Pregnancy and Reflux!

This blog series is lovely isn't it?  Symptom after symptom of various ailments and discomforts that come with the joy of a new baby... only to then have your sleep interrupted and sanity stretched =)  Yet... people still opt to have kids!  Ha... we're on #3 and though a bit fearful of what's to come, actually excited.  I suppose I'm always one who rises to challenges.  Though having a nanny is huge and I don't know what I'd do without extra help.

So...  about gastroesophageal reflux or heart burn...


This can happen to folks who are not pregnant but it is a common symptom in pregnancy.  Starts in the 1st trimester and may very well last or even get worse as the belly gets bigger and more pressure is pushing on the stomach.  Usually, one notices discomfort like a burning sensation in the chest and a sour taste in the mouth though sometimes it is subtle and one may only experience bloating or belching.


Foods that can exacerbate heartburn include:
-  tomato based foods
-  caffeine
-  chocolate
-  mint
-  carbonated beverages
-  fatty foods
-  spicy foods
-  dairy


There are some meds that can exacerbate heartburn as well so make sure you talk to your doctor.


Things you can try to do for it include:
-  avoid those list of foods that exacerbate the symptoms
-  eat smaller meals more frequently
-  eat slower
-  drink less during meals
-  avoid bending or exercising right after eating
-  avoid lying down sooner than 2-3 hrs after eating
-  avoid tight fitting garments or belts around the waist
-  avoid smoking and alcohol (well if you're pregnant you shouldn't be anyway!)


If you need meds you should speak to your doctor.  Tums or maalox may help.  You may also be put on something like Zantac or Prilosec or even Reglan.


I'm glad that I actually don't get this symptom too badly though certain meals do trigger it.  I had indian buffet for lunch today which is a lot of food and a lot of creamy sauce... so probably was not the best idea.

1st Trimester Fatigue

Alright so I find the first trimester the hardest time of pregnancy because of the onset of symptoms that can occur during this time.  Some folks get it real bad and others not so much... and lucky me I get to experience it all!


My previous blog focused on nausea.  I'll talk about fatigue next because that is usually the other huge give away!  I get soooo tired during this time.  During the day, it is hard to have energy to do the things I need to do.  Being at work and needing to interact with patients is one challenge but being home and chasing around a preschooler and toddler is another thing altogether!  I'm usually so spent that I have no desire/energy to do anything else at night after dinner except crash in my bed.  So my house is a complete mess and I'm so disorganized... which drives me nuts!


So how am I still up right now blogging?  Well,  I think I'm getting some energy back as I'm heading into my second trimester.  Noticed how I didn't blog at all in November?  Heh.  Most people will feel better by the second trimester... only to feel tired again by the third.


It is a challenge to feel so tired and needing sleep... but then having sleep interrupted at night from increased frequency of urination!  That of course is another common symptom in the first trimester.


So what to do about it?


-  may seem counter intuitive but exercise actually does help
-  small frequent meals with extra protein
-  eat healthy with lots of fruits and vegetables
-  decrease activities and cut out unnecessary activities that tire you out
-  get rest!  take a nap if you can
-  hang in there.. should improve in the 2nd trimester

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...