TTC with large 10cm fibroid

[Apple78]

Hi.
Starting a new thread as couldn't find anything very recent on this. Have been ttc for 7 months now since my miscarriage at 8 weeks in July last year.

I knew I had a large fibroid (10cm) before ttc but my GP and consultant advised that it should not affect my chances of conceiving due to the location (on the outside of the uterus right on top). They said it could cause pain during pregnancy but was unlikely to harm the baby.

Since the mc I have been getting some pain from fibroid, mainly first thing in the morning but it soon goes away when I get moving. However, we haven't had any success with conceiving and I'm wondering whether we were just lucky the first time (it happened the first month of trying) or whether something could be wrong. My periods have become longer and heavier but the consultant I'm seeing says a fibroid on the outside of the uterus should not affect my periods.

The consultant is keen to whip out the fibroid as she says it would make a pregnancy more comfortable. All along I've been keen to avoid surgery due to the risk of heavy bleeding which could lead to an emergency hysterectomy. I know this is very unlikely but it scares me as we desperately want to start a family. The other option is embolisation where they block off the blood supply to the fibroid, but I've read that this isn't normally recommended for women who want to retain their fertility. My consultant, however, thinks it's a viable option and has suggested we look at a combined approach of embolisation to cut off the blood supply and then surgery to take the fibroid out. She did admit that as a surgeon she always prefers the surgery option, so I feel like she isn't really considering the full picture. It all seems drastic to me as the fibroid is more of a nuisance than anything else. I can live with it (although it does make me self conscious as my tummy is quite big).

I've heard of the newish drug, Esmya, which is used to shrink fibroids before surgery and see it's now licenced for women to take intermittently to manage fibroids. Has anyone tried taking this prior to ttc and did it work?

I really can't decide what to do and would be grateful if anyone could share their experiences if they've been in a similar situation.
Thanks.

Hi all. I've no experience of fibroids but saw your thread and thought of an article I'd read recently on shrinking fibroids naturally. I thought I'd link to it in case it was of interest.

www.floliving.com/what-causes-uterine-fibroids/

All the very best of luck to you all x

Hi Ladies,

Apple, I'm glad you have the medication hopefully that will shrink the fibroid quite a bit. How was your appointment were you given any useful information? would be interested to hear how you got on.

Bacon, thank you for your reply. I was in hospital for a couple of days I actually thought it would be as long as 5 days as that's what it said online but you know how quick hospitals are to get you out quickly! I felt like I would have maybe been better staying 1 more night as its easier to get around with all the hospital adaptions if that makes sense. But having said that I slept really well when I got back and I only slept a bit whilst I was in hospital so it was probably better.
I know what you mean about the different views of consultants. It wasn't an easy decision to go for surgery particularly when it went from the what was going to be a simple procedure to open surgery!
I have never had surgery or even been to hospital so it was pretty major. I actually worried the other day what if I have gone through all of this and there are no improvements! I'm sure there will be though and I'm glad they were removed as mine had grown and would have continued to get bigger.

I am currently getting some very sharp pains ahead of AF hoping it will get better soon!

Little , thanks for the link.

Hope to speak to you again soon ladies.

Hi ladies

Sorry I haven't had chance to post sooner. Hopeful - how are you getting on? Has AF arrived?

I went to see a private consultant who examined me and looked at the results of the MRI scan and recommended surgery. However, he said he would certainly not recommend embolisation (which matches what both of you were told and what I've read online) as it's not recommended for ladies wanting to retain their fertility.

The consultant said that my fibroid is too large for keyhole, so full open surgery would be needed. I preferred his manner to the other consultant I've been seeing so am waiting to be referred to him now on the NHS to then go on his NHS waiting list for the op. He said the waiting list is about six months though - quite a long time. However, in the meantime he said the Esmya is worth a go and should stop my periods. I was really against surgery to begin with but this consultant said he thinks it improve pregnancy outcomes and I am fed up with looking pregnant when I'm not!

I've been taking Esmya for three weeks now and am hoping it will miraculously make my fibroid disappear! Don't think it will happen but you never know. The consultant said usually it shrinks fibroids by 20-30% max. I am feeling exhausted at the moment but I've had a bug too so I can't be sure which is causing the tiredness. My middle has definitely shrunk too (my trousers are looser) but again I don't know if that is from the medication or due to not eating for a few days due to the illness!

Hopeful - how long did you wait for your op? Six months seems like a very long time to wait but then if the medication shrinks the fibroid it might lower the risk of bleeding so I suppose the wait could be a good thing.

Hope you're all well. x

Hi Ladies,

Apple, I'm glad to hear your appointment with the consultant went well and even though it means you have been advised surgery I'm sure you are pleased you've got a solution. I had to wait about 10 weeks for my original op date, which was then cancelled by mistake and because I was too anxious about it being ungraded to open surgery! It may of been so quick because I declined the medication which I would have had to have for 3 months. It was a gamble I took because the medication is supposed to shrink the fibroid as you say which should make the operation safer.

My AF arrived after 25 days ( usually 28 days) and was unfortunately about the same it terms of heaviness. I have read online though that they can be lighter, heavier longer, shorter for a few months after surgery. I had a few wobbles where I thought what if I have had this done for nothing and it doesn't improve anything but then the alternative could of been the fibroids continue to grow and I could of ended up having a hysterectomy if there were problems at a later stage ,so I'm happy about it now.

Recovery is slow, I'm able to do a lot more but still get lots of different pains and am very tired and still off sick. The scar is healing nicely although my belly is huge apparently the surgery causes it to swell but hopefully it will all go back to normal soon.

It is major surgery but I surprised how well I have coped. My consultant wrote a follow up letter to my GP saying I have 3 fibroids removed! largest was 7 x5 cm and in the fundus.

I am more than happy to provide any information you need about the surgery.

Hi Apple!

Whilst I'm not currently TTC, I am nursing 7 (potentially more) fibroids, 2 of which are large (12cm + 7cm) and pedunculated on top of my womb. I've had a lot of pain with them, presumed to be because the stalks they're on are twisting and they're fighting for space.

I've been on Esmya for 2 months now and the side effects aren't fun. I've had hot flushes, feel nauseous nearly all the time, had quite a few headaches and have felt so tired that at times I've had to put my head down on my desk to take a spontaneous nap. I've just been for a follow up appointment with my consultant who doesn't think Esmya is making a remarkable difference to my fibroids and as I'm still having consistent pain with them, I've decided to opt for a myomectomy, which I'm having on the 12th June. If I wanted to conceive now, it's unlikely that I would be able to carry a baby to full term with the positioning of my fibroids as they are so I'd rather have them sorted now so that I limit the issues with conceiving further down the line.

My consultant has advised me that it'll most likely be a horizontal incision but because of the size of them and the fact they are on top of my womb, there's a chance she'll have to do a vertical incision. I've been signed off work for 8 weeks to recover post-op. At this point I can't wait for it to be over - I'm in almost constant pain and can do very little exertion without really feeling the consequences.

I found this excellent thread that gives pre-op and post-op advice for a myomectomy if anyone's interested - www.fertilityfriends.co.uk/forum/index.php?topic=313215.0.

Can't wait to kick these 'broids in to oblivion!!!!

Hi jgatz54. Thanks for joining us! Sorry to hear about your painful fibroids. It's not long now until your op though so hopefully they'll be all gone soon! It doesn't sound like you're having to wait too long for the myomectomy. I'm still waiting for the referral letter to see the consultant to get on the waiting list! Then it's a six month wait after that! Thanks for the link for pre and post op advice - I'll have a read. I'm terrified as I've never had any type of surgery before or taken any medication (apart from the contraceptive pill and now Esmya). Even the thought of having to take antibiotics after the op scares me as I've never taken any before!

Luckily the Esmya doesn't seem to be causing any major side effects (touch wood!). The pain seems to be getting more frequent but I'm hoping that means it's working! My fibroid still looks massive and I'm really struggling to cover it up during this nice weather. I feel very self conscious and dread someone asking me if I'm pregnant!

Hopeful - 10 weeks seems really quick to wait for your op compared to my six months plus! How are you feeling now? Has your belly gone down? Have you been bored at home recovering or has it gone fast?

Someone suggested phoning up to see if they have any cancellations for the op once I'm on the list. Might be worth trying it but I'd have to be ready in case they said to drop everything and go! Hmm...not sure what work would think about that!

Hi Ladies,

jgatz. I hope your op goes well do keep us updated. You will need at least 8 weeks off work, I am still off and its been 8 weeks but still feel shattered. I was advised that it could be a vertical incision on the day of the op which sent me into a panic but my own surgeon said it would be a horizontal. When I woke up that's the first thing I wanted to know and the nurse reassured me it was a bikini incision.If you have any queries regarding the op I am happy to provide you with any information.

Apple, hope you are doing well. Yes, 10 weeks was good I think I was originally told 3 months and then there may of been a cancellation. I went in for surgery a month after that though after mine was mistakenly cancelled. My main advise is that you need to be prepared, if you are all organised and happy to go if there's a cancellation then that's good. I needed to get myself organised before which is why I was glad it was rescheduled because it took me a while to feel prepared. I have never had surgery before so this has been very significant, it is major surgery but you will be surprised how you managed to cope with it , I was and I am a bit of wimp!

My pains are getting better although still having internal pains although not as frequent. My stomach hurts if I over do things and the incision feels a bit tender but okay. My stomach is not as big but still bigger than before the op! I really hope it improves.The main thing is I still feel very tired post surgery probably not helped by me still having anemia which I suppose would be expected initially after surgery.

I now feel that I m getting there slowly.

jgatz54 - I just wanted to wish you luck for tomorrow. Let us know how you're doing when you feel up to it.

Hopeful - I'm glad to hear you're getting there slowly. Do you think you'll be able to return to work soon?

I am still waiting for an appointment to see the consultant to get onto the waiting list. I'm almost at the end of the second month of taking the Esmya and (touchwood) I haven't had any noticeable side effects. The fibroid pain seems to be getting more frequent than it was, but I'm hoping this is a good sign and that the fibroid is dying! My tummy is still massive.

Bacon - I'm hoping we haven't heard from you because you have good news, but let us know how you are when and if you get chance.

Hi just saw this thread I had a open myomectomy on Wednesday due to painful and heavy periods continous bloating and discomfort made me make the decision to have them removed (biggest fibroid being 15 cm by 10cm weighing 1.4kg distorted my womb I had 4 all removed ). Even though I am sore I think this is the best decision I ever made. All the dr has said to us is that if I ever did get pregnant I would have to have a c section.

Hi all,

Thank you for the well wishes!

I am now Day 7 post-myomectomy. The surgery was a great success - I the 5 small fibroids had shrunk to nothing with the Esmya and there were 3 other large ones that needed removing. The biggest was about 12cm in diameter as suspected, the next was about 5cm and another one was found that was about 3cm.

I opted for a spinal anesthetic which was a GOD SEND! The operation was about 2hrs long and when I came round, I was numb from my waist to my toes. That lasted until Tuesday lunchtime but meant that I was quite "with it" after my op. That first night was a bit of a blur but I was woken up hourly for blood pressure checks and more pills.

In the morning, a nurse removed my catheter and helped me out of bed. Whilst I managed to get up and shower, I almost collapsed in the shower and ended up having to be carried back to bed. Nothing can prepare you for how even the smallest of activities can completely exhaust you. Physio started that day too with very light pelvic floor exercises - again, totally exhausted after that.

My biggest piece of advice is to take the drugs - all the drugs - as soon as pain starts to hit and get ahead of it. It is uncomfortable and it is painful but if you can mentally prepare for that (which I did) and stay ahead of the game with the painkillers, you'll be in a good place.

Bowel movements didn't kick in until Wednesday evening. The post-op bloat actually causes a lot more pain than the operation itself at times so make sure you ask for laxatives from the onset. Eat lots of fruit and veg too and make sure you do the exercises they give you which all help to aid the wind you get.

Coming home was harder than I thought it would be. Little things like being able to sit down on the sofa and get up again were far more challenging than I anticipated. My mum has been looking after me since I got back and I haven't lifted a thing or over exerted myself. Every day gets a little easier and I can now climb the stairs without it feeling like I've run a marathon and without it inducing extreme pain.

My scar is really neat (like a c-section scar) and I've just taken off my bandage. I feel extremely bloated around my middle still and it's quite numb around the scar, which I think is pretty normal. I'm drinking lots of peppermint tea, 8 liters of water a day and moving every 30mins but if anyone else has any other tips on how to cure this, I'm all ears! I sleep for about 2-3hrs a day still but will be going for a little walk down the road tomorrow to see how much I can cope with.

I'm signed off work for 8 weeks and whilst right now I don't think I'll need all that time, I am reminding myself that I'm only 7 days post-op. I'm seeing the consultant on the 3rd for a check up but I'm so glad I had it done and that I'm on the right side of it.

No idea when my periods will come back and my natural cycles can reestablish themselves. Hoping it will be soon!

Glad your feeling well jgatz54 I hope your little walk was good. I was signed off for 4 weeks and told to come back if I thought I needed more time. One thing I don't like is my scare. Due to the size and the fact that they did't shrink even with the injections the cut was quite big. Now nearly 2 weeks post op getting around well still sore in certain parts. If my cycle has gone back to normal i should becoming on this week. I am dreading it I hope it's not to painful.

Hi Ladies,

Jgatz, glad your op went well, you have described everything I went through aswell,the first few days are so difficult moving aren't they and you feel so relieved to be able to walk again lol. It's good you got physio advice, I didn't get any advice from the hospital and didn't do any pelvic exercises so should probably start doing them although I am now walking alot further. In regards to the bloating, my stomach is still very bloated which is rather depressing but hope it will improve. I read that you should massage the area around the scar between
6 -12 weeks to help the area heal and get move movement around the skin to prevent problems occurring in the future. You say you feel okay now, but I also felt quite good in the first few weeks but then around the 3rd week I took a bit of a dip. I know, now you go through lots of different stages and you will experience new and different pains so you need to take it slow and take time to recover. You will also find that your energy levels are quite low when you start doing more so you need to rest, it is major surgery.

Apple78- I am going back to work in a few days but on a phased return, I have still been very tired so need to ease myself back in to normality! Hope you have an appointment now.

Godmother 78- Hope you are recovering well. I know what you mean about the scar I find that because my stomach is still bloated I have a bit of an overhang if you get what I mean! I seemed to have gained a few pounds since surgery but I'm trying not to worry about how it all looks because I suppose takes a while to go back to normal. I am using Kelocote scar gel which is supposed to be good and massaging the area which helps.

It would be lovely to hear from you all ladies.

Hi Hopefulbunny I am doing the same massaging the area around the scar. I will look for the kelocote i just bought bio oil as I thought that would work when healed.

Hi ladies how are you all getting on?

Godmother78, I think they all do the same but I had heard positive stuff about kelocote. I'm not keen on massaging as I'm very squeamish but i want it to get better so I will persevere with it! How are you finding everything else with your recovery.

Hope you are all well.

Hi Hopefulbunny I am recovering well still getting tired quite quickly but am getting there. I should be back at work in the next 2 weeks.
Hope your recovery is going well.

Hi ladies

Hope you are all well. It's good to hear how you're getting on. How is it going back to work? I bet it's very tiring at first.

I got a letter through to see the consultant on the NHS but it isn't until November! I then got sent an appointment letter to see the other consultant so went back last week to discuss options. It seems there isn't much of a wait for surgery there compared to waiting six months for the other consultant. I could probably have it August/Sept but the consultant still wants me to consider embolisation in conjuction with the myomectomy due to the high risk of bleeding, so I'm waiting to see the consultant radiologist to discuss before confirming a date for my op. The Esmya doesn't seem to be shrinking the fibroid so far and I'm almost at the end of the first course. The consultant examined my tummy and said it's likely I'll need a vertical incision rather than a bikini line cut. I don't really mind from a cosmetic point of view, but it means the recovery period will be longer.

I should be able to see the consultant radiologist in the next six weeks and then make a decision on whether to have the embolisation the day before the surgery or not. I'm so confused as everything I've read says not to have embolisation if future fertility is desired but the consultant thinks that my fibroid is so large and the blood supply so complicated that embolisation would decrease the risk associated with a myomectomy for such a large fibroid. It's a difficult decision, but I'm hoping I'll feel better about making the choice after I've spoken to the radiologist.

Godmother - was embolisation ever mentioned to you due to the size of your largest fibroid?

Hope you are all doing ok.

Hi Apple78
Embolisation was not even mentioned as I was told myomectomy was the best option if I wanted a baby in the future. The injections that I had before my operation did nothing to be honest. I was supposed to have a c-section cut but as they did not shrink the cut was vertical right to the top of my belly button. The cut has nearly all healed apart from one little bit that is in a crease. I would honestly say look at all the literature about embolisation.

Hi ladies,

Hope you are all doing well.

So sorry I've been very quiet lately! I've felt I've not really had much to report, but I've still been keeping up to date with all of your progress. It's really helpful to hear about your experiences, especially as the surgery can seem so daunting.

Hopeful I'm so pleased you are recovering well and are able to head gently back into work soon. I know it's been a long journey, but it must be a good feeling to know it will soon be all behind you and you can focus on a fibroid-free future!

Hi GodMother and Jgatz! I hope your recoveries are still going well and that you start to feel more back to normal with each day. You ladies are all so brave! I really hope your quality of life is much improved now that you don't have fibroids to contend with.

Apple - that's good that you could be able to have the surgery as soon as August/September. Is the consultant who is recommending the embolisation the same person who was recommending surgery in the first instance? I remember you said she was a little pushy. I agree with GodMother that it would be wise to get all the facts and second opinions on whether embolisation is needed, especially as it's worrying you. It seems odd that it wasn't mentioned to GodMother considering her fibroid was around the same size and has been successfully removed. It also hasn't been mentioned to me and mine is around the same size as yours. All cases are different, but don't feel pressured into anything - you've got to be completely comfortable with everything, it's your body and your future.
I really hope you get some answers/guidance from the radiologist. Let us know how you get on.

I'm convinced my fibroid is growing, as my tummy seems constantly bloated now, so I'm going back to the GP next week and to see my consultant again. I am also starting reflexology with a lady who specialises in working with ladies who have problems such as fibroids, endo etc. She seems to really know her stuff and has got some great results for people. I'm not daft and I know it's not going to make it disappear, but I'm really interested to try it and see if it helps in any way. I'll keep you posted!

Take care everyone.

Hi Bacon17 I always say trust your body I always new when mine were growing and every time I had a scan it showed it had indeed grown.
I hope you get it sorted soon.

Hi Bacon. It's good to hear from you.

I haven't had my appointment with the radiologist yet but have an ultrasound next week to check on the fibroid. I have finished the first three months of Esmya and am now on the month off. Coming off it has made me realise how uncomfortable I am with the fibroid. Whilst on the Esmya my tummy was still massive but I had no pain, no bloated feeling, no heaviness. The past couple of days I feel like I'm carrying a sack of potatoes around in my stomach and have back ache and hip pain! Two people have asked me in the past couple of weeks whether I'm pregnant. Not good!

Can't wait to get back on the Esmya whilst I make the decision on whether to have the embolisation or not. I have done some research and found some trials where they did embolisation prior to surgery and the women in the group who had the embolisation had a shorter op time, less bleeding and faster recovery. The trials were only in very small groups of women though. Yes Bacon, it was the same consultant as the other one has a ridiculously long NHS waiting list! I said I was worried about the embolisation causing permanent damage to the area, for example the ovary (as the blood supply feeds one of the ovaries and the fibroid), but the consultant said you can't do anything without a uterus but can still try to get pregnant with one ovary so I suppose she has a point!

I'll let you know what I decide after I've seen the radiologist. Let us know how you get on with the reflexology. What did the GP say about your fibroid?

Godmother - it's good to hear your cut has nearly all healed. How are you feeling in general?

Hopeful and jgatz - I hope you're both continuing to recover well.

Hi Ladies,

Bacon, nice to hear from you. Hope you see some improvements with reflexology let us know how you get on.

Godmother and Jgatz, hope you are recovering well have you had post op yet?

Hi Apple , that's frustrating that you are still waiting hopefully you will hear soon and get things sorted.

I've had my post op which was pretty useless really as i didn't get to see my surgeon and saw a lady who didn't seem to be able to get my medical reports up so couldn't give me any meaning advise on the queries I had. I'm still getting some pains post surgery so have been referred for another scan to see whats it is. I will then have another follow up app hopefully with my surgeon!

I'm ready to start ttcing now so will see what happens!

Hi ladies

How is everyone getting on?

I went to see the consultant radiologist to discuss embolisation prior to surgery and I was glad I went. For an NHS appointment I had plenty of time (was in there almost an hour!) and had plenty of opportunity to ask questions and discuss my concerns. The consultant examined me and thinks my fibroid has grown since the MRI scan (March). I can tell myself it has as I feel very big and bloated. Anyway, after much discussion and going over the pros and cons, I have decided I will have embolisation the day before the surgery. The consultant said that because they know I'll be having the surgery the next day to remove the fibroid, they won't try to kill if off completely with the embolisation, but will just do enough to reduce the blood flow to make the surgery less risky. Also, because they know I want to be able to get pregnant they will keep away from the ovarian artery and may use some sort of clips or something to stop 'backflow' of particles so they don't go where they shouldn't.

So, now I've decided on the course of action I'm just waiting for a date! I'll be going into hospital to have the embolisation with a local anesthetic and then staying in hospital overnight ready for the surgery the next day. I've been told it's likely the hospital stay will be around five nights and the recovery period 8-12 weeks.

The consultant said I'll have the op(s) this side of Christmas but couldn't tell me when. Now I've made my decision I just want it over with so hope the wait isn't too much longer!

Bacon - it does seem the advice on fibroids does seem to vary a lot and I was originally keen to leave mine and TTC, but it's now reached the point where I'm really self-conscious about it and feel very uncomfortable so something has to be done. In a way I wish I'd just opted for the surgery at the beginning as it would have been easier when the fibroid was smaller but I was hopeful that it wouldn't interfere with TTC and didn't expect it to get so massive!! I think it's worse because I'm petite and so it's very obvious and probably does take up a lot more space in my body than it would in a larger lady.

Hope you are all well. x

Hi Ladies,

I've been meaning to post for a while, how are you all?

Apple, have you got your date for your op yet? I definitely agree that the recovery can be up to 12 weeks it certainly was for me. You make very quick progress straight after the op but then you go onto further stages of the recovery if that makes sense. You can easily think you have fully recovered sooner but you will find that you feel quite tired so it really is best to rest as much as you can.

Nothing new for me other than I have another post op follow up which I will discuss my high prolactin. I've had a scan and all seemed really good , with no new fibroids! I've also had day 3 and 21 bloods done and it shows I'm ovulating so very pleased about that. My iron levels seem to have returned to normal now so the op obviously resolved that problem.

Hope you are all well would be lovely to hear how you are all getting on.

Hi Hopefulbunny. It's lovely to hear from you and I'm glad you're doing well and fibroid free! It must feel great!

I finally have a date for my op (embolisation plus open myomectomy). Going in at the end of this month. I can't wait as it feels like it's been such a long journey and I just want to get it over with now and move on.

Do you know if they normally do a scan post-op or was yours only because you were still getting some pain? It seems like a good idea to have one to check everything looks ok, but from what I can gather I don't think they usually do it.

I am feeling a bit nervous about going in hospital, but the overriding feeling is relief that I've made a decision and am getting the op over and done with! I can't wait not to look pregnant anymore. I've made a checklist (it's like going on holiday!) and feel quite prepared. I've told work to expect not to see me for 8-12 weeks but I really don't know what to expect pain wise afterwards. The surgeon won't know until they open me up whether an incision into the uterus is needed. I hope not, as it will make healing easier. They still think a vertical scar is likely too, but can't say for sure until the day either as the surgeon will have a good feel of the fibroid once I'm under the anesthetic.

I really hope we don't have to wait 12 months afterwards to TTC but that's what the surgeon has said. I read a study online that was carried out in Japan where they said the results showed that the uterus was fully healed three months after a myomectomy. I suppose it depends on the individual and what was actually involved in the surgery. Fingers crossed I will heal quickly but if they don't do a scan or anything post op then I don't know if they will actually know when I have healed.

Hope everyone else is well. x

Hi Apple,

I'm glad you have date for your op you may have had it already by now?
I hope it all goes well for you.

I had a scan because I was getting pains following the surgery so they requested one to check all was okay and the lady said it all looked very healthy! so I had another follow up recently and because of my high prolactin the consultant said they need to check macroprolactin levels ( these don't matter apparently but they have to work it out separately to see if still high) and if the prolactin is still high I would need referral to endocrinologist to have and might have to go on medication to reduce levels because it can impact on fertility. So I'm still waiting for the blood test results to see if I will need a referral. In the mean while AF was almost 3 days late ( have been 27 days recently to the book! ) so thought I would test because i got my self worried I was going through the menopause and would you believe it I got a bfp!!!!!

Very early days so taking things slow but very much in shock.

Would be lovely to hear from you all hope you are all well.