How I Got To Pelvic Floor Physical Therapy For Endo

I have endometriosis, and there’s a lot I want to say about that. To start, I want to share some of my experiences with pelvic floor physical therapy (PT). This is a topic that’s getting an exciting amount of attention among doctors and people with endo, and I want to add my story to help anyone who might be considering whether this is a good choice for themselves.

Pelvic floor PT is becoming an increasingly common recommendation for people with endo, but many doctors don’t explain why it’s a good idea or provide any guidance for how to find a pelvic floor physical therapist, or what to expect once you get there.

And I want to reiterate: my experiences are my own, and what has worked for me may or may not work for you. Part of navigating a chronic disease we don’t know much about is reading about other people’s trials and errors. So here are some of my own trials, errors, and successes to help inform you as you make your own roadmap to treating your endo.

Why Does the Pelvic Floor Need Physical Therapy?

I first heard about pelvic floor PT about ten years ago when I was working as a full time Pilates instructor. We had a pelvic floor PT visit to do an educational seminar, and she explained that the pelvic floor is made up of several different muscles working in conjunction with our abs, glutes, and back muscles to support our movement and our organs. 

The muscles that make up our pelvic floor can become dysfunctional due to injury, disease, surgery, pain (that’s right – pain itself can cause dysfunction), or patterns of over/underuse. Dysfunctional muscles may either be overly tight or spasmodic and therefore weak, or they might not engage well and be weak. Muscle dysfunction is rarely isolated to one muscle; even if it starts in one place, the dysfunction will spread to other muscles around that joint or body part as they try to compensate for the original weakness.

When it comes to the pelvic floor, the relationships between these muscles, pain, the gut, the brain, and how dysfunctional pelvic floor muscles impact the rest of our movement is complicated. As a result, the symptoms of pelvic floor dysfunction are often mistaken for other conditions – which, in some cases, are caused by (or are related to) the pelvic floor dysfunction to begin with! 

Pelvic floor dysfunction can send doctors on wild goose chases around our anatomy. Symptoms of pelvic floor dysfunction can include pelvic pain, back pain, rib pain, sciatic pain, pain during intercourse, and pain while urinating or bowel movements. The PT who was presenting the seminar said that pelvic floor dysfunction can present itself anywhere between the ribs and the knees.

There is a high occurrence of pelvic floor dysfunction among people with endo, but the nature of that relationship is unclear. It’s not known if one causes the other, but treating the dysfunctional pelvic floor muscles can be a way to treat and manage pelvic floor pain related to endo.

Which brings me to my story with pelvic floor PT. It’s a long one, so go ahead and grab snacks.

After the Laproscopy, Then What?

I had my first (and so far, only) laparoscopy with ablation in October of 2017. At my post op appointment, my gynecologist recommended either birth control or Lupron, neither of which I’m interested in. (I am in no way knocking the decision to try one of these options, they just don’t feel right for me – another blog post). I asked my gynecologist if pelvic floor PT might help, and she said no.

After my lap, my symptoms got worse. As the months went on, I noticed that not only were my periods getting worse, I was now getting similarly intense pain during ovulation and sex. I was also experiencing pain in my thoracic spine and sternum so intense I couldn’t get out of bed on some days. 

The thoracic pain is what escalated out of control. It felt like being constantly stabbed in the back, just to the right of my spine right at where my shoulder blades sit. My sternum felt locked, and the stabbing pain in my chest that accompanied any movement seemed to say, “Try it, and something breaks.” I could barely breathe or lay down without agonizing pain.

After a not at all fun trip to the ER, I went to my primary care doctor who prescribed a muscle relaxer, which honestly did help, even more than the tramadol he also sent me home with. The relief I felt from the muscle relaxers made me think that maybe there was a musculoskeletal component to my pain that wasn’t being addressed. I requested physical therapy, and I got a referral.

Back to Back PT

At this point, I was going to the physical therapist for my thoracic pain. While my pelvic pain was continuing to escalate, it didn’t seem like much could be done for that. I decided to focus on my back, which was so bad I could barely wash my hair or lift a glass of water to my mouth.

The first PT I went to was not a great experience. Along with endometriosis, I also have Complex PTSD as a result of childhood trauma and abuse. I’m sure all the traumatic experiences I’ve had with doctors haven’t helped. Even though I have a lot of experience with manual therapy, the lack of consideration for my medical history combined with the amount of physical touching and so much of his weight on my body made me extremely uncomfortable. I didn’t go back.

The next PT I saw for several months. His general take on my condition was that I needed to learn how to relax. Like so many doctors, this one over attributed my pain to my trauma. Once he heard childhood abuse, I could almost see the connection he made in his brain: Another anxiety case.

I kept going to those appointments mostly out of spite. I could feel that I wasn’t making improvement, but I was determined to go through the steps. I kept trying to bring up my pelvic pain, but the PT would say to see my gynecologist. I also kept going because I felt bad about ditching the first PT. I wasn’t sure if I could just pull up stakes and head to yet another office.

After seven months or so of not getting much further than, “you need to learn how to relax,” I decided to change my approach. It was an excruciating seven months, though. Physically, the manipulations and scraping he did along my spine and ribs would be sore for days, but also it was also mentally and emotionally painful to be made to think that I was the cause of my own pain. I stuck it out as long as I could, and probably for too long.

In my research on trauma, I had uncovered a technique called “biofeedback”. 

I found a PT that was not quite two hours from my home who offered this service. The focus again was on my back, so during a typical session, I sat in a comfortable chair while my PT placed sticky pads on my neck and upper back and a heart rate monitor on my finger. These pads were connected to a laptop that would show a measurement of how much activity was happening in my neck and back muscles.

The idea was that I would be able to use this visual information as feedback. I could see where my baseline of muscle activity was, and then the PT would talk me through meditation exercises to bring down the level of activity.

As it turns out, I’m really good at that. I can take deep breaths and bring down my heart rate and muscle activity. The evidence was right there on the screen. My back pain was unfazed. Maybe, my pain wasn’t because I couldn’t relax after all. 

This PT was also doing some manual therapy on my back, and in one session, I asked her to look at some recurring pain in my right knee. As she poked around she observed that my quads were extremely tight. When she got to my adductors (inner thigh muscles), her eyes widened. “This is hypertonic,” she said. (Hypertonic refers to a muscle that is too tight and/or unable to relax.)

I nodded and told her that’s how my inner thighs always feel, and also my pelvic floor muscles. I asked her if she thought pelvic floor physical therapy might help. She said it absolutely would, and she got me a list of referrals.

From Back to Pelvis

It had now been about a year since I first went to a PT for my back, and I was starting to understand that I’d been barking up the wrong tree. I went through the list of pelvic floor specialists and found one that accepted my insurance.

At this point, I’d been in pain long enough and I was frustrated enough with the process that I wanted to see the best damn physical therapist I could find. I decided to go with a practice in Beverly Hills, which was about a three and a half hour drive from my home. 

When I called to make the appointment, I insisted on seeing the therapist who is the head of the practice. It was a little pushy of me, yes, but I figured I’ve gone too far to see someone who is anything less than an expert in this type of care.

In my first appointment, the PT did a thorough assessment of my posture, movement, and muscle function. The internal work wasn’t as terrible as I thought it would be. It felt like having a trigger point massage done on the inside of my vagina.

I transitioned to a different therapist after a few sessions who turned out to be absolutely wonderful. I saw her once a week for the next several months. She identified that I also have scoliosis, and we alternated sessions between working on my pelvic floor and my thoracic spine. She discovered which of my pelvic floor muscles are too tight (I’m looking at you, right side obturator internus), and her manual therapy plus the at-home stretching and exercises brought a lot of balance to my pelvic floor.

A typical session would start with a quick assessment. From there, my PT would see if my SI joint needed any mobilizing and she would do whatever external work my glutes were needing. If we were doing internal work, she would leave the room while I took off my leggings and got under a sheet.

I would lay on my back with a pillow under my knees and my legs slightly spread. She would sit next to me and with lots of lubrication, use a finger to massage and manipulate my pelvic floor muscles from inside my vagina. Occasionally I would have to do something like press my right knee into her other hand while she palpated internally. But mostly we would have light chit chat in between her asking me how things were feeling.

As my pelvic floor and glute muscles got the stretching and strengthening they needed, my thoracic spine finally started to hurt less. Our pelvic floor is kind of like the foundation to a house. If our foundation gets out of whack, that imbalance will reverberate up and down through our muscles and skeleton. I don’t think even another five years of PT on my back would have been successful if it weren’t for the pelvic floor work.

My progress was slow but steady. I was keeping track of my symptoms, and noticed all sorts of things improving. I wasn’t needing to urinate as often; bowel movements were more regular and far less painful; sex was less painful; my posture was improving; and my back was hurting less.

The biggest surprise for me was just how much pain reduction happened when I addressed my pelvic floor muscles. I had thought for sure that at least some of the burning, stabbing, ripping, pulling, and electricity like pains I had around my pelvis, vagina, and anus were outside the scope of a PT. No way in heck is manual therapy going to make it not hurt when I pee.

I was mistaken. In my case, there was all sorts of pain that became far more manageable when my pelvic floor muscles got some attention. I don’t want to oversell anything, though.

Stuff still hurts. It hurts less, though, and it’s far more manageable. I can have sex most of the time without pain. My bowel movements almost never make me sweat and throw up anymore, except on the worst day of my period. I can generally exercise without my back screaming in pain or my sternum getting locked in place. 

All things considered, for me, PT was totally worth it, and I enthusiastically recommend it to others. That’s saying a lot because it was a huge pain in the ass to get to that step (almost as much as the literal pain I had in my ass). I have more I want to share about this topic, but I’ll leave it there for now. If you’re considering pelvic floor PT for yourself, I hope reading about my experience helps you make the choice that’s right for you.


Read more about pelvic floor dysfunction here: https://www.healthline.com/health/pelvic-floor-dysfunction#diagnosis

Read more about pelvic floor dysfunction and endo here: https://centerforendo.com/the-significance-of-pelvic-floor-muscle-dysfunction

The Flight of the Butterflies

Every spring, for about two weeks, monarch butterflies take over the air with their annual migration. They’re so thick you can’t walk down the street without having them thunk softly into you. As far as springtime events go, a massive horde of butterflies is far better than the bee swarms that appear looking for shade and water, or the occasional locust clouds that set upon Las Vegas. 

The butterflies make a beautiful, if somewhat chaotic procession. Their large, delicate wings work so hard to keep them aloft, and for so little forward progress per flap. They move as quickly as they can, but it’s not fast enough to navigate the perils of modern human-centric development. 

Each year, thousands of butterflies are killed by cars, trains, and other human inventions. The butterflies create a grotesque layer of broken wings and goo on car hoods, and we all sigh and shrug our shoulders about the loss. 

This blog post is what happened when I asked myself, what if we did things differently? What if we didn’t commit to a yearly butterfly massacre? What would the rest of our society have to look like in order for us to value butterfly lives as much as our own? 

Photo by Suzy Hazelwood on Pexels.com


From: The Department of Pollinator Preservation

Date: 5/19/2052

It’s that time of year again! We are weeks away from welcoming thousands of monarch butterflies as they flutter through the desert in their spring migration. 


  • Butterflies have the right of way! On migration days, there should be no daytime vehicular traffic between 7am to 7pm. In order to preserve butterfly lives, roads will be limited to emergency travel only. Residents may travel by foot, bicycle, skateboard, or other similarly sized, low-speed mobility device. 
  • Contact your local Community Support Network to coordinate deliveries of food, water, medicine, and check-ins for yourself and your neighbors.

Activities throughout the month:

Residents are connecting at weekly neighborhood potlucks to plan ahead for no-car days. 

  • Potlucks are every Thursday from 6pm-8pm at several locations throughout the community. 

Photo and Video Contest: Show us your best pics of the monarch migration, your milkweed garden, or any other butterfly moments you can capture on film! Winners will be announced at the Butterfly Days Festival.

At the Library: At your local library branch, you can find butterfly themed activities for all ages. Learn about how butterflies fly, how scientists track their movements, and how caterpillars turn into butterflies during free, weekly presentations.

At Your Community Garden: Gardeners throughout the area have been tending their milkweed and native flowers. Sign up for your own plot, or learn about volunteering in one of the community plots.

Butterfly Days Festival

Saturday, 8:00am

Memorial For Lost Monarchs

We open the festival with a memorial service to those butterflies whose lives were cut short by previous generations of humans who did not honor their passage. 

Saturday, 9:00am-5:00pm

Monarch Festival

There will be free milkweed plants and local flowers for residents to take home, and local botanists will be available to answer any questions. Enjoy flower and butterfly-themed snacks, listen to local music, and see what’s new in our community gardens.

Accepting My Autism

I was 35 years old and really getting to know myself. Now, I’m 35 years old and autistic, thanks to a recent diagnosis. It feels like something new, but I’ve really been autistic all along. 

All the different things I obsessed about collecting as a kid – rocks, books, clocks, pogs, small figurines? Might have been autism. The hours I spent joyfully arranging and rearranging my collections? That could have been autism. My intense childhood “tantrums” where I would hold my breath until I passed out? My constant struggle with being socially “appropriate”? Also possibly autism.

Every day brings a succession of tiny earthquakes that are rattling my life into focus. What does any of this mean, and what does it mean for me to accept that I’m autistic?

Like many stories about receiving an autism diagnosis, mine starts with a lifelong feeling of being different from other people. However, the possibility that I might be autistic didn’t cross my mind until I was in my late twenties and learning more about trauma. I knew that I had CPTSD from childhood abuse, and as I read different articles and blogs, I kept noticing places where my experience with CPTSD sounded a lot like other people’s experiences with autism. 

When I read about autistic meltdowns, I thought, “Wow, that sounds exactly like my panic attacks.” But it hadn’t yet occurred to me that my panic attacks might actually be autistic meltdowns. 

As I progressed with trauma therapy and EMDR, I noticed that some things were getting better for me, while other things felt like they were getting worse. I felt like my internal experiences – my thoughts and my emotions – were improving. I felt a shift toward more mindfulness and reduced negative self-talk. I felt my resilience increase. Finally, my brain felt like a nice place for me to be.

As a result, I was more able to understand and express my thoughts, emotions, and needs in a given moment. However, that led to me realizing that I frequently experience mental and emotional distress. It was a bummer at first, to have flashing moments of feeling present and centered just to realize that actually, my nervous system is jangling due to some previously unrecognized input. 

The distress from my own thoughts, flashbacks, and emotions was lessened, but I was noticing how distressed I was by noises, bright lights, the feel of my clothes. I realized that I have always struggled to keep track of dialogue in movies and conversations. I could see how other people’s emotions can be overwhelming for me, regardless of whether they’re expressing anger, sadness, or even joy.

I especially noticed how stressful I found social interactions. I was more confident in how I was feeling and what I wanted to say, but I was also paralyzed by not knowing if what I wanted to contribute was appropriate, relevant, or something that I needed to say at all. In groups of people – even online – I will shake, sweat, and feel my stomach tie into knots with the effort of deciding if I should speak up. This was not getting better with therapy. 

It’s Autism, Actually

Around this time, I subscribed to the Trauma Geek on social media for the excellent information they share. I started noticing their posts about autism and other parts of the neurodiversity spectrum, and more than once was totally floored by how much I saw myself in them. 

One day, I decided on a whim to take some online autism assessments. All but one indicated that I was almost certainly on the spectrum, and I should see a doctor about getting a formal assessment.

So I did. 

As it turns out, I’m autistic. 

As a kid, I was called argumentative, defiant, lazy, moody, negative, rude, and selfish. As it turns out, I was autistic.

As an adult, I’m often considered irritable, hypersensitive, unreliable, unemployable, and too opinionated. As it turns out, I am autistic. 

This paradigm shift has been profound. For much of my life, I’ve been told that if I just try harder, I could be like other people. With the right therapy, meds, diet, exercise, and good old fashioned effort, I could overcome my crippling anxiety, trauma, and whatever-else-is-wrong-with-me to be a better daughter, a better friend, a better student, a better employee, or have something like a “normal” life. 

I honestly believed it, too. I have been holding onto expectations for myself, that if I go through these steps, then one day, I wouldn’t be so different. But that isn’t how this works. I realize now that I’m not going to therapy myself out of being autistic, and I’m not sure that was a helpful approach for anxiety or trauma, either. These daily earthquakes are also revealing the fault lines of my internalized ableism.

Accept and Accomodate

Accepting my autism means accepting that some things are hard and overwhelming for me because my brain works differently. Social situations, schedule changes, unanticipated demands or expectations, phone calls, and certain sensory input often cause intense physiological reactions that can inhibit my ability to complete “normal” tasks. 

Acknowledging this reality doesn’t mean accepting that everyday tasks must always be a succession of miserable struggles. Rather, it opens up opportunities to do things for myself to make my experience a little easier. I can wear headphones while I’m shopping. I know what kinds of clothing and food are best for me to avoid sensory distress. I can add to my overall resilience bank by getting enough sleep, moving my body, and making time for my special interests. I can have compassion for myself when I do all of these things yet still struggle. 

I’m figuring out how to accept my autism, but I wonder if other people will. There are things I can do to accommodate myself, but there are also things I need from other people in order to feel like I am safe and belong in a particular place. 

Will it be ok if I visibly stim around other people, or will it lead to further social isolation? Could I ask a potential employer to work from home and have schedule flexibility or would I be seen as even less reliant and employable than I already am? 

I’ve been autistic my entire life, and it feels like there have been consequences for that. Do those consequences really go away once I self-disclose my autism? 

So far, the answer to that has been no. I told my dentist about my autism diagnosis because I struggle to make it through a simple teeth cleaning without turning into a crying, hyperventilating mess. I figured that having information about my diagnosis might help contextualize some of my experiences with them as a patient. My dentist laughed and said that everyone is uncomfortable at the dentist.

I told my primary care doctor about my diagnosis, and his first response was incredulity. He was skeptical about where I received this diagnosis, and then proceeded to tell me that I’m smart, and smart people think differently, but that isn’t the same thing as autism. I guess my doctor doesn’t think smart people can be autistic, or maybe he thinks autistic people can’t also be smart. 

I’m grateful to my partner and the friends with whom I’ve shared my diagnosis, who have been absolutely lovely and understanding as I figure out how to express my autistic self. It’s quite frustrating though, to realize there are levels of acceptance that are up to other people. Of all the things I’ve been working to accept, that has been the hardest. 

How I Exercise With Endometriosis

Exercise can be a double edged sword for people with endometriosis. We all know that exercise is beneficial. Resistance training helps to build bone density, muscle mass, as well as coordination, muscle strength, and endurance. Cardiovascular exercise helps improve our heart and lung health. 

That’s great! The problem is that for many of us, exercise can also initiate pain that might last for a day or the rest of that week or month. It can be very difficult to exercise enough to stay mobile and strong, but not so much that we end up in bed with a heating pad.

When I was a personal trainer and Pilates instructor, one idea I learned about is periodization. This involves breaking down larger fitness related goals into smaller phases, which are organized with with increasing difficulty and rest periods.

In its strictest definition, periodization is most often applied to athletes or people training for strength gains. However, it’s an idea that can apply to anyone’s fitness routine, and I think it applies especially well to my menstrual cycle.

What works for me is to think about my exercise routine as part of my menstrual cycle, and tailor my workouts accordingly. Here’s what that looks like:

Days 1-3: When I’m on my period and my pain is the highest that it gets, I don’t even try to exercise. These are days where I’m taking lots of anti inflammatories, and I’m trying to just make it from the bed to the bathroom.

Days 4-7: As my period winds down, I’ll get back to what I consider my exercise foundation: stretching, walking, and basic Pilates mat exercises. I’ll spend thirty minutes or so stretching my quads, hamstrings, glutes, ab muscles, and back, and then I’ll either walk or do Pilates exercises for an additional 15-30 minutes.

Key Exercises:

  • Kneeling Quad Stretch
  • Supported Happy Baby Stretch
  • Shoulder Bridge
  • Activation exercises for Transverse Abdominus
  • Spine Extensions

Days 7-14: This is where I begin to add to my workouts. Stretching, walking, and Pilates remain the foundation, and these things are now my warm up routine. I’ll also add in some bodyweight exercises like squats, planks, and lunges. I’ll aim to do 3-4 bodyweight exercises in a workout, generally around 3 sets of 10-15 repetitions.

Key Exercises:

  • Bodyweight Squats
  • Planks
  • Upper Body resistance band exercises

Days 14-21: If my body is feeling good, I’ll make some of those body weight exercises into weighted exercises using kettlebells or dumbbells. I might also add in some more vigorous bodyweight exercises like burpees or jumping jacks. 

Key Exercises:

  • Weighted Squats
  • Walking Lunges
  • Upper Body Dumbbell exercises

Days 21-28: I’ll begin to wind down my workout intensity, returning to bodyweight exercises. As I feel my period approaching around day 25 or 26, I’ll bring my focus back to walking, stretching, and Pilates. 

Key Exercises:

  • Bodyweight Step Ups
  • Pilates Ab Series
  • Pilates Roll Up

Incorporating this rhythm into my workout routine has been very helpful for me in maintaining my muscle mass, mobility, and weight. It feels like I’m spending less time fighting my body and more time exercising because I’m recognizing my own limits and working within them. 

Maintaining consistency in my workouts also lets me track how my body feels over time. If my warm up exercises are feeling particularly challenging, then I’ll moderate my workout accordingly. But, if I get through my warm up and I’m feeling good, I might try for a few extra reps.

Sure, there are times where I either work out too much or not enough and end up in more pain than I would rather be in. It’s a process of personal trial and error, and keeping a journal to track your activity will be crucial in determining what exercise intensity is appropriate for you.

I would love to hear about your strategies to stay active while managing your endometriosis! Please share your favorite workout plans, YouTube channels, or exercise equipment that keeps you moving!

A Blog Post About Trash

My rural, desert community may be small, but it has a few eye catching features. First are the windmills, which make up the largest wind farm in America. For as big as they look from the gas stations on the 58, you don’t really get a sense of how massive they are unless you take the scenic drive up into the mountains. They’re wonders of engineering, design, and a daily reminder that people can come up with pretty big solutions when we try.

The next thing you’re likely to notice is the garbage, because it’s hard to miss. I’m not trying to be mean or air my town’s dirty laundry. Anyone who passes through can see it, and those of us who live here are intimately familiar with the refuse that lines our fences and curbs. The shrubs that grow in vacant lots look like weird little Christmas trees, with their branches full of shredded plastic bags, glittering in the sun like garland.

The reason we are home to the world’s largest wind farm (I know, Tehachapi likes to take credit) is that our area has uniquely windy conditions. Average daily winds are around 10-20 mph, and as I write this, the winds are blowing closer to 40 mph with gusts up to 60 mph.

Today is also trash day, so people are starting to set their garbage cans out. What happens next is pretty predictable. The wind topples over garbage cans, and then it’s not long before it gets carried through the streets and across the desert.

The wind isn’t the only natural force that contributes to our trash problems. The dogs that roam through the area will gladly open up a garbage bag, and a raven can empty a trash can in minutes looking for something to eat. 

As a result, it looks like Mojave is home to a bunch of litter bugs who just don’t care much about their community. This makes tourists who pass by less careful about catching the trash that slips from their cars. Even in our local Facebook pages, we often blame each other for the trash that piles up. Vaguely passive aggressive posts will finger wag at “those people” for not picking up after themselves.

A Mojave alley. Photo by Joyce Nash

Not only are our trash receptacles inadequate for our environment, there’s also not enough of them. In our park, which is often strewn with litter, there are only five garbage cans! There used to be more, but they were removed and only those few were replaced. 

We are also a community with high rates of poverty and a higher than average rate of renters vs. homeowners. There are frequently many people (often extended family) living in one house or apartment. The single garbage cans allotted to each address are just not enough.

Few homeowners are eager to spend more money on additional garbage cans for their tenets, and few renters want to make it a problem with their landlords (especially when there are so many other problems that need to be fixed). And so the trash piles up.

It is easy to see our trash problem as an issue of “personal responsibility”. If all of us in Mojave would just be personally responsible for our own trash, and maybe also the trash that blows into our yards, then the problem would be solved. 

It wouldn’t, though. That doesn’t address the issue of not having enough receptacles to hold it, or what to do when the wind, birds, or dogs inevitably redistribute it. 

Our trash problem isn’t because we’re too lazy or irresponsible to deal with it. Our trash problem is a failure of infrastructure and civic planning. 

We have figured out how to harness energy from the wind with giant windmills, but we can’t figure out a wind-proof trash can? We have trash cans that keep out bears, but not ravens?

Considering all the other incredible things people have figured out, this trash problem doesn’t seem impossible. It is a matter of priorities, though, and for the leadership in Kern County, things like “providing a basic level of services” and “ensuring safety and quality of life” seem to be low on the list.

I’m not writing this because I have a clever trash related solution. I wish I did, because the wind has already knocked one of my neighbor’s garbage bags out of their can. What I want is for us to challenge the story we tell ourselves when we see trash piled up against fences, whether they’re here in Mojave or somewhere else.

Did that trash get there because lazy people didn’t pick up after themselves? Or did the trash pile up as a result of lots of different factors?

What we think about trash on the road matters. If we believe it’s the result of lazy people, then that will impact how we treat those people and that place. Lazy people don’t need help, they just need to get to work. But, if we see the trash as a failure of planning, leadership, and collective action, then that opens up all kinds of possible solutions. 

I haven’t really touched on the environmental impact of all this loose garbage, or the health and safety risks to people and animals that it presents. All of these problems are a real part of the day to day life here. Do you avoid walking in sandals due to dirty diapers, food wrappers, and other trash on the sidewalk? I do.

For as urgent as these problems are, I doubt we’ll get to a solution as long as we see the trash as a moral failing of our community. The only thing lazy here is the “personal responsibility” argument, so let’s put it where it belongs: in the trash. 

Endometriosis 101: Symptom Tracking

One of the worst things about endometriosis (besides the pain) is how little is known about this disease. Researchers don’t really know what causes it, and doctors don’t have many good answers when it comes to treating it.

Getting to a positive diagnosis is bad enough, and many of the symptoms that are widespread among endo patients – like GI pain – are not commonly recognized as part of the endo experience. Even the most hallmark symptom – severe menstrual pain – is often dismissed as normal.

It can even be tough to recognize endo symptoms within our own bodies! Given the cyclic nature of endometriosis, symptoms seem to mysteriously appear and disappear. With so little information available, it’s easy to wonder if new symptoms are endo-related or not. This leaves a lot of patients in the dark about what is going on with their bodies, and what kind of treatment they may need.

Whether you’re new to your endo journey or not, tracking your symptoms can be a powerful tool to help you understand your body and your symptoms. The information that tracking provides will help you make choices about your diet, lifestyle, or medical treatments.

There are very few one-size-fits-all answers for endometriosis, and it can often feel like taking shots in the dark to try and find some relief. When I started to track my diet, I noticed I had a lot of dairy, sugar, and carbs from beans. I was having pretty intense GI symptoms, so I cut out dairy, reduced sugar, and traded in a couple of servings of beans each week for chicken.

In the past year, I’ve also learned to not do all of the chores on the same day.

I prefer to use a notebook and pencil, but if an app would work better for you, that’s great! The best method to track your symptoms is the one you can stick with. It does require setting aside time throughout your day to jot down notes, but it’s worth it.

Tracking can also help at your doctor’s appointments. You’ll have a better understanding of your own symptoms, how they impact your life, and what you’ve tried. Having a physical notebook (if you go that route) can also indicate to your doctor that you’re serious about your symptoms. This can backfire, though, and doctors can see this level of note taking as a sign of obsessiveness and anxiety. That’s a sign for you to get a new doctor.

On the whole, symptom tracking has been one of the most helpful tools I’ve picked up to help manage my endo. If you would like to get started, here are some links below to get you going. Ultimately, it doesn’t matter what your tracking system looks like, as long as it works for you!

Here’s How to use a Bullet Journal for Better Mental Health from Buzzfeed.com

29 Bullet Journal Layouts for Anyone Trying to be Healthy from Buzzfeed.com

That New Doctor Feeling

My palms are sweaty. My knees are weak but I don’t eat spaghetti. No, I’m not just revisiting one of the biggest songs of my high school years, I’m thinking about the appointment I have tomorrow with a new gynecologist. It’ll be my first pap smear in at least five years. (I’ll talk about why the long gap in another post soon.)

Honestly, the pap smear part isn’t what is so scary. I’m expecting that to be somewhat painful, especially since I’ve had pelvic and bladder pain spring up today as I get close to my cycle. It might hurt to stand up straight, but getting prepped for this appointment feels an awful lot like squaring up for a rap battle.

I’ve got my lines that I’m working on, making sure I have a good hook in my intro. I want to sound prepared but not paranoid, well-read but not obsessive. I want to reflect a calm, cool, not-at-all-anxious demeanor while still communicating the reality of my symptoms. Me? Anxious? Psshhh, my heart rate is that high because I just ran a mile. Yup, right before the appointment. Just out running.

As I anticipate what the doctor might say, I don’t want to get stuck in Worst-Case-Disaster thinking. But also, I’ve been to doctors before. I have some experience to draw from as I get ready.

Doc: Tell me about your symptoms

Me: I have endometriosis. So, pelvic pain; back pain; urinary pain; bowel pain; GI pain; pain during ovulation; extreme menstrual pain.

Doc: Birth control!

Me: Sorry, I was on many kinds birth control for several years and it didn’t help my symptoms. I was also dangerously depressed and suicidal.

Doc: Lupron! Orilissa!

Me: Sorry, not an option for me.

Doc: Well, I’m not sure what you expect me to do then.

Me: Can you please just stick the q-tip up my vagina and do a pap smear?

I’m afraid of being brushed off, dismissed, and ignored. I’m afraid of being made to feel like I’m making poor choices for my disease management by someone who may be working from outdated or inadequate knowledge. I don’t want to have to be an advocate for myself, I just want to just be a patient.

My goal for this appointment is mostly to get a pap smear. I don’t think anything is wrong, but it’s been a while. I’m also hoping to find out what are the tests or imaging I should be doing to monitor the impacts of the endometriosis. I want to avoid another laparoscopy for as long as possible, but it seems like a good idea to keep track of things in my blood work, right?

We know that endo can cause imbalances in vitamin and mineral levels, especially B6, B12, and vitamin D. Maybe that’s something to keep an eye on? I also know that my liver showed signs of damage in my last ultrasound, so I’m hoping to find a way to ask whether that requires monitoring without sounding like someone who spends far too much time thinking about their own liver.

So, until tomorrow, deep breaths and lots of pelvic floor stretching.

Who Designed This? Mojave Truck Stop Edition

There are lots of things that my community does not have. As an unincorporated, rural community of less than 5,000 people, we make do without things like doctors, farmer’s markets, movie theaters, and such. 

But one thing we do have is a park. It’s actually quite large, and has lots of well established trees for shade, a playground, basketball court, and picnic tables. Yes, the bathrooms are now permanently closed after being used as a place to take and sell drugs. But still, there’s a splash pad, and the park is full during the spring and summer with kids and families.

The Mojave Park, circa 2020. Photo by Joyce Nash

Can I tell you about one more of our park’s features? The library is located there! Yes, the library is tiny, but it exists! And I just think it’s adorable that the library is in the park, and a great way to make it easier for people to utilize this resource.

So of course there is a truck stop being constructed less than 500 feet from the park. 500 FEET. And less than 200 feet from the library.

To be fair, the property that the truck stop will occupy was previously some kind of gas station, although it’s been vacant for at least the past seven years. There is a hangar-type building with a couple of bays for cars, and there used to be gas pumps. Occasionally, people would use it as a backdrop for photo shoots or videos. You can even see it in the picture.

But now, there will be semi trucks regularly going in and out of this property, less than 500 feet from where children and families go to play and enjoy the outdoors. There are so many things wrong with this plan, it’s hard to know where to start.

Community Health

Our park is truly a gem. I often walk there for exercise, and there are typically other people there, playing with their dogs, tossing horseshoes, or simply existing. In the afternoons, the park is packed with families; blankets on the ground, snacks spread out, and kids running wild through the splash pad. 

It’s common to see summertime cookouts, parties, and reunions. Our park is highly utilized, despite the lack of basic amenities such as bathrooms.

Mojave is not a wealthy community. We have alarmingly high numbers in almost every category where you want the number to be low, including poverty, unemployment, hunger, and chronic diseases.

This park is important; not only is it one of our most valuable community hubs, it also is important to the personal health of all of us who use it.

Research has shown that access to parks and green spaces reduces stress, improves health, and promotes community by providing people with the physical space to create it. A truck stop so close to our only park would have a hugely negative impact on this shared space, our safety, and our health.


A map of the Mojave Truck Stop (center) and its proximity to a busy crosswalk and park

The truck stop will be located just hundreds of feet from the park, which is itself next to the local high school and elementary school. Kids regularly cross the four lane divided highway to get to the park or school. The crosswalk is within a few hundred feet of where trucks will be entering and exiting the truck stop. 

Those of us in Mojave know that this crosswalk is notoriously dangerous. Because the road is oriented east-west, the glare from the sun can be blinding. Several years ago, a young girl was killed by a vehicle while crossing the street, and that’s what spurred the push to get the slightly more visible crosswalk we have today. 

The park is also the home of the Mojave Veterans Building, which is another hot spot for local activity. It’s the regular meeting spot for the Mojave Seniors; it’s where food distributions happen (with large crowds), and it’s where we vote. All of these activities will become more dangerous if we have to navigate a regular flow of semi trucks to get to them.

Air Pollution

Even with improving standards, trucks still produce a disproportionate amount of emissions. As reported in the San Francisco Chronicle in 2019, “The transportation sector accounts for 41% of greenhouse gas emissions in California, and 10% derives from heavy trucks, which comprise only 4% of all vehicles on the road.”

It is infuriating that our community’s main source of green space is about to be subjected to heavy amounts of pollution. The place where we go to run, exercise, and breathe deep is now going to smell a lot more like truck exhaust.

Noise Pollution

Trucks are loud. Libraries, typically, are not. Even with kids playing in the afternoons, the library manages to be a peaceful place. It’s hard to imagine how much harder storytime will be with the regular sounds of trucks within 200 feet. 

Research indicates that noise pollution can have measurable adverse reactions on humans, including hearing loss, high blood pressure, heart disease, and insomnia. The increase in noise will certainly have an impact on our library patrons, but especially the library workers.


Kern County can be a real head scratcher. So often, the development we see in our East Kern communities seems to be the opposite of what we need to actually develop. We get liquefied natural gas storage less than a mile from neighborhoods; giant solar farms adjacent to homes and businesses; and now, a truck stop in the place where we go for fresh air, quiet, and community.

Someone, in an office somewhere in Bakersfield, signed off on the permits for this truck stop. Did they pull up a map before they put pen to paper? What was the thought process behind this approval? What are the priorities for the people who make these decisions?

If our health and wellbeing were a priority, it’s hard to see how this is a good idea. If our safety and our ability to get fresh air were priorities, then this truck stop would be a proposal in a trash can.

So what is the priority for Kern County’s leadership? In a word: money. (Power would be a good word here, too). When it comes to East Kern, that means selling out to the highest bidder, regardless of the environmental or community health risks. And sure, money is great. The county needs money in order to provide essential services.

But somehow, those services never make it out to us. I want to see what Mojave and East Kern could look like if our leadership put us first. I think there would be room for all kinds of things without so many truck stops.


Farooqi, Zia Ur Rahman, et al. “Vehicular Noise Pollution: Its Environmental Implications and Strategic Control.” Autonomous Vehicle and Smart Traffic, 9 Sept. 2020, http://www.intechopen.com/books/autonomous-vehicle-and-smart-traffic/vehicular-noise-pollution-its-environmental-implications-and-strategic-control, 10.5772/intechopen.85707.

Gies, Erica. The Health Benefits of Parks Written by Erica Gies. 2007. http://cloud.tpl.org/pubs/benefits_HealthBenefitsReport.pdf

“Heavy Trucks Are New Target for Reducing Air Pollution.” Governing, 9 Dec. 2019, http://www.governing.com/news/headlines/heavy-trucks-are-new-target-for-reducing-air-pollution.html#:~:text=The%20transportation%20sector%20accounts%20for. Accessed 4 May 2021.

How Cities Use Parks to Improve Public Health. American Planning Association, 2003, planning-org-uploaded-media.s3.amazonaws.com/publication/download_pdf/Parks-Improve-Public-Health.pdf. Accessed 4 May 2021. https://planning-org-uploaded-media.s3.amazonaws.com/publication/download_pdf/Parks-Improve-Public-Health.pdf