Recovery: Month 12.5 (Aug 4) + In-depth Excision Review

It's been 380 days since my excision and A LOT has changed since July 2017! I didn't think weekly (or even monthly) updates would be beneficial once I got to the point where the initial healing from surgery was done. But I wanted to post an update looking back now that I have several post-excision menstrual cycles under my belt to compare to my pre-surgery cycles. I feel confident I can more accurately review this entire journey at this point (considering most laser ablation procedures fail within the first 1–6 months after surgery). It has honestly been a HARD recovery, but I truly feel it was a miracle since my excision has been successful and benefited me in countless ways. This is going to be long since I'm doing an in-depth review, so in an effort to keep this more organized, I'm going to break things down into sections.

HEALING

To be blatantly honest, my excision has been my toughest surgery–by far the most painful, uncomfortable, and nauseating, and definitely the longest recovery. BUT I wish I'd done it sooner because despite the pain, I feel a night and day difference. I've had several other surgeries to compare it to—oral, knee, foot (bone and nerve surgery–ouch), shoulder (removal of a tumor growing on a nerve–ouch), and underarm (yes, seriously)—so I know the drill when it comes to recovery.

The first 3 days after my excision were the worst (as in, give me ALL the morphine), and the first 3 weeks were pretty bad. By about 2 months I was no longer sore to the touch, and somewhere between 4 and 6 months was when I felt fully recovered from the surgery itself (compared to a few days or weeks with my other surgeries). Once my body had recovered from the surgical procedure, I discovered some underlying issues, but I've been making good progress on those issues and finding total body healing. (Since I want to keep this post primarily about my recovery, I will go over the underlying issues in my next blog post.)

I think a few things contributed to my healing: plenty of rest, infrared light, a good diet, and physical therapy.

Rest
I had plenty of help at home while I was healing so I was able to sleep and rest a lot. My mom took the day shifts, my husband took the evening shifts, and neighbors brought in meals. My employer was also great and let me have plenty of time off (miraculously the clients I work with were quiet the entire time I was gone and had no last minute needs). I went back to the office 13 days after my surgery, which wasn't too strenuous since I have a desk job, but it was still hard, both physically and mentally. In an ideal situation I easily could've taken another full work week to heal.

In addition, I also made sure to keep my life as simple and stress-free as possible. This is easier said than done, but I tried not to overdo it at work and church, did a bit of yoga, tried to get adequate sleep, made simple meals, and donned my mesh underwear/sweat pants/dresses for several weeks.

Infrared light
I used a large infrared light on my surgical site for about 20–45 minutes, 1–2 times per day for the first 2 weeks. Infrared light penetrates deep into the body to stimulate blood flow and promote healing, plus it got nice and toasty so it felt good on my lower abdomen.

Physical therapy
A little over 2 months post-op I started pelvic floor physical therapy and visceral manipulation. My PT worked out a lot of the knots in my muscles, stretched the fascia in my abdomen, broke up the adhesions forming from my surgery, and taught me some stretches to do to prevent scar tissue from becoming a problem. I continued to do weekly PT sessions for 2 or 3 months, at which point my therapist said I should be able to maintain the results myself. I've had no issues with tightness, pulling, or pain since.

Diet
I ate a decent diet before surgery, but afterwards I really tried to clean things up even more. Since nearly 100% of the nutrients your body needs come from plant foods, I tried to eat a balanced, nutrient-dense diet to allow my body to recover quickly. Initially I was eating soft and simple foods (like applesauce, bananas, avocados, potatoes, juice, etc), but gradually incorporated more and more variety. Here are some specifics of what I did:

• Replaced a lot of processed/refined foods and most animal products with home cooked foods and plant alternatives. I've learned that because meat is treated with hormones and cow dairy comes from lactating (and therefore hormonal) animals, those foods specifically can wreak havoc on human hormones. Staying off of those has definitely improved my health.
• My diet is about 95% plant-based. I eat meat here and there as well as a bit of goat or sheep dairy products. Meals typically consist of veggies (cruciferous and leafy greens are a major part of my diet, but I routinely eat about 20–30 varieties), fruit (usually berries, tropical fruit, apples, or bananas), as well as legumes, nuts, and gluten-free grains. 
• Added in a multivitamin. I was originally taking a different multi, but in the last week or so I've switched over to an all natural vitamin by Naturelo and I've really liked it so far.
• Increased my water intake.
• Did food sensitivity testing through EverlyWell, eliminated foods my body can't handle, and noticed several improvements. (For anyone interested in their products, here's a link to get 10% off. They have tons of really cool tests, so definitely check them out!)
• Followed the suggestions from Period Repair Manual by Lara Briden, as well as used the resources available on NutritionFacts.org, and listened to the advice of my nutritional scientist husband. (He's also just starting up a website and a blog. You can peruse his new site Pure Energy Health if you're interested.)

SCARRING

I stopped taking weekly or monthly pictures a long time ago, but I did take one on my 12 month anniversary and I've been pleasantly surprised by how well my scars have healed. They're not as wide or gnarly as other scars on my body and they've lightened up pretty well too. (As a side note, I took the pictures below while I was on my period and my stomach is very much not bloated.) I gave up on my butterfly closures and scar treatments once I started PT and visceral manipulation, but I think the scar treatments I did, the positive changes in my diet, and my overall improvement in health allowed my skin to heal better. My scars are still visible, but they're nothing I'm ashamed of. Here are my anniversary pictures:

July 20, 2018: My well-healed and light scars. Can you even see them? 

My bellybutton scar. This is the only angle you can see it.

POST-OP PERIODS & MENSTRUAL HEALTH

My first post-op period
If there was one time I was grateful for the depo shot it was right after surgery. I've heard from many people that their first several periods were really rough, so I was glad that I did not get my period back for a few months. I got the depo shot in May 2017 and had constant spotting for months, followed by about 3 months of full on heavy bleeding. It was heavy enough I ended up getting my iron levels checked, and I managed to keep my levels up by supplementing with iron. The bleeding finally stopped mid-November when my cycle returned (i.e., I ovulated) and then I had an actual period the day after Thanksgiving 2017. I had no bloating and my cramps were more of an annoyance than painful, and only lasted about an hour in the morning. I actually forgot they were there as I got up to eat breakfast and mingle with family. In addition, I actually had red blood flowing out of me and a 4 day period, rather than the black, clotty tar-like blood I'd endured for 8 days pre-surgery.

My periods since December 2017
Over the past year, these are the specific things I've noticed:

• My period has consistently been 3–4 days long instead of 8 days.
• I have no bloating before or on my period. Zero. Zilch. Nada.
• My cramps gradually intensified over my first few periods, but they went from like a .25 on a scale out of 10, to like a 1 or a 2 (tops) and while it was initially disappointing, they weren't bad enough to take pain meds. Compare that to when I was relying on 800mg of ibuprofen, a slew of natural remedies (namely cramp bark and ginger), and a tens unit to barely even function as a human. After a few months I discovered I was deficient in some nutrients, I corrected the issue, and my past several periods have honestly been a breeze and 100% pain free. Zero cramps, zero bloating, zero breast pain, and I've almost gotten my PMS under control too.
• My cycle isn't like clockwork, but it's more predictable. Before my cycles ranged from 12–56+ days, but now the range is more like 27–33 days. Not perfect, but much better. I've even gotten pretty good at predicting down to the day when my period will start so I haven't been taken by surprise since November.
• My flow has been more predictable. Before I didn't know if it would be super light or super heavy, but now I know the first two days will be the heaviest, followed by two light days, and maybe a day or two of very light spotting after that.
• I pass fewer blood clots, and the ones I do pass.
• My flow is more along the lines of a normal, healthy period (which is easy to keep track of since I've been using a menstrual cup since November).
• I still have some issues with pre-menstrual spotting, but this appears now to be more an issue related to low progesterone, rather than endometriosis. My spotting now is more red or brown and pretty light, whereas it was black, clotty, and heavier before.
• I don't really have an issue with the dreaded "period poops" anymore. My bowel movements have been regular and pain-free for the past year and my period doesn't drastically affect that. Before surgery I was going once every 5–10 days (and sometimes I'd bleed and be sore for days after), but since surgery I've been going 6–10 times per week. Shortly after surgery I attributed this regularity to triphala (which I still take every once in a while), but I've since learned my body works as designed when I eat fiber and drink plenty of water.

Bloating
Since I can hardly believe how much this has improved I took some pictures to prove that I no longer get bloated. Here are some pictures from just before my period as well as on my last period.

July 17, 2018: This is the day before my period started 

July 20, 2018: My anniversary date and the middle of my period

Menstrual health
I wouldn't feel confident in determining the success of my excision if I would've been on hormones, but I am proud to say that the last hormones I put into my body were from the depo shot in May 2017. I know that when I get my period there is nothing covering up the way that it feels, so I know that my periods have changed for the better. After experiencing so many horrible side effects from the shot and the Nuvaring (you can read about that here), as well as the pill, I knew synthetic hormones weren't for me. Considering the copper IUD had been a disaster as well, I nervously ventured into the world of less effective non-hormonal birth control, but had bad reactions to latex condoms, non-latex condoms, and spermicide.

As a last-ditch effort out of desperation I started the Sympto-thermal method (STM) of birth control*. While I was skeptical initially, it's worked flawlessly for birth control, but even more amazing, it's allowed me to keep track of my menstrual and overall health, understand what things affect my hormones, keep a rough understanding of my hormone levels, confirm that all my post-excision cycles have been ovulatory so far, and anticipate my periods down to the day. STM has allowed me to improve my hormonal health because I can see exactly what's going on, and while I'm not quite at 100%, I'm a lot closer than I was 5 years ago, or even 1 year ago.

*I'll do another post to explain what this is and how it's helped, but essentially this method charts the 3 signs of fertility to determine the fertile window—basal body temperature, cervical fluid, and the optional cervical position. If anyone's interested in this method, get the book Taking Charge of Your Fertility by Toni Weschler and consider buying a TempDrop which is a wearable thermometer and makes charting a breeze.

SEX
Last but not least: sex. This is probably the topic I like talking about least because excision didn't magically make sex amazing. I still have trouble, but there have been improvements.

Here are the things it helped with:

• Penetration is now possible.
• Sex no longer brings me to tears. However, at its worst sex still hurts a bit, and at its best it feels neutral. It used to feel really sharp, but now when it hurts it's either tight, burning, or a tearing sensation. I think the surgery and the pelvic floor physical therapy is primarily responsible for this improvement.
• My husband no longer bumps against my cervix and vaginal wall. I know this is a combination of 3 different things, but I don't really know which thing helped most—some is related to the excision, some to the surgical straightening of my vagina, and some related to the different positions we use now.

Here are the things it didn't help with:

• Eliminating 100% of my pain. I had expert excision of my endometriosis, surgical straightening of my vagina, pelvic floor physical therapy, urology appointments, exercises, stretches, etc. and each one of those improved different aspects of my pain. However, my pain now is due my body's inability to lubricate so it's likely a psychological rather than physical problem. Period sex on my heaviest day (i.e., when I'm super wet) is totally pain-free though.
• Increasing my libido. I have like zero sex drive, but my hunch is that this is related to the fact that sex still isn't enjoyable for me.