1st Trimester Morning Sickness

I've been waiting for the word to get out before I started blogging about this topic... pregnancy!  Now folks can be radiant and happily pregnant or sick and miserable and then there is everything in between.  I figured I'd share some of my experiences as well as some lessons I've learned.  Here I am on baby #3, you would think that wisdom comes from experience?  Well, not always...


There is so much to talk about!  I'll start with "morning sickness" since this is usually my dead give-away at my work place.  Even though it is commonly called "morning sickness" nausea does not always or only occur in the mornings.  The medical term for this is hyperemesis gravidarum.  It can last all day!  Hide it as I may try, people usually grow suspicious when they hear me hurling in the bathroom.  I had it the worse with my first where I even lost weight during the 1st trimester.  It was somewhat improved with my second child where although I was pretty sick to the stomach, I did not actually vomit enough to lose weight.  With this third child, I actually experienced very little nausea and I think it is because I was training for a marathon and didn't even know I was pregnant until 3 weeks before my race!  Exercise is known to help with 1st trimester symptoms and I can now say first hand that it definitely helped my nausea!


Usually, nausea starts at around week 6 and lasts into the beginning of the second trimester.  Most people feel much better by week 14 or 15, however, there are some reports of unfortunate souls who have nausea the entire pregnancy.  Some folks have it so severely that they end up needing to go to the hospital for IV fluids.  The important thing is to stay hydrated.


So some things that may help with nausea include:
- eating small frequent meals especially foods that are high in protein and complex carbs
- having cheese or crackers by the bedside so you can eat before sleep and even before getting out of bed
- drink water water water!
- ginger (I can't eat this plain but they make ginger candy) and ginger ale helps
- switching to different prenatal vitamin or take different time of day (this definitely made me sick that I had to resort to gummy vitamins)
- supplement with vitamin B6 (I tried this... maybe it helped)
- sea bands (I bought them... I personally did not find it too helpful but maybe I was just too sick for anything to help)


If it is so bad that you are losing weight... then you may be prescribed something like zantac, phenergan, reglan or zofran.  You have to talk to your OB to see what is right for you.


So with this child, I actually experienced very little nausea/vomiting!  That is until last night but I think I caught a GI bug.  Getting sick while pregnant is a whole other topic... not fun.  I'll save it for another post.

Two Birthday Celebrations, a Marathon... and Thanksgiving =)

Long time no blog!  November was a crazy month for me and it just flew by.  One daughter turned three, the other daughter turned one... I ran 26.2 miles in between their birthdays and Thanksgiving was thrown in there as well!


Here is a sample of some things I'm thankful for this year:


-  a stimulating and rewarding job where the staff is like family
-  friends near and far to laugh and cry with
-  our church with its dynamic worship, insightful sermons, and a community to grow with and serve
-  willing grandparents sacrificing time and energy to babysit and help with household chores
-  two healthy daughters who make me smile all the time
-  a patient and supportive husband who ran 6+ miles with me during the Philly Marathon!
-  a loving and gracious God who gave me the most meaningful gift of all... His Son, Jesus... it is because of Him that I can have peace that transcends understanding, eternal hope in times of despair, and an ongoing dynamic and intimate relationship with my Father in heaven

Being a mom and learning the art of balance

Long time no write!

As marathon date draws closer and my training sessions increase (2-3 hour chunks of time on weekends!)... I find myself just wanting to sleep when I'm done with the essentials of keeping up with my email inbox.  I'm also finding myself hungry all the time!

Now I've posted before on the benefits of exercise and how training for this marathon has done wonders to my overall mood and sanity.  At the same time, I also notice myself getting frustrated when I cannot make a training session as I had originally planned.  For who knew...  infants and toddlers are not so predictable and do not always follow the schedule I put forth for them!  I'm learning the lesson of balancing my expectations and readjusting them to fit what my life will allow.  I admit that it is very hard for a “type A schedule oriented planner” like myself to just “let go and go with the flow”.  I have to tell myself that it is not the end of the world if I am not running the exact number of miles the schedule says I'm to run.  Hey, if I end up finishing the marathon.. great!  But if not... isn’t it also the journey that counts?  I have to say though... I'm going to try really really really hard to finish!

So this post is really about me being a mom trying to balance time and expectations.  It should be okay for it to be about me when I need it to be about me, but not at the expense of my kids and husband!  I need to step back sometimes and remember the big picture.


Now this marathon run did start out as something on my bucket list and was all about me wanting to do something for just me.  I've recently decided to run for a cause.  I joined the Team in Training for Leukemia & Lymphoma Society.  I figured it doesn't have to be just about me and I can raise support to fight blood cancer.  Being a family physician I have several patients with several of these diagnoses and it seems appropriate to run for them.  On a more personal note, I have a good friend who was diagnosed with Multiple Myeloma while overseas doing missions.  He has two small children and is a physician himself.  His and his wife's story of faith through their battle with the uncertainties and pain has been a true source of encouragement for me.  So here I go!  If anyone is interested in supporting this cause you can click here to see my website.

Now on a side note, I’ve always thought there are so many good verses in the Bible that draws analogies with our Christian faith and running!  Here are a couple that come to mind:

"I press on toward the goal for the prize of the upward call of God in Christ Jesus."  (Philippians 3:14)

"I have fought the good fight, I have finished the race, I have kept the faith."  (2 Timothy 4:7)

“Everyone who competes in the games goes into strict training. They do it to get a crown that will not last; but we do it to get a crown that will last forever. Therefore I do not run like a man running aimlessly; I do not fight like a man beating the air. No, I beat my body and make it my slave so that after I have preached to others, I myself will not be disqualified for the prize.”  (1 Corinthians 9:25-27)  

Flu Shots

It is that time of year again for flu shots.  Last year, I did not get my swine flu shot in time and I was really sick with the swine flu... and pregnant!  So this year, I decided to get my shot a little on the earlier side and get everyone in the family vaccinated as well.  The flu vaccine this year combines both seasonal flu as well as swine flu.  For more information from the cdc you can click here.

Being in primary care, I will most definitely be exposed to the flu.  Since my immune system is not the greatest with such sleep deprivation, I need all the help I can get to stay healthy.  The basic idea is to inoculate against a dead virus so that my body will make antibodies.  Then when the real live virus hits... I got my defense system ready to go.  This should translate to no illness or less severe symptoms and shorter duration of illness.  I'm telling you... last year I was coughing and sick for over 4 weeks!  

More importantly, I need to get vaccinated so that I protect my patients and my two small children from being sick.  Sometimes, you may catch what you think is the common cold (when it is actually the flu) and the symptoms seem mild and go away because your immune system is pretty strong.  However, you can then pass along that same virus to someone else who has a weaker immune system (very young or very old) and that person can get very sick... even die.  This is why it is recommended for all healthcare providers to get the flu shot.  It is really to protect the patients who have weaker immune systems.  And in fact, all parents of small children should get the flu shot to protect against their young ones.

Yes... we still get a lot of people very wary of vaccines.  I can only say you have to weigh the pros and cons and make the best choice based on the facts.  Of course there are real contraindications of why you should not get the flu shot (ie. if you are allergic to eggs or if you have had a bad reaction to it in the past).  Again for more detailed information you can go to the cdc site listed above.

So my kids did great!  My ten month old did cry during the shot but she was crying before the needle, so I think she was just upset because daddy was holding her so tightly.  The parental grip on an infant is an art and can make all the difference in the experience.  The child should feel safe and secure.  The grip should not be so hard as to cause pain or discomfort but yet firm enough that the limb does not move.  The last thing you want is a flailing limb around a sharp needle!

My toddler was amazingly brave.  She watched the needle the whole time and did not even flinch or shed a tear.  Maybe it helped that mommy and daddy got shots first and she watched us get it with no incidence.  However, she did witness the baby crying during her shot... so who knows.  Well, many kids are crying way before the needle is anywhere near them.  I definitely think the fear of the needle and anticipation is far worse than the actual shot itself.  We've had our share of screaming wiggling children putting up quite a fight in our office.

Finally I just want to dispel a common myth about the flu shot.  Flu shots cannot cause the flu!  I really like how WebMD puts it and you can click here for more common myths about the flu:

This is the flu myth most likely to drive experts bonkers.  “There is simply no way that the flu vaccine can give you the flu,” says Hay.  “It’s impossible.”

Why? For one, injected flu vaccines only contain dead virus, and a dead virus is, well, dead: it can’t infect you.  There is one type of live virus flu vaccine, the nasal vaccine, FluMist.  But in this case, the virus is specially engineered to remove the parts of the virus that make people sick.

Despite the scientific impossibility of getting the flu from the flu vaccines, this widespread flu myth won’t die.  Experts suspect two reasons for its persistence.  One, people mistake the side effects of the vaccine for flu.  While side effects to the vaccine these days tend to be a sore arm, in the past, side effects often felt like mild symptoms of the flu. Two, flu season coincides with a time of year when bugs causing colds and other respiratory illnesses are in the air.  Many people get the vaccine and then, within a few days, get sick with an unrelated cold virus.  However, they blame the innocent flu vaccine, rather than their co-worker with a runny nose and cough.

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I'm also going to cut and paste this section here from WebMD on dosing of the flu vaccine:

My children are under 9 years old. How many doses of the seasonal flu vaccine do they need?

It's really quite complicated for parents whose children are 8 years old or younger and who have never been fully vaccinated against the flu.

How many doses of flu vaccine will a child under age 9 years need this year? It will depend on two things:

• Whether the child got any H1N1 vaccine AND
• Whether the child previously got a seasonal vaccination, when that was given, and how many doses they got.

Children who got a previous seasonal flu vaccine as recommended -- AND got just one dose of the H1N1 pandemic vaccine last year -- need only one dose of the seasonal vaccine this year. We give them credit for getting the priming dose last year, but only if they previously got the seasonal vaccine.

Children under age 9 years who never before got a seasonal flu vaccination will need two doses of the seasonal vaccine this year -- even if they got the 2009 H1N1 pandemic flu vaccine.

Children under age 9 years who have had a previous flu vaccination but who did not get the 2009 H1N1 pandemic flu vaccine will need two doses of the seasonal vaccine this year.

If a child needs two doses of the flu vaccine, the second dose must be given no sooner than four weeks after the first dose.

It's such a hassle to get young children two doses of flu vaccine a month apart. Won't they get at least some protection from a single dose of the vaccine?

No.

Terrible Two Tantrums

My older daughter is now almost three years old.  I think she hit the "terrible two" stage when she was around 18 months.  So what is this stage about?

I think this is a challenging time for toddlers and caregivers because there is so much growth, change, and development!  The toddler brain is really like a sponge soaking up and processing so many new words, feelings, and experiences.  Realization about their individuality leads to pushing boundaries.  What's more, it is difficult for a toddler to control their emotions.  So as a result, you can have crazy silly laughter one minute and a total meltdown a second later!

This is also a very fun stage where the most amusing and sometimes very insightful things get said.  All in all, I do like this stage because there is so much meaningful conversation with my little girl.  At the same time, I need to be one step ahead of her and she needs to know who is boss.  Otherwise, if unchecked, the child can easily turn into a "crying brat who always gets her way".

So tricks to dealing with a toddler in the midst of a tantrum?  For me, it helps to step back a little and try to differentiate between a manipulative tantrum versus a frustration tantrum.  Is my child throwing this fit just to get her way or is she throwing a fit because she is frustrated that she is not getting her way?

I do not want her to get the message that all she needs to do is throw a tantrum to get what she wants.  So I try to stay firm with my decision.  If I said "no" to something and now she is throwing a fit.  Well, she needs to know that I will not change my answer to "yes" just because she is throwing a fit.  So in those circumstances, I tell her firmly my answer and reasons and essentially wait out or ignore the tantrum until it passes.

Now most of the time, my child tantrums because she is unable to achieve whatever it is that she had set her mind to... so more out of frustration.  I try to help her in those situations but it is tricky because she will melt down if I try to help too much.

Bottom line... it is all an art.  I do have to stay calm as a parent.  Otherwise it may just escalate the situation.  Identifying tantrum triggers and trying to avoid them is key.  At the same time, giving her something to do and keeping her mind, body, fingers busy is helpful, too.  Fun times...

Air Travel with Toddlers/Infants

This is a topic I've been thinking about a lot lately especially since we did quite a bit of traveling the end of August and beginning of September.  Most people find traveling to be a pain especially with all the increased security since 911.  Well, imagine doing it all with children 2 and under!

Preparations Before the Trip

I always try to pack as light as possible.  This is not an easy task because when you travel with little ones you have to pack so many things... diapers, food, bath stuff etc!  In addition if renting a car or traveling anywhere by car, we will also need to bring their car seats and possibly a stroller.  The list can go on if you want to bring a pack n play and booster seat and bathtub...

Most places will have a Walmart or Babies R Us.. so we actually decided to just buy diapers and baby food at our destination (can do this if staying long enough or have another baby around the same weight that we can split diaper costs with).  Paying money for an extra checked bag is probably around the same price as a box of diapers.

Thankfully, we were also very fortunate that we had family in both places we traveled to.  They were able to help provide some of these bulky items (pack n play, booster seats) so that we did not have to bring it with us on the plane.  That was a huge help!

Now if one has to bring all this extra stuff, I would recommend just biting the bullet to pay extra money and checking as many things as possible.   Going through security with a million carry-on bags is just stressful and chaotic!

The Airport Experience

Keeping track of luggage as well as a toddler and infant is not an easy task.  I actually carry my infant in the baby bjorn so that my hands are free to help with luggage and to grab my toddler's hands if daddy is busy with luggage.  We use the stroller and carseat to load backpacks, diaper bag, and my pumpbag so there is less to carry.  I've also seen some folks strap their toddler to their carseat and then push the carseat with a handle so it is like luggage.  That is a pretty good idea for the toddler who likes to wander!

So the challenge is to get everything on the conveyer belt while keeping the toddler out of trouble... and without banging my infant in the head (since I'm carrying her in front and have free hands but some of our stuff is bulky!)  Usually, I put my bags on the belt then walk through security with toddler in one hand and infant strapped to me while husband is left putting the rest of our stuff (strollers/carseats etc) onto the belt.  After going through I usually have to wait with the security guy because every time they have to take out my bottles and pump stuff and run some test on them.  I have learned to keep all my liquids in a separate bag that is easy to remove from the diaper bag.  Otherwise, these security people make a mess rummaging through pulling things out and they don't necessarily help put things back!

Finally we are through security.  Whew!  Now we go to the gate and while one parent watches our stuff, I take one kid at a time to the bathroom... diaper change one last time for infant and potty run for the toddler.  We keep her in her pull-up just in case she has an accident as well as xtra pair of clothes.  Thankfully she has been great.  It is such a pain though to go potty with a toddler in those tiny airplane bathrooms!

Most airlines will allow you to pre board if you have kids.  This is a huge help because there is so much stuff.  We usually have to roll our car seat and strollers to the end of the gate runway right before you board the plane so they can take it.  Then we bring our toddlers car seat on board so she can be strapped in it during the flight.  With the narrow aisle to walk down and all our stuff.. it is just cumbersome.  But finally... in our seats!

The Flight

So previously I said to pack light.  However, it is crucial that we remember to bring some entertainment for our toddler for during the flight.  3 hour flight to Houston was nothing compared to the 6 hour flight to San Diego that we had to endure!  Now... timing is everything.  If you have a child who will sleep anywhere and anytime then flying during nap time is great because you know they will be out for 1-2 hours which is less time to entertain them during the flight.  

With out kids... they are not great sleepers and usually get very cranky when they are tired.  However, if we bear with it.. they should pass out.  Our little one screams her little head off.. but will pass out... however, one of us has to hold her and sometimes walk the aisle and bounce to keep her asleep.  The most painful moments are when we are not allowed to get up because of take off or landing or turbulence and she is just screaming.  Oh well.  Little we can do...

Our toddler on the other hand... sigh.  She totally melts down when she is super tired and it is not easy to get her to fall asleep in such an environment.  Now when she does fall asleep, it is just as hard keeping her asleep since her head bobs around.  I thought buying her a neck pillow was the answer but she just would not put it on.  Oh well.. again.  It is what it is.

So I try to bring some new book or new toy that she has never seen as part of her entertainment.  Plus, eating snacks take up some of the time as well.  Finally as a last resort... Dora videos!

Getting Off

Getting off the plane is a little harder I think.  We have to gather all our stuff from different overhead compartments as well as the stuff under the seats and we have to unstrap the car seat our toddler is sitting on!  Some people choose to sit all the way in the back.  This way we don't feel like we are holding other people up.  Plus it is closer to the bathrooms and to the back area in case we have to get up to bounce our little one.  

As a side note... where you end up sitting can actually make or break an experience.  Folks who like kids and try to entertain them before/during/after the flight are probably the ideal folks to sit near.  Ha.. they should probably add a feature to the online booking where you can designate if you want to be as far away from kids as possible.  Folks who do not like kids are a nightmare to sit next to... adds to the parents' stress I think.

So how to have an overall good airplane experience?  Attitude is key!  Gotta think positive... lower expectations... expect the unexpected... plus a sense of humor always helps =)  Bon voyage!

Mommies need to exercise!

Long time no blog!  The summer is flying by and between work... putting my kids to sleep at night... and trying to train for the marathon... it has been hard to find time to write since I just want to go to sleep by the time I turn on my computer.  Yes, I'm going to run the marathon!  It is on my bucket list and I feel this is the year to do it.  So here is a quick blog about exercise...


I used to be this almost fanatical field hockey player.  It took up a big chunk of my time/energy/passion.  This was especially true during high school, but was also a significant part of my life during college.  So then after college, without the structure and discipline of an organized sports team, it took more effort on my part to exercise.  In medical school, I was able to play club volleyball because I had friends who played.  Therefore, there was always some outlet for my stress.  Once I started residency and was working 80 hour weeks... exercise kind of took a backseat.  I'd try to go to the gym to run every now and then but it was hard to be motivated and hard to be consistent.  Then I had kids and exercise pretty much went out the window!  It is no wonder I started feeling like I was going crazy!  Not only did life just become so much more chaotic but I also stopped the one thing that was always my source of stress release.


So I am someone who needs a goal to stay motivated.  Just deciding to run on the treadmill everyday is not enough incentive... I had to tell myself that I need to run so that I can finish a marathon race.  Once I really started training I was amazed at the huge difference it made in my mood.  It seriously feels like I'm taking a "happy pill"!  I'd get home past 11 o'clock at night (because I can't run until my kids are asleep... which is usually past 9pm) but be full of energy and glee.  I have always advocated exercise to my patients and know you can get this endorphin kick, but actually experiencing it is beyond what words can describe.


Of course, the trick is to actually do it.  It may require getting an accountability partner or like in my case, need to set some sort of goal.


Here are 10 reasons to exercise from the Mayo Clinic:

1. Keep excess pounds at bay. Combined with a healthy diet, aerobic exercise helps you lose weight — and keep it off.
2. Increase your stamina. Aerobic exercise may make you tired in the short term. But over the long term, you'll enjoy increased stamina and reduced fatigue.
3. Ward off viral illnesses. Aerobic exercise activates your immune system. This leaves you less susceptible to minor viral illnesses, such as colds and flu.
4. Reduce health risks. Aerobic exercise reduces the risk of many conditions, including obesity, heart disease, high blood pressure, type 2 diabetes, stroke and certain types of cancer. Weight-bearing aerobic exercises, such as walking, reduce the risk of osteoporosis.
5. Manage chronic conditions. Aerobic exercise helps lower high blood pressure and control blood sugar. If you've had a heart attack, aerobic exercise helps prevent subsequent attacks.
6. Strengthen your heart. A stronger heart doesn't need to beat as fast. A stronger heart also pumps blood more efficiently, which improves blood flow to all parts of your body.
7. Keep your arteries clear. Aerobic exercise boosts your high-density lipoprotein (HDL), or "good," cholesterol and lowers your low-density lipoprotein (LDL), or "bad," cholesterol. The potential result? Less buildup of plaques in your arteries.
8. Boost your mood. Aerobic exercise can ease the gloominess of depression, reduce the tension associated with anxiety and promote relaxation.
9. Stay active and independent as you get older. Aerobic exercise keeps your muscles strong, which can help you maintain mobility as you get older. Aerobic exercise also keeps your mind sharp. At least 30 minutes of aerobic exercise three days a week seems to reduce cognitive decline in older adults.
10. Live longer. People who participate in regular aerobic exercise appear to live longer than those who don't exercise regularly.