Crash

That is, after about six weeks on Armour Thyroid, the best way to describe how I feel right now.

I have noticed a gradual resurgence of old symptoms - like shortness of breath, brain fog and now a wicked case of joint pain. I thought it was those new pillows I bought like two or three weeks ago, and now realize - it's probably because my meds started crapping out after not being increased properly and my symptoms were coming back worse than ever.

This is the point where patients often hear one of several things: "The meds aren't working, my doctor wants me to go back on Synthroid," or "See? It doesn't work - it can't be regulated so you need to stop using it." Sometimes the patient will exhibit hyperthyroid symptoms - I've heard people say, "My so-and-so was on that stuff and all her hair fell out and she almost had a heart attack and died. It's terrible." What that means is that the doctor put that person on too much Armour - because it's considered old-fashioned and bloodwork is king, many doctors - including mine, it looks like - don't often dose patients properly.

Do I blame the medication? No, not really. It's a combination of things - the dose, the amount of time spent on that dose without increasing, and other things. My vitamin D levels are low again, and my wonderful gastroenterologist has me on 2,000 units per day now (instead of the mega crazy 50 thousand a week like before). I started noticing symptoms before the Vitamin D was added, so I don't think it's a toxicity issue, since I'd probably have to take nearly the entire bottle in one sitting to achieve those levels.

As I thought about how my symptoms have manifested themselves - gradual tiredness at times that I usually had a lot of energy, brain fog, joint pain and decreasing motivation - I pictured myself digging a hole with the 1/2 grain (or 30 mg) dose I was on. That's quite low to start with, and it's customary to increase by 1/2 every two weeks or so, something my doctor didn't do. In fact, while he wanted blood levels taken again at the end of the month (which I just got done on Friday), he doesn't want to see me again until January. Sorry, but that isn't going to happen.

How I felt, I realized, was like treading water and then sinking into a hole. Once you increase your dose - I have actually been taking two pills a day now instead of one, just to see what happens - it's like trying to claw your way to the top of the hole to get out. When I read the Stop the Thyroid Madness! website, advocate and patient Janie Bowthorpe basically said the same thing:

The key to understanding this mistake is with the word “starting dose”. When first starting on any natural desiccated thyroid product, it can be wise to start on one grain or less, which is lower than you will ultimately need. Why? To help your body adjust to the direct T3. BUT, patients have found it UNWISE to stay on that low dose much longer than 2 weeks without raising. Why? Because hypothyroid symptoms can return with a VENGEANCE due to the feedback loop between the hypothalamus, pituitary and thyroid gland, i.e your hypothalamus gland senses the addition of desiccated thyroid (thinking the thyroid sent it), then sends a message to the pituitary gland, which in turn sends a message to the thyroid gland to stop producing, making you even more hypothyroid than you began.

Basically, I'm feeling exactly the way she described.

Interestingly enough, the hypothalamus regulates body temperature, and many people with hypothyroidism have consistently low body temperatures. I have had low body temps for years; in fact, last night I woke up with that stiff neck issue, took an Advil and suddenly felt ill - I took my temperature and it said 96. something or other. I took it this morning and it was 95.6, just a few minutes ago and it was 98.2. Holy crap.

Some doctors will scoff at the idea of considering low body temps as a marker for hypothyroidism, and then go back to the TSH values with religious fervency. I don't even know how I can adequately assess whether I'm ill half the time or not because my temps never reflect a typical 'fever' reading, so I generally just go by how I feel physically. Who knows.

In the meantime, I will ask for my blood test results after a month on the T3/T4 combination meds. I'm not sure if I should go back down to taking 1 1/2 pills, because splitting it myself doesn't sit well with me as it's not a surefire way to regulate the dose I'm getting. I definitely will call the doctor with my concerns and have him write a new prescription, this time only asking for a limited number of pills so that we can increase in increments of one-half every two weeks or so.

More reading:
Hypothalamus-pituitary-thyroid gland feedback loop - Wikipedia

Milwaukee co-sleeping ads: a fear-mongering lack of information

I'm sure I'm like the zillionth blogger to talk about this, and for good reason: those stupid Milwaukee Department of Health ads are over the top. They're making national headlines now as the AP has picked up the story and the public's reaction to it. And as usual, they also come with a million comments from idiots who think that people who do this should have children removed from their custody, blah blah blah.

As I searched for photos online about the project, I found a few of them - besides the butcher ones that ran recently. This campaign, from what I can tell, is not "new" - another blog posted various photos from it as early as last year. It seems like only now is it really drawing any widespread criticism.

I don't even co-sleep, and can probably count the number of times I have on one hand. And I still find them absolutely ridiculous. I should add that, for my second and third children, they slept in a bassinette/Pack 'n Play thingy in our room for at least a full six months before we moved them into their own beds.

What a nice touch. But where are your
sources? 

You see similar ads that encourage - coerce, guilt - you into vaccinating, for everything under the sun. The bottom line of these campaigns is not only that you should vaccinate for every illness that comes down the pike, but that a government entity knows more about raising your children than you do. Granted, some people do need help in that department, sadly, but the majority of people who co-sleep responsibly have probably got that figured out by now.

The ad campaigns are disturbing on many levels - of course, no parent would let their child play with a knife. However, how many news articles do you read about toddlers finding a loaded weapon in the home, accidentally discharging it and causing fatal injuries? According to this article, as of 2009 there was at least "one gun crime per household in West Milwaukee." How many of those households had young children living in them? It seems that co-sleeping is the least of their worries.

Another very disturbing fact about these ads is that they lack just that: facts. Where is the information that says co-sleeping can be safe? Where is the data that suggests certain people should not co-sleep with their child, or the suggestions on how to do it more safely? You won't find them here. That you'd have to get from the Big Bad Internet or your pediatrician (good luck with that).

It seems the only pediatrician who will give you good advice is Dr. Sears, who, with a family of eight children, is already bucking the traditional system when it comes to the politics of parenting. His recommendations are on his website. He says,

Worldwide research shows that the SIDS rate is lowest (and even unheard of) in countries where co-sleeping is the norm.

On countries where there just is no Babies 'R Us and cribs are probably an anomaly, what do they do? They share the family bed, of course. Does the United States think they are the only nation of people who has ever co-slept with their child?

Seriously? 

I question these statistics, and so do other studies.
They call it "crib death" for a reason, don't they?

Dr. Sears goes on to note:

The Consumer Product Safety Commission published data that described infant fatalities in adult beds. These same data, however, showed more than 3 times as many crib related infant fatalities compared to adult bed accidents. 

He does say, however, there is an exception: if mom is a smoker or abuses alcohol. Both of which are reasons not to co-sleep. This blogger also pointed out that

most babies in Milwaukee die because they were born too early, or because they have birth defects. Only 19% of the infant deaths are the result of SIDS or accidental suffocation, according to a 2010 report. And only a fraction of those deaths occurred in infants that were sharing a bed.

The city's report on infant mortality - which is around 11.1 deaths per 1,000 births - says that "Of these deaths, the majority died in an unsafe sleep environment." They do not say, however, what percentage of those environments contained risk factors for SIDS.

Ways to lower your risk include breastfeeding - something many serious co-sleeping parents do in order to better facilitate nursing at night. Since these mothers are already breastfeeding, it is unlikely they would willingly ingest drugs or alcohol that would compromise their sleep patterns, because of the fact that it would come out in their breastmilk. Similarly, they are probably less likely to be smokers, because it is obviously unhealthy around an infant, but can diminish milk supply.

(This interesting study also suggests that mothers who do smoke and breastfeed are more likely to have babies with disrupted sleep, due to the nicotine in their breastmilk.)

One thing I take issue with is the designation of SIDS for obvious cases of suffocation. True SIDS has no known cause, but according to PubMed Health:

Sudden infant death syndrome (SIDS) is the unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death.

If you wake up and find your baby wedged between the bed and the wall, that's a very explainable cause of death, don't you think? While accidentally falling asleep with your child in an unsafe place is unadvisable, accidents do happen - and safe, long-term co-sleeping hardly falls into this category. This is similar to the number of deaths that happened because of unsafe cribs that were often improperly assembled. While tragic, would they dare call that SIDS? I doubt it.

Among the risk factors for true SIDS are being born to a teen mother (Milwaukee apparently has the highest rate of teen pregnancy in the entire nation), mothers who smoke or use illegal drugs, late or no prenatal care and living in impoverished conditions. Last year, Milwaukee was ranked the fourth-poorest city in the nation. It could be a long-shot, but I'm guessing the average co-sleeping parent doesn't fit this profile very well.

Either way, this is not an adequately objective campaign on how to inform parents of both the potential risks and benefits of co-sleeping. It's already hard enough to get unbiased information as a parent on things like vaccinations, circumcision, breastfeeding and formula use and a myriad of other parenting issues, especially when you seek to do things in a non-conventional manner that breaks tradition and the norm. This isn't helping, other than to create more "mommy wars" hostility and spread even more misinformation.

More reading:
Scientific benefits of co-sleeping - Dr. Sears
Infant Mortality Rates - City of Milwaukee

Scheduled 11/11 births should expose broken maternity system

Photo: Hilde Vanstraelen/
www.biewoef.be

Yesterday we heard of loads of special births on November 11 - from inductions to planned cesareans to doctors offering cash to patients if they'd deliver on that landmark occasion. Today, the details of these births surface: cue the Pitocin IVs!

A Groton, CT mom delivers her baby after her doctor "decided she needed to have her labor induced." The baby weighed just over 7 pounds. As the clock neared 11:11, her "sisters started yelling, 'Push, push!'" (Side note: they'd make great L&D nurses, I bet.)

A number of births were mentioned in this article, including two "natural" births and one planned cesarean:

But in Colorado, Cayson Childers’ birthday wasn’t left to chance. His parents ensured his arrival by scheduling a Caesarean section for Friday, and then doctors were able to make the operation work right at 11:11 a.m.

The casual attitudes about surgical birth mentioned here almost make me want to puke.

This Syracuse, NY baby was delivered because the doctors thought it was "big." The child weighed 7 pounds, 13 ounces. The delivery was originally scheduled for the following week, but was moved to Friday. Don't want to put on an additional six or seven ounces in the meantime, right? Way to play it safe.

Adriana Jones, of Baldwinsville, was originally scheduled to have her baby, via Cesarean section, next week. But because the baby was big, Jones’ doctor recommended the delivery take place sooner.

The planned C-section was rescheduled for 11:30 a.m. Friday, but Dr. Suzanne Bartol-Krueger was able to get Jones in a little earlier. How kind of you, doctor!

It's important for me to say that really, I'm not so much criticizing these moms. They made their decision to go ahead with induction or cesarean plans, no doubt at the advising of their physician. Did they make the best decision? That's not really for me to say. But stories like this, and the media's reaction to them, make me kind of shake my head a little because it does several things, in my opinion.

First, it is often met with very casual attitudes about surgical and induced births. Both can be perfectly safe, if done for the right reasons. Sometimes, those reasons are clear, and sometimes not.

Many of these articles often feel the need to clarify whether they were vaginal or cesarean births, which is something I suppose readers are dying to know: did this happen all on its own or what? In any other situation, no mom should really have to justify how her baby came into the world. Some would argue that these women shouldn't either, but it should raise some eyebrows about what constitutes "medical necessity" these days. And when a birth wasn't cesarean, the media usually says it was a "natural birth," which we can probably translate as simply a vaginal birth. Is it news when the IV is hooked up and mom is pumped full of Pit in order for that baby to be born, practically dragged kicking and screaming into the world? Or when mom is laboring normally on her own after going into spontaneous labor? While some people will say, "Who cares?" it's clear there is quite a difference.

I can see how these timely births would start a new Mommy Wars debate: Why can't I schedule a birth on a special day like this? Does it have to be natural to count? Why not have a repeat cesarean because of this? Many argue that mom should have a choice of how she gives birth, even if it means something like a planned cesarean section for no reason other than she wants one. Fine, as long as you are well-informed of the risks and benefits of doing so, and get your information from someone other than a well-meaning but clueless friend or a doctor who is happy to oblige because it means he can finally go on vacation. Of course, you'd do it anyway, I suppose, but I can at least respect a truly well-informed decision. Doing it simply because you're effing miserable and 36 weeks and "It's time! The baby is practicing breathing movements!" is just stupid. But to each her own.

Really what this does is expose the often suspect practices in modern maternity care that have escalated exponentially in the last few decades. My mom told me of my 1974 birth, "The doctor told me he absolutely would not induce because of the risks and rushed in from a dinner party to deliver you while wearing a tux." Nowadays we hear, "Induction is perfectly safe. I don't want to have to come from my dinner party and deliver you while wearing a tux." What a change in thinking.

Are we accepting a woman's right to choose where and how she gives birth, but only to a point? If she wants to put her baby and body at risk, there are probably no shortage of physicians willing to accommodate her wishes. I hate to be a party pooper, but blasé attitudes about surgical and pushed births are what makes people say, "So what? Who cares? So she wants to have a cesarean for absolutely no reason. Isn't that her right?" Like in my last post, I think the birth of a baby is always something to be celebrated, but these kinds of births so far remove us from the frame of 'normal' that we don't even know what it means anymore. We can schedule hair appointments, meal reservations and oil changes: why not birth?

OB bribes mothers to deliver babies on 11/11

"I'll pay you if you give birth before midnight tonight!" 

As we approached the landmark "11/11" this week, I'm sure all of us were waiting to hear "miraculous birth stories!" of babies that "happened" to be born on November 11, 2011 at 11:11 a.m. (or p.m.) Most of us are jaded enough to realize that no, usually none of these babies just happen to come into the world at such an auspicious moment all on their own, and when you read more details on many of these births it's no surprise that they are either planned cesareans or inductions. Yay.

The birth of a baby is always a joyous occasion and something to celebrate. But I cannot imagine actually planning the date, no matter how close I was to my due date, just to have a "fun birthday" like this. Kind of takes the magic and suspense out of it, you know?

So one Iowa OB has decided, back in February, actually, to put money into a savings account for those patients who delivered on 11/11. Oh, how nice! Helping baby to get a good start in life with a tidy sum saved up in an account just for Junior. Excuse me while I go vomit.

So far, he's had two scheduled cesareans lined up and one induction. Surprise!

In just reading between the lines, I get a few creepy suspicions about Dr. Valone. Two of his patients are repeat cesareans because "they delivered that way in the past," which sounds like he is not very pro-VBAC. Perhaps his idea of informed consent about surgical births and the dangers of VBAC includes, "Well, I could pay you to deliver your baby by repeat cesarean on November 11. How about that?" His fees, according to the article, range from $900 to $2,000, "depending on the case and the insurer." Financial incentive much? Does this almost sound like "the better insurance you have, the more I charge" to you?

Further down in the article, it says he will deliver two more women by induction "whose pregnancies have reached full term." Full term, to most people, is 37 weeks. His comment, "We're doing it proactively rather than just waiting to see what happens" sounds like he pushes the big baby scare tactic. How much do you want to bet this patient is not very close to 39 weeks? $2,000, maybe?

One of his patients, a young 20-year-old mother has passed her due date by THREE DAYS and is awaiting induction today. This is her first child. I fear for this woman, for many reasons. I hope she has a vaginal birth, but honestly - who can say? The article also says things like, "Natural birth proponents urge women to avoid the medications that induce delivery unless there is a strong medical reason to take them," but Dr. Valone assures us all that "it's safe" and you're better off if they go that route (meaning, "Take the Pitocin!") rather than trying to start their labor at home.

No sources, no nothing that indicates that Dr. Valone perhaps is a c-section, induction-happy doctor who is basically bribing women to give birth before the clock strikes midnight (or five p.m., which is probably the end of his shift). And these women are eating it up like candy, which is nauseating, at best. Yeah, it's their choice, but when you're presented with the possibility of a wad of cash and the assurance that "It's safe and you're better off!" how can you resist?

I would hope that offering financial rewards to patients in order to force their births to take place (or coerce them) would be considered, at the very least, unethical. When you blab in the media about doing such a thing, you'd better be willing to offer sound proof that they do, in fact, have some medical condition (besides a prior uterine scar) that means this induction or cesarean was necessary; otherwise all those hospital bans on elective inductions and cesareans don't mean a thing. I'd love to think an official from ACOG, and perhaps the Iowa State Medical Board, would be questioning this doctor on his choice of practices and perhaps taking a look at medical records. But then again, I doubt anyone will bat an eyelash.

Didn't have to dig very hard to find this one.

Michelle Duggar - Pregnant again!

It's positive!

So, the Duggars are expecting their 20th child. Wow (she says with a glazed-over expression...)

It's not that I'm not excited for them; in fact, I think that if that's what they want, great! I'm just waiting for more nasty comments to fly, since it seems that no one has anything nice to say about this family.

Every time they announce a pregnancy, more myths, rumors and stupidity surface. It's things like this that just further ignite controversy over a woman's uterus, I think - the old idea that when you're pregnant, you're not thinking rationally and therefore that gives others - including complete strangers - the right to make decisions for you, make statements about your moral character, mental status, financial situation, family size and physical health.

I really think the biggest cause of vitriol is because fewer people have larger families anymore. That's it. Not that they're "killing the planet" by single-handedly overpopulating it, but because they have all those kids and are well-adjusted and appear to be reasonably sane. Because no one else wants more children, surely these people shouldn't either, and by all rights should be criticized for daring to think outside the box. Quiverfull movement aside, no one can understand why you'd want "more mouths to feed" and will criticize and label you, no matter what religious persuasion you happen to be.

Case in point - there is a large family (I think at last count they were on child #9) floating around town, the mother sort of dressed in Bohemian style, with the most beautiful hair. Her many daughters, all while maintaining their own sort of individual eclectic style, have long hair like hers, and therefore they are quite recognizable even from a distance. I've been seeing this family - in the grocery store, at the library - where mom usually has the youngest in a sling and is happily tooling around with her homeschooled bunch. No one is freaking out, yelling or fighting and everyone looks happy and well-adjusted, despite the fact that the oldest will often be seen holding one of her many baby siblings and looking totally okay with that. I have on many occasions wanted to stop her and just say, "I think you have an awesomely beautiful family!" and photograph them in all their splendor. I thought about this the last time I saw them, as I was out for a morning walk and noticed them up ahead of me on the sidewalk. I was sort of stalking them, I guess, admiring how they plodded through town like the von Trapp family.

I remember at one point hearing rather disparaging comments about them from my neighbor, who said something like "They all sit up front at mass" with an eyeroll, like they are the poster children for stereotypically dutiful Catholicism. Why the religious reference? I thought. Maybe she just wants that many kids, and there's nothing wrong with that.

I get so sick of the "Oh, the perfect family and you're done!" crap; the bullying, both overt and subtle, that goes on when someone decides to have more children than what our culture deems "necessary." And that's exactly what it is: bullying. We as a society are so set against it and want to teach each other how to love, respect, and all that crap - yet the minute we see someone with more than the prerequisite number of kids coming our way, we immediately snap to judgment. There is such negative bias against larger families, even those with far fewer than 20 kids, because we are now living in a "two-kid world." Anything more than that is often considered a burden or an inconvenience.

An editorial recently ran in Shine magazine about a woman who is childless by choice, and wants her friends, family and strangers to stop asking about when she's having kids, especially now that the population toll has reached 7 billion. Great - I can respect your choice and think if you don't want kids, don't have them. Do the responsible thing and go to great lengths to protect yourself from pregnancy; I wish everyone could be as responsible as that. But some of the comments were, as they usually are, disgusting - implying that people who wanted kids were stupid breeders and totally ignorant.

I find some of the comments about Michelle Duggar, though, as ignorant as some of the her harshest critics say she is - worrying about her pre-eclampsia, birth defects, leaving her children motherless, blah blah blah. You stand just as much chance of having a child with birth defects at age 20 as Michelle Duggar; statistically more women have children with Down Syndrome at a younger age, even though the risks of it go up after age 35.

A childless friend commented on the Duggar story and remarked that 'she didn't even carry the last baby to term.' Perhaps, but that almost makes it sound like she had an abortion. And it's not like all of her children were premature; her premature baby was no different than any of the millions of others born in this country every year, for various reasons - it's just that we heard more about it because of the media's focus. Should that be a reason for her to stop having children? I have a friend who has three children and had complicated pregnancies and pre-term births every time. Does that mean she shouldn't have any more?

With the current crisis of forced abortions in China, why are we worrying about this? When a family can stay together, under one roof and raise a family without outside assistance - not to mention they can raise them to be loving, conscientious and productive members of society - who are we to criticize when in other parts of the world there are women who are forced by their own government to undergo abortions when they want to be pregnant and have a family? And even if you aren't financially stable, does that mean you have no right to have a family?

Bottom line: Reproductive rights don't end with abortion. Everyone is so concerned about Michelle Duggar's health, which is great - but something tells me she has it under control. She has support from her OB, which is amazing, especially considering the overwhelming lack of support some OBs seem notorious for. When you start invoking China's horrible one-child policy and saying things like "Remove her fallopian tubes!" you are still attacking her basic human rights.

I am the 32 percent - but should anyone care?

Photo credit: Kirsten Ferree. 

The current cesarean rate in the US is hovering over 32 percent - and in my household, right now the rate is 66 percent - but as one doctor asked, Should anyone care?

Obviously a lot of people think you should care, for a number of reasons. Interestingly enough, several very good, informative articles have been done in mainstream publications about the rising cesarean rate, including Huffington Post, Time and others. (And perhaps rather ironically, I 'overheard' a conversation in the comments section on The SOB blog about how HufPo has become 'woo' in discussing childbirth matters, something that is probably far from the truth. And since when is telling people about the reality of high c-section rates 'woo?' Speaking of The SOB, her readers nearly swallowed their tongues when she wrote a post about the rising cesarean rate correlating with inductions. I guess they, too, don't want to believe the truth.)

When a doctor implies that he doesn't care about a particular aspect of his patient's care - especially something so serious as major surgery - it scares me. It makes me think of women who are pregnant with their first child, who may be relatively new to (or completely unaware of) the idea of "modern obstetrics" and many of the double standards and fear-mongering that many women are exposed to. Surely they've been to a doctor before, but something changes once you are expecting: as if the life inside of you means you have no individual rights of your own. If they come into it with little information or knowledge, like many of us have gained only through our own good or sometimes horrible experiences, it can be especially tricky. I hate to instill fear into the minds of people who are going through what should be a wonderful journey, not a fight; but how can I not tell someone, "You should be afraid of having a cesarean. And here's why."

"At a recent Las Vegas conference on obstetrical safety, some 125 members of the audience were asked to raise their hand to indicate their personal C-section rate. “Less than 15 percent?” the speaker asked. Two hands in the large auditorium went up. “Fifteen to 30 percent?” Half the hands were up. “More than 30 percent?” The rest. Then the speaker asked the room, “How many of you care?” No one raised a hand, and the room broke out in laughter."

"I watched mine with my
second, asked them to
keep the curtain down and
they said no...I watched it
through the light...and
listened to them talk about
me like I wasn't there. That
is why I think they want the
curtain - so they can pretend
like I don't exist." - Jade,
who had two cesareans

Since not everyone is into the Occupy Wall Street movement, I figured I would create a meme, of sorts, that some of us could identify with, if on another level. While the majority of people expressed how much they liked the image (if "like" is really the word), some were offended. One commented that it seemed to reduce us to percentages - and that's true. I agree, in that it does women reduce to 'just a number' to those doctors who are "dispensing" cesareans with a casual attitude. When you consider that a roomful of doctors laughs at the idea of caring about a 32 percent cesarean rate, where does that put us? Do they really care about your birth plan, or your wishes in labor? Do they really care that you don't want to be cut, or that, even more, you might not really need to be cut - that they hold the ultimate knowledge and power over you that says, 'I am going to do this, whether you like it or not'? Or that you trust them implicitly to not put you at additional risk unless it's truly necessary?

I'd like to think that what those physicians should have done was look to the two doctors who raised their hands and ask, "What are you doing differently?" The answers might be interesting, if only they'd listen.

When a room full of physicians laughs out loud about the high cesarean rate, it does reduce us to numbers, in probably the most callous way possible. It reduces us to a slab of meat on the table, a science experiment, a non-entity who provides entertainment, a conversation piece, a way to make a living, and possibly not much else. It certainly doesn't elevate us to mother of a child or human being. 


Related Posts:
The Myth of The Emergency Cesarean
My response to Free Advice Legal Forums: Childbirth Issues
Spreading the word on 'cut-happy' doctors