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**Michele** · 07-09-2006, 10:01 AM

The end of my internship
I'm done! And moved! Goodness I feel like I can breath again. It's amazing how emotionally/mentally taxing my internship was, not to mention over 80 hour work weeks, sleepless non-call nights, 24/7 patient care....I never fully realized it until it was over. I might have finally stopped waking in the middle of the night panicked that my Nextel wasn't plugged in or "was that a beep-beep I just heard?" I don't have that constant feeling of failure or that I'm going to be directly responsible for a patients death or prolonged hospitilization. And damn it feels good to sleep in and take a nap when I want to!

Our new home
Our new house is wonderful. Russ did an amazing job picking it out by himself. It's a 3/2 and about 1500 sq ft with an oversized 2 car garage. The kitchen is HUGE and I have so much space!! I'm excited to be able to cook again. I'm planning to make a nice pot of sauce and I want to start making breads and soups. I made both dinner and dessert last night and it was awesome! I haven't cooked that much in a year! I forgot how much I enjoy it.

The fencers are coming to give us an estimate for the back yard tomorrow. The dogs love the backyard! The house is on a bayou (canal) that connects to a pretty decent sized lake (1x9 miles)...and we have a little dock! But being from Florida I know all about the potential dangers in a lake and canal...especially for the pups...So they don't get to play off leash until the fence is up.

Our house is on a cul-de-sac at the end of a pretty long road in the back of the neighborhood...so I feel really safe...especially with the pups.

In 3 days Russ has developed the caffeine addiction I took 3 months to cultivate during my internship. He's constantly amazed when he gets home and the first things I say are "go get out of those scrubs, sit down and what do you want to drink?" It's still too close...I remember how I felt every day when I got home from work. I needed five to ten minutes to just be.

His schedule is hard to get used to though...I have to keep a calendar just so I can figure it out. He's doing an internal medicine pre-lim year. He has q4d call right now. The program is really strict about their hours. I think they were in violation in the past and have really cracked down. And since Russ isn't one to hang around the hospital...as soon as he's done...he's home! It's weird not having him come home some nights though. I had home-call...this in-house call is a new concept to me.

Even though I've only been here less than one-week, I'm a little lonely...I was used to being the one doing stuff and with people and now the roles are reversed...it's different. My sister was in town in Gainesville and we could hit the mall or go for ice cream whenever I had free time....and now I don't know anyone. It also doesn't help that our cell phones don't work here and we don't have long distance. I can't even call my mom! We've ordered new phones and they should be here soon. I haven't met any of the spouses yet, but one of Russ' internmates will also be a resident mate and he and his wife are from the area....so we've got tenative dinner plans to meet. I do have plans to join the local vet association and LLL...so hopefully I'll meet some folks there. I've only met the two male neighbors so far...the wives were out at the time...and goodness I've only been here less than a week!

**Michele** · 07-13-2006, 11:02 AM

The fencers are here today. Yay! Tui got her Xanax so hopefully it'll be an OK day.

----------------------

Pregnancy weight gain.

I've never really had a weight problem. I was a skinny child...where people thought I had a problem with weight gain...of course that all normalized when I hit college and I put on the freshman 20. After that, my main problem was a classic case of "hand in mouth." Food just went from my hand to my mouth. And I got lazy. So the combo of too many calories in and not enough calories expended and you gain weight. Big shocker right? So to keep it under control I occasionally crash diet and go on workout binges etc. I did a great job losing weight for the wedding...with regular exercise and smarter food choices...of course though after the wedding I put a lot of it back on. I don't have a desire to be the skinny thing I was back in high school...I don't think it's realistic. But I'd like to be thinner than I am...or was pre-pregnancy. I had hoped to lose some weight before getting pregnant...having read how hard it is to lose afterwards...but with the internship and all I didn't. So I started pregnancy about 12 pounds over where I wanted to be. The doc made a total pregnancy weight gain goal of about 20 pounds...combined with my 12 extra pounds that sounded about right.

Well, I'm there...infact, I'm closer to 30 pounds over my pre-pregnancy weight. :! I didn't think I'd actually make the doc's goal, but I didn't think I'd be this far over already. I figured by then end, I'd be about 30 up...but I still have 15 weeks to go. I know some of it is water weight...I'm swollen...and the heat definitely isn't helping. But it's still frustrating.

The simple point is that I eat too much. :yum: And it'd probably be ok if I ate too much lettuce or too much fruit. But I don't. I eat too much pasta, and too much peanut butter on graham crackers, and too much cheese, and too much mac-n-cheese, and too much popcorn, and too much cake, and too many cookies and too many brownies...mmm brownies....ok I digress. But I feel like I'm always hungry. And it's not that I'm actually thirsty...I mean I guess I could be....but I'm drinking over 3 liters of water a day....maybe I need more....I guess if I spend more time peeing...I'll have less time to eat...

Realistically, I know I shouldn't fret so much. I know that it's going to be hard to cut back now...but I should try. I should try to make a better choice before giving into the sweet cravings...but I'm real good at tricking myself into thinking I'll have both...so just have the sweet thing first. But of course, one sweet leads to another, and sometimes another...

Anyway, my big idea was to not try to cut back, but to add some exercise. I read you aren't supposed to start working out while pregnant...but you can continue a plan if you were used to it before...well my workout consisted of having students run around the hospital chasing down lab values...not very aerobic...my muscle builders were picking up a yorkie or two, or holding down a cat to draw blood. I figured I could start a plan, but only if I started slow and listened to my body. So I started walking. I walk a slow mile with Pula. It takes us 30 minutes. I get tired, she gets tired, but I make sure to talk to her throughout so I'm not pushing myself too hard. I think it's good for me.

Hopefully it helps. I'm worried since I read that weight gain is about 1 pound a week now on out. I can't do that. I can't afford new clothes...and I hate having my thighs rub. I get the crotch wedgie now.

Is it really possible to stop gaining? I guess we will wait and see.

Just FYI I probably eat well over 2500 calories a day and 1400 feels like I'm starving myself (but is probably more where I should be at non-pregnant)...I don't want you all to think I'm not eating over here and worry about me and the baby...trust me we're well fed...

Anyway, today is the 4th day I've walked and I'm proud of myself.

**Michele** · 07-17-2006, 01:18 PM

My Birthday

Yesterday was my birthday! It started out a very happy day. Russ had to go into the hospital, but it was supposed to be a short day...he just had to check on his patients and write a few notes. I made myself breakfast, had a nice walk and (phone) talk with my friend. And Russ came home at 10:30am with a cake!!! I thought it was going to be great. We agreed to go to the mall and then out to dinner. Yay! Shopping is one of my favorite things to do! I can make a day out of it...but it's really more like an indoor nature hike. I walk, stop and look, walk somemore...but really don't buy anything. If I need something? That's a different story...but if I just have time to burn....oooh, I love just walking in the cool airconditioning, browsing the racks and people watching. I took a shower and in that time, he fell ill with the "sleepiness". A "30 minute nap" (really a 2+ hour nap) later, I still couldn't get him moving...so a nice birthday breakdown....and then the mall was closed. Very nice. I broke down about being soo lonely and isolated...and it was my birthday, in a new place and I just wanted some support from him to make it nice. I wasn't asking for much....just some togetherness time...he wasn't even post call.... Anyway, he made up for it by calling the friend we were "someday" going to have dinner with and he invited them out. The food was great. The intern-mate/resident-mate was nice and his wife was really nice too. She's already invited me over for dinner and to do one of those "speed dinner/meal preparation" thingies!

It ended up to be a great time.

**Michele** · 07-22-2006, 04:22 PM

A job?!?!?

Ugh!! So Russ is completely freaked out by the fact that I'm not working and we're going to "run out" of money before the baby gets here. So I have to get a freakin' job.

I'm not qualified to do anything!! I mean, I'm very qualified to be a vet, but seriously, who is going to hire me as a vet knowing that I'm due in October....and that I can't do surgery because I get too damn hot gowned up. And I can't bend over very well to do exams on the floor (which would be about 80% of the job). And I'm not licensed (which I'm working on, but kinda dragging my feet on...)

So what else do you do?

I don't want to work from home...I need to get out of this damn house...I'm so freakin' lonely!

I guess I can apply at Target or something. I don't know. I've never really had a job before. I mean, I worked as a kennel and vet tech in high school and undergrad....and I had a very brief stint as a hostess/waitress which I was TERRIBLE at. Other than that? Nope no real life experiences here.

And do you know what getting a job means? It means I actually have to get dressed in real clothes. I don't think he realizes this will mean I have to spend money to buy maternity clothes for a very temporary part time job. Right now I have 1 pair of jeans, 1 pair of jean shorts and 2 pairs of black shorts. And a handful of tops. That's it. If I have to look somewhat decent I'm screwed. I have 1 black dress that really isn't appropriate for even a job interview. He's crazy.

I don't wanna.

Poo.

**Michele** · 08-17-2006, 10:04 AM

So Russ gave up on the "job now" part, but not the "work on your damn license" part. Ugh....that's on the plan for today. I don't exactly know why I'm balking so much on getting my vet license. Maybe because then I have to think about applying and interviewing and contract negotiation....all things I very much suck at. And what if I end up at a crappy clinic...I mean I guess I survived an internship I can do anything right??

Pregnancy stuff:

You all probably saw the posts about my BP and the fun in L&D Triage. I've been taking it easier...if I could really even be doing less...and I'm putting my feet up more and stuff...the swelling seems to be responding to that. I'm still seeing the floaty things, though...which could be normal they said. I guess I just have to wait and see what she says at my appt on Tuesday. I've also stopped checking my BP....it's just causing me to worry and that's not good either. I'm getting some stretch marks which I have mixed feelings on. Part of me is completely disgusted by them, but another part of me is proud because it means I'm for real going to be a mom. I've been stalking that site http://www.shapeofamother.com. I'm trying to stop weighing myself....but it's like a bad car wreck, I just can't turn away.... The baby's butt is right up in my stomach (at least I think it is) and my ability to eat is becoming affected...it's weird to feel hungry but become full after a few bites...I guess it's a good diet plan!

Baby stuff:

We finally chose a crib. I couldn't find what I wanted so I let Russ pick it out. It came yesterday!!! We haven't opened the boxes yet, but plan to soon to make sure all is ok. We're going to prime the nursery on Sunday and plan to paint the following week/weekend. We're doing an underwater theme. We bought a convertible crib and plan to keep the room as a guest room, but decorated as a nursery. We're going to keep the baby in our room for a little while and we're going to have company in and out for the holidays, so it seems like the best plan. I also went shopping and bought some baby outfits from Carter's. I bought those little one piece things with long sleeves and feet....I think they are soo cute! Russ and I are starting to play the "is it a boy or a girl" game. I made it this long without knowing, but the closer it gets the more I just wanna know... In just over 2 months, we'll know. We've got about 8 names of each gender picked out...but plan to meet the little one before deciding. I really haven't gotten much of a personality feel from the baby yet. Overall I think it's a quiet baby...doesn't really move around all that much.

Boob stuff:

My goodness!! Will they ever stop freakin' growing?!?!? I broke down and ordered some bras online. It's scary because I'm guessing at my size...two out of the three didn't fit so I have to return those....but I found a place in town that sells bigger bras and yesterday I found one that fit!!! Finally....and I wore it out of the store!

Each day I become more and more scared of my "milk coming in." What do people like Punky Brewster do??? Oh yeah....a reduction!

My sister is coming to visit in a couple of weeks! Yay!! We're planning to shop, and eat and get pedicures! Should be tons of fun!

**Michele** · 08-29-2006, 07:42 AM

Well it's been one hectic week!!!

Daegan (3#7oz, 16.5in) made his early entrance via emergancy C-section on Tuesday. I developed rapid severe pre-eclampsia and HELLP syndrome. I was seen by the doc on the 11th because I thought I was swelling a little too much and because my BP when I checked it at the grocery store was 135/95. I only had 1+ protein in my urine and my BP came down after laying in bed for a little while, so they sent me home with a 24hr urine collection and to recheck with my doc at my next appt...which was 11days later (the 22nd).

On Sunday (20th) I tried to help Russ paint the nursery, but since we had the air off and all the windows open, it was too hot (>100) and I was swelling more...so I laid on the couch. Really Russ kept making me stop helping but you know. Monday I was still pretty swollen and so I decided to "bed rest" myself and spoiled myself on the couch in the AC all day. And collected my pee for the docs appt the next day. I started to get some gas-type pains around my diaphragm. I couldn't tell whether it was belly or chest pain...nothing really helped them except some TUMS and occ walking it off...they would go away a little then come back. They felt like gas honestly, but didn't go away like gas usually does. Monday night the gas pains woke me up at 12am....and kept me up...at 3am I woke Russ up because I was concerned, but then after being awake with him for a while, taking more TUMS and Tylenol, the pains went away enough for me to sleep again...and since I had the appt at 8am and was able to sleep on and off, I figured I'd wait for the appt...nothing else seemed weird. Tuesday I went in for my appt at 8am and was told that my appt had been re-scheduled but they couldn't get a hold of me to tell me...they said I could turn in my pee though and if I really thought I should be seen I could see the walk-in doc...I still wasn't totally convinced I needed to be seen. I actually called Russ and hashed it out with him...I thought I was just being a first-time pregnant weenie and that just last week I was deemed OK...but then since I was there and the pain hadn't completely gone away I decided to see the walk-in doc. So the nurse starts checking me in and sees my cankles and takes my BP (158/112) and starts to look really worried. They did a quick urine dipstick which showed 1+ protein and 4+ glucose (my GTT test said I was not diabetic). After rechecking my BP like 50 times, she has the high risk Maternal Fetal Medicine doc see me. He palpates my belly, checks my cervix and transfered me to the hospital to be admitted. I was admitted at 11 am for bloodwork and monitoring. Baby looked good on fetal monitors and on ultrasound. My cervix was completely closed and normal for 30w6d. My BP remained high. My bloodwork showed low platelets, inc kidney values and inc liver values, but not that bad...so they planned to recheck my blood in 4 hours. They were waiting on my 24hr urine results (thank goodness I had already collected it...otherwise they probably would have started collecting it at admission and maybe the additional 24h would have been bad) and the lab was taking a long time because they said they were getting a high reading...so in preparation I was put on MagSulfate and was given a steroid shot for the baby's lungs....the plan was to hold off induction as long as possible...maybe even a week or more if they could...they finally got a reading at 5pm (before my second set of bloods was back) and my urine protein was 25g (0.3g=pre-eclampsia, 5g=severe pre-eclampsia, the docs hadn't seen one over 20g)...I was given the very weak option of pitocin etc induction for a vaginal birth, but the docs were scared I might not make it (my bloods came back worse the second time)...so at 5:59pm Daegan was born via C-section. His 1,5 min apgars were 7,8...but he ended up needing the ventilator for about 36 hours and surfactant. He is off all breathing assistance now...on his own on room air and doing well. His bili levels went up a little so they had him on the lights/blanket, but they went down and now he's off the lights. We had a scare with some green stuff in his orogastric tube...a couple of xrays and it decreasing/disappearing later, and they deemed him OK and stopped the antibiotics and started feeding him breast milk!! He's still getting parenteral nutrition though, but they pulled his umbilical catheter. After his birth, all my numbers and signs started to go back to normal and I was discharged on Saturday. They said he'll probably be in the NICU until his due date (Oct 25th). I've been pumping like a fiend to get as much milk for him as I can and so far it seems to be working. The hopsital has a nice little stash for him, and my freezer here is almost full.

At the home front, Russ and I were really unprepared for an early baby...luckily work has been good to him with hours so he could be with me, and MIL is here to help clean etc for me while I recover. And friends and family have really chipped in to buy us stuff. Now we're getting all stocked on diapers, preemie clothes, nursery furniture, blankets, bedding, everything. So when the little man can come home we'll be ready!

Good news is though, they were still able to do the low horizontal incision with sutures so I have a shot at a VBAC later and won't have as bad a scar as staples leave. And since he was so early I have hardly an stretch marks because my belly really didn't get that big yet. I have to think of the positives because when I think about what might have been if I didn't see the doc that day....

Anyway, he's here and we love him!!

**Michele** · 08-29-2006, 07:45 AM

Oh! And for "will my boobs ever stop freakin' growing??"

Nope...they are one place I'm getting new stretch marks!!

And as far as weight loss....I gained 55 pounds during my 31 wk pregnancy. I have since the birth (1 week today!) lost 22 pounds! I really did have a lot of fluid!

**Michele** · 08-29-2006, 09:37 PM

1 week old!!:ra:

**Michele** · 09-03-2006, 08:28 PM

So the little guy is doing really well. He's getitng 1 ounce every 3 hours and is gaining weight! They're still gavage feeding him because he's still too young to suck, swallow, and breathe at the same time. He's got a crusty eye (future Ophthalmologist is a little concerned

) but we're still waiting on the cultures...the crust wipes off easily with saline and his eye doesn't really look inflammed.

I went for my one week recheck appt on Friday at 10 am (appt time 10 am I arrived at 9:40 am). They took me back to draw blood at 10:30 am...then at 11:00 am they took my weight and BP....then at 12 noon I was still waiting...so I went to the desk to ask...I was getting "full" and starting to become ridiculously hungry and thirsty (no food/drink allowed in the waiting room). At 12 noon I was informed that my bloodwork wasn't back yet (no shit they just drew it that morning) and that the staff was going out to lunch and wouldn't be back for an HOUR. Yeah, they got to eat, but I had to sit on my ass and wait?!?!? BS!! I was pissed but very calm. I asked if this was typical, and apparently it is. So I told them that if the doctor had problems with my bloodwork he could call me and I left! So I feel guilty for leaving my appointment, especially since I like the doctors there, but it's the free care clinic associated with the hospital where Russ is at...and I think that the insured patients get the same care as the un-insured...but no one really deserves to be treated like that. At least they could have told me a lie...not that they were going to eat...or told me that I could go get something to eat and come back later when I was more likely to be seen. Ugh.

And unfortunately I think I have mastitis. It sucks. My bras are a little tight...I've ordered new ones, but they haven't arrived yet...and the store in town is out of my size...so I think I was getting a clogged area....I was massaging....but my sister and MIL are here and I started waiting longer in between pumping sessions...and that area is now much more painful...not really swollen or very inflammed looking (yet?) but I"m really achy and I have a fever.

So now I can't go see my baby. MIL left today so this am we let her hold him the whole time...so I was going to let my sister hold him a lot tonight...but we can't go...and she's leaving tomorrow afternoon. Russ is off so he's going to take her tomorrow morning....but I'm sad...very sad that I can't see my boy.

And should I got to the doc? Right now, based on all I've read, I should try to manage it at home right now (inc pumping, warm/cold compresses, rest, fluids, etc) but if I have to go in??? I really don't want to go back to that clinic. Wah! This sucks!

At least Daegan is doing well. I'm glad for the ability to vent!

**Michele** · 09-04-2006, 07:24 PM

Ahhh....Tylenol, warm/cold compresses, pumping like there's no tomorrow....and a NORMAL temperature and no more achiness or sore boobs!!! Yay!!!

So tomorrow I'm going to go see my boy!!

**Michele** · 09-07-2006, 10:41 AM

**Michele** · 09-07-2006, 04:30 PM

Remember how I said I lost 30 pounds in a week after Daegan was born???

I thought you all might like to see how that happened...

This is me 4 days before Daegan was born....August 18th...

This is me the day AFTER he was born...August 23rd...

This is me a little over a week after he was born....Sept 1st...

I saw a friend yesterday that I hadn't seen since I was in the hospital....she said, "Don't take this the wrong way, but you look really different. I almost wouldn't recognize you." Meaning, I was fat...but not really fat....swollen. Very very swollen....I have new stretch marks...non-pregnant ones that came from the swelling...after the surgery, when I was stuck in the hospital bed, all the edema went to my ass and hips...making them very wide...I had to use the bigger wheelchair...and couldn't sit in a regular chair I got soo wide...which I'm sure looked quite silly on my frame. I guess that's what an acute drop in albumin and protein combined with IV fluids will do to you.

I'm only 20 pounds over my pre-pregnancy weight now. Granted that's still 15 pounds over where I'd like to be....but I've got time.

**Michele** · 09-13-2006, 09:04 PM

Daegan update

Little bugger is doing pretty well. He's up almost a pound since birth! Yay! He was moved to an open crib about a week ago because he can maintain his own body temp. He's still being fed via the tube...but 2 days ago they said it was ok to try to "nipple" him. We tried the bottle and he's kinda sucky at it...today I got to try breast feeding him! He mostly just rooted around, but did latch and take a couple of sucks...it was nice just to try.

We're doing the Kangaroo Care thing (skin-to-skin contact) and Daegan seems to like it. I love it because it makes me feel closer to him. They also are upping his feeds almost each day to keep up with his weight gain. They decreased blood draws to once weekly. He's been switched out of "intern" care and into "attending" care because his case is no longer interesting/of teaching value....which is ALWAYS a good thing.

Some concerns....he's still having about 4 bradycardic episodes every night and a couple during the day. He recovers on his own and very quickly...it's just scary to me. The docs aren't too concerned...since it could still just be all related to prematurity...but it could also be reflux so they added Reglan and Zantac to his routine. He's only been on them 2 days, but no improvement so far. I'm not so patiently waiting to see if it helps. The other news today was that he has some immature white blood cells circulating...which is usually a sign of infection. He's sneezed a few times yesterday and today...but his oxygenation has been better than it's been....at least when I'm there (less desaturations). They did give him the RSV shot today...and he'll get that each month until March. So I'm freaked out by his blood work. Sometimes knowing too much medicine is a bad thing. If he doesn't have any problems tonight, they are going to recheck blood work in the morning....if he has any problems he's getting a full sepsis workup...bloodwork, blood cultures and antibiotics. I hate thinking about the little guy getting poked again. And then that means he'll get another IV catheter....more tubes....and more and more worrying for me.

They say it's "two steps forward, one step back" but I really don't want to go backwards! I hope it's nothing.

My hand for comparison....and I wear small gloves (size 6-6.5).

Kangaroo Care

The face

Givin' shaka

**Michele** · 09-14-2006, 03:45 PM

Bloodwork today was BETTER! His CRP was normal, and those scary immature white blood cells were gone! Yay! He gained over 2 ounces in 24hrs and they've upped his "nippling" to every other feed. Hopefully he'll get the hang of this sucking thing soon!

Mama just freaks out for nothing, huh? Guess it comes with the territory!

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