Varicose Vein Surgery

 When I was nineteen I started developing varicose veins. It's genetic. I started wearing support stocking religiously, but let's face it, I picked the wrong profession if I wanted to protect my legs and veins. And having three babies didn't help either. When I had Thing 1, I was told that I needed to wait until I was done having children before I did anything about fixing them. Technology has advanced since then. (Which is good because after my pregnancies and standing on my feet for so many years not only do my legs look terrible they hurt a lot too. Lots of burning, aching and cramping.) The first time I saw my OB he told me that I needed surgery on my legs and there wasn't really another answer. As soon as I could get in (after my pregnancy) I went to see a vascular surgeon. He said I that I have venous reflux disease and it's actually better to take care of it sooner versus later. What has been happening is that the valves in some of my veins aren't working effectively, which causes the blood to back up and some of the smaller veins to swell to the point that they are completely ineffective and not to mention ghastly looking. The longer I let it go the more damage will occur to the small veins.
 The solution is the VNUS close system. The surgeon inserts a catheter into the ineffective veins and irradiates them and as he pulls the catheter out they seal shut. That's procedure #1. On the second day he fixes the smaller swollen veins that possibly can be fixed and cuts out the others. They don't use general anesthesia, so there is less risk (and cost) to the patient. Just a Valium, a Keflex, a Percocet and some Lidocaine. (Although I still fell asleep half way through each surgery.) Each procedure takes less than an hour and has a pretty short recovery time overall. (It used to be that surgical intervention involved 'vein stripping', where the vein is literally removed through incisions in the groin and knee areas. It required general anesthesia and involved a long and painful recovery. Currently there are other options besides the VNUS procedure, but this is the one my surgeon prefers because it has the best outcomes.)
 So that's what I was doing Tuesday on my husband's lunch break. When I laid down on the table the tech said "Now there is proof positive that nurses don't just sit on their butts."  (That's right!) I felt very loopy for the rest of each day, but I was functioning fairly well by Thursday. Ok, ok my house was sliding even further down hill and I couldn't stand for very long, but my kids were happy and taken care of and that's what matters, right? I have to say that now my leg feels sooo much better. No more cramping, aching or burning. The staples and stitches are annoying, but they'll be gone soon. I've known people who have had it done and the scarring is pretty minimal too. So we're going to do this party again tomorrow! That's not the way I planned it, but while I was on the table the nurse mentioned to the surgeon that he had a cancellation that they needed to fill and I said that I would take. Probably crazy after the week I just had, honestly worst week in recent memory, and it had little to do with my surgery but my surgeon is good, busy and really hard to get into. Not to mention if I do it now, versus next February when he has openings it would save me several thousand more dollars. Yup, tomorrow is good for me.

 So here are some tips and lessons I learned from the experience:

1. If your varicose veins are causing you pain, you don't have to wait until you're done having kids to get relief. And you don't need an extended recovery time either.
2. Choose the surgeon that is hardest to get in to see and pray that someone cancels. He's the guy who knows what he's doing. I've heard scary stories of people who went to surgeons with less experience because they were easier to get into.
3. If your baby has reflux and you're having surgery, live it up and eat what you want. You have to pump and dump anyway, why not enjoy what you are eating for a couple days? (Although don't go to overboard, small amounts of those irritating foods will stay in your system for more than a few days.)
4. My surgeries on my leg didn't hurt nearly as much smashing my toe this weekend did. That's the real reason I walk with a limp.

Getting Ready to be Outnumbered

With any luck by the time you are reading this I will no longer be pregnant. Hooray! Pregnancy itself is a generally an unpleasant experience, but being 9 months pregnant in August in St George, UT makes it worse.
 With Thing 1 I was sent into labor by being hit by an industrial flat-bed truck. With Thing 2 from the time I started having contractions to the time I was complete was twenty-five minutes, going into labor that fast put my body into shock. So let's hope that Miss Cindy Lou-Who arrives without a traumatic experience. My husband is pretty stressed about it. I figure being stressed isn't going to change the outcome, so why bother? I'm too excited to not be pregnant to worry much about what could possibly go wrong between here and there.
  In preparation for her debut I have been getting ready for quite awhile. Here's what I have been up to:

• Since about March, every time I saw a "stock-up worthy" deal on diapers I bought a few packages.
• I snagged numerous cute outfits from the clearance section. (Once I got several Disney themed onesies for 50 cents each at Walmart.)
• I thoroughly cleaned my house so I have less to worry about later.
• I made a few freezer meals to make life easier.
• I finished all of my back to school shopping in July.
• I packed my bag and arranged childcare.
• I ordered a new car seat and bassinet, which are ready and waiting.

And as Thing 1 observed, "Now all we need is a baby."

Book Review: Full of Life

It is my belief that just because this is my third baby and I have a BS in Nursing doesn't mean that I know everything there is to know about pregnancy and having babies. So I picked up Full of Life: Mom-to-Mom Tips I Wish Someone Had Told Me When I Was Pregnant by Nancy O'Dell, hoping for some new insights. This book is not an encycolpedia reference for pregnancy and motherhood, however it was more enjoyable to read than any of the other pregnancy books that I have read. It didn't tell me anything that I didn't know, but it does have some really good tips and is written in a style like you are talking to a friend. I would recommend it to first-time moms. Here are some the tips that I thought were most helpful.

• A typical fertile couple has a 20% chance of conceiving with each cycle and an 85% chance of becoming pregnant within one year.
• Your pregnancy is really 40 weeks, not just 9 months.
• Your cravings may be very specific and may change at a moments notice.
• When telling your boss the news, know your rights before hand. If you have worked for a company full-time for at least 12 months before your date of delivery the federal Family and Medical Leave Act (FMLA) entitles you to 12 weeks of maternity leave, during which time they have to hold your position for you. Whether or not you get paid during that time is another story.
• If you were exercising regularly before you were pregnant, it is safe to continue to do so while you are pregnant.
• It is not uncommon to have irrational, panic-inducing dreams while you are pregnant.
• If you are having constipation issues, try baking pureed prunes (yes, baby food will do just nicely) into a spice cake. It should take care of the problem without the taste and texture of actually eating prunes.
• When creating a baby registry, don't register for blankets, stuffed toys and smaller baby clothes. You will probably get enough of those anyway. Register for sizes 9 months and above, and items like a 2nd car seat base, strollers and baby socks.
• Sleeping on your left side is best for baby. It improves circulation. Sleeping on your back can cut off circulation (and oxygen) to your baby.
• Things that can prevent leg cramps: drink plenty of water, eat Potassium rich foods, take a warm shower and stretch your calves before bed.
• Things to relieve leg cramps: get you husband to massage your calves (yes, I realize these will probably occur at some ungodly hour, have him do it anyway), stretch and flex your calves repeatedly, get up and walk it off.
• Fetal hiccups show that baby's diaphragm is working.
• Your breasts can leak breast milk even before you have a baby.
• Bladder leakage can happen: wear a pad, do your kegels, limit bladder irritating beverages (those that are carbonated, acidic or contain caffeine), and cross your legs when you cough.
• Breast-feeding is not automatic. Take a class or read a book before you have your baby.
• Register at the hospital before the big day.
• In addition to comfy clothes, make sure that you pack your laptop, camera, extra batteries and camera card for your trip to the hospital.
• The most effective way to push a baby out is like you're pushing to have a bowel movement. Yes, it is true.
• Despite all of the discomforts and trials of pregnancy, it is all worth it in the end. :)

3 Things That I Recommend to Every Pregnant Woman

I am pregnant with my third child, and there are few things that I wish I had known about the first time around that I thought I would share.

1. An exercise ball. My husband is a computer programmer which means that he spend a lot of time sitting at a desk. A co-worker recommended this for lower back pain. After trying it out he bought one for me too. Whenever I am sitting at a computer for more than 2 minutes I sit on this. It eases lower back and pelvic pain. Frankly it's a good idea for more than pregnant people, but especially for pregnant people. (And totally worth the $15-17)

2. A foam kitchen mat.  I have tile floors and standing in my kitchen for awhile really makes my legs ache. This isn't a cure-all, but it helps. And they're easy to clean too.

3. Stretchy maternity tank tops.  Why is that designers of many maternity shirts think that because I now have more cleavage than normal I want everyone to see it?  Besides covering up top, these tanks help cover that gap at the bottom, making my maternity and some of my regular clothes last a little longer.  I really don't get the maternity shirts that don't cover my belly. I figure other people want to see my stretch marks about as much as I do. I know that there are a few brands that specialize in maternity tank tops and belly bands. And the tanks run around $25 each. However, last week I went to Ross and found similar tank tops for $6 each. One size fits all. Now that's more like it. And I've tried the belly bands, they're not as magical as everyone told me they were.

Vitamin D during pregnancy could prevent RSV in infants

 This week a study was published online from the American Academy of Pediatrics that found that a deficiency of Vitamin D in cord blood is associated increased rate of RSV in infants. So it stands to reason that if an infant is not starting out Vitamin D deficient, they are decreasing their chances of catching RSV. The study suggested that if pregnant women increased their Vitamin D intake, it would decrease the rate of RSV by about 20%. That is AMAZING! And not only would it decrease the number of cases of RSV, it would decrease the severity, meaning fewer deaths, fewer tiny babies on CPAP and vents, and fewer infants being held down by nurses like me so they can have boogers sucked out through a tube in their noses. I may be jeopardizing my job security by proclaiming this information to the world, but I'm OK with that. But seriously RSV is a HUGE part of what I do and I would be glad to see fewer kids come down with it.
 The point is, if you are pregnant I recommend that you make sure that you are getting enough Vitamin D. Start today.  Not only does it reduce rates of RSV, your body needs it for cardiovascular health, a thriving immune system and strong bones. One may ask how much is enough Vitamin D and where do I get it?- The latest recommendations (as of November 2010)  for daily intake is the same for men and women under age 70, 600 international units, and 400 IU for children. Now there is debate that because of these new study findings, perhaps pregnant women should get more than that. It remains to be seen. The caveat with Vitamin D is that if you take too much it can lead to toxicity. (Vitamin D poisoning can lead to dehydration, vomiting, loss of appetite, constipation, muscle weakness, irritability, fatigue and kidney stones. Pregnant women have enough issues with those conditions without taking a vitamin supplement that would make them worse.) Vitamin D toxicity is actually pretty rare. It only happens when too much is taken over a period of time, usually months, and when an adult is taking 50,000 IU or more per day. Vitamin D from food has never resulted in an overdose.

  Of course you can get your Vitamin D from a prenatal vitamin or a Vit D supplement, but if you are looking for an answer that doesn't come in a pill form, here are a few good places:

• sunshine- not that the sun actually contains Vit D, but our skin has the power to turn ultraviolet light (UVB rays) into Vitamin D. (Aren't our bodies amazing?)
• fish- especially fatty varieties like catfish, salmon and tuna
• eggs
• fish liver oils- I suppose this proves that my grandma was right, or at least partly. Eating a tablespoon of cod liver oil a day can prevent illness. One tablespoon contains 1360 IU. That doesn't mean you can convince me to take it. It smells ghastly.
• mushrooms- I recently learned that a serving of button mushrooms contains 100% of the Vitamin D that you need for a day.
• In the United States milk is fortified with Vitamins A&D, because they help with the absorption of calcium. (Many people find it surprising that "Vitamin D milk" or whole milk has no more vitamins than skim or 2% milk. The only thing that it has more of is saturated fat.)
• Most cereals, butter and dairy products are also fortified with Vitamin D.

 Now I'm asking you to do me a favor. If know someone who is pregnant, share this information with them. Making sure that you're getting enough Vitamin D  while you're pregnant is a simple way to make a huge difference. If 20% fewer children in the United States came down with RSV each year, that's roughly a million children. And think how many families that would effect if there were that many children who weren't coming down with RSV. The thought makes me happy. So please, please, if you are reading this, spread the good news to your friends and family so they can keep their families happy and healthy.

Food Storage Friday: Pregnancy

Last Saturday my husband and I were sitting in the shallow end of the pool watching our kids play in the water.
My husband patted his stomach and said "I need to exercise more."
I patted my stomach and said "I also need to exercise more."
"That's not fat. That's a baby." It's not that I think I am fat. It's just that since I became pregnant, exercise has dropped down to less than once a month. I need to do better, but growing a baby just makes me tired.
I grabbed a love handle and said "This is not a baby."
"No, that's food storage for the baby. You're just practicing what you preach."
That man never ceases to make me laugh.
Happy Mother's Day and have a great weekend.

Helpful info for Moms who have had bladder issues after childbirth

 A few months ago I was talking with a good friend and I came to the realization that there are a lot of women out there who have been done a disservice by their post-partum nurses and OB-GYN's. She (and many others) have no idea what Kegel exercises are and how they are helpful in getting your body back to normal after childbirth. Perhaps many of my readers are already well-informed about this, but if I'm able to enlighten one woman who wasn't, than my time is well-spent.
 Pregnancy and child birth do a number on a woman's body. In order to grow a healthy child, the muscles get stretched out of place and weakened. The birth process is the most stressful on your body, because that 'not so little' bundle of joy has to fit through a comparatively tiny hole. Sometimes this results in tearing of the skin and muscles in the perineal area. Every woman who has delivered (or will soon deliver) a child should do Kegel exercises, but if you have given birth to large children, had difficult deliveries, had an episiotimy and/or torn during the delivery process, it is especially important that you do these exercises. And if you are pregnant can really decrease the perineal tearing during the delivery process by doing these exercises.
 So what are Kegel exercises anyway? They are exercises discovered by a Dr. Kegel to strengthen the muscles that control urinary flow. You're practicing squeezing and relaxing those muscles. And no one has to know that you're even doing them. There are two ways to determine if you are squeezing the correct muscles.

1. In the bathroom, stop your urine midstream. The muscles you squeeze to do that are the ones that you need to exercise.
2. Or lay on the floor and focus on squeezing the muscles around your urethra and anus. If you are squeezing your stomach or bottom muscles, you are squeezing the wrong muscles.

Now that you know exactly which muscles to exercise try this:

1. Squeeze for 3 seconds and then relax for 3 seconds. If you can't do that, build up to it.
2. Repeat this 10 to 15 times per session. Try to do this at least 3 times a day. These exercises are only effective if you do them regularly.

If you suffer from stress incontinence (bladder leakage when you laugh or sneeze), try these exercises. Doing these exercises can also help to prevent bladder, bowel and uterine prolapse (where the pelvic muscles are not strong enough to keep the pelvic organs where they belong). If you already have some prolapse it is important that you see a doctor to have it corrected before it gets worse. It is also important that you drink lots of water and get enough fiber so you're not straining in the bathroom and making things worse.

Ok, this part may be a little TMI, but I think it's helpful. I pushed for four hours (wish I were exagerating, but I'm not) with my first child, who came out the wrong way and would not be turned. Afterwards my CNM said "I am totally amazed that you only have a first degree tear." The reason is I had an hour commute to work each way, and every day I did Kegel's on my way to and from work. That was a good 2 (sometimes 3 with traffic) hours of exercise each day four days a week. Thank you nursing instructors who drilled that into me! It made a huge difference. Having strong pelvic muscles before your delivery can prevent a great deal of pain and suffering, and greatly improve your delivery experience.

Why You Should Probably Be Taking a Prenatal Vitamin Even If You Aren't Pregnant

The process of growing and breastfeeding a child for six months sucks out 5 years worth of nutrition from your body. This means that if you are not supplementing your diet while pregnant and/or breastfeeding your body will remove mineral and other nutrition stores from your body in order to create/ feed that little bundle of joy. Your body will actually take calcium from your bones and give it to your baby. This is one of the reasons women are more likely to suffer from bone loss. (There also another  bigger and more complex explanation that has to do with estrogen, but I won't get into that.) So if you plan on having a child in the next five years, or even if you have had a child in the past few years, you need to build (or rebuild) those nutrient stores by taking a vitamin. (This is a tidbit that I didn't learn until I had to start teaching it to people,  and is a good reminder for myself because I haven't been good about taking them lately.)

If you're pregnant or breastfeeding, prenatal vitamins are good for your baby. Taking a prenatal when pregnant drastically reduces your risk of having a child with birth defects. The problem with prenatal vitamins is that for many women the iron in them has a tendency to make pregnant women nauseated. When I was pregnant with my son, every time I took a prenatal vitamin I started vomiting. There is a method of getting around this. If you take prenatal vitamin with a glass of milk, the protein in the milk decreases indigestion, and your body also when given the choice of calcium or iron, will choose calcium. It can't effectively absorb both at the same time. (There's a long explanation involving chemistry, but brevity I'll fore-go that one too.) The downside is that you're not getting the iron. (But that's better than throwing up all of it, right?) If you can't handle that go for the gummi vites and some folic acid.
 Other good reasons to take a prenatal vitamin: They make your hair and nails grow stronger, faster and healthier. I started taking a prenatal vitamin when I was fifteen for this very reason. (and I took them consistently until I got pregnant, the irony) Also, prenatal vitamins are super cheap. However, you should be forewarned that the iron can make you constipated, so make sure you are drinking plenty of water.

When Looking for a Doctor, Ask a Nurse

 Today's post is about something that I wish that I had learned much earlier than I did. When you need a good doctor for something, the best recommendation you can get is from a nurse. Even if you don't know a nurse who works with the kind of physician you're looking for, you can still call the hospital and ask for recommendations. The best time to do this is on a Sunday afternoon when things are generally slower and nurses have more time to answer all of your questions. The nurses generally know who has good or bad track records. They work with the doctors on a regular basis and can pick out the ones who know their stuff. Now if you ask them they're probably not going to say "Oh, I definitely wouldn't see Dr. A because he is terrible about washing his hands." or "Dr. B is flaming moron" or "Dr. C is in danger of losing his license", but if there is stuff going on, they'll know. Trust me. They can point you towards the someone who will take good care of you.

 Sometimes which doctor you see doesn't really make a big difference, but there are many times that having a good doctor makes a big difference in how much time and money are spent on your or your child's health, not to mention what a difference it can make on your entire life. Any time spent researching the matter will not be wasted. I have a few stories to further illustrate my point.

 When I had my first baby (and was a very brand new nurse) someone who I respected recommended that I see a particular group of certified nurse midwives. All was well until I got to the delivery, which was a disaster. The most telling moment was after she broke my water and then said "I don't know what to do now." (I wish I were kidding, but I'm not.) After that experience I started taking a poll of all of the nurses that I worked with (at the time I worked on multiple units). At least 75% went to one particular OB/GYN. So with my second child that's who I went to. She was WONDERFUL! I really don't think I can say enough good things about her. Not just because of the way she treated me as a patient, but because of what a wonderful care provider she was to the patients that I observed her with.

 With my first child I wasn't sure who to pick as a pediatrician, so one was assigned to me. He seemed nice enough so I kept going to him. However, the more that I got to work with him the less impressed I was. When my second child was very tiny, my friends told me a sad story of patient from our unit. This toddler was complaining of severe neck and back pain and running fevers. This doctor ordered IV fluids and Tylenol (which are great), but refused when every nurse who took care of this patient, begged for a lumbar puncture and antibiotics. After four days of the patient not improving, a scan was ordered. It then became apparent that the patient had started with spinal meningitis and it had spread to the brain. That poor child will be mentally delayed for the rest of his life, and this was preventable. Ug, it still makes me sick/sad/angry to think about it. Needless to say, I did not take my children back to him.

 If you can't find a nurse to give you recommendations, here are qualities that you should look for:

1. Your doctor should really listen to what you have to say
2. Your doctor should be willing to admit when he or she doesn't know something and needs to consult someone else.
3. Your doctor should never treat you like you are stupid because you don't understand medical jargon.
4. Your doctor should never seem to be "put out" to take care of you or answer your questions, that why they get paid.
5. Your doctor should keep you updated.