The Happiest Drunk on the Block

Yay for conscious sedation during dental work!

Holy crap, I'm in

I just turned in the paperwork for the ADN program at a local community college. So in 18-24 months, I'll be starting my first semester of nursing school. No assessment tests (I have a BA), no pre-program classes (I have a BA), and no swollen uterus (I have 4-8 weeks left. Oh, did I neglect to mention that? Time somehow flew. Another post for another day).

In other positive news, the pigs are gone. The yard we had them in was fairly devestated (picture Beirut, for instance), and the grass literally was greener on the other side of the fence (simply by virtue of there being grass). So they started busting out. We thought we were being all clever by putting the portable electric fencing inside the other yard but they had the nasty habit of charging *through* it instead of backing off. So they busted out again. Then the last time I realized that I couldn't: herd the pigs, fix the fence, and keep the kids from killing each other while I tried to do the first two. Poor Husband had to rush home twice in a week to help me corral them. His partners probably find it very amusing.

After wandering around the yard for 10 minutes weeping hysterically, I called the butcher and begged them (more weeping) to "come out and kill these damn things." They took pity on me and when Husband and I managed to lure three of them into the kids' play yard (again: Beirut). Lovely Clyde the Butcher came out and dispatched them that day. The other three we got into the old freezer (don't worry, it's 18'x20'), and they went to the Great Beyond two days later.

I picked them up the day before yesterday and I can't tell you how much more relaxed I feel. Between that and stepping down as the organizer for a local Meetup group, it's like I was on vacation for two weeks. I had no idea how much they were freaking me out until their collective weight was off my shoulders.

We've pretty much decided that we won't have more pigs until we have permanent fencing, which we might be able to do in the spring, but probably not. Luckily, Clyde the Butcher sells directly so we can buy from him if we need to.

I probably have lots more to report but I can't think of it now and it's time for the news.

Patho-ver me

Yesterday was the first day of my pathophysiology class. I'm very excited. I have a few days before we're divided into discussion groups and start working, so I'm putting up the bat signal for anyone who's taken it and can recommend good study guides. I LOVE Springhouse Notes (the A&P book was immeasurably useful to me), but they don't seem to be in print anymore, and they never seemed to have a patho volume. Boo. There's the Incredibly Easy series, but I don't know. Seems like false advertising. Anyone ever use one?

I really don't want to buy any textbooks, but I'm willing to be convinced.

Hurry up and wait

Last night I had my first clinical. Mostly it was orientation, and *yawn*. We also worked in the "feeder dining room" and fed residents who needed help with it. I helped a lovely but somewhat confused resident. Unfortunately, between my apparently fading hearing and her low voice, it was a bit of a farce. But she got a fairly good meal down and we watched the birds in the aviary. Nice.

Now I'm in the interminable job wait. I've applied for a number. I'm quite excited about one: Hospice home health aide. The more I think about it, the more I think Hospice is where I want to end up (short-term, people, I'm talking work). I think it's such incredibly important work, people there don't seem to fall into the politics and backstabbing - and if I'm wrong, please don't write to me about it, I need my little dream.

I wonder, though, since I'm still techincally in class, if they'll disregard my applications. One spot has been open since December. I hope they're hot to fill it. To get to be a voyeur in someone's house and support them through death? Too cool for words. I know that's slightly twisted but what can I say. I have my foibles.

Tonight we work 1:1 or 2:1 with residents. Everyone is nervous but me. I figure I've been training for this job for the last 4 years, right? Feeding people who don't want to eat? Changing wet/dirty diapers? Making endless beds? No problemo.

What I *am* nervous about is the general load of work for the hours of the shift. Seriously, there were probably 10-12 residents in the feeder room and there would only have been THREE CNAs to help them. I just think that's nuts. A normal pt load is 8-10. That's 8-10 people who can't do most things for themselves. Dressing, feeding, walking (I canNOT say "ambulate"), cleaning, toileting, feeding, toileting, meds... it's a wonder anything gets done at all. I am afraid I'll be paralyzed by a crisis of indecision. Wha-? Who? When??

I know a lot of it is just figuring out your own routine, but that's so not something I'm good at, the routine. I'm not routine-y. Now martini, that's another story.

Elimination diet and the junk-food junkie

It's clear to me that Perp needs to go on a strict elimination diet. Her skin worsens by the day and aside from strawberries and tomatoes, there is no clear trigger. I made the mistake of going back to a scented laundry soap and that is probably a part of the problem, but it's not the only one. I know that Dude's skin improved immeasurably when I took him off wheat (plus he gained a pound in a month!), so I know it's probably going to be worth the effort. But. Ew.

So.

I have a list of foods that she *should* be able to eat safely, but ensuring that she doesn't have anything else is going to be difficult. I'll have to send food to school for a few weeks, and insist that she eat NOTHING else there or at the ILs' place. This may prove to be harder than it looks. I think there are a few things on here I'm going to let her have yet, but if things don't get better within two weeks, I'll cut them out too. Oh, this is going to suck.

The biggest problem, I think, is going to be convincing people that this is necessary and useful. People don't always accept that simple foods, which are supposed to be good for you, after all, could cause her skin to be so bad. But it's true, they could. We know that tomatoes and strawberries make her flare hideously, so why can't other foods? I hope I can make that point without resorting to the "she's my child and I'll decide what's good for her" argument. I'm afraid if I have to make it, that will mean she cannot be in places where people don't respect my decision. Ugh.

On the plus side, I did this with Dude for a couple of months and lost like 15 lb, so it could be great for me to get back on the ED train. Extra oils for the kids, though.

So if you are considering doing an elimination diet, or if you've never heard of it and want to see the weeks of hell before us, here it is, copied and edited from this guy:

Allowed foods
Meat and seafood:
Fresh or fresh frozen lamb

Any type of wild game is acceptable. Deep-water ocean fish such as orange roughy, halibut, tuna, and wild salmon are allowed. All salmon from Alaska is wild.

Turkey is allowable if it is fresh, has not been injected or pre-basted with “butterball” chemicals, is not ground, pressed, or otherwise processed, and has no additives.

Vegetables: sweet potatoes (except that Dude can't have them *sigh*), yams, cabbage, carrots, squash (many varieties), asparagus, cauliflower, avocados, celery, garlic, okra, radishes, greens (beet, mustard, spinach, collards, etc.), cucumbers, eggplant, Brussels sprouts, kale, avocado, broccoli, parsnips, green peppers (not hot pepper or peppery spices), rutabaga, leek, and turnips.

Because wheat, corn, rice, rye, oats, barley, buckwheat, millet, and other grains are common causes of allergy, and because all grains belong to related food families, avoid grains while on this diet. This means you must avoid all breads and other foods made with any kind of flour. Although buckwheat, amaranth, milo and quinoa do not belong to the grain family, many grain sensitive people react to those grain substitutes and they should also be avoided. There is no way to make a sandwich, so get used to it.

Fruit: fresh or fresh frozen fruits (not fruits dried in sugar or packed in sugar or syrup), including bananas, grapes, peaches, pears, pineapple, kiwi, papaya, mangos, melons (watermelon, cantaloupe, honeydew, Crenshaw), cherries, apricots, pomegranates, mangos, coconuts, plums, persimmons, blackberries, blueberries, cranberries, raspberries, or loganberries. Eat only small servings of fruit, as fruits contain lots of natural sugar. Fruit canned in its own juice without sugar or additives are allowed. Avoid fruit juice except in small amounts.

You can eat nuts, including filberts (hazel nuts), almonds, or pecans. Use fresh cracked or nuts still in the shell, not roasted, or otherwise treated. (Peanuts are not nuts despite their name. They are actually legumes. Avoid peanuts.)

You may use safflower oil, sunflower oil, flaxseed oil, sesame oil and extra virgin olive oil. Use only cold pressed oils with no additives, purchased from a natural food source.

For condiments, you may use honey in very small amounts as a sweetener. Stevia is highly recommended as a natural sweetener. (Avoid NutraSweet®, Equal®, aspartame and saccharine, which are artificial chemical sweeteners.) Sea salt is allowed. The allowed oils can be used for cooking and on salads. Chopped nuts (of allowed types), ginger, garlic, cilantro, almond butter, and sesame butter are allowed. Many of the nut butters are processed in the same equipment that makes peanut butter, so read the label for warnings about small amounts of potential allergens.

Foods You Must Strictly Avoid

Strictly avoid: milk, cheese, yogurt, egg, all grains (including corn, wheat, rye, oats, barley, rice), sugar, oranges, grapefruit, legumes, beans, peas, peanuts, beef, chicken, pork, apple, white potato, food colorings, chemical additives, emulsifiers, yeast, preservatives, chocolate, cola, processed and packaged foods, coffee, tea, and alcoholic beverages.

Milk and milk-containing foods: Avoid milk and dairy products entirely, including cheese, butter, ice cream, margarine, yogurt, cream soups, breads, crackers, cookies, cakes, candies, luncheon meats, and other manufactured or processed foods. Casein and lactalbumin are other names for milk protein. Read all labels carefully.

Egg-containing foods: Avoid eggs or any foods containing egg, including custards, cakes, cookies, ice cream, pies, macaroni, salad dressings, noodles, pancake mixes, and all other manufactured or processed foods.

Grain-containing foods: Avoid wheat, corn, rye, barley, rice, and all grains and foods containing grains. This includes all commercial breads, cookies, crackers, cereals, batters, luncheon meats, pancake mixes, candies and a wide variety of other packaged and processed foods.

Citrus: Avoid orange, grapefruit, and foods containing those citrus fruits.

Sugar-containing foods: Avoid cane sugar, beet sugar, corn sugar, fructose, glucose, and brown sugar—including candies, cakes, sugar-coated cereals, ice cream, carbonated beverages, and the wide spectrum of processed and packaged foods which contain sugar. Sugar is hidden in dozens of foods including catsup, pickles, relishe, and salad dressings. Avoid artificially sweetened food or drinks that contain NutraSweet®, Equal® or aspartame. A very small amount of honey is allowed, but sweets are very addicting and it is best to go through a total withdrawal. Stevia is best tolerated as a sweetener.

Legumes: Avoid peanuts, beans and peas of all kinds, including string beans, lima beans, soy beans, baked beans, green peas, field peas, black-eyed peas, and vegetable gums. Soy bean protein ("textured protein") is hidden in a variety of manufactured foods. Read labels carefully.

Chocolate & cola-containing foods: Avoid chocolate and cola drinks of all kinds, including diet cola. Avoid all sweets, candies and foods to which chocolate has been added.

Meats: Avoid all forms of beef, pork and chicken, including luncheon meats, hot dogs, bacon, sausage and hamburger. Avoid all cold cuts. Avoid tenderized, spiced, processed or otherwise treated meat products of any kind. Most shrimp now sold in the USA is farmed in Asia and raised on human waste, antibiotics, etc.)

Fruits & Vegetables: Avoid white potatoes (even if the outside skin is red), French fried potatoes, potato chips and any food containing potato. Avoid tomato, corn, and rice. Avoid fresh, frozen or dried apples, oranges, and foods containing apple or citrus flavoring (which is often an artificial chemical). Avoid any other fruit or vegetable that was regularly eaten more often than once each week in the past.

Yeast-containing foods: Avoid breads, wine, vinegar, mushrooms, and dried fruits. Use only vitamins that are formulated to be yeast-free and hypoallergenic, without chemical additives or preservatives.

Coffee, tea & alcohol: Avoid all coffee and tea products (including instant and caffeine free). Also avoid herbal teas and all alcoholic beverages. Drink pure water, it’s good for you. Carbonated water, unsweetened but with all natural fruit flavor is acceptable.

Condiments: Avoid black, Cayenne. and any kind of hot pepper. Avoid onion, NutraSweet®, Equal® and aspartame, which are artificial chemical sweeteners. Beware of many spices that are mixtures of both labeled and unlabeled ingredients. Stevia as a sweetener is allowed, if a pure extract.

Elimination procrastination

I finally went to my midwife to plan out an elimination diet for me and the Dude. I took both kids in for RAST draws and they both came back entirely negative (at least for the things we though of). Yet I was still sure that there was a dietary component, especially since Dude's skin got so much worse after I got the greenlight from the allergist and stopped monitoring what he ate.

Now, on day 4 of a fairly extensive elimination diet, I can already see a difference in his skin. Crazy! His cheeks, which always had a weird, rosy color that should have been cute but wasn't, have cleared up and are nearly blemish free. The weird scaliness on his torso is almost gone. His legs are still sketchy and he hasn't lost the antecubital eczematous patches but even they seem to be a little better. I suppose the primary culprit is wheat. It's too soon for me to be rid of any dairy, I think. I haven't had much with eggs in it, and no actual whole eggs for several weeks. Peanut butter? Probably a few weeks ago.

I was pretty sure wheat was a prblem from early on but I never thought to cut it out of MY diet, so when I took it out of his and didn't see a difference, I shrugged and gave him a cracker. sigh

Stay tuned for updates as they come up.

On informed consent

At the outset, let me state that I firmly believe most Americans do more research before they buy a car than they do on their own health care. Not only is it a shame, I think it's scandalous and I can't believe no one makes a bigger fuss over it. What the fuck, people? It's YOUR body. Get to know it. Take charge of its care and feeding. Well, maybe not so much with the feeding (as she mows her way through another Lindt truffle).

This being said, it can be really, really hard, perhaps bordering on impossible, to obtain true informed consent. For most people, the word of their doc is good enough and is easily traded for personal knowledge. So maybe it shouldn't be a surprise to me that Average Joe knows more about the 50" plasma tv he's about to buy than the flex sig he's to undergo Tuesday next.

When I was pregnant with Perp, I had crazy frequent Braxton Hicks contractions from fairly early on, around 19w, give or take. I had no previous experience with pregnancy, and you could say I wasn't entirely in tune with my uterus unless it was involved in its favorite, complicated sloughing procedure. So I trotted off to L&D to be monitored.

Nice Nurse checked me and there was no cervical change, nothing to indicate anything was Going On Down There, but had me wait for a doc to be sure. I leafed through a magazine and half-heartedly watched the montior from time to time. It is oddly hypnotizing, I'll admit.

Young Intern flapped her stick arms in distress when she saw my contraction pattern (every 2-4 minutes, which I could have told her, had she asked).

She scuttled off to kibbutz with the resident and came back an hour later (I shit you not, there was no one in labor and everyone else was chilling at the nurses' station) she came back and declared I needed "a medicine to relax your uterus and stop it from contracting." Despite no cervical change. "It will make your heart beat kind of fast and you may feel a little woozy." Because it's an asthma medication. Off-label. Not approved for obstetrical use.

Do you know anyone who takes Neurontin for peripheral neuropathy? Did you know it was tested and approved as an epilepsy drug?

Methotrexate? Approved for treating neoplastic disease. But not chemical abortions. Or multiple sclerosis.

How was I supposed to give consent? I accepted the terb based on the information I was given. It never occured to me to ask if the drug was approved for my use; I just assumed it was. Why would I think otherwise? I had no access to anything supporting or contradicting her claim. All I had was her word and her limited, get-the-patient-to-agree spiel. She made me believe the pregnancy was in jeapordy. She swayed me with fear.

So I accepted and she gave me the shot. And when I got home and looked it up, I was beyond pissed that she would gloss over several important facts regarding its use, and present it as necessary despite clear indications that it wasn't.

How are patients supposed to wade through the morass of selective information so many docs offer? I am not, of course, suggesting that all docs are like this. And I understand that expediency is important. But it is equally important, if not moreso, that patients understand what is truly at stake. What the true risks are. Whether the drug has even been tested for this particular use or if it's being prescribed because someone noticed a salutory effect and hey, why not use it that way even if we don't KNOW it's okay for this patient group (hello*, Femara)? Aren't indications listed for a reason? Isn't testing done for a reason?

I'd love to be able to say that evidence-based medicine is the answer but of course, women are chronically under-researched. Even in obstetrics, apparently. When 1 in 5 prescriptions is written for nonapproved use, perhaps it's time we included the patient in the equation and asked how they felt about being part of an uncontrolled experiment.




*I'll give you a nice prize if you can find mention of letrozole's approved use on that site.

Apparently I DO hate my kids

So there's this pretty heated debate going on this week, and I've come to the conclusion that the only reason I went for my homebirth is because I wanted to die, and take my baby with me. Why else would anyone want to stray from the warmth and safety of their local hospital? Well, there's nosocomial infection; iatrogenic problems; avoiding unnecessary and often unadvisable interventions; docs dismissing birth plans out of hand, even when the bullet point in question is valid. For instance, I requested no cord traction, recognizing the increase in uterine involution and subsequent hysterectomy, and my doc said, "Yeah, well I like to do a bit of traction." Um. I'd like for you NOT to, so let's just leave it at that. For starters.

Anyone who knows me from CM knows I wanted my homebirth and that I did a lot of research and soul searching over my decision. Anyone who knows me IRL probably isn't reading this, but they would know the same. Anyone who tries to tell me that I didn't make an informed decision is living in a dream land, as was the resident who told me that the Terbutaline they wanted to give me with Perp's pregnancy was "for slowing down contractions and relaxing the uterus." Actually, Uninformed Resident, it's an asthma medication that just so happens to have the salutory effects you listed. You did not let this little fact slip past your pursed lips, however, so my consent was less than informed, wouldn't you say? The information you did give me was related to the immediate side effects (increased heart rate, primarily). It was a breach of our doctor/patient relationship that you left by the wayside a pretty important fact: Terb isn't approved by FDA for obsetrical patients, it's used off-label and that, my friend, is information a patient needs to make informed consent.

So, off that particular soapbox and back to my primary point: women who choose homebirth are not unfamiliar with the potential problems, even disasters, that may await them at home. Nor are they unaware of the same potential problems or disasters that may await them at the hospital. So they take a calculated risk and choose to have their babies at home where, according to WHO and any number of studies (despite Dr. Amy's statistical gymnastics strongly felt opinion), they are deemed to be *less* at risk of death or injury than they are at home.

The attending at Perp's birth did at least three things that were directly contraindicated in my case. They were interventions that would see a midwife excoriated for dangerous practice, if not outright malpractce, but in hospital they were considered standard procedures.

So I chose to have my baby at home. With a qualified midwife, and just to prove I'm not entirely down on the medical profession, with parallel OB care up to 38 weeks when my OB dropped me because she didn't approve of my plan and didn't want to be liable. How that would ever be possible is hard for me to figure, but okay, now I know where we stand and I won't ever set foot in her office again. Fair dinkum.

And here I sit, 9 weeks later, my homebirthed son in my lap, and I am glad.