Postpartum exercise and keeping the Crohn's monster away

"I'm sick and tired of always being sick and tired." Anastacia, US singer, Crohn's sufferer.

So whatever magical protective hormones that were racing around my body during pregnancy to keep the Crohn's at bay have left the building and the result is a Crohn's monster that's more than slightly acting up. All the usual symptoms have rolled in: stomach pain, urgent need to go, diarrhoea, fatigue, loss of appetite.

I had my Infliximab transfusion earlier this week which will go a long way toward taming the beast, but I know from experience medication alone only goes so far. Diet and exercise is a huge factor in what keeps me well. Sounds easy enough, you'd think. Except with no appetite I forget to eat. Most nights dinner time arrives and I've only managed a cup of coffee and cupcake (they go together, what can I say!?!) and exercise, well apparently after giving birth you're not supposed to do anything physical, or so say the experts.

Physiotherapist: No lifting anything heavier than the baby. You shouldn't be doing any cardio for three months and don't even think about running for 6 months.
Midwife: Try light walking at first and then ease back into it with gentle yoga and relaxation exercises after the first few months.
OBgyn: No strenuous exercise for at least 6 weeks. You just gave birth, you need to take it easy.

Sigh. At least we're getting closer. The frustrating thing is that I feel like I can exercise. I'm not sore or stiff. I was quite fit prior to becoming pregnant and exercised well into my pregnancy. Since the delivery I've been doing all the Kegal exercises and lower ab exercises they recommended. I was told it would take at least six weeks to reach the target repetitions, except, I've reached them now at two weeks. Surely, there must be some exceptions to this no exercise rule?

The key to defying medical advice is to keep googling until you find a website that endorses exactly what you want to do (er... don't try this at home kids and if you do, always, ALWAYS ignore everything said on yahoo answers). So after careful perusing of the interwebs I stumbled across this page which states "General guidelines are as follows: If a woman exercised regularly for 8 to 12 weeks before delivery, she can safely resume moderate aerobic exercise 10 to 14 days after an uncomplicated vaginal delivery, or approximately 21 days after a cesarean delivery."

Hallalujah! 14 days after delivery was yesterday. Let's go! I did jump on the cross trainer today. I did 20 minutes and it felt GREAT! I was originally only going to do 10 minutes, but I felt ok so I did another 5 minutes and that felt ok, so I did another 5. I've really missed cardio. I've decided to (try) and be sensible about it. I will aim for 5000 steps per day, that half what experts say we should be doing, with 10 to 20 minutes on the cross trainer every other day and see how that feels. Obviously I don't want to do myself any damage by going in too hard too fast, but at the same time, sitting around doing nothing while the Crohn's Monster runs rampant in my guts isn't going to work either.

Thoughts?

Good Toilet Posture

In the decade since being diagnosed with Crohn's disease I've had major surgeries, minor surgeries and invasive procedures. I've seen doctors and physio's, chiropractors and dieticians, nurses and a host of allied health. I've experienced pain that ranged from minor discomfort to excruciating agony. The main line of defence has been medication. Fair enough, it's a medical condition and doctors work within a medical model.

Anyone with any type of digestive disorder knows that diet is just as important as medication in managing symptoms, yet for the most part Gastroenterologists are fairly blasé about it's impact, citing that there's no real evidence to say one way or another. Which raises an interesting question in itself. Why isn't there, if, as sufferers we know that it does? but that's probably a topic for another blog. I once saw a dietician who was so concerned by my weight loss she recommended adding saturated fats to my diet to "calorie add". I don't even know where to begin to explain why thats at least ten kinds of wrong. Most of what I know I've learnt through either my own research, from talking to other people with IBD or from experience. Basically, the medical community associated with IBD has contributed very little to my understanding and management of my illness outside of the drugs and surgical interventions.

Compare that with my recent experiences during pregnancy, labour and post-partum. Obstetrics, if you'll pardon the pun, has really got it's shit together. In a three day admission I saw midwives, ObGyn, paediatrician and even had a 45 minute one on one session with a physiotherapist. There was a checklist of education topics covering everything from the physical, emotional and practical aspects of having just birthed a baby and having to care for that baby post discharge. Post-natal depression was raised frequently. I can't remember the last time, if ever, I was asked how Crohn's was impacting on my mental state.

Despite gastroenterology's almost complete medicalisation of the disease, it amazes me that not one person has ever spoken to me about toilet posture. Toilet posture (you would think) would be fairly important, given that going to the loo itself is the cause of much physical pain and apprehension.

So imagine my surprise and delight when I wandered to the toilet for the first time after giving birth, stitched up and both sore and swollen, dreading the inevitable pain that was sure to come, only to find a poster on the wall explaining how to go to the toilet without doing yourself damage. Why did it take having a baby to get my hands on this? I'm of the opinion that a brochure on correct toilet posture should be handed out with the What is Crohn's brochure on diagnosis.

How to go to the toilet
Don’t ignore urges to use your bladder or bowel.
Avoid straining - take your time when you empty your bladder and bowel to make sure they are completely empty.


The best position to sit on the toilet is:
Sit leaning forward with your knees higher than your hips
Legs wide apart with your elbows on your thighs
Let your tummy bulge out and relax
Always sit on the toilet seat. Do not hover above it
Stay relaxed on the toilet; relax your breathing
Allow yourself time, do not rush.

Bathroom Attendant

On the weekend we went to check out the newly refurbished Myer. Once a high end store, stocked with quality overpriced products, Myer, in Melbourne's CBD has come to resemble more low end stores (like Dimmey's) in recent times. With it's unmaintained building, sparse staff and jumble sale stock bins. So, $300 million dollars later and an advertising budget to match, the new Myer was 'Revealed'. It was ok. It didn't have the glizty sparkley dazzle I was expecting, but there is no doubt it is a massive improvement from what it was.

After several moments of looking around, nature called. I went to the women's toilets on the sixth floor and was surprised to find a bathroom attendant! At first I thought she was just using the facilities, but no, as I walked in she pointed to an empty stall with a smile that didn't quite reach her eyes. I smiled back and muttered a slightly bewildered thanks.

Now, the toilets on the 6th floor aren't that big. We're talking 3 sinks with automated taps along the rear wall and eight stalls opposite. Two automated hand dryers on the right and exits on the left. I'm pretty sure I could have found my way to the empty stall on my own. Likewise, when I emerged from the stall she waved towards the empty sinks. It's entirely possible that I may have gotten lost somewhere between the eleven steps from the stall to the sink I suppose. She watched me as I washed my hands, which was a little strange, especially since she made no conversation, not even a benign "How's the weather outside?" and as I left I said goodbye and she acknowledged me with another smile that didn't quite meet her eyes.

Imagine, Myer spends $300 million dollars classing up the joint and you get told your job is now to stand in the toilet all day and assist people to use what are largely simple and self explanatory facilities. It's not like they have bars of soap and cotton hand towels and little bottles of perfume and talcum powder and free manicures. It's also not like the room is a maze that requires a tour guide. What the point? I'm as aquatinted with bathrooms as any person with Crohn's, but even I would tell the boss to bugger off at that.

I wonder if they rotate the staff around? Today you're in haberdashery, tomorrow 6th floor women's and Thursday it's entertainment or, if this is this woman's full time gig? I should have given her a copy of the sits vacant. No wonder her smile didn't meet her eyes. Maybe that's where they send staff who mess up as a punishment. Maybe this poor woman took too long on her break or gave cheek to her manager? I also wonder if bathroom attendants have some cool executive title to cover the fact that they basically stand in the toilet all day.

Hi, my name is Jane Doe, senior manager of crapiatrics from the department of individual client waste management, at your service...

Enjoy it now because...

According to the people of the world I will never sleep, eat, shower, drink coffee, read, watch TV, bake, go anywhere, do anything ever again. I won't have the time or the energy. Once this baby comes I will never, ever be able to do a single solitary thing at all. My house will be a mess because I wont do any housework, I won't have time. I'll be a mess because showers and personal hygiene will be a thing of the past. I'll gain even more weight because I wont have the energy to exercise or the time to eat properly.

My partner's life won't change at all though.

I've been told to get all the sleep I can now because once the baby comes... I didn't know you could bank up sleep, store it up in advance for times you can't sleep, how handy is that? I was complaining of feeling bored and restless and somebody actually said "Enjoy it now" Are you fucking kidding me? Have you felt bored and restless? If I never feel bored and restless again I'll be pretty happy.

When I started telling people I was pregnant all I heard about was how awful pregnancy is. Morning sickness, weak bladder, fatigue, weight gain, your skin breaks out, you get haemorrhoids, stretch marks, the baby kicks you all day and night, you can't sleep... blah blah blah. I've really enjoyed being pregnant. I think feeling my baby move is the single most amazing thing I've ever felt. Morning sickness was minimal, I maintained healthy diet and exercised well into my pregnancy. Sleep has been disturbed in the third trimester, my breathing was laboured as the baby pressed on my diaphragm and I got this annoying itching but, for fucks sake, none of that is really much to complain about. Try an intestinal blockage some time. Hell, I"ve had side effects from Crohn's medications that were worse.

From what I've heard labour with be traumatic and painful and I'll wish I was dead. The hospital will send me away because they'll claim my contractions are braxston hicks and when I'm just far enough away from the ER the baby will start to come. There's a billion complications that are likely and I'll need a c-section, blood transfusion and Crohn's surgeon on stand-by. My vagina will stretch and never be the same again. They'll have to cut it because the baby's bulbous head wont fit. It'll breach. That's if I don't give birth in some public toilet halfway back to the hospital first.

What the fuck is wrong with people??? I don't understand this compulsion everyone has to fill a pregnant woman's ears with horror stories about pregnancy, about the birth, about caring for a newborn. What is this need women have to scare the absolute shit out of each other?

I mean, if it's that's truly horrible, why would anybody ever have a second kid?

I feel like I've ranted about this a lot, but at the same time I feel like I'm being bombarded by negativity all the time. I'm pretty sure I've seen women with babies out and about, in shopping centres and coffee houses and cafes. I think I can recall seeing women with children having lunch and browsing in clothing stores and bookstores. I've seen them in parks and gardens. I live near a golf course and I know I've seen women with babies walking and (some of them even jogging!) around the walking track. Some of them even looked... dare I say it... good. They looked fit and healthy and were smiling. OMG!

if I've seen these women, then obviously, life doesn't end once the baby comes around. While I may feel tired and the baby's needs will obviously come before my own but I'm pretty sure the kid will sleep long enough for me to have a coffee, jump in the shower and throw on some pants, and if not, the baby does have a second parent who is more than capable of stepping in for 10 minutes.

Yes, life is going to change in a big way, but let's not get ridiculous about it.