C25K - Day 2

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 4 consists of a 5 minute warm up walk, followed by a 3 minute run, a 90 second walk, a 5 minute run and a 2 and a half minute walk. The runs/walks are then repeated once and you end with a 5 minute cool down walk. The total running time is 16 minutes.

The second run was done on the 18th of July. My usual path was quite busy with construction workers and even blocked off in a few places, forcing me to run around them. There also seemed to be a larger than normal amount of dog walking traffic for some reason. Despite the increase in traffic, I managed to do 4.5 km during the podcast itself, including the warm up and cool down walks.

I found this run to be quite a bit easier than the first run of the week, surprisingly. The backs of my thighs were really tight and achy from cleaning my son's room the day before (lots of squats and bending over at the waist) and I was honestly thinking of taking an extra couple of rest days, doing the second run on Friday and the third run on Monday. Instead, I went out hoping that running would help my sore thighs instead of hurt them more. I was partly right. While I was running, my legs didn't hurt at all, but once I slowed back down to a walk, the pain came back with a vengeance! For the first time ever, the running parts were actually easier than the walking parts of the podcast!

It's the last run of the week tomorrow, then on to Week 5!

C25K - Week 3 Day 3

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 3 consists of a 5 minute warm up walk, followed by a 90 second run, a 90 second walk, a 3 minute run and a 3 minute walk (then repeat all once). The final 3 minute walk is considered your cool down walk.

I did the third run this past Friday (the 13th) and it was the hardest run of the week. Several times I nearly gave up and walked, but I'm glad I didn't, as just a few seconds after I was tempted to quit Laura came on and said it's time to slow down to a walk. By the end of the second 3 minute run I was really struggling, but persevered and walked a third lap around the housing estate.

Week 4 starts tomorrow. I also have my Nike+ sensor, so will be able to use it during the runs. Hopefully it will help measure distances a bit better.

C25K - Week 3 Day 2 (and other updates)

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 3 consists of a 5 minute warm up walk, followed by a 90 second run, a 90 second walk, a 3 minute run and a 3 minute walk (then repeat all once). The final 3 minute walk is considered your cool down walk.

Today was the first run in which I've used my new iPod. Up to now, I was "one of those people" who swore he would never get an Apple product. My main gripe is that they're so expensive (£147+ for a white 8GB iPod Touch). Now that I have one though, I rather like it. The iPod is stored in a "one size fits most" armband which I put on my upper right arm when I'm out and about. The armband is water resistant, which is good, and is hidden from sight under my t-shirt sleeve. It took me a few minutes to get used to, but once I did, I barely paid it any notice. Unfortunately, I don't have the sensor for the Nike+ app yet, so can't say whether I like it or not.

The run itself went well with my pace slightly increased since the first run. Monday's run finished at exactly 2 laps (approximately 1.6 miles according to Google); today's run finished a little ways past that, so I went ahead and completed the third lap accompanied by a few of my own mp3s.

I found the first 3 minute run to be slightly more difficult than last time; by the time Laura said "slow down" I was huffing and quite out of breath. The second 3 minute run wasn't as bad though and I had enough energy to push my speed a bit during the final 60 seconds.

Today was "weighing in" day. My "just me" weight this week is 148 lbs; my clothed weight is 68 kg. A slight increase, but well within normal perimeters.

I also picked up my blood test results from my GP today and made an appointment to see Dr. Curtis, my gender specialist, at the end of this month. Hopefully he'll give me the OK to pursue top surgery.   

C25K - Week 3 Day 1

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 3 consists of a 5 minute warm up walk, followed by a 90 second run, a 90 second walk, a 3 minute run and a 3 minute walk (then repeat all once). The final 3 minute walk is considered your cool down walk.

Over the weekend I had come to accept that I wouldn't be able to start week 3 until next week due to my mp3 player having fizzled (my computer refuses to find it). This morning however, I remembered that my mobile phone plays mp3s and after a bit of searching, I found the headphones for it. So I was able to start week 3 this week after all!

This run was really easy! When Laura (the woman narrating the NHS C25K podcast) said what the running times were going to be, I thought "There's no way I can run for 3 minutes straight!". But once the first 3 minute run started, it didn't seem so bad and it was over before I got out of breath. Having a 3 minute walk afterwards helped out a lot though. I think if I would have only had a 90 second walk after the 3 minutes, I wouldn't have found it as easy! The podcast ended right at 2 laps around the housing estate - around 1.7 miles.

My next run (and next weigh in) is Wednesday.

C25K - Week 2 Day 3

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 2 consists of 1 podcast in which you alternately run for 90 seconds and walk for 2 minutes. You do this for a total of 20 minutes, with 5 minutes before and after to warm up and cool down.

Today was the last run of the week and was done in the pouring rain. By the time I had finished the 5 minute warm up walk, I was soaked through. By this time I was tempted to call it quits, but I thought "I might as well do it, can't very well get any wetter".

Everything went really well, with all the runs giving me no problems. I don't know if it was the rain or my stamina having gotten better, but it seemed that I was able to run and walk faster than I did in the previous two runs. The podcast had reached the middle point of the last 2 minute walk when my mp3 player decided to fizz out. I didn't give up though. I ran from where I was to my house. I counted foot falls rather than seconds (right foot, left foot 1. right foot, left foot 2.), so while the timing may have been off a bit, at least I still got that last run in! Skipped the cool down walk, but I did some stretches instead.

I'm worried about my Mp3 player. I plugged it into my computer and it's not finding it, so I can't change the files. Looks like I might have to get that iPod Touch sooner than I had planned. 

Week 3 starts on Monday!

End of Fresh Start Programme

Today was the final meeting of the 10 week Fresh Start programme for me and the others who have been attending with me since May. As it was our last session, we only did the exercise portion and the weigh in and final waist measurement. The usual food education and taste-testing was replaced with filling out a general satisfaction form.

My final measurements are weight: 66.8 kilograms (147 pounds) and waist: 34 inches. In the last 10 weeks, I have lost 11 pounds and 2 inches off my waist. Not too bad!

On the 18th of July we start the post programme support which lasts for 9 weeks. This consists of going in to get weighed and measured, updating our portions allotments, and having a quick chat with the staff while the new group does their exercises.

While I appreciate the post programme support sessions, I'm going to miss attending the proper Fresh Start sessions themselves. I learned a lot from them and really enjoyed the exercise class each week.

C25K - Week 2 Day 2

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 2 consists of 1 podcast in which you alternately run for 90 seconds and walk for 2 minutes. You do this for a total of 20 minutes, with 5 minutes before and after to warm up and cool down.

Today's run went rather well, even taking into consideration that I deviated from my normal route. Instead of running around the perimeter of my housing estate, I instead ran through a neighbouring estate, past Hough Green railway station, and along Liverpool Road. I was very aware that Liverpool Road is quite a bit busier than the road around my housing estate - both in pedestrians and vehicular traffic. But no one stared, pointed, or laughed at me - not that I would have noticed with my headphones on and me having "zoned out" (i.e. totally immersed in the act of running).

The final run of week 2 is on Friday. I'll probably go back to my "usual" route as I'll be able to calculate the distance ran easier. One day I'll get a GPS/MP3 player and will thus be able to vary my route more often.  

C25K - Week 2 Day 1

To take the place of the 10 week Fresh Start fitness/health programme, I have started the 9 week (estimated) NHS Choices Couch to 5K running programme. The C25K programme is a downloadable podcast that encourages you to build up to running a full 5 kilometres.

Week 2 consists of 1 podcast in which you alternately run for 90 seconds and walk for 2 minutes. You do this for a total of 20 minutes, with 5 minutes before and after to warm up and cool down.

I found the first 90 second run to be fairly easy, but I forgot to check my speed and thus the other runs were quite a bit slower as I tired myself out with the first one! I managed to cover about 2 miles during the podcast and finished the final lap around my housing estate while listening to the music I had put on my MP3 player to bring the total distance up to 2.9 miles - in the rain.

My running shoes seem to be taking good care of my ankles. I was able to walk up the stairs without any pain right after my third mile, which is a good indicator of how well the shoes support my arches and ankles!

Couch to 5K - Week 1 Day 3

Yesterday I went into town and had my gait analysed at the local sports fitness store. The computer said I need support shoes (I have collapsed arches in my feet) so I went ahead and bought a pair while I was there.

Today's run was done this evening instead of this morning as I went on a day trip to St Helen's with a friend as soon as Paul left for school. I wore my new shoes while I was out to help "break them in".

The run went well, though the pace was slower than the previous two runs. I think it was due partly to having new shoes and not being used to running in them and partly because I changed the time I ran. Normally, I run around 10am. Today I started at about 6:30pm. The good part is that during the run, my ankles didn't hurt at all and at the moment, they seem to be in good shape. Hopefully this means that the shoes are doing their job properly.

I'm resting the entire weekend from running, although I'll probably get some walking and weight training/resistance bands in at some point.

Week 2 starts Monday!

Couch to 5K - Week 1 Day 2

My run today went rather well. Once again, I managed to run for the allotted eight minutes and walk the rest without too much difficulty. Although, I did have to mentally spur myself on for the second to last run. Again, I did three miles in about 40 minutes.

After I had rested for a while though, I noticed that my feet have developed blisters! There are two blisters on my left foot (one on my third toe and a big one on the outside of my heel) and a popped one on the fourth toe of my right foot. Also, my ankles are really bothering me.

Problems with my ankles isn't really that surprising, as I've had weak ankles for the last 20 years, but I wasn't expecting them to hurt this much! I've put plasters on the blisters, slathered my feet in lotion and put some Voltarol spray on my ankles. That will have to do for now. When I go into town tomorrow, I will buy some ankle supports, more painkiller spray, and whatever else looks like it might help (perhaps some cooling plasters, if I can find them).

I'm not giving up though.

Couch to 5K - Week 1 Day 1

Today I started the "Couch to 5K" fitness plan as detailed on NHS Choices. Each workout takes approximately 30 minutes to complete. You do the workout three days a week. The first week entails five minutes of a warm up walk, followed by eight stints of running for sixty seconds and walking for ninety seconds, then finally a cool down walk lasting another five minutes.

To be honest, I wasn't sure if I would last the entire 30 minutes the first time through. I haven't done any serious running since high school - nearly 20 years ago. But I managed to finish it and even walked longer than the five minute cool down. In total, I walked and ran nearly three miles today - that's three laps around the housing estate in which I live - in about 40 minutes.

This first time wasn't super difficult, but neither was it a walk in the park. By the time I got back home, I was panting, covered in sweat and my calves and ankles were aching. My next workout day is Wednesday, so I'll be changing the scenery a bit and doing the workout on my way to the Fresh Start class. Here's to Wednesday!

Sponsored Walk - Planning Stages

I went into the Halton Link today to enquire about legalities of having a sponsored walk to raise awareness of Halton PCT (and other PCTs in the UK) denying treatment and medicine for transgender people. Any money raised will go towards my top surgery and any left over will be given to another trans person who is in the same situation I am.

The woman I spoke with said that as long as I don't collect money on the streets, I'll be fine and to make sure I come by the Halton Link when I start asking businesses to sponsor me!

I'm hoping to do the walk on my 35th birthday which will also be exactly one year since I came out to all my friends and family. This week I'll be figuring out the route I want to take (I know I'll be walking from Widnes town centre, across the Widnes/Runcorn bridge, back across and head home to Hough Green) and designing and printing out sponsorship forms. Next week I'll go around to local businesses, asking them to sponsor me. The week after, I'll contact local media (radio, papers) and tell them about it.

It's my hope that doing this will raise awareness in the general population about transgender rights pertaining to medical treatment and the situations we often find ourselves in when we try to get funding for surgeries and hormones that will greatly increase our quality of life.

Funding Setbacks

First, let me update you so you won't be completely lost. Two months ago my GP put in a funding request to my Primary Care Trust for my testosterone prescription. They denied the funding on the grounds that because I had gone to a private gender specialist, I had gone off their "approved transgender care pathway".

Fitness Update - 5 weeks on Fresh Start

On the 2nd of May 2012, I went to my first Fresh Start fitness course. At that time, I weighed 71.9 kilograms and my waist was 36 inches.

Fresh Start is a free weekly fitness course in Halton which combines exercise with learning about food and portions. The one I attend is taught by three wonderful people - Sophie the dietician, Paul the fitness instructor, and Steve who helps with the fitness and weighs us every week.

I really love the fitness part. Paul does a fantastic job of tailoring the circuits (or whatever we're doing in a given week) to each person and he doesn't hesitate to challenge us to reach just a bit further.

Last Wednesday, the 6th of June, was the half way point in the 10 week course. My measurements were 70 kilograms in weight and 34 inches around my waist. Not a huge difference, but I wasn't expecting too much as I'm on testosterone which has a tendency to put the weight on. To be honest, I would have been happy had my weight just stayed put from the first week.

We have another four weeks left of the course and I will make another fitness update at that time. Until then, happy exercising!

FTM Pathway for Halton and St Helens PCT

I received another email from the Interim Chief Operating Officer of Halton CCG today. In his email, he listed the Female to Male (FtM) core surgical procedures. These are the surgeries that are recommended for support and funding by PCTs in the North West of England.

The recommendation of the North West Specialised Commissioning Team is that PCTs support and fund the following core surgical procedures for female to male (FtM) patients where an application has been made by the patient’s clinician:

 

·         Mastectomy

·         Hysterectomy

·         Vaginectomy

·         Salpingo-oophorectomy

·         Metoidoplasty or phalloplasty

·         Urethroplasty

·         Scrotoplasty and placement of testicular prostheses

 

The recommended non-core procedures are not routinely funded.  Requests for funding on an individual case basis can be made and these requests are considered for funding by a PCT in line with existing local

policies for plastic surgery/cosmetic procedures.  It must be stressed that this list is not exhaustive and any other procedure not listed would be considered as non-core procedure until further review.  The following

are non-core procedures:

 

·         Breast augmentation in trans women

·         Reduction Thyroid chondroplasty

·         Rhinoplasty / other facial bone reduction

·         Blepharoplasty

·         Face-lift

·         Hair removal/ electrolysis

·         Body contouring – e.g. suction-assisted lipoplasty of the waist

·         Voice modification surgery

·         Procedures to decrease areas of baldness

·         Storage of gametes

·         Skin resurfacing -  e.g. acid peel (a method of removing the upper layer of skin in order to improve skin smoothness)

 As you can see, mastectomies are considered to be a core surgical procedure for FtMs and PCTs are supposed to fund them.

He also attached a document which details the pathways for transgender people. You can find it after the jump, but be warned that it seems to be out of date in regards to the Gender Identity Clinics that are listed. The document lists Leeds Becklin Centre and Claybrook Centre in London. This is incorrect. The current GICs are located at Seacroft Hospital in Leeds and Charing Cross (CHX) in London.

I have emailed my contact asking for further clarification and will post another blog entry when I receive it.

Transgender Care Path for Halton & St Helens PCT

A couple of weeks ago, I emailed Halton & St Helen's PCT asking why my GP told me that the PCT had not instructed him to follow the Standards of Care for Transgender people as written by the WPATH.

Today I received an email from the Interim Chief Operating Officer of Halton CCG, located at Victoria House in Runcorn, Cheshire, replying to my inquiry which details the basic care path that Halton & St Helens PCT follows. Here is that email:

There is no single universally accepted pathway for patients with gender dysphoria.  There is a recommended pathway that has been established by the North West Specialised Commissioning Team which we follow locally – work in which I was involved in when I worked with that team.  This is based upon the WPATH Standards of Care, often referred to as the Harry Benjamin criteria.  The recommended pathway can be summarised as follows:

 

·       Patient sees his/her General Practitioner for assessment and management of gender dysphoria. The GP refers the patient to a local specialist in gender dysphoria where that is available or to the local NHS mental health provider for access to further evaluation.

 

·       Patient is assessed by the local NHS psychiatrist, who may or may not be an expert in the field of gender dysphoria.  If the local psychiatrist considers the case to merit further evaluation and can rule out the presence of an obvious mental illness that may be the cause of the symptoms of gender dysphoria, the patient is referred on to the Gender Identity Clinic (GIC).

 

·       Depending on the operational policy of the GIC confirmation of funding may be requested from the patient’s PCT before an outpatient appointment is made. It is important to note that the PCT making the decision need to be aware that there could be a surgical cost at the end of the pathway and that this could be several years in the future.

 

·       The Gender Identity Clinic - Experts in gender dysphoria assess the patient and initiate Real Life Experience (RLE), prescribing hormones and monitoring the patient, usually in partnership with the patients own GP.  During this period, patients may additionally require psychotherapy, speech therapy, group sessions and other interventions.  After 12-24 months of assessment, the patient is seen by two consultants (one of whom has not previously been involved with the care and treatment of the particular patient, acting as a second opinion) for a final assessment to judge if the patient is suitable for surgery.  If the patient is considered suitable and is personally ready for surgery, a referral is made to the preferred provider for consideration of Gender Reassignment Surgery (GRS). 

 

·       The provider of GRS requests confirmation of funding for surgery from the patient’s PCT and provides an outpatient surgical consultation appointment once funding is confirmed.

 

·       The PCT considers the request for funding and once it is ensured that the patient meets the criteria, confirms funding for GRS.

 

·       Patient undergoes appropriate GRS and returns to follow-up with GIC.

 

·       Patient discharged from GIC when appropriate and returns to primary care for maintenance hormone therapy and monitoring, if appropriate.

 

You will have to travel for aspects of this care, such as assessment at a GIC and, should you wish to have surgery, for surgical interventions, as there are no local services due to the specialised nature of the interventions you require.  You should, however, expect support from your GP in terms of arranging ‘shared care’ and local monitoring working in partnership with GIC to minimise travel to and from these centres.

 

To summate, Halton GPs are following the WPATH Standards of Care and recommended pathways based upon these.  This said, there is clearly a need for improved liaison between the services providing specialised interventions and your GP to enable them to deliver as much care to you locally as possible.

 This path, as outlined above, is missing one thing though. According to my sources, Halton & St Helens PCT refuses to fund the top surgery for both FTMs and MTFs. Knowing this, I emailed a reply back asking if this was true and to be given the PCTs policy on funding for surgery. When/if I get a response, I will post it up here. 

If you have any questions, please comment below and I will either answer them (if I know the answer) or will forward them to my contact in the Halton CCG.