Friday, August 23, 2013

Quandry

Trigger warning: here's a discussion of pregnancy loss and probably rape. Feel free to skip this post if you aren't in the right headspace for it.

See? Lime Cat (who is more accurately wearing a pumelo) is not amused. Trigger warnings are serious stuff yo.

So in the realm of "awful things we get to do as the pharmacist," there are two or three that come to mind. One is telling someone how much their life-saving medicine will cost and then watching their face fall because it is too much. This one doesn't happen too often, and when it happens and the patient gets super mad but has a carton of cigarettes with them, I get a wee bit cynical.

Two is talking to a hospice caregiver who is just starting out with hospice. The caregiver is stoic but has a deer in the headlights look the entire time. It is a lot to switch mindsets from "s/he will get better" to "s/he will die soon but comfortably."

Three is a rape victim who hopefully is getting the full rape STI prevention cocktail and not just looking at the Plan B shelf in a terrified manner. The only part of having it sitting out on a shelf that worries me is these ladies, who really need a referral to the victim support system in the area (and yes, probably the Plan B as well). If they can just cower and grab the thing off the shelf, how will they get that referral to get a rape kit so the bad guy gets caught? That cocktail of meds has a number of serious side effects and it's a lot to keep track of it all (some are taken four times a day for quite a long time).

And fourth is the woman getting medicines for dealing with a miscarriage. I haven't had this one happen while I was working yet but I would totally cry while explaining the medications. I will. I suppose that makes me more personable or human and not healthcare mystic than anything I could say.

So, dear readers, what would you want to hear from your pharmacist if you were in one of these positions? If you have been there, what insensitive thing did someone say that could be avoided? Today one of my classmates is curious but I am too. I can share my experience with loss a tiny bit and my experience with hospice and affording meds as well, but the rest? Maybe you all have some ideas. Maybe my brain is just too tied up in dosing vanco right now to think this through.

What do you wish you had heard from your pharmacist? What would you like to hear in the future? About any sensitive and icky topic, IVF meds included for sure.

Wednesday, August 21, 2013

PAIL monthly theme: feeding babies

  • How did you feed your baby?
    • Primarily breast milk at the breast with the first one and even moreso (so far) with the second. Bottles while at daycare as one might imagine, except that time my pump got stolen and we couldn't afford one for a week when I snuck over to daycare instead of eating lunch myself to feed the baby. It was miserable.
  • If you exclusively breastfed your child, how long did you do it? Did you have a “goal” for length of time, or did you just wing it?
    • The goal with the kid was a year and she was sick when we got to a year so we plugged along at it until 13 months when I was done. So done. I needed the 2.5 hours a day back to study for finals. I think she would have been happy to continue, as would I except for the horrid pumping. Ugh pumping. Now? My goal is next week and maybe as long as October and then we'll see.
  • If you formula fed, how did you choose the formula brand? What are your suggestions for finding the best brand for your child?
    • In my dream world, we could switch to formula whenever it suited us so I am super curious about this. In the real world, I have to fight to continue nursing until at least a year or close to it so Little Monster can then transition to other sorts of milk.
  • Did you research breastfeeding prior to your child(ren)’s birth?
    • Yes. I took a class that was me and the educator and mostly weird, I read the La Leche League book and was tempted to throw it at someone who wrote it for the minimal information on how to pump and still nurse and the shaming of non-stay at home moms. Ugh.
  • Did your method of feeding your child(ren) differ from what you had hoped/planned to do? How did that make you feel?
    • That is a complicated question. I'd hoped that nursing would go well. It did eventually for the kid (we hit our stride at 4 months or so) and immediately with Little Monster, but I really don't like nursing. It is just uncomfortable for me. I would have loved to nurse for 6 months and then try to transition to formula this time (and it could be the thrush talking, but probably not completely). Yep I am selfish but I just don't like adding to my discomfort level all the time. We've had our latch checked and it's great, it's just me and presumably that awful Raynault's. I guess it makes me feel super ambivalent about the whole thing. Maybe if nursing felt like a choice rather than a desperate grab for a way to keep the baby fed without bankrupting the family it would feel different.
  • If you worked outside the home during the first year, how did that affect your decision?
    • Most of the time I was in school after the kid turned 6 months old I really wanted to be done pumping. Every day I wanted to be done. I was so glad to have a group of ladies with teens who had nursed their babies who cheered me on, visited with me while I washed pump stuff in the bathroom, and were just awesome. This time, no cheering section but I've been home much more. We'll see how things go in January when I'm back in school full time.
  • What would you tell an expectant mom about the realities of breastfeeding & formula feeding? Is there something you wish you’d have been told?
    • I never know how to react to the non-rude but turn and walk away because I'm nursing people. Mostly I ignore them because it's about them and not me. The other thing I wish I'd known about nursing was just seeing more women actually holding babies who were eating. Positioning is something people can tell you about and diagram, but until you actually see the baby in action, it's hard to figure out properly. That's why I nurse Little Monster everywhere we get the chance without a cover. Someone is watching and needs to learn what's going on. I suppose now that YouTube is a thing, you could find some good videos to remedy this. Our internet before the kid was born was a dirt track to the internet super highway so videos weren't really an option.
  • Do you feel your “preferred” method to feed your child was affected by how those around you feed their babies?
    • No because we still know very few people with babies. Also yes a little bit because my in-laws get up and walk out of the room if the baby is nursing. Being supportive in word is fine but it's weird to be talking, the baby starts yelling, and then suddenly she and I are alone because she's eating. I often strategically fed the kid before we'd visit so we didn't get walked out on too often. My extended family is totally unimpressed and ignores nursing because it's a normal part of life and totally not worth commenting on.
  • How much (in your estimation) did you spend on feeding your child for his/her first year of life? (pumping supplies / formula cost / lactation consultants / etc)
    • First pump: about $65 as insurance co-pay
    • Second pump: $250
    • Nursing bras: $140
    • Spare pump parts: about $60 (across both kids)
    • Bottles: about $50 with the kid, about the same with Little Monster because in the 4 moves in between their births the bottles all vanished. Arg.
    • Lactation consultant: Free and paid for by a grant the first time, free and paid for by the hospital the second.
    • Milk storage box: $8
    • Milk storage bags: about $20 for 120 of them
    • Total so far: $643
  • How did the transition to solids go?
    • Well... not so awesome. We made purees for the kid and she was never that into solids after the purees. Even things she loved as purees she loathed 6 months later as solids. It coincided with us being broke and not having the healthiest options available to us, so the kid doesn't eat all that many veggies or fruits or meats or anything besides her favorite selection of about 10 things. She refuses to try new things.
    •  Since we are trying again with the second baby, we are just doing baby led weaning. It's easier for everyone and it is making the kid nominally more interested in trying new foods to either set a good example for the baby or because it looks appealing once the baby has it. This is going wonderfully well and we will keep it up.
    • I have also decided not to panic about allergies because... well, why? All of mine were adult onset anyway so there's limited risk of the baby having any at all. Plus we are savvy and can easily assess if there's been an allergic reaction as we are seasoned parents of an allergic kid (please FSM no really scary reactions. Hives I can handle but more? Eeeep).
    • We are about a month into baby led weaning and everyone is happy with it, aside from the baby who gets thirsty with her meals and then has to wait to nurse. We also don't have a proper high chair and Little Monster doesn't sit up on her own just yet so the booster means a lot of tipping over and fussing.

Monday, August 19, 2013

The proper time to panic

I am starting to be concerned about this semester. Or, I have considered that now might be the time to panic. Granted, this is the hardest material in all of pharmacy school but my brain hurts a great deal after every lecture and I am less coherent in non-school related conversations than usual. Example: typically by the end of the semester, unless you are asking me something about a specific drug or treatment regimen, I have trouble putting together a sentence that includes all the words. I often lose one or more and then have to explain it. In the last few days though I have moved up to calling the girls by the wrong name about 30% of the time, lost the word for lunch and pizza (and probably more things, but it's really amusing to try to talk around those two. Me to spouse: "You know the food that happens about this time of day and it usually isn't the same for me and you because you eat nasty lunch meat and I eat something else and now I am hungry but the baby is eating and I can't think of the word for this? Could you help?"), and just felt overwhelmed by everything. Usually it takes a few weeks or even until after midterms to get to this level of absolute brain redistribution (that is, all brain for pharmacy school and zero for everything non-essential, and what is essential dwindles as finals approach toward sleep, study, caffeine).

Some of it is that we got a new learning management system so all of my class materials are hidden in new places in an interface that looks funny and doesn't organize things the same way at all. It triples the time it takes me to prepare for a lecture because I can't find the files to read and the textbook assignment is in page numbers and my e-book seems to have forgotten page numbers exist and soforth. It amuses me that while I like new tech, I hate having to adapt to it and it frustrates me until I've gotten to play with it enough that I know what I'm doing. I hate it doubly much when it is misbehaving and I know it but I can't make it stop.

I'll also add that I keep coming home and looking at the living room and thinking, "At any moment Little Monster will be mobile. She rolls but hasn't realized she could roll more than once, she bounces in crawling position and spins but doesn't quite crawl. Yet. At any moment..." and wondering how to keep the kid's tiny toys away from her and how we will ever barricade the TV and other cords and it overwhelms me very quickly. I just don't even know where to start. Probably with toy removal.

To boot, I have had what I suspect is a lingering very angry cyst for the past 2 months and I got fed up and saw my OB. Who is leaving. Just like every other doc I've seen in the past 10 months who had been with the clinic less than a year (so about 5 in a practice of around 35). Sigh. Anyway, it's the usual round of tests and trying to fix things. I am pleased that my doc was all "and let's check your thyroid because your hair is dwindling" without me pointing it out and asking "so... do we check my thyroid too?" Which means I am somewhat seriously considering getting a wig made with what's left of my hair for when it is all gone because it must be that noticeable to everyone else. Today's exam included a student (resident? I wasn't really paying attention) so I got double manual inspections and it hurts triple much as a result. OW. Hopefully it is a cyst and not scar tissue or some other ugliness. Endo folks, how did you get a diagnosis? I'm very pleased to know that it's PCOS but if it's also something else, I wanna know now so I can get this as fixed as possible.

And I suppose at this point, I am just trying to stay as close to caught up as possible at everything while still putting the computer away from 4:30pm until after bedtime. I think I may suddenly lose even more sleep this semester than the average person with a baby and professional school (and really, does that person exist? Doubt it.)...

Of course, there's the bonus stress of the spouse's career crash and current unemployment. It mostly looms beneath the surface at this point. I hate uncertainty and mystery and indecision and that is where we are. When you crash your career with one wrong move (since that's all it takes in this industry and that also makes me nuts... but it isn't my industry so I should just let it go...) it is hard to think of what is next and what should be next and what you'd like to be next. Hates-moving-so-much kid adds to the stress. Before we would just have moved for work and gotten over it, but now? Now we will try to move just once more, possibly ever, probably to at most one more community. That probably means following my job and that means a holding pattern until I have one. In 2 years or a bit less. Sigh.

For family movie night, I'm going to demand we watch Hitchhiker's Guide to the Galaxy this week because I need a 100 minute reminder not to panic. Assuming I have a hundred minutes to spare from studying. Sigh.

Friday, August 9, 2013

Everybody's baby

One of the weirdest and most unexpected things I've discovered about being a parent is how willing I am to let other people into the baby's space. I'm pretty introverted, but the kind of introvert who likes to interface with people well enough to be willing to do it all day. I find my solitude in brief moments in a wild space where everyone is chattering and that's fine with me.

But as an introvert, if I'm just out in public, I want to be left alone for the most part. Saying hi is fine as we pass, but absolutely no mini-conversations. When I lived briefly in the South, there was this "How yall doing today?" conversation that just made me want to hide (and move back north where no chatting was required) that went like this:

"Howdy. How yall doing today?"
"Good and you?"
"Just fine, thanks."

It happened maybe 15 times a day, just as you passed someone around in the world in any old place, with any old stranger. Loathed it.

The entertaining thing is that now the person doing this annoying chatting thing is my spouse. Sigh.

Anyway, I had figured that as a very private person who is pretty ordinary looking (aside from my awesome eyebrow) nobody would be interested in my baby and now baby and kid. I had expected I'd keep people away from any baby because babies were private property, right?

Wrong!

We have adorable, giant eyed babies and the one with hair has curls that are too cute (and seem to be going away now that she's 5 and has had her hair cut). Everyone wants to look at them. Everyone has to stop us and coo and remark on how adorable and all that jazz. It is amazing to me how interested people get in this baby particularly, although that's probably because she is out and about much more than the kid was as a baby born in a harsher winter. I will say the repeated comments are a bit demoralizing and overly Aryan (would you be complimenting my non-pale baby for being so cute? Hmmm...) but otherwise, I don't mind.

Our faith community regularly passes Little Monster around. I'd say on any given meeting day, at least 5 and often 10 people have held her. She is a popular baby (by virtue of being the only baby around) and a social baby who likes to smile at everyone, especially if they have glasses or gray hair like Grandma. We walk in the mall sometimes and every time we run into someone wanting to peek at the baby and exclaim at how cute she is and how we've made hir day.

The surprising thing to me is that it doesn't bug me at all. I am totally willing and happy to pass the baby off to whomever, whenever. I had no idea that I'd be fine toting around everybody's baby.

Example: at the playground, some girl, maybe 7 years old? 8? comes over and asks if she can hold the baby and with zero hesitation, I pass her off. Yes, I stayed fairly close by but I let a total stranger hold the baby for 20 minutes or more. Honestly I stayed close because the baby was fussing if she couldn't see me (this may be a hard phase).

A friend's mom died not too long ago, so we took the baby to the funeral on the premise that babies make funerals easier for everyone, especially if the person who died was old. She acted as a sort of therapy baby and was hugged and cried on by several people and enjoyed by all.

I am so glad that I have this chance to let every random stranger paw at my baby. That 5K we did last weekend? It supported a local organization that helps families dealing with the NICU, baby loss, or extended antepartum hospitalization. It's a great group that's doing lots of cool things. It was very moving to spend the morning with families who have survived the NICU, and with the full range of outcomes. Several kids had trach holes and g-tubes. One of the various bits of swag we got was a bottle of hand sanitizer on a clip that you could attach to your stroller or diaper bag, and I saw that a great many of the strollers and diaper bags were already outfitted with them.

I get to be grateful and enjoy having everybody's baby. It's humbling to remember that not everyone has a baby who can be passed around with ease and to remember to parent the baby you get, not the one you expect to have. This extroverted baby? Clearly accessing some recessive genes in her parents, and being stinking cute flirting with the old folks.

Thursday, August 8, 2013

Winning!

So I have mentioned my goal of getting into shape. I have probably mentioned that for me, the scale isn't the goal. I'm setting "doing things" goals to stave off scale obsessions. So far, that means being comfortable walking a 5K without dying or being in agony. It's a huge accomplishment for me even though I'm sure it's small potatoes for city people and athlete types. 

Today was my first non-scale and non-athletic victory. I fit into a beloved clothing item again! It's just a sweater type deal but it fits properly again! Squee! It's also a really good thing it fits as currently the spouse and I are experiencing seasonal imbalance  issues where I am cold and zie is overheating, cranking up the fan or AC or both. I've concluded the only thing to do is to move somewhere very cold so I can wear fabulous sweaters all the time and the spouse can keep wearing shorts but never again need an accursed fan. Or at least that will work until either the glaciers all melt or new ones form en masse, which I'm hopeful will take a few years. 

Baby steps! Tiny victory! Now I had better get back to reviewing everything I've ever learned for this semester's ├╝ber class, reading 2 books and 10 articles for the first class of the semester, and that new exercise regimen. Plus feeding Little Monster solid food twice a day and helping her practice scooting and sitting up, and preventing cat attacks on the girls. 

Sunday, August 4, 2013

Oh the torture: pumping part 1

I don't think many people talk about the nasty part of working/going to school and nursing a baby: pumping. It is unpleasant at best and just awful at worst. (and hey, this has been lounging in my drafts for weeks and weeks so it's an amalgam of pumping with full time daycare and pumping with just long-term stockpile in mind).

So let's talk logistics of pumping, since that isn't super widely discussed. For me it means that I have about 3 dozen 2.5 oz bottles in rotation with about a dozen at daycare, a dozen clean or in the wash, and a dozen in my deep freeze. This puts me an average of 3-5 days ahead of need (at 4 months it did, anyway) so everything gets deep frozen before going to the freezer at daycare.

I pump when the baby wakes up and eats in the morning (one side, about 30-40 minutes depending on everyone's patience). Then I pump both sides about 2 hours after they leave for daycare (9am), 2 hours after that, and then about 3 hours after that but for 20-25 minutes instead of the typical 30ish minutes (2-ish) when we picked the girls up from daycare at 4pm-4:30. On the weekends I just pumped that first time in the morning, and post-daycare, I am (after a pumping break because I loathe it) back to this as well.

I have heard that keeping a set of pump attachments in the fridge all day works well to reduce the amount of dishes you wind up with, but because of what's presumably Raynaud's, it isn't an option for me. The cold added to the pain in a big way. 

As far as storage goes, here's a picture of my freezing prep.

I keep 2-3 days' worth of milk in the fridge in whatever volume it was pumped (bottle with no sticker since I group each day's bottles together, oldest on the left) and freeze it only in the 2.5 oz bottles or 5-6oz bags. This makes the math simpler for me since the baby eats either 2 bottles or 1 bag of milk per feeding & eats 3-4 times a day at daycare. 

We use the Total Baby app at home and we also used it at daycare to track what Little Monster was up to. Not having a paper report helped us immensely because we'd never find the thing in the bags of cloth diapers & 5 year old debris plus it meant we could match up milk inventory easily. The app syncs across an infinite number of iDevices and can be backed up to the computer. I don't add milk to the inventory in the app until it gets frozen because I never know how dates will get combined and it keeps me from obsessing about how long I'm pumping and if I'm getting enough and all that jazz. We arranged that all milk listed as in the freezer was at daycare and in the deep freeze was at home so if our daycare provider wanted to time a thawed bottle it was easy to find on the list. 

For labeling bottles I use garage sale stickers and put just the date since daycare didn't require a name as well. I keep a pen with the stickers in my milk pail above the fridge. The pail gets used for setting a bag in as I pour a measured 5 or 6 oz into it so if I spill it's easy to clean up. The Lansinosh bags have worked well for us so far although we haven't thawed many. I like the label space above the body of the bag. They also fit into a playing card box with some dividers out (you'd buy one from a comic/games shop, it holds 3200 cards, and we took out 2 dividers. Think the thing cost about $8 but it's priceless for saving on freezer space and potential messes.) and that makes storage really nice. Here's a picture of it, for your reference.
Notice the real sized card and the comically large card. The label folds above the zipper part so I don't worry about the box causing leaks. Bags are frozen flat elsewhere in the freezer then added to a box.

I have 3 full sets of pumping stuff so I only wash one side's worth during the day by hand & dishwasher the rest. To pump into I have 9 bottles that are 5 oz (plus another few that advertise Medela) and 3 that are 9 oz for use only in the morning when I occasionally get over 6 oz of milk. Also the big bottles are easier to maneuver when pumping while nursing. None of these came with lids so I bought some of these. I've also pitched the 4 oz BPA laden bottles that came with my pump (5 years ago) so I gained some 2 part lids there too. I don't freeze bottles with the 2 piece lid because they are big and don't store well (plus I suspect they leak). Did you know so many bottles had standard necks so you can pump into almost any old regular bottle?

I should add that I have an Ameda pump (in style, no less). It's slick to go from batteries (less suction than plugged in or using a car adapter) to car to electric outlet and back, plus it has a closed system. Maybe it's just me, but I sometimes pump too much into a bottle and milk backs up into stuff and with this pump, unlike the Medela single electric I had (same parts as the common ones, I think this thing doesn't exist anymore) no milk gets into the pump itself. That's what a "closed system" means. PLUS the Medela custom size flanges fit into the horns that come with it (while the custom size flanges made by Ameda don't fit tightly at all) so you can get a wide range of custom sizes to fit you exactly. I have two different sizes so it is great to get a tight fit and be more comfortable pumping. Also if you buy the Ameda pump and need a non-25mm size, don't waste your money on their custom size sets. The inserts don't stick tightly enough to pump successfully. They do make decent funnels for mixing up powdered drinks that need to go into a bottle with a narrow neck (hey... or formula would work too... hmm...).

While I pump I usually listen to an audio book or watch TV. I almost always can set up my computer nearby so I play a slideshow of baby pictures to help with let-down. If it's an awful day pumping I watch videos of the baby too so I can hear her chattering. In the realm of TMI, I have one side that produces more milk and yet is really hard to pump from, so if I'm pumping and nursing, baby gets the bad side. It's where I've had mastitis all three times too. I also have a milk duct that randomly empties an inch from where it should so that's part of the problem and ensures I get wet every time I pump. I actually keep a cloth diaper in my pump bag that I wedge in the bottom of my bra to protect the rest of me from sogginess. 

Now that we aren't doing daycare I pump only the one side after a long sleep (4+ hours) and try to get 5 oz to freeze in keeping with the system. This means after she eats, the spouse puts the baby back to bed. Usually she sleeps a bit longer but it can be 20 minutes of rocking to get her settled so that gives me the chance to finish pumping and everyone is back asleep at about the same time.

Anyone have any questions about pumping that I might answer? Part 2 is going to be travel logistics and stuff I accidentally forgot to mention.

Friday, August 2, 2013

Project dream catcher: redefined

So I set myself a pretty big primary goal of running this 5k tomorrow. 

An then I didn't much talk about it again because things went so far from the plan it was amazing. I had these nice steps and a good plan and it just didn't work out. 

In the beginning I thought I might have average fitness, where a little jogging wouldn't be a big deal. I figured I would hurt but it would be all right in a day or two. As it turned out, I was vastly overestimating the shape I was in. During my first work out, my leg went numb after about ten minutes and took over an hour to come back. The circulation seemed to be lower than normal too. So I decided I needed a new goal, one I could reach. Since my family decided to come walk in the 5k anyway, it was an easy choice to train instead to walk the 5k. I am improving a lot and the numbness is decreasing so that's good. It could be that we are walking outside where there's no AC and fans to cause trouble. It could just be that my body is more used to moving and walking long distances. 

This week I got convinced to start going to water aerobics 3 days a week so we are doing that too. Even though I can't swim it's a good work out and isn't irritating anything like walking/running does. 

So I'm really excited about this 5k tomorrow. We didn't do any fundraising but I'm happy enough just to participate. Monday I will look at the calendar and plan the next 5k for about 3 months from now with the goal of actually running in that one. Baby steps seem insignificant but they are progress and every step forward is something. 

I'm really glad to have had the encouragement to pursue such a big goal and although it got scaled back, the dream is caught and I am going to get there. In time. That marathon after graduation is inching closer and I want to be ready in just shy of 2 years to finish what I've got a good start on already.