Wednesday, February 1, 2012

Cholestasis of Pregnancy

In a final F-You to me, my pregnancy ended in a spectacularly bizarre fashion.  It wasn't bad enough that I was high risk from the start.  It wasn't challenging enough that I BLED or spotted through the first trimester and I had spotting off & on throughout the entire pregnancy.  It wasn't enough of a bummer that my pregnancy with my first son was textbook perfect and this one, likely my last, was one problem after another.  No, I ended up with a pretty serious problem right at the end.

I suddenly began experiencing severe itching around 36-weeks.  I casually mentioned it on Facebook and a friend cautioned that symptom could indicate liver problems and suggested that I call my doctor right away.  I initially dismissed the idea because itching doesn't seem all that dangerous and I hate bugging my doctor since I'm sure that I'm already his most annoying patient.  I ultimately decided to mention it to him because it's his job to deal with me, however annoying I may be, and the thought of having a liver problem scares the heck out of me.  You know, because you need a functioning liver in order to do things like live.

His response was that itching is most likely caused by dry skin, but he was concerned that it was my hands & feet that were so itchy.  Specifically, my palms & soles.  Now, when I say that my palms & soles were itchy, I don't mean that I randomly scratched every now and then.  The itching intensified at night and I would be awake and scratching at myself for hours every night.  I'd use a rough washcloth and rub it against my hands & feet for hours on end.  A few times I scratched myself with my wig brush because the stiff bristles felt good even if they made my skin red and sore.  Nothing gave me any relief other than eventually passing out from exhaustion. . .and, even then, I'd wake up scratching.

The doctor mentioned that itchy hands and feet could be a symptom of cholestasis of pregnancy (CP or ICP) and he wanted me to go to the lab right away to get blood drawn.  My liver function, as indicated by enzyme levels, and my bile acid levels were what he specifically wanted to see.  I went to the lab late that day and the results indicated that a specific enzyme was four times over the upper normal level.  I saw that number and was like, "Oh sh*t!"  Seriously, liver problems are something that I really fear and that number scared me.

Based on that test result alone, my doctor decided to proceed as though he had all data and had me begin to take a handful of medicines to manage the symptoms of ICP.  He gave me scripts for Actigall, Atarax, and hydrocortisone lotion.  So much for being the hippie who doesn't like to take medications while pregnant.  Now I was forced to do so for my own health and sanity and for the health of my as-yet unborn baby.

Why did he not have all the data to make a firm diagnosis?  There are only a handful of labs in the country that run bile acid tests.  Why?  I have no freaking idea other than ICP is a fairly rare complication of pregnancy.  So, naturally, that's exactly what I ended up diagnosed with once those bile acids came back.  Oh sh*t indeed!

Of course, I spent plenty of quality time with Dr. Google and what I read only freaked me out all the more.  Did you know that mothers with ICP have a significantly higher chance of having a stillbirth later in pregnancy?  As in, the last couple of weeks of pregnancy.  Having had 36-weeks of emotional turmoil, I wasn't expecting to face the possibility that I may not be able to hold this baby and take him home.

My c-section was initially scheduled for 39w5d and my doctor bumped me up to 38-weeks on the nose along with ordering twice-weekly NST visits at the hospital and telling me to go to Labor & Delivery (L&D) if I notice it takes more than one hour to feel ten fetal movements instead of the standard two hours.  By the way, non-stress test (NST) is a total misnomer because you're only there if there is a potential problem so I'd say all moms to be are stressed in that room.

My itching never improved, even with meds, but my liver enzymes did drop down some and that was encouraging.  The problem was, as one would expect, the very real risk of stillbirth.  It's standard protocol to deliver prior to 38-weeks because the risk of stillbirth significantly increases at the end of pregnancy.

I became so fearful for my baby that I'd try to force fetal movement throughout the day so I could have some assurance that he was still living.  One night I fell asleep and woke with a start when I realized that I hadn't felt any movement in the last hour.  Sure, he may have been sleeping. . .but he may have been dead.

That's the emotional cruelty of ICP.  Your bile acids can spike to dangerous levels with absolutely zero warning.  Those bile acids get high enough and your baby dies.  You have no idea that it's about to happen or even that it's happening.  You just show up to your NST and the RN isn't able to find a heartbeat or you can't seem to get the baby to move during your fetal kick counts and you go to L&D only to discover that it's not a living baby you'll be delivering.

So I spent my time bargaining and pleading with God for my baby.  I'm holding my 6-week old baby in my lap as I type this and just remembering those fears makes me feel sick and brings tears to my eyes.  How I worried that I would lose this baby!  I became convinced that this baby was going to die; his little heart would stop and my heart would break.

I had a meltdown early one morning and cried to my husband that I couldn't take these fears any longer.  I was 37w3d and I couldn't understand why we were waiting for me to reach 38-weeks other than to increase the chances that the baby wouldn't need to spend any time in the NICU.  I said the thing that was rattling around in my brain:  I'd rather have a baby in the NICU than a baby in a box in the cemetery.

I showed up to my NST that morning and the RN asked how I was that day and I burst into tears.  Well, I didn't just cry.  I was pretty hysterical.  I told her that I couldn't take losing another baby, not this close to the end, not now, not this baby.  I couldn't sleep, couldn't concentrate, couldn't think of anything else besides the fear of losing my baby.  She simply said, "It's time." 

She phoned my doctor, spoke with the perinatologist and the hospital, and the OB currently on duty at the hospital.  All agreed that I could deliver that day.  And that's exactly what happened.

The good news is that my baby was perfectly healthy and didn't even spend one minute in the NICU, my liver is functioning perfectly well now, this harrowing experience is over and I have a beautiful baby in my arms.  The bad news is that I'd have a significantly higher chance of developing ICP in a subsequent pregnancy (60 to 90% chance, depending on the source) and that it tends to manifest earlier and more severe in subsequent pregnancies.  My husband was already not a fan of hearing my talk about wanting a third baby and this bit of knowledge slammed the door on us having a third.  He flatly refuses to consider a third baby and a part of me understands. . .but another part of me still wants a third baby.

Why write this down?  I don't know.  I guess it's a good reminder that even the weirdest symptoms could indicate serious problems.  I shudder to consider what could have happened had I not mentioned this crazy itching.  I think it's also a good thing to explain just how emotionally difficult it is to get an ICP diagnosis.  It's not just itching and whining.  The itching was horrible, but the fear of losing your baby right at the end of pregnancy is so much worse. 

I still would like to write down something about my delivery and my recent bouts of second guessing myself about breastfeeding (bizarre, but true), but my time is pretty limited these days if I want to use both hands to type so it might be a few days or weeks.

Wednesday, November 23, 2011

Turkey Gravy

These measurements are all eyeballed. . .play around with the recipe to find what works for you. This makes a HUGE batch of gravy. I usually end up making a turkey casserole sometime after roasting a turkey and I use this gravy in place of any "cream" soups. I also have added this gravy to homemade turkey soup to thicken it a little bit.

Bloggy McBloggerstein's Turkey Gravy
2 Tb butter
1 small chopped brown onion
2 chopped carrots (or small handful of chopped baby carrots)
1 stalk chopped celery
2 cups red wine (I tend to use merlot when cooking with red)
11 cups turkey or chicken broth or stock (I usually have this in the freezer, but feel free to use cans or cubes)
Any pan drippings from roasting a turkey or chickens (defat if desired, but realize the fat brings the most flavor)
2 chopped cloves of garlic
Handful of sliced fresh mushrooms
Seasonings to taste: salt, pepper, sage, & a little bit of rosemary.
Cooked potato flesh (no skins!) for thickening (or instant potato granules - NOT flakes - if you're lazy like me!)

1.  Cook onion, carrots, celery in butter until they begin to brown.  I'm assuming that you've just roasted a turkey and you have already deglazed your pan to get the caramelized bits.
2.  Add wine, broth (or stock), pan drippings, garlic, & mushrooms and cover.
3.  Increase heat to boil for about 20 minutes or so.  Feel free to drop the heat and simmer longer, but usually you're doing this while a turkey is resting or being carved and you don't have endless time on your side.
4.  Add seasonings & use a handheld stick blender and blend until smooth.
5.  Add cooked potato flesh (no skins!) and blend until it reaches desired thickness.

Note: Do not use wine that is labeled "cooking wine" for this recipe. In my experience, you should cook with wines that you'd happily drink because most cooking wines are horrible.

Turkey is Easier Than You Think

I love turkey and I make it a few times throughout the year.  My turkey is always moist and delicious.  I've noted that a lot of people are intimidated by making turkey and it's really quite simple.  Don't be afraid to attempt to roast a turkey; if you can handle a roasted chicken, you can handle a roasted turkey.

Bloggy McBloggerstein's Brined Turkey


1. Defrost the turkey in the fridge. Usually takes around 4 or 5 days for a 14-pounder. Cut turkey out of the plastic and pull the neck and giblets out of the cavities (check both).

2. Brine the turkey for between 12 and 24 hours. My brine recipe is: 1 cup orange juice, 8 cups water, 1/2 cup kosher salt, some salt, pepper, and dried sage. Mix together and add turkey. Put the whole thing in an Igloo cooler and dump an ice-maker full of ice in the cooler. Flip bird over half-way through brining.

3. I use an electric roasting pan instead of using the oven because I don't like heating up the whole house and it seems to cook the turkey faster. Pull the turkey out of the brine (be sure to drain any brine out of the cavities, but there is no need to rinse the bird - besides, that means you'd have to sanitize your sink!) and place directly in electric roasting pan. Put 5 pats of butter on turkey - on both breasts, near the drumsticks, and in middle of back. You don't need a lot of butter because brining keeps the meat VERY moist.

4. I usually use the following seasonings: some salt and pepper, a little onion powder, a shake of granulated garlic, and a sprinkle of dried sage. Sometimes I use a tiny bit of dried rosemary. Sometimes I stuff the main cavity with a quartered peeled onion and a couple peeled cloves of garlic. Sometimes I stuff it with a quartered orange. You can play a lot with poultry seasonings. Of course, you can always stuff some prepared stuffing in the turkey too - but don't pack it tightly in the cavity.

5. Cover electric roaster and roast for 2 hours at 325 F. Then turn the heat up to 350 F for 45 mins to 1 1/2 hours. There is no need to babysit the bird or baste at all. Use a meat thermometer to tell when the turkey is done instead of watching the clock. The turkey is done when the meat thermometer reaches 165 F. I usually test four places in the turkey to ensure it is all cooked: each breast and near each drumstick. Be sure not to hit a bone with the thermometer or else you'll get a false reading.

6. Turn off the roaster and remove turkey to a cutting board and let the bird rest for about 30 minutes. When I'm really lazy I just leave the turkey in the roaster (lid off) and carve it in the appliance instead of dirtying up my giant cutting board (it's a heavy son of a gun!). The reason you want to let the bird rest is because it helps redistribute the juices throughout the meat. If you carve or cut into it right away, you lose much of the juice and get dry meat (this is true with any meat). The brining also helps keep the meat moist.

7. For carving, I usually cut off the wing tips first and then the drumsticks. It is easiest to cut at the joints. Then I begin carving the breast meat, cut the rest of the wings off, then the thighs. I'm not fond of skin and I always pull the skin off as I'm carving. I usually end up flipping the bird over a couple of times to make sure I've picked it clean. Then I use the carcass and skin and make turkey stock so I can make homemade turkey soup a few days later. In case you don't know what to do with the pan drippings, you can use it to make gravy (I have a recipe for that too) or to punch up the flavor of any boxed stove-top stuffing.

Follow this recipe and you'll have awesome turkey each time.  Enjoy!

Monday, November 21, 2011

Middle-Aged Adolescents

I think that anyone who knows me at all or reads what I write in this blog can agree that I'm fairly direct and to the point.  I have a low tolerance for bullsh*t and little interest in drama.  I try not to engage in gossip and I try to be a kind & giving person even toward people who I just don't care for all that much.  Indeed, I try to keep those negative thoughts to myself because I believe in treating others the way I'd like to be treated. 

Yeah, I know, I sound like I'm The Last Girlscout.  I'm not trying to say that I'm oh-so-evolved as an individual, but I most definitely do not suffer from emotional retardation that makes me act as though I am still a snippy teenager running the mean girls schtick.  I'm 36-years old and it would be ridiculous if I were still behaving like it's the early-90s.  I don't feel the need to try to push down others to elevate myself because that's a fool's way to get a temporary lift and it's just not my style.  I am who I am, I know who I am, and I like who I am.  Anyone who has a problem with that can just suck it.

I'm usually a good judge of character and I don't exactly shrink away from rolling in the mud with b*tches and that's why it surprises me when one chooses to square off with me over a completely chickensh*t reason that makes absolutely zero sense.  Life can be so full of crap and I truly value honesty in relationships.  It may sound naive, but I think it's a shame that all women don't feel the same way.  I get that sometimes others are spoiling for a fight and there are certainly times that I've launched myself in the ring, but I have flesh & blood family who I haven't had a single word of contact with in over three decades and there is no way that I'll hesitate to burn down a relationship with a friend if I feel that they are not genuine with me or if I feel that they are actively out to sabotage my happiness.

Of course, using the word "friend" is debatable because friends don't try to cut down other friends.  Friends don't give their friends ultimatums regarding other non-mutual friends.  Friends don't ignore special times in their friends' lives; special times like birthdays, buying new houses, having a long desired baby.  Friends don't make up outright lies to try to eject their friends from social groups - particularly when the lie is completely unnecessary.  And friends sure as heck don't pull this c*nty behavior in the weeks and short months after their friend suffered the unexpected death of a young family member, after a friend moved to a new house while in the third trimester of pregnancy, and after the friend's mother just spent 40+ days in a rehab facility to relearn how to walk.

As I list out all this behavior, I've come to believe that this friend is impossibly pathetic and I'm surprised that I feel mainly indifference rather than righteous fury toward her unwarranted attack during what anyone can see is a difficult time in my life.  Her childishness is rather lame and I feel pity more than anything at the moment.  On some level I'd like to blow the lid off this situation and get others involved too, but ultimately that's her style and not mine.  And I guess that I just don't care.  If someone wants to act like a douche toward me, well, that's their choice.  What am I supposed to do about it and why would I want to?  I choose to move on because life is too short and I'm too good of a person to deserve that kind of treatment.

Why would I want a false friend?  Why would I waste my energy exposing the ugliness when women like that usually do a good enough job exposing their own ugliness?  Given enough rope, they do eventually hang themselves.  Life is challenging enough so why would I want to stay in a group where this kind of d*ckish and duplicitous behavior occurs?  Why spend my time with thoughtless and inconsiderate @ssholes?

It would be one thing if this behavior was simple insensitivity and I've pondered this possibility at length.  I know that I am a hot-head and I have a tendency to fire first and ask questions later.  After bouncing the entire situation off my hubs at length, I've determined that I'm neither overreacting nor reading into anything.  It simply is not the case that someone is being a clueless twit.  This was designed to be intentionally hurtful and that's what I can't accept and will not tolerate.  While some people thrive on their own maliciousness and drama, I do not.  Again, I believe it's pretty pathetic to act this way at my age and certainly at hers.  I received her message loud & clear, therefore, I think I'll do this person a favor and tell them to go f*ck themselves.

Have you ever had to tangle with a middle-aged adolescent?  How did you handle the situation?


PS  If you think this is about you, it's a good clue that it is not.  In my experience, people like this come up with all kinds of dumb excuses to justify and ignore their own shockingly bad behavior.

Thursday, November 3, 2011

Best Birthday Present EVAR!!

For much of my life, I have had extraordinarily disappointing birthdays.  I wouldn't go so far as to curse the day of my birth, but it has been decades since I've looked forward to my special day.  To put it mildly, it has most often left something to be desired.

My husband knows the reasons why I feel particularly unloved and uncared about on my birthday and, to his credit, he has always tried very hard to make that day a good one for me.  Last year, he was out of town for my birthday. . .other than when I was attending my brother's service, it has been the only time we've slept apart since we got together.  It wasn't all badness & sadness though because I met up with some friends at a local theme park that day and they treated me to a very tasty funnel cake.

My birthday this year wasn't all that great, I swear that my son went out of his way to make me cry that day, but my husband certainly came through with what can only be called The Best Birthday Present of All Time! 

After five or so years of casually looking and ten months of serious looking, we bought another house.  Not only did we buy another house, but we bought a FREAKING AWESOME house that is exactly what we both wanted.  It is the perfect place to raise our boys and we both fell in love with the location, the floor plan, the backyard.

When did escrow close on this house?  On my birthday.  As I said, best birthday present ever!

My husband has already told me that I shouldn't expect him to buy me another house for my birthday next year. . .geez, what a cheapskate!  Ha!

Wednesday, November 2, 2011

What Exactly is "Normal" Down Below?

Have you missed my blog posts about sex in general or vagina in particular?  Well, then you're in luck!  Prudes need not read any further - you've been warned.

I've noticed for many years that most porn actresses sport nearly identical looking nether regions.  Not only is there a specific "look" in porn videos, but print photos apparently received the same memo and reveal much of the same predictable result.  What is the preferred look that our X-rated friends are hustling?  It is a snatch that is totally devoid of any hair and with an utter lack of any labia minora visible. 

From an aesthetic standpoint, I can see why the hairless look is more popular for men and women.  After all, one watches porn to see people screwing. . .not to see what looks like a woman giving birth to a baby bear.  Hair obscures the vision and porn is all about visual stimulation.  I get that and I'm okay with it.  Of course, this grooming style spilled over to the general public a long time ago and I'd wager that nearly all women under the age of 30 keep up a bald vulva.  Whether or not they realize that they were manipulated into doing so by the porn industry (either through a significant other suggesting it or them doing it on their own after seeing it represented) is debatable and it doesn't really matter.  Speaking for myself, I think variety is fun and see nothing wrong with a rotation between shag, hardwood, or Berber.

The absence of labia minora is more puzzling and, I think, it has far more damaging consequences for women in general.  After all, hair can grow back as pubic fashions change and removing hair is a much easier proposition than removing excess labia.  Depending on the media, there are a few options:  one can tuck in their labia minora, have their labia minora digitally altered to look smaller or disappear entirely, or one can have a labiaplasty.  Obviously, cutting away a sensitive part of your genitals is the most extreme example and it's the one that I see becoming the result of exercising the first two options. 

The more times that women see a tucked labia or a photoshopped vulva, the more times that she'll feel unusual or weird for not looking the same way.  Ultimately, she may well end up seeing a plastic surgeon to "fix" what was never broken in the first place.  She seeks to be "normal" when, in fact, she already was the normal one.

It's like breast implants.  Heavily padded bras are one thing, but getting a surgery to alter your body is an entirely different animal.  Once women and men began seeing the result of breast implants, more women sought them.  The motivation behind the surgery makes no difference because the result is the same.  As more women get big fake boobs, women without big boobs begin to feel increasingly bizarre.  The natural women probably realize that they are being manipulated to want something unnatural, but the fact is that the natural woman looks weird at a certain point (and in certain geographic areas or work industries) rather than the other way around. 

Breast augmentations have become very popular and quite common.  Is labiaplasty the next plastic surgery craze?  If so, where do we put down our foot and say "ENOUGH!" 

Natural is no longer necessarily "normal."  Our sense of normalcy is being changed by surgeons, one cut at a time.  I can't blame the surgeons for filling a need.  The surgery most often wouldn't even be considered if it weren't for the porn industry normalizing an unnatural look.

A designer snatch.  A customized c*nt.  A perfect p*ssy.  I respectfully submit that such things aren't worthy of pursuit.  As I say about most (certainly not all) cosmetic surgery, I think the money would be better spent with a psychiatrist to find out why you're so unhappy with your own self.  To find out why you feel the need to surgically alter (mutilate, enhance, or whatever you want to call it) your body in an effort to find peace and contentment.

I think my husband said it best when he said that no man is going to refuse to have sex with a woman because her p*ssy lips protrude.  Indeed, I'd suggest that having at least a little protrusion makes sex more pleasurable for both men and women because the labia are an extension of the vagina and the stroking friction feels good.  That said, there is a wide range of normal and warm & wet feels good no matter what the rest of the packaging looks like.

I write all of this knowing that I'm a hypocrite.  I've often thought that I'd like to do one specific thing to my snatch.  My husband, and every other man who I've mentioned this to, thinks I'm absolutely nuts.  I know I have a great little p*ssy and I logically realize that my emotions on the matter have been manipulated by the porn industry.  However, there is still that part of me that thinks it would be so much better if I just do this one little thing. 

Thank goodness I have the number of a good therapist!

Tuesday, November 1, 2011

I'm Back. . .Maybe

Some of you may have noticed that I've been silent lately.  It would be fair to say that I've been, for the most part, stunned silent.  It's been well over six-weeks since my nephew died and I'm still unable to begin processing my grief.  It's not that I can't handle grief, goodness knows that I can certainly handle grief, it's that I'm afraid to fall too deeply in to that pit of sadness and hurt during what should be - what needs to be - a happy and joyful time in my life. 

I know that sounds selfish, but it's not even only for my own sake that I refuse to address my pain.  It's for the sake of my children, the one I hold and the one I'm still carrying.  For being such a young child, my son has witnessed far too much of my grief and I don't want his mind to somehow connect my pregnancy to my tears and despair because I don't want him to somehow think it's his little brother's fault that Mama is so sad. . .so sad yet again.  I don't want my unborn son to be negatively impacted by my own mental state.  I know that I don't care for myself adequately when I'm down there and that means that he won't be adequately nourished either.  That's not even addressing whether or not a fetus suffers developmentally based upon the mother's depression or stress hormone levels.  Without a doubt, my boys would suffer if I allowed myself to delve into the aching depths of human sadness.

Of course, it isn't all selflessness.  This baby in my womb only came after two solid years of trying every month, after losing one precious babe, after subjecting myself to hormone treatments that made for an unbelievably stressful first half of pregnancy.  After two years of bitter disappointment each month, I want to experience all the joy I possibly can.  Is it wrong that I want to try to enjoy what will most likely be my final pregnancy?  If it is, then I guess I'm wrong.

I simply can't wrap my head around a 17-year old kid dying from a heart attack.  I just can't.  It's like something you read about and feel sorry for the family who was impacted by such a fluke occurrence.  Only it's not some random anonymous family.  It's my family.  It's my family who has been hurt by yet another unnaturally natural death.  It's such a bizarre and unthinkable thing that I don't know whether to laugh, cry, scream, pull at my hair, or some mixture of all responses.

So how am I handling my grief?  I'm not.  I push it back down whenever it comes up and I generally pretend that it does not exist.  Is this healthy?  No, not by a long shot.  Is this the most sensible way I can handle it at the moment?  Yes.  I know the time is coming where my grief will begin to manifest itself in other ways and I'm already having difficulty pushing it from my mind when it comes to me, but thus far only the silence of midnight's moon has been the witness to my weeping so I'm thankful my son has been spared.  It's a scene that he's seen before, but I know it frightens him and he's seen it altogether too often.

Why do I cry in the night?  Why else?  It's when I say my prayers and I can't help but cry when I pray for my nieces and nephews.  Most nights I automatically put his name in there, my mind still unable to accept that he no longer has need for any of my prayers, and that's when it hits me the hardest.  I begin to play the highlight reel - tears always come when I think of him joking and clowning around - and I have to muffle my cries in my pillow and begin praying that sleep comes mercifully soon.

Perhaps I'd be well on the road to healing if I'd been able to attend his funeral?  I don't know and it doesn't matter since I was unable to attend.  My mother fell and broke her hip just days after his death (she only just returned home), I wasn't keen to leave my little boy because it really messed with his head when I did so to attend my brother's service last year, and my OB wasn't wild about the notion of me traveling 3,000 miles away when I was still having bleeding episodes in this pregnancy.  So I didn't go.  I wish on some level that I had, but my parents and my children needed me to stay here and I did.

I don't know that I will be able to continue blogging, but I will make an effort.  Though I have always been brutally honest in this blog, I won't be able to address these emotions because they need to stay bottled up for the time being.  The way I see it, I probably have plenty to write about without participating in a bit of free therapy.  So I'm back. . .maybe.