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.

TMI: Lady-parts postpartum discussion

While I am excited to have my body back, there are some things I wish I'd understood about what would happen to my body during the postpartum period, so I'm documenting it and passing it along to other first-time mothers. Just a warning, the ick-factor of the subject matter may make some people uncomfortable.


First, the bleeding/discharge, also known as lochia. A friend recommended I stock up on sanitary pads a couple of months ago, and the hospital gave me a package of maternity pads, but I didn't really understand what I was in for. It's been two weeks and I'm still bleeding, though it is lessening. It's like menstrual flow at first, and then it changes (as mentioned in the wiki article I've linked to). There is also the smell, which is a lot like the typical coppery menstrual smell, along with a fresh-meat/meat counter scent that is probably related to healing up from the level 2 perineal tear. I recommend buying heavy-duty pads and just preparing yourself to spend a few weeks feeling less-than-pretty while dealing with your messy Aunt Flow.


Second, anemia. Most women experience anemia in the Third Trimester, I learned. I'd never been anemic before, and even with extra iron in my prenatal vitamin, my iron, etc tested low. I ended up taking ferrous fumarate supplements my last couple of months of pregnancy, because the last thing I wanted was to go into childbirth anemic. With all the bleeding that has been going on, and all the energy that is required to take care of a newborn, I strongly recommend taking extra iron in the Third Trimester and continuing it for a while afterwards.



Third, constipation. In the last weeks of pregnancy I didn't eat much, so I didn't have much in the way of bowel movements, but given that I was taking iron supplements, which are known to be constipating, I made sure to eat a couple of dried figs for fiber every day. Also, I learned the hard way that some of the pain medications used during childbirth can cause constipation/hard stools, and when you're sore and healing from an episiotomy or a tear, (or a C-section for that matter) the last thing you want to do is bear down, so do yourself a favor and have stool softeners waiting for you when you get home from the hospital.You'll be taking them for a couple of weeks, at least, until you're healed up "down there."



Fourth, inflammation and pain. Sitting was very uncomfortable for several days. I can't take NSAIDs, but I wish I could, because the inflammation of the vaginal and rectal areas are aggravated by the pressure/pain from sitting, including using the toilet. In my case, I have access to a Japanese bidet (a Toto Washlet) or I would have used a sitz bath. Soaking helps with the discomfort as well as keeping clean. I use baby wipes instead of toilet tissue right now, as it reduces the abrasion of tender tissues. In the medical profession pain is considered the fifth vital sign. It is important to keep pain levels down when you're healing because otherwise your body diverts resources toward the stress response (fight or flight, production of adrenaline, cortisol, etc). Add pain on top of dealing with a fussy newborn and a sleep deficit, and you're likely to be irritable toward everyone around you. So make sure you've got adequate pain relief when you leave the hospital.