Old News: Past Blog Posts

Wednesday, January 14, 2015

Back in the Saddle

It didn't seem like a good omen when I couldn't find the spinning room at my gym. The room I had been accustomed to teaching and attending spin classes was mostly vacant, spare for a few giant tires and hefty ropes. Those damn cross-fitters had apparently pushed themselves into even the darkest corners where we had previously hidden the gym's red-headed step child they call group fitness classes. Finally, I opened the correct door (ding, ding, ding!) and was pleased to find an even better version of our old spin studio. 

Disaster averted. 

I breathed a sigh of relief, pleasantly surprised to find that even my cycling shows had made the transition to the new space unscathed. I shed my winter garb to expose my ill-fitting workout attire and instinctively climbed onto the instructor's bike at the head of the room, facing two wide rows of empty bikes. I turned the lights off, save two weak rows of rope lights along the side and back walls. There was a brief moment of gratitude that the room is free of mirrors as I started the music. 

My hips felt immediately too wide for the seat, my butt bones (ischial tuberosities) struggled at first to support and balance the weight of my expanded ass. Quietly, I gave this foreign body basic instructions on leveling the pelvis and dipping toes slightly to connect with the pedals. It was a struggle, but eventually I was able to ignore the uncomfortable sensation of my thighs connecting with my flopping belly with each pedal stroke. 

I settled into the music and coached myself to keep with the pace. The first few tracks, I found myself bombarded with excuses that have been offered so readily by others over the last few weeks.

t took me six months to get back to the gym after my c-section.
Take it very slow.
Don't push your body.
Be careful not to overdo it.
I tore my incision doing housework. (WTF??)

These thoughts clouded my brain and slowed my speed (oh shit, what if my incision busts open?) until I remembered the only advice I should really concern myself with: listen to your body, it will tell you when you're overdoing it (my doctor/the man who sliced me open in the first place).
The sensation I felt on that bike wasn't pain. It wasn't the sharp unzipping sensation I'd felt early in my recovery when I walked too fast or moved wrong in bed. What I was feeling was good old fashioned fatigue of both the legs and the lungs; the unavoidable affects of months of inactivity. All normal. All okay. All totally understandable and completely manageable.

By track 2, I was more relaxed. I nodded and spit some banter at the bike in the back left corner, dedicating the next climb to it's invisible rider. I winked at the center bike. The dialogue I typically bring to my classes played along in my head as I challenged them (me) to give just a little more and push just a bit harder. I assured them (me) that they (I) could do *anything* for 30 seconds (so sprint dammit!!). I smiled because I was unwrapping a part of myself I thought might have been dead and gone, and because I probably looked like a lunatic. 

Track 4 left me feeling exhilarated, like I could kick this workout right in it's good-for-nothing pants without giving it a second thought. By the end of track 5 however, I was begging myself for mercy and wondering if I shouldn't just pack it up and go back home to my sweatpants and maternity tops. With only two more 'working tracks' left, that seemed a little silly, so I put my big girl pants on (which are significantly less comfortable than my sweatpants) and powered through the next two songs, falling a few beats behind at times and easing way up on the resistance. 

When the cool down was done and the stretching was over, I mopped my bike and face with a towel and squeezed back into my workout jacket. The damage that my body incurred over the past 8 months suddenly seemed less debilitating and way less permanent. Sure, the hips will stay wide and wobbly in the saddle and the belly will flop around for a nice long while, but my determination and desire haven't suffered more than a few bumps and bruises. They have lived to fight another day. 

And they will. 

Therapy Walk

(Written 1/9/15)

I should probably admit I've always secretly been a bit of a snob when it comes to walking for exercise.  Secretly. See, I tell my patients it's great. Top notch stuff. And I totally mean that...for them. For me, if I'm not huffing and puffing and moving faster than the next guy on the trail, then what the hell is the point?

Cue almost eight months of doctor-advised sedentary living during my recent high risk pregnancy. I replaced morning runs with greasy, calorie-packed fast food breakfast. Lifting and spinning away the stress at the gym became stress-eating on my way to and from my biweekly then weekly check up and ultrasounds at the MFM. The week I finally delivered (only 6 weeks early...I considered it a helluva success), the scale creaked beneath me at just a smidge over 200 lbs. It was distressing sure, but not surprising.

My little man came just in time for the holidays and his arrival was paired with more stress-eating as we anxiously awaited his homecoming from the NICU stay, not once but twice now. 

To complicate things, I am just 4 weeks out of an emergency cesarean section. And no, the irony of spending 30 weeks battling a weak cervix, then laboring for almost a week while the damn thing stubbornly refuses to dilate is not lost on me. 

My last two babies were both tiny and delivered vaginally. The physical backlash from their arrival was minimal and I was back to running and lifting in a matter of weeks. After 4 weeks, I am just now able to resume normal activities including lifting and carrying my toddlers. I realize I am lucky because many women take months to feel even remotely mobile and strong again. My doctor is a realist and he suggested listening to my body and taking it at my own pace. 

This pregnancy, I was blessed with both a weak cervix (something that I've apparently always had and is relatively symptomless) and an irritable uterus, which is exactly as ridiculous and annoying as it sounds. Over the course of my second and third trimesters, I was slowly rendered completely useless and basically immobile. Eventually, I couldn't manage stairs very easily, couldn't lift or carry my toddlers, and even the most benign activities like rolling over in bed and walking across a parking lot were a legitimate struggle. 

Resuming my ability to walk and basic endurance initially came as a necessity. I had to walk just over 500 feet to see my baby in the NICU from my hospital room for the first five days of his life. It doesn't sound like much, but it felt like light years at the time. The first time I attempted it out of a wheelchair (post delivery, day 2) I had to take a break halfway. After that, I waddled and huffed my way back and forth several times a day. Once I was discharged, the trek from the parking garage was probably 4 times that distance. Again, necessity drove my recovery. I had to see that kiddo and I stubbornly refused to succumb to the use of a wheelchair.

Today, he is in another NICU, in a different hospital and after months of pre and postpartum shuffling, I am finally walking almost normally again. As my kiddo figures out how to keep his temperature up and put on some much needed weight (someday...someday we'll reach 6lbs!!), I am struggling to reclaim my body and my identity as a strong, capable woman who can hold her own at the gym and fire up a room of group fitness class goers. 

Let me preface this by saying I am aware that this is gonna sound like a totally douchy thing to say, but being involved in fitness is less of a 'hobby' for me and more of a part of who I am. I have never been more aware of that fact than when I was suddenly unable to hit the streets for a run and had to step away from my fitness instructor job. The exercise was also my major outlet for any stressors that might arise. With past babies, when things weren't going so well, I would lace up my shoes for a 'therapy run.' Losing that outlet was tough on me over the past 8 months (mildly stressful--cue the ice cream!) Today, at 4 weeks post op, I found myself on a 'therapy walk' through the breezeways throughout BJC/Washington University medical campus. 

It a walk. I wasn't winning a race or setting any PRs. I wasn't even really breaking a sweat. But I'll be damned if it was totally liberating. 

During the walk, I would catch my reflection from a curtained window or some such reflective surface every so often and it still startles me. The hips are too wide and the gait is still a bit too lateral in nature. The belly still protrudes, an imposter of that of maybe a second trimester tummy. The boobs are totally unrecognizable. 

Still, regardless of what I saw and the fact that I was moving at an obnoxiously slow pace, the feeling was familiar, in a completely satisfying way. My breath was challenged and heavy. The movement was just repetitive enough to be hypnotic and totally cathartic. The tension dropped away from my jaw and shoulders (where I like to carry my stress, apparently) and moved into the muscles crossing my hips, knees and ankles, propelling me in the loop across the series of breezeways again and again. It felt so good to be moving again, I was reluctant to stop. I allowed myself the better part of an hour before I headed back to the elevator to see my baby.  
I wasn't panting or sweaty, but I was refreshed and recharged. It may have just been a walk, but it did it's job. Even better, the walk gave me hope that I hadn't totally lost that part of myself that's been suppressed for so long. I am still me deep down in there someplace, hiding deep in this squishy postpartum body, and I get closer to that me with each step. 

Saturday, January 10, 2015

NICU Repeat Offender

It's the kind of cold that takes 1,000 microscopic bites out of any exposed skin and brings tears to your eyes. The sort of Midwestern weather that cannot be ignored or unremarked upon; igniting conversations between strangers as they attempt to shake it from their bones while they duck into buildings and hold doors for each other. 

I do just that on the parking garage elevator, smiling at a couple's infant who is tucked away in his stroller beneath a pile of blankets and zipped neatly under a winter car seat cover. 

I scurry across the enclosed bridge connecting the garage to the main building, flanked by giant glass walls and on the underside of a large electric train running in a loop past small scale photos of St Louis landmarks. As I pass the security desk, I dig for my week-long parent access badge and secure it to the bottom hem of my hoodie. It's now worn and bent from curious toddler fingers and almost a week of wear. The atrium rises to my right: bright, colorful and showcasing a giant hot air balloon structure. The sporadic clinks and murmurs of people dining on breakfast drifts up into the glass ceiling. I board another elevator and press 5 without much thought, this is day six of my new routine. 

Two giant doors at one end of the fifth floor bank of elevators are propped open and reveal the dimly lit waiting area of the Neonatal Intensive Care Unit. I sign my name in a black binder and lift a phone to request access to the unit. The unit is sprawling and boasts four large 'pods' and several smaller ones as well as a number of private rooms. Within the walls, up to ninety metal frame cribs, warming tables, and plexiglass isolettes cradle unimaginably tiny babies that come attached to monitors via wires and nutrition and medicines via IVs, their breaths either controlled or supplemented by machines through tubes and cannulas. Some of the tiniest and earliest babies lie with eyes fused shut and their tiny wrinkled limbs lying loose and exposed at their sides for the benefit of heaters or glowing supernaturally under blue lights, others (older and chubbier) are wrapped snuggly and gazing up at mobiles or are seated in vibrating chairs or swings. Their existence is set to a soundtrack of dinging and beeping tempered with the occasional electronic lullaby music. The whole scene feels surreal and could easily be mistaken for a technicolor Twilight Zone episode. Doctors, nurses, technicians, therapists and support staff carry on dutifully, apparently obvious to the unnatural state of their working environment. 

In a few places, parents and other visitors sit bedside in tall backed rocking chairs. The newer mothers look bewildered and a bit shell-shocked, their bellies are still loose and swollen, no doubt feeling unnaturally empty and only adding to their distress. In some cases, their arms are still pricked with IVs and they rely on wheelchairs to carry them into the floor. Other moms, like myself, look somewhat less sleepless and blindsided, they're showered and blowdried. They carry large purses and insulted bags of pumped milk. They've figured out a way to awkwardly balance NICU visits with the rest of their chaotic lives. This being a level 4 NICU, many parents are even living out of hotels or other temporary housing. 

I do not allow myself to feel sad -- at least not for me or my baby -- as I make my way to my son's bedside. I know I am one of the most fortunate parents here. My son's arrival at 34 weeks is child's play (no pun intended) in comparison to the micro-preemies or very sick babies that occupy the unit.

We are here because, as our pediatrician is fond of saying, if it's going to happen to someone, it's going to happen to our family. Since we started having children 34 months ago, we've delivered three preemies, spent a total of 11.5 weeks in three different NICUs, spent four days in a PICU, had five ER visits and five admissions to pediatric hospitals and three surgeries (two as outpatients). 

Our youngest had been home from the NICU barely four days when he suddenly started registering low temperatures and couldn't seem to warm up even with two hours of skin to skin with his mama, I wasn't interested in messing around at home. After a number of anxious texts to a pediatrician friend of mine and a call to our pediatrician's exchange, we called in Nana to sit with big brothers while we hauled our tiny little guy to one of the two major pediatric hospitals just a couple exits away on I-64/40 (it's almost as if there was some sub-conscious premonitions at play when my husband purchased our house six years ago) 

After an uncomfortably long 15 or 20 minutes in the waiting room, during which time I listened to children cough and hack and wondered if I was out of my mind to bring our tiny and vulnerable child to this cesspool of disease and infections (turns out, there was an isolation room we could have occupied, but no one alerted us until too late). 

Eventually, we were granted access to a bright and chilly exam room and they drew a curtain that pictured a larger than life ram on a cliff top, which I imagine an older child would find either fascinating or terrifying. We spent the next seven hours in this room, enduring two shifts worth of residents and attendings and a very sweet nurse who took pity on our empty stomachs (potentially sick baby trumps dinner) and brought us pizza and chicken wings at 1am. 

Our first contact was a resident who I found to be inappropriately cheerful to the point causing me to wonder if her disposition was masking nerves.  Whether it was her intention or not, she left us with the impression that we would be home in no time and our concerns were totally unwarranted. The attending who followed her was either overly tired or intentionally dramatic, perhaps a mix of both. Between pregnant pauses, she told us that our instincts were correct in bringing him in. Very small babies could be very sick and exhibit no more symptoms than low core temperatures and decreased appetites. Indeed, we had experienced this only 18 months earlier when our middle son was admitted for viral meningitis (hence the PICU stay). Unfortunately, she told us (long pause), we'd be admitted for a minimum of 48 hours of observation and preventative antibiotics to rule out the possibility of infection causing low temperatures. 

The next few hours were punctuated with various pokes and prods, none of which went either smoothly or according to plan. They started by inserting an IV, which didn't go terribly but didn't draw enough blood to send to the lab. Now a heel stick was necessary to collect the remainder of the blood. Next, a urine sample was collected via catheter. I don't know how many times you've observed urine catheters used to collect urine specimen from an infant, for me it's only happened once before, but this seemed to last a little longer and require a bit more maneuvering than I remembered from the last time. This sample also proved too small and a urine bag was secured and tucked around his diaper  to remedy the problem. During all these proceedures, I was in charge of dipping the Soothie pacifier in sugar water to dampen the discomfort for the little guy. We went through a whole lot of sugar water and I was left craving a snickers bar to take the edge off my own stress.

I hit my breaking point with the lumbar puncture. When my second son had the LP that diagnosed his meningitis, they had asked us to step out of the exam room. This time, they allowed us to stay and asked only that we remain seated before putting the needle in the hands of our overly quirky and under confident resident. She took an enormous amount of time identifying landmarks on my son's tiny spine before missing her target and drawing a bloody sample. I bit my lips and swallowed my tears. While my baby wailed, I silently tore her a new (probably also underperforming) asshole. I understood now that the request to stay seated and my c-section lifting restrictions were perhaps the only things that kept me from throwing her across the room in that moment. Without a word, a new kit was passed to the attending doctor present who was the perfect middle ground between confidant and cheerful. In just moments, the deed was done and we could go back to snuggling our little pin cushion, I mean baby. 

The resident was lucky I am not typically capable of being rude or confrontational (and maybe also because of my recent c-section). She was punished in the moment by my failing to be polite or kind to her. Once the peanut gallery had fully adjourned from our space, my husband and I exchanged a look. 

He was the first to speak. 'I know this is a teaching hospital and that people have to learn, but...'

'...I'd prefer they learn on someone else's kid,' I finished for him grumpily. At some point, the heroic attending returned to give us an update and make some small talk which was possibly also designed to keep us from calling our lawyers. He was very effective and I was grateful for that because we don't have a lawyer.

Soon enough, I had re-focused my energies towards hating the ED exam room chairs. They were incredibly uncomfortable and I was craving some sleep. When the nurse arrived go tell us we were just waiting for a room to be ready, she noted my discomfort and suggested I stretch out on the exam table and she dimmed the lights for us. It was still very uncomfortable as I tried to position my knees so that my c-section incision wouldn't scream at me and cradle our tiny patient without compromising 

Around 3 am, we were finally escorted up to our new home on the 8th floor. I clung to our little guy as the nurse pushed his IV pole alongside us.  The hubs carried the car seat and my pump and my purse and the diaper bag and somehow didn't make it look awkward.  We looked like a small band of ER refugees, weary and looking for shelter.

We were greeted rather quickly by the team of doctors and the nurse who would be treating our tiny patient. They reviewed the game plan and I sent my husband away to catch a few short hours of sleep before the larger munchkins began to stir (I believe it amounted to 2 hours).

I set up camp on the poor excuse for a sleeping surface (a glorified park bench for all I'm concerned) wrapped in the stiff linens and knit blankets I have come to associate with hospitals and poor quality of sleep. Little man was graciously still waking to eat every few hours (which I took as both awesome/a sign of health and exhausting). When he was sleeping, the room was inevitably singing with the beeps and dings of his IV antibiotics, considered preventative as we awaited lab results. Sleep was a scarcity over the next few days. 

For the past six years, we have hosted a New Years party at our home. The party has become smaller and a little less raucous as our friends have also become parents and learned that sitters come at a premium on that particular night. Still, we were wise to take a pass on hosting this year. We celebrated instead by leaving the baby with his nurse at the nurses station (that's one way to find a sitter I guess) and slipping away for a quick meal down the street from the street. In the hours leading up to midnight, a team from the lab borrowed the little guy to draw more blood. They interrupted my nap to ask permission to use a scalp vein. I was mostly annoyed by the interruption because we've had two other babies with scalp IVs and stick him wherever you can find a vein and dammit I just wanted five minutes of sleep!!


Happy freaking New Year. 

Little dude was back in time to nurse his way into 2015 while I commented on how I can't stand Jenny McCarthy and how I didn't recognize any of the musical acts from the Times Square broadcast. I live under a pop culture rock where I seethe every time I peek out and realize Ms McCarthy still has a career. 

By January 2nd, it became apparent that our patient was probably not sick (yay!) but still doing a crummy job of keeping his temperature up (boo...) The hospitalist -- who by the way, was awesome and renewed my faith in medical professionals -- took a big breath before proclaiming that she had consulted with the neonatologists and they figured he was just being a preemie and needed some more time 'in the box.' 

In a matter of hours, we were doing our refugee walk again, this time down to the 5th floor. 

...so here we are. NICU repeat offenders. Waiting for a baby to learn thermoregulation during the coldest part of this Missouri winter. We are like most, both blessed and cursed, but I am consciously choosing to ignore the latter. 


Monday, January 5, 2015

What to Expect When You're no Longer Expecting

The postpartum body is a strange and really not super beautiful thing. We get fairly hung up worrying about what pregnancy itself will do to our bodies, but many of us forget to suss out a clear picture of how things will look and feel once the ugly deed is all done and over with. Here are a few of the sad truths that mommy and her body can look forward to in the days and weeks following the arrival of your little bundle of joy. 

1. A good, old fashioned ass kicking. In my experience, childbirth is one of two things and possibly a combination of both. It's an endurance athlete's wet dream: a vaginal delivery (especially a natural one) is a physical challenge involving hours, and sometimes days, of significant bodily discomfort, blood, sweat and tears. If you're an adrenaline junkie marathoner, you're in for a real treat. Delivery is also possibly a major abdominal surgery involving a significant amount of anesthesia. Once the drugs wear off, you can enjoy the sensation that someone tried to gut you with a hacksaw, through muscles and around organs which turn out to be very necessary in basic functional mobility and bodily functions (namely your bladder and any basic movement).

Either way, you are left feeling a special sort of exhausted and sore in very surprising places including your shoulders and your jaw. I've never been in a bar fight (at least, not yet), but I imagine the day after a bar fight -- particularly one you've lost -- feels a little like postpartum day two or three. A week after delivering my son via ceserian, I was still finding myself clenching my teeth at night in some bizarre postpartum traumatic stress disorder (PPTSD, which I thought was a clever joke invented by me, but turns out to be a real thing and more serious than sore muscles and clenched teeth). 

2. The great uterine retreat. Oh, here's a fun one: The best part of labor (the contractions) don't really stop until your uterus finally curls itself back down to its usual size. The process takes weeks and involves continued uterine contractions. Awesome, right? Granted, the contractions are not nearly as frequent or severe as the ones that happen pre-delivery but who needs that shit once Junior is actually here and systematically trying to destroy you (see below)?

3. Your basic needs take a backseat to spending every moment at your infant's beck and call, leaving you raw and defenseless against your postpartum hormones. If you haven't already experienced what it feels like to be a stark raving lunatic, here's your chance. It's my understanding that in order to facilitate adequate drama during competition-style reality shows, producers often limit food and sleep for participants. See, people are a lot more prone to emotionally snap for the cameras --  think flipping tables and pulling out hair weaves -- when they're exhausted and under-fed. It makes for excellent television (okay, I admit 'excellent' is a strong word when it comes to reality TV), but it's not great for marriages or mom's basic mental or physical health. So unless you're counting on royalties from America's Next Top Mommy, I suggest doing your best to squeeze a few meals and naps into your day.

4. The belly dilemma. Many pregnant women are quite proud of their growing bellies. This is especially true for those who can pull off what I call 'pregnancy adorableness' (I do not fall into this category, I'm more: 'frumpy, jiggly pregnant'). I once read an account by a nurse of a new mom who had brought her pre-pregnancy jeans to wear home from the hospital. It made me laugh out loud. However, in the first few days/weeks and maybe even longer, even our formally adorable pregnant friends must figure out how to accommodate their boggy and still swollen bellies...which secretly gives me great joy because I am a dick. Whatever pregnancy body-type you fall into, expect to get a few more weeks (or months...or years) out of your maternity pants.

5. The boob issue. Just north of the problem belly there's a whole other bizarre natural phenomenon taking place. The day my milk came in with my first baby, I remember standing dumbfounded in front of the bathroom mirror wondering what porn star had secretly donated her breasts to the upper portion of my torso (which wrongly implies I am intimately familiar with the porn industry). I can't remember if I was more appalled or mesmerized --probably both -- but I do remember that my husband was downright elated. Unfortunately, they were so sore and uncomfortable I wouldn't let him within 10 feet of them. Lactating boobs are proof that God has a cruel sense of humor and/or hates men. 

6. A hostage to your hormones. Another strong indicator that whomever designed the female body is a mean-spirited son of a bitch is the postpartum hormones. I mentioned them before, but they're so significant, I feel I should take one more crack at them to be sure I really hammer the point home. I have always considered myself a pretty emotionally stable individual. Then I started having children. Suddenly I was capable of becoming weepy and totally unhinged with zero provocation and even less warning. My husband has become so accustomed to my unprovoked sniveling that he barely notices anymore. Between an infant, two toddlers, and a sad-sack wife, the poor guy is totally surrounded by unexplainable tears. I can expect to cry during any commercial featuring a baby or child, any song featuring a melody, and sometimes when folding laundry. One time, a friend texted me in her 3rd trimester to ask how long she should expect to feel so weepy and emotional. I confidently explained that it will get worse postpartum and then -- according to my older mom-friends -- improve shortly after never. 

7. Bloody hell. My husband missed the birth of our first child by just a few minutes, but he commented that when he arrived, the delivery room was so covered in the bloody mess of a vaginal delivery of a breech baby, it looked a lot like a crime scene. I suppose that's understandable, but the bleeding doesn't stop in the delivery room. It's like new-mom SWAG, you get to take it home with you! And to make matters even worse, tampons are not an option. Not to worry, the hospital will supply you with disposable mesh undies and a diaper-sized maxi pad, making you feel equal parts geriatric and adolescent. Don't worry though, the bleeding will stop in a few short weeks...or months. I'm told you shouldn't trust anything that bleeds for several days and doesn't die. I never trusted my vagina much anyways. 

8. Cognitive Fuzz. It doesn't matter if you are a brain surgeon or a beautician, having a baby will give your cognitive function a swift kick in the pants. Don't expect to remember what you did with the TV remote and don't be surprised when you find it in the freezer hanging out with bags of breast milk. Wearing your nursing bra inside out and spending an extra 15 minutes looking for your left shoe will become the new norm. I think it gets better. Meanwhile, if you see my gray knit boots, please call me. 

I am obligated to admit that this is, at best a partial list. My sleep-deprived new-mom brain is confident that I have left out some vital symptoms of motherhood. There are also probably some significant spelling and grammar errors in this piece. Feel free to alert me of errors and omissions. I'll be either changing my maxi pad or crying over the fact that I can't find my favorite maternity pants.

Quit your bitching lady, I'm totally worth it.