Wednesday, August 31, 2011

September

I believe in evidence based medicine.  I think hope most doctors do.  However, I also believe that every cure doesn't have to come from your neighborhood Walgreen's.  Our medical ancestors did a great job observing the reproducible effects of certain plants on humans.  They understood willow bark eased inflammation.  They knew coca leaves increased endurance.  There are plenty of 'natural' treatments that exist that deserve as much attention as their pharmaceutical counterparts.  It is important, therefore, for science to lend them the credibility they deserve through research that is as rigorous and unbiased as the kind applied to fancy drugs and funded by deep-pocketed companies.

This month I have decided to focus on caring for my future patient while having a little fun.  I hope to start a personal notebook I can keep with me that will review, with scholarly references, alternative medicine remedies.  My goal will be to review one remedy a week.  What better way to start this off than a lecture on Complementary and Alternative Medicine (CAM) in my clinical medicine class!  I originally thought that it would be difficult to find scholarly articles on the efficacy and safety of CAM, however I found out during class that in 1998 US Congress established the National Center for Complementary and Alternative Medicine (NCCAM) under the NIH to support research on the efficacy and safety of CAM.  How convenient.  Oh, and NCCAM funded a Center for Research and Excellence at the medical school I attend.  Go figure.  The professor that was lecturing focuses mainly on the anti-inflammatory uses of resveratrol (the famous wine component) and marijuana (also famous).  The following lecture was given by our local acupuncturist.  Yes, I did have a needle placed, and no it didn't hurt.  Actually, it didn't do much, but it was just so I could see what it would feel like.

As you can see I really do need to let the nerd in me out, cause that doesn't happen enough at school.

Hopefully with the NCCAM as a resource (and a wealth of online journals) I will be able to review at least 4 remedies -- that is, translate what scientists say about them.  Individual results may vary ;)

Tuesday, August 30, 2011

Month in Review

Oi vey.  This month has gone by too fast.  And now comes the time when I peek in the freezer and find... frozen vegetables, beef, some chicken, and berries.  No milk.

It turns out churning out an extra 5 oz a day is harder than it sounds.  I figured since Johnny was starting solids that would cut out a feeding a day.  I could pop that feeding in the freezer and I'd have 100oz in no time.  Instead he finds it is a good excuse to eat some more, hence his 22lbs, 6month old self.  Fiddlesticks.  Instead of having extra I've been struggling to keep up resulting in midday milk runs.

I think I am going to put this challenge on hold and try again in a few months.  Eat some oatmeal, drink some tea, and let his appetite for milk wane a little bit.  Right now I think the stress of pumping for more than one is too much.

On the upside, washing our diapers by hand is still going well!  There have been some bumps along the way -- we had some bad build up from a non-cloth-diaper-friendly detergent that took some serious stripping to get rid of.  After classes started I had to get used to getting up early to fit in a double load of diapers before going to school.  Our side of the building only gets sunshine in the morning, so we have to get the diapers out early to get maximum UV exposure.  With the brisk wind and dry air we've had lately, the diapers have been dry by mid-afternoon -- perfect.  The highlight of the summer thought was my discovery of bamboo fleece.  It is infinitely softer than the hemp, wash after wash.  I'm in love.  I also found adding vinegar to the (cold) rinse not only made the hemp come out softer, but it also helps the detergent rinse out quicker.  A lifesaver.

Speaking of detergent, I'm the guest blogger on Rockin' Green's blog this week!  So head over there and check it out!  They are our detergent of choice (and not because they sent us a fabulous bag of their Remix, although we appreciate it).  It smells yummy, rinses out easily, doesn't give anyone in my house a rash, and is my go to detergent for getting out tough stains.  This weekend I used it to get blueberry stains out of Izzy's light pink pants.  You wouldn't know she sat on blueberries for 15 minutes from looking at her pants.  I also use it off label for scrubbing the grout in the bathroom.  The best part is my clothes smell like nothing coming off the drying rack.  Just the way I like them.

Tuesday, August 23, 2011

Update

So I'm not as far ahead as I had hoped to be.  We have about 10-12 extra oz in the fridge after I had to throw out about 16-20 because they had sat out too long.

Finding the extra time to pump has been difficult.  We have classes all morning long, then I usually study for 3-5hr blocks in the afternoon.  I don't have a key to the pump room so I've been having to pump in a study room in the basement after hours.  That is getting fixed though.  On top of all of this, Johnny has started waking up in the middle of the night to eat again.  He had been sleeping great most of the summer -- 10-12 hours at a time.  Now we wakes up consistently at 4am, sometimes 11p or 12a too.  He doesn't eat in the middle of the night on the weekends though, and eats less often while I'm in school, so I'm sure its due to my not being around during the day.  As a result I've been more tired and less likely to add an extra pumping session after the kids go to bed.  All I really want to do at that point is go to sleep myself.  If only I could pump in my sleep...

I might try going for high yield this weekend after the stress of my first exam has passed.

Thursday, August 18, 2011

The Big E

My boobs embarrass me.
Okay, not all the time.  Actually, not even most of the time.  Want to crack a joke about them?  Go right ahead! It won't phase me, at least not for long.
However, ask me to talk to someone about making pumping arrangements and my ears turn bright red, my pupils dilate, and my heart starts to pound.  It is my equivalent of standing in front of an audience in my underwear.  You say its a man?  I might faint right now.
I've come to the conclusion it is the fact that I am bringing my breasts to the attention of someone in authority.  As soon as I open my mouth I feel as though they become the elephant in the room (or perhaps "the big E in the room" is a better euphemism...).  It should be like a conversation about taking a break for an insulin shot, but its not because my breasts are sexual.  At least that's what society says.

In grade school it was emphasized that we girls must keep the 4 B's (boobs, back, belly, butt) covered at all times lest an adolescent boy become faint from cerebral hypoperfusion.  We were taught all about menstrual cycles, male anatomy, female anatomy, ejaculation, ovulation, where babies come from, and where to get a prescription for birth control without our parents knowing (believe it), but no one talked about our breasts.  It was touched on a little in  the obligatory "lets pretend this sack of potatoes is your baby" exercise in prophylactic contraception, but the overarching message was that our breasts are sexual.  They are to be used in the art of seduction and as sexual playthings.  That's it.

Its not like I grew up in a house where this was the only message too -- my mom breastfed all of us and formula never entered the equation of child-rearing for me.  However its amazing how deep of an impact it can have when society, pop culture, etc. are repeatedly telling you how titillating your breasts are to men.  When you step out the door of your home that message completely washes away anything else you know.

In the end it makes a perfectly normal bodily function -- lactation -- embarrassing and stressful.

How do we fix this though?  Ban ads that display breasts in a sexual manner?  Have girls run around topless? I don't see either of those happening (and I'm a fan of relative modesty to boot).  Rather I'd love to see more examples of breastfeeding in everyday life.  It starts with women feeling free to nurse in public -- not just nurse ins, but during day to day activities like eating at a restaurant, worshiping at church, or while the kids play at a park.  I don't mean finding a dark secluded corner to do it either -- I mean nursing right there in the midst of things.  I don't think I ever witnessed a mother nursing her child in public before I had my daughter.  If I did, I didn't know what was happening.  I'd love to see examples in the mainstream as well -- advertisements, TV, and media to start.  It would be great to see posters promoting breastfeeding in doctors' offices too.  There are plenty of posters for Plavix and sponsored information kiosks about healthy living.  Why not add just one poster of a mother breastfeeding?

Until breastfeeding becomes as commonplace as Maxim, regardless of how many women breastfeed sexual stigma will continue to overpower the normalcy of lactation.  It needs to change.

Monday, August 15, 2011

Hydration

You know that scene in Spaceballs where Lone Star, Dot, Barf, and the princess are walking across the desert and Lone Star and Barf are saying "water...water...water", Dot is saying "oil...oil...oil", and the princess is saying "room service...room service...room service"?  That's what I feel like some days.  Actually most days.  Especially this weekend.
I was working move-in, which meant I spent the entire day Saturday sitting outside in the hot, humid sun wearing long pants, boots, and too many shirts.  By 10am I could feel the sweat rolling down between my shoulder blades and creeping past the curve in my back to pool on my shirt just above my belt.  Gross, yah?  Luckily I have this totally awesome Contigo water bottle with a built in carribbeaner and an automatic seal and... wait, what?  You said I left it at home? Well $#@%.
Under normal circumstances this would be no big deal, but as I have discovered the thirst of a lactating woman is insatiable.  There was an info table giving out free 8oz bottles of water, and the health center table had a snow cone machine, but neither of these were really enough.  I mean, come on -- 8oz is what I give my daughter when she's thirsty.  I am a fully grown woman with an active pair of camel humps for my son.  My usual goal for the day is 120oz.  That's 15 8oz bottles.  I don't have enough pockets for that.
I think I did manage to snag 8 small bottles throughout the day, and I got a Gatorade bottle that I refilled a few times, but it was ridiculously wasteful going through all those bottles, and I felt like a crack addict -- is that water?  A bottle of water?  Can I have some?  Please?  Just one hit, I promise, then I'll leave you alone.
Meanwhile I forgot my cooler and had to dump what I pumped at lunchtime today.  One step back.  However, all Jhonny ate was what I pumped this morning.  One step forward.  I also managed to keep up with him on Saturday, and even get ahead a little bit.  Another step forward.  Keep up like this and I'll get to 100 eventually :)

BTW, I LOVE my Contigo.  Its very easy to use, has a built in carribbeaner so I can clip it on anything, has a wide opening for ice, and has a button you press to open it for drinking, which means no more spills and no more toddler pouring out my water.  It also makes it very easy to pour water from my bottle into my daughter's sippy cup on the go.  Only downside is it's top heavy when empty.  I've knocked it over countless times during a lecture or meeting attracting numerous death stares.  I still haven't learned to lay it on the floor when empty.

Wednesday, August 10, 2011

Pumping

Sucks.

In both senses of the word. The more negative connotation is actually part of the reason why I chose this challenge. Attaching a suction cup to your chest for 30 minutes at a time is hard to get excited about. I'd rather breastfeed my son without a cover while standing in the middle of a crowded room holding a conversation with someone than retreat to a quiet corner with my little beeping machine. I figured if I was doing it for someone else besides my child it might be more bearable. Just a little bit.

Actually, all it has done is keep me motivated. When Johnny was a newborn I started pumping shortly after my milk came in so I never down-regulated appropriately. The result was 122oz of frozen milk in the first two weeks and persistent engorgement. After stockpiling so much I became lazy. Sometimes I wouldn't bother to pump if I was out and John had to give Johnny a bottle. I'd rather be engorged until his next feeding than sit down for 20 minutes. We blasted clear though those 122oz. Recently though I've been making an effort to pump a little extra. The closest HMBANA bank has a minimum requirement of 100oz, so my goal is to have 100oz of excess milk stored in the freezer by the end of the month. That's just 5 extra ounces a day for the rest of the month. I have no idea how much we have in the fridge at the moment -- I just know that I've been keeping a little ahead of Johnny since school started Monday. I have a good feeling about it though.

Thursday, August 4, 2011

Pain, Boobs, and other things

Its been a while.  I seem to have gotten distracted by other things - sewing, cooking, cleaning, and most time consming pain.  My recent pregnancy left me with a protruding disc, persistent back pain, and leg and foot numbess.  This 2 month process of medical appoitnments has brought me to the waiting room of the surgery center for a big fat shot in my back.  The best part has been that the only pain reliever I can take while breastfeeding is ibuprofen.  Awesome.  That doesn't do much for the numbness and tingling though which lead to constant tripping over things, like the dishwasher and curbs.  The good news is I can't feel the resulting cuts, scrapes, and bruises.  In reality the appoitnments have been enjoyable, despite the pain.  I've met a lot of excellent doctors that love what they do and love their patients.  I just got done with my injection (yes, I'm blogging on my phone on a gurney) and had great time talking to the doctor that did it.  I've said before that becoming a doctor is like entering a fraternity and medical school is the hazing ritual.  Once you say "medical student" the memories start flowing and the commiserating is wonderful.

It has also been fun to see the confusion and mild panic when I ask "so can I still breastfeed my son?".  Which brings me to the other thing I wanted to talk about: boobs.  I was happy to see the headline of my AMA digest yesterday was the new report from the CDC on breastfeeding.  The headline benefit that I've seen the AMA mention repeatedly is that breastfed babies have lower rates of obesity at 9mos, which translates to a lower rate of obesity later in life.  The biggest challenge I see with breastfeeding is community and environment.  We've created over several generations an atmosphere in which breastfeeding is 'weird'.  Case in point: I was volunteering/shadowing at a rural WIC office last week and while standing in the breastfeeding support room surrounded by posters of moms breastfeeding, a fellow medical student pointed at the Medela poster of a mom breastfeeding twins and remarked "that's kind of creepy".  Meanwhile I was thinking "that chick has some mad skillz".  She went on to remark that some of the children in the posters looked too old to be breastfeeding.  They all looked under 12 months to me, which is the goal for WHO and the CDC.  It's this kind of thinking that we need to work to change.  We need to get back to a point where we as a society can see breastfeeding as normal, natural, acceptable, and totally awesome.  It will help to increase breastfeeding rates, which will lead to other great health benefits: lower rates of obesity for mother and child, lower rates of breast cancer in moms, lower rates of illness in infants, better survival rates for premature infants... the list goes on.  So, the next time you see a mother breastfeeding anywhere I hope you at least realize what an amazing thing she is doing for herself and her child.

So, with last month's challenge blown out of the water, and school starting in 4 days (which means back to the pump!), I've decided to challenge myself to pump a little extra to donate.  This is something I've been wanting to do for a while, especially since I haven't been able to donate plasma, so what better time than the present.