Tag Archives: pregnancy

Becoming at Peace With a Body’s Betrayal

Having an autoimmune condition, you’d think you’d get used to being betrayed by your body. That you’d know you can’t always depend on it to do the right thing, or to work right. You’d think so.

And yet last month, as I laid down on the exam bed, 12 weeks pregnant, and my doctor could no longer find my baby’s heartbeat, I was surprised, like I never thought my body would betray me in this way. Crohn’s, sure. But this?

At my 8 week exam I watched as that tiny heart fluttered on the screen and I cried with extreme joy. I’d gotten pregnant so fast that I wasn’t even sure we were ready, but we were so happy. My stomach grew faster than it had with our daughter, so by 11 weeks I began telling people the news. Not everyone, but people at the daycare to make sure we’d have a spot secured for #2, and people at work who may realize I had a bump.

And that’s the thing, the bump. The doctor told me that the fetus had expired at about 9 weeks. But I had no idea. My body continued to grow. I still felt nauseated and tired. I still felt pregnant. My body told me I was pregnant. My body lied, and lied, and lied to me, for weeks.

In the days following this revelation, as I tried to understand what was happening, as I went back into the hospital for the D&C, as I recovered at home and answered emails and calls from friends and family who’d heard… I just couldn’t stand to look at myself. My stomach was still big. Before I’d learned that I’d miscarried, I’d look at my little bump and smile, so warm and happy that we were having another baby. And after, it seemed somehow bigger, and ugly, and wrong. I wanted it gone. I longed for the flat stomach I’d had when I was 20, before I’d even had kids. I dragged an old college sweatshirt from the back of my closet because it hid my stomach. But I still couldn’t get away, because like it or not, you’re stuck in your body.

And there was a bigger reason for all of this, this hating my stomach. It was when my daughter put her hand on it and asked, “is your stomach getting bigger or smaller,” as she had asked frequently over the past weeks. For the first time I had to respond in a new way. “Smaller,” I said. She looked up at me. “Why did the baby die?” she asked.

After that, I didn’t know what to do with myself. I didn’t want to be in any situation where my daughter could see my stomach. Or where anyone could see it.  I’d exercise and do situps, but counter-productively I’d gorge on junk food like I never had before. And I shopped like money was water, going online and ordering any and all clothes that looked like they’d offer a good disguise. Baggy shirts, printed dresses, leggings that didn’t push on the hated bump like an annoying finger reminding me of what I’d lost.

And then, one day, it hit me. Until then, for some reason, I didn’t realize the simple fact: I was mad at my body for betraying me. I was feeling this way but hadn’t put it into a clear thought. This unspoken anger and hurt I was feeling was about my body. And when I realized this, that my anger was toward my body, that’s when I began to forgive it.

I’m still exercising every morning, and I’m still shopping for flattering clothes, but I’ve slowed down on the shopping and slowed down on the junk food as well. My body betrayed me, but it’s the only one I’ve got. And I need to get it in shape if I’m going to try again – and I am, we are – we’re going to try for another baby. But not yet. I’m not fully at peace with my body, my post-pregnancy but not post-baby body. I need a little more time. But at least I know now that this time, while it was terrible, what my body has done is not unforgivable.

Advertisements

Which Drugs Are Safe for Breastfeeding Moms?

I’m republishing this blog post by Lisa Emrich because I think it’s an incredibly helpful guide, and definitely relevant for Crohn’s.

Breastfeeding and RA Drugs: What is Safe to Take?

by  Lisa Emrich
Tuesday, August 02, 2011

World Breastfeeding Week is August 1-7, 2011.   Choosing to breastfeed is an important decision for every mother, especially mothers who live with rheumatoid arthritis.  The medications we take for RA are powerful drugs with serious and potential side-effects.  Every mother wants to know that the health of her child is not being affected by these medications.

Knowledge of what are safe medications to take is vital.  BabyCenter.com offers a consolidated chart of medications which are usually safe to take while breastfeeding, probably safe in usual doses, hazardous, and not safe to take.  The list was compiled by Philip Anderson, a pharmacist and editor of LactMed which is the National Library of Medicine’s drug and lactation database.

Mothers want to know how various medications or chemicals may impact their children, especially breastfeeding infants.  LactMed provides information regarding the impact of many drugs and chemicals on lactation, infants, and breastfeeding mothers.  The database also offers summaries on individual reports and studies involving infants exposed to different medications in breastmilk.

LactMed is “A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.”

Searching the LactMed database is easy and the information is presented in clear language.  All data comes from scientific literature and is fully referenced.  Statements regarding a drug’s compatibility with breastfeeding are provided by the American Academy of Pediatrics (AAP).

A new feature for the database is the LactMed App for iPhone and Android mobile devices.  The app presents the very same information which is available on the website, including hot links to supporting reference materials.  The app was very easy to use and is the source of the information shared below.  This information is not intended to be complete nor provide medical advice.  It is only a sampling of what is shared in LactMed.  Please discuss options with your rheumatologist.

Medications Used in RA and Their Effect on Breastfeeding

STEROIDS:

Prednisone – Limited information indicates maternal doses up to 20mg produce low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants;.  With high doses, the use of prednisolone (instead of prednisone) and avoiding breastfeeding for 3-4 hours after a dose should decrease the amount received by the infant.

Prednisolone – Limited information indicates that maternal doses up to 50mg produce low levels in breastmilk and would not be expected to cause any adverse effects in breastfed infants.  With high doses, avoiding breastfeeding for 4 hours after a dose should markedly decrease the dose received by the infant.

Dexamethasone– Because no information is available on use during breastfeeding, an alternate corticosteroid may be preferred especially while nursing a newborn or preterm infant.

BIOLOGIC AGENTS:

Cimzia (certolizumab pegol) – *

Enbrel (etanercept) – *

Humira (adalimumab) – *

Remicade (infliximab) – *

Simponi (golimumab) – “since no information is available… an alternate drug may be preferred.”

Actemra (tocilizumab) – not listed in LactMed

Kineret (anakinra) – not listed in LactMed

Orencia (abatacept) – not listed in LactMed

Rituxan (rituximab) – not listed in LactMed

*Preliminary data indicates this medication is minimally excreted into breastmilk, which would be expected because of its high molecular weight and size.  Since the medication is not orally absorbed, any amount found in breastmilk is unlikely to adversely affect the breastfed infant over 1 month of age.  LactMed includes information regarding the normal growth and development of infants who were breastfed while the mothers used one of these medications.  However, until more data becomes available, an alternative drug may be preferred, especially when nursing a newborn or preterm infant.
DMARDs:

Arava (leflunomide) – not listed in LactMed

Rheumatrex, Trexall (methotrexate) – Some authors state that the low, weekly doses used in RA are of low-risk to breastfed infants.  Exclusively breastfed infants should be monitored with complete blood count with differential if methotrexate is used during lactation.

Plaquenil (hydroxychloroquine) – Generally considered safe; infants receive only small amounts in breastmilk and no evidence of visual or hearing deficits were seen in one study.

Azulfidine (sulfasalazine) – Generally considered safe, but carefully observe breastfed infants for signs of diarrhea as some cases have been reported.

Cuprimine, Depen (penicillamine) – Some authors state that use of penicillamine is unacceptable during lactation, however others stress that transfer to infant through breastmilk is likely to be low.

Dynacin, Minocin (minocycline) – Short-term use is acceptable in nursing mothers; monitor infant for rash or possible effects on gastrointestinal flora.

Ridaura (auranofin, oral gold) – Recommendations are mixed; monitoring for possible adverse effects in the breastfed infant would seem prudent.

Myochrysine (gold sodium thiomalate, injectable gold) – Recommendations are mixed; monitoring for possible adverse effects in the breastfed infant would seem prudent.

IMMUNOSUPPRESSANTS:

Cytoxan (cyclophosphamide) – Sources consider breastfeeding to be contraindicated.

Imuran, Azasan (azathioprine) – Exclusively breastfed infants should be monitored with complete blood count with differential and liver function tests if azathioprine is used during lactation.  Avoiding breastfeeding for 4-6 hours after a dose should markedly decrease the amount received by the infant in breastmilk.

Neoral, Sandimmune, Gengraf (cyclosporine) – Cyclosporine concentration in milk is variable, probably more concentrated in the milk fat in hindmilk.  Most infants studied have not had detectable cyclosporine blood levels.

NSAIDs:

Motrin, Advil (ibuprofen) – Ibuprofen is a good choice as an anti-inflammatory agent in nursing mothers.

Tylenol, Favarall, Tempra (acetaminophen) – Acetaminophen is a good choice for analgesia and fever reduction in nursing mothers.

Aleve (naproxen sodium) – Limited information available; however because of naproxen’s long half-life and reported serious adverse reaction in a breastfed newborn, the mother may prefer to use other agents.

Actron, Orudis KT (ketoprofen) – No published literature available; but with low levels found in breastmilk and a short half-life, ketaprofen is unlikely to adversely affect the breastfed infant. 

Celebrex (celecoxib) – Because of low levels in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects.

OxyContin, Roxicodone (oxycodone) – Maternal use of maximum dosages of oral narcotics while breastfeeding can cause infant drowsiness; monitor for drowsiness, adequate weight gain, and development milestones.  If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, contact a physician immediately.

Ultram (tramadol) – Tramadol produces low levels in milk and is unlikely to adversely affect healthy, full-term infants and acceptable to use during breastfeeding.

Voltaren(diclofenac sodium) – Available data is limited, however most reviewers consider diclofenac to be acceptable during breastfeeding.

The National Library of Medicine also offers DailyMed, a website which provides healthcare providers and consumers comprehensive information regarding FDA-approved drugs.  You can read up-to-date label information for any of the drugs you may be taking. 

Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.

Nursery

One of my pregnant friends asked for photos of the munchkin’s room, since she’s currently working on her own nursery. So then I thought, ooh, I can make that a blog post. (Flodder.)

My husband and I put a lot of work into it and we’re really proud of it. And we think the munchkin likes it too.

This is her crib, which has her special “color blanket” hanging on the side. (Although when she says it, it sounds like she’s saying “cuddle blanket,” which is very cute.) She loves that blanket. And so do I – I used to go every week to a knitting group, and when I was really pregnant I stopped going because I felt too huge to move, and then when I had the munchkin I just became overwhelmed and stopped having any free time to go. So, one day I get a call from the knit shop’s owner, a friend of mine, who says – I have something for you and I’m leaving it outside your door. A few hours later I checked, and there it was – a beautiful blanket, each square knit by a member of the knitting group. It was so meaningful – and you know what, it’s really soft and machine washable too. We’re so lucky. (By the way, she also made the munchkin the coveted Baby Surprise Jacket. Swoon.)

Above the crib hangs the mobile my husband and I made before she was born. We made animals that we thought she’d get to see in the neighborhood – a dog, cat, squirrel, bird and rabbit.

Then we have the rocking chair (actually my dad’s old LaZBoy with a slipcover on it) and draped over that is the absolutely incredible blanket my grandma knit. Above it hangs two paintings by Bren Bataclan, who I was lucky enough to meet many years ago when his art was a little more affordable than now (but I’d still buy his art now…I am a huge fan!)

I love this adorable and sweet needlepoint that my mother-in-law (or as my aunt liked to say, mother-in-love) made for us!

Then the closet and dresser. The doors in her room, by the way, are painted a lovely pale green and the walls are pale blue. We thought she was going to be a boy. But I still like it this way.

Above the dresser is another art project we did before the munchkin was born. We took photos of all our family members in profile (including our cat!) and used photoshop + paint + exacto knife to create silouhettes. We used the paint that we used on the walls and doors. I love how it came out.

The fourth wall of the room has her diaper table, and above it we hung a needlepoint my mom did for my room back in the day (“the day” being the 1970’s). Above that my husband hung geese he made out of food boxes headed for the recycling bin. For a while when the munchkin wouldn’t sit still for diaper changes, these kept her sort of occupied.

The bottom shelf of the diaper table holds many of her books. As you probably noticed, they’re also throughout the room. Actually, they’re throughout the house. Like her parents she loves books, which makes us very happy.

Woah, Freaky!

I just had to share this because it’s happened twice in just a few weeks. I had a dream in which this woman I know told me she was pregnant. I don’t know her that well – we belong to the same industry organization and just see each other occasionally. I saw her today and told her about the dream, and her jaw dropped, she said, “well yes, I am, but just 9 weeks so please don’t tell anyone!”

The same thing happened a few weeks ago. I dreamt a friend who lives in another city was pregnant, and when I woke up I figured it as an excuse to email her and say hi. I wrote, “I dreamed you were pregnant with a girl.” She wrote back: “actually, it’s a boy.”

Baybee?

This morning my toddler put her hand on my stomach and said “baby?” So either she’s very confused, or I’ve got some Prednisone weight to work off.

Anyway, I was thinking about a conversation I had with the nurse at my GI during my last Humira. I mentioned I plan to do it at my office, and she was very surprised I wasn’t doing it at home. Now, I work at a medical advertising agency, where we have doctors and nurses on staff. Perfect scenario should something go wrong. It’s quiet, comfortable, and I can shut my office door. At home, I have a toddler prone to tantrums and piles of cat hair that are threatening to revolt, and the only other adult is a landscape architect. Back when I was pregnant, our (doctor) neighbor asked if my husband was going to deliver the baby. He responded, “only if she’s having a tree.” So – yeah, definitely, I’m giving myself the Humira at work.

Covet: the Cute Little Knit Elephant

Because someone very special to me is pregnant, I’ve been looking up special knitting patterns for babies. This one just caught my eye, newly released by knitty.com.

It’s incredibly adorable and has a wonderful story to go with it – it was originally created in the 1930’s and the knit designer adapted it for today using new yarns. I like how it’s a mesh of old and new, and clearly the design has withstood the test of time. I like to imagine it would become a treasured toy for the baby-to-be. Maybe I’ll have to make one for my daughter too!

The Decision Tree

I’m halfway through The Decision Tree by Thomas Goetz, which is subtitled “taking control of your health in the new era of personalized medicine.” I’m finding it to offer a very interesting history of medicine in terms of diagnosis and the doctor/patient relationship.

The other day I posted about the difficult decision to have a child when dealing with a chronic condition. In response to the post, a friend told me via email that she’s also going through that, and so we discussed it a bit more; coincidentally I’d just read something in The Decision Tree that was relevant, and I wrote this to her:

“It’s a risk, it’s always a risk. I remember in my first trimester I was just scared all the time when I’d think of what couldl possibly happen. Then I had to take a deep breath and say, ‘Stress is bad for baby.’ You have to bury that away, push it aside, so you can just live, or else you’ll go completely crazy.  With most things today, a diagnosis is not a death sentence. People are beating things all the time that were previously just thought of as fatal. I read today that just 60 years ago, no one understood the dangers of hypertension – no one even knew it existed. Even though President FDR had unbelievably bad hypertension, which now can be seen plainly when looking at his medical records, his doctors didn’t know it existed because no one did. So, even though he was president and had access to the best medical care available, one day he just had a stroke and died. And the doctors were all shocked. But there’s no way that would happen today. I guess my point is that our children will have access to even better care than we do, so even though ‘anything’ can happen, that isn’t necessarily a bad thing.”

Yes, I totally just quoted myself.

Also, I like how Goetz ends chapter 5, “Throughout, our overall objective should not be to avoid or manage disease. Rather, we should aim to mazimize and improve our health.” I like that – prevention as cure. Obviously I couldn’t prevent having Crohn’s, but I can help manage the disease by taking good care of myself.

I promise to share any other items of interest as I finish up the book.