Response to the media coverage about coil insertion

I've been waiting to write this post to see how the media coverage develops and what other experiences women have had before I tell what happened to me. But I've been gratified that I'm not alone and more should have been done. This will make men uncomfortable, but please be sure it's important and it will affect every woman in your life in one way or another at some point. It's about gynaecological procedures, particularly having a coil fitted, but it can also be attributed to the use of a speculum, which is needed for many procedures including the smear test, which every woman should have.

If you haven't seen the news items, here's the latest from the BBC, thank you Naga: Having coil fitted should not hurt, say experts.

Naga Munchetty talking about her experience

The reason why I was trying to have a coil fitted was because I'd been diagnosed with endometriosis, which I've written about before, and adenomyosis. The difference between those two conditions is cells grow outside the uterus with endometriosis and the cells grow within the walls of the uterus with adenomyosis, both where they shouldn't be, causing all sorts of problems, usually around menstruation and periods. The doctors said the best treatment would be having a coil fitted and I trusted them. I've reason not to as I've had a checkered history with diagnosis in the past, which I've also written about before. They diagnosed me with an MRI scan, after not picking it up years before with an ultrasound that I've since learned is an unreliable diagnostic tool for endometriosis.

I went to a local clinic to have the coil fitted. Like most women I've read about, the only pain advice was to take ibuprofen and paracetamol beforehand, nothing else was mentioned. I almost passed out with the pain so they referred me to the hospital. I almost passed out with the pain again, but I felt it was a failure on my part so I said they should keep trying. This is common as the failure to have the coil fitted makes you feel like a wimp who can't handle the pain, because for women, pain in that area is part of life, from period cramps to cystitis, from tampons to sex, from birth to the menopause. I told them to keep putting me through it as I felt like less than a woman. They stopped when they said they didn't want to traumatise me. They reassured me that women who had given birth sometimes can't have a coil fitted as it's so painful for them. I must say everyone was lovely, it was no fault of theirs, just of perhaps their training, knowledge and what they were allowed to do.

Representation of the pain

That's when they told me the scan picked up a kink in my anatomy that would make the procedure difficult and painful, but it was worth a try. Why didn't they tell me this beforehand? Was it really worth a try? A local anaesthetic, anaesthetic gel or an anaesthetic spray were never discussed as possibilities, which doctors have been saying they offer in the media coverage about this issue. It was never even mentioned to me. The only alternative offered was having it done under general anaesthetic, which they don't do unless it's absolutely necessary due to the risks.

When I had an endoscopy during the time they were trying to to diagnose what was wrong with me, they used an anaesthetic spray and a sedative and I felt nothing. Why can't they do the same for women who find the use of the speculum and having a coil fitted extremely painful? If there are women who are passing out and throwing up with the pain, doesn't that signify there's a problem that should be addressed?

Blood oranges

The upshot is I went back to the clinic, who put me on the pill. It was horrendous at first, with heavy bleeding and more symptoms than I get with the endometriosis, but it was good when it settled down after a few months. Until it stopped working after a year or so; I was basically bleeding for months and had to be put on iron tablets due to the blood loss causing anaemia. That's when I had a contraceptive implant put in my arm and everything has improved, for now.

All this unnecessary pain reminds me of the epic speech Kristin Scott Thomas delivers in Fleabag: https://www.radiotimes.com/tv/comedy/women-are-born-with-pain-built-in-kristin-scott-thomass-epic-speech-on-fleabag/

About the speculum, an instrument of discomfort for most women and an instrument of torture for me, the inventor is a controversial figure who hated the procedure he invented a device for, which tells you everything: "if there was anything I hated, it was investigating the organs of the female pelvis". Here's more about the history of the device: https://www.theatlantic.com/health/archive/2014/11/why-no-one-can-design-a-better-speculum/382534/

Speculaas, delicious biscuit

I've mentioned nothing about men as I'm sure having your prostate checked and any procedures on your reproductive organs are painful, but they are not described as routine and women have to regularly undergo these kind of procedures. But if men had to experience such pain, I think something would have been done about it years ago. I hope with all this coverage and calls to redesign the speculum, change is on its way.

Feeling the weight

I've written about hard subjects before, just take a look at my previous posts about anxiety, panic attacks and the EU referendum! But this is one of the hardest, maybe the hardest, at least for me. It may not seem that way when you read it, but this is a blog post I never thought I would have to write, about a subject I never thought would affect me. But affect me it has and it has hit me hard. I'm annoyed at myself because it feels like it's mostly my fault.

How thin do I look? I can't have been healthy!

I am close to being overweight, almost 11 stone, when for most of my adult life, I've been around 9 stone. Now I don't want to go back to that weight as I think it was unhealthy. However I reckon I have put on a stone and a half over the past year or so, I feel unhealthy with it and I should lose that. Luckily I can fit into most of my clothes still because I wear leggings, but I can't wear my jeans anymore. If I carry on like this, I'll have to go up a dress size. I have no excuse, but I have reasons. To try and make sense of why this has happened, to come to terms with it and hopefully do something about it, I'm writing this blog post.

I will have to go back to my childhood to explain. I was never interested in bad food: fast food, burgers, takeaways. I prefer simple food, simple ingredients, unadulterated meals. I'd choose a salad over a McDonalds. I don't like sauces, not even ketchup on my chips. I'm more interested in fruit and veg than sweets and cake. In fact, the first time I was off school sick, it was because I ate too much fruit! Even now, I can't walk past a fruit bowl without being tempted. When I was a teenager, people used to joke I was anorexic and I took it as a compliment. They'd pick me up, exclaiming how light I was. I was proud of it! But I never courted it. I just wasn't interested in food, never was. I'm still not really interested. I eat to live.

I love fruit, all fruit, even exotic fruit like snakefruit (right)

Things changed when I turned sixteen when my anxiety hit and I started having panic attacks. My life spiralled out of control. I went from having little appetite to having none at all. I still don't really have an appetite as such. I developed an eating disorder where I found it difficult to eat. It was both a symptom and a way of coping with my mental health problems, trying to control something when I couldn't control anything else. I stopped eating altogether at one point because it was easier than fighting through what I called the upchuck reflex. My friends had to forcefeed me when I started shaking uncontrollably. Since then, I haven't had a normal relationship with food, not liking eating in public for instance. My appetite, what there is of it, is the first thing to go when I'm ill, mentally or physically. When I can't eat fruit, I know it's serious. It's become a canary in a coal mine for me.

Now I have a handle on my anxiety, which used to sap my appetite, I have to deal with one. I must have had one before my anxiety hit, but that was more than 20 years ago and I don't remember. So when people learn to manage their appetite from childhood to adulthood naturally, I've had to deal with it all at once, which has been a bit much.

This is me under there!

However, apart from sugar cravings during that time of the month, I've been managing pretty well. That's why putting on so much weight is a surprise to me. It started before lockdown, before I knew I had endometriosis, which makes me bloat. My weight shot up on medication for my balance problem, but it went back down when I stopped taking it. That was the first time I went over 10 stone. I'm now on medication for the endometriosis and putting on weight is a side effect, but not to this extent and I'd prefer to take the tablets as the benefits outweight the weight gain. They've stopped the sugar cravings for one!

Due to my balance problem, I don't sleep well; I often wake up in the night and I sleep very shallowly, so anything can wake me. Sleep problems can make you put on weight, or more prone to putting on weight.

Me asleep(ish)

I'm not a great one for exercise and with lockdown, I'm currently only going in to work once a week; my cycle commute is my only real exercise, which was enough before, but it seems no longer. I will have to start exercising properly, which will be hard and I'll have to be careful what sort of exercise I do because of my balance problem. I definitely need to improve my cardiovascular health. The other thing is when I exercise. It takes me an hour to even get moving every morning; to say I'm not a morning person is an understatement. Vertigo upon waking due to my balance problem makes me groggy, so exercising before work is out. I'm knackered after a day working and exercise will knacker me further, for the usual reasons, but also my balance problem makes most physical things tiring. So I'm going to start at weekends and see how I go.

When I could fit in a dress like this

I don't eat unhealthily, but I do rely on ready meals and frozen meals at least once a week. The weird thing is, I eat the same thing as my brother; he has larger portions and eats more chocolate bars than me, but exercises less than me; even on our lunchtimes walks, he dawdles, whereas I try to keep the pace up; and his weight has barely changed.

Stress can do weird things to the body, to the hormones and goodness knows we've had enough stress lately. But I thought I was coping with 2020 okay, surprisingly well given my history of anxiety, including all the mental whiplash when things kept changing and first I was going to go in to work 2-3 days a week, then 4 days, and now one day a week. I had a few wobbles in the beginning, but maybe underneath I'm not coping so well.

One of my favourite photos of me, with my nephew Thomas

So between my endometriosis, balance problem and anxiety, which all cause the insomnia, that may be the reason behind my weight gain. This means it's not as much my fault as I thought. But the biggest cause is probably my age. I noticed a difference in my metabolism when I entered my 30s. I guess I can't eat what I'm used to eating without consequences anymore. So even though I haven't changed my diet any over the last few years, maybe even being a little healthier, I'm going to have to now. However with my history of an eating disorder, caused by the need for control, I'm going to have to be careful. I'm cutting sweet things out of my diet, which is no hardship, it's been easy over the last few days. I mostly eat them when I'm bored or watching TV. But I'm going to miss my Mum's flapjacks and scones. Then I'm going to build up to fewer carbs like bread (which I adore), pasta and rice. But I know it's bad to cut out food groups altogether, so everything in moderation. I will try to eat more vegetarian meals as well, I tend to choose them off the menu anyway. So all signs point to the fact that changing my diet should be relatively painless.

Turning 30

The first step has been getting over myself, stopping feeling sorry for myself and thinking this is temporary. I'm going to have to do all this as the trend in my weight has been steadily increasing; it's only going to go one way and will continue that way unless I do something. I have to lose the identity of my younger self who could eat anything and stay thin. I should also eat more slowly: due to my eating disorder, I ate fast to beat the upchuck reflex, otherwise I would have ended up eating nothing. That habit has stuck and I don't need it anymore.

I'm going to have to strike a fine balance between the problems exercising with a balance problem and changing my diet with an anxiety issue, but I'm up to the task. I'm the little girl who stopped biting my nails because I hated the way they looked, just like that. I decided to stop, so I did. I'm the teenager who stopped drinking alcohol because I knew I was drinking to drown my anxiety, so after my third hangover, I stopped. I now only drink on special occasions like celebrations and then only a few sips to be social. I got over a breakdown and am managing my anxiety. I've dealt with two chronic illness diagnoses and live with the symptoms daily. I can beat this too. All I need is an incentive like I've had before and one look in the mirror at the body I don't recognise anymore and one walk upstairs which makes me out of breath, that's enough incentive to be getting on with.

The most body confident I've been, taken by Dave Amann

The Framework Five - Critical Assessment

Summary
Critical assessment takes into account the origin, context and suitability of the information being studied, how it is influenced by not only the creator, but everyone involved in handling and disseminating it. These factors determine the authority and therefore credibility of the source of information, the most important assessment.

Personal
There are some very timely examples of critically assessing information I could use as my example: politics such as "he who I don't like to name" (could be one of two people in power to be honest) and Brexit; healthcare with the coronavirus; science with climate change. However all those are depressing and can be downright scary, especially now it seems the whole world has changed. I prefer not to dwell on them too long and the world of misinformation is massive and complex when it comes to these subjects, so this post would be very long otherwise.

I could be very British and talk about the weather, specifically weather apps as they seem to vary wildly, particularly about whether it will rain. But I'm going to get personal, hopefully not too personal. I have three chronic health conditions, meaning I have to live with them as they are not going to go away: anxiety, a vestibular problem and endometriosis. For two of which, I've had to fight the system for treatment and if I hadn't done my own research, I may not have been diagnosed in the first place. So it's something I feel I can talk about with some passion and authority, something I've proved myself in being adept at critically assessing information, but it wasn't always the way. Doctors can easily dismiss things you've looked up on the internet and don't like self-diagnosis, at least in my experience. When it comes to your health, you know when something is wrong; you know yourself, your body and your symptoms best. So you have to become an expert very quickly and advocate for yourself.

Without going into too much detail, my endometriosis has an "unusual presentation of symptoms" and vestibular conditions are hard to diagnose; you tend to get given the easiest answer and told there's nothing they can do. I have explained my vestibular journey in more detail on my blog before: Bittersweet Victory. Just click on the anxiety tag to see my numerous posts about anxiety, but this one is a good place to start: My Past, Present and Future. The endometriosis is a new thing, even though I've probably been living with it for many years, so I haven't written much about it yet.

Trust me, I'm a doctor

In the beginning, I thought healthcare professionals knew best and deferred to them. I didn't ask enough questions, or the right questions, assuming what they were telling me was correct. I always have a problem with figures of authority, quailing in front of them. I should have critically assessed the situation, their situation. I should have taken into account the little time they had, the fact they weren't a specialist in the field and whether they were doing the right tests to critically assess my symptoms to prove their assertions.

When I spoke to a specialist, they said what the previous doctor had told me was wrong. I was sent back and forth, given different diagnoses. When they gave me another diagnosis and told me there was nothing they could do, I researched it and discovered it didn't fit as there was one essential symptom I was missing, cross-checked it on numerous websites, some very academic full of sciencey terms I didn't understand. I looked them up and learned the lingo so I could speak their language when I saw them next to show them I'm serious: I am a mix of stubbornness and curiosity at the best of times and it stood me in good stead. I got a test done off my own back, returned with the results and with irrefutable evidence, they couldn't ignore me. I had to push for treatment and when I found the right person, the person who was willing to listen and didn't just dismiss me, I asked all the questions. I asked what tests they were doing and why, got them to explain the results.

When it came to the second diagnosis of endometriosis, I visited practically every department of the hospital so they could rule everything else out first. I didn't accept what they told me each time, knowing everyone is fallible, even doctors, and pushed for more, knowing what they were saying wasn't right. I critically assessed every person I spoke to, ensuring they had the authority to back up what they were telling me. I quietly defied them and did my research afterwards. They didn't listen to me, so I let them go through the motions, doubting myself. I held my ground, more in desperation than anything else. When they ultimately came up with nothing, that's when they listened to me, they were finally in the right place to listen. I came with a carefully rehearsed speech and proof from an authoritative website. I was proved right and it goes to show, sometimes the authority comes from you and not external sources.

My critical assessment during these medical journeys each took years, comprising the critical assessment of the doctors and specialists themselves, their job titles, specialisms and whether this was just their opinion or they had information to back it up from tests and other sources. I then did my own research, using books, websites and yes, blogs. Blog posts were especially useful for other people's experiences and other avenues to research, some even had links to read and advice. Finally, which leads me to my professional example, I joined a Facebook group for support and shared experience for better understanding of what living with the condition is like.

Capt. Benjamin Sisko (Avery Brooks)
from Star Trek: Deep Space Nine

Professional
In comparison, my professional example will seem downright boring and far less dramatic. It can be fun though as it's about social media. Social media is all about people and individual accounts, on Facebook, Twitter or whichever platform you're using. You can use hashtags and lists all you like, but it still comes down to the individual account. Twitter in particular becomes unwieldy very quickly the more accounts you follow. So now I use Hootsuite (other social media managers are available) to manage it better, and I've created Twitter lists on topics. I can separate social media accounts into three categories: macro, micro and mono.

First there is the macro, an account that covers a lot of people, or sites, such as the UL Twitter account; it may be one library, but it is vast and covers a wide range of collections, not to mention people. Then there is the micro account, one library such as the MMLL Instagram account or Classics library Twitter account. Finally, there is the mono account, one single channel, for one single person, such as my own Twitter account. So you have to take into account who they are representing, the context they are based in and who may be behind the account.

I have curated these streams and lists myself, populating them with people and places I know in real life, so I have critically assessed them in person and know what they are an authority on. Others I know by reputation, such as Orkney Library and know they have built up authority through other's opinions. Lastly, there are the recommended accounts, those accounts I have been referred to by people I trust.

Social media is a great source of information, but you have to know where it's coming from. So even the accounts I have critically assessed and deemed good, I still assess the information they provide. I don't take much notice of retweets unless they have made a comment. Tweets with links and images I can be easily swayed by, especially those with a suitable gif or meme; it makes their tweet or post seem more credible.

The Credible Hulk

Critical assessment is key in social media as there is a lot of misinformation out there, but also it can be a great big echo chamber where you only see the information that follows your cognitive biases, that agrees with you, in more ways than one. So don't surround yourself with people like you, curate your sources wisely.

Themes
Again, my information sources are centred around people: information from doctors and healthcare professionals, and information from individual social media accounts. I assess them by their job, professional knowledge of them and whether I have met them in real life. I feel more confident critically assessing information professionally as there are processes and policies to follow, known authoritative sources and places to use, as well as people to ask. You feel on surer ground.

My undoing

This is the hardest post I've ever had to write. I started it, but couldn't finish it. I've been emotional for more than two weeks. The reason? I left my job of 10 years. I’ve been drawing it out with a couple of secondments to different places in the University, but this time, it’s for good! It's so long and thanks for all the fish (I don't like fish).

Think this was during one of the conferences we held in the building. Photo credit: conference photographer

Being at Cambridge Judge Business School (CJBS) for so many years, seeing so many people leave and so many arrive, I never really believed there would come a time when it would be me saying goodbye. It’s a sign that I have been so happy, but it's also a massive change. However an opportunity that was too good to pass up came my way: a job in not just one, but two libraries I’ve always wanted to work for, have skills in and a fascination for the subject: Classics and Languages.

Dressed up to the 80s for the first work Christmas party, in my favourite colour

2009 seems such a long time ago, but trying to organise a team in my first week on the job for the 800th anniversary of the University of Cambridge celebratory University Challenge inter-department quiz seems like yesterday; our team lost in the first round to the Anglo Saxon Norse and Celtic department, but by a very close margin.

One of the many random things I had to do while at CJBS

So much has happened in the decade I've been working for CJBS, not least doing my second degree to become a certified librarian, two secondments to the Engineering and Homerton College libraries, being published in a professional publication, and speaking at a conference. On a personal level, being a bridesmaid twice and my nieces and nephews being born, moving out of home for the first time and moving house again, learning to drive, having a breakdown and being signed off work, finally getting a hold on my panic attacks and anxiety, two huge holidays (and numerous smaller ones), being diagnosed with a vestibular disorder which gives me vertigo, being diagnosed with endometriosis, film reviewing for community radio, and a lot of writing in a view to finally finishing the book in my head.

As Leela, for the space-themed Christmas party

I could only have managed to achieve and weather these significant life events with a secure grounding, at home yes, but also at work. I've been struggling with the change of job for that reason, not having the rock of CJBS any longer, though it has felt less of a rock recently. What's worse is that I've pulled the rug from under my own feet. But now life is feeling steadier again; I always adapt well to change, it's the anticipation that gets to me; I now feel able to finish this post.

Giving a presentation. Photo credit: camlibs

Cambridge Judge Business School has given me so much: my first permanent job after graduating from University; my vocation in life as a librarian; a chance to use my personal experience with mental health professionally as a Wellbeing Advocate which I can continue at the Faculty of Classics; and most importantly, friends for life. The attitude, community and atmosphere has made me feel I belong. To feel included is a wonderful thing. But I can't put it off any longer: to paraphrase Cecelia Ahern’s new book Postscript, just because saying goodbye is so hard isn’t a reason to stay.

Getting my staff recognition award. Photo credit: no doubt Dave Amann

Obviously this is an anxious time for me, with the uncertainty of what lies ahead utmost in the doubt I had about leaving. I must admit on the first day of my new job, I did think, "What have I done?" CJBS is a wondrous place. However this is mitigated by the places I've gone to to as I already know people, there is a great community around me, surrounded by lots of fantastic libraries and already knowing a lot of the software, processes and policies I've taken on. I've been reflecting on my reasons for leaving, which are numerous, questioning whether I've made the right decision; burnout is certainly in there; progression and development is a major factor; changes that have been made within the School, the team and to my job; and obviously the sheer number of years working there. I need new inspiration, to further my confidence and to find a new home knowing I'll always have this one to come back to.

Dressed up for my final work Christmas party in 2018

It made it so hard to leave, I felt so at home; it is a kind of grief, which I'm slowly coming out of now I've been in my new job for two weeks. But I took my leave in increments, telling certain people in person alone who I wanted to hear it from me, some were really positive, some were sad and one made me downright teary! It gave me the chance to show my appreciation and thank them for making my worklife better, easier and more fun. We don't tell the people in our lives what they mean to us, what their actions have done for us and what impact they have made on our lives. Being given the opportunity to do just that was a blessing. I hope it was as moving, uplifting and confidence-boosting for them as it was for me.

Another of the random things I had to do for CJBS, screenshot from a video filmed by Dave Amann (you can find the full video online if you know where to look (I'm not telling you!)

I'm not saying goodbye though as I'm going to stay in touch with many of the people, as you wish, even if it's just on Facebook, but I've not gone far, just down the road. Cambridge is such a small place, I'll bump into people, see them at events and on my commute to and from work. Now, bring me that horizon.

Cambridge Judge Business School e-luminate-d

P. S. I hope you found all my references in this post (Douglas Adams, The Princess Bride and Pirates of the Caribbean). The title for this post was taken from the document I wrote listing all the things I hold to take myself off of in terms of websites, databases, files, intranets, wikis and posters, as well as clearing out my desk, folders and any remnants of me that are left behind. I'm still doing it to this day! I literally have to delete myself.

The photo that is up on many of the University's pages. Photo credit: Sir Cam

NB: Parts of this post were shamelessly taken from the email I sent out to say I was leaving, crediting myself in case of self-plagiarism!

As a mummy for Comic Relief (yes, that is me in there)

Burnout and us

There has been a lot of talk recently about burnout, especially as it was reported as a medical condition, widely covered in the press, but the WHO term it as an occupational phenomenon. It has been a topic where I work and something I wish to tackle in my role as a wellbeing advocate for the University of Cambridge.

However I came across an article that has made me rethink burnout and how it's actually a more personal topic than I realised. I immediately bookmarked the article as it intimately resonated with me. Ignore the fact that it's on Buzzfeed; it's basically an academic article: https://www.buzzfeednews.com/article/annehelenpetersen/millennials-burnout-generation-debt-work

It has made me realise that I'm suffering from burnout, a generational and contemporary problem apparently. It is why among my group of friends, acquaintances and Facebook community, it seems very few of us have settled down, got married and had children. Some of them are only just starting to at the age of 35. Those who are just coming round to that idea, after finally getting to a place in their careers where they feel stable, are made to reconsider bringing new life into a world with uncertain political situations, unstable global circumstances and the decline in the climate and the environment.

That is not only the way I feel, but also my mental health has prevented me from even getting close to a place where children might be a possibility. Add to that my physical health; a recent diagnosis of endometriosis, after a few years of an "unusual presentation" of symptoms and almost 20 years of symptoms I was unaware of, which I will write about at a later date once I've had a procedure and seen a specialist, might mean it's impossible anyway or at least more difficult.

Let's break the article down. I'll try and beware of sweeping statements, but I will ignore the exceptions. One statement to start with: burnout isn't necessarily a bad thing to our employers, our families and those we rely on, "our capacity to burn out and keep working is our greatest value."

Millennials
If you're born between 1981 and 1996, you're classed as a millennial whether you like it or not. We went through extensive exams, global terrorism, the financial crisis. We grew up with computers, mobile phones and then social media. We're the most connected generation, but this has made us feel unconnected. Millennials are "struggling to achieve the same standards of living as our parents, operating in psychological and physical precariousness, all while being told that if we just work harder, meritocracy will prevail, and we’ll begin thriving. The carrot dangling in front of us is the dream that the to-do list will end, or at least become far more manageable."

Life has become work
Our work-life balance is gone. "That’s one of the most ineffable and frustrating expressions of burnout: It takes things that should be enjoyable and flattens them into a list of tasks." Even when we're not working, we might be treating life like work; TV programmes we watch become a box-ticking exercise, life experiences are on a mental to-do list and relationships/friendships can be treated like goals. We feel guilty when we're not working, so we're always on call, always contactable: "burnout isn’t a place to visit and come back from; it’s our permanent residence."

Errand paralysis
The time-intensive, analog tasks with little reward, but necessary sit undone. I put it down to anxiety, procrastination and laziness, which I've been beating myself up over for a while now, especially as I hadn't been through my finances for months. I've been putting off tasks at work which have no deadlines. I moved house a few months ago and I've been getting my stuff in order in phases. It's made me feel inefficient, unproductive and unmotivated. It's made me feel less engaged with life.

Self-optimisation
Everything we do has to be efficient. We take the shortest routes, easiest options, multi-purpose products: convenience is key. We're our own promoters, showing our best selves on Instagram and Facebook, sharing opinions on Twitter and creating a personal brand on LinkedIn. However the things that are supposed to help like website optimisation, there's an app for that and electronic customer service, only make things worse.

Decision fatigue
Life is full of options, it's difficult to choose. We're bombarded with information and information overload has become the norm. Our attention is divided all the time. Just having our phone on our desk, email alerts and a social media tab open, is an unconscious diversion. We are not just experiencing information overload, but cognitive overload.

"Self-care isn’t a solution; it’s exhausting."
We know there's a problem, with the rise in mental health problems. Meditation, yoga, health apps, sleep trackers, Marie Kondo... "What is anxiety if not the condition of trying to live under these conditions?"

The solution
If you're reading this expecting a solution? There isn't one.

"You don’t fix burnout by going on vacation. You don’t fix it through “life hacks,” like inbox zero, or by using a meditation app for five minutes in the morning, or doing Sunday meal prep for the entire family, or starting a bullet journal. You don’t fix it by reading a book on how to “unfu*k yourself.” You don’t fix it with vacation, or an adult coloring book, or “anxiety baking,” or the Pomodoro Technique."

We have to understand that "it doesn’t feel hopeless. It’s not a problem I can solve, but it’s a reality I can acknowledge, a paradigm through which I can understand my actions."

Mental health and physical health

I feel like a fraud. It's taken me this long to write a post for Mental Health Awareness Week as I found out last weekend that my mental health problems stem not just from one chronic illness that causes my physical symptoms, but now two. I know I shouldn't blame all of my mental health problems on my physical health, but they play a significant part.

It is true that sometimes it's difficult to know where physical health and mental health start and end. Which is the chicken and which is the egg? For me, I question whether the physical health problems I didn't know I had caused the anxiety, or if the anxiety was there already. What a lot of people don't realise is the sheer gamut of physical symptoms mental health problems can cause. I've made a list at the end of this post of those I've experienced, differentiating between anxiety and panic attacks.

However my anxiety issues started, they are here to stay. They can be situational such as when I have to teach, go on a date, or travel by plane. They can be due to memories such as seeing a person who reminds me of bad times, songs that evoke negative emotions or anything that brings up when I was bullied at school. They can also be muscle memory as anything that increases my heart rate, gives me butterflies in my stomach or affects my breathing can bring on anxiety as my body equates those functions with an attack. Exercise can be problematic and I avoid being overly excited.

I have chronicled my vestibular problem before and the moments of seemingly random out of the blue vertigo started at a similar time to my panic attacks, which lead to generalised anxiety (GAD). However, after almost three years of again seemingly random out of the blue gut problems, which I initially dismissed as caused by my anxiety, then possibly by a tropical holiday, then by my diet, then by something more sinister, then dismissed as IBS, it turns out they're caused by endometriosis, which can cause dizziness and anxiety, along with other mental health problems. I was passed around the hospital, visiting many different departments, with frequent tests, procedures and treatments over those years; some were disruptive and some were downright disturbing, but I got to know how amazing the NHS is far more than I have ever done.

That said, when you have a history of mental health problems, no matter how great the system is, you will come across people, from the most harried of GPs to the most senior of consultants, who take one look at your medical record and write your symptoms off as psychosomatic or just another manifestation of anxiety. However I knew there was something wrong. I knew my body. That is one of the upsides of having a mental health problem, you become very self-aware, hyperaware almost. I'm an introvert and highly sensitive, so it's more pronounced for me. That's why I love that there's a move to rebrand hypochondria as health anxiety. So any change, yes you question whether it's just another anxiety symptom, but after living with anxiety for half my life at that stage, I knew it wasn't. Apart from the sudden onset and the fact that I was in the best place with my anxiety than I had ever been due to undergoing cognitive behavioural therapy (CBT), I knew the effects of anxiety inside and out; I had lived through the vast majority of them right up to and including a mental breakdown.

So I had to fight, just like I had to fight for my vestibular diagnosis. I wish I didn't have to, but I'm lucky that I haven't experienced as much of the stigma towards mental health as I know others have. Every test they did, there was a valid reason to do it and every time it came back negative, equivocal or there was no improvement, I forced the issue. That's why it took so long, they had to rule out a tropical disease with blood and stool tests, a parasite by sending samples to a special centre, coeliac disease with more tests, food allergies and intolerances with elimination diets, something more sinister with endoscopies, via a leftfield nuclear medicine scan until finally I had the third MRI of my life, which revealed the problem. I could have given up, but the doubters, including me at times, were wrong, my concerns had been validated and once more my perseverance has been justified.

Everything is interconnected and the endometriosis, which with hindsight has been causing increasing severity in my period-related symptoms over the years, but, in medical terminology, has an unusual presentation because the gynecological symptoms aren't significant and the gut problems are far worse. The only pattern, not dietary, not regular and certainly not serious, but still affecting my quality of life, was that time of the month. It is another cog in the wheel of understanding my gradually worsening health where it feels like my body is beginning to fail me and there's no cure, just management. The not knowing, the uncertainty was unbearable, but a diagnosis, that I can live with.

TRIGGER WARNING, these symptoms aren't pretty, but I don't get most of them anymore:

Anxiety:

• Weakened immune system leading to colds and bugs
• Lack of energy and motivation
• Lack of concentration due to racing and spiralling fixating thoughts
• Dizziness
• Breathlessness and shallow breathing
• Muscle tension meaning diarrhoea, constipation and stomach cramps
• Muscle tension leading to pain in the shoulders, neck, back and jaw
• Dental pain due to clenching of the jaw
• Headaches
• Nausea
• Restless legs, jitters and fidgety behaviour, including eye twitching
• Food cravings, usually sugar
• Loss of appetite
• Sudden need to pass water
• Intense thirst
• Sweating, including night sweats
• Hypersensitivity of the skin
• Sleeplessness and insomnia
• Hot flushes
• Reliance on distractions such as TV and alcohol

Panic attacks, in order of occurrence:

1. Hyperventilation (but you don't realise)
2. Pins and needles, usually in the extremities, but starting in the nose
3. Feeling of handcuffs around the wrists
4. Wind: burping and farting
5. Bodily functions stop such as sneezing, digestion and oxygen to the extremities
6. Tight chest so it feels like you can't breathe
7. Heart palpitations so it feels like you're having a heart attack
8. Hot flushes so severe you start to take your clothes off
9. Claustrophobia so you have to take anything constricting off including your bra and jewellery
10. Self-harming through pinching to relieve the pain inside
11. Vertigo meaning severe nausea
12. Throwing up
13. Shaking
14. The need to be as low to the ground as possible, usually on the floor
15. Can't take in food or liquid as throat closes off
16. Severe tension in limbs so you can't move
17. Severe tension in the jaw so you can't speak
18. Need to have people around, but not liking to be touched
19. Feeling of impending doom
20. Whiteout where you lose your vision and feel like you're going to faint

Afterwards I get thirsty but can only sip, the shakes, cold chills, diarrhoea and severe fatigue. That's the adrenaline comedown. It's good to feel the cold as that's the first sign I'm coming out of it. The next day I feel hungover and I often find bruises where I've unconsciously pinched myself.

They say you can't pass out due to a panic attack, but I beg to differ, particularly when they're this severe. Also, they say they only last 15 minutes, which may be true, but you can have another straight afterwards; I had panic attacks all day every day for almost a week which came in waves and left my legs black and blue as I had been pinching them so much. I wish I'd taken a photo so people can see, but also not as it could encourage self-harming and it was that shocking, I don't want to remember.

However writing posts like this is important as it not only helps others understand their own mental health conditions and if I help just one person, then that's a success, but it also shows me how far I've come, what I've lived through and how strong I can be. Some days I need that.