10 types of sex after kids (and infertility)

Note: this post is irreverent and probably unprofessional. It happens. It's a blog. Also NSFW.

[Here's where I demonstrate my inability to use blogger and insert a jump cut by putting in a picture of a pot after I burned the water in it off... whoops...]

One of the blogs I love is Michelle over at Early Mama.  As an odd duck being young-ish and infertile, it's a nice place to not feel like such a mutant parent for a different set of reasons than the infertility set.  I also really like the perspective that you don't have to cancel your whole life to be a parent, or that you have to have your whole life laid out perfectly before you have children, since I hear both of those from my age peers (who either are now stay at home and happy moms who've lapped me more than once or have zero children because "it's not time yet").

Yesterday she posted a really awesome response to a HuffPo article about 15 types of sex you have in your 20s titled 15 types of sex after kids.  I laughed quite hard.  Then I thought... but there's sex after kids and infertility too!

Here's my short list, because I totally couldn't think of 15 (but I can tell you about at least that many ways to treat arthritis):

1. Newly (secondarily) infertile sex: a mix of grief and “now we can do whatever we want since we’ll never get pregnant on our own HAH! missionary position” sex

2. Striving for an additional child sex: probably more work than fun

3. Grief sex: BFN again and all you can do is cry on each other at first, and then hold each other, and then...

4. Scheduled sex: because you forgot for a few... you know... something about not sleeping with a baby/toddler/preschooler/kid around, and if it's on the calendar, we might remember it

5. Family fun night at the YMCA sex: while the kid(s) are away frolicking

6. Check out this sexy movie scene sex: inspiration, am I right?

7. Sick and sleepy kid sex: fewer interruptions, yes please

8. Interrupted sex: you have to go potty again? That's like 10 times tonight. Seriously.

9. Kick the cat sex: what was the cat doing on there anyway? Totally had it coming.
10. Wait... this is fun again sex: after nursing is over and touching is ok again, when there's no more treatments or My Fertility Friend apps or things to pee on

What did I miss?

Addictions

I will confess: I am an addict.  My current active addictions are vanilla coke and facebook.  I don't lightly toss around the label either.  One class had us give up something for 3 weeks and write about our experiences, and I went through serious facebook withdrawal.  It was awful and agonizing and when I got facebook back, I totally started using it twice as much as I had before WITHOUT MEANING TO (like I must check it about 3 times an hour, minimum).  It just happened... I didn't mean to type in facebook when I opened a new tab to... do something... what was I doing again?

I mention this because I am currently (at 5pm yesterday, since this will post early morning Thursday) sipping a very delicious vanilla coke.  I know I shouldn't.  I will doubly never sleep if I finish this thing.  My teeth are in bad shape and more coke will not help, but I had a headache...

Also because one of the topics that inevitably comes up, over and over again, in pharmacy school is the increasing prevalence of addiction to pain killers.  CNN has (what appears to be) a nice one-hour feature on the problem of accidental overdoses due to prescription drug use.  It will be rebroadcast this Saturday at 8 and 11pm eastern and pacific time in case you want to watch it.  Hint: it's a great idea to watch it and get a feel for what we all can do to help.

Did you know that the leading cause of accidental death in the US is prescription drug overdose ("accidental poisoning")?  That more people die of overdoses than in car accidents?  Did you know 80% of the world's narcotic painkillers get consumed in the US, even though we have 5% of the world's population?  Most people don't know that.  We should all know it. We all need to act to halt this epidemic.

I'm one of those future "attack counseling" pharmacists who will tell every patient getting a narcotic or sedative not to take it with alcohol because it can kill you.  I'll probably tell them every time, just for good measure, because sometimes people aren't listening the first time.  I know several people who have very nearly died mixing a glass of wine and some vicodin and maybe a Valium too.  It's not a game.  It is your life that hangs in the balance.

Misusing prescription pain medications is a really easy way to die.  Keeping extras around the house when you are feeling better is a great way to inspire the addicts in your life (read: any and everyone could be an addict, so don't assume you don't know one) to steal them and to give rebellious teens looking for a "safe" way to get high the chance to get addicted.  If your doctor writes you a prescription for more than you need of a narcotic painkiller, you can ask the pharmacy not to give you all of it.  I understand about pain, I really do.  Pain doesn't make you an addict, but so many addicts start out in pain and get way too many pills with little supervision, it's scary.

No, it is not OK to share your prescriptions ever with anyone else.  It's illegal, and you could be liable if you gave someone the drugs that killed them.  No, getting high or buzzed is not one bit safer if you take a prescription medication rather than one you bought off the street (and remind your children of this when they are 10 or 11 and getting high is still scary).  No, it is not safe to let people get a month's worth of heavy duty painkillers all at once but we do it anyway.  If you need them, yes, get a prescription AND then get some way to lock up those meds so they don't get stolen or "fall in the toilet" or whatever.  (aside: I'm amazed at the number of people who keep their medications above their toilet.  Don't do that please.)

Treatment works and it's worth seeking help early and often if someone in your life needs it.  10-15% of the population will be addicted to drugs or alcohol at some point in their lives.  We are all in this together and we need to keep an eye out for signs of addiction - doctor or pharmacy shopping, medications disappearing around someone (after they visit, for example), working all the time or suddenly changing behaviors (like being sick from work all the time).

My active addictions are pretty harmless, but not all addictions are.  It's a serious, progressive, fatal disease to be addicted to drugs or alcohol.  Let's all step up and do our part to make sure fewer people die of it.

Our infertile years

I really enjoyed Jules' news item post about this article titled Our Infertile Years that appeared at Salon last week (yep, I'm behind...).  It's a good view of what the inside of infertility looks like, something I don't think the general public has any sense of.

My experience is a bit different because of two things: first, we knew what was wrong and second, we had a small child to parent at the same time.

Secondary infertility sucks in all the ways that primary infertility does, with the added rub that you can never avoid babies/children.  It's impossible to avoid them because children, once you have them, hang out with other children.  As a parent you get relegated to the kids' section of events where you inevitably end up talking about the only thing you have in common with other parents... kids.

Our TTC history has these year-long gaps between miscarriages in which there was this constant struggle between being cautiously hopeful that I'd get pregnant and scared that if/when I did, it would end too soon again (and then it did, twice).  After the second miscarriage I went off the deep end for a few months.  There was a lot of anger at everyone and everything, me most of all.  When you combine that with a terribly 2 year old, it's extra hard in a uniquely unpleasant way.  Then there's the big change in my life, and maybe someday that will get written, but not now.

When the kid started preschool at age 3, we went to orientation.  There were about 15 kids in her class with the two teachers.  One set of twins, one pair of boys very close in age, and the rest single kids with siblings.  Most had a younger sibling, several exactly the age of the baby we didn't have.  At least by then I was sad and not so angry anymore.  Eventually it happened that one of the other kids needed a ride to preschool, and I volunteered because I knew I was the only person with only one kid.  One other mom had only the preschooler at home most of the time but she lived on the opposite end of town too.

As a couple, oh my was it an agonizing thing to go through.  Playing the blame game because it's a dual problem for us, emotions and hormones for me that often win and I get extra unreasonable. We stared down splitting up several times and at least once I arranged an elsewhere to depart to if I decided it was time.  I never felt very satisfied with a conversation we had about the whole thing, very rarely felt heard or understood at all.

The Salon article closes with the author talking about the first year with her twin boys: "In their first year, we learned how to parent our children - and not each other."  I think that the extra bonus unpleasantness of secondary infertility is this part - that you're trying to parent each other (unsuccessfully) while also parenting a small person who keeps changing and demanding new things and creatively evading all your strategies at managing behavior.

I have lots to say about all the "just be grateful you have one" commentary from some people.  First, the obvious response: "Of course I am.  Being grateful for what I have doesn't mean I don't want her to be a sister.  Being grateful doesn't limit me to wanting nothing more."  Furthermore, it's a special kind of torture to have people rub it in.  Yes, if there was no desire for more children, I'd probably spend more time enjoying the one I have.  Or maybe I'd play video games or take up skiing instead.  There's no way to examine my life without that desire for a bigger family.  It isn't me, and it will never be me.  Perhaps in time that desire would change if we knew no more was an option, but it would never be gone unless we added to our family somehow.

I don't really know how to handle the reality that just might be mine, where we have two actual children after so much waiting and worry.  If I get to pick family size, I'd really like 4 children, but I'm not deeply attached to all of them being biologically mine.  If the spouse gets to pick, it's two or maybe three, and again, not so committed to all being biologically ours.  It hurts just to think that the roller coaster of infertility may not be over, that we might decide to try for another child at some point (assuming this goes well).  It hurts to know that it will never be easy or simple or pain-free.  If we decide to adopt, then it's a whole new set of craziness and emotional ugh to go through.

In the end, I'm not sure that the infertile years ever go away.  They shape who we are and how we live and that's forever.  Esperanza has a great post about the early part of secondary infertility and how much going through it is awful (several actually, but this one is so much my experience, I'm linking to it).  Go read that if you haven't and remember those secretly (perhaps more likely to be secret than those primary infertiles, perhaps not) infertile folks around you who are struggling for just one more child.

"I don't know what you're going to do with a third of a pecan pie"

I'm feeling pretty wonky and hypertensive and maybe anemic (but there's a lab test for that, and I haven't had it, so it might just be that I'm feeling wonky) so I've been spending very little time doing things like walking or standing.  Maybe all that shopping was overdoing it, although I didn't stand for more than about 15 minutes at a shot during any of it because of testing rocking chairs and soforth.

Anyway, I made a pecan pie for Thanksgiving and about a third of it came home with us.

I requested pie delivery by the spouse and was met with "I don't know what you're going to do with a third of a pecan pie."  Duh. The answer is "eat it, or at least some of it."  Eventually the pie arrived.  I didn't eat the entire third of a pie.

Yet.

I've scheduled my meals and snacks to match a hobbit's schedule, and pecan pie is decidedly not enough to be second breakfasts, even if it's a third of a pie.

And now, more water and a proper second breakfast.

Also, it's nearly the spouse's birthday, and it's one of those that ends in a zero and is a big deal.  Since I imagine nobody in real life will make a big fuss about what an awesome human the spouse is, here's a little tribute.

Spouse, you are totally awesome.  I know your job has recently started to be pretty awful and its future is uncertain, but you rock for sticking with it and making the best of the situation.  I appreciate all the things you do for me and the kid, all the hours at the library with her so I can study, all the cat vomit cleaning, all the little things.  The big things are great too, like the putting up with me and supporting my sorry bacon through school (some more) and loving me despite my very glaring faults.  It doesn't go unnoticed.  We appreciate you.  You're the super coolest co-parent and I'm glad to have you along for the ride.  It's so cute when you're playing with Little Monster (aka poking at my belly and being kicked in response) and making up silly songs.  If you haven't noticed, it makes me cry a bunch.  I do insist that if you want my blog to have a theme song, it must not involve the words "bloggity blog blog" because you are much more creative than that appropriation of Frosty the Snowman's song suggests.

I hope this next decade brings all the happiness and joy that you deserve, and that you enjoy it when it gets here.  Happy birthday!

Monday Snapshot: Cute outfit! edition

This is part of PAIL's Monday Snapshot feature!  Go check out more, and learn about Kristen's really cool blog Buck Up, Buttercup here!

I pretty much have a "no photos" policy in the name of maintaining anonymity, however I feel that pictures of clothes or food or people without identifying things in them are fair game.

Here's a picture of what will be Little Monster's "coming home" outfit from the hospital because it's that rad.  I've avoided buying baby stuff because I keep thinking it will jinx things, but at the same time, well, our budget just isn't such that we can wait to buy everything once we have a baby in our arms.  So it's time.  Time to buy a single totally new outfit for child 2 so nobody can say it was all hand-me-downs.  Time to buy some maternity clothes so I can wear something that fits besides a single skirt and 2 shirts.  Time to stop being quite so scared.

Behold, the most excellent future baby outfit ever, according to me.

That's right.  Mommy's little monster.  Bwah ha ha ha! With little monster hat and those cuffs that fold over like mittens!  Swoon!

Visiting

We've been visiting the spouse's parents for a few days and it's been a daunting thing, as usual.  I worry a lot about setting a child free in a pristine, child-resident-free environment.  My in-laws have totally redone the house since the spouse and my brother-in-law lived here, down to, well, everything.  New shiny white paint, new very white carpet, new crumb-free furniture, new bathroom that's never had soapy bath toys chucked at it.  The strangest piece to me is that they left on Friday and we've been here all alone since then, eating their food and making a (minor) mess.  Not sure who planned that exactly, but whatever.  I am unwilling to be in charge of the extended family's inability/unwillingness to make plans (with us) any amount in advance, and if that means we stay here alone for 3 days of our 5 day visit, that's life.

We went shopping on Black Friday, and I think it's probably the first time I've done so on purpose.  Our local crunchy stuff parenting store had a really good sale, so we went.  It wasn't crowded and they had cider and cookies (aww, how cute!) and 75% off cloth diaper covers in a size we needed (kapow!).  Then we went to the Baby Stuff Warehouse Store to make sure the carseat we bought (some time ago, when it was on clearance) will actually fit in the car.  As it turns out, it had become a Toys AND Baby Stuff store since our last visit maybe a year ago or more, so parking was a nightmare but apparently everyone left just as we arrived, so eventually we got the carseat temporarily installed and the kid and I test-drove various strollers around.  We're both pretty happy with one that's $100 less than the perfect stroller, so we'll see how that all goes when we are ready to actually buy a stroller.

While we were there, we looked at the 50% off baby clothes... and despite having resolved not to buy any newborn sized clothes, the perfect outfit combo thing presented itself, so we cracked and bought it.  There's another picture for the snapshot tomorrow too, although I'll try to rotate it properly.

Saturday we went shopping again (oh how I hate shopping) at a small business that sells used children's clothes and stuff to enjoy their 40% off everything sale.  Mostly we got things for the kid because she has gotten enormous but not quite enormous enough to fit into many of her long pants, but we did pick out a few things for Little Monster.  It's a challenge to have to keep reminding her that she can't get frilly pink or purple dresses for the baby because boy babies don't wear frilly pink or purple dresses.  I feel like "dress" is the line for me.  All other clothing that we already own for babies will be worn by Little Monster, pink or not, but no dresses on boys unless they are old enough to decide so for themselves or the kid does the dressing in the context of "pretend play."

It's a good thing our town has very few places to shop.  It keeps me out of trouble.

Stories in any other format...

Historically we around the Future PharmD household have had long commutes.  It started with the spouse taking a half hour each way by bus, then me with 1.5 hours each way, then the spouse commuting 45 minutes each way and me being a shuttle in the 2 hour travel extravaganza that was taking the kid to preschool last year (how did I think that was a good idea?).  This meant we decided on audio books as a way to fill all that empty time driving alone or with a touchy small child awfully early in the morning.

Esperanza wrote an interesting post about adaptations of books to movies, and of our lives to blog posts, and it got me thinking.

The first book I "read" without ever seeing the text was The Hitchhiker's Guide to the Galaxy and we listened to it on cassettes driving to visit my grandparents.  I remember it from when I was 5 or 6.  When I got older I read the text itself, and then later saw the movie and then the remake of the movie (and the TV series too, I think).  All these versions of one story mean a multiplicity of views of the characters that's more fully developed than if only one interpretation were available.  Example: in the recent movie, Marvin the brilliant and depressed robot's performance is heavily influenced by the original radio plays while Arthur's performance comes more from the text (of the later books, actually).

Since theater is an interest of mine, I am always thinking in terms of performances and interpretations of the text.  We went to see The Lion, The Witch, and the Wardrobe as put on by a local school recently and I was struck by how little the actors understood how scary living in opression is.  At no time was I convinced the animals in Narnia were really afraid of the Witch.  This didn't bother the kid at all because she doesn't know the story and this play wasn't set in the context of World War II.  It was just fun for her.  The medium is the message, and the message she got was straight from that overly cheery play and not from the story of 4 kids lost in the woods who suddenly have to save a whole nation of scared "people."

Around here, we are considering the merits of books as physical things versus digital things.  I've taken to buying textbooks digitally because they are just too enormous to haul around and I can't have my computer out to take notes and a 5 inch thick book open in my tiny study space.  I can fit the tiny tablet next to the computer though, and it's much more portable AND I can switch between textbooks easily without any hauling or bookmark-finding.

Some (many? most?) people don't read a book more than once.  I am peculiar in that I am almost always reading a book but rarely is it a new book.  I've got maybe 20 that I rotate through and reread.  Since I've been reading some of these for years now, they are starting to get pretty worn out.  Also since they're favorites, a great many of them we also own as audio books in one format or another (some cassettes, some CDs, mostly digital files, shows you how long we've been collecting audio books).  The spouse thinks it's gratuitous to add digital text copies to the two versions we have already.  I think it makes sense to add digital copies to preserve the physical copies either for special occasion reading or just in the name of collecting, and since a few physical copies are already disintegrating, it avoids replacing them.

The current family approach to new book acquisition is: digital books for very heavy or very short-term books (brain candy, read once sorts of things), physical books if we really want to read something, audio books as we see fit but probably for things with replay/reread value.

I just don't know what format I want to show the kid.  She can't browse digital books in the same way she can physical books on the bookshelves.  She can't tell if I'm reading, playing a game, or doing school work if I'm using the iPad.  She can tell exactly what I'm doing if I'm hauling around a book and reading it.

So what do you all think?  Should we add another format of the same stories or should we keep reading the physical copies that aren't in such great shape because someday, knowing what we read over and over has value?

"I don't know how you do it!"

If I had to list the most common question that I get after mentioning that I'm in pharmacy school and own a small child, it would be that.

Exactly what "it" is beyond "be in professional school and have a small child at home" I'm not sure, and that's a post for another time.

There are several answers to that question, and at least one friend who's starting med school with a 14 month old next year was really curious, so you're all (3 or 4 of you) stuck getting the answer.

1. I don't. I have an amazing spouse who picks up the slack in parenting, cooking, and house cleaning.  I do the laundry and sometimes the dishes and grocery shopping, but that's about it.  It's wicked hard to be the primary parent while the co-parent is in professional school and some classmates have more success at making this work than others.  Sometimes the parent in school just doesn't sleep (see those who work full time in addition to school... sheesh. I am not nearly smart enough to sleep that little and be successful at school and survive at work) or have free time.

Aside: when I describe my study/school routine to people, they are either shocked and in disbelief at how much I study and go to school, or just disbelieve that it's possible.  I study less than I hear med students do in most weeks, and I think that's for the best, but my grades aren't super shiny (see repeating that class I failed... whoops...).  It's a lot of time and I'm glad to put in the time because I want to be prepared to make as few mistakes as possible so I don't hurt people.

2. In the "I don't" vein, a lot of things slide.  Most laundry never gets folded. It gets chucked into drawers in heaps (I do fold t-shirts so they fit in the drawer).  There are always dirty dishes.  There's always a basket of laundry waiting to be put away.  We try but usually fail at planning meals a week at a time.  We get take-out too often, especially during weeks where I have lots of exams.  We have on occasion recruited my semi-retired mother to come stay for a week or 10 days around finals so someone else can help mind the kid and cook and clean because I study 18+ hours a day and while not studying, my brain is kind of mush and only useful to regurgitate stuff that will be on the exam (so no conversation attempts then please).

3. We ask for help.  Our faith community has a list of people willing to provide childcare, and the kid will go hang out with other adults at least one night a week starting soon so I can study and the spouse can deep clean.  If someone ever utters the words, "If there's any way I can help..." I make a note in my spreadsheet and I contact them for crock pot meals or childcare or rides to wherever I need to go if the spouse has the car.  When we were in a bind for baby food, we recruited three people to help make some and freeze it for us.

4. My Little Pony, Bobby's World, and Voltron.  The kid is a well-practiced TV zombie and she can spend up to two hours watching it with little adult attention needed.  Is this my favorite? No.  Does it mean that in an emergency I get a couple more hours to study? Yes.  Other favorite TV shows from when she was smaller: Fraggle Rock (awesome because a DVD can be set to play 4 episodes in a row and then adults can sneak off to the office to study), Super Hero Squad, Garfield and Friends, and Caillou.

5. I actually leave the house to study.  If I'm home, I will be interrupted, no matter how well-meaning the spouse and kid are.  If I need to be uninterrupted, I have to leave, and I do.  According to the academic success types at school, it's a bad idea to study at a coffee shop, noisy public library, or other random and noisy public place.  If I didn't study in such noisy places, I'd get very little night or weekend studying done.  I find that restaurants are a decent place to study as well because as a person alone, I get stuck somewhere in the far back where it's pretty quiet.  I just have to remember to ask for a pitcher of water because I will get forgotten about, and that's fine by me.  Studying at school during the day is a great strategy too.  Go early before class, stay late after class, study during breaks between classes.

6. When it's time to be home, it's time to be home and the books go away.  Really.  I schedule free time into my week (and there's about 10 hours of it right now but it turns into more like 20 overall with cleaning/meal prep time too) and I make an effort to be school-free and involved in family time when it's on the schedule.  This means I have to stick to the rest of my schedule so I'm not worrying about whatever I'm not doing during that time.

7. Excellent childcare, 5 days a week.  Somehow this often surprises people... but I'm not sure why.  It's not like small children can sit through a boring lecture any better than me (although once the kid went to chemistry class when she was a few months old and napped the whole time, which was awesome).  I am thrilled that the kid gets to spend time with other kids her age and a caring adult who really likes hanging out with the preschool set and she is thrilled to get to play all day and do art projects and all that jazz.

8. You just get through whatever life hands you.  I didn't plan out this whole "school and small children" combo deal.  I did decide that I was going to stay in school so I didn't kick myself later for not finishing it now.  We decided together that we could make me in school and a family work, and we were too chicken to wait to have children (good decision in light of secondary infertility suck-fest), so we just made it work.  If (heaven forbid) something happens and I'm suddenly a single parent, because I'm in school, I know that I'll have a job soon that will pay the bills and that I could live in lousy on-campus housing in the meantime.  If I were a stay-at-home mom, I wouldn't have that security of knowing I had a career waiting (almost) for me.  If we'd waited to have the kid, we probably wouldn't have been any more successful, and life would be profoundly different and this would be a primary infertility blog for a long time, since school is spendy and so are infertility treatments.

Gratitude

It's Thanksgiving in America today, and I am very grateful for all the things I am lucky enough to have.

I am grateful for a spouse who loves me back and is happy to be co-pilot of our silly little family.
I'm grateful for a kid who is such a joy until 7:45pm every day.  She's creative and friendly and awesome before 7:45pm, and that's fantastic.
I'm grateful that the cat hasn't succeeded in killing me by tripping me on the stairs yet, and that we still have the goofy critter despite that motor vehicle accident a couple of years ago.  Well worth the small fortune we spent on hir.
I'm so grateful for second chances, and third and fourth and even fifth chances.
I'm thrilled and grateful to magically be pregnant and so far, successfully so.  I'm grateful to have managed to keep enough hope to try one more month when I was really ready to quit.
I'm grateful that I have a nice place to sleep and a spouse with a job that pays the bills, even if it's recently changed to be a far less pleasant job.  I even get to have a washer and dryer in my own house! How miraculous is that!
I'm grateful to be suffering through pharmacy school now rather than waiting 10 years to go back to school, and that I get the chance to be in school at all.  Wahoo educational system that mostly works and has gotten me this far!
I'm very grateful for all you lovely folk around the blogosphere for making me feel at home and like I belong somewhere and like I'm not totally insane as I go through all this weirdness that is life complicated by infertility and loss.
I'm grateful for my extended family and their love and support, even if sometimes they aren't totally sure how to show either one.

I'm grateful that this little bloggy project has managed to reach 100 posts today in just over a year.  It's been a wild ride and I hope things calm down some but remain interesting just a little bit.  Little things are pretty great too and deserve their moment in the spotlight.

So how are you?

Stuff lately:

Me: So ready to be done for the semester.  Some of my electives end early (one is finished, one just has another week to go I think...?) and two core classes are just presentations now, so that's weird.  I'm contemplating actually making a study plan to get ready for finals, and I'm going to actually do that today. Really.  Suffering through what is hopefully the end of my most recent sinus infection with a side of almost ear infection, and I think the last one was exactly a year ago, when I was much less pregnant and also slightly less nervous about the whole thing.  Today I opted for the z-pack so I should be better soon enough after 7 weeks of bleh.  Food is not my thing at the moment but I have now gained a kilo over what I weighed pre-pregnancy, so I'm just gonna keep eating stuff.  Craving beef and lentil soup, so it's burgers tonight and lentil soup tomorrow.  Still doing a terrible job remembering to eat so I'm setting up more reminders in my online calendar.

Spouse: playing some Spiderman video game (that the kid picked out at the movie rental place) on the TV and the Penny Arcade game on the iDevice (and I like that one too), excited to see family for Thanksgiving, even willing and excited to go shopping for Little Monster provisions during sales this upcoming weekend (not that this is surprising in the least), also spends several minutes a day chatting to Little Monster and sometimes singing ridiculous made-up songs

Kid: resisting sleeping in her room because "it's too dark."  I discovered the other day that during naps at daycare the room is dark except for a crack of light from the closet.  Her room is never that dark at night, plus she has a night light, a glowing ladybug that projects stars onto the ceiling, and a glowing Lego lantern person next to her pillow.  Currently we are having the Great Nightly Struggle to get her to stay in her room and at least pretend to be asleep.  Still.  After about an hour of negotiating, punishing by taking things away for the next day, and room escapes, she goes to sleep.

Cat: finds eating my larger vining philodendron to be a great pastime and is still longing for the out of doors.  I wonder if zie's secretly throwing up somewhere because it's a supposedly poisonous plant, or if it doesn't bother hir iron stomach.  At least my miniature rose and decidedly poisonous dieffenbachia remain intact.  The dieffenbachia's name is Happy by the way, as named by the kid.

Little Monster: seems to enjoy lectures on immunomodulation, addiction, and leadership styles (go figure).  Has distinct sleeping and kicking periods, including one about 3am that I've been waking up for (and then I don't get back to sleep for several hours).  Zie is due to be a well outfitted pre-baby with the upcoming shopping trip.  I think next weekend we'll put up the crib and start assembling various baby stuff in it.  Or I'll decide it's bad luck and wait until there's an actual baby around to do that.

In which I'm pretty amused that my body worked

As part of a class project I've been researching treatments for "morning" sickness in pregnancy, including the natural remedies and all that jazz.  My personal recommendation is Sea Bands or a similar product that's squishing that spot on your wrist, by the way, and if that doesn't work, go ask your doctor's office.  The American College of Obstetricians and Gynecologists (that's the lady-parts doctors) recommend taking vitamin B6 at a 25 mg dose, three times a day for treating nausea and vomiting in pregnancy, and adding an antihistamine to that if needed as the first-line treatment.

Then I was browsing places in the diet where you might be getting a lot of vitamin B6, because there's some evidence that having a higher level of B6 decreases nausea and vomiting, so maybe people who never get morning sickness are just eating lots of whatever food it is.

And highest on the list? Chickpeas or garbanzo beans (why we can't just have one name, I have no idea, silly English).  What did I eat almost exclusively in weeks 9-15 of pregnancy?  Hummus aka chickpea paste on crackers.

Huh.

Maybe there is something to all that "your body knows what you need" deal.

On beauty

I briefly thought of myself as beautiful, for a few months when I was 14.  I didn't try to change a thing about myself for at least 6 months, which is certainly some sort of record for me.

I really like this blog post that a friend linked to about why we need to tell our (daughters) that we are beautiful.  It goes right along with Jules' recent post about loving our bodies just as they are, because our bodies have done some amazing things.  Beautiful is certainly how I look at pictures of my mom and my grandma at my age, so me thinking otherwise is probably wrong.

So I'll have to make it a project to tell the kid that I'm beautiful and to tell other little ones that their moms are beautiful too, and I'd even venture so far as to say that complimenting other moms on their beauty is important because we forget.

By telling the wee ones all the time how beautiful they are, we are establishing that youth=beauty.  As they grow, we stop telling children how beautiful they are, but not because they are less beautiful.  We stop because they get self-conscious and don't want adults telling them anything about themselves AND YET they get all nervous about suddenly not hearing what they've always heard about themselves (silly adolescents with frontal lobes the size of raisins, pretending to dislike things they actually need a lot of).  Do you hear anyone call a woman in her 30s beautiful without her having made an effort to look beautiful (vast make-up and fancy outfit)?  Why on earth not?

So let's fix this, one child at a time and one mom at a time.  Let's speak out loud what is true: moms are beautiful just as much as kids and just as much as childless young women.  Beauty changes when we age, yes, but it remains.  Let's all make a point to tell the beautiful women in our lives that they are beautiful just as they are.

Deal?

Traditions!

This is part of PAIL's monthly theme post series! Check out more traditions here!

Aside from being one of my favorite songs from a musical, (note that I've seen far more musicals than most people, so this is a pretty significant statement) tradition is something we are trying to build around here.  Pre-kid, we established the tradition of alternating whose family we saw for Thanksgiving.  It's also traditional for me to make at least one if not three or four pies for Thanksgiving, no matter how many people are going to attend whatever dinner it is.  Once we had apple pie for breakfast for a week afterward because I got so overexcited about apple pies that there were three for the 7 people at dinner (including the kid who ate two bites and then was done), plus at least one other pie.

In terms of holiday decorating, we decidedly do ornaments.  The kid has gotten an ornament each December from her aunt, and we adults started with a moose ornament theme, adding one each year.  I think now we've moved on to adding bird ornaments.  There are no holiday decorations for December until after American Thanksgiving (how do you Canadians decide when to put up seasonal decorations without that line?).  We do a festive winter pine tree and the spouse's family traditionally goes out to hack one down from a tree farm, and we went and got one ourselves last year, despite it being well outside our budget.  We even pretended to let the kid pick it out.  She decided she didn't like the one we chose, then we walked around a bit more, suggested a few more, and then looped back to that one, and poof! She liked it!  With only the mini car now, I imagine this is out but we'll go along to cut down Grandma and Grandpa's tree.

In the name of being broke, we've established that the kid gets a single present from us and one from Santa.  So far it's been pretty successful and I hope it's a few years before the kid realizes that other kids get more than one present from their parents.

I am a big fan of twinkly lights and I'll put them up all over the house.  During this decorating process, we've established the tradition of everyone having egg nog and playing festive holiday music.  Egg nog is a tradition from the spouse's family again, but it's delicious, so we have adopted it.

Our approach to traditions is to choose ones we both like to be our family's own.  We try to negotiate well ahead of the tradition's timing how it will be implemented and what will happen so nobody is upset about it, which goes well among the three of us and less well among the extended family.  My mother in law has tried to establish having a big holiday cookie baking day at her house with me and my sister in law, but it's hard because my sister in law gets weird during the holidays (often declaring herself Scrooge, probably because she gets subjected to the vast swath of her large family asking why they don't have kids yet and passing off babysitting to her as a result) and I'm in school, so 10 dozen cookies just don't have time to be eaten before New Year's if we don't make them until after the end of finals.  Perhaps now that the kid is big enough to be really involved in cookie baking, this will work out better.  Interestingly, despite not usually being invited, the spouse has joined us for cookie baking for a couple of years (while my brother in law leaves the house lest he be asked to wash something or otherwise help).  Perhaps we just need to make it a family tradition of our own so nobody gets left out.

I am hopeful that we'll create some bigger traditions with the kid's collaboration (and maybe even Little Monster's input eventually).  Growing up my family traditionally didn't put nametags on presents so it was a surprise to guess who each present was for (bonus surprise!).  This doesn't go so well now that my mom's memory is dwindling, so we've given up on it, and it's a smidgen sad but mostly just life.  Back on the farm it was traditional for me and my sibling to get up and do all the chores as a surprise present as well, but no more farm, so that's also out.

We've sort of established with my family that for our festive December dinner, we cook something elaborate and everyone helps with the chopping or frying or something.  Last year we made baked egg rolls and that clearly required everyone's help with all the chopping and then rolling... and it was delicious, and gluten free and/or dairy free and low salicylates and we almost got the kid to try one (but she did eat some carrots and bok choy, so that's something).  I think this year we'll do lo mein.  This reminds me of an excellent (if sacrilegious) book in which Jesus and his best buddy Biff start a tradition of eating Chinese food to celebrate Jesus' birthday, which I hear is a thing common in big cities because Chinese take-out places are open Christmas day (you lucky ducks).

The 10 year hole in the heart

Just about ten years ago, a very dear friend lost his fight with depression.  I've written about him before, maybe a couple of times.  I didn't obsess about the upcoming anniversary at all this year, and that's new.  This morning I was thinking to myself that it was already mid-November and whoa.  The date dawned on me.  I did burn off all the water I was attempting to boil to make pasta this morning because I was taking a break from school and apparently also from paying attention... oops.

I think about him every day, but not every day do I wonder if it's partially my fault that he died (anymore), that if I'd told someone else how badly he was doing something else might have happened.  I guess time has healed things a little bit so that's something.  In the first months after he died I was sure I'd never feel whole again.  Now I'm used to being broken and I think the ways the pieces have gone back together is for the best.  Just because there are gaps in who I thought I was doesn't mean I'm useless.

The thing that's been the most helpful of all is this song, actually.  Being cracked and broken can be beautiful too.  All those gaps make for quite the light show on the other side.

Anyway, if there's someone in your life who's struggling with depression, don't wait forever to address it.  If it's you who might need help, don't wait.  You're worth it and we need you around.

So lyrics about love that's probably more romantic than friendly, but still profoundly helpful with life reassembly.

CRACKED AND BROKEN
(Diana Jones)

I want to know you, know where you've been
Know how you came through
The sound of your voice, your original sin
Where we are is where we begin

Cracked and broken and beautiful
Cracked and broken that's how the light shines through
Cracked and broken and beautiful

I want to see you
In the full of the morning, in the last of the evening
Unfurled and uncovered
And in the same light I want you to see me

Cracked and broken and beautiful
Cracked and broken, that's how the light shines through
Cracked and broken and beautiful

And I want to feel where our edges are rough
What our corners are made of
Where you and I start, where we both come apart
And where we both come together again

Cracked and broken and beautiful
Cracked and broken, that's how the light shines through
Cracked and broken and beautiful

When china breaks
It's never the same
When I felt your love
My heart became

Cracked and broken and beautiful
Cracked and broken, that's how the light shines through
Cracked and broken and beautiful
Beautiful.

V day

That's right, it's viability day today.  24 weeks holy wow.

I realized while reading Post Secret the other day that a chunk of what's making me so mopey and broken-nervous-feeling lately is how much those losses hurt, in addition to the perpetual infertile-freak-out-things-will-crash-at-any-moment nerves.  Last winter instead of getting out the usual decorations for the festive winter holidays, we just made blue snowflakes out of paper.  It was a great game for everyone and the spouse in particular made some achingly lovely ones.  We decided to collect a new bird ornament every year after the kid chose a pheasant as her ornament (and then it got hung on the naked and unstable curtain rod until we moved, so it could be a few years before it resurfaces).  I snuck a small blue bird ornament into the mix as well, because even though everything was sad and lousy and awful, the Blue Bird of Happiness was out there somewhere, waiting to be chased until it turns up right at home, where it always was. 

Sidenote: The Blue Bird is the classic early 20th century play first produced by Stanislavski, that really famous Russian teacher of acting.  In it, a brother and sister go off on a journey to find happiness by catching (a sight of? I don't recall if they need the bird or just to see it) the Blue Bird of Happiness.  In the end, it turns out to have been in their house in a cage all along.  I often forget how spoiled I have been to see so much truly great theater, and that trying to create it is a valuable endeavor, even if you don't get there.

I think that as time goes by, I'm going to get out the blue paper and make some more snowflakes because it's still all right to be sad for what will never be, even in the middle of that silly blue bird twittering like crazy right here at home.

Sidenote 2: The kid's latest career aspiration (based solely on interests) is to be an ornithologist.  One of the mobile devices got a guide to North American birds app installed and she's been tormenting the cat playing bird sounds whenever the opportunity presents itself since.  Cutest thing ever to see the cat come tearing into a room, set to pounce on that noisy bird, and then look totally lost when THE BIRD IS A LIE.

The coolest class I've taken yet in a whole lot of years of college

This semester I got to take a few pretty snazzy electives including Spanish (apparently my pronunciation has improved during the semester, but that's not saying much, as it was profoundly awful at the start. The spouse accused me of sounding French and then Japanese while practicing...).  The highlight was a class on Lifestyle Modification though.

What's that all about, you may be wondering...

The short answer is that whenever your doctor says, "Improve your diet and get more exercise" there ought to be someone for you to see to help you figure out what this means.  Depending on what's wrong with you, just getting on the right diet can mean you get to scale back your medications a lot.  Think of it as getting a prescription for exercise that you take to an extra-cool pharmacy and we help you fulfill it.

The long answer is that with the success of the Asheville project where pharmacists were hired by a company (the city of Asheville NC) to cut healthcare costs by optimizing medication regimes and improving health, there's about to be a big market for people who can run a service like this.  Wearing a pharmacist hat, we fix medication problems and help people find medications that work best for them and their lives, while wearing a Lifestyle Modification hat we help implement little steps toward healthy changes in diet and exercise that in turn mean changing medications because maybe people don't need them anymore.

How super cool is that? Really!  If people with hypertension can learn to stick with an appropriate diet, you can see a drop in blood pressure equal to that you get from most first-line medicines.  Yep, programs like this usually need the support of a dietician to make it work for the greatest number of people, but with pharmacists at the center, it's a great model AND we get to use all of our skills (I really like using skills beyond "try to read the doctor's mind based on what is prescribed and what the patient can tell me" and "telephone the insurance company... again..." whenever possible).

The other thing that's nice about it is everyone at the company can benefit from company-wide wellness efforts, not just people who are already sick enough to be taking medications.  Things like smoking cessation groups or online classes are often available in a program like this, as are a certain number of mental health visits a year.  Often cheap gym memberships or having a gym in-house gets included for everyone at the company, not just for those in the medication management part of it.

This class focused on how to figure out a diet prescription for someone to lose weight (and about how fast it's safe to lose weight), how to develop an exercise program that will work for someone without them overdoing it, and how exercise changes medications we're taking (that's the technical stuff with names so long we abbreviate it to PK and PD that is really fascinating and complex and makes me appreciate the miraculous workings of our bodies).  We covered a little bit of the business of getting set up and resources to support such a business, and I'm considering seeing if I can weasel a rotation doing this into my schedule.  I have the problem that I want to do ALL the rotations, especially ones that are far away, so that's bound to be an obstacle.

Work-life balance

I'm at a place where I'm preparing to pick rotations (well, in October of next year).  Most rotations at most pharmacy schools in the US are 5 weeks long and we do 8 of them (some schools let you do a 9th if you want, and length may vary a bit as well), starting in June and finishing up in April with December off.  I get 3 elective rotations to choose from, and I can choose pretty much anything I want and get credit for it.  In 15 weeks I can develop a specialty if I want, or choose general things that will make me well qualified anywhere.

The big factor, to me, is to try to explore some interesting options for a career path while picking electives that I'll enjoy and that might set me up to do a residency if I feel like it.  The other big factor is to consider choosing rotations that let me check out the various scheduling options within pharmacy.

The big choice: community or hospital?  I think I'd be happy with either one, so to me it's more about the common schedules for folks in either of those settings than which practice setting.  This summer at the hospital I saw pharmacists working 7 days in a row, 10 hour days with the following 7 days off alongside folk who had the more usual 4-5 days a week with every third weekend, 8.5 hour days.  I'm not sure which I'd like better but working 7-70 seems kind of appealing because getting a whole week off gives us flexibility to do stuff during school breaks and the option to either pick up part time work or just relax for a week sounds really tempting.  Alternately having a rotating schedule seems like it would be hard on kids rather than the simple "mommy works this week" schedule.

I've also been considering if I want to try to find a full time job at all or if I would rather be a rent-a-pharmacist and work when it suited me as the replacement for the day.  It's much harder to work at various locations and fill in, but the pay is good and the flexibility is great.  There's also the advantage of getting to see how various settings work before taking a job permanently.  The downside is that the benefits are awful or non-existent unless I worked for a particular chain rather than an agency, and where we live that would mean traveling further between locations.

I've promised the kid that once she's done with kindergarten, I'll be done with school and I'll just work (and actually be on rotation for that first year, but it's much closer to work than anything else).  I worry that it will feel like I'm cheating her out of family time if I wind up working a lot of nights and weekends.  Maybe I'll sign up for the dreaded third shift somewhere and sleep while she's in school so we have after school and evenings together.

So I guess that to me, it's more important to have a job where I get to be a good mom than it is to have the perfect job.  Yes, the kid's adaptable and Little Monster will have to be to live with us, but I also really want a chance to enjoy being a person and not a drone.

A very strange thing

Recently our cat has forgiven me for allowing those dastardly kittens to come home and stay for a bit more than a year.  When we moved, not all 3 cats could go, so the kittens were re-homed (are they still kittens when they're 15 months old? No real idea).  Fluffinella (no, that's not the cat's real name, but it would be an awesome name for a cat, right?) is probably 5ish and a pretty cool customer.  Zie likes people sometimes but not always, as probably isn't uncommon for cats who start in one home, go to the humane society, and then go to another animal shelter for a few weeks before moving in with an 18 month old in a medium-sized apartment.  Pre-kittens, zie sometimes came and sat with me while I used the laptop but not very often.  In the last week or three though, the cat has been desperate to sit with/on me and my laptop at least once a day and sometimes even after I've gotten up a few times.

It dawned on me just now that Fluffinella is purring loudly across my belly because I am getting punched by Little Monster in the cat-region of my guts.  They are interacting! Oh my!  I suspect that Fluffinella is feeling all this punching and enjoys the belly massage, and Little Monster is being extra kicky-punchy.

If only I could use the mouse without getting bitten, this would be a lovely set up.  Personal warming critter for me, massage for the cat, entertainment and interaction for Little Monster, everyone wins!  Did I mention that kicks in the ribs mean less tap dancing on my bladder? Yes please! Fluffinella has some wonky teeth so hir "playful" bites hurt quite a bit and the trick is that I get bitten if I get my hand too close to hir mouth (and usually this means near the mouse trackpad of the computer).  On the upside I'm learning more ways to use the computer with only the keyboard.

The great pregnancy facebook announcement

After much consideration and soliciting advice from the Bitter Infertiles podcast divas, I've decided that the time to make the "oh yeah, by the way, additional child arriving relatively soon" announcement on my personal facebook page has almost arrived.  The one with my name on it, as you might imagine.  Someday there might be more some social media to go with this little blog.  For now, nah.

I've got some ideas of what not to do (pictures involving spaghetti sauce or sonograms are out absolutely) but I'm still considering what exactly to do.

It's my plan that this one status update will be it until there's hopefully a baby to display a few pictures of, because I get irked with the incessant food comparison status updates (much like I still cringe at the unexpected bump photo from the fertile crowd, especially for third children or more). 

So thoughts? Suggestions?  Which of these is least hateful and hurtful?

Possibilities:

1: After 3 years and 3 losses, we are excited to welcome kid #2 to the family in early March.

2: After lots of waiting, we are excited to have reached 24 weeks pregnant (gestation?) with kid #2, expected to make his or her arrival in early March.

3. It's official: we're expecting kid #2 any time between now and early March.

4. We are pleased to announce that after 3 years of waiting and losses, kid #2 is due to make his/her arrival in early March.

5 (addendum to any of the above) For those still waiting, our hearts are with you always.

Help!

She could have died: a birth story

So I've been reading birth stories and I realized I haven't contributed mine to the chorus.  Here's the story of how we got the kid.

At 37 weeks gestation I was diagnosed with hypertension and was on high preeclampsia watch as a result.  For some silly reason we weren't on high alert for imminent kid arrival yet and I was lucky they didn't have me admitted and induced right away.  My doc (a family practice doc, not an OB) put me on modified bed rest with me allowed out of the house only to go to class and absolutely no standing for very long (since it made me dizzy).  This went fairly well although sometimes I'd get downstairs and my blood pressure would be so high I'd just stagger back up (very slowly) and skip class.

And then we got to 40 weeks according to all the ultrasounds' dating (10 days before my due date based on LMP but with all those ultrasounds dating her 10 days ahead, they moved my due date up).  Nothing happened.  I was maybe a cm dilated and still hypertensive right at the line between "panic! Deliver now!" and "well, it's not a big deal."  We had a NST about 4 days after my due date on a Friday and the kid was downright feisty and the tech doing the test was just shocked at how active she was.  My area had a lot of high risk pregnancies because of limited prenatal care, lots of drug/alcohol abuse, and environmental pollution that causes all kinds of nasty birth defects, so I'd bet the tech had seen lots of sad things too.

My doctor decided to let me go to 41 weeks and then schedule an induction for about 42 weeks if I was still doing all right.  I had to come in for a mid-week appointment and she'd do another NST in a week.

Sunday I started having contractions in a pattern.  This was maybe the 4th time I'd had contractions for a few hours, so at first it wasn't so exciting.  In about 8 hours things progressed to where I was having contractions every 5-7 minutes that lasted about a minute each, so we called our doula and she turned up about an hour later (she lived a distance away).

Brief interlude: I have attended hundreds or even thousands of births as a farm kid, so I knew that when things go south, it's fast and you need to be right there ready to intervene but I also knew that I wanted to stay at home as long as possible because my mom had a really long labor her first time and my grandma had as well.  I also figured that since we'd never been to a hospital for a birth, having a doula who knew what to expect and how things usually went would be helpful.

We all chatted, the three of us, for quite a long time.  We wandered around, did some massage because my back and hips hurt like mad, usual stuff.  We griped about our 3 TV stations and that two were the same network.  At about 2am my contractions got to be 3-5 minutes apart and were hard to talk through, and by 3am I couldn't talk through them, so we decided to adjourn to the hospital so there would be plenty of time to get settled.

At about 7am my water broke and I started throwing up with every contraction.  It was no fun and such a relief to have two people to alternate holding the puke bucket and washing it out.  By 10:00 I hit transition and was in a very different place (with less vomiting).  I'd done a modified hypnobirthing meditation thing to help with pain and it was working pretty well.  I opted for no epidural mostly because I have a lot of very surprising reactions to medications and I figured that while in labor wasn't the time to test out what happens if I got an epidural.  During this phase of birth I got super quiet and was very internally focused all of the time.  Everyone was shocked (the lady in the room next door was howling, and her baby was over 10 lbs, so that's totally fair) and I don't think the nurses quite understood what to do with me being so quiet so having a doula along with the spouse was invaluable.

Shortly after 10, the fetal heart rate monitor dipped way down.  It was great there to have a doula, because she caught this first and wiggled the thing around trying to find a better heartbeat, figuring that the kid had just shifted.  In a few minutes the nurse turned up and they found a heartbeat again (phew) but it didn't last very long and we had to go to internal monitoring which meant staying in bed (which I'd mostly been doing anyway!).  My doctor showed up (yay for delivering during the day, in this practice it meant I got my doctor if she was in the office) about 11 and it was time to push.  After about a half hour the kid's heart rate quit rebounding as much after a contraction and then it dipped really low during contractions.  I wasn't making much progress pushing (she was just short of crowning through a lot of contractions).  Very quickly a whole lot of things happened, maybe three more people showed up, and my doctor decided it was time for a vacuum extraction.  We were given the options of continuing to push or go with the extraction, but knowing that for three contractions things had looked worse each time, it was clearly time to intervene.

The vacuum extraction meant an episiotomy (boo), one last push, and some yanking and then we had a baby, a few minutes shy of 24 hours from that first contraction.  She was quite purple (almost blue) because she'd had her cord around her neck quite tightly.  She wasn't breathing on her own but within a few seconds she took her first breath and then wailed. Once.  She got whisked off to the nursery (no NICU at this hospital, just a few beds for babies who needed some care short-term) after I saw her for just a moment.  The spouse went with the kid and my doula stayed with me.  The placenta turned up intact and I quit bleeding fairly quickly so I never had to have an IV or any pitocin.  In about an hour, I'd had several drinks and was permitted to go visit the kid in the nursery by my nurse and my doula headed home to crash.  The kid was just starting to get some good color to her after being under an oxygen hood the entire time (almost).  She'd had to have a chest x-ray because she stayed purple too long and they were worried she had a heart defect and would need to be flown to the hospital with neonatologists and a NICU for surgery (an hour flight).  It came back fine so we got to stay put.

If we hadn't been in the hospital being monitored, the kid could easily have died during birth.  Her cord was short and around her neck, maybe more than once.  At the least, without that intervention she could have been oxygen deprived enough to have some serious complications like cerebral palsy.  That's why nobody will ever convince me that a home birth is a good idea.  The kid's birth was going great until within 5-6 minutes it went downhill, and we only knew that because she was being monitored constantly.  Just because you are considered "low risk" during pregnancy doesn't mean the birth will go smoothly.  Being right there in a hospital means the intervention you need is right there, easily reachable really fast.  Don't be afraid you'll miss out on some magical experience because you deliver in a hospital.  Remember that you're ensuring that if things go wrong, you have help right there.

I will say that the hospital experience was so much easier having a doula.  If we'd had someone who was less trained but had been through a hospital birth before like a sister or friend, that extra support person probably would have been enough for us, although the help in labor positioning was really great.

After 2 days we got to go home and adapt to life with the kid, and it's been exciting ever since.

Midwinter paper season’s greeting exchange?

So SRB over at Little Chicken Nuggets has a brilliant idea - a festive seasonal holiday-ish actual paper card exchange!  I adore mail, and I bet you do too, so let's do this.  I'll send you a card and email you my address so if it suits you, you can send me one too.  Fun mail! Brilliant idea!

Note: my form is not nearly so cute as SRB's but it should hopefully be functional.

Form!

A Tribute to TBD!

TBD, you are a very lucky baby.  You have an awesome mom and dad, and I am confident that HGB will be an awesome big brother.  Plus you have this really nifty extended family spread all over the world and connected by the Internet.  Before your arrival, you are already a minor internet star in SRB's little corner of the internet (and really, our own little place to belong is the best one of all). 

Today is a really cool day for you and your mom to celebrate your imminent arrival.  I hope you enjoy the whole ordeal and don't tap-dance on SRB's bladder too much (maybe a few friendly kicks in the ribs would suffice).  Little Monster (currently residing, like you, in utero) can take care of the tap-dancing on your behalf.  I actually think that Little Monster is excited at the prospect of more really cool babies being in the world and that you are a baby zie will know (at least via blog).

I'm really looking forward to you turning up and being adorable and awesome.  Being the younger sibling is rough but I'm sure you'll find it to be a good time.  I imagine that since you and HGB will be close together in age, you'll be close together as buddies too.  We have this book around here about brothers that's called There's a Dragon In My Sleeping Bag and the kid (she's 4) really likes it.  In it, the brothers both have a friend animal move in and vote his brother out (of playing, of his spot at the dinner table, of sleeping space in the same room) but in the end, the animals leave and the brothers make up.  They realize they not only get to be best friends, they are also brothers and that is the best thing of all.

I hope that as you grow up, you and HGB get to have as much fun being best friends and brothers as those boys in the book.  It took me 13 years to appreciate my sibling, but I'm so glad to have a sibling to hang around with now, and I'm sure you'll be much smarter than me and will have a great time playing with HGB far sooner.  Enjoy your good fortune and be a stellar baby when you get here.  Sleeping at night is a great idea, and a few hours at a time is even better.  Really, just being your gooey self will suffice in the short term.

Congrats to SRB and an early welcome to TBD!

Thoughts on diapers

So I think in the realms of baby stuff obsession in an attempt to distract myself from my impending doctor's appointment (that got moved to tomorrow due to "an emergency surgery that needed to be scheduled" and how sad that I know exactly what sort of surgery this probably is, and how sad that it happens to anyone ever...) I am now into cloth diapers.  One of the blogs I follow had a post about cloth diapers, and from there I got all excited to read other posts about cloth diapers because there's such a variety.  If you thought cloth diapering was one unified thing, oh no. One family's cloth diapering may be totally different than another's and that's awesome.

When we were getting ready for having the kid, we knew we needed to pick the cheapest way to go for everything because we were scandalously broke (now we're regular broke and it's a vast improvement).  The spouse does number crunching and made some fancy comparison spreadsheet deal, and found that even with our coin op laundry at the time, cloth was cheaper if we did prefolds.  So that's what we did.

We bought 2 dozen (they were cheaper by the dozen from our local diaper/crunchy baby shop) bleached infant sized prefolds and 3 covers (2 different kinds as I recall, we only ever had one cover of the second variety) to start with, then a dozen more unbleached prefolds and more covers later, maybe so we had about 5 before daycare.  Because I have trouble with snaps, we picked velcro covers and found that up to about 15 months they stayed put with no baby interference, and as we had a long narrow kid, it gave us more flexibility to get a cover to stay on her scrawny behind.  We had enough room in our diaper trash can (no pail for us, we got a foot-operated trash can from a big box store that has a removable plastic insert part so no wet bag needed either) for 2 days' worth of diapers, so that's how often we did laundry.  We used whatever laundry detergent we had laying around, which turned out to be a mistake.  More on that later.

We shopped around and just bought plain old washcloths from the big box store that were fairly thick since they'd get laundered a lot and in hot water with diapers.  For clean-up we just used plain water that we kept at the diapering station in a pump pot we rescued from my in-law's basement and the 70s.  Water stayed warm in there for about 24 hours which was nice.

The Kid started out little (7 lbs-ish?) and with a cache of freebie disposables, so we didn't start cloth until she was about a month old (3 weeks? dunno) and into pampers size 1 disposables (maybe weighed 8 or 9 lbs then).

When the kid started daycare full time at 6 months old, we found a place that would do our cloth diapers but without any dumping (silly state policy, that, since you're supposed to dump ALL diapers with poo in the toilet.. but I digress).  We found that we didn't have enough covers to have them be reused during the day at daycare so we doubled the number to 10 in her size.  Aside from needing a giant diaper bag, this all went really smoothly.  In time we bought larger covers and large prefolds.  For a bit when she was between sizes we double diapered with the smalls at night in a bigger sized cover.

At about 15 months old, the kid developed an awful yeast infection that wouldn't go away while she was in cloth but improved when in disposables, so we started ironing the prefolds after washing and machine drying.  That totally fixed it.  I also tried to get the diapers outside for some sun.  Maybe this was earlier and it was still winter, but in the decent weather I dried the diapers outside and tossed them into the drier with a small load of laundry to get fluffed because otherwise they were very scratchy.  Organic chemistry will sap your ability to remember anything else that happened during the class.

Then when the kid was 18 or 19 months old, we moved.  Our new daycare would take cloth diapers but after about 3 weeks, our provider offered to buy disposables for the kid to use because cloth was too much for her time-wise (prefolds add about 30 seconds to diaper-change time once you get used to them).  Since it didn't change our costs, we went with it.  However this meant that only 2-3 diapers got worn a day and diaper laundry didn't get done for too long (remember, we had 10 covers and 36 prefolds, so it was about a week before we got to the laundry once...oops...).  Our diaper pail grew a scary mold and the diapers all turned bright pink.  It turns out we'd been using a liquid detergent that had optical brighteners in it, and when there was mold (icky scary green fuzzy mold eeeeeew), it caused the chemicals left in the diapers to turn pink rather than reflecting white like they had been.  The majority of our diapers were now ruined, although the covers were salvageable (aside from creepy, the mold ate away a lot of the cotton too so no absorbancy was left even after washing). 

Then we switched to disposables for about 18 months and I hated it.  So many more leaks, so much trash (and if you think hauling stinky diapers down 2 flights of stairs and to the other end of the building to wash is awful, double the volume and weight and triple the smell to take diapers out to the trash).  We did cloth training pants and I hated it slightly less than having to keep buying those highly expensive disposable training pants, although being in cloth made zero difference in the kid's interest in potty training.

Moral of the story: cloth at home only will not work for us because we need to do laundry more often, and since we did diapers alone, it stopped being cost-effective to wash just 5 diapers at a time rather than 12.  Also don't use detergent with optical brighteners on your diapers (or maybe any other clothes).

For Little Monster, we are planning to do the same system because we've got all the wee baby stuff left in good condition and the bigger covers.  We have not actually talked to our daycare provider about this (yay she magically has an opening for an infant at the same time we need childcare for Little Monster! YAY! one daycare for two children!) but it's on the agenda for the next few days.  I'm thinking I'll get a couple of newborn-sized cloth diapers so we could start cloth sooner and because they are so stinking cute.  I'm actually thinking I'll try an all-in-one to see if I'm in love with it and want more (and then I'll pick up extra hours at work to cover this luxury).

The obligatory post-OB visit post

Despite me freaking out endlessly (with zero cause to be worried, really) in the days before this appointment, everything is fine.  I still haven't gained any weight (I actually lost a pound again this month after getting back to my pre-pregnancy weight the month before) but I'm measuring where I should and Little Monster's heart rate is totally fine.  It was all I could do not to cry after hearing it.

I did make a vague attempt to discuss the anxiety deal with the doc, and she was all "It's just hormones" and then I very nearly cried a lot, so instead of pointing out why I am pretty sure it isn't "just hormones" I focused on not crying.  When I got to my car afterward I cried for a few minutes, then for 10 more when I got home.  Clearly it's time to find a regular doctor and talk to her about this because at least this OB was too much in a hurry to be very concerned.  In the realm of entertaining, they had the depression scale conversion to diagnosis of severity posted right next to the blood pressure deal (I know it's a sphignomanometer, but who uses that word? Not even me).  So... good job posting it but bad job paying some attention or even doing the assessment on someone who cries even mentioning the subject (but maybe she missed that, trying to figure out how to work the computer).

Now I'm coping and hoping to avoid a proper panic attack by watching a rom com and eating too much candy (well, not really too much, but it's more than I should perhaps).

In the realm of thrilling, I get to repeat the glucose test again in 4 week, the Friday before finals. Yay!

What's a compounding pharmacy anyway, and how did all these people get sick?

You may have heard about the fungal meningitis outbreak that's happening all over the US.  At last count, at least 30 people have died and over 400 are infected (although not all have meningitis, some have fungal infections elsewhere that are still serious).  Its epicenter is a compounding pharmacy in Massachusetts that made lots of contaminated "sterile" injections.

There are a few things I think most people have no idea about, so I figured I'd explain.  And if there's stuff that doesn't make sense to non-healthcare/pharmacy types, leave a comment and I'll address that stuff too.

1) Why do we have compounding pharmacies? What do they do anyway?

Compounding pharmacies take various commercially-available medications and mix them together to prepare special prescription preparations for specific patients.  All pharmacies do some compounding, be they hospitals or community locations.  For example, one I've compounded a fair bit is a mouthwash for patients getting chemo.  It involves me getting a bottle of an antacid, benadryl, and lidocaine liquid from the shelf and mixing them as the doctor requests based on the needs of the patient (or the oncologist's favorite recipe).  Patients then gargle with the stuff and spit it out.  I saw this made in the hospital too, and saw the recipe for something similar at a long-term-care pharmacy (that's the pharmacy that serves nursing homes and other inpatient but not a hospital places like jails and group homes).  There are regulations about compounding on the professional level and states have their own laws and regulations too.  That basic mixing of commercial products that aren't sterile (not for injection that is) is much less heavily regulated than sterile compounding because it's much less dangerous if you do it wrong and because the products used usually have preservatives in them to prevent scary stuff from growing.  You have to use these in a timely manner though.

Sterile compounding is further split into high risk and low risk compounding (and you might add very high risk and medium risk to the list).  Low risk is what happens in hospitals most of the time when you make an IV - a sterile IV bag gets a single injection of sterile medication.  To make it safer we do this in an environment that reduces risk (a clean room) and wearing the full garb to prevent contamination.  For people who need infusions (that's IVs) often, home infusion pharmacies exist.

High risk sterile compounding is when you mix lots of things into one bag because there's more risk for contamination OR things getting injected into a place in the body with no immune system (eyes, spinal column/brain).  An example of this is a patient who can't eat or keep anything down who gets all their nutrition from a daily IV with all the nutrients added according to their needs (think pregnant folk with hyperemesis or people lacking a stomach).  Another high risk item is something that gets injected into the spinal column or an organ itself (epidurals, steroid shots for back pain caused by joint degeneration, stuff we use during open heart surgery).  Many of these products are made from non-sterile ingredients (think a jar of a powder that gets added to water) as well as sterile ingredients.  Because they are going into a place that won't tolerate preservatives, these products have to be made and then used pretty quickly.  It's also tough to get something to be sterile if you aren't using fancy, hard to clean equipment that's really expensive.

We have compounding pharmacies because of the shortage of commercial drug products that are cheap to make (especially injectables) and because commercial products don't work for everyone.  Some people are allergic to gluten so they need gluten-free medications made for them, others need a topical version of something (aspiring cream for arthritic elbows).  Drug shortages are a big part of why compounding pharmacies are making so many high risk things.  Cost is another factor.  If you use a brand name sterile product it can cost 10 or more times more than the compounded version that will do the same thing (but can't be identical because that's in violation of the brand name patent).  A good example of this cost factor is Makena, the progesterone injection used to prevent preterm labor.  It came on the market costing $1,500 a dose and patients need up to 21 doses (now it's down to $700 a dose) and you can compound it from the raw drug and sterile ingredients for more like $20-40 a dose.

We also have compounding pharmacies because it's hard for every pharmacy to be equipped to make all these sterile high risk products.  It's extra training, extra space, extra liability insurance that most places aren't big enough to afford investing in.  The tactic has been to find a large compounding pharmacy and pay them to make the high risk (sometimes medium risk or low risk things too) because it saves money in the big picture.  Big systems of hospitals and clinics often have their own compounding pharmacy or pharmacy that does compounding and other stuff, but hospitals and clinics without a big system to support the demand for one contract out.

2) How did all these people get sick then?

Because the compounding pharmacy in question wasn't following their own cleaning procedures within clean rooms and surrounding their equipment.  It's a pain in the tailfeathers to do all the cleaning required to make sterile products and it feels like you're cleaning stuff that's already clean all the time (but that feeling is a lie!).  Nobody was following their auditing procedure to check that the staff was doing what they were supposed to do.  Despite state warnings and fines, things hadn't improved and the board of pharmacy wasn't back to follow up on their progress.  If the state board of pharmacy had been on top of this, they would have probably closed this place down a lot sooner.  When you add in that one of the board members was CEO of this company, it gets stickier.

The compounding pharmacy was furthermore doing a number of illegal or at least very unethical things.  They crossed the line into manufacturing this steroid injection (and other products too) because they routinely made the injection, sent it out to various pharmacies and clinics, and then got prescriptions (if ever) from the doctors.  Manufacturing is making a bunch of a drug or drug product (the difference is that a product is a mixture of things) and selling it to pharmacies while never getting a prescription for a particular person.   Furthermore, they were shipping products to a variety of states without being licensed as a pharmacy in many (most?) of them.  To be licensed as a pharmacy in my state you have to be inspected annually by the state board of pharmacy.  Few states besides Massachusetts (maybe even none) had licensed this pharmacy, and yet they were selling drugs within the state.  Pharmacists also have to be licensed in each state where they work (so the national mail order chains license pharmacists either within a region or in all the states), and I'm not sure this place had licensed their pharmacists properly either.

In this specific case, some equipment was contaminated with a common fungus found in most dirt.  When it got into the steroid injections, it survived long enough to get injected, and with no immune cells to kill the spores, it grew and is inflaming brains across the country.

3) Do we need more legislation and federal oversight to keep this from happening?

I'm not convinced we need more legislation.  I think we need to work harder to fix the sterile drug shortage.  If you could just buy this steroid injection somewhere, most pharmacies and clinics would buy that rather than compounding it or paying someone to compound it.  We also need to actually enforce the best practices that we have on the books now and take serious (and timely) action when things are out of line.  It is important that we have compounding pharmacies because they fill an important role, and if we legislate about ALL compounding, even the non-sterile stuff that's done all over the place, we set ourselves up for a big headache.  Not all compounding requires the same level of oversight because not all of it is equally risky.

I do think we need a change in regulation from a state-based and state-exclusive system into one where we have a federal network of oversight (and licensing for all healthcare professionals).  Example: a doctor loses their license in one state, moves across the country, gets licensed there, and does something bad.  Or this lab tech who has hepatitis C and stole injectable drugs from hospitals (and using needles that got transferred back to patients) in several states, always getting caught and fired but because he wasn't licensed (why don't we license lab techs in every state?) there was nobody to report him to and no way to find out his history across state lines.  The same sort of federal-span oversight of pharmacies and pharmacists (and pharmacy technicians!) is also important for the same reasons.  When we confine things to one state we lose out on the big picture, so I say we let states keep doing their own thing but reporting to a national database that all other states have access to in real time.  If I'd been on the imaginary national board of pharmacy, I'd be inspecting extra often any pharmacy selling sterile products in multiple states because it's extra high risk and therefore needs extra oversight.  Because nobody knew this pharmacy was selling to so many states (as far as I can make out at least), nobody knew to look closely enough and we have an expensive and tragic scenario.

Turkey day!

Being American, this is a big deal.  Food, family, and football for an entire day.  Since the spouse's birthday is on/near Thanksgiving every year, it's a doubly big deal.  Last year we visited my family for Thanksgiving so it's the spouse's family's turn this year...

Only I really just want to stay home.  It's at least a 2 hour drive there and I hate the car and so does the kid.  I'd invite everyone here but it's the week before my first "real" final so I will be swamped and the week after a big deal for the spouse at work so we're double swamped.

To make matters more complex, the spouse is having a momentous birthday this year so I feel extra bad for potentially making demands not to go anywhere to see family, especially since it isn't my family we'd be skipping out on.  On the other hand, it isn't so far that the spouse's family couldn't come down to visit (they already have more times since we moved here than in the year we lived a half hour further away and were expecting the kid/had a brand new baby).  Why should I spend all my time traveling when I could spend it cleaning the house and studying instead?

On the other OTHER hand, we don't have TV.  We do own a TV but it's hooked into the video game system and sometimes a VCR and nothing else.  We get netflix and watch DVDs.  Staying home means no football :(  I'm not sure it would be Thanksgiving with no football.  I make sacrifices for school, and the loss of televised football is a big one for me so to have to wait until December sometime to catch a game on TV would be hard. #firstworldproblems

Laziness and house-cleaning or football and family?

In which I suddenly need an app for that

I own an iPod touch.  It's very shiny and takes pictures and everything, without obligating me to text or phone anyone.  Also Lego Harry Potter.  Just sayin.

It also has the capability to set alarms and remind me of things.  I do use this, a great deal, but up to this point for appointments and school things only.

Today I realized the time has arrived to add reminders for more basic things like taking my meds (I get to take Zantac twice a day so I feel human) and meals and snack times.

Just now I realized that I feel awful and shaky and weird.  Then I looked at the clock and noticed it's been 4 hours since I ate and probably that long since I had any water, and I also realized I never took my meds this morning so OF COURSE I feel like hurling and that a baby dragon is clawing at my stomach.  Duh.

So I'm setting some more alarms so I remember things like snack time and med time and soforth. I think I'll even include in the snack time reminders some healthy suggestions like "carrot time" and "go eat a salad already and you'll feel better."

Dear pregnancy brain,
Thanks for waiting this long to attack full force.  Now if you can confine your attacks to the realm of self-care, that would be amazing.  I need my brain for memorizing and synthesizing vast quantities of information that will help keep patients safe in the future.

Much love (you silly brain of mine, you),
Ms. Future PharmD