It’s hard to believe that Teegan is already six months old. Everything has gone so incredibly fast this time. He’s not a little baby anymore! Teegan has such an easy going personality. He just wants someone to look at him so he can smile back. He definitely is a second child and unfortuntely is frequently waiting for attention becuase Mila tends to hog the limelight…
He just started sitting up for a few seconds at a time!
He had a lot of projectile spit up when he was first born. In fact, the first few weeks he would almost stop breathing because his spit up would come out of his nose and he couldn’t breathe. It was pretty scary. The ENT doctor scoped him and he was diagnosed with acid reflux. We recently switched to omeprazole and he is so much better. He eyes don’t water and he doesn’t arch his back like he used to when he would get a bout of reflux. He’s also gobbling down his bottles voraciously and his growth has taken off. This week we started some oatmeal cereal, which he devours. He’s not so sure about the pureed carrots or avocados yet…
I also can’t believe this is my 7th week back at work. I was really nervous for the transition this time, but it’s amazingly gone really well. I am working full time but am hopeful sometime in the next year I will go down to part time (2 full days, 3 half days). Being back has been really nice in unexpected ways. My patients are really happy to have me back and they are excited for my family. With everything that happend during and after my pregnancy, I also gained more experience and empathy about what it feels like to be a patient and have unknowns and fears about your health– which definitely makes me a better doctor.
So now we’re just enjoying life as a family of four. I have my “parejita” (little pair) as my patients like to say.
This postpartum period has been both easier and more challenging than it was with Mila.
Teegan is such a good baby. He is not fussy like Mila was. He loves to be cuddled, snuggled and held. At night he sleeps right next to our bed and he will open his eyes every so often to look at me to make sure I am still there as he drifts off to sleep. People told me that little boys have a special connection to their mamas and I can already see it. He still gets up every 2.5-3 hours overnight to eat, but he goes right back to sleep pretty quickly. I can’t hardly complain about anything.
However, the same cannot be said for my body. I’m having a harder time recovering from this pregnancy. My lupus was much more active, requiring lots and lots of medications, in high doses. I was hoping I would be able to taper down off the medications right away after he was born but unfortunately things are still flaring.
The high doses of steroids caused me to have high blood sugars, necessitating insulin during the pregnancy. As I’ve started to go down on the steroids my sugars have not gone back to normal as I hoped and it’s possible I may end up with pre-diabetes. Nothing is for sure yet because I’m not completely off the steroids, but I’m a little nervous. I’m hoping my body will recover over time.
Also, the steroids weakened my bones. I started running after my postpartum visit which was so nice after being sedentary for so long (first for preterm contractions and then after the c-section). On my third run/walk I developed severe pain below my left knee and couldn’t finish my run. Turns out I fractured my tibia right below the knee. It’s a horizontal fracture that luckily didn’t displace the bone. So now I’m on crutches for the next 6 weeks. Luckily I have great help with the little ones. My mom was able to extend her stay for an extra week and now Jake’s mom and sister are helping out. It takes a village, right?
This is just a little bump in the road- I’m very blessed to have two adorable, precious babies and an amazingly supportive husband and a wonderful family. Hopefully I’ll find some time to sit at my sewing machine since it is my happy place….
With my mom and my babies at the LA zoo, before crutches.
Towards the end of my pregnancy, I noticed that one of the moles on my left upper arm had become red and was bleeding. I knew that my history of sun exposure (with my fair skin) and lupus make me higher risk for skin cancer. So I saw the dermatologist who did a biopsy and it came back as a “Spitz Nevus with dysplasia”. I actually had to look this up, and it’s no wonder I didn’t remember- they are uncommon, about 1 in 100,000. They look very similar under the microscope to malignant melanoma (the bad kind of skin cancer that can be deadly). Even though a Spitz Nevus isn’t deadly, since they are so similar, they recommend that they are completely cut out.
When I went to the surgeon he told me I would end up with a scar, but I was completely unprepared for the size of the scar I have. Plus I was not prepared to have the “train tracks” aka “centipede legs” from the 8 stitches. It’s right on the front of my arm and VERY visible, especially in Southern California where people wear lots of sleeveless shirts.
I know it’s just a scar. And in the grand picture it doesn’t matter. In fact at this moment I couldn’t be more blessed! I have a perfect baby, my lupus is stable, and my husband is amazing…. But I’m still mourning my old arm and that this new look is now me.
I have several projects in the works with fun posts coming up, but thought I would write about something that has been on my mind a lot lately.
I’m losing my hair.
Every morning when I brush my hair I am losing handfuls of it. Then during the day it continually sheds all over everything. My ponytail is about half the size it used to be. In light of everything that has happened in the past year it seems insignificant, but it still bothers me. I am imagining myself in a wig soon.
I think the most frustrating part is that I don’t know what is causing it- so I don’t know how long to expect it to last. There are so many possibilities: a lupus flare (when lupus itself is more active you can lose a lot of hair), the medications I am taking for lupus (I just recently stopped azathioprine, but am still taking plaquenil and prednisone), the high fever that got me hospitalized in August (physical stress can cause hair loss), hormone changes (we are undergoing fertility treatment) or just plain ol’ emotional stress.
I started taking the supplement biotin to see if that will help.
Keep your fingers crossed that it will stabilize and slow down soon.
This weekend is exactly what I needed. I felt like I walked around with a smile from ear to ear for the past two days.
I am in New Orleans for the annual ACP Conference of Internal Medicine. I’m not sure how many physicians are here, but there are lots. During the day there are probably at least a hundred different lectures to choose from and in between lectures and in the evening there is time to spend relaxing with colleagues.
There are a lot of people from MN here, mainly people I know from residency. After spending 3 years there, it feels like I am “home” this weekend.
It is also navy week in New Orleans so over lunch on Thursday we toured the USS WASP. I got to hold a gun.
Thursday night we went to Emeril’s (the famous chefs’ first restaurant). We had an amazing time- and they were able to make me a very tasty vegan meal (my dietary choices have provided my colleagues with a lot of material for teasing me).
And speaking of dietary choices (vegan), I’ve been getting my share of red beans and rice.
It’s been a great time, but also excited to see my husband tonight. Four nights away might be my max.
Lupus. It’s that weird disease that feels impossible to diagnose. Managed by rheumatology which is the specialty that manages all those elusive diseases….
Of which, I now have. I have lupus.
The last several months have been an interesting journey. Life has been throwing me a lot of curve balls and it seems that each time that I felt like I had a handle on it, life would throw me another. In early October, right when we moved out here, we had our first miscarriage. Very early at about 6 1/2 weeks. Then we were lucky and got pregnant right away again. Yay! And saw a heartbeat, but then lost that baby around 9 weeks. So, this prompted a battery of tests with more and more abnormal results…. which finally lead up to the phone call I received yesterday: “You have lupus and you should start taking plaquenil today”.
I spent the rest of the afternoon in shock. I would see a patient, come back to my office and cry, then go out and see another patient. I’m sure I looked like a crazy doctor with bloodshot, puffy eyes.
Right now I feel overwhelmed, scared, and helpless. I mean, why lupus? Why an autoimmune disease? Why not something like high cholesterol where I can change my diet? And why a disease that can cause kidney failure? (Right now I can only seem to remember lupus patients on dialysis or with kidney transplants- not those that are functioning well).
I imagine I will have many more blog posts on this in the days/months to come as I wrap my head around what this means for me and my family (and hopeful future family).
I had a little downtime between patients this morning (scheduling glitch, but such a nice Friday morning surprise) and I was catching up on reading the stack of NEJM (New England Journal of Medicine) journals on my desk.
I started the article Accessing Supplement Safety- The FDA’s Controversial Proposal and when I got to the third paragraph, I thought: I need to let my previous colleage Pieter know about this article, it’s so well written. Then I glanced at the top of the page, and it was WRITTEN by PIETER COHEN. 🙂 So, I guess he already knows about it.
(<– This is Pieter)
Pieter is an amazing doctor, someone who has truly inspired me. Please read his article. There is also an audio interview with him here.
My life has felt a bit overwhelming and stressful lately, so I decided it was time to take a step back and think about some of the wonderful things in my life. And most of those are people. I have been blessed with many great people in my life.
Yesterday I was sitting in my new office (in Hollywood, CA) and I received a text message from Rosie, my friend and medical assistant, in Boston. It made me teary. Rosie really made my job in Boston special.
When I first started to practice in Boston I was coming from hospital medicine. Switching to a full time clinic job was more foreign than I anticipated. In the hospital, patients have already had a significant work-up in the Emergency Department and you already know that they are sick. In clinic, you have to decide if an issue is serious or if it’s something that will get better on its own. And, seriously, was not prepared for the questions patients would ask (“uh…. what? Um…. I’m not sure…”). I mean, they did not teach us that stuff in medical school! Trial by fire.
And I’m super organized, which is good and bad. If things aren’t all done in order, I get flustered (which is probably why the move and all of our snaffoos have been so hard on me). But, luckily, I was partnered with Rosie, who saved me every day.
Rosie is very organized and pays attention to the details, just like me. So I could count on her, which allowed me to relax. I knew things were going to get done.
And, she’s also an absolute sweetheart. So, my patients also loved her. Which is doubly awesome.
We both had multiple stressors over the past year, and there was something calming about going to work and being a team. Even if everything else in our lives was chaotic, we could function and get things done at work. I think that was good for both of us. Seeing Rosie always put a smile on my face. Sounds cheesy, but, it’s true.
Rosie has been one of my favorite people to show my sewing projects to. She’s always interested (or at least pretends well ;-)). One day she asked if I wanted to go to a fabric store that she knew about in Cambridge, MA. Didn’t take much convincing. So we went together after work. I got the adorable polka-dots that I used for the back of Andrew’s quilt and a beautiful bird fabric that caught Rosie’s eye.
So, I had a yard of the bird fabric sitting in my apartment waiting for a project to make for Rosie. When I saw a tote bag tutorial, I thought, this is it! The fabric was a thin quilting cotton weight so I added fusible interfacing to it to give it more weight. I have added interfacing to pouches before and it worked well, but I don’t know if I did something wrong this time because after the tote was finished I noticed that if you folded the bag there would be a strange crease in the material from the interfacing bending. Has anyone else had this happen? Any ideas on how to avoid this? Did I not iron it long enough? Otherwise, I think the tote turned out really cute.
I did have some problems with the pattern though. The lining was cut out exactly the same size but had a smaller seam allowance so it was all bunchy when I tried to insert it. So, I had to go back and resize the lining.
I could literally write a novel about Rosie. Here’s a couple of parting photos:
Rosie planned the most amazing surprise bridal shower for me at work. I literally had no idea and when I walked in the conference room with all the decorations and food and co-workers, I cried. THANKS.
Before I left for CA, Rosie took me out for dinner at a Brazillian restaurant. We had “Mu-que-ca’s” (a Brazillian meal in a clay pot). YUM.
At the beginning of 2010 I moved to Boston, MA to be with my husband (who was my boyfriend at that time). Before I moved to Massachussets I was working as a “hospitalist” in Minnesota. A “hospitalist” is a doctor that only works in the hospital, taking care of patients that are admitted. It’s exciting (at times) and very stressful. And I didn’t care so much for all the overnight shifts.
I decided to become a primary care physician when I moved to Boston. I had a suspicion that I would love working in clinic and getting to know patients over time. In residency, clinic time is limited as most of your training is in the hospital so it’s difficult to imagine what it would be like working in clinic full-time. And I was right. I LOVE IT.
I worked for Cambridge Health Alliance (CHA). I interviewed at a few locations and chose Somerville Primary Care. It must have been a beautiful fall day when I chose that clinic for me to not notice that the entire clinic was underground without windows (which became very evident when I started working in the winter).
SPC is an exciting place to work because it has a diverse patient population: Hatiain-Creole, Brazillian Portuguese, and Spanish speaking patients. Cuide a los pacientes hispanohablantes.
There are so many people that touched my life at SPC: Rosie (the most wonderful Medical Assistant in the world), Pieter Cohen MD, Carolyn Jordan cNP, Lynne Crawford cNP, Diedre Alesso cNP, Arshiya Seth MD, Carole Demosthene MD and all the residents of SPC. Really, I could just list everyone at the clinic. I will cherish my time at SPC forever. I learned so much about what it means to be a primary care physician.
As I start my new job at Kaiser Permanente in Hollywood, I hope I can carry with me all the wonderful tidbits I learned in Boston.
I am a primary care physician in Orange County, CA. I spend my days healing others, but am careful to take care of myself as I navigate my way through life while living with Lupus. I have the most fantastic husband who has always been the creative person, but I’m starting to explore the other side.