Thursday, 31 December 2009

Post-op recovery! The end of 2009 ....

In recent weeks I have ended up back in bed again with pain and infection after what had been a good recovery after my hysterectomy in October!
Why? Chances are I have been doing 'too much'. But how do you know what is 'too much'? Some days I wake up and I feel so very, very good and want to do all the things I would do normally. So I try ...then later on hit what feels like a wave of exhaustion when even standing up is too much.
We went out for dinner to friends a couple of weeks ago - on the way there Clive warned me that he had told our hosts that we couldn't stay late due to me getting tired. I almost felt insulted at the suggestion and stubbornly declared that we'd leave when it seemed right to do so. The company was wonderful; food even better but at 10.30 p.m. it was as if someone had flicked a switch inside me! Clive was right ... and we left.
I am not used to my body letting me down when mentally I am determined to make a full and quick recovery!

So for the past few weeks I am having to say 'no' to certain things and pace myself. It means I am not able to do things - yet - which I want to, but hopefully it will mean a better recovery in the long run. I was warned at least 12 weeks and I am only at 9. So I must be a patient patient! I had intended working on my next book over the past weeks but my attention span isn't as good as usual.

Yesterday and today I have begun to make my way through my email box and line up some blog entries. But I also feel I should perhaps practice what I preach and be good to me! By doing that it makes it better for those around me too. I often speak of my HANZAK principles of patient care. So how can I make them apply to me now?

I have been inspired by the forums and information at
It is a good feeling to know that the aches, pains and concerns you have are the same as others! I have had messages from many telling me how their lives have been better after the op and I am keen to join those ranks! We all get strength from hope and the will to make things better.
My relationships with others and myself have been challenged over these weeks but we have all learnt that honesty is best. There is no point me pretending I feel okay if I don't as I know we shall all pay the price later!

I often say that when people are ill mentally they need the same TLC as those suffering physically and need support and acknowledgment that they are not well. Yet post-op it is the same except it is ME that has had difficulty in accepting this! My body has been bombarded with chemicals, had major surgery and parts removed with physical scars, most of which are internal, yet some days I have reacted as if nothing has happened! In trying to do too much I have made myself poorly which in turn impacts on those around me. It is hard to find that balance between not being a martyr but equally not being Superwoman! I guess a balanced, sensible attitude is the answer. Sadly I have postponed some events for January but hope to rebook them when I am stronger.

I need to make a full recovery but what will help me?
Nurture - everyone around me has made me feel special and cared for. I really appreciate this.
Education - learning about the operation and what can be expected is good. I am going to a physiotherapy group next week for others like me!
Exercise - I made a good start with this with walking but confess this has not been as consistent. I am keen to get the okay from my consultant to get back to Pilates and using some fitness DVDs in the lounge!
Diet - Christmas is always a greedy time but I am keen to get my diet better in the New Year. We have just booked a cruise for September so I have a vision of me in a little black dress I want to get back into!
Sleep - I am aware how important this is and make sure I get plenty! I have been treated to breakfast in bed several times!

Recovery should be about having fun too and taking care of myself. It was amazing the lift I got from having my hair and nails done after my last infection. Each day I try to do something constructive but also balance it with a fun thing. Dominic and I sat through 3 hours of Avatar at the cinema last week, munching popcorn. It was his choice but I found I loved it! I am also having a lot of pleasure with the arrival of baby Ruby - Clive's niece's daughter.

She is so dainty that I am knitting her more tiny cardigans - fun, relaxation and construction all in one go!

Recovery is also a team concept! I found by putting on a brave face and overdoing things I got poorly and made life worse for those around me. I have learnt to accept help graciously and with gratitude.

I have needed to learn to be kind to me! My internal dialogue has needed to be modified into a more positive yet sensible one, e.g. physically I am not up to certain things but clearing my desk and inbox little by little will help me in the long run. Sitting around moping won't help but small actions will.

So as I face the end of 2009 I feel optimistic about 2010. It has been a rollercoaster year but as my late Grandma used to say 'if you have your health, you have everything'. So on that basis with continued recovery ... I will!

Wishing you all a healthy and happy 2010,


Wednesday, 30 December 2009

'What about the Children' conference

Readers may be interested in attending this conference.

What About The Children?
"Raising awareness of the never changing emotional needs of children under three in our ever changing society."
What About The Children? has no political or religious affiliation. Registered Charity No. 1108816

telephone: 0845 602 7145
What About The Children? National Conference
Tuesday 2nd March 2010
The Resource Centre 356 Holloway Road London N7 6PA
Delegate Fee £70 (includes Tea, Coffe and Lunch)
'What is critical for a child's healthy emotional development?'

Lane Strathearn, (MBBS, FRACP) Assistant Professor of Paediatrics at Baylor College of Medicine, Houston, Texas.
Dr Strathearn’s field is developmental paediatrics, with neuro biology of mother infant attachment as a particular area of interest.
Jane Barlow, (DPhil; FFPH Hon) Professor of Public Health in the Early Years at Warwick University.
Professor Barlow’s areas of interest include the effectiveness of early interventions in the primary prevention of mental health problems. She is particularly interested in the evaluation of interventions that are directed at promoting the parent-infant relationship.

Janice Saunders, Project Worker/Trainer for Parents as First Teachers.

Anna Marley, Consultant Clinical Psychologist, NHS.

Heather Stevenson, Independent Trainer and Counsellor

Carol Mannion, Developmental Therapist

Pamela Stewart, Psychotherapist HMP Holloway

Comments about last year’s national conference
‘Excellent event. Fantastic speakers, very accessible. I am left feeling energised and re-invigorated’- Early Years Professional

‘Excellent conference as always – well reflected with all speakers’- Parent

‘I attended my first What About The Children? Conference last year and felt that it was the best conference I had attended for a long time. I welcomed the opportunity to attend again this year’- Health Visitor

For more information and Booking Form please go to our web site
Or email Conference Organiser Cath Armstrong

Elaine Hanzak

Review of 'Eyes without Sparkle - a journey through postnatal illness'.

I was delighted to find the following review of my book by Dr.Kevin Craig.

A compelling account of Elaine Hanzak's experience of post natal depression and her subsequent recovery. Her vivid account speaks for many who suffer with depression and has helped carers and family members understand what the condition feels like to those living through it.

He has also reviewed some other books too. See:-

Elaine Hanzak

Tuesday, 29 December 2009

Postnatal depression treatments are not cost effective, say York researchers

Thanks to Sarah Cowley for this information.

An HTA commissioned report about screening for postnatal depression was published last July, but has now come out in a (free content) article, details below. The headline suggesting that PND treatments are not cost-effective is misleading; the screening was found to be not cost effective. Instead, care and awareness by GPs is health visitors and advocated.

Routine screening for postnatal depression in primary care - as recommended in recent guidance from the National Institute for Health and Clinical Excellence (NICE) - does not appear to represent value for money for the NHS, researchers at the University of York have concluded.

The results of a study by academics in the University's Department of Health Sciences, Hull York Medical School and the Centre for Health Economics suggest that both the NICE recommendation and widespread current practice should be reviewed. The research is published on today.

More than one in 10 women suffer from postnatal depression six weeks after giving birth, yet fewer than half of cases are detected in routine clinical practice. Screening strategies using brief depression questionnaires have been advocated but have attracted substantial controversy.

Furthermore, guidelines issued by NICE in 2007 recommend the use of specific questions to identify possible postnatal depression, but the effectiveness and value for money of this strategy is uncertain.

The researchers at York used a computer model to evaluate the cost effectiveness of screening for postnatal depression in primary care.

The project was commissioned by the NHS Health Technology Assessment Programme; a body which investigates what works and what represents value for money in the NHS. The research was led by Professor Simon Gilbody and Dr Catherine Hewitt, of the Department of Health Sciences and Hull York Medical School (HYMS) together with leading health economists Mike Paulden and Stephen Palmer, of CHE.

Professor Simon Gilbody who led the project, said: "While postnatal depression is a very important condition, screening for this disorder with questionnaires was costly and wrongly identified many women as depressed, resulting in inappropriate care."

Screening for postnatal depression with one of the most widely used questionnaires, the Edinburgh Postnatal Depression Scale, had an incremental cost effectiveness ratio of £41,103 per quality adjusted life year or QALY (a combined measure of quantity and quality of life) compared with routine care only.

The ratio for all other strategies ranged from £49,928 to £272,463 per QALY compared with routine care only, well above the conventional NHS cost effectiveness threshold of £20-30,000 per QALY.

In contrast, the strategy of treating post natal depression without using screening as is current practice represented good value for money.

The York-based research team concluded: "These findings suggest that both the recent NICE guidance and widespread current practice do not result in value for money for the NHS, and do not satisfy the National Screening Committee's criteria for the adoption of a screening strategy as part of national health policy."

Professor Gilbody added that "Postnatal depression is very important, but screening doesn't seem to be the answer. GPs and health visitors should be vigilant to Post Natal Depression and be able offer high quality treatment when they are sure a woman needs care."

The York team call for further research to quantify the cost of incorrect diagnosis and the wider impact of postnatal depression treatment strategies on the quality of life of the mother and her family.

Source: University of York

For article see

Elaine Hanzak

Thursday, 10 December 2009

Life after hysterectomy!

Well what an eventful seven weeks! And where have they gone? If anyone had told me I could just lose time like this I would never have believed them. I feel I am finally emerging now and increasingly ready to conquer the world again - although perhaps a country ... county... town.... street.... house ... at a time!

I confess I was worried about my op. I am a drama queen at the best of times and knowing my illness record I never do anything by halves! I had also never had a full cut operation before and the thought of an 8 inch scar across my tummy was something I did not relish. It also meant increased separation from Dominic as I could not drive for weeks and the need to rely on my parents and Clive for my every whim. As a normally very independent and capable person it meant the rug was quite literally pulled from under me.

But I had to accept the operation was needed. I had been suffering from gynaecological problems for several years; had two emergency stays in hospital for it this year and many days of pain and inconvenience. I had planned that my work diary was cleared by the middle of October until the New Year to allow time for recovery which is estimated at 6 - 12 weeks. Emotionally I had concerns too. I wonder how many ladies who have suffered postnatal illness do go on to have problems in the menopause/gynaecological area? The theories around hormones causing/adding to postnatal illnesses is very strong, so I was worried that I might be affected over this too. I am aware that depression can be a post-operative symptom of hysterectomy too.

Just as postnatal illness is a condition related to loss (of an expected 'normal' motherhood) an operation to remove your reproductive organs is also about loss - no more children, a possible loss of femininity, etc. Earlier in the year I had felt the loss of having no more children VERY strongly. I had sobbed myself silly over it and hurt those around me. I wrote quite cruel letters to Nick unfairly blaming him for the fact we never had any more children - that I had been prepared to risk puerperal psychosis again but he wasn't - and who could blame him? I love my brother and sister deeply and the concept of 'family' - it wasn't that Dominic wasn't enough - I just wanted him to have siblings. But I hurt him too in the process of my ramblings. I am truly sorry for that. Then with the breakdown of our family these last two years it all just seemed too much to cope with.

At the same time I seemed to receive a string of messages from other sufferers of puerperal psychosis who were scared to have another baby but wanted them. It seems my feelings around this were not unusual. The partners are often reluctant too - how on earth can they be expected to just sit back and say 'but of course we'll try again for another baby' when they have witnessed the mother of their child go through absolute hell the previous time? As the mother I feel the illness protects you and I found it easy to get maternal over pink frilly dresses, when all Nick could remember was pain and heartache. The only thing we were told by the psychiatrist when I was discharged was that if I ever got pregnant again then the chances of postnatal illness was higher! However, he did stress that everyone would be on my case next time. I like to think so. But it didn't happen for various reasons. We have a wonderful, healthy and bright son which is so much more than some have. I feel now I have put that issue to bed and moved on. I needed to for everyone.

I will put some advice for those thinking of another child at the end. I am delighted to say that some of the mums who contacted me are now expecting again and have plans in place with their health and family support teams to make the next birth and subsequent months easier!

So how did it go? I felt very tearful being booked in. I also said some pathetic 'poor me' things to Clive on the journey to York hospital and upset us both! 'Going down' really felt tough! The staff were brilliant though and dealt with me very sensitively. I have tiny veins - so small they had to gas me to sleep! When I awoke in the recovery room I felt relieved and floating on the morphine. I remember coming round and I could hear one of mine and Clive's songs playing on the radio - why does that happen? Of all the songs why then? As time went by I began to bleed heavily and the pain started to build. Next thing all hell let loose! Staff seemed to come out of the woodwork and I began to cry with the pain and panic. A gorgeous nurse called Debbie held my hand and kept stroking my hair and reassuring me. It was just like when Dominic was born!!! All mayhem but in the midst I felt that the rest of the world disappeared as I focused on Debbie's hand and reassuring words. I remember pouring my heart out to her and telling all this was my fault! I must have been so bad and I was being punished. Eventually I was told I had to go back into theatre; I scribbled a signature and plunged into darkness again.

When I came round next time I had left the stormy waters behind and it seemed I emerged into a calm and tranquil sea. Wow! Seven weeks on I am still in it! I don't remember much about the first couple of days except a stunning bunch of red roses Clive brought me. Each time I opened my eyes they were the first thing I saw, and I smiled. I had my Blackberry with me and Dominic had sent me hugs via Facebook. Little messages kept me going. Quite often I would dose off and I would wake up to find my Blackberry held up in front of my face! Mum and Dad arrived the next day with their usual unconditional love and support. The team at York hospital were great and I could not have wished for better care.

It seemed I had had a blood clot which just needed to disperse and possibly there had been no need for the second theatre trip. But no matter, I seemed okay. I was sore but quite amazed at how soon I could move around. Having a shower the first time was like having run a marathon. I was surprised that after three days I didn't need a dressing and my scar was so neat and tidy. The average length of stay is 5 days. I was determined to do it as so many around me had rolled their eyes and said 'yes, that's for NORMAL people - not you'! So with pride and determination I left on day 5!

Clive was looking after me the first week but he ended up with back trouble! What a pair we made. I had to learn how to move again - carefully, and he treated me like a porcelain doll. My Mum had a major operation 30 years ago and I remember her coming home. I marveled at how she had coped with three children and a shift worker post-op. She reminded me that her Mum had helped an awful lot. Grandma would have been 100 next year, but we still miss her and Grandpa. Does anyone else especially miss loved-ones at such times?

I had got myself some very un-sexy black jogging bottoms to wear initially - at least I was dressed. Looking back the first week passed quickly with lots of rest. We also got into little walks every day. I found if I went too far I would feel very sick. But each day I got a bit further. Clive made a good nurse but luckily didn't dress as one!! His sister Lynn was also wonderful.

Two weeks after my op Clive took me back to my parents. It was fab to see Dominic too who also waited on me hand and foot. I felt very guilty 'just sitting' and getting my every need met. Two days later we flew out to Malaga for a week in a timeshare with Mum and Dad. I got insurance from and took it all very slowly. Dad ensured I carried nothing at all and once we got to the apartment I stayed there the whole week! The journey was very tiring and the next day I was VERY sore and hardly moved but after that the days of laying in the sun were brilliant. We even had UK NW television and took smug comfort in the wind and rain of the UK whilst we basked in 80 degrees.

It was a risk me going to Spain so soon after my operation but so glad I did. It is nice to have a suntan in November/December too, and everyone tells me how well I look. Thanks Mum and Dad!

I did have a MAJOR upset a week after my op when my website and emails all 'went' due to an issue with the domain name. Perhaps though it was good that it did go offline with me, so to speak, as it stopped my usual avalanche of mail which I wasn't really up to dealing with. It has been back now for a week and I am finding it quite hard to keep up with already! I just hope I haven't lost any potential speaking events for next year or offering support if needed. But I accept I needed 'me time' too.

The last few weeks have gone with a gradual return to normality. Each day I seem to have more stamina and desire to 'do'. I have had a few tears of frustration when my head has wanted to do things but my body refuses to follow it! My challenge tomorrow is to do the M62 drive myself for an exciting weekend with Dom. Mum and Dad are going to London to be in the audience of Strictly come Dancing! Knowing them they'll end up grinning behind Bruce!

I got a great deal of information and support from the
They have a daily tip for you in recovery which I found inspiring. The forums were useful to look at too when you have an 'is this normal?' moment. I highly recommend the site and wish the hospital had told me about it earlier on - I will be telling my consultant so at my appointment on the 17th.

I am not very good at doing 'nothing' but I have had to accept that for a few weeks. Daytime television can become a drag. I found I couldn't concentrate on much either, so my plan to write my book hasn't happened - yet! But I do have something to show for the last few weeks - a load of pink and white baby clothes which I have knitted! My sister is expecting her first baby in March and Clive's niece had a baby girl yesterday. I can't wait to have a cuddle and be a brilliant Auntie. At last my wish to buy and make pink and frilly things is granted - the difference is that I won't have the sleepless nights but hope to offer their Mums any support I can. And not be a pain!!! Mum and Dad sent me a stunning basket of fruit when I was in hospital and it is now refilled ready for baby Ruby!

So what have learnt from this experience?

* That recovery is similar whether it is a mental or physical illness, although the time aspect of a physical illness is easier to deal with - you have a vague outline of what is likely to happen.
* To practice what I preach - i.e. be good to yourself, appeal to the senses.
* Appreciate what those around you do for you - by trying to do too much, too soon it makes problems for everyone.
* 'Enjoy' your 'off' time - it passes very quickly.
* Having a recovery 'plan' of support and allowing myself 'time-off' has helped.
* Having realistic goals of treats to aim for but having a 'just in case' plan if I wasn't well enough, has been good.
* Asking for help, advice and support is good for everyone involved.
* That this too will pass and make you stronger (our new mantra!)

My worries have all but gone - my scar is just a reminder; it hurt but I didn't suffer; I feel closer to Dom who is growing into a fine young man; I feel all-woman even if my tummy is as round as a Christmas pudding but will wait for Pilates later to tone it; I have enjoyed and appreciated being spoiled and some time-off; I love my special people even more!

But most importantly I feel the mission statement from Postpartum Support International is just as valid post-hysterectomy as it is for those suffering mental illness after childbirth -

* You are not to blame
* You are not alone
* You will get better.

I know I still have a way to go towards a full recovery and I still need to take care of myself and be gentle. I have had some wonderful support from many people in many different ways - I have appreciated it all. Thank you so much. When Clive speaks he stresses the need for support to help you through life. I agree entirely.

Now if you'll excuse me I have a new baby to visit!


Advice for those considering another baby after suffering from postnatal illness
I want another baby but suffered badly from PND with my first child. Am I more likely to suffer from it second time around?
Sadly statistics show us that there is a 50% risk as opposed to 15 – 20% of developing a mental health problem after pregnancy if you have suffered one before. However, please bear in mind that every pregnancy is different and just because it happened first time is not an automatic assumption it will happen again. Yet there are ways to minimise the risk and give you more control and confidence you will be well next time as you will have less fear and far more knowledge.
It is vital to get your support team in place and ensure that in the early days after giving birth all systems are in place to allow you maximum time for rest, for yourself and your baby. Even before you get pregnant reconnect with the health professionals and family and friends involved the first time and review what worked, what didn’t and what could have been better, e.g. medication, talking therapy. Recall the early signs from last time and warn everyone to look out for them and to respond accordingly thus meaning a faster recovery. Try to plan to give birth at a different time of year to make it ‘different’ from first time. Have discussed and written plans in place for the birth and early days, for example, who will help to look after the first child. Avoid any major stressors, such as moving house. Ensure you keep physically well by eating properly, by taking gentle exercise. Make your plans to feel reassured and in control, have the support structures ready, think positively and visualise the happy pregnancy and motherhood that can be yours.

I also recommend you read 'When Baby Brings the Blues' by Dr. A Dalfern as she has some great tips and advice.

Thursday, 3 December 2009

Website and email fixed!

During the past month my website and email at have been offline.

I am relieved and delighted to say they are now reinstated.

However, if you have tried to contact me during November by email I will not have received it, so please resend.

My email now returns to

I am recovering well from the surgery I had too, although finding it hard to 'do nothing'! I am making great progress but am surprised how little I can do before I hit 'a brick wall' of weakness. But each day I get a little stronger.

Come the New year I hope to be back 'on form'.

Best wishes,

Elaine Hanzak