#I even worked out strength and prehab / rehab stuff before that

[toimintalaama]

My knees are dead 💀

Went to the gym (yay) and used the elliptical for an hour (yay). Now my knees and hips want to disintegrate (less yay)

[mybumpbirthandbeyond]

Grit

I didn’t think I’d be writing a blog again so soon after the last two, but there’s been plenty going on and it’s easier for me to write about how I’m feeling at the time. I mentioned my consult with Antony, Gráinne and Lyndsey in my last blog. It was originally meant to be a follow up to my in person consult with Gráinne, but it turned into a more practical consult with me doing various exercises to see if they were still viable. Remember those crunches with a double leg lift that Antony loves so much? I thought they were definitely gone, so how I ended up doing exactly that I’ll never know, but Antony is a master at proving to you that you’re capable of so much more than you think and before you know it, you’re doing something you had no idea he was asking you to do in the first place. I was lying on the floor doing headlifts and before I knew it I was lifting my legs knowing fine well that they didn’t agree with my back and I probably wasn’t overly comfortable with the idea. I did a few full press-ups, decline press-ups and various strength exercises. Most were, thankfully, easy enough. The press-ups I already knew from what Gráinne has said were a no so I was at peace with that. I know I won’t be doing them fully again until I’m postnatal. We talked through how I was feeling about the prehab programme but thankfully I was feeling better about that because Gráinne has been so thorough in going through what was and wasn’t on the table. Lyndsey was seeing me the following week in person and she was also going to be checking things exercise wise so I was feeling pretty relieved all round. It was weird that it had been 7 months since I last saw Lyndsey in person. I was there every couple of weeks for 10 months then just stopped. We were confined to the treatment room as opposed to the gym, but there was still enough space for me to be put through my paces. This time we were joined by an MSK student in his final year. Lyndsey had filled the student in on my case before I arrived - she said they’d basically been through Instagram 🤣 It was weird having someone know the stuff I had done then ask me questions about it because it was their first time seeing it. I didn’t mind at all, but the questions were actually quite thought provoking for having just met him! He asked me how I felt finding out I was pregnant - was I scared? I said no my fear was actually surrounding my progress not my pregnancy. He asked about chin-ups. I laughed and said no more chin-ups until the postnatal period. We went through any exercises we weren’t sure of from the consult the week before as well, which really helped to reassure me what I could and couldn’t do. One of the most important things I took away was something I had had on my mind even before I fell pregnant. What would happen to me after birth? Before Covid in Fife, it used to be that there was ranking system of women who were priorities to be seen on the ward by pelvic health physios. I didn’t know that until I saw Lyndsey and she recommended I speak to patient relations. We know already I ranked at the bottom of that list in my first. Somehow I didn’t think that would be the case this time but everything had probably changed. Lyndsey said they weren’t on the wards at all now but I wouldn’t be forgotten about - she would be contacting me within a week and seeing me ideally between 4-6 weeks.

That makes me think a GP check in my case is pointless. Certainly from my experience anyway. I have a few friends who are GPs and also mums so I know their checks are thorough, but I can’t help thinking there should be a checklist for a GP - any stitches/wounds should be checked; breasts for engorgement, mastitis or thrush; possible diastasis so referrals should then be made; mental health/well-being checks, and they should last longer than bloody 10 minutes if they need to! There may already be a checklist, but I doubt it from hearing so many women say it was a waste of time. My own experience was I directed the GP to my stitches, I told her I still had symptoms of thrush that hadn’t that that hadn’t cleared up, and that I had a separation so she would need to refer me. I can and always have been able to advocate for myself - others can’t and it’s those people we need to help.

I came out of that consult feeling really positive - between the exercises I was given by all three physios, there was quite a bit still on the table and they were happy with how everything looked. I’ve also started online pregnancy strength and fitness classes with Lorna at Ur Mama Strength and she is excellent. She had previously very kindly given me tips and strategies to work on for my chin-ups which helped massively. I go into a bit more about classes below, but basically it’s two classes per week at 45 minutes each which is perfect to slot in with prehab and keep me active.

The problem is how I’ve been feeling. Lazy is one thing I’ve alluded to, but I’ve not just felt lazy - I’ve felt guilty. I’ve gone from doing my rehab most nights and pushing myself hard, to almost not being able to bring myself to do prehab. I almost can’t admit that out loud. I feel like I’m hiding behind my written words but if the truth be told, if I recorded a video saying exactly this, I would be ashamed. It’s the closest I am to speaking directly to my physios and admitting I haven’t done what I said i’d do. I’m not holding up my end of the bargain. My face is going red even writing that. I know they know I’m hard on myself. I know I am. I watched someone say they felt guilty early postnatal not doing something. When I get to that stage this time? I absolutely know I will berate myself endlessly. No amount of support or telling will fix that. I know exactly the faces and words all three would use to tell me to give myself a break and that’s why I think the world of them, but I know it doesn’t matter. I can’t and won’t be able to help it. Part of it is when I do eventually get to doing something, another exercise is modified or removed altogether and I’m left feeling like I’ve missed my opportunity because that exercise is now benched. I said the other night I swore when I lost a few exercises and I wasn’t joking. When that happens, if I’m honest, it takes me minute to accept it.

When people are given help, it blows my mind that they don’t follow it. What biggest motivator is there than getting your body back? I felt guilty not doing pelvic floor exercises for gods sake and there was really nothing wrong with my pelvic floor 🙈 it’s me who’s to blame if things go wrong. I may have been proactive and advocated for myself to get help, but now I have it, what use is it unless I hold up my end? You don’t need to tell me to work hard. I’d rather die than be considered lazy. Bit dramatic maybe but I’d certainly die of embarrassment. Feeling lazy is bad enough! I thought I didn’t care what people think of me. To some extent that’s true - the people who don’t matter I don’t care. But the people who do matter to me, it’s everything.

Obviously I can’t push myself hard in pregnancy but I feel like consistency is still important. The classes with Lorna have been a godsend from that point of view - structure and routine. Lorna knows my story and she absolutely knows her stuff. She is without doubt one of the most highly qualified, diligent, and one of the best as far as I’m concerned. As much as it speaks volumes as to how far I’ve come that I can know what is right and what isn’t, sometimes just checking in on a more routine basis with someone far more qualified than me is reassuring. I may have come a long way in terms of rehab, but this is now prehab and a pregnancy with an existing, significant diastasis. Not exactly something I feel comfortable with in the slightest. I’m confident in that I know my body, but even then it’s thrown me some curveballs this time that I’ve struggled to understand.

That’s why I value my consults so much. That’s why I have lived and in some respects still live from one consult to the next in my journey. It goes without saying that I take much more from these than just exercises. I’ve said it before, but this is an opportunity to have questions answered, to speak my mind and know that my three physios are the ones who get it when no one else does. How do you feel when someone understands how you’re feeling and can not only say the right things, but can reassure you because they know everything you’re going through?

This is not just a mechanical thing - fix my tummy and send me on my way. I’m broken in more than a physical sense by this. Initially in those early days there was just so much other shit going on it took a back seat. I thought it would take time but that it would be sorted one way or another. I kept pushing feelings away until I broke down in March. That night I was doing my exercises but I couldn’t fight the feeling I was overwhelmed. It was the stupidest thing that set me off. Initially I was angry which powered me on at first, then I just collapsed in a heap crying on the mat and couldn’t get up. No one knows that. I then resented rehab and refused to do it for a few nights. Probably indicates how bad I was hurting. I got a message the next day from Gráinne out the blue asking me about some questionnaires to fill in. I know she won’t take this the wrong way given everything that was going on but I almost didn’t reply as quickly as I do normally. I didn’t want a reminder that day because I still felt hollow. Somehow, without going into massive detail, it came out and she made me feel 100 times better. That’s the importance of getting the right person, or in my case, the right team. They’ll pull you back from the brink again and again.

As much as I value my consults, it can be uncomfortable talking about your feelings. Knowing it’s as close to face to face as you’re going to get. Knowing it’s recorded and will be made available for others to see and analyse. I don’t in any way begrudge that it’s public. I think it’s fantastic because the more public this is, the more people this helps. Having three of the most incredible people listening who are so understanding and so supportive is invaluable, but it can still be hard to be honest. I have developed what I consider to be a close relationship with all three of them, but it’s still difficult. I don’t wear my heart on my sleeve and I don’t articulate my feelings often. I bottle things up even to my nearest and dearest. I sometimes rewatch the consults and think we all get along so well and a lot of the time there’s quite a bit of banter and plenty of laughs. I couldn’t be more grateful for that. However, any time I’ve hit a dark place, I always thought it might be valuable to share it, but by the time we have a consult I’m past it and then it would just seem like dwelling. I’ve probably been able to analyse my feelings more in retrospect and hopefully that has still helped people understand, but it’s probably not a true reflection on how I really felt at the time. Nobody needs to see me cry that’s for sure, but I do worry that I’m painting some kind of rosier picture sometimes. I guess that’s why I still write these blogs. This is how it all started of course, but you need to see the whole picture to understand. Sometimes the armour I’ve built up hides the cracks.

My next consult is a virtual one with Lyndsey and then I’m seeing Gráinne in person should everything stay as it is pandemic wise. I know when I see the ultrasound I’ll know how much my ‘laziness’ may have impacted on my muscles and linea alba. It will thin again and the muscles are bound to separate, but I have to do all I can to maintain strength and mitigate the changes as much as possible. That’s probably another reason I’m feeling guilty.

So I guess this is an apology to my physios for not holding up my end of the deal. I can’t promise it won’t happen again or that I won’t falter. This pregnancy seems to be different in terms of how I’m feeling day to day. What I can promise is, that I will more than make up for it on the other side - that I won’t just promise, I’ll guarantee. After all, they know better than anyone that this is a marathon, not a sprint.

[mybumpbirthandbeyond]

Operation Abs of Steel

It’s crazy to think I’m at this point already. I genuinely feel like I’ve blinked and I’m back at the start again. Only this time is so different; this time, I am informed; I have the most incredible team in place already so I’ll be seen so much quicker; and I know what’s to come.

I have probably thought about the first two in person consults since falling pregnant. The first two being my first with Lyndsey, and my first with Gráinne. They are the official starting point for rehab this time around, and will tell me exactly what my separation looks like after a second pregnancy. This is the comparison point for any progress up to the date I have surgery. These will be the hardest hitting – the reality check of how far I have to go and how hard I will have to work. This is the start of an even longer road….

Prior to any consults, I wanted to get started. Most people are probably getting the measure of me by now: I don’t like to sit and do nothing and I like to work hard. The fact that I felt so much better more quickly this time, just increased that desire. I had been in touch with Lorna from Ur Mama Strength (I had done her classes until I was about 35 weeks pregnant). She kindly sent me the postpartum guide she sends all her pregnant women which gave a guide for things like connective breath work, walking and mobility for the first 6 weeks postpartum. I did that as well incorporating some of the stuff I had been doing right up until the week before I had Emily from prehab and of course, my pelvic floor exercises.

The checklist of things that physios look for was in the back of my head when I started. First of all, could I properly carry out the connective breathing and was there any sign of rib flare? I never had rib flare last time and I certainly didn’t pick that out this time either. The appearance of my tummy in general was awful when breathing – wrinkly skin just like an elephant, mind of its’ own, loose skin that is paper thin. Aesthetically, this definitely appears worse this time. I knew I would have to do a self-assessment at some stage and I was pretty nervous about that. I knew it was bad and probably as bad as last time, but the thought of finding out how bad, somehow made me apprehensive.

My hand continued to sink and sink telling me there was little to no tension. I had to use two hands to measure the gap between the rectus muscles and even that wasn’t enough. It seemed to be about 11 fw + at the widest point at rest. This is more or less exactly like last time – the only difference was I didn’t self-assess last time. Knowing that, I had a bit of wobble starting exercises again. Staring at the same ceiling I had for the best part of a year before I fell pregnant, but knowing I was back lying on my back really overwhelmed me. Knowing how long it took, and how much hard work I put in to get to where I was, it was pretty difficult to imagine being able to do that again, starting from scratch. But I shook it off. What made me progress last time to the point that I did? Not sitting around feeling sorry for myself that’s for sure (though I allowed myself that once or twice on the really bad days). It was gritty determination, competitiveness, stubbornness, and unwavering resolve that got me to where I needed to be. I couldn’t change that about me if I tried so there’s no way I won’t get back to where I was, if not even further.

Prior to my first in person consult, I had a virtual consult with the team. This was actually scheduled for the week I had Emily, thinking it would be my last one before the baby was born. When she arrived early, we decided to push it a few weeks. We ended up looking at a few things. I’m not entirely sure what they expected to see, but one of the exercises was one Antony said many people would be shocked by at 2.5 weeks postpartum. I struggled to see what was shocking about it – without meaning it in a boastful way, it felt easy. The good news was the initial signs were promising – I was clearly managing to generate tension and control the pressure well considering where I was at. We booked in my next consult for after my appointment with Lyndsey.

In the lead up to my appointment with Lyndsey, I started to test my ability to manage the pressure based on what I had done in the virtual consult. Headlifts felt fine and I also did a few more challenging things like birddog and introducing resistance to some of the exercises. Most of the time I could see the exercises were manageable. Birddog was a funny one – it felt like there was lots of pressure, but it didn’t feel that different to being in standing. It was pretty hard to feel and do the exercise at the same time so I got my husband to check – by this point he’s about as knowledgeable as I am! (though I still have the edge 😉) We agreed that gravity didn’t help and it was likely any additional pressure was not doming, but the weight of my organs falling forward. One of the many things I have learned from my physios is the pressure is visible when I am just standing doing nothing – that’s why my tummy protrudes. If that’s the case, if there is little to no change when doing more challenging core exercises, what’s to stop me from doing those exercises? I can’t prevent or stop the pressure when standing or sitting down, so what’s the difference?

It’s lessons like that that have made the world of difference to how I view this journey. I have learned so much already, and despite not knowing a thing last time, I wouldn’t have risked trying anything until I was seen by someone who was qualified to tell me. This time, I know enough to try things myself without bothering my physios for a simple yes or no.

My appointment with Lyndsey felt like an exam day in some ways. I had this nervous apprehension and kept clock watching until the appointment time. Don’t get me wrong, I am excited to see what happens as time goes on, but as I said, the first appointments will be the hardest. I think my experience of being asked when I was due the previous day hadn’t helped. You feel ashamed, self-conscious and like crap to put it bluntly. It knocks your confidence and just demonstrates how much work there is to do.

I had been really worried about prolapse this time around. There’s something about being blissfully ignorant that can be comforting. The fact that I see posts on prolapse all the time and how your chances increase the more children you have, did not help. That’s probably a positive indication of how much more readily available this information now is on social media. My birth was very lucky in that I only grazed this time instead of needing another episiotomy so it had made a lot of difference, but there was still an initial heavy feeling for the first few weeks. I had stopped bleeding earlier than I had with Cailean, but I’m pretty certain I’ve already had a cycle as I started bleeding again almost as soon as it had stopped. Us females are so lucky….🙄🤦🏽‍♀️

I had been doing my pelvic floor exercises as I said, but I was still a bit worried when it came to the pelvic floor check. It’s so integral to the core and what will be my rehab, that it was important to know exactly what was going on. Thankfully it was good news – good contraction and release, no damage to the muscle and no indication of any prolapse. My endurance could be better, but I’ll build that back up again, just like I did last time.

The tummy assessment was unsurprising. 11fw + was what Lyndsey also found at rest. Tension was awful as her hand also sank down to my bowel. On contraction when I did a crunch, above the belly button was 4 fw, at the belly button was 8 fw and below was 6 fw. Lyndsey had the impression my tummy looked better in standing but we both agreed there was next to no elasticity in the skin, particularly above my waistband and below my belly button. As Lyndsey pointed out, this could get worse as we improve the tummy itself and the only way this will be fixed will be when I have surgery.

I was asked to fill out the outcome measures as a mark of where I’m at mentally. I have been filling in two regularly for Gráinne, but by the time I’m finished, I wouldn’t be surprised if there wasn’t a single pelvic health outcome measure that I haven’t completed!!

We were then able to go into the hospital gym to try out some exercises. Lyndsey had spoken to Gráinne and they had come up with a plan. It once again dawned on me how lucky I am – how many people do you hear of who end up with a team of physios all more than willing to collaborate and work together in your best interests? Unbelievable.

The basic exercises all have their place, but as I’ve said before, they are the ones I hate – they make me feel incapable and like I’m really weak. I expected to do progressions of these – such as introducing resistance to the likes of clams or glute bridges. The fact I was able to do things like birddog with resistance, bear holds and lunges with theraband was a pleasant surprise – I was starting at a further point than last time. To me, that indicates things will hopefully move quicker, and I will progress sooner, which is everything I hoped for this time around. The reigns are firmly on at this point so I’m only to do rehab 3 - 4 times per week, but I expected that. Plus, it’s harder to fit in with two kids so probably not a bad thing!

I came out of the appointment with my confidence back. It’s amazing what seeing someone in person and being able to try things out while being assessed does for your mindset. I had taken being in person consults for granted. I think the toll my second pregnancy had taken on me mentally during lockdown and the fact I had only been seen twice in person throughout the entire duration had also played a part. Don’t get me wrong, I have made great progress through previous virtual appointments, but when you’re dealing with something physical, there is no substitute for someone being able to put their hands on you.

Getting started was one of the most important things to me. The apprehension of not knowing what the diagnosis was and where I would be rehab wise, was only going to be counteracted by the fact I would be back in control once I got started. I am the master of my own fate now – the progress will be dependent on me putting in the work. As I’ve said before, this is what I thrive on – the pressure I put on myself to succeed and the fact I will work harder than ever to ensure that I do. The goals I have set this time around are ambitious and will be challenging, but I have plenty of time and to be honest, I need a challenge to remain focused. Rehab 2.0/Operation Abs of Steel starts now.