Insidious Anemia

I haven't done much blogging in the past year and a half, haven't done much writing at all, which, believe me, has been painful. Writing has always been my preferred form of self-expression. I wrote my first "story" when I was six.

What has kept me from writing? Life with a toddler. Life, and anemia.

Since my last post of any real substance, in December of 2013 (!), I mentioned the desperate need for a break, the feelings of being exhausted and overwhelmed.  It didn't get any better, really, it just gradually got worse. Two home renovations and travel abroad with a toddler had me questioning my sanity and my decision to have a baby at my age. I felt so tired all the time, me, someone who always used to be high-vitality. I attributed my inability to keep up with my house, play with my child and ferry him around to various activities, and stay awake late enough to spend time with his father to having a baby late in life. My waning vitality was so subtle and insidious that it didn't occur to us it might be anything else. I was in a fog, and my partner was so wrapped up in his very demanding work that he didn't notice anything amiss. I must be too old for this, I thought to myself, many times. My partner, who is nearly a decade younger and finds our son exhausting as well, thought the same thing.

By February 2015 I was starting to think that I was depressed but didn't feel depressed. It was the only reason I could think of why I felt so desperately tired two hours after getting up in the morning. The couch seemed to beckon to me with a siren's call.  In the fog that enveloped me, I didn't really take note of the increasing lightheadedness, my intolerance to cold, the erratic heartbeat, the difficulty catching my breath after any form of exertion, the paleness of my skin and my gums and my eyelids. I was vomiting almost daily due to acid reflux/GERD, and tortured intermittently with IBS-like colon spasms. My name was Misery.

Finally, after experiencing two 5+ hour long IBS episodes in three days, I went to see my doctor. With tears in my eyes, I told her I just couldn't take any more. 10 vials of blood, a CT scan, an endoscopy and a colonoscopy turned up serious anemia (ferritin level of 7), a hiatal hernia, a duodenal ulcer. All the vomiting had caused my lap band to slip very badly. I started iron sucrose infusions and had surgery to repair the hernia and take out the band.

Repairing the hernia and removing the band took care of the GERD. I can drink coffee and orange juice and eat chocolate and tomatoes again! No more waking up at 3am to purge my stomach of the acid that kept me up coughing all night. I'd forgotten what it felt like to wake up feeling renewed.

Three weeks after my first iron infusion (I had 5 in six weeks) I noticed a dramatic difference in my energy level. So did my partner. "I know it is working," he said, "because it is 9pm and you're still awake."

Today, I feel like a whole new person. Or rather, I feel like my old self. I no longer mourn my pre-pregnancy self and question my decision to have a baby at 43.

And my son, he's loving his new mama. He's loving that I have the energy to play with him. I'm less irritable, too. More patient. My New Year's Resolution this year was to try to be a better partner and a better mother. It's taken 5 months to get there, but what a difference in my quality of life, and that of my family.

I've never been anemic before. I didn't know enough about it to connect the dots, and I was so busy, so foggy, I'm not sure I would have connected the dots. But now I know. And I'm passing it on.

If you feel exhausted all the time; if you feel cold when everyone else is fine; if your gums and the insides of your eyelids are pale; if you find yourself feeling lightheaded in the shower or after standing up; if your heart pounds or you feel breathless with simple exertion; if you feel headachy or foggy or dazed or lost -- if even two of these symptoms sound familiar -- you're probably anemic.

A lot of women are mildly anemic, especially women who have had multiple children, have heavy menstrual cycles, or are vegetarian. A lot of women, and indeed the medical establishment, are resigned to mild anemia because taking iron orally can be either hard on the stomach, or constipating (in my case, both).

I've learned that taking iron with a swig of orange juice or similar source of Vitamin C makes it more bioavailable. I've also learned that you shouldn't take iron at the same time as thyroid medication or most antacid medications (wait 3 hours).

I've learned that getting iron by IV is a lot less of a hassle than it used to be, and that it makes a huge difference very quickly. Instead of having to do iron dextrose over a 3 to 4 hour period, they now do iron sucrose (Venofer), which can be done as an IV push over 5 minutes, with or without running a saline drip. I'm usually in and out in 30 minutes. Now, it isn't without some side effects, but it is worth it. I usually get a mild headache, my joints feel achy for a few days, and sometimes my low back aches (kidneys) if I don't drink a lot of water.

I've learned that it takes 4 months to completely replace your red blood cells, so 6 weeks in to the iron replacement, I'm basically 1/3 of the way there. I'll go in a couple of weeks to get my ferritin levels tested, and next week I'll go back to taking my oral iron (325mg once a day instead of 3x a day). Even though I feel like a new person, energy wise, and now that I'm not having the dizzy spells, the breathlessness and the pounding heart, I've still got the pale gums, skin, and eyelids, the low body temp, and the tendency to feel cold when others feel warm. I'm looking forward to the day everything is back to normal.

Eudaimonia -- Well-being and The Good Life

I am the first to admit that I have a good life. A beautiful home, a generous and loving partner who is an excellent breadwinner, and a healthy, adorable baby boy. I'm lucky and I know it. Some days, as I'm doing the mundane household chores or consoling a teething baby, I am visited with a sense of the surreal.  Never, in a thousand imaginings of how I wanted my life to be, would I have imagined myself being Susie Homemaker balancing a baby on my hip as I see my man off to work.

Sure, I enjoyed the kept-woman period and did my best to enjoy being freed from a 9-to-5 job even as part of me resented being dependent and without enough income to support myself. My partner assisted me in growing my internet storefront business as best he could during the economic crash, and he was incredibly supportive as my family went through one health crisis after another. But finding out I was pregnant, well, that was a huge life-changer. And now, as the Little Man reaches the 8 month mark, as my body still recovers from the effects of pregnancy and childbirth, the reality of my life as an unintentional mother is both incredibly real, and incredibly surreal.

Little Man's milestone last month was cutting two teeth. This month, it seems to be locomotion. He started off with the military-style forearms and toes crawl at the beginning of the month and this week he's crawling on his hands and knees. And really getting around. I went to brush my teeth and freaked out when he wasn't anywhere near where I left him. He's also figured out how to pull himself up to a standing position. The first two days he fell over whenever I wasn't watching him like a hawk, but today he's stable on those sturdy little legs. He's falling on his face when his arms give out, but the thunks on the hardwood floor aren't quite as alarmingly loud. I'm kissing and rubbing boo-boos, mostly on his head. It's time to take the next step of child-proofing the plugs and adding baby-gates.

The benefit to all his physical exertion is he's finally napping for about an hour twice a day. The drawback is he's gotten very clingy -- perhaps from the pain / discomfort and the scariness of falling. He often cries when I put him down, so I basically wear the baby carrier 16 hours a day and carry him around in it until he pushes at me to let me know he wants out. If I put him down and move too far away, he starts to cry. Finding time for bio-breaks has become a challenge.

Solid foods are hit and miss. There are days when he won't eat cereal or pureed foods at all. Since my milk dried up he's been on formula, so his poops are really stinky, but less frequent. I worry that he's not getting enough calories, but whenever I pick him up he feels very solid. He's not a chubby baby by any stretch of the imagination, but neither is he a skinny one.

It seems like I'm never alone anymore. I am a person who enjoys my solitude. I think that has been the most difficult adjustment. I'm starting back to the gym, though, and my neighbor is coming over twice a week in the morning to give me a chance to workout, so Little Man is going to learn to adjust to not having me around all the time. I hope.

The acid reflux still gets away from me about once a week. I'm managing it with eating a boring diet and medication. I've also had a half-dozen spastic colon episodes. Very painful. Like labor pains. I'm trying to reduce the amount of time Little Man spends on my chest and belly, since his 20-plus pounds pressing into my body seems to aggravate things. I've had the x-rays and CT scan, the upper GI imaging, and over 30 different blood tests and aside from exceptionally large ovaries (courtesy of PCOS) there is nothing unusual. I'm in excellent health, though borderline anemic. I had eliminated all supplements when I noticed that pills weren't resting well on my acidic stomach, but now that it seems to be (mostly) under control, I'm taking them a few times a week. It's not perfect, but it's better than nothing.

At present I'm 75# lighter than I was the day I delivered Little Man. I'd like to drop another 30 this year. We'll see. I think I can manage 3 pounds a month. I'm wearing large women's tops and extra-large bottoms. Right now my excess weight is all below the belly button, courtesy of 10 years of sitting at a desk. I'm looking forward to focusing on my abdomen and thighs at the gym and getting my upper and lower body in better proportion to each other. Given that my mother and sister both were mermaid-shaped, I'm thinking I'm probably going to be bigger on the bottom no matter what I do, but my doc thinks the softness of the muscles in my lower abdomen has something to do with the spastic colon problem, so it's important to get that area of my body back in tone.

Through it all, M has been wonderfully supportive. He knows this isn't the life I'd imagined for myself, and he checks in with me a couple of times a month to make sure I'm doing ok. Believe it or not, the life I was building toward was living in a small house on the coast or in the mountains, alone, with lots of books and paper and time to meditate and garden. I'd imagined my various friends and partners visiting me, but never staying for long. For all my capacity to be a social person, I'm a hermit at heart. He's such an introvert that he considers me an extrovert. Heh.

It's all good though. I'm happy and pretty much healthy. The baby is happy and healthy. So is M. There are things I want to do, and they'll wait. Right now, it's important to be there for the Little Man.

End surreality check :)

Holiday travels, losing weight, and my sweet baby boy

A month has passed since my last post. It's been a busy month.

Little Man and I came back from Puerto Vallarta with colds, but by the 20th of December it looked like we'd kicked them. Then the cold virus caught a second wind and we were both feeling lousy again, just in time for the trip to Canada.

It was below zero on both the C and the F temperature scales in Winnipeg. I wore Little Man in the Baby Bjorn most of the time, with my coat pulled around us both. He stayed warm, though his poor face got chafed from rubbing against my sweaters. Most of the fabrics I wear are soft and light so they don't bother his skin, but fabrics I can wear year-round in California can only be worn there in the summertime.

The change in climate really created sinus issues for the Little Man -- saline drops weren't working to clear him up so I ended up giving him benedryl so he could drink his milk. To make things even more interesting, my breastmilk dried up shortly after we got back from Mexico, so the poor little guy was on formula. Stinky coming out, formula is.

The visit with M's family was great. Little Man is blessed with an easy disposition so he didn't seem to mind being passed around between the 20+ people at the gathering on Christmas Day. He just needed to spend a few minutes with me every hour to re-charge and he was good. His great-grandmothers were over-joyed to see him. I'm a bit of a sap and cried when they held him.

We were inundated with gifts for the Little Man. Fortunately, we had a second suitcase that was lightly packed so we could bring most of it back with us. Lots of toys and cute little outfits. We were there a week and nearly every day we were off somewhere doing something -- Boxing Day at the Mall, seeing The Hobbit, dinner with Cousins, making sure M's mother got her fair share of time with her grandchild, etc. The nice thing about all the spare adults around was that I got some baby-free time and much-needed naps. Best of all, M's father is even better with the Little Man than he is, so I felt comfortable leaving the baby with him for a couple of hours while M showed me some of his old stomping grounds and tourist sights. I told him he was very fortunate to have grown up in a population center rather than in some small town on the Plains. The capitol of Manitoba had the financial resources to fund the education of a child prodigy, and he had access to universities and college-educated people in far larger numbers than he otherwise would have.

Thankfully, the trip home was a lot less eventful than the leg to Canada was. No cancelled / redirected flights that meant hours waiting for standby and then traveling a day later -- no, just a plane that wouldn't start because it was too cold outside. We left Winnipeg an hour late and had to run to catch our connecting flight in Denver: 40 gates wearing a baby and two shoulder bags! M waited to get the baby seat and the rollaway bag. Fortunately, the airline held the flight for 15 minutes so that we and 40 other people wouldn't be stranded. Little Man was an angel on the flights. Once again he charmed everyone around us, and he fussed very little.

It was nice to get home. My old friend Dato and his partner took advantage of the house-sitting offer which got them away from the rain and cold along the Oregon coast. It was mostly sunny and dry here, so they got to spend a couple of days exploring San Francisco. The weather in SF is always better in winter than in summer. Funny how that works :)

Now that we're home, I want to start working on getting my milk production going again, but before we do that, I need to tackle the intra-abdominal pressure that is giving me both acid reflux and constipation. It really sucks that I'd never had a problem with either until Little Man was born and now the problems are big enough to affect how I sleep, how I eat, and what medications and supplements I take. I'm pretty anemic these days, but I can't take iron or even just a multi-vitamin with iron because it really binds me up and even stool softeners and milk of magnesia can take 3 days to produce a bowel movement. I saw the doctor and we're trying a week of really upping the fiber in my diet to see if that produces desired changes, otherwise, it is on to scanning or scoping. I've a feeling something is going on in my colon -- literally -- whenever I bend over I can feel something move inside me, like the kick of a baby or the snick of a ligament being pulled and then settling back into place.

That, and I've dropped nearly 15# since Thanksgiving, without trying, and much of that time with reduced or no breastmilk production. Call me silly, but I think the milk drying up is a sign something is going on.

With regards to weightloss, I've been really good about watching my portion sizes. I ate my fair share of Christmas treats -- but not too many. A sweet-tooth was never my problem, nor was junk-food. No, I was a gourmand with portion-control issues and a serious hormonal imbalance.  Lovely enough, having Little Man seems to have balanced out a lot of the hormonal weirdness of PCOS, which has made losing weight the past 7 months much easier than the prior few years. So I'm down 70# from my pre-pregnancy weight. My goal is to drop another 30# in 2013. That should put me solidly in the size 12 to 14 range and my BMI in the 20s, where it belongs, and down 160# from my highest weight in 2007. After that, it's all maintenance. I've three very good reasons to keep my weight down and be healthy and fit: me, Little Man, and M. I want to be around to see Little Man grow up and help M raise him, and given that I'll be 45 in a couple of months, its important that I take my health very seriously. I'm not 30 anymore :)

Once Little Man is over his cold I'm going to get us both on a sleep-play-feeding schedule. He's dabbling with solid foods, but I'd like to get him eating more. He's not crawling yet, but he does wriggle himself around pretty well on his belly. He's getting close to cutting a bottom tooth, I think, and he's chewing on everything he can get his hands on. He's passing things from hand-to-hand now. He knows his name. He's babbling more, and he's getting good at vocalizing when he's unhappy (grumbling) as well as laughing and cooing when he's happy. He's a fun, sweet baby, and most days I feel incredibly blessed.

2012 was an amazing year for me. Lots of changes. I've got high hopes for 2013.

Today's one of those PJ days

It's official: I'm one of those new moms who spends the entire day wearing pajamas at least once a week. I do get to shower at least every other day though, and now that the Little Man can hold his head up and he's tall enough to be in his walker, I get to brush my teeth all in one go every day.

I'm extremely fortunate that Little Man is an easy baby. I'm hoping we will continue to be so, but I'm not counting on it. He wakes up all smiles in the morning and he's mostly a fuss-free baby for the rest of the day. That said, he's prone to what I call power-naps (under 30 mins) and is very alert and talkative, so I don't get much opportunity to nap during the day. However, I'm able to get a 4 to 5 hour stretch of uninterrupted sleep each night, which is a blessing.

I'm still pumping milk every 3.5 to 4 hours (except for that 5 hour stretch at night) and Little Man is still downing nearly 30 ounces of milk each day. Every once in a while I have to open a bottle of formula, but mostly, my supply is keeping up with his demand. I'm actually grateful that he isn't nursing. I miss the intimacy of it, but bottle-feeding is pretty convenient in that 1) someone else can spot me in feeding the baby on occasion, 2) I'm not getting mastitis and Little Man isn't getting thrush and 3) bottle-feeding takes less time than breast-feeding. Little Man didn't like my low-flow nipples -- he wanted his milk NOW -- which is why he refused to transition back to my breast. He'll down 4 ounces of milk in under 10 minutes, rather than 45 minutes, which means we both get to sleep sooner and I am not sore from having to hold him to my breast. Pumping is taking 5 to 10 minutes, and I'd still be pumping even if I he was on the tit, so, really, I'm getting back 30 minutes of my life 5 or 6 times a day. That's three hours. That's an eternity in new-mommy time.

What else?  The quest to start baby-proofing has begun now that little man is starting to squirm around on his belly. The first thing to tackle is the home entertainment unit.  I've had nightmares about the baby teething on the wires and drooling into all those electronics with their pretty lights. After months of searching I found a TV console that will hold the DVR, the PS3, the Wii, the Nintendo, the home theater PC, the gigabit switch, the Denon receiver, and all associated handsets and remotes. It's supposed to be delivered next week, as is the new Klipsch speaker that will just fit into the cabinet drawer specially designed to house center channel speakers. I'm looking forward to all the wires disappearing.  I've worked hard at ignoring them for over a year now. The irony is that we have a data closet with a NAS server and all the equipment for the internet and TV services in it, and we completely wired the house with ethernet, cable, and TV in every room -- but we've still got wires everywhere in the family room. Go figure ;)

We're in the process of re-financing the house because rates have dropped so low. It's a bit of a hassle, but a point is a point and that adds up to tens of thousands of dollars over the long run. The good news is that the house was appraised at 15% higher than what we bought it for 18 months ago, so we've gotten great value for all of the improvements we've done. We've got just one more. We're replacing the 30+ year old perimeter fence next month and then we're done for a while. M promised :)

The GERD situation is slowly improving. The upper GI test didn't show anything unusual other than slower-than-usual movement through the esophagus due to edema -- the stomach acid has caused a fair amount of irritation and swelling. It's still weird to me that I didn't experience heartburn during the pregnancy but I'm getting it now.  All that weird post-pregnancy body-change stuff.

It looks like the little guy is waking up from his nap, so it's time to end this post. Thanks for reading.

I made it through 3 months!

M and I finally got our romantic dinner together last night. Fourth try was a charm :) M's father and sister watched over the Little Man while we ate dinner just a few blocks from home. We dined at The Melting Pot, and this time we ate with enough moderation to get to the chocolate fondue course with room to eat some of it. It was a leisurely two hour meal that reminded me how much I enjoy his company. For all that we are so different, we complement each other. He thanked me for giving him a son. I told him he was the only man I could imagine having a child with. It was a good night.

Little Man is three months old now. He's been a lot of fun for his grandfather and aunt, and a very easy baby. Normally he's very alert for long periods of time interspersed with occasional power-naps, but he's going through a growth spurt -- eating often and sleeping for 3 or 4 hours at a time -- so he's easier than usual. And he's such a happy little guy. Grinning and talking (when he's not grumping about having gas), making eye contact, and playing with his toys. He's flipped himself over onto his back as of yesterday, which surprised everyone, including himself.

The weather has been gorgeous here, perfect really. Blue skies, warm days, cool afternoon breezes. I generally spend most of the afternoon outside with Little Man, gathering peaches and tomatoes, monitoring the growth of the summer squash and cucumber, playing with the baby, and listening to audio books. It's a comfortable life, for the most part. M earns good money and provides well or us, and in exchange, I take very good care of us all. Being a stay-at-home mom is very different from the "kept woman" we used to joke about me being, but I can't complain. It's not a life or role I'd ever envisioned myself in, but it is working out. And perhaps that is the key -- I didn't have my heart set on things being a certain way, looking a certain way, etc, so I'm able to go with the flow of What It Is with little friction or disappointment.

The heartburn / acid reflux / GERD situation seems to be improving, though it's a bit early to be certain. I'm still struggling to keep my food intake up, especially protein, and I really notice it in my energy level some days. Humping all 14# of Little Man around, plus pumping breast-milk every 3 to 4 hours, trying to keep up with the housework and coordinating with 5 neighbors to get the fence around our property re-done is wearing me down. And I am pretty sure that is nutritional, because I'm rarely easily worn-out. But apparently all this is pretty normal for new moms. I'll get the hang of it.

Interestingly enough, my PCOS symptoms seem to be abating. I think that the prolonged changes in my hormonal balance due to pregnancy and lactation is over-riding / interrupting that awful cycle of androgen and testosterone generation. It's certainly made weight-loss much easier (read: normal), which itself helps reduce the excess hormones floating around.

The center of the universe

I remember saying to more than one person on more than one occasion that I didn't want to be the center of anyone's universe -- that it was too much responsibility. Yet here I am, the center of an infant's universe. It's a lot of responsibility, but more than that, it's stressful. Taking care of a baby 24/7, no matter how much I adore him, is wearing. It finally occurred to me during a long awaited shower that the terrible heartburn and acid reflux I've been suffering might be stress-related. I'm very good at sublimating stress and just pushing forward -- it's how I got through all the sickness and death from years 2008 through 2010 -- but at some point I have to wake up to the fact that some levels of stress, or stressful situations, are not sustainable.

I am used to copious amounts of me-time. I'm an introvert who has worked hard to balance-out my introversion with a tolerance/appreciation for extraverted activities, but I'm an introvert all the same. One of the great benefits of the Information Age is the ability to maintain contacts with friends and family wherever they, or I, am. But one of the drawbacks is that this ease of remaining in close contact with people far away is that I've neglected developing much in the way of local relationships. I am developing some good relations with my neighbors, one of whom is great with Alex, but with my family all living 3+ hours away, and my best friends all living 500+ miles away, I don't have anyone to help out with Little Man. So I had a talk with his father about needing him to spot me with the baby more.

I do my best to make sure that M gets his full quota of sleep, so I take care of the baby at night as well as during the day. M usually spends 10 or 20 minutes with him her and there throughout the evenings, but usually hands the baby off to me when he starts to fuss. Given that the only time I have to get much done for myself or around the house is when M is entertaining Little Man, I'm always feeling rushed and stressed trying to get things accomplished during those mini-breaks. It's just not sustainable. So we talked, and he acknowledged that I do make things awfully easy on him, and that taking care of the baby 24/7 is a lot of effort. We both know that right now Little Man is completely dependent on me, and that he will slowly outgrow it, but for the next 6 months or so, it's mostly all on me. But there are still things he can do. This weekend he took care of the baby for a couple of hours while I got a much-needed massage. Yesterday he stayed home from work and helped take care of the baby and drove me to the doctor because I'd basically been up for 3 nights with acid-reflux and night coughing and was too exhausted to drive myself.

The good news is that my weight-loss is at a much more sustainable rate of 1-2 pounds a week (I've dropped 12# the past two months). The bad news is I need an upper GI test to try to figure out what is going on with my stomach and the acid reflux. Hopefully it is not my LES valve or I may need surgery. Yesterday I ate 1 cup of rice and a protein shake with bananas and blueberries. Not enough protein (14g) to sustain lean muscle mass -- but at least I slept through the night (minus baby interruptions) without coughing up the contents of my stomach. I wish I could eat more of my protein bars but I only have one type that isn't covered in chocolate. And chocolate, like coffee and tomatoes and many other fruits, are big no-nos for GERD. *whine*

So, I'm trying to eat a careful, bland diet with lots of protein and extra calories for breastmilk production, and trying to find ways to get myself baby-breaks. I love the Little Man beyond description, but being the center of his universe these past 3 months is starting to take it's toll.