Battle of the Bulge

This is my last week of maternity leave, well, actually my last three days as I go back on Thursday - an event that I'm actually dreading a bit. It was my choosing, going back on Thursday instead of next Monday as originally planned (I didn't want to start on a Monday), but that doesn't escape the fact that my days spent snuggling my little boy all day long are over. To make matters worse, now my husband's new work schedule takes effect meaning that we will never again except by a fluke have a weekend together where neither of us is working. It's sad really. No family trips to the zoo, no more Sunday family dinners with my parents, not even family trips to the grocery store... Oh, the luxuries that money provides! If we had the money for only one of us to work, it would be great, but there is no use crying over something that is not even a remote possibility. Not without both of us changing jobs, which may end up happening anyway if we can't make our current schedules work. Alas, that is a topic that provides endless fodder for griping, and therefore I shall leave it at that for now.

What is really preoccupying my mind these days is trying to maintain my health. Since Owen's birth I've been hovering in a kind of nervous limbo state about when my symptoms will return, and going back to work just makes it more nerve-wracking. Due to the fact that I'm breastfeeding Owen, I am not on any medication since none are approved while pregnant or nursing. I'm already exhausted just from Owen's routine of frequent eating, diaper changes, and crying spells, and now I get to add working full time into the mix. To say that I'm nervous about relapsing is an understatement - I'm terrified. The only good thing if it happens this year is that my treatment would be free since I've already spent my deductible and my out-of-pocket maximum for my insurance. The particulars of dealing with a relapse are part of what worries me - I won't be able to hold my son with an IV in my arm for a week, let alone feed him, clothe him, change him. I'll most likely have to work that week in a drugged haze since all of my PTO has been used up on leave, and I can only hope that I'll be able to get something done one armed and drugged. And then there is the specter of not knowing what symptoms my relapse will be - it could be anything from tingling to blindness to paralysis!  Just thinking about it sends my stress level into dangerous territory, so on the whole I'm trying not to worry even though it is my default state.


The cause of my new worries. I'd say he's worth it.

To make matters worse, my husband keeps bugging me about the baby weight. I have maybe 10-15 pounds more than I did before, which is not that much, but it's apparently enough for me to be nagged about. Frankly, I'm not concerned as it took nine months to put on so I'm giving myself nine months to take it off - that means until March 2014. In the last three months I've lost 25 pounds, so it's not like I still look like I'm in the third trimester. Owen and I go for a walk around Green Lake (which round trip from our apartment is about 3 miles) once a week. I eat healthfully and in moderation, I'm trying to stay hydrated and well rested, and for me that is enough right now. I just wish it would be enough for him... Women get enough hounding about our bodies from society alone that we don't need our closest allies joining the chorus. It took a long time for me to be comfortable with my body and I don't need someone placing little seeds of self-doubt back into my head. I appreciate that it's done out of a position of caring about my health, but right now my neurological health and sanity are bigger issues. For my height I am considered overweight, but just barely (my current BMI is 26.6, overweight is considered 25-29.9). Before the pregnancy I was at the upper end of normal anyway. As part of recovering from the C-section, I not allowed to exercise for the first 6 weeks - which translates into 1.5 months! I just wish that he'd let me take the lead for now. If Owen's first birthday comes and I've not made any progress then he can bug me about it, but until then I just wish he'd keep his mouth shut on the subject.

The Son has Arrived!

It's been a little while since I've posted anything, mainly because nothing much was happening other than waiting around for the baby. Lucky for me, he decided to come early at 39 weeks. A healthy, happy, so far perfect little man with a full head of dark wavy hair. My husband was instantly smitten and has been super wonderful so far, grinning from ear to ear and willing to help out as much as possible. I ended up needing to have him via C-section and therefore haven't been too mobile after the surgery, so the new daddy has been the one to get up in the night to bring me the baby to nurse and to do all the heavy lifting (I'm restricted to no more than the baby's weight).

Stats: Owen Arthur Phillips, born May 1, 2013 at Swedish First Hill, 6 lbs 9oz at I believe 17.5 inches but I don't actually know that for sure.

Details of the labor if you want them:

What was supposed to be a minimal intervention labor and delivery turned into a C-section after labor stalled for 6 hours... which turned out to be a good thing in the end because there was a problem with the placenta that would have made a vaginal delivery almost impossible had we kept trying.

The labor itself didn't turn out how I had planned, but rarely do you have any real control over that sort of thing. Last Monday I went to the doctor because I had been seeing spots and had a headache. This resulted in some labs being drawn and me getting put on bed rest for the rest of the week, which bummed me out. It was supposed to be my last week at work and I didn't want to waste the PTO sitting at home watching tv. We went back to the doctor on Tuesday to go over the labs and to recheck my blood pressure, which was better but still high for me. I went home, put my feet up, and waited thinking it could be a long week ahead or more if the baby was late. Luckily I didn't have to wait that long. At about 6pm that night contractions started, getting to one ever 5 minutes or so by 10:30, and me vomiting with them by 11pm. That was our sign to head to the hospital. Our boy was on his way. We arrived by 11:30-11:45ish and prepared ourselves for the upcoming task.

The vomiting at home should have been a sign that it wouldn't be the last. I threw up multiple times the first few hours until they had given me enough anti-nausea meds to make it stop and even then I felt on edge. Labor hastened for the next 3-4 hours, until it just seemed to stop progressing. We arrived at triage dilated to a 4/10, and at about 4 am had only made it to a 7/10. I was getting this intense burning sensation in my lower back and hips. I've been describing it as having to red hot pokers twisting in on either side. It just wouldn't relent, so I "gave in" at about 7 am and asked for an epidural, as the IV pain meds (fentanyl) was not doing the trick. Despite my reservations about it, in the end it was the right decision as it allowed us to see that there was another issue at work.

The epidural worked pretty quickly and completely for the first 2 hours; I could hardly tell I was even having contractions anymore. Things seemed to be working out better, that is until my blood pressure and the baby's blood pressure dropped. The time it took for them to stabilize the both of us used up the initial bolus of meds that was working so well. When that wore off and it was down to the pump, only half of me was numb. They had to readjust the catheter to fix it, but that only solved the problem of my pain - labor was still not progressing. They tried to hasten it by giving me some Pitocin to make the contractions stronger, but instead it just made baby's heart blood pressure and heart rate drop resulting me resting for two hours on my side with an oxygen mask to stabilize him.  Each time they tried again, or tried changing my position by rolling, baby's vitals would drop again. I was really hoping to avoid C-section but even I could see that it was necessary. So after being in labor for almost 18 hours, I was wheeled into the OR and 15 minutes later had a crying baby boy. It is surprising how fast the procedure is; it took longer to stitch me up than it did to release him.

The next 48 hours were spent confined to a hospital post partum recovery room - the first 24 of those confined to bed entirely. We had a steady stream of family visitors all coming to see our little cutie while I was all drugged out and disheveled in bed. Friday mid afternoon we were able to go home, which my husband was anxious to do. I, on the other hand, was not in as big of a rush. We made it home and through our first few nights alone as a new little family. Little Owen is now almost 6 days old and just as cute as can be. I'm slowing healing. The first day home I felt like someone had beaten me up on top of the surgical pain. Now most of the soreness has retreated but I'm still moving more than I should, which is resulting in the occasional abdominal twinge and grimace of pain. I just need to remind myself to rest and to not get so involved in trying to help out that I over do it.

 

Swelter and Swoon

Hello August! This is supposed to be the warmest day of the year so far and I am on bunny patrol, ie making sure that our furry friend Pico doesn't succomb to the heat. Rabbits apparently can't get warmer than 85 degrees, and the forecast edging close to 90 today means that all the blinds and curtains are drawn, the lights and electronics off, and I spend the day in the dark all for the protection of Pico.

Desert wildflowers from Tucson this past March. They do much better in the heat than I.

I also have a high likelihood of swooning from the heat today as well. My health has taken another turn the past few weeks, and when I'm coming off of a symptomatic flare, everything seems heightened: I get vertigo again, my balance gets off, I'm more fatigued, etc. Some gelato or  frozen yogurt or something will be called for today, as well as salad for dinner to avoid turning on the oven. It makes me feel like a wuss. I've lived in the desert for crying out loud and now 90 is causing me to worry.

This is the first morning in two weeks where I actually awoke energized, as if all the steroids are finally working their way out of my system. There are bound to be more of them in the coming weeks, but it's nice to feel a modicum of normalcy again even for a little while. We have the unfortunate task of deciding what to do about my "treatment" in the coming days, as it looks like being on nothing is not working. I just wish there were options that didn't involve needles. Well, I exaggerate, there is one on the market, but it is generally agreed upon within the MS community that it wasn't really ready - they were just desperate to have an oral medication option. It can cause dramatically lowered heart rate and apparently some people have died on it. That doesn't leave me feeling too much in a hurry to get on it. There are some more promising meds in the pipeline, but clinical trials are always sooo slow, especially when you are one of the ones waiting for the benefits. Once they start getting better treatments out, maybe the prices can start to come down. As it is, even with insurance, medication costs are in the thousands for most patients. The sticker shock of it all is enough to swoon over.

Last week after my last neuro appointment, the hubby and I were talking under a tree outside of my work before I went back, and this man came over relating his sob story about not qualifing for care from a free clinic because he is on disability, but not having enough money to go to a regular clinic, and needing a few bucks to get a prescription filled. When we told him that we couldn't help because were we just discussing how expensive our own medical costs are, his entire countenance changed. He went from trying to sell is on helping him out to offering help to us on how to get DSHS and Social Security help. He was lost in the quagmire of technicalities of an inefficient system and we are standing at the brink of an equally inefficient system just run by different entities.

Health care as a fee-for-use system doesn't work. No research gets funded unless you have someone with resources get sick. Where are the advocates for the voiceless sick, those without the resources to mobilize the masses with charity drives? Where is my therapeutic Olympic horse? Oh wait, you mean that I have to drop everything to go to any appointment during the work week because in order to maintain the health insurance to pay for said appointments I have to be at work instead, so that's not feasible if you want to get paid. Fee-for-use works great for spot maintenance, such as when you broke your arm roller skating and need acute care. Everybody has a body, therefore everybody needs to pay into and be involved in the system. That way, when your child develops a high fever at 4 am on a saturday morning there are systems in place for you to be able to get treatment instead of waiting for it to get higher and be forced to go the ER (which is supposed to be a last resort, not your primary access point).

Bleh, I hate this issue. I just seems so clearly simple to me, but I never feel like it is articulated well and people are always arguing over it. Upfront costs vs delayed costs. I'll take upfront monthly payments to have something covered later over not paying anything now and being stuck with tens of thousands of dollars out of the blue. I guess it wouldn't be so bad if those who refuse to pay into the system through insurance actually put the money into a dedicated medical only spending account so that they have something when the unexpected arises. Instead they just spend it on other things and then beg the hospitals to lower their bills because they didn't plan for mishaps. It's irresponsible. You don't go to a restaurant and eat a large meal because you didn't eat earlier and then ask the restaurant to forgive the debt, and yet we think it's ok to act this way for medical care.

Crossroads are always befuddling

It seems like the new year is upon us and we can not avoid making some life changing decisions this year; they have been put off long enough. The short version is: save money to buy a house versus save money to go to graduate school, both complicated by health care and employment questions. As the old saying goes, as a door closes a window opens, but who really wants to be the one to close that door themselves?

Here's the breakdown of the options:

 (a) Buy a House - As all the newspapers, radio, and television broadcasts are apt to remind you, now is a great time to buy a house if you can afford to as prices are at record lows, interest rates are at record lows, and the selection is still pretty good to get into a good neighborhood. Everything says that now is the time to move, but realistically the soonest that will happen for us is in about 1-2 years since we need to save roughly $500 a month to afford a down payment. It is doable, although it will not be all that easy. It will mean bringing lunch to work daily for a year for both of us, not going out to eat - which we already rarely do, taking the bus/cycling/walking as many places as possible, and not incurring any large bills along the way. We've already begun to build our credit through the socially deplorable credit card system (that is worth a whole other entry about the decrepitude of credit cards) and through paying down my student loans. While setting a decent financial standing for ourselves is a good start, it will still be a stretch to get into the areas that we'd want to buy in, especially considering that we are trying to avoid buying a second car. In order to avoid that additional purchase, we would need to move within the Seattle metropolitan area that is readily connected by transit and light rail to the downtown core. It's better for our health and pocket book to live somewhere that is not car dependent.

(b) Go to Graduate School - This is not necessarily in conflict with buying a house, but that is very dependent on where I can find a program that is a good fit. The public health progam at the University of Washington will definately be applied to, but the main problem there is that the faculty does not focus on what I would like to focus on, meaning that while I could go through the program and graduate and get into the field I long for, my field of expertise would be different than what I'm currently most interested in. Graduate School, like all post-secondary education, is an innately selfish thing to do - it is all about you. The programs that interest me most are on the otherside of the country, as the west only has a handful of accredited programs. This would mean a complete change in our lives that I'm not entirely sure we want to do. I've always said that the Seattle area is one area that if you don't leave when you are young you will never leave, and it feels like we are getting enough roots down here that moving will be more difficult than it would have been a few years ago. It is not impossible, but with all of my doctors here, most of our family here, and the hubby finally beginning to get some work experience, it doesn't feel like a good time to leave. Graduate school is something that I feel I must do, but the timing of it is less certain.

(c) Health Considerations - The past year we have been lucky in that I've been pretty healthy, except when it comes to side effects from the medication I was one. Now that that has been stopped, we get to choose between the other possible options - all with worse side effects, or not going on any and taking the chance of a relapse. Plus there is the whole family planning issue, as none of the approved medications are safe for pregnancy and require washout periods for the medication to leave your system before even starting. In addition, none of the other possible medications are approved by my insurance, meaning that we'd be paying much higher monthly just to received the meds. Health maintenance is expensive once you have a "pre-existing condition;" as a result I need to maintain health coverage through an employer while going to grad school because it will be near impossible for me to afford to self-insure for the two years it would take to get the degree. Most jobs grant insurance benefits at 30 hours a week. Being a full time student while working 30 hours a week sounds really taxing from my current perspective. The hubby is currently self-insured, meaning we also have to pay for his health coverage unless he gets a good full-time job with benefits. It is situations like this that make me long for nationalized health care. The stress of how we can manage to keep ourselves covered is enough to make us not want to pursue our passions.

(d) Career Considerations - As has probably become clear, neither the hubby or I are currently in the fields we would ultimately like to build a career in. We'd like to do something that is both creative and intellectually fulfilling; I'd like to travel more and feel like I'm working for a higher mission than just making profit. I can't pursue my interests without going back to school. He can't pursue his without drastically retooling his skills as the field of journalism has changed dramatically since he graduated from college.  We both can't leave our current situations at once, as we need an income to survive on. I'd have to say that the vast majority of people we know from our graduating classes are either unemployed or under-employed due to the current economic mess.  That does not inspire us to cut all safety nets of our current jobs to pursue a career, and yet we are both frustrated by our situations. 

Basically, one of these issues is going to have to be decided upon in the next few weeks in order to move forward. It just feels like we are stuck in a holding pattern, like our choices are few, which is not really the case. Maybe I'm just overthinking everything again. It makes me anxious to contemplate stepping out of my safe job in my safe community to do something selfish like go to school. I should be lucky that I am even in the position to make such decisions, especially as a woman in a first world country.  If only there was a way to have the path elucidated without such animosity and uncertainty - makes me feel like a wuss sometimes.

Cost-Effectiveness

I've been trying for the past few years to reread my copy of "Pathologies of Power" by Dr. Paul Farmer, one of my living heros. Having first read this book 5 years ago while finishing my undergraduate degree at ASU, it is marked up with my notes from class. Reading through it you can see the voracity with which I devoured it on initial read - the first few chapters are nearly illegible due to my underlines, cirlces, and arrows connecting the ideas across the pages. It got to the point where my markings ceased because almost all of it was being marked as something I should remember. Comical in hindsight, but it still stirs my excitement over the subject and reminds me that this is something I have a passion for and would like to pursue.

Anyway, I finally picked it up again after a good 10 months of inactivity and was once again thrown into the world of MDRTB (multi-drug resistant tuberculosis) and structural violence against the poor. This particular chapter's conversation of cost-effectiveness in terms of health care I find particularly timely, as today the nation averted a near financial meltdown.  Specifically, Farmer talks about the distribution of technological developments and the use of the phrase "cost-effective:"

"In the name of cost-efectiveness, we cut back health benefits to the poor, who are more likely to be sick than the nonpoor. We miss our chance to heal. In the settting, we're told, of scarce resources, we imperil the health care safety net. In the name of expedience, we miss our chance to be humane and compassionate. ... how can we glibly use terms like cost-effective when we see how they are perverted in contemporary parlance? You want to help the poor? Then your projects must be self-sustaining or cost-effective. You want to erase the poor? Hey, knock yourself out. The sky's the limit." (Chap 7,pg 176-7)

Farmer's distaste for the status quo is palpable, even infectious. We can not just sit by and let those in power inform us that certain humans are worth the money to take care of and others are better off dead. We've had quite the political discourse the past few years about the need to cut excess from operating budgets for programs no longer deems "cost-effective"; sadly many public health and social programs have been on the chopping block because those in power are divorced from the reality of the disenfranchised who acutely feel the effects of these decisions. As someone who grew up for the majority of my childhood without health insurance and therefore not going to the doctor unless I was really sick (which thankfully was rare), I can't help but think that those who view public health and social safety-net programs, such as emergency shelters and walk-in clinics, as expendible are blinded my their own affluence. 

But enough griping. There are, of course, successes that have emerged from the process of stream-lining. Although I find it hard to think of an example, there must be, otherwise the concept would not be so widely accepted.

 My hero, Dr. Paul Farmer - picture from the back cover of "Pathologies of Power"