Snow Day!!!!

Hurrah! Snow day! We got a bunch of snow in one of those CO freak spring storms and classes were cancelled this am. Me and the dogs are enjoying some quality R&R, which is extra nice since I haven't been able to sleep properly for about the last week. In fact, I've been so miserably tired I've started writing a blog post about 3 times entitled "Not glowing" referring to the difficulties of being preggo.

But, everytime I've started it, I've deleted it. Even though there are days (many) when I totally want to fast forward to August, I don't want anyone to believe for a minute that I'm not thrilled about this baby. Baby yes. Being pregnant...less so. It makes it even less tolerable when you're so excited to meet this little person who's coming to change your life forever! She's kicking the crap out of me even as I write this. Letting me know she's on the way and to get ready!

Days like today make me think about it even more since, seriously have you seen what's on TV during the day? Wow. And really, who studies on a snow day?! I can't wait till I have a little 1 1/2 year old to run around in the snow with on a day like today!

The big bright side right now...half done!!! Wahoo! On Friday we go for our anatomy scan, which means a lot less when you've had as many ultrasounds as we have! Since the big 16 week ultrasound where we learned she is in fact a she, my doc's checked two more times and there's no doubt in my mind, it's definitely a girl! Also on Friday I'm doing my oral glucose tolerance test. Basically I drink a high sugar syrupy drink and one hour later they check my blood sugar to make sure I am able to use it appropriately. Women become more insulin resistant during pregnancy so that a larger amount of glucose stays in the blood to be taken up by the baby. This becomes a problem when blood sugar gets too high and can lead to birth defects if it is uncontrolled early in pregnancy (we're past that point) and very large babies in women with poor control. Then after birth, the baby does not get as much sugar as it is used to, but it's pancreas is still kicking out a ton of insulin, so these big huge babies get hypoglycemic after birth and can have seizures from that. I have a strong family history of diabetes and so we are doing this test a little early. I'm hopeful that it will be ok, but this has been my biggest anxiety about pregnancy for years. Those women who have gestational diabetes are 66% more likely to develop type II diabetes later in life, so it's a big deal. Hopefully it will go alright; should find out by Monday or Tuesday next week. I'll feel better when that's done with!

I hope everyone enjoys their day, even if you're all not lucky enough to have a snow day!!

Light Reading

I don't think any one will really appreciate how pumped I am to have stumbled over a copy of The San Francisco Ferry Plaza Farmers' Market Cookbook! I love that farmers' market so much that it inevitably leaves me disappointed when I visit any market around here even in the bounty of summer. Maybe J, but maybe not, could understand how much I think about thsi place. I get cravings to go there. Many cravings. And not just because I'm pregnant. At least once a week I think about being there on a Saturday morning, seeing all the delicious produce and looking at the beautiful city, bay, bridges. I probably tell J about these once a month or less, so really I control myself better than I get any credit for. Anyway, I'm pumped to read the recipes and look at the great pix. It's like an early birthday present! (I love my birthday, and my birthday is tomorrow...woohooo!)

On a sadder note, I actually heard someone running for office on the platform that as a state legislator she "defunded Planned Parenthood." Whaaaaaa? Regardless of your feelings on abortion, I think we can all agree that birth control, affordable birth control, is one of the most important services health care can provide. In this country 50% of pregnancies are unplanned. The emotional, physical, and financial toll this takes is enormous, not just for the individuals involved but for society at large. I feel very passionate about pregnancy prevention, it is a major part of my desire to be an OB/Gyn. I'm not asking everyone to feel like I do, but seriously, I was taken aback by that commercial.

One more reason to read my awesome cookbook and turn off the boob tube!

Hard

Today I spent the day in a hospice setting. It was a difficult day. I really only saw one patient throughout the course of my day, she is dying from cervical cancer (don't get me started on getting paps in a timely fashion, that's for another post). Advanced cancer is painful, and this woman is in pain. Her family does not want her to receive pain meds because they've "seen other hospice patients and they are all out of it." They want her to only receive pain medications when she asks for them, or in med lingo, prn.

Here's the difficulty with end of life pain meds. Pain is difficult to control, particularly in patients who have a lot of it for a long time. And once the patient is feeling the pain and asking for meds, it is harder to keep it at bay than it is if we "stay ahead of the pain". By staying ahead of the pain this does not mean snowing people so they are completely incoherent. It means giving a monitored dose of long acting pain medication in a scheduled fashion so that people are less likely to need the short acting, heavy hitting "breakthrough" meds. In addition to the benefit of less pain, the patients are often less agitated and better able to handle their surroundings and are less likely to become delirious secondary to pain and anxiety.

It's also important for patients and families to understand that addiction to pain medications in this setting is almost never an issue. Addiction implies an illness defined by the patient actively seeking out a drug. Pain medications for chronic pain almost never fit this category. Dependence on the pain meds often does happen. The patient will grow to require higher doses, but often this stems from advancing disease processes rather than the patient getting used to a certain dose of meds. The patients may withdraw if they are removed from the pain meds, and this is also not a sign of addiction. In fact, withdrawal can occur even from antidepressants, a class of drugs which is not addictive in nature.

It's important to me that patients become informed about what palliative care and hospice really mean. It is not simply a place to die. In fact, hospice is not a place at all, but a philosophy of care. Hospice often happens at home. Currently the average patient is in hospice care for a median of 15 days. 15 days until they pass away. This is most often because both physicians and patients are not informed about when a patient may receive hospice and what kinds of services they may be eligible for when they do. If you feel a loved one may need Hospice care, or would like to find out more about what Hospice entails, please visit www.hospicenet.org.

The people who work with Hospice are about as caring and giving as it gets. I truly believe if more people understood hospice and what they do, more people would take advantage of this amazing benefit at the end of life. Check them out.

And as one last note from my soapbox - talk with your loved ones about your wishes long before you reach an end of life situation. It can make all the difference in the world.

I learned sumthin...

Everyone all year has told me how much they learned on the internal medicine rotation (re: rotation I just finished with). I didn't really believe them as I went through the rotation and pretty much just struggled to hang on for the ride. But now as I go through my family medicine rotation, I know that it's true. I know what meds to give people with specific conditions. I know when a symptom is very serious and can't be ignored, and when "it's just a virus." And I'm finally starting to understand treatment of diabetes. Starting. Diabetics who can alter their insulin levels to their carb intake are still much more proficient than I am. I'm starting to feel like a doctor. Or at least like I could someday be a doctor. Which trust me, at the beginning of third year, was not the case. And more importantly, I like it and know it was the right decision. Every now and again when the hours are long I haven't been able to shake the feeling that maybe I should have just finished the PhD and moved on. It would be done by now, there would be no residency to follow. But there would be no catching babies. No teasing out a history of potential endometrial cancer that may have gone overlooked. No pulling off ascites fluid to make someone's quality of life better in their end stage liver disease. It would be a different life. In some ways better (more time with the coming kiddo) and in some ways so much worse. I know residency will seem impossibly hard at times, but in the long run, I don't want to do anything else.

It does make it easier to feel this way when you get off work at 3 every day.....

Drumroll please....

For those who knew, this is not what we were expecting going into the ultrasound on Friday! He was pretty sure it was a boy! He sounded so sure we had even picked up some cute baby sheets that were on a crazy sale. Luckily, returnable. Those who know me well, know that I'm not a huge fan of the little girls covered in head to toe pink. Never has been my thing. I'm a little nervous.

When we went in, my sister came with us, but waited in the waiting room so me and J could find out the sex alone, then J went to get her. As soon as he left the room I said "oh god, here comes the pink nightmare." Please keep this in mind when looking at those "oh so cute" pink lacy...things. I do, however, love purple. And really, yellow is not as gender neutral as people think it is...how often do you see boys wearing yellow...

It will be great to have a girl. Almost all my girlfriends have girls, and it makes me excited for them to someday meet. Knowing what wonderful women are in my life, I know their daughters will have such great role models, and become such wonderful women in their own right. I just hope I don't screw mine up so she can fit in with all those beautiful ladies!

I am not, however, excited about how tight my pants are getting. It's a weird feeling to feel like you'll fit into your clothes one day, then the next there's no way that button is getting to that hole, no matter how hard you try. Tough stuff for any woman, any person really. But I'm trying to stay positive and today I finally feel like I am well enough and have enough time to get back to the gym. I got the red light on running/jogging and that makes me sad, so I guess I will become one of those power walker types. The big guy should appreciate that. Not that any of this will help the expanding waistline (clearly) but I'll be better ready for delivery (too scary to think about really right now) and hopefully I can stave off the dreaded ankle swelling. Blah.

Well, I do plan to keep updating this site on the baby, but I won't forget about medicine stuff too. I will be starting family medicine today, and I'm really looking forward to it. I'm even more excited for it since I got an email from my attending saying she works from 7:30am to 3pm. Nice!