Sunday, December 27, 2009

Back to Work

Well, tomorrow is back to work after being off for two weeks (the first week due to knee injury and the second week was scheduled PTO). I'm a little nervous but really feel that all will be well. I'm getting around pretty good on my knee. It gets stiff when not moving it but quickly loosens up. I would say that the knee is functioning at about 75% at this point. I do have some limitations on my range of motion (ROM), i.e. can't straighten it yet. I still am limping which causes some discomfort in other muscles and joints (especially since my ankles are some of my more troublesome joints). I will bring my crutch with me in case I need it. I'm a little nervous about sitting on the stool in the exam rooms...I'm worried that I will have trouble getting up without falling or hurting myself. I will stand when in rooms as much as possible to avoid this. The only thing I am very unsure about is first assisting for c-sections. There are none tomorrow (scheduled anyway) but on New Year's Eve there are 2! Will see how things are feeling and decide whether I can do it or not.

My knee still has puffy spots...but they are mild. I seem to have plateau'd (sp). The first week I was improving daily after the initial 2-3 days. This past week's progress has included more mobility and the ability to walk without a crutch. However, it's really been very slow progression. I have my f/u appointment on Tuesday to go over the results of the MRI and determine the POC. I suspect surgery is in my near future. I was supposed to have had the f/u last week but they rescheduled it to this week so the doctor could be present. That seems to be a huge hint that I will need surgery.

Here's hoping that all goes well tomorrow. I'm looking forward to getting back to work and to seeing my patients. I miss it all :)

Friday, December 25, 2009

Random Thoughts

I want to wish everyone a Merry Christmas and a wonderful New Year. Now I feel like breaking out in song!

It's been quite busy these past few days, with preparation for Christmas, Nutcracker with my mother and the girls, making poor attempts at resting my knee. I've enjoyed the time for the most part...

Highlights (aside from the obvious of spending lots of time with my close family and friends)

-homemade fudge from my BFF
- seeing the Nutcracker
- italian christmas cookies made and decorated bymy mom, me, the kids, and my BFF

Friday, December 18, 2009

The bathtub

I am so excited because I made it into the bathtub! Getting out might be a whole other blog post. And yes, I am blogging from my tub...the modern miracle of my fabulous cellphone :) I'm hoping my BFF might catch on and try buying something up to date and user useful, let alone friendly. Her phone is a piece of shite. Having a text conversation with her is like talking to a man with ADD...the conversation is all over the place and disjointed and confusing. You see, on my phone, text is laid out in chat form. Nice and organized, not to mention that I have a kkeyboard and she has some weird number/symbol/letter thing going on. Oh and no touch screen either. I'm so used to touch screen that if I use my moms crackberry, I start hitting the screen and get p*ssed off that it doesn't do anything!

Oh I rambling?

So, I got my christmas cards done. I'm off to do some christmas shopping and dinner with my BFF. I get to ride in a wheelchair - what fun!

Thursday, December 17, 2009


I started a rumor that my knee was injured when Tonya Harding attacked me. I thought that was clever but likely that only people my age and older would get it. :p

I am struggling with my insurance company - I am surrounded by incompetence as well so that doesn't help. My rheum wanted to increase the dose interval on my meds which would likely require preauth as they are a bit expensive. I get a notice from my insurance that I am now required to use a specialty pharmacy instead of the ease of my local pharmacy. Ok. So I mail the Rx off to the pharmacy, like , 6-8 weeks ago. In the meantime I have some samples from my rheum to keep me going. I haven't filled any prescriptions at my local pharmacy since prior to the new RX. I get told that they can't fill it until the middle of this month....but it will be for the four syringes. Ok, I have enough samples to get by. I call back when I am supposed to and say ship my sh*t (well, maybe not in those words). They inform me that it has to be preauth'd. Uh wait...what have we been doing for past 6 weeks that you guys have had this Rx????

Ok, so I put on my patience mask and they get the ball rolling. Three days later my rheum's office calls me to let me know it's been approved. Woohoo! I go off to have my MRI done and come home to get a message from my insurance saying that my request for additional doses has been approved. Woohoo! I call the pharm to get it shipped. They promptly inform me that it can't be shipped until a week into january. Are you punking me???? Oh and it hasn't been authorized for the additional doses. But wait....did I dream the two calls saying it had? Maybe it was drug-induced wishful thinking. So the pharm chick calls my insurance to be told that the case is still pending. WTF? So I am waiting patiently...*snicker*....a couple days then will try again. It aggravates me because the increased dosing is working. Hardly any temps recently and very quick and low at that (like 99 as a high), they go away within a few minutes. My joints aren't giving me a lot of grief anymore. So aside from some fibro issues and the knee thing, I had been feeling better. Then this happens.

Guess what my temp is right now? 99.8 F*ck.

On the lighter side of husband has been a doll. The girls too. They have been very helpful, waiting on me like the Queen that I am. My bestie and my mother have also been attentive to my needs, as it should be - LOL! I have a plan in place for grocery shopping and finishing my Christmas shopping, all with injured knee.

The knee, btw, is getting better....swelling is down considerably, less painful, and I can bear some weight now. My worst fear is falling. I'm scared it will go out again. I won't know MRI results and plan of care (POC) until Christmas Eve. That sucks. My husband says it ain't right that a football player can get injured and have the MRI and follow-up immediately. I mentioned a slight difference...I'm not an athlete making millions.

Sunday, December 13, 2009


I am writing this blog post from my bed. Are you titillated by the title? Well here's the scoop. I was out dancing with my BFF and my husband. I had had quite a bit to drink but wasn't dizzy or anything like that. I'm on the dance floorwith my BFF when I lean back a bit, then have the thought that 'something just happened and I'm gonna fall'. Two seconds later I hit the floor. So, I'm all emabarrased and not really sure what happened. My BFF helps meup, and I go down again when I try to put weight on my leg. Now, sh*t be hurtin' in my knee and I know something is wrong. I manage to get up with the assistance of my BFF and husband. I'm horribly embarrased and just want to get out of there. I barely make it to the car and we head back to my BFF's place. They both start insisting I go to the ER. I respectfully and politely decline repeatedly. Really, my knee doesn't hurt that much. BTW, alcohol makes a wonderful anethestic. I get up to show them I'm ok. When I turn towards my husband, something happens in my knee again and I scream. This happens once more and they get adamant about going to the ER. You see, my drunken but sound logic was that they wouldn't do anything but x-rays and say follow up with your doc on Monday...elevate, ice, etc. I could save $125 on the co-pay by waiting until urgent care was open. But they wasn't havin' it. In fact, I think my husband was getting ticked off.

So off we still very drunk and embarrassed. We get there and fortunately it isn't busy. The staff are very kind and pleasant. What can I say? I'm a funny drunk. In fact, my cell phone got into the hands of my bestieso there's some very funny video footage. So, x-rays get done, the PA sees me and says likely menisucs tear which means go home and rest it, ice, pain meds, blah blah. Gee, big surprise. So home I go....they get me all comfy as possible with ice etc. I manage to sleep for a bit then wake frequently due to pain. My alcoholic anesthestic was wearing off. So while finally deciding to take a pain pill (kinda wanted to wait until I was a bit more sober...cuz that whole stop breathing thing doesn't work for me) and researching from my cell phone on meniscus tears, I learn that this was probably already present and I just didn't recognize it for what it was. I had been having these episodes of popping in the same knee for 3-4 months now. Not painful, just weird feeling with occasional twinges of pain. I thought it was just an arthritis thing but now I know that I likely had a tear and just totally blew it out finally.

So where does the poledancing come in? I was NOT poledancing. However my BFF thinks it will be fun to see who can generate the best rumor on Facebook on how I blew out my knee. That's her first crack at it!

Thursday, December 10, 2009

Tales from the Office

I have a personal patient who I can't wait to catch her baby. But I am worried she'll end up delivering at home. She's a grand multip (has had more than 5 babies) with a history of fast labors. Her longest labor was 4 hours. The last couple kids have been after 1 or 2 hours. She had been feeling a little crampy so I checked her...nothing much going on. But she's making me nervous cuz the last one other time I had this patient scenario, the patient delivered at home because it went so fast. I also was worried that even if she makes it to the hospital, I won't get there in time. So I gave her my cell phone number and told her not to stalk me, just call when she goes to the hospital so I can head in to. I'm hoping she won't go into labor while I am on vacation. She's not due until after the new year.

I have another personal patient (multip) who is now past her due date. Don't really want to induce her. We are still waiting for spontaneous labor. We have a week to go until we have to talk induction (42 weeks). At least that will be right before I go on vacation. I promised my husband and children I wouldn't work on vacation. But truth be told...I probably would if any of these personal patients come in. I just don't want to miss their births.

I have another one, a primip who is also term...about 40weeks. I've been stripping her membranes the past two weeks in the hopes that she'll have her baby before I go on vacation. How did I end up with so many personal patients all due around the same time?????

I am inducing another personal patient due to blood pressure issues. She's a multip with a favorable cervix so I am hoping all goes smoothly and quickly with her. I have such a blast with her and her husband. And her daughter is such a seeing her!

Favorite complaint - I feel like I have a bladder infection and I drink plenty of water. Comes along with a urine sample that has small ketones and nothing else. "You feel this way because you don't drink enough water." She says "But I do". I look pointedly at her McDonalds cup and ask what's in that cup? It's obviously orange whatever it is. Busted.

I did a new OB appointment with a couple from the Middle East. They have been here for 3 months. They were adorable! She was so worried because she had a miscarriage at 4 weeks the first time and is Rh negative. She didn't get Rhogam afterwards. So now she's scared for this pregnancy. Someone (family doctor I guess) has scared the crap out of her. I explain, via the translator, that she was too early for there to be any concern. I reassure her and have them both smiling and happy by the end of the visit.

6 Babies Part II

So the first primip very slowly made her way to 10cms....this was after numerous position changes and using the peanut. She was also experiencing a lot of pressure and was very umcomfortable with that. She began to whine a lot. For those that know me, my tolerance for whining is minimal. I stayed out of the room as much as possible initially because none of the pep talks or support seemed to be helping her. Her family was clustered around her, offering encouragement and support. She just wasn't havin' it.

Meanwhile, the other primip was 8cms and feeling some pain. We got her epidural dosed and I broker her water. We got her settled again so I went back to dealing with the whiny primip.

The whiny primip had been pushing for awhile - some of her pushes were great and others not so much. The baby had a good bit of caput and momma had protruding ischial spines which were holding baby up a bit. I was a little concerned that she might not be able to get the baby out, especially if she continued to fight the process. After an hour and a half of pushing and slow but steady progress, we got her epidural dosed up again. I also kicked out the family except for the FOB. They were very understanding, and I kept them updated. I talked to the doc on call with me...he basically said to tell her she had 30 minutes to do something or he would come in and section her. Not the response I was wanting. She was potentially vacuumable at this point but he really needed to be the one to make that decision. I was so ticked off that he wouldn't come and evaluate. I went back to the room, where the patient was a little more settled after getting her epidural redosed, and told the patient what he had said. I could see that the caput was starting to crown. I then proceeded to talk to her as if she was my child. I told her she didn't need a section and if she would just suck it up and do the work, she could do this. I told her I wasn't letting her have a section....she was only gonna do this one way. And we got to work.

Forty minutes later, she delivered an adorable baby with a huge conehead after a 90second shoulder dystocia. Apgars were 1 min - 2, 5 min - 6, 10 min - 8, 15 min - 10. I thought I would have to change my underwear after the whole thing was said and done. It was nervewracking! The next day, I went to see her and the baby and both were doing great! Oh, and this was over an intact perieum - and the baby was close to 8 pounds!

The second primip by this time was complete and ready to push. She did a great job. We had a baby crowning fairly quickly. She also had an adorable baby after a 2 minute shoulder/body dystocia. The baby had apgars of 5-6-8. The baby weighed in at almost 9 pounds and momma just had a single periurthral tear that I threw a few stitches in. Change my pants again. Both doing very well the next day.

So two beautiful natural birthes. Then karma had to strike....and I get two shoulder dystocias.....geez.

I went home and got some rest. It's a good thing cause I was destined to be up all night on the Sunday night.

A woman came in who I had seen a few times in the office. She was 4cms in the office and was planning a trial of labor after having a c/s with her first baby. Her first baby was 9+ pounds and OP (posterior position) along with some chorio (infection in the uterus) - unfortunately a failed homebirth. She's tiny as well. Maybe 5 foot at best. I knew this baby was smaller - I estimated between 8 and 8 and a half. She was coming up on 41 weeks so was really hoping she would go into labor over the weekend. Otherwise we would be breaking her water on the following Monday.

She called me and let me know she was contracting and getting more uncomfortable. I suggested coming in. Two hours later, she finally showed up - just I am really starting to worry! Her water was broke as well, which she failed to mention to me. She was 4-5cms. So I had her walk for awhile alternating with rest. The plan was to wait until she was a little more uncomfortable then have her get in the tub. But then the baby was acting up a little - nothing major but enough that I wanted to keep an eye on the baby. Once I was happy with the baby again, we just never made it to the tub....the waterproof doppler couldn't be found so she would have to get out every 15-20 minutes for a quick listen. We decided not to bother with it. She did many position changes, with her husband on one side and me on the other. I did some massage of her back and later had her husband do some effluerage, whcih she liked. Like the other two women who birthed naturally, she was gorgeous to watch. So calm and relaxed. She was about 5-6cms, when I checked her 4 hours after the first exam. I was a little concerned about the slow progress but just tried to remind myself that labor doesn't always follow Friedman's curve.

In the meantime I caught a baby for the doc on call. This patient had a history of a precipitous labor with her first baby. She went from 5cms to 8 after walking. I broke her water, then got her in the tub. She was the type of person who never seems to be happy with anything but who knows...she was in labor after all. I found it difficult to establish a rapport with her (which is something that doesn't happen often for me) but the nurse was actually doing labor support! What a pleasant change. So I left them to it. She ended up delivering about an hour and a half after I broke her water. I was surprised as I didn't think it would take that long. So that was baby #5.

In the meantime, my other lady is continuing to do very well....seems to be getting more transitiony so I start getting a little more excited. Soon, she wants to push. I check her and she just has a small anterior lip which easily reduces with the next contraction. I tell her she can push when she feels ready. When I look at her pushing and her big belly I start worrying. I so want her to be successful. But her belly looks huge in comparison to her. But she very quickly crowns up and we have a baby! She pushed for 23 minutes. She had small periurethral tears. WOOHOO! She was so happy afterwards. I was so happy for her! Her labor from admission to delivery was about 8 hours....but anytime one has to stay awake all night labor seems long.

I left at 7am, when I went off call.

6 Babies

I had a busy weekend on call not too long ago....are you ready to hear about it? Here goes...

Friday night was quiet. I had one page from triage around midnight. It was a patient having her first baby. She was initially 2-3cms then 3cms after walking for an hour. She was contracting regularly and uncomfortable with them. I ordered therapuetic rest fro her and sent her home (morphine shot - works by giving momma some rest - when she wakes the prodromal labor will either be gone or will have turned into active labor.) In hindsight, I don't really think it was prodromal labor. I think she was just in very early labor. Why do I think this you ask??? She came back around 6am Saturday morning and was 8cms!

I rush on in. The patient is doing incredibly the time I get there she's completely dilated and the baby is at a +2 station. I send the resident scurrying off (she was standing by for me) and we get done to business. The patient is doing a beautiful job of pushing her baby out. She is so calm and chats in between the contractions!?! Her boyfriend and family are all present and doing a very nice job of being supportive. I guide her through the delivery of baby #1. She does an amazing job. I repair her tear and off to go check on another patient who I admitted while on my way in.

This new patient was also a primip (first baby) and had come in since her water had broken earlier during the night. This patient was planning an epidural and I had the nurse start pitocin as she wasn't in labor. Her cervix was a fingertip/75% effaced and soft when she arrived. She was also ready to get things going. She was comfortably ensconced in her room with lots of family present. At first I thought the family would be obnoxious but as the day went by, it was the patient who was obnoxious and the family was great! :p I told her I would check on her later.

I then attempted to leave to meet my mother for some Christmas shopping. I was halfway to the mall when I got a page from a personal patient of mine. I had caught her first baby with a student midwife and had spent this pregnancy with her as well. My plan had been to catch this baby even if I wasn't on call. How nice of her to go into labor while I was on call! She's been contracting all night and her water broke a couple hours ago. I suggest she come on in as she says the contractions are now 6 minutes apart and getting stronger. I turn around and head back to the hospital. She arrives a little later and is actively laboring....although you can't tell it by looking at her! She's 5cms and doing beautifully. We get her in the tub where she labors until she's ready to deliver. She moves to the bed and pushes out a gorgeous baby #2 over an intact perineum in six minutes flat. The enitre time, she remained so calm and focused. What a beautiful birth goddess! I aways wish I could take pictures of women when they look like this...But it's so private and intimate. I just want women to see how beautiful they look when they are in the throes of labor. Anyway, she delivered only a couple hours after arriving. Nice.

I check back on my primip who is slowly but surely getting into labor. She's had a couple doses of stadol but isn't quite to the point of being ready for an epidural. She's 3cms now. I tell the nurse if she asks for more stadol again, to go ahead and let her have the epidural. No exam. After all she's been ruptured and if I don't put some specific guidelines down, some of the nurses will check patients frequently even with the water being broke. I decide to head out and try to meet my mom again.

I manage to get lunch and some shopping done with my mother. While at lunch I get a call about a new patient. This patient is also a primip who came in for a labor check. She's 4cms and crying I guess...wants an epidural. Ok, go for it.

I head back to the hospital to check on everyone. The primip on pit has an epidural and is very comfy. I check her and she's 8cms now - woohoo! The family has multiplied...there are about 12 people in the room - no exaggeration! The nurse has told them no more than four people. However, there's not a policy. It's really up to the provider. They want the soon-to-be grandparents to be there along with the FOB, which makes 5 people. I tell them that's no problem. I normally don't put any limitation unless they are interfering with the woman and her labor or if there are complications. She had meconium and so we would also have the neo and nursery nurse there as well, so it was gonna be pretty crowded.

I check on the other primip and she's also comfy with her epidural. She's 6cms and intact bag of water. I leave her be as I am afraid that her fast progress will put me into a situation of trying to be in two places at the same time. I didn't need to worry. The first primip sitch turned into a nightmare and she wasn't gonna deliver anytime soon.

To Be Continued...

Tuesday, December 1, 2009

And the stupidity award goes to....

The mom who left her 6-year-old alseep in the front seat of her minivan while she took her younger child into Starbucks for her caffeine fix, quite a ways away.

I was on my way to see New Moon with my mother and daughter when we came across this situation. We kinda looked at each other and looked around the parking lot. No momma in sight. We decided we had to do something, but not really sure what. Then we saw a woman come out of Starbucks and thought maybe she was the owner...nope, different vehicle. I finally told my mother to go buy the tckets and I would trek across the parking lot to the policeman parked at the empty end of this lot - it was quite a distance and likely would make me miss the beginning of the movie getting involved. But we felt like if something happened to that kid, we could have prevented it buy intervening. Then we saw momma come out and unlock the car with her keyless entry.

Hey, at least she didn't leave the keys in the car with the kid!