Sorry to disappear from the blogosphere for such a long time. I've just been a wee bit busy here. When I posted last, my partner was off on vacation, I was on call, and my blood pressure was teetering on the borderline. I made it through the first week of OtherDoc's vacation relatively unscathed. I had lots of clinic patients, but the deliveries remained somewhat manageable. I, on the other hand, was feeling pretty drug out and worn down. (Wonder why?) At my 38 week appointment, my OB was on vacation as well, so I saw another physician in the practice. My pressure was 148/89, my cervix was closed (surprise) and my NST looked great. I got the lecture about taking it easy (yeah, right) and I had to repeat the dreaded labs and 24 hour urine protein. I saved that joy for the weekend. I collected on Saturday and turned it in on Sunday when I went in to round on patients.
I'm not sure if this is a coincidence or not, but on Sunday I admitted and delivered a severe HELLP patient of mine. She had no preeclampsia, only HELLP, and she got really sick really fast. She came in complaining of upper abdominal pain. Her labs were just mildly bumped at that time, but she was term with a favorable cervix, so we began Mag Sulfate and started the induction immediately. Luckily she delivered within a couple of hours. Then the fun with labs started, her liver enzymes soared as her platelets plummeted. The platelet count nadir was around 40,000, just shy of needing a platelet transfusion. Luckily, with the help of Dexamethasone, she turned the corner and recovered very quickly. She was able to go home on her 3rd day post-partum. Later that day I checked my own labs. No signs of HELLP, but my 24 hour urine protein was solidly in the mild preeclampsia range. Knowing that my time was limited, and in anticipation of having the smackdown at my Wednesday afternoon appointment, I attempted to stack my schedule for Monday, Tuesday, and Wednesday morning.
Monday was an absolute blur, lots of clinic patients, charts, and 3 inductions, not to mention my sick HELLP patient. I was waiting on a delivery (around 5:30) when I got a phone call from my physician at labor and delivery. Uh-oh. It turns out that he had been looking for my labs, and when he saw the 24 hour urine protein, he was compelled to find me and tell me to stop working...pronto, and to pick a day for induction. Eeek. I immediately flashed on how sick my patient had gotten in such a short time, and I knew that it was time to start taking care of me. He sounded like he meant business, so I immediately called the back up covering physician, who was wonderful and told me not to worry about him covering my patients, even though I had stacked inductions and sections for the next few days. I then made out an extensive check out list and did the final delivery ( a rather difficult vacuum, at that). Then I went to see my patients that I had scheduled for induction and explained that I had been pulled from work by my own physician and would not be attending their deliveries. Then I cried, in front of the patients, and felt like an idiot. Both women were very understanding. I finally got home around 11pm, cried some more, and felt like the weight of the world had finally been removed from my shoulders. Tuesday I did absolutely nothing but sit and catch up on my patients via computer. Wednesday I (finally) packed my hospital bag and prepared to go to my appointment. Little did I know how important that would be....
To be continued...
Tuesday, July 31, 2007
Sunday, July 08, 2007
The Home Stretch
It seems as though, in these last few weeks of pregnancy, I should be surging toward the finish line with my last burst of energy...stretching forward and extending further than ever I have before. In actuality, I find myself barely limping (literally, stupid sciatic nerve pain) along, dragging my feet, and procrastinating the whole way. I haven't packed my hospital bag. The nursery really isn't ready. I'm really not mentally prepared for this new arrival, and yet I find myself hoping that he's getting here sooner than later!
Sorry for the long silence, but as per usual, I've been busier than ever at work and at home. I am covering call for my partner, as he is taking his annual 2 week long vacation (if this doesn't put me into labor, I'm not sure what will). We've had visitors for the last 3 weekends in a row, and while wonderful, it has been exhausting. I wanted to thank each and every one of you for all of your helpful comments, well wishes, and hints about flipping my stubborn breech baby! I promise, I've not been holding these comments hostage, rather, I've just not had a chance to get them all published until today. First of all, I did check the website to find it to be the same one I've directed patients toward in the past, I did do the knee-chest reposition manueuvers, the inclines were just too much blood rushing to my face, and I didn't have immediate access to a swimming pool deep enough in which to do handstands (without embarrassing myself at the public pool by having my stubbly legs waving about in the air, that is), but I did suspend my belly between two rafts in my daughter's oversized wading pool. I did not do moxibustion. I wasn't really sure where to get the candles and wasn't certain enough about the technique to order them from the internet. I barely have time to make my own OB appointments, so seeing a chiropractor was not a real possiblity, although I do have patients that have had success in this arena. As far as visualization/hypnosis stuff, I think it ended up more like begging, pleading, and cajoling the Bean...pleeeeaaaassssseeee turn around, c'mon, I'll buy you a pony, etc. The fact of the matter is, I don't think any of the traditional techniques had one iota of influence on my stubborn child. The evening before my second ultrasound, I could palpate his hard head right below my ribcage, and I had resigned myself to making the decision for version or elective section (because I am too a'skeered of the risks associated with vaginal breech births). Then, my 20 pound girlcat took matters into her own paws. She leaped upon my belly, positioning herself directly over the caput of my stubborn son, and proceeded to activate her very loud purrbox. She hatched my belly and purred for about an hour, and boy, did the baby respond! He wriggled and kicked like crazy, it was, at times, almost painful, but after that hour, I could no longer feel his head in my upper belly. The ultrasound the following day confirmed that I had, indeed, had a successful cephalic version via kitty, and vertex he has remained ever since. So much for traditional methods of flipping breech babies! If I were to try to rationalize why this worked when nothing else did, I guess I could say that it is close to vibroacoustic stimulation like we use to "wake up" sleeping babies on non-stress tests. Who knows? All I know is that he is now vertex, and getting way too chubbly (hopefully) to turn back around now.
As for his estimated weight, a good 7 pounds as of a little over a week ago, of course I'm taking it with a grain of salt. The limitations of ultrasound in predicting weight accurately in the third trimester are not lost on me, but what woman doesn't cringe a bit thinking about the possibility that, indeed, the measurement is closer to correct than not, or, worse still, is off by a pound in the positive direction? I'm trying not to think about it too much and trying to trust that I don't feel like I'm carrying an almost 8 pound kid at this point. We shall see. My BP has been holding steady 140s/80s, no protein, normal labs. I even lost a pound this week. (Whee!) This next week, we are going to try to take professional belly/family photos, so I must find some inoffensive similarly colored shirts for Mr. Whoo, CindyLou, and me. We have a to-do list a mile long. I thank you all once again for checking in on me and all of the encouragement. Now I must get into the hospital to round (I've started to deliver some patients whose due dates are *after* mine, and there is very little in my life as an OB/GYN that is more discouraging than that!), continue to wash baby clothes, and maybe, just maybe, pack my own hospital bag. Just like a real pregnant person.
Sorry for the long silence, but as per usual, I've been busier than ever at work and at home. I am covering call for my partner, as he is taking his annual 2 week long vacation (if this doesn't put me into labor, I'm not sure what will). We've had visitors for the last 3 weekends in a row, and while wonderful, it has been exhausting. I wanted to thank each and every one of you for all of your helpful comments, well wishes, and hints about flipping my stubborn breech baby! I promise, I've not been holding these comments hostage, rather, I've just not had a chance to get them all published until today. First of all, I did check the website to find it to be the same one I've directed patients toward in the past, I did do the knee-chest reposition manueuvers, the inclines were just too much blood rushing to my face, and I didn't have immediate access to a swimming pool deep enough in which to do handstands (without embarrassing myself at the public pool by having my stubbly legs waving about in the air, that is), but I did suspend my belly between two rafts in my daughter's oversized wading pool. I did not do moxibustion. I wasn't really sure where to get the candles and wasn't certain enough about the technique to order them from the internet. I barely have time to make my own OB appointments, so seeing a chiropractor was not a real possiblity, although I do have patients that have had success in this arena. As far as visualization/hypnosis stuff, I think it ended up more like begging, pleading, and cajoling the Bean...pleeeeaaaassssseeee turn around, c'mon, I'll buy you a pony, etc. The fact of the matter is, I don't think any of the traditional techniques had one iota of influence on my stubborn child. The evening before my second ultrasound, I could palpate his hard head right below my ribcage, and I had resigned myself to making the decision for version or elective section (because I am too a'skeered of the risks associated with vaginal breech births). Then, my 20 pound girlcat took matters into her own paws. She leaped upon my belly, positioning herself directly over the caput of my stubborn son, and proceeded to activate her very loud purrbox. She hatched my belly and purred for about an hour, and boy, did the baby respond! He wriggled and kicked like crazy, it was, at times, almost painful, but after that hour, I could no longer feel his head in my upper belly. The ultrasound the following day confirmed that I had, indeed, had a successful cephalic version via kitty, and vertex he has remained ever since. So much for traditional methods of flipping breech babies! If I were to try to rationalize why this worked when nothing else did, I guess I could say that it is close to vibroacoustic stimulation like we use to "wake up" sleeping babies on non-stress tests. Who knows? All I know is that he is now vertex, and getting way too chubbly (hopefully) to turn back around now.
As for his estimated weight, a good 7 pounds as of a little over a week ago, of course I'm taking it with a grain of salt. The limitations of ultrasound in predicting weight accurately in the third trimester are not lost on me, but what woman doesn't cringe a bit thinking about the possibility that, indeed, the measurement is closer to correct than not, or, worse still, is off by a pound in the positive direction? I'm trying not to think about it too much and trying to trust that I don't feel like I'm carrying an almost 8 pound kid at this point. We shall see. My BP has been holding steady 140s/80s, no protein, normal labs. I even lost a pound this week. (Whee!) This next week, we are going to try to take professional belly/family photos, so I must find some inoffensive similarly colored shirts for Mr. Whoo, CindyLou, and me. We have a to-do list a mile long. I thank you all once again for checking in on me and all of the encouragement. Now I must get into the hospital to round (I've started to deliver some patients whose due dates are *after* mine, and there is very little in my life as an OB/GYN that is more discouraging than that!), continue to wash baby clothes, and maybe, just maybe, pack my own hospital bag. Just like a real pregnant person.
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