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11/07/2014

Discomfort as a Skill

I've become more comfortable with being uncomfortable.  
 
I stumbled upon that realization the other week when thinking about why this time took, of all my attempts at real recovery, and not the other times. 
 
Last autumn I started working on assertiveness.  I bought a workbook, like a middle schooler.  This was initially more for my professional persona than anything else, but I noticed the benefits in other areas of my life, too.  
 
When I was being more assertive, it was easier for me to identify feelings instead of just reacting to them.  It's not surprising, then, that I found myself able to be less and less in my eating disorder as it stopped having reactions to immediately protect me against. 
 
This was all incredibly uncomfortable.  That discomfort has started to pass after many moons, though I'm not sure it'll ever be gone entirely.  
 
It's been supplanted by a different kind of discomfort as I've slowly gained weight since the longtime birth control fully worked itself out of my system in the spring.
 
In PCOS, birth control essentially protects the ovaries and balance the amounts of estrogen and androgens they produce.  When the body has less free testosterone, insulin levels stay steadier, and insulin resistance doesn't develop (at least with me).
 
Off birth control, that protection disappears and the ovaries (and pituitary and hypothalamus) go into overdrive producing androgens. The more androgens in your system, the more insulin your body wants to produce.  The more insulin in your system, the more androgens, etc., etc.  
 
Some of the super awesome signposts of high androgen levels include male pattern hair thinning (such as at the corners of the forehead), oily skin and acne, and the growth of dark, bristly hairs in places you'd prefer they not appear.  (I want electrolysis if I'm not knocked up by Christmas.  NYC medi-spa recommendations welcome.)
 
Those symptoms aren't fun, but they're not so, so terrible.  (Okay, if I'm being honest, the acne is really depressing.)
 
What's making me so entirely uncomfortable is the belly fat that has very gradually grown since about April.  That's an insulin thing, and it means I should really get my butt to a doctor to have a fasting glucose test to see if I need to be on the insulin regulation drug Metformin.  
 
In the meantime, though, talk about the major fear of most eating disordered people coming to fruition:  weight gain, not due to out of control diet, right on your abdomen.   It is so exquisitely uncomfortable*.  
 
But being that I have finally learned how to be uncomfortable, I finally have the ability to just sit with that feeling of I hate this so much when it crops up (which is still several times a day).   
 
About a month ago, I surprised myself by realizing that going into eating disordered behaviors (whether restricting or purging or whatever) doesn't really occur to me anymore.  At some point I took it off the table. 
 
Which leaves me here, with a belly growing for upsetting reasons (if the belly fat weren't upsetting enough all on its own), and the ability to sit with how much I hate it.   That may sound incredibly depressing, but I can assure you, it's liberating.  (If uncomfortable.)
 
Next on the docket: finding a PCP's office who actually understand whether or not they're in my HMO network, because apparently no doctor's office anywhere has fully figured out how to work with the PPACA plans offered on the state exchanges.  But that is a whoooole other post
 
 

*"But CN, when you get pregnant your belly's going to grow anyway."  Yes, obviously.  But, you know, that'll be a fetus, not just adipose tissue.

11/03/2014

Welcome Back

It's been almost 2 years since I regularly posted.  What's the deal?  What have I been up to?

I decided to step away because I found myself identifying too much as "someone with an eating disorder" even as I tried to recover fully.  At some point I realized that blogging as "someone with an eating disorder" was a self-perpetuating cycle.  Identity is a huge part of many people's eating disorder maintenance, and that was certainly true for me.  "I'm anorexic," or "I'm bulimic," or "I'm a binge eater" becomes as sure an identifier as "I'm from the U.S." or "I'm an Aquarius."

I knew I wanted to get healthier, finally, for good, largely because 2012 was a crap year, and I couldn't take another one like it. 

The bigger reason, though, is that the husband and I realized we both would genuinely like to be parents.   We'd both been in denial about that for a few years, for a variety of reasons.  But in 2013 we started having serious thoughts in that direction, and it proved a fantastic springboard for a real, true recovery for me. 

Maintaining recover hasn't always been easy.  In fact, sometimes it's been really, really hard.  But it's going very well.  Better than I'd ever have thought.

Which brings us to today, or, to begin at the beginning, to January 2014.  At the ripe old age of 19, I went on the Pill largely for its on-label purpose, but also because my periods had never fully regularized, and I thought it couldn't hurt to have something to help my acne.  (Ortho Tri Cyclen had just become the first official BCP for that.)  I stayed on BCP for 12.5 years.  When hypothetical family planning came up at annual exams, I'd ask my gynecologist about my irregular periods before, and she'd wave off any worries with, "That's normal; once you're an adult, and exercising regularly, and eating right, they tend to even out."

I went off the Pill in January 2014 and I waited... and waited.  By April there was nothin' doin'.  I had to find a new gynecologist due to new insurance, and my first meeting with her revolved mostly around my eating disorder history.  She sent me packing with instructions to call in 4 weeks if my period didn't arrive.  By May she prescribed Provera to jump-start my period (and to see if a period would happen at all; she figured my ED had screwed up my estrogen regulation).  Got my period, got told "come back in 6 weeks if nothing else happens." 

I was back there 6 weeks later.  Since about March my skin had been getting worse and worse; I'd started putting some weight on my belly despite no diet changes (that was particularly fun); and I felt like I was constantly pulling more and more bristly, dark hairs out of my face. 

Finally, in late June, I strong-armed my gynecologist into ordering an ultrasound for me. I suspected, after some basic Googling, that I had polycistic ovarian syndrome (PCOS), thought to be one of the most common endocrine disorders in women. 

If you're not familiar with it (I wasn't): PCOS is essentailly a hormone imbalance: your body makes excess androgens such as testosterone.  This in turns leads to ovulatory dysfunction and other reproductive disruption, as well as to fun inflammation-related things like cystic acne and (later) higher heart disease risk.  Jackpot!

"I don't think you have PCOS," my new gynecologist had said at our first appointment in April, solely based on my weight. 

She called me the evening after my June ultrasound, clearly surprised, to tell me that I did, in fact, have polycystic ovaries. 

Isn't being right just the best?

She put me on Clomid (unmonitored -- something I learned is a reeeeeeally bad idea) in July.  By early August we started seeing a reproductive endocrinologist, and are still. 

So NOW that brings us to today. PCOS is diet-sensitive, in that it's directly related to insulin levels in the blood and insulin resistance.  Having to rewire diet and operate from the mindset of not eating certain foods in certain amounts is a tough adjustment for anyone, I imagine, but having an eating disorder history complicates it further.

I debated for several months about whether I'd open up about this here, having known for a good year+ that I wanted to come back to blogging.  After several failed medicated cycles, I find I'm ready to write about it. 

As you can imagine, the focus of this blog is going to shift a bit from what it used to be.  I still plan on covering timely topics related to eating disorders, food, feminism, the portrayal of women in our media, and all the things you're used to seeing here.  I feel I'm ready to do that again from the identity of someone who's recovered, not someone who's in an eating disorder.

But I also plan to focus on the journey of infertility; on what it feels like to be diagnosed with and then try to live around PCOS; and on the intersection of all these themes, old and new.  Because boy howdy, do they ever intersect.

So there you have it.  Welcome back, [hypothetically-still-here] readers.  And welcome back, me.  I've missed you!

6/21/2013

A Temporary Goodbye

182 days late, I am popping in to say [a temporary] goodbye.

You'll still see me on Facebook (where I share things/post occasionally), Twitter (where I mostly favorite or retweet), or Tumblr (where I exclusively hit the "love" icon).  You'll see me in comment threads here and there.

Thank you for reading, for commenting, for emailing.  The words of encouragement and commiseration, the jokes and the stories, have meant and still mean more than I can adequately say.

A summer and fall break is/was the thing.  More soon...

12/21/2012

Helpful Holiday Eating Disorder Support Ideas

The other week, I sent [redacted] an email asking her, in all caps, WHY, WHYYYY I ever go to Blisstree?  So often that site is a miasma of body-negative, food-freaked-out bleh that I just can't even go there.  (And yet, I do.)

However, here's a piece there that really, for me at least, gets it right:

How To Cope With Holiday Weight and Eating Stress... Without Triggering An Eating Disorder Relapse

Non-AP capitalization style aside, this is finally a Blisstree piece to which I am happy to direct some traffic.  Doubtless that fact is buoyed by the author's being in recover herself.  Regardless, it's short, sweet, and written in accessible yet not dumbed-down language.

Something else about it that specifically stands out: the piece outright discusses purging, which so much ED-related media doesn't.  Anorexia being the daintier disease (in popular culture, at least), bulimia and the other disorders that typically involve purging are sort of the ugly stepchildren (despite the fact that their sufferers are much more numerous).

And I definitely second the suggestion to audit the media you consume over the holidays, though frankly, even at this experienced stage, that hadn't really occurred to me.

Anyway, give it a read, if you like.  It's stamped Cynical Nymph Approved.

12/15/2012

Mental Illness, "Overmedication," Us


I'd like to say a word about psychopharmacology.  This word's been percolating for a couple of busy weeks and today presents my first opportunity to express it here.

Obviously I haven't been blogging predictably for a while.  Part of this is generic busy-ness.  Part of it's apathy and self-defeat.  But part of it's crippling, numbing depression.  (Okay, I admit, that and the apathy and self-defeat might be related.  Just a bit.)

Look, it's been a helluva Fall.  The past several weeks in particular have been difficult.

And for whatever reason, in the midst of all the difficulty, I made the patently farcical decision to titrate off of my SSRI.

Uh, yeah.  Awesome idea.  That went about as well as you might expect, particularly given my absence in these parts as of late.  (Which usually implies a not-so-hot spell.)

So, I titrated off of my meds.  Some vagueblogging-worthy stuff occurred.  I ended up in my therapist's office this Tuesday, sobbing.

I started stepping back up to my normal SSRI dose Tuesday night.  I already feel better.  Everything isn't roses and rainbows and kitten farts, but I feel better.

In a certain slice of our culture, it's correct to conclude that we're an "overmedicated" society.  There's this assumption that we're "overmedicated," that we as a greater entity are happy to pop a pill rather than… whatever other option we might have.  Even when we're the ones directly benefiting from psychopharma meds, as in the link there, some of us (including me sometimes) are dedicated to the belief that our culture is overmedicated, pill-happy.

But what does that really mean?  This month I've been percolating the idea that maybe it's just an extension of our Puritanism to insist, even if we are individual evidence against the theory, that we are An Overmedicated Society and that medication is Usually Not The Answer.

Well, what do we mean, "overmedicated"?  What do we mean when we say that?

Do we mean to support the stigma against psychiatric treatment?  Because the trope that Americans are ready to pop a pill rather than deal with a "real" problem supports exactly that.

Do we mean that medication should be reserved for "real" problems rather than depression, which we should white-knuckle through? Or rather than personality disorders, which aren't directly impacted by medication according to current evidence?  Because medication can mean the difference between having and not having the extra psychic energy to mount a fierce battle against, say, borderline personality disorder, or bulimia.

But, you know, I don't care what we mean.  The implication of "overmedicated" is, eventually, "over-treated."  The implication is hierarchies, is real struggles and ersatz ones.  Is a continued stigma in reaching out for support for mental illness.  Is, at the end of the day, continued bullshit.

We're not "overmedicated."  We're under-treated.

Please take a second to imagine a U.S. in which psycho-social counseling and other treatments were readily accessible and universally unstigmatized.  Really, really take a moment and imagine what that might look like.

Now tell me with a straight face that you sincerely think we'd still be "overmedicated."

I know I don't think so.  I don't know - I might be in denial.  I might be exactly identical, psychopharmacological speaking, in this alternate reality as I am here and now.  But maybe not.

Look at me, write to me, with a straight face and in good faith, and tell me that more accessibility from day one might mean less need for psychopharma medication at day seventy-three hundred (or day two thousand, or day whenever).  (I'm at day eleven thousand two hundred eighty-something.)