Happy News Bear.

Sometimes being a family doctor is amazing. It is a great privilege to care for an individual or an entire family. One of the best parts of my job is delivering good news.

The other day a young woman came to my office. I hadn’t seen her in quite some time. A lot had changed in her life. She’s gotten married last year,l and they bought a house. She is a busy woman, working long hours which was one of the reasons she has come to see me.

She was tired. More tired than she had ever been before. We talked for a bit, then I asked her a few questions. Some of my followers who are physicians will likely already guess the diagnosis.

My first question was about her period. I asked her when her last menstrual cycle was. Her face went blank.

“Um … I … maybe … oh, geez, I have no idea.”

“Have you been using contraception?” I ask.

“Not really, no.”

“Well, let’s do a pregnancy test. And while you are in the bathroom, think back and see if you can remember when that last period was.” Is she a few weeks pregnant, or a few months?!

Upon her return from the bathroom, she reports that she thinks her last period was in February.  (As an aside, how did three months go by and she didn’t notice she wasn’t getting her monthly cycle??!).

Of course, her pregnancy test was positive.

I suspected she was probably close to 11 to 12 weeks pregnant.  She is a fairly thin woman and upon further questioning, she admitted noticing that her clothes were fitting a bit tighter.  Uh huh.  I had her lie down on my exam room table and took out the doppler.  It took a few minutes, but there it was.  The sound of very fast hoofs.  A gentle gallop, about double the patient’s heart beat.  The distinct sound of a new life growing.

“Do you hear that?”  I asked her.

Her face told me she did.  Tears welled up in her eyes.  “Is that… is that a baby?”

“It is indeed,” I said.  “If I had to guess, I’d say you were about 3 months pregnant, and probably due around the end of November, maybe early December.”

“Wow.”

She left my office stunned, but happy.  Suddenly it all made sense to her, why she was so tired, why she was gaining weight.

It never ceases to amaze me how some patients can get so wrapped up in their lives that they miss something so obvious when it comes to their health.  In this instance it was good news.  The best news, really.

On this Mother’s Day, I am reminded how lucky I am to love my job.

A Birth Story – Part Two.

Okay, so where was I?

Right  – husband brought the kids to the hospital, they met their new little brother, my parents arrived and the entire family met the new little man.  Then, my nurse came in to check on me and ushered everyone out of recovery.  This is when it got interesting.

In every patient post-delivery, it is common practice for the nursing staff to check the woman’s bleeding and status of the uterus – firm or boggy.  The nurse checking me said I was “oozing”.  The next thing I know, my OB is at my bedside ordering IM (intramuscular) Ergot, PR (per-rectal) misoprostol and IV (intravenous) oxytocin.  Then my OB starts massaging my uterus, and not in that “ah, what a nice massage” kind of way, she is pushing down on my uterus with such force that I cried out in pain.  Remember, this is only 1 hour post-operatively and I was still pretty much frozen from the upper abdomen down to my legs from the spinal anesthetic.  Frozen yes, but oh my, I could feel that “massage”.  It was awful.  No one said anything, but it was obvious to me that I had just had a postpartum hemorrhage.  Caught very early, mind you, but a hemorrhage nonetheless. Thankfully, no one in the family knew what was going on as my husband had taken the baby to the waiting room while the nurses worked on me.

Eventually it was time to head up to the postpartum/maternity ward.  I had requested a private room and got one, thankfully.  Once I was settled, it was almost 6pm, maybe a bit later, and the kids were getting super antsy, so husband took them home. My brother stayed behind to visit for while and bonded with his new nephew.  About an hour later, my best friend came and spent a few hours with me and new baby which was so nice.  Although I was pretty tired, I was still bedridden and admittedly a bit lonely after everyone left, so it was so nice to have her there.

That first night was pretty good.  Baby latched, nursed on an off most of the night, and the post-op pain was relatively well controlled until about 4am when I started noticing I was passing gas and the pain started.  I asked for pain relief and was given SC (subcutaneous) morphine which helped.  A few hours later, the nurse had me getting up to the bathroom, she removed the catheter and I was encouraged to start walking around as much as I could.  The OB resident came in to see me and dropped the not-so-subtle hint that I might be released the next day.  Only 48 hours post-op?  Seemed a bit soon to me, but apparently the “rules” had changed since having my son 2.5 years ago.  It used to be women were discharged 72 hours after c-section.  Now it’s 48 hours.  Too soon, in my books.  Too soon.

Later that day, another girlfriend came to visit.  She is due in a few weeks with her first child.  It was lovely to have her come visit.  She brought me an ice-cold lemonade and some aromatherapy for my sore neck.  But by the end of that visit,  I was noticing some new pain starting.  Under my rib cage, on the right side.  Kind of like a muscle spasm.  After she left,  I asked for some pain medication.  For some reason, I wasn’t allowed to have any SC morphine, so instead I was given 2 mg of hydromorphone. It did nothing.

Around 10pm, the pain was escalating and I was starting to get really emotional about it.  It hurt to take a deep breath, and of course, crying didn’t make it any better.  It was probably the worse “stitch” I ever had – you know, those pains in the chest wall you can get when you run too fast?  Well, now that I think about it, it’s exactly what it felt like but 100 times worse.  I called my husband and cried on the phone to him.  I hadn’t slept all day, baby was cluster feeding that night since about 7pm and I was exhausted.  When I was on the phone with him, my nurse came in and saw me crying.  I hung up the phone and just let it all out with the nurse.  She said she would page the OB resident on call and see about getting me more pain meds.  About 20-30 minutes later, the nurse returned and told me that the OB was too busy to come see me, but had ordered 10 mg of oxycodone.

The last thing I remember was texting my husband an hour later, telling him that I could feel the meds working and the pain was better.  Then, nothing.  I woke up at 4am with the baby on my chest, asleep.  I have to admit something here, I felt good!  Not just pain-free good, but “I’m kind of high – good”.  Wow.  Suddenly I understood how easy it can be for some patients to get addicted to Oxycodone.  It’s a very dangerous narcotic, one not to be taken lightly – pardon the pun.

That morning, the OB resident came in and told me I could be released that day.  I explained my pain from the previous night and that I was not comfortable leaving.  My concerns were heard and I stayed an extra day/night.  The rest of the recovery went pretty smoothly.  That horrendous muscle spasm pain never returned, and I later discovered from my med school colleague (and good friend) that the manipulation of my fallopian tubes likely caused the pain – referred pain to the diaphragm.   It was great just to have an explanation for it.  It was awful pain and at that moment the physician in me took a backseat and I was just a patient.  In retrospect, I’m not sure knowing the origin of the pain would have helped at all at the time.  I am just glad that it was short-lived.

I was released on the third post-operative day (72 hours after delivery).  The kids hadn’t seen me or the baby in two days so our reunion was wonderful.  In the last 2.5 weeks, life has slowly returned to our new normal.  Husband gets the kids ready for school in the morning.  The baby and I are camped out in the basement as he sleeps on my chest at nighttime still.  It’s the only way both of us get any sleep.  Eventually, I will move him to the bassinet, but likely not for a few more weeks.

The decision to have a third child was a difficult one.  We went back and forth for almost 6 months.  Despite the sleep deprivation and the generally chaotic nature of our life right now, I cannot imagine not having had my new son.  I can’t put it into words, but I truly feel complete now that I have had him.  My family of four was perfect – but my family of five is so much more.  I can’t wait to see who this new little person is and how he’ll fit into our lives.

Thank you for reading.

A Birth Story – Part One.

I’ve never written a birth story for any of my kids.  I generally have a great memory for important events in my life, and it never ceases to amaze my husband how I can remember tiny little details from an event 10 years ago.  The births of my children, despite all being surgical, were all different in subtle ways.  As this was/is my last child, I feel the need to document it and what better way than on my own blog.

So, here goes.

Monday, September 16, 2013 – 39w3d gestational age.  I was booked for a repeat, elective, c-section at 1:45pm.  That morning, I woke up at 4 am, very hungry, and couldn’t fall back asleep.  So, I got up and had a little snack.  Now, I know you’re not supposed to have anything to eat after midnight before any surgical procedure, but my OB told me I could eat something very early and continue to drink clear fluids up until 3 hours prior to surgery.  New rules, apparently.   Thank goodness.  How is it fair to keep a term-pregnant woman NPO for hours on end?!

I ate a piece of toast with peanut butter and honey, and a huge glass of milk.  I went back to bed  and slept another hour or two before my eldest woke up at 7am.  We kept her home from school that day.  Husband woke up with the kids and got them breakfast while I stayed in bed until about 9am.  I was surprised to feel a little bit nervous.  In fact, my “nervous tummy” started acting up, something I hadn’t experienced since finding out I was pregnant back in January. My parents arrived around 10am and we enjoyed the morning watching the kids run around, excited to be home.  The eldest knew I was going to the hospital, the younger one I’m not sure understood really what was happening, but I could sense that he knew something was about to change.

Husband put the youngest to nap while I got my bags ready for the car.  Eldest was very clingy and wanted to come to the hospital but we explained that she would have to come later on after baby was born.  We said goodbye, took a final photo of my pregnant belly and left for the hospital.

Upon arrival at L+D and Admitting, it felt like I was checking into a hotel.  I don’t have third-party insurance, so I paid for a private room and thankfully there was one available.  Our hospital just underwent a large renovation and built two new floors for L+D and postpartum with a lot of private rooms.  A nurse led us to an L+D room where I put on a gown, had an IV started, met with the Anesthetist, and had the cord-blood package prepared.  Another Anesthetist came in to talk to me about participating in a study.  It was a randomized controlled study of ultrasound vs no ultrasound prior to spinal anesthesia.  Apparently, the hypothesis is that ultrasound-guided spinal anesthesia is better than manual palpation for placement of spinal anesthesia.  I agreed to participate mostly because I remembered with my second c-section that the Anesthetist had to poke me a few extra times before he got the needle in the right spot. The next day, I would have an ultrasound of my back to look at the site and confirm how many “attempts” were needed to initiate the anesthesia.  I presume they would then compare whether I had the ultrasound or not in the operating room and how many attempts were needed.  I am always happy to participate in research studies, it’s important to the advancement of medicine and really, it’s not onerous as I’m already there and need the procedure anyway.

About an hour later, we were told it was time to head to the operating room, a bit earlier than expected, but I was glad not to have been bumped by an emergency as I was starting to feel a bit hungry and light-headed. Husband put on hospital scrubs over his street clothes and away we went.  While I got prepped in the OR, husband had to wait in the surgical waiting room.  The nurses told him it’d be about 15-20 minutes.  It was a little longer than that.  Inside the OR, I got up on the table and assumed the position on the table for the spinal – sitting with a pillow across my hugely pregnant abdomen, head flexed, chin tucked in, shoulders relaxed and lower back pushing out as much as I could to open up the vertebral space.  The Anesthetist palpated my hips and chose the L3-L4 vertebral space, from what I could tell.

The distinct burning sensation of the topical was next.   I was told repeatedly it would hurt, but really, it was nothing.  What hurt was staying  in that position.  I was randomized NOT to receive an ultrasound-guided spinal.  Instead, I got one the old-fashioned way, and it took about 20 minutes.  Not kidding. Twenty minutes in that position and I could feel my neck stiffening up.  I counted five attempts at getting into the spinal fluid space.  FIVE.  Finally, I could feel the final attempt was different and there was a sudden warm feeling down my bum and my legs started getting numb.  As I was being positioned onto the table, I suddenly knew my blood pressure was bottoming out.  I got nauseated, sweaty, clammy and hot.  I told the Anesthetist and she said she was “taking care of it”.  Ugh, what an incredibly nasty feeling, seriously.  Thankfully it passed quickly.   Later on, I asked her what she had given me and how low my pressure was.  She gave me phenylephrine as my blood pressure bottomed out at 80/37 (“normal” is 120/80).  No wonder I felt like crap.

Eventually once the OR staff had my abdomen prepped and draped, they brought in my husband.  I could tell he had been at bit concerned as it was well over half an hour since I’d seen him. I told him about the numerous attempts at the spinal and how my blood pressure had dropped. In retrospect, poor guy probably didn’t need to know that. My OB had already started the c-section and commented on how “lovely” my tissues were.  I replied, “I bet you say that to all your patients.” The OR staff laughed.  Apparently not.  I remember telling her it was probably all that running I had done prior to the pregnancy and then asked when I could resume running again.  “Six weeks,” she replied.  Yay!! That means by Halloween, if all goes well, I’ll be going out for my first run.  I can’t wait!

Suddenly, I heard my OB say, “Dad, are you ready?”  Husband stood up with the digital camera and his iPhone and started taking pictures.  I didn’t know it at the time, but the iPhone was set to video and he recorded the birth!!!  I could hear everyone saying, “Baby is so cute!”  Husband said, “It’s a …. baby!!!”  Apparently only the baby’s head was out at this point.  I could hear the first cries, and then felt this incredible pressure under my rib cage as the OB pushed down on the uterus to deliver the rest of the body.  That’s when husband said, “It’s …. a BOY!!!”

And, just like that, my family of 4 became 5 and I had a brand new son.

At this point in the story, I have a confession to make.  I knew all along I was having another boy. At the anatomy ultrasound, I asked the tech to write the sex of the baby on a piece of paper and seal it in an envelope. I never told anyone, not even my husband, that I opened the envelope a few weeks later, around Mother’s Day. I knew this was going to be my last pregnancy.  I didn’t know the sex of either my daughter or my son, (and I loved not knowing), but I knew I wanted this pregnancy to be different. I wanted to know what it was like to know the sex while baby was still in utero.  Husband was clear that he wanted to be surprised.  I had to respect his wishes, so I never told him that I opened he envelope. To this day, I am so proud of myself for keeping it a secret, not only from him but also from everyone. It was the easiest secret I have ever kept.  I told husband a few minutes after the delivery when baby boy was on my chest for some skin-to-skin time. I worried he might be upset with me, but he wasn’t. I think he was more shocked that I was able to keep a secret. He asked me if I regretted it, not having the surprise at delivery.  Without a moment’s hesitation, I was happy to say no, I had no regrets. I wanted to know for this final pregnancy and I was absolutely happy with the decision to open the envelope.

By this time, the OB was working her magic on my reproductive organs, and the Respiratory Therapist took my son from my chest to check him.  He was a bit mucusy, so she suctioned him but he received perfect Apgar of 9 and 9.  While he was at the warmer, I suddenly felt very strange again.  The nausea came back, the sweats and heat and this incredible pressure on my chest.  The physician in me considered the possibility that I was having an amniotic fluid embolism, and of course that only made me feel worse.  I told the Anesthetist and she reported to me that my blood pressure was totally fine but she said she’d give me some more phenylephrine.  Within a few minutes, I was feeling better.  I suspected I was about to have another vagal episode as the surgeons manipulated my fallopian tubes.  (I told you this would be my last pregnancy!)

Finally, surgery was complete and I was moved to recovery. Once I was settled, husband left to get the kids and my parents. I had some time alone with my brand new son. The recovery room nurses were checking me quite regularly, all seemed to be fine, I put baby on the breast and he started nursing immediately.  That familiar tingling of the nipple sent shivers down my spine. The latch wasn’t quite right but baby was swallowing, so he was definitely getting the colostrum. After two separate 25-35 minute feeds, my husband’s parents arrived and met their newest grandson. Husband returned with the kids and they came running into the recovery room.  The looks of expectation and excitement on their little faces was absolutely priceless. He didn’t tell them they had a new baby brother – he waited for them to see the colour of the blanket. Daughter looked a teensy bit disappointed that he was a boy.  Her daddy told her that new baby looked a lot like her (he does, its uncanny), so she assumed that meant it was a girl.  Son was just thrilled, boy or girl, he didn’t seem to care. Up until that moment, I wasn’t sure how much he understood what was going on with my growing belly, but I have no doubt now that when he saw that little baby, he knew he was a big brother and that this was his baby brother.  His face completely lit up.  It’s a sight I will not soon forget. 

To be continued … but first, a photo or two.

Introducing the young man to Mr Mulder
Introducing the young man to Mr Mulder

 

The little man at 6 days old

The little man at 6 days old

 

Are you ever ready?

This is the last Sunday that I will have two children. Tomorrow is my booked c-section and the birth of my 3rd, and final, child.

Where did the last 9 months go?  It literally feels like yesterday that I discovered I was pregnant.  I thought I had all the time in the world to prepare for this surprise blessing.  Suddenly, it’s tomorrow.

I am excited to meet this new little person who has been growing inside me all these months.  I wonder what he/she will look like – will my Mediterranean European genes finally overtake my husband’s Scottish/Finnish heritage?  Or will I have another blond hair/blue-green eyed child?  In any event,  I think this child will be the strongest willed of them all.  If the kicks and punches I’ve been getting the last week or so are any indication,  this one is going to be feisty!

Speaking of feisty, last night I was watching Star Trek: Into Darkness, and the little one was having a ball inside my uterus.  I took a video and husband joked that it looked like that scene in Alien when Ripley dreams she’s got one inside her stomach.  You know the scene, right? Chest burst.

And just for fun – here’s a clip of what it looked like for real, last night.  (I apologize in advance if this grosses anyone out! You’ve been warned!)

Cheers, everyone.  The next time I write, I will be the Urban Doctor Mom of Three!

 

The Home Stretch.

My apologies to my followers for my lack of blogging this past month.  Between vacation, cottaging and getting back to work, it has been very busy.

My practice was well-covered during my two weeks of vacation but it feels like everyone waited for me to come back. The last two weeks have been solidly booked!!!  Most patients have admitted that they wanted to get fit in before I left on maternity leave.  (It’s not for another month, folks!  Calm down!!)  But I understand their concerns.  They don’t know that the doctor who is going to cover for me is an excellent physician.  The few folks who have met her have already told me how much they liked her.  I know they will be in good hands.  Still, I am trying to accommodate everyone before I leave, hence why it’s been so busy.

Yet, this week, strangely enough, is quite dead at the office. So strange.  I’m not complaining!  I have a lot to prepare for before my leave starts next month.  My office needs a major clean-out and  I have to prepare of list of patients for my locum to watch out for.   There are a few folks I’m worried about, medically speaking, and a few patients whom I fear may give my locum a hard time.  In previous leaves, everyone has been well-behaved, so I’m sure I’m fretting for nothing.

I haven’t quite reached the point where I’m “done” yet.  I think I still have a few more weeks left in me, but there comes a time when I just don’t want to be at work anymore.  Mentally, I get to a point where I am just spent.

The last few weeks of pregnancy are bittersweet, and I suspect it will be more so for me this time around.  This will be my last pregnancy.  I am determined to enjoy every last-minute.  It’s hard though.  I feel huge, I’m uncomfortable all.the.time, and my thighs are rubbing together.  I am so eager to start running again that I’ve already started asking my Obstetrician what the earliest is that I could do it.  As I am having a Caesarean section, I don’t expect to be able to run for at least 12 weeks, which frankly, is going to be really, really hard.  I remember how much better I felt when I was running and with the postpartum hormone crash, the weather getting colder, the days shorter, not to mention the inconsistent sleep, I am going to need to do something.  Running became my go-to girl for keeping myself sane.

So, the countdown begins.

 

Epic fatigue.

I am 29 weeks pregnant.  Hard to believe how fast this pregnancy is going.  Baby is very active and so far this pregnancy has been very similar to the other two, except for the occasional brutal bouts of heartburn.

But can I just complain for a moment?

I am tired.  Bone tired.  Despite at least 8 hours of solid, uninterrupted sleep (except when I have to change sides w/ my body pillow), I am exhausted by 11am.  Like, I could fall asleep at my desk between seeing patients exhausted.  This makes me nervous because it’s just the beginning of the 3rd trimester – there is still a lot of time left and if I’m already this tired?  I don’t even want to think about it.

I am so tired that I can’t even work on my cross-stitching in the evenings.  After dinner, I recline on the couch, my cat comes for snuggles and an hour or two later I’m dozing and ready for bed.

Did I mention that the occasional nap doesn’t help either?  Oy.

I walk as much as I can, for as long as I can.  Inevitably, the lower back stiffness kicks in and I have to stop, or it’s a particularly hot and humid day and I just can’t physically muster the energy to keep going.  I miss running.  Oh, how I miss running.  Part of me wishes I hadn’t stopped but I had to listen to my body and at the time, during the peak of the fatigue of the first trimester, I just couldn’t.

Have I mentioned it’s taken me 5 days to write this post?!

No real point to this post.  Just needed to vent.

And … now I need another nap.

The heart, it burns!

Gastroparesis, in a nutshell, is delayed stomach emptying.  There are a lot of causes, most notably diabetes, post-surgical and idiopathic.  There is another cause – pregnancy.

Lucky for me, I got to experience this first hand last week.

After my breakfast one morning, I started getting a burning sensation in my upper chest, dead center. To say it was awful would be an understatement.  My husband and I had just taken our daughter to school and he was taking me to work.  Sitting in the car, I felt like everything I’d eaten that morning was stuck in my esophagus and the burning sensation I experienced felt like acid was eating away a hole in my esophagus.  I felt like I needed to burp but couldn’t.  I drank some water but it only made it worse.  I told my husband to stop the car, that I had to walk the rest of the way (about 5 blocks) to the office.  Gravity had to help, right?

It was the longest walk of my life.  I kid you not. Brutal, absolutely brutal.  I can’t even describe it.  The burn, oh the burn, was so awful, I felt like throwing up but couldn’t.  I made it to the office, took a Gavsicon and my secretary went out to get me some milk.  The Gaviscon didn’t work but the milk did help.  Eventually, the symptoms subsided and I was able to get on with the day but it was the longest day of my life.  I could barely eat my lunch, it felt like nothing was moving down my esophagus.  I picked up an antacid at the pharmacy on the way home and started that.  After a few days the burning went away and that feeling of food staying in my esophagus eventually settled down.  Every now and then it creeps back up, literally.

I’ve had many pregnant patients coming to see me for heartburn relief.  I had no idea how bad it really can get.  I was lucky with the other two pregnancies – never a sign of heartburn. Of course, third time couldn’t be the charm, right?!   Ugh.  I have 2.5 months left to go, and the thought of dealing with this all summer is something I’d rather not deal with, but I suppose beggars can’t be choosers.  If there’s a silver lining,  I just did my sugar test and I passed, thank goodness! I know I really ought not to complain – heartburn and mild gastroparesis are nothing compared to what could go wrong in pregnancy.  I am fortunate to have had otherwise totally healthy and normal pregnancies to date.  I suppose this really is just par for the course.  I got off lucky the other two pregnancies, I know that.

Still, I get to complain, a little bit. I am, after all, nurturing and housing a brand new human being! 😉  I call it my Superpower.

Half way!

I haven’t posted a lot about this pregnancy, but as I have come to the half-way mark (20 weeks), I felt the need to.

Wow, 20 weeks.  This child is coming!  I can’t believe how fast the time is going.  Just yesterday, it seems, I discovered I was pregnant and the panic set in.  Now, this little one is just four and a half months away from making his/her entrance.

I hope he/she is ready!

Older brother and sister are forces to be reckoned with.  This little one is going to have to adapt, and adapt quickly!  Husband jokes that this one is going to be a lot like Maggie Simpson.  Keeps her mouth shut, but knows everything!

Last week we had our anatomy ultrasound and thankfully, together with the genetic screening, little one appears healthy.  Gender was even revealed to the technician (but not to us!).   Husband doesn’t want to know.  I would have found out had he said he did too.  As this is the LAST baby I am going to have (yes, I do mean LAST!!), I figured why mess with the status quo?  We didn’t find out for the last two pregnancies, so we won’t for this one.  (But, I did ask the tech to write the gender on a piece of paper and seal it in an envelope.)  I haven’t opened the envelope.  I suppose I wanted the option of finding out if I changed my mind.  I still haven’t decided if I’m going to.  I really did enjoy the surprise at delivery and I’m not sure I want to give that up, again, as this is the LAST pregnancy I intend on having.

So, I have no idea who is growing inside me.  Some days I am thinking it’s a girl, other days I’m sure it’s a boy.  It really doesn’t matter.  I just can’t wait to meet him/her.

Confessions.

So, I’ve had this secret for the past few months.  It’s been hard not to write about it, which is one of the reasons my blog has been quiet lately.  The more I wanted to spill my secret, the further I stayed away.

But it’s time now, I think.

Back in January, I got quite the surprise with a positive pregnancy test.

Yes, that’s right.

I’m pregnant again!!!

Eeek!!!!  Number 3 is on the way!!!  I was initially terrified and anxious and a doubting Thomas.  This wasn’t exactly planned, but I also knew deep down that I wasn’t quite done with two children.  I wanted one more pregnancy, one more child.   I would look at my son, the baby, and think that he should be a big brother.  So, if all goes well, come mid-September, he will be.

For the most part, my first trimester was very similar to my other two pregnancies – extreme fatigue and vague nausea.  Though, I have to admit, the vague nausea was much more pronounced this time.  For several weeks I have to say, I felt gross.  Nothing would settle my stomach except, perhaps, the concoctions of fruit juice, club soda and bitters my husband would make for me in the evenings.

The other thing that was new was this running thing I’d been doing.  You may recall that I was close to reaching my goal of running 10 km.  Sadly, that’s not going to happen anytime soon.  I tried a few runs during those first few weeks, but just couldn’t get past 2-3 km without shin splints, breathlessness and sheer exhaustion.  Clearly, my body was trying to tell me something.   There was pretty much zero exercise with the first two pregnancies – not exactly healthy, I know – but that’s just the way it was.  I walked a lot, yes, but that was the extent of my exercise.  My pregnant body liked sitting on the couch, cross-stitching.

So, there you have it. My confessions.

I’m pregnant again.

I’m not running.

And I’m spending the next 6 months, on my butt, on the couch, cross stitching…. with some walking here and there.

😉

When the Alternative Approach Conflicts with Western Medicine.

I had one of those encounters a few days ago that left me angry and irritated.  Angry because I can’t understand how a woman, in her mid- 40s and pregnant (first trimester), can walk around comfortably knowing her blood pressure is high, yet refuses treatment.  Irritated, because she will be coming back in a week or so to check her blood pressure again, and it’s going to remain high and I will have the same conversation with her and she’ll refuse treatment.  She intends to treat her blood pressure the “natural” way – acupuncture, massage therapy, herbal teas, naturopathy and Reiki.

Uh huh.

Did I mention she has 4 other children at home?

Her blood pressure wasn’t just a little elevated, it was 150/100.  Two years ago, her blood pressure was 140/80.  She likely had some early essential hypertension then.  Now, being pregnant, not only does she have untreated essential, chronic hypertension, she is also hugely at risk for developing preeclampsia.  I explained this to her. I told her all the risks to her own health (seizure, stroke, death), as well as to the baby she is carrying (spontaneous abortion, intrauterine fetal growth restriction, intrauterine fetal demise, stillbirth).  She still refused treatment.

I have several patients in my practice who want to have a family doctor but don’t actually prescribe to a lot of Western medicine.  These patient will see their naturopath, osteopath, chiropractor and acupuncturist first.  Sometimes they come to see me when those approaches aren’t working.  Some patients accept that those approaches didn’t help and come to me seeking the “Western” approach, which more times that not, relieves their problem.

A lot of these patients actually “interview” me at their first visit and ask me how I feel about these approaches. My answer is generally pretty straight forward. I don’t really have a problem when patients seek the alternative/complementary approach.  It is their money to spend.  Sometimes a chiropractor can be quite helpful for mechanical back pain.  I would know as I saw one in my 20s and it helped immensely.  But sometimes these approaches don’t work.  I saw an acupuncturist for my migraine headaches.  Countless needles in my skull and a few hundred dollars later, and my headaches were unchanged.  What worked were the triptan drugs, thank you very much.

When alternative medicine becomes an issue with me is when the patient with a blood pressure of 180/110, and now complaining of headaches, repeatedly comes to the office to check how the alternative approach is working (it isn’t), then refuses to take my advice on treatment.   When confronted with this, the patient responds with, “Okay, I’ll go back to Dr. So-and-So ND, and change the herbs. Thank you.”  Uh huh.   My job is, according to the patient, apparently done.  This is when it gets tricky.  How many times can I see this patient with dangerously high blood pressure before he strokes out?  My job is to make sure he doesn’t. Yet, after explaining the risks to him, he still refuses the anti-hypertensive medication that has proven to work.  So, I have to ask him why he continues to return to my office for visits?  Clearly we are at a stalemate.  And this is when I go back to the rest of the answer to that question he asked me two years ago.  “Remember the conversation we had when we first met?” I ask him.  He looks at me, puzzled.  After a moment, he understands.  This is when I say,  “It’s time to re-evaluate our doctor-patient relationship.  I am afraid I can no longer, in good conscience, continue to be your physician if you repeatedly refuse treatment for your hypertension.  You are at great risk of having a stroke.  By continuing to be your physician when you refuse to treat your hypertension, I am violating my Hippocratic Oath.”

I fear this may be how my relationship with the pregnant woman will end.  She will return to my office in a week or two to check her blood pressure.  I expect it will continue to be elevated.  And I suspect she will continue to refuse Western medical treatment.  Not only is she risking her own life, now she is risking the life of her unborn child, not to mention risking the well-being of her four other children at home who need their mother.

How, in good conscience, can I continue to be her physician?