Quaternary Care

I had to deal with four doctor's appointments in the past two days: there was my annual OB/Gyn (hey did you know that this is pronounced Obee Gine-rhymes-with-wine-and-Caroline? I have always said O-B-G-Y-N, five separate letters - my doctor said this indicates an ana... a meticulous personality) visit; Patrick had a six year well kid check, Caroline and Edward went in for their six month appointment and then for a surprise second encore I took a cat to the vet. So in case you are wondering, yes I have read this month's issue of everything.

1. I finally got a chance to ask my OB about the pathology report on Caroline's placenta. As you may recall she was 4lbs 2 ounces at birth which is just not normal for a 36 weeks (and six days. and 21 hours) fetus. As you may also recall I was injecting blood thinners on a daily basis for nine months because my OB was convinced that even a single gene MTHFR mutation can lead to clotting issues. So I suppose she can be excused for being ghoulishly pleased by the pathology report that showed a compromised placenta (infractions? villi something? and something something else?) that was a little less than half the size of Edward's. She opined that without the heparin Caroline would not have survived to be born.

I never really believed some of the stuff I did with the pregnancy. Every night I spent hooked up to monitors in the hospital I was like, "Really? Isn't this a little dramatic?" I injected the blood thinners because I was afraid not to do it, but it felt more superstitious than medical. The terbutaline pump certainly helped keep the contractions down but I was never certain that the contractions were doing anything anyway; until I went off the terbutaline and delivered within fourteen hours. It was a bit sobering to reflect back on the things I thought were optional overkill and realize that they probably saved Caroline and Edward's lives.

I thanked my OB but in retrospect I should have offered to detail her car. With my hair.

2. I switched Patrick from his old pediatrician (who was fine) to the pediatrician Caroline and Edward lucked into (same practice) and with whom I am madly in love. What is it with women and their doctors? I cannot count the number of females I know who have one-sided attachments to their physicians and yet I have never once met a man who gushed "Oh I just adore my cardiologist."

Patrick is tall'ish, lean'ish and he has a spider angioma where his lip meets his face.  This is a benign lesion that looks like a small cut from a distance and like a possible little tumor if you are his freak of a mother and study it very very closely for over a year. When asked how he liked the new babies he replied, casually, "Pretty ok, I guess." When asked how the babies are doing he became animated and said, "Caroline is a MENACE!" Then he laughed merrily and told stories about all of the things she gets into that make me blench.

This is an aside:

I have a plastic bin under the couch that contains diapers, baby nail clippers, diaper cream etc. I also have a tub of wipes stashed under there. The first time this happened I thought it was a fluke but by her fifth time I realized that she was doing this intentionally - Caroline likes to roll under the couch, knock the wipes tub over, click open the lid and pull all the wipes out; possibly chewing on one for good measure.

One of the problems with having a six year old is he is privy to all the family secrets and he has absolutely zero discretion. Let me assure you that I had not planned on telling our pediatrician that I have carelessly let Caroline get into the baby wipes on more than one occasion.

3. After Patrick yammered yesterday I took the babies in for their appointment today. The doctor said, "What was it Patrick called Caroline? A menace? I have never heard a six month old baby described like... ."

Then he said "Oh my!" as he realized what we were talking about. I wrote about that appointment (hmmm, at considerable length I see) here at REDBOOK. Oh, before I forget, as he checked her eyes I asked him - in his professional, medical opinion - to tell me what color they are. The question was subject to considerable debate while my family was here and I wanted an objective, expert opinion to confirm that I am right and that everyone else is wrong wrong wrong. Green, he said. Possibly gray-green. Not brown? I clarified. Oh heavens no, said the good doctor. So. There. Certified green.

4. Darwin and Rusty were very close. They slept together. Rusty always groomed Darwin (although we never saw him return the favor - there is always a Giver and a Taker, isn't there?) When Rusty died I was worried about how Darwin would handle the loss. Cats are very sensitive; so I tried to make sure he was given lots of extra attention and I think he was ok for about a month. Then about a week ago he peed on the couch. Twice. And the rug. Last night (morning?) at 5 am I was on my way back to bed when I heard that tell-tale sound of covering (paw scratching rug) that makes every devoted cat owner turn cold and pale. I went in search of the sound and found him in the playroom, having just peed in poor Patrick's Lego bin.

Oh.... cats.

Repeatedly urinating in the same wrong place is probably behavioral. Defecating, almost certainly ditto. But randomly peeing all over the place is usually the sign of a physical problem so I called the vet and they saw him this afternoon. Turns out he has a bladder infection, the poor thing, but I have never been happier to hear about a disease in my life. You can treat an infection, it's much harder to treat grief - particularly when it expresses itself in urine.

PS I should have said yesterday that the early bedtime is only relevant if you have problems with the way things are going. If your baby happily goes to bed at midnight and you happily wake up at noon, rock on.

Comments

[Pam L]

Yes, discretion is NOT the better part of ...kids. I think many of my neighbors would be horrified to know some of the things their children have told me. One girl told me they had to sell their truck because they couldn't afford it any more, and one poor boy told me he didn't think his step-dad liked him very much-isn't that sad? And this boy is such a nice kid...anyway, all kinds of stuff. Of course MY kids never told anyone that I snore, right??

[Sheridan]

"I thanked my OB but in retrospect I should have offered to detail her car. With my hair."

I think I love you...

[Annalien]

Oh my, I nearly choked laughing (while eating) at the mental image of Caroline in the ped's office as described in your Redbook post! You are SO good with words, I really love your writing. Thanks for sharing you life with us.

[MomVee]

I think your OB/Gyn made that up. I have _never_ heard it pronounced like that, always O-B-G-Y-N.

[lisak]

Have read both posts, woo hoo! Healthy babes! Am wondering about Edwards eyes? There was some concern early on and I am wondering how that stands, not about the color, which I am sure is lovely.

Also, I have heard Ob/Gyn pronounced obee-gin--hmm.

Obee-Gin - like the alcohol. Glad to hear how well everyone is doing! It's amazing to read how much the preventative medicine while you were pregnant really did make all the difference in the world. Truly amazing.

[JuliaKB]

And now you have given me a most excellent idea for what to do for my OB if I actually get to bring this baby home alive. I think my hair is just long enough to pull it off.

My clotting tests have been inconclusive, but definitely not Factor V, so I am not taking thinners, but among my gazzillion worries, I oscillate between worrying about my hyperglycemia, which can make macrosomic babies, and the fact that A had a very small placenta, which can cause growth restrictions. My head is a lovely place to be. It may be more productive (in the wildly optimistic sort of way) to check out a few books on car detailing in the meantime, no?

So glad to hear everyone is doing so well, including the MENACE. And I heartily concur on the kids and family secrets. Mine once outed my pregnancy by inquiring whether I was sure I can have that glass of wine, which I accepted so as to not make a deal out of it, and was planning on kinda sipping. I could still hide in baggy clothing then.

[Amy]

Every time I see MTHFR I think it's an abbreviation for motherfucker.

[Sandra]

So happy to learn that Patrick and the babies are doing so well. And thank you for the post at Redbook. I was laughing until tears rolled down my face with the description of Caroline!!!

[Candy]

Should the peeing turn into something more emotional, there is a hormone you can purchase that you spray where the cat has gone, and it's supposed to calm them down. I have a bottle of it at home, but cannot remember the name. If you need it, I'll happily check it out for you.

My children call my dog a menace. I would gladly swap you one 1-year old half pit bull half Labrador called Chloe the Menace for one beautiful 6 month old named Caroline the Menace.

[clarabella]

Well, call me anal then, because I won't ever be able to say Obee-gine OR Obee-gin. It makes my skin crawl. I couldn't even refer to my doctor, while I was preggo, as merely an OB. I felt like I was belittling him by truncating his title. Yeah, I just used truncating. (Ok, maybe I am a little too anal.)

[Jenn]

See, I always say "OB-gahyn" because when I say the full word it comes out "gahy-ni-kol-uh-jist," so my shortened version is a reflection of the full word. Or I spell it out. Depends on my mood....

[Jen]

Nope, it is supposed to be O-B-G-Y-N and don't let anyone tell you we have THAT kind of personality. You can't spell the first half and then not the second. It isn't consistent.

[rosie]

i just read your redbook entry and i had to comment here: "She looked like a rabid suicidal Chihuahua" literally had me in tears of laughter. love the visual.

[Kira]

O-B-G-Y-N.
Period. There is ana - er - meticulous, and then there is JUST SIMPLY RIGHT.

By the way, I am loving how much you are loving your kids. Just gorgeous.

[Slim]

Wait, is the implication that it's bad to be a . . . detail-oriented person? Huh.

The only hard part about adoring a doctor is getting evidence that your feelings are unrequited. My OB/GYN's file on me does not contain any hearts, smiley-faces, or notations that "This is my very most favorite patient ever."

[Alex]

You know, as many horror stories as I've run across with infertility patients (etc.) and O-B-G-Y-Ns (and yes, I have heard the other pronunciation, but come on...), it's lovely to hear that yours did such a wonderful job. It's nice to hear the stories about the good, careful doctors out there.

[Kelly]

I have greeny-grey eyes too and find that they really POP green when I wear blue (or cry and my eyes get all red). Just aside.

[SweetC]

I fourth (fifth?) The spelling as my mom has been a labor and delivery nurse for 35+ years and she has always said O-B-G-Y-N and sometimes just "Gyn" (like Gin, the beverage) when referring to a patient (as opposed to L&D)

[jen]

I adore your writing. I swear this week has been like Christmas with all your posting. Though how you are doing it, I cannot imagine. And from the REDBOOK post, I am baffled as to how you can carry two buckets anywhere, regardless of people opening doors for you. The one I have nearly pulls me to the ground with it. Do you do some super strengthening arm exercises or are the twins enough in and of themselves?

[Jen]

Must be regional or something. I always thought of obee-guynee as sort of medical people shorthand and felt like O B G Y N was more appropriate for those of us who only drop in, rather than say it all day every day.

On the other hand, I've never heard anyone say "Gin" but clearly that's out there too.

[Jenny]

I'm with you, too, on O-B-G-Y-N. And HA HA HA for Amy's comment about MTHFR -- I always do exactly the same thing! Excellent. :)

By the way, the cat hormone spray that Candy mentioned is called Feliway. It does work, although it makes the cats sniff around a lot. :)

[Laurie A]

Re: Switching pediatricians. IAlthough, like you, my 2-1/2 y.o.s dr was adequate, I switched him to another dr. within the practice whom we had seen on a weekend visit (my son always seems to come down with something on the weekends - thank goodness for weekend coverage!). When I last took him because he complained his knee felt funny ("like fuzzers of cat fur") it dawned on me why I liked this doctor: he thinks out loud. I can tell what theories/approaches he's considering and why he's eliminating them or keeping them. When he does this, it's like he knows what I've been thinking.

By the way, my son had Lyme disease from a deer tick bite. Apparently it must have felt like the furballs that our long-haired cat leaves around the house were running through the inside of his knee. Poor kid.

[Kathryn]

All this spelling is making me think of a friend of mine whose gyn was named Dr. Meyer. She sang a little song:

My gynecologist has a first name
It's DO-C-T-O-R
My gynecologist has a second name
it's M-E-Y-E-R
I love to see her every day
and if you ask me why I'll saaaaaay. . .

cuz doctor meyer has a way with my V-A-G-I-N-A.

[Kathryn]

All this spelling is making me think of a friend of mine whose gyn was named Dr. Meyer. She sang a little song:

My gynecologist has a first name
It's DO-C-T-O-R
My gynecologist has a second name
it's M-E-Y-E-R
I love to see her every day
and if you ask me why I'll saaaaaay. . .

cuz doctor meyer has a way with my V-A-G-I-N-A.

[tree town gal]

Ususally, I'm lurking around the edges but I must tell you how spoiled I feel reading these regular posts; how do you find the time... I think Caroline might need her own TV show or maybe star in the next Batman movie: The Menace.

Your last Redbook post describing Caroline at her Ped visit was beyond David Sedaris funny and left me audibly snorting. My family descended, wondering why I'm enjoying writing a research paper that much. Busted... I just got so busted.

[Kelsey]

So what do you use to get cat pee out of the couch? My cat just did the same thing - jealous of the new baby they tell me. But I'm scared she'll do it again if I don't get it completely up.

[Pork With Bones]

Yay, yay, yay for a good doctor. Who certainly deserves a car detailing, or maybe free tickets to Aruba.

Also? Kathryn just totally cracked me up. "'Cause Dr. Meyer has a way..." Oh, my.

[Christine]

Thank goodness for good doctors.

And I swear, I thought everyone called them "O-B-G-Y-Ns." Huh.

[Michelle]

Oh Julia, I'm so glad you posted about Caroline's placental report. I have been wondering. When you said that you had started the injections and that you were leary, I was so glad that you decided to continue despite your being unconvinced.

We lost our daughter Audrey at 33 weeks. She measured small almost from day one. When she was born, she weighed 3'3", small for that age. The report was the same as Caroline's. We also discovered after losing her that I carry a single copy of the MTHFR gene. I remain convinced to this day that if I had been on the lovenix then, we would have her with us today.

2 years, 3 rounds of IVF, an ectopic and a miscarriage later (I'm 2 live babies for 7 pregnancies), we have our sweet little Natalie. I'll never know if she would have made it without those daily injections, but I am beyond glad I did it.

I thank God every day for the miracle of modern medicine. It ain't perfect, but it beats the alternative!

[Michelle]

ugh..."lovenOx"...

[Kathryn]

stupid double comment. Sorry everyone.

[sozzled]

peeing in the Lego?? I can't even tell Tim what I'm chuckling about because peeing in Lego for Tim is what burning the flag is to some people. We are members of the Anti Icky Poo of the month club, so you know we put up with a lot from our cats, but peeing in the Lego would be the end of it. I'm glad you took him in, and hope all is well again in your house soon.

[ailo]

I just wanted to drop a note that I am so glad you are posting more. You're one of my favorite reads online, and it always makes my morning when you've submitted a new post. And it doesn't hurt that you tend to include pictures of grinning babies. Thank you!

[Aurelia]

About the heparin and the placenta stuff---I always believe that we should go by the pathology evidence to determine if someone had a clotting issue and not just the blood tests.

Reason being that science hasn't discovered all the clotting disorders yet and so while you may have one gene for MTHFR, you may still have needed the heparin anyway. Because maybe you were never tested for a newer kind of clotting issue.

Anyway, I'm very glad that they checked. It's nice to know these things.

[kate]

Several years ago, during my first year of music school, we were introduced during one of our weekly performance sessions to a guy from Scotland who was a Modernist music composer/performer. His "thing" was perfectly stereophonically setting up speakers in an auditorium and "performing" his compositions which consisted of prerecorded somewhat naturally occurring percussive sounds. Despite it's irritatingly esoteric nature, his creative process was quite interesting. Anyhow (getting to the point of why I'm sharing a story about music you've likely never [and probably won't ever] heard), he was describing the creative process for him, and how happenstance was the best way, that his favorite piece as of yet was a recording that he took when he came upon his wife in the bathroom where she had run a tub full of water and then emptied their son's Legos into it to wash them because their ailing cat had relieved himself into the Lego bin. Apparently the hollow plastic bumping against the ceramic tub in the echo-chamber of the tiled bathroom produced a "cacophony [that was] most enchanting".

So there you are. Your cat has created a scenario by which you can, in your very own home, compose and perform a modern (most enchanting) symphony.