I did learn a great deal during my week-and-a-bit in the clinic. One thing that's rather easy to learn if you're lucky like me, and go through your procedure and recovery with very little trouble, is - humility. There's a lot of luck involved in the diagnosis and treatment of any disease, and when you hang out in a clinic, you will usually see quite a lot of people that have it much worse. 

I also gained a much deeper appreciation, and a lot more respect, for the people working in the care industry. Everyone on my ward was always calm and friendly, even if there was a lot to do. They were going back and forth all the time, and put in some extra time before their shift and some extra time afterwards to make sure the hand-over was complete, and their colleagues were informed about everything. Whenever there was an issue, they'd be there, happy to help. Any questions were answered if possible, or if it was a question for a doctor, that was stated clearly and then the doctor would be asked about it. Once I was woken up for the night-shift checks, and the lady apologised for having to wake me - even though it was her job to do so, and I knew when I went to bed rather early that this would happen. 

Working a care job is a very hard job, but seeing the people on this team, you'd never suspect it. They were, one and all, really wonderful and I can't praise them enough.

Another thing I have learned? How to administer an anti-thrombosis injection to myself. Because of side issues of Cushing's Disease like a less effective immune system and a higher risk of thrombosis, I got extra antibiotics plus extra anti-thrombosis injections for a full 5 days, 3 times a day. That was a lot of injections... and I was offered, straight from the start, that I could do them myself if I wanted to. After a few of them, and after one of the ladies managed to accidentally hit a spot where it actually hurt, I did decide to try it. The trick is to pinch a fold of muscle in your thigh (or belly, but I went for the thigh), insert the needle, then let go of the pinch and slowly press in the injection. It did not hurt at all that way. (It got a little uncomfortable and stung afterwards, as the liquid moved through the tissues, but that can't be changed. You also inevitably get a "blauer Fleck" around the point, proof that the anticoagulation stuff is working!) 

When you get surgery like mine, you also get to do fun things for a while. Such as dragging an infusion stand around with you; I quickly dubbed him Hans-Georg. Though, admittedly, we had a lot of fun together, the nurse's declaration that he would be my new best friend was not completely correct. I was quite glad to officially break up with him on Tuesday night! 

I also learned that I tend to drink a lot if there's tea available right outside my door, and I have nothing to do all day. Except, well, hang around and sip tea, especially as that also seemed to help my nose to get less congested. And sniffing the tea was a nice way to try and wake up the sense of smell.

Finally, I got told (before surgery) to ask for pain medication afterwards as soon as I'd realise the pain was coming back, or increasing. Both the surgeon and my roommate at that point made it very clear that trying to just endure the pain would be a very bad idea. The explanation? Traumatic pain like you have after a surgery is harder to dampen down the higher it was able to rise, and there's a kind of memory mechanism that will kick in over a certain threshold. You do not want to have pain memory. So, basically, waiting too long before asking for more pain meds after a surgery will mean that they take longer to take effect, and that you will need more and possibly stronger ones to work. Since I was not planning on having more pain than absolutely necessary, I asked for some more drugs straight away when I noticed the pain coming in - and that did work wonderfully.

Fun side story: When I first came to again after surgery in the wake-up ward, I had some pain in my nose (which was to be expected) and in my left ankle (which was utterly unexpected). The pain meds made the nose pain go away, but the ankle persisted in being really painful. I told the nurses about it, and there was nothing visible, no swelling... and then they removed the foot part of the surgical hose, and a minute later, the pain was gone. There must have been a tiny fold pressing on a weird spot!

While we're at parallels... if you're asking me about my favourite book, I'd be hard pressed to give you an answer, there's quite a lot of them that I enjoy and like to re-read now and then. Even a favourite author would be a hard question to answer - there's a handful of them as well. (Jane Austen is among them, by the way, and C.J. Cherryh.)

But my favourite playwright? Easy question. It's Bertolt Brecht. He wrote quite a lot of plays, most of them looking at the not-so-nice and not-so-intelligent character traits and acts of human beings. He's the inventor, so to say, of the style of the Epic Theatre, intended to get people to think about what they see on stage, instead of just getting drawn in and getting pulled along.

My favourite piece is the Threepenny Opera, which is one (if not the) of his most upbeat pieces. (Also has great music.) But he also wrote something very relevant to today's developments: "The Resistible Rise of Arturo Ui", which is a parable to the rise of Hitler. In case you're interested, there's the full play online, in a version brought onto stage by the CSU Theatre Production:

I only looked at a few of the scenes, but it looks good to me. Brecht-good, which means scary, in this case... There's also music, and dancing, and good costumes, and a lot of very obvious parallels to what we'd prefer to never have again.

If you watch it, I hope you enjoy it - do let me know in the comments what you think about it!  

It's said that having a positive outlook on life is a good thing... and I agree. I know a few people who have a tendency to having a negative outlook on things in general, and get the feeling easily and quickly that everything is against them, or wanting them to suffer, or something in that direction - and it does sound like bad things happen to them more often than to others, and that they have bad luck more often as well. 

Though of course, staying upbeat and positive and optimistic? Sometimes, that's hard to do. For instance, Tuesday this week was rather shitty - literally, in part. The poor little cat had constipation, and it was so bad that she obviously was in great pain and distress. 

The reason for that was a change in her food, which, in turn, is due to her having problems that point to an allergy or a sensitivity to something in her food, including food that she'd been eating without issues for years. Possibly age has increased these sensitivities. Now the hard thing is to find out what is causing that. Current hypothesis is that it's binding agents, which are added to almost all canned cat foods, and which do not need to be declared on the can. That, in turn, means the only way to find out about them is to ask directly at the manufacturer's.

As we've also found that she is sensitive to a number of meats - including beef, which is the main ingredient in most ready-made cat foods, and chicken, which runs a close second - the amount of ready-to-buy foods without binding agents and suitable for her, especially to find out if it is the binding agents, runs very close to zero. There's some few ones, but they are most often in tiny cans, we have a large cat, and I refuse to buy so much packaging, as it would mean several cans per day. (The cat is already the largest producer of waste in form of packages in our household. By far!)

So we switched to raw food, which gives us complete control over what she has, but the change led to the really, really bad constipation. The vet visit solved that, and it actually overshot the goal a little, so we had to deal with some more shit than expected, in places where it was not completely welcome... I will leave the rest to your imagination, or better not. (Overall not too bad. Things are mostly clean again, and the last things to wash lined up for their go. We will cope.)

In addition, I got some news on that same day that were not too delightful as well. Nothing really superdrastic, but somewhere between annoying and troublesome.

In all of that, I did try to see the positive aspects. I was very, very fortunate to get an appointment at the vet straight that afternoon, without having to wait for ages in the waiting room as an unplanned emergency (somebody else had cancelled last minute, and I could slip in). I got an offer for help for one of the bad-news-issues, which made no sense as it would have caused an inordinate amount of effort on the offering party's side, but it was still heart-warming to hear that someone would go to these lengths for me, without a second thought. 

It will pass, I told myself. It will get better soon again. Just keep at it... you'll manage. Also huge luck with the vet appointment. Cat getting better. Everything going to be alright.

And yes, it did. The day after, the cat was getting better; she's almost back to normal now, and has successfully used the litter box with no visible issues. (Whew. Never knew you could be so delighted about cat shit.) There's been a few emails with better news, including one that turned the troublesome issue (late delivery of my medication) into a resolved problem (chances are very high it will arrive in time after all). Plus there were a few other things that are very to utterly delightful in the mail yesterday and today morning.

So I'm pretty happy today, and it feels like it was a very good thing to try and stay positive and not give up and see everything as bleak and horrible and awful. And yes, I know that this can be hard, and sometimes straight out impossible. Before I got on the HRT and my hormones were so far out of whack, dropping a pencil could ruin half the day at minimum, and though it was better than nothing, no amount of trying to be positive would put it into proper perspective. But it's always worth the try to stay as much of an optimist as you can!

(If you read German, there's an interesting article here about how a positive mindset and feeling like someone lucky will make it more probable that good things happen to you.)

I've hinted at it yesterday: Other health issues. During the last two or so years, I've had some troubles that all seemed more or less unrelated, and that were all sort of not so bad that they'd merit a visit at some doctor's, and too squishy to really pinpoint them. However, they were gradually getting worse.

It started when we were doing a bit of strength training during the second lockdown, as the pandemic was still causing things to be cancelled - which resulted, for me, not in a strength gain, but in joint problems instead. Those got better with less training, but there was still a rather persistent niggle, and it was very easy for me to overload or overstress them. (Also made my motivation for strength training take a very, very steep nosedive.)

There was also the weight gain, not really quick but still a good bit more noticeable than in the years before. My hair stopped growing, there was more hair loss, and the braid became shorter and shorter as well. I had dry eyes, and a dry mouth.

And then... more joint pains, and muscle pains. Tender knees, tender hips, tender fingers. I got the impression that in spite of bouldering regularly, I lost strength instead of gaining it (or even just maintaining), and when trying to do a bit more, it quickly resulted in... more pain, due to overstressing something. Plus I got more and more depressed, and things just looked ever bleaker. This all got worse over time, and I was really at a loss as to what was going on.

Until I finally, in a stroke of sheer and pure luck, I listened to a podcast about menopause.

The symptoms list? Oh, how familiar it sounded. All of it. Well, almost all of it - I'd never had the infamous hot flushes, which might have been a hint towards what was happening. The way it was, though, I never had considered menopause as a possible reason (and it's usually not expected to start in the early fourties with such an impact).

Long story short, having ticked off most of that symptoms list, I found myself a doctor specialising in hormonal treatments, got an appointment, left some blood there, and a few days later I got the results: Early menopause, with really low levels in both estrogen and progesterone. (Well. You can insert a bad joke about being early for a change here, if you like - I've missed enough deadlines in my life, or cut it very close, that I really don't mind.)

Based on that bloodwork, I'm now getting hormone replacement therapy, and things are so, so much better. There's still some issues, but we're also not yet finished with the stage of figuring out what the proper levels for me are. The most important thing, though, is that I'm feeling like myself again, and am functional once more. Now I just have to remember to take one of the magic capsules in the morning and in the evening to keep things peachy. (There's actually a reminder app running on my phone now, just for that. Works wonders.)

The betterment, by the way, was almost instant. There was a real, significant difference just a few days after starting therapy, on all levels. I'm still not where I used to be, but gradually, things are getting better again, and I feel like I'm making progress once more instead of just stalling or things getting worse.

So... what I learned, when reading up on the stuff: Menopause has a large impact on a woman's body, as there are estrogen and progesterone receptors about everywhere. EVERYWHERE. (Like in your brain.) Not getting enough of the stuff has an impact on overall health and well-being, including bone health and density, muscle strength (there's the explanation for my loss of bouldering strength) and cardiovascular health. There's a reason why women after a certain age have the same risk as men to get a stroke or a heart attack, and that's lower estrogen levels. Same reason for the brittle bones at a higher age.

Also - depressive mood swings, or full-out depression can be a result of too low levels of hormones. When dropping a pencil suddenly means that you feel like the day is ruined, because obviously you cannot do ANYTHING right... well. Not a very good situation.

Now mind you - every body is different, and there's some people that breeze through menopause and don't feel anything, but just in case you'll land in the other camp... if you're over 35, consider reading up a bit on menopause and peri-menopause (that's before the proper start of things stopping, so to say) just so you know what possible symptoms are. Maybe get your hormone levels checked on a day when you're feeling really good, at a known point within your cycle, so you have a baseline you can work from.

And once stuff starts happening... do consider a replacement therapy. These days, bioidentical hormones are available, which are what your own body would produce, and the side effects of those are very low. That includes the risk of cancer, which can be linked to non-bioidentical hormones that were used in some of the studies that caused a big scare about HRT some years ago. And in the sense of full disclosure: I was feeling so bad before the therapy started that I'd have gladly accepted a 10% increase of the risk for cancer, in exchange for feeling better again.

Now you're all up to date, and this blog will return to its usual shenanigans. Unless you have questions - then let me know, and I'll try to answer them!

This blog has seen one or the other post about personal stuff over the years... and it's time for another one. Actually, for two, but as they are relatively unrelated topics, I'll make two posts out of it.

Back in 2016, I went on a weight-loss journey that took most of the year, and I've been normal weight ever since I hit that goal weight in September. It did not stay at the goal weight very long - I went slightly above it pretty soon, as in one or two kilos, but that was okay with me. It was still a reasonable weight for me, and I did keep to this okay range for a year or two. Or, actually, even almost three.

However... since then I have gradually, slowly, sneakily gotten back into the habit of eating just a tiny little bit more than I need. Which means, Thank You Captain Obvious, that I've gradually, slowly, sneakily put on a bit more weight again than I'd like to have. Reasons for that (not the putting on, but the eating a tad more) are unclear, but they might include other health issues, a bit of emotional eating or boredom eating, old bad habits coming through again, a genetic predisposal to an appetite that is a bit too large, having the occasional bout of not sleeping enough, and there might be more, but I think that's already quite enough to have on the list, so I'll just stop here.

Now, back in 2016 when I was hardcore dieting, I logged everything I ate and drank to keep track of my calorie input, and very obviously, that worked as a strategy for me. It's a bit of a numbers game to play - how much have I had today already? Was it enough protein? (From experience, I know that I need a certain amount to feel okay, and not perpetually hungry.) Do I really want to eat that bit of chocolate or had I rather be finished earlier with the dieting? How much do I actually need to feel okay, and how much do I actually need for maintenance? It's amazing, and can be a real eye-opener, to weigh out portions and see how much or how little the same amount of calories can be. 

After months of logging all the food, it did get a bit old though. I wanted very much to be able to eat without logging everything as a crutch, and in the start, that worked fairly well. Over time, though, it looks like I'm prone to having just a little bit more than necessary. That's not bad if it happens once in a while and gets evened out by eating less on some other day, and lucky the person who does that naturally, but unfortunately that's not me. I just eat a little more occasionally, and never too little to even it out.

I've tried several times to lose some weight again freestyle, without logging, but it seems like I'm still not good enough at estimating caloric values, and at eating less without having numbers to cling to. So the smart thing would probably have been to do a week or two of tracking now and then, just to make sure my internal calibration, so to say, gets re-adjusted.

Well. I didn't, because I wanted so, so much to be able to wing it... and now I've gotten precariously close to overweight again, and while my clothes all still fit, they fit tighter now. So I've gone back to doing what works for me: Logging everything, and trying to go for a significant deficit each day. (Because I am also, still, an impatient person.)

And, surprise surprise, it's not as bad as I feared. Yes, it is a little more work when cooking, and preparing food. Yes, it also means taking care of what gets eaten (There's the protein quota to be met, which of course has an impact on the kinds of food that are smart to eat, and those that are a less smart choice). However... weighing and logging everything before I eat it also means that it's not as easy to just have a piece of chocolate, or a cookie, or another coffee (with milk, otherwise it wouldn't really count)... and because I'm a lazy person, that already helps with having less of the "boredom food" than I'd usually have. Snack fruit in the afternoon. The bit of chocolate in the break. Taking another small serving, just because it tastes so good. (I blame you, good-quality-food that does not even need a lot of cooking skills to taste delicious.) Having a last spoonful of whatever before putting leftovers into the fridge. All those little things... adding up.

We'll see how it goes now, playing this numbers game this time around. I will be trying to figure out my current daily energy needs while I'm at it (there's a brilliant spreadsheet hanging out on reddit for this), hoping that fluctuating water levels will not muck up things too much. And then, for the future, I hope I'll be smart enough to do a week of logging for re-calibration sooner and not later, so there's less to lose should the numbers go creeping up again.

I know that weight and weight loss can be a sensitive topic for a lot of people, and it used to be for me as well - until I got all my dieting myths and preconceptions blasted by the book "Fettlogik überwinden", which in the meantime has also come out in English, as "Conquering Fat Logic". So...if you have any questions, please feel free to ask.