living with chronic illnesses.)

People with chronic pain - with chronic illness - seem to me to be more likely to be very, very good at judging whether the side-effects and interactions of a new medication are worth the benefit we'll get from it. I've got so many things I need to discuss at every doctor's appointment that by the time an issue makes it to the top of the queue, I've probably been dealing with it for months. I often know what we want - but I don't have an awful lot of time to discuss it in, because I need to talk about three other things this appointment too.

But if you're well? Mmm. If you're healthy, and you're used to uncertain patients who aren't keen on taking pills... well, I can see why I'd come across as worryingly desperate. Mostly, it's because I am.

Just another thing, I suppose, to chalk up to coming from different sides of the cultural divide that is pain.

Friday, 14 September 2012

Myth #1: teenagers don't get endometriosis


kaberettPosted by kaberett

[Content notes: graphic medical descriptions, discussion of surgery, medical disregard for health]

Everyone gets period pain, right? ... right?

No? Really? Damn. You see, everyone around me - family, friends, doctors - spent six years assuring me that pain so bad I couldn't stand; that mefenamic acid and co-codamol together didn't control; that I couldn't think in complete sentences through -- was normal. Normal: it was just most people dealt with it better than me. What kind of wuss am I?

As it turns out, if you're in that much pain it is not okay. Regardless of the reason - regardless if you've got a low pain threshold - being in pain is rubbish, and the compassionate and helpful response is never encouragement to toughen up.

Me? I'm one of the lucky ones. I have secondary dysmenorrhea: my pain has an identifiable organic cause, so I get a diagnosis and an attempt at treatment. Hurrah!

... oh. Wait. The other thing. I have endometriosis: it's a chronic condition in which material resembling the womb lining exists outside the womb, typically in the abdominal cavity, rarely in the lungs, and - in a vanishingly tiny number of cases - the central nervous system and brain. This material builds up and breaks down in response to the body's hormonal cycle; it grows into organs, gluing them together; the net result, for most sufferers, is chronic pain and fatigue. If you're really unlucky, it'll eat into your sciatic and genitofemoral nerves - causing shooting pains in the thighs and labia.

Somewhere between 45 and 70% of people presenting with chronic pelvic pain have endometriosis.[1] Estimates of prevalence range from 2 to 22% of people with uteruses of reproductive age; I most commonly see estimates of 10-15%. These estimates are necessarily uncertain, because the only way to diagnose endometriosis is via laparoscopic (keyhole) surgery.

The average diagnostic delay in the UK is eight years.

I'll say that again: for an illness causing chronic pain and fatigue, affecting a significant fraction of the female-assigned-at-birth population,  the average time to diagnosis in the UK, from when symptoms first appear, is eight years.[2]

Europe-wide, "there is often a delay of up to 12 years".

Here's some of the "why": sufferers think, or are told, that their symptoms are normal. (See above.) Hormonal drugs provide temporary relief. Inadequate diagnostic measures are applied: you do not want to know how many useless transvaginal ultrasounds I had before I finally got referred to someone who could do something useful.

I'm decidedly middle-class; I've had extensive scientific training; I'm a powerful self-advocate; I'm covered by my parents' medical insurance, which I ended up using. I'm lucky.

And even with that - even with all that - it took six years for me to be diagnosed. Take a moment to think about what that means for the average.

More than once along the way, medical professionals told me that teenagers don't get endometriosis.

The Women's Surgery Group guidelines on endometriosis include:
Diagnostic and operative laparoscopy should be considered in those women with pelvic pain which has not responded after 3 months of nonsteroidal antiinflammatory drugs (NSAIDs), and/or 3 months of oral contraceptives.
I was on NSAIDs for six years. I spent 18 months on hormonal birth control that was causing severe depression. ("No," said the GP, "that's a rare side effect. It won't be the medication." Depression and anxiety will affect up to 10% of users of any form of HBC: it's a crapshoot finding one that won't do it to you. Me? I had a history of progesterone-sensitive depression, at the point the GP said that.)

Six years is conspicuously longer than six months.

Over and over, when talking to people with endometriosis, I hear that they've been symptomatic since they were fifteen, fourteen, thirteen. I was symptomatic from my very first period. But everyone gets period pain, they say, and that is how we convince ourselves that this is nothing out of the ordinary, nothing bad, that we should just man up. And we tell ourselves this while we are gasping for air on our sides on the floor, because breathing hurts.

When surgery was performed on me at the age of 18, I was classed as stage IV (severe) endometriosis. Even after they'd excised as much as they could, I am classed as stage IV - because the disease has glued my bowel and my uterus together, and the only way to disentangle them is to remove a segment of my gut, in a major procedure requiring a three-month recovery period and potentially a temporary colostomy. If I tell you that I have a family history of serious bowel scarring, and that the new endometriosis adhesions formed in the sites of my surgery incisions following my diagnostic laparoscopy, I hope you'll understand why I'm not keen on that option.

You do the maths: with an average diagnostic delay of 8 years, and an average age at menarche (first period) of 13, is it any surprise that teenagers don't get diagnosed very often?

Teenagers do get endometriosis. If you have chronic pelvic pain - or if you know somebody who does - please know this: it's not normal, and it's not okay. Know that there are places you can turn for help. Know what you're looking for. Know that not all of us have all the symptoms. Know that what feels like constipation might be nodules in the rectovaginal septum, and that's something worth shouting about. Pay attention. Notice. Notice when we don't talk about our pain, when the people who love us and the doctors who should be caring for us try to get us to ignore it, because we're not supposed to talk about periods. Try to notice when you stop trusting yourself: give yourself permission to listen to your body, to not just power-on-through, to complain about it and to demand that something be done.

Please don't ever feel you need to make a self-deprecating joke about chocolate ice-cream again.

In this, at least, you never have to be alone again.

kaberett can be reached at their username at gmail.com and is willing to answer any questions you might have about endometriosis. This post is part of an irregular series in which they talk about info they've picked up over the years.

Additional references
[1] Z Harel. (2006) Dysmenorrhea in adolescents and young adults: etiology and management. Journal of Pediatric & Adolescent Gynecology 19:363:371
[2] K Ballard, K Lowton & J Wright. (2006) What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertility & Sterility 86:1296-1301