#but i also feel shrunken when i find myself engaged with them for long periods of time

[seikatsu-ga-tsuzuku]

Unfortunately I find myself back in the “the only thing that makes me feel alive is playing video games” era. Terrible small hole to find yourself in.

[haxballfan-blog]

When You're Sad, Your Skin Is Sad

Correlation doesn't prove causation, but I can't help but notice that both times I’ve lived in my teenage bedroom I’ve felt especially sad. In high school, it was an angry sadness that sought attention. But when I came back to my parents house in March to ride out COVID, the sadness became deep and dull—about everything and nothing. I go to bed dreading the next day like it holds a big test I haven’t studied for. In the morning, I alternately jolt awake while it’s still dark, or tether myself to my comforter well into the workday. I’ve been very privileged in the ways I’ve experienced the past few months, but also very anxious. And actually, the CDC estimates that 40-percent of adults exhibit symptoms of anxiety or depressive disorders as of this past July. (In 2019, that number was 11-percent.) So, yes, I’m crying a lot more than usual; maybe you are too. I’m also breaking out more than usual—and you?

“Yes, stress causes you to break out,” says Dr. Amy Wechsler, who, as one of only a handful of doctors in the US board-certified in both dermatology and psychiatry, is uniquely qualified to answer questions about this kind of stuff—she even wrote the book on it. Dr. Wechsler cites a well-known study done on a college campus during exam week, where researchers found a strong correlation between stress and the severity of acne. “But exam period is like two weeks long, and when the exams go away the breakouts go away. Imagine if you had exam period for five months, you know? That’s like what we’re going through right now.”

According to Dr. Wechsler, the root of stress acne lies in a molecule called cortisol. Cortisol is a hormone that’s pumped out by the body to fight illness, control blood sugar levels, regulate metabolism, and influence memory formation. In general it’s anti-inflammatory, but when you’re stressed, your body responds by producing more cortisol than it would normally as part of the fight-or-flight response meant to keep you alert when you need to be. If that stress is prolonged, and you don’t have the proper coping mechanisms to deal with it, cortisol starts to act very inflammatory.

“Inflammation is the root cause of acne, and eczema, and psoriasis,” says Dr. Wechsler, who also adds that high levels of cortisol over a long period of time will break down collagen, the molecule in your skin that keeps it looking plump. “That’s why when people are really stressed out for a while, they look like they aged overnight.” For a good, obvious example of this phenomenon, take a look at a photo of President Obama in his first year as president compared to his last. Cortisol also weakens your skin’s natural barrier, so you’ll start to experience more transepidermal water loss. Several months of anxiety may leave you with a totally different skin type: even if your skin is normally oily, it will start to dry out and get more sensitive. Dr. Wechsler notes that when your barrier is compromised, your skin is more likely to react to something that normally wouldn’t cause a problem. “That’s when people say things like, ‘I’ve been using the same product forever, they haven’t changed their ingredients, but now I can’t tolerate it.’”

The tricky part about cortisol is that once levels are high, it can be difficult to bring them down on your own. At minimum, you need to make sure you’re getting an adequate amount of sleep each night, which can be difficult when you’re feeling anxious. “Cortisol is at its lowest for everybody during sleep, and healing molecules like beta-endorphins, growth hormones, and oxytocin,” a mood enhancer, “are always at their highest,” says Dr. Wechsler, who compares the molecules’ relationship to a see-saw. If you’re not getting much sleep, you’re not giving the anti-inflammatories a chance to catch up to the cortisol.

During the daytime, you can sort of hack your body chemicals by engaging in activities that directly trigger a release of those happy molecules. Completing your skincare routine floods your brain with dopamine, otherwise known as the “feel-good neurotransmitter.” So would cooking a complicated dinner, or organizing your bedroom, or finishing a book. A workout can help balance too-low endorphins, a fact I always felt was fallacy until I experienced my first runner’s high a few months ago. Not into exercise? Pop on a John Mulaney stand up special—any will do!—for a rush of endorphins you don’t have to sweat for. And to raise your oxytocin levels, turn down the lights and grab your vibrator. Sex drive can lower when you’re depressed, but each time you orgasm your body releases cortisol-lowering, calm-inducing oxytocin.

Of course, these things won’t stop you from feeling anxious, but they might help you feel a little bit better on the day-to-day, and you also may see a difference in your skin. “When people are very anxious, they feel this loss of control over what’s going on in their lives, and normal routines fall by the wayside because they feel unimportant,” Dr. Wechsler explains. “A skincare routine gives you back a little control,” she adds, conceding that, at the very least, 10 minutes of caring for yourself will feel better than reading the news, or scrolling through Instagram.

The absolute easiest, low-effort way to help balance cortisol? For a sad person at least, it’s crying. Scientists aren’t quite sure how or why, but studies show that a good crying session decreases cortisol levels. It was once widely believed that tears were a way to expel excess stress hormones, but now, most researchers think that the benefits of crying have to do with social signaling: just getting out the message that you’re in distress seems to help alleviate some of that distress. And, if you’re crying to somebody, they’re likely to give you a hug, rub your back, or stroke your hair—all triggers for oxytocin.

But while crying is good for the skin internally, it can leave your face feeling… not so great. Which is the reason I called Dr. Wechsler in the first place—I wear my recent crying obviously, and am left frantically icing my face before morning meetings and check-ins with family. Beyond how I look, my post-crying face hurts. My eyes get incredibly puffy, and I often find myself stuck between a rock and a hard place when I cry at night. It happens, without fail, after I do my skincare routine, and I wasn’t sure whether the salty tears left on my skin were further contributing to breakouts. To make my outsides match my insides after a solid catharsis, I wanted to figure out a post-crying best practice—a sad girl beauty routine, if you will.

What I’d learn is that your eyes work overtime to produce tears, which draws an abundance of blood to the surface of your eyelids. If you cry at night, that blood doesn’t have anywhere to go—it pools in your face when you’re lying flat. “If you’re crying during the day and you’re standing up and walking around, gravity will take the swelling from your eyelids, bring it down your face, and flush it out,” adds Dr. Wechsler. For those particularly concerned about morning puffiness, you can stay upright until the swelling subsides, or try Dr. Weschler’s favorite method. “Put a teaspoon in a glass of ice water, let it get really cold, and then take the back of the teaspoon and put it on your eyelid with a little bit of pressure. Both the cold and the pressure really help those blood vessels calm back down,” says Dr. Wechsler, who learned the tip from one of her model patients. Doing that right away will probably help prevent morning puffiness, but if you aren’t feeling up to it, just go to sleep and try to keep your head elevated with an extra pillow. You can always try the spoon trick (and some vertical action) in the morning.

As for the tears themselves, Dr. Wechsler recommends rinsing them off to abate dryness. If you’ve cried within a half hour of doing your skincare routine, you can rinse with a gentle cleanser (or water, if you think another wash will be too drying) and re-apply your skincare products. Otherwise, just rinse and moisturize again.

Remember how I mentioned cortisol is difficult to lower on your own? If you’re experiencing symptoms of anxiety and depression, you might also consider seeking out the help of a trained therapist. While it’s easy to ruminate on how we look on the outside, it’s important to emphasize that this skin issue is indicative of a larger, internal problem. Aside from the auxiliary benefit of helping balance your skin, talking to someone can help alleviate the feelings of loneliness, grief, and uncertainty you might be feeling right now. Therapy for Black Girls, the National Queer & Trans Therapists of Color Network, and Open Path Collective all offer remote therapy options at accessible price points. You might also check out Psychology Today’s list of therapists, which is quite comprehensive—you can filter results by things like specialty, sexuality, and race. If you’re a Black woman, you can also apply for a grant from The Loveland Foundation to subsidize your sessions.

Knowing that my skin is feeling as vulnerable as I am right now, I’ve been taking it easy with my skincare. And the benefit is twofold: nixing breakout treatments lets my skin actually heal, and using fewer products means I’m more likely to actually do my routine (even when I don’t feel like it). I’ve noticed new pimples subsiding after fortifying my compromised skin barrier with products rich in ceramides, natural moisturizing factors, and lipids. I’ve also been chasing opportunities to feel good as often as I can, masked and tiptoeing around the border of my own shrunken comfort zone. Still the breakouts, and the tears, come in waves. But then again, they always have.

[binglesbanglesbabies]

Pcos, an ovarian mass and laparoscopic surgery Part 2, operation to 4 weeks after

Part 2

I wasn’t asked to do anything special pre-surgery to make the surgery any easier, except no eating/drinking after midnight.  I still went ahead and ate lightly the day before, tried to keep it to mostly liquids so that my bowels would be smaller and more out of the way, but again, it wasn’t necessary, just what I felt would be better.

The surgery: Jan 28th

I had read so many accounts I was horrified that the laparoscopic removal would fail and I would need to be cut open hip to hip. Of course they had to have someone there to drive you home, so I brought my mother and step-father.  The pre-surgery was the same for anything else, height and weight asked/checked.  They did an ekg to check my heart was ok for surgery, ran through the 100 odd questions of allergies, a urine test to make sure I wasn’t pregnant, pertinent medical info, yada, yada, placed an iv.  Asked me if I had stomach upset/acid reflux (I do/did) so they gave me some iv pepto (their words not mine lol). Surgeon came in to “pep talk” us through the procedure. Then the interminable wait to be wheeled in to surgery.  On the way, I was stopped at a nursing station for the anesthesiologist to give me a shot (he told me what it was for, I’m sorry, it’s a blur now). In the surgical suite they literally wrapped my upper torso up like a burrito.  They told me it was to keep me warm, but I can almost guarantee it was to keep me from twitching and messing with the machinery while they were messing around in my abdomen.  Anesthetic and a few deep breaths later I was being wheeled back into my room post-surgery.

Here things get SUPER foggy.  I don’t remember much but feeling rushed out of the hospital.  It probably took a LOT longer than I feel like it did, but I was literally falling asleep on myself the whole time, so big chunks of time are missing during this period.  I barely remember getting dressed, except I had to have my mother help me, because I couldn’t bend over to put my pants and shoes on. This is one of the first times I have EVER been super happy they had a wheelchair for me, because I never would have made it out otherwise.  They warned me I may bleed, because whenever you mess with the reproductive system, it tends to kick up a fuss.  There may also be pain in your upper arms and back if any gas is not removed.  I had none.  My obgyn said if this happens, try to lay on an incline with your feet elevated, head down, to move the gas away from the diaphragm, which causes the pain.  But again, I got lucky, I had none.  And yes, they did shave my abdomen, sorry guys whoever did it, blame the pcos for the hair!

What they do during this surgery is make a few small incisions in your abdomen (for me it was three), one in the upper end of my belly button, one on each side of my abdomen, several inches above the hip.  They blow air into your abdomen to expand it so they have room to move around and then use a machine with small arms and rods with cameras and surgical tools to operate inside of you so they don’t have to cut you open too far.  It’s much less invasive and patients heal faster.  In my case they also took samples of the fluid filling the mass before removal and tissue samples of the mass, ovary, etc to check for cancer (came back negative).  They also took a look at the left ovary, it’s pretty bad, I have the pics to prove it.

For the rest of the day after surgery I was in very little pain.  My stomach was extremely shrunken in from the compression caused by the air.  I’ve never been that skinny and probably won’t again lol.  The incisions were covered in surgical glue.  I slept off and on most of the day, trying to get over the anesthetic.  The next day is when the pain kicked in.  Woah buddy.  I was heavily bruising, the swelling began, I was incapable of bending, pulling/pushing, taking a deep breath, laughing, coughing, sneezing.  You’d be surprised how much you use your abdominal muscles, whew!  I did not have any bleeding until I was using the bathroom, twisted to get the toilet paper (bad mistake!) heard/felt a tiny pop internally and then woosh, it started.  It was scary/bad enough I almost called the obgyn, but the paperwork assured me bleeding was normal, and I wasn’t bleeding enough according to the paperwork to call, so I gave it a day, and it did get lighter and lighter over the next few days and stopped.

In addition to the pain from the actual surgery site(s) my uterus decided to go into panic mode and cramp like hell for about a week.  I have NEVER been more glad for narcotics.  I took those for about 2 weeks before going back to the motrin I had been on for kidney stone pain.

What I was NOT prepared for was the sudden smack-down by my emotions.  I swear my hormones were in crazy flux. By week 2 I was crying over stupid things, moody, angry, it took about a week for all of that to clear up, ugh.  Still don’t know if that was because of the ovary removal, or because of pcos. I went through everything from crying they wouldn’t take my left ovary, to crying that it was necessary to have the right removed (which logically I know is ridiculous, because I don’t want kids (re: hereditary fun stuff I’d rather not pass on, also being ace plays into that, but that’s another story for another time).  Also, having to sit and sleep in awkward positions was horrible.  Made my back ache.  Sitting up is murder after having an ovary removed because it causes groin pain.  Laying flat all the time causes your back to ache.  I found a semi-reclined position that I sat in for over two weeks that worked for me, but my best advice is: use pillows, get creative.

Also, constipation is a thing. Your bowels will need some time to decompress, laxatives help.

Expect weird random twinges of pain. It's caused supposedly by your nerves healing. It's a thing. It's ridiculous.

Here’s some SUPER IMPORTANT information.  GIVE YOURSELF TIME TO HEAL.

I was so expecting to jump up and get gong a few days after surgery.  The first week I mostly slept.  It took me at least 2 weeks to start feeling better.  3 weeks to feel almost normal.  Over 4 weeks now and I still have pain in my groin if I sit too long.  Turning/twisting still pulls in my right side and groin and surgery sites.  Bending is STILL hard, bending to pick something up: PLEASE be careful.  Still not attempting to pick up heavy stuff.  Squatting is a little easier, but not ideal.  I still find engaging my core (abdominal muscles) to push/pull/pick up heavy items is still a challenge, and will cause squeals of pain from my surgery sites.  My abdomen swelled quite large, especially around the incisions.  Conversely, where they removed the mass sunk in.  My stomach is only now starting to “deflate”, so slowly.  For a week after surgery, I didn’t eat much, then I was ravenously hungry for about 2 weeks.  Externally the glue started to fall off almost a week after surgery.  The incisions weren’t even healed yet, caused me to get quite worried, but at the post op visit with the obgyn, she assured me this was normal, and they’d close over time.  The did leak, and were filled with white granulomas (white blood cells) which looks like pus, but isn’t.  The middle one’s glue popped and bled, filling my belly button with blood, but the glue still hasn’t entirely broken loose on that one, though by week 2 the other surgical glue had fallen off.  Check with your surgeon if you’re worried, but again, this all seems normal at this point.   At 4 weeks , the incisions are still not entirely closed up.  I have been covering them with bandages to help keep out bacteria and minimize rubbing from clothing.

PAJAMA BOTTOMS ARE YOUR FRIEND.  Also elastic waistbands.  It took me over 3 weeks to even try on a pair of jeans, and they still have the tendency to rub right across those incisions and the button to poke the incision in my belly button: not fun.  Today was the first day I didn’t feel discomfort wearing jeans while standing, sitting on the other hand...

I was also not prepared for the general weakness.  Without engaging your core, your limb strength just does’t cut it, lol.

AGAIN GIVE YOURSELF TIME TO HEAL.

Walking helps.  Seriously.  Don’t do like I did and try the whole 30 mins thing 2 weeks out of surgery.  Try 10 mins at a stretch after a couple weeks.  Then, walk 2 10 minute stretches during the course of the day.  Then 3 10 minute stretches or increase the time in the other split portions. If you feel pain, stop, don’t push yourself because you want to get better all at once.  I’m still not 100% back to normal activity, and I read it can take up to 12 weeks to be to that stage.

Tips/tricks to prepare:

If you have pets/children: if you can afford it, make sure you have a supply on hand for at least 3-4 weeks of food, litter, whatever.  Anything heavy you may need to lift is going to be impossible, especially if you don’t have help.

Try to see if you can get someone to help you if possible.  Trying to walk your dog or clean litter boxes, or care for small children is going to be very difficult for a while.

Be prepared to not be able to lift very heavy things, push/pull open heavy doors.  My discharge paperwork said not to even lift a full gallon of milk/water, and trust me, for the first week or two, it just ain’t happenin’

Listen to your body.  It will tell you when to stop.

Buy some laxatives for post-surgery constipation.

Buy some pads/panty liners for post-surgery bleeding.

Get your laundry done before surgery, you’re not going to want to do it for a while.  Wash small loads after surgery, laundry is heavy, don’t strain yourself.

Rest.

Buy some meals you don’t have to cook (think something you can slap in the microwave or oven for a few minutes and be done, or sandwich material, cereals, etc.) Standing up and cooking is going to be difficult for a while.

Be prepared to have family members (especially the males), act like you should be over it in no time. Especially with “3 tiny cuts”.  They don’t understand that there’s a lot of complicated healing going on below the surface that can’t be seen, not that that’s any excuse for being an unsupportive douche.

Just don’t push yourself to be better all at once, even if family/friends insist you should be “over it by now”.  There’s a mini tornado of healing happening inside you, let it do what it needs to.