Self-Prescribing

I have been living in the Medical Intensive Care Unit this month (aka, "MICU", "M.I.", "Mic Uoo"). The sickest of sick people come through here. I have seen many people die this month despite the most valiant efforts of the best of Western Medicine. Yesterday was a crazy morning, for example. At one time we had someone being intubated (a breathing tube getting put down their throat) and 2 "Code Blues" going on at the same time (that's when someone is actively dying--not breathing and no pulse). The 1st Code was on a patient that was an alcoholic "found down" and unresponsive in his apartment by his friends after a binge of drinking. He was hypothermic (body temp was 90 degrees) and had no brain stem function. You can't declare someone dead, however, until they are normal body temperature. When he got warmed up, he actually started waking up some, but was very, very sick. That Code lasted for a long time. He regained his pulse and blood pressure a few times, but a few coding-episodes later, he died.

Simultaneously, I was cheering on a fellow resident preparing for a non-urgent intubation. While I was outside the room, the nurse from the room next door calls for my help stating his patient's blood pressure is only 29/13! I quickly went in there to find out he had no pulse, and I quickly initiated chest compressions (this patient was already intubated). It took a couple minutes before more people came in to help out. Thankfully, this code did not last that long--the patient quickly regained his pulse and blood pressure after some intervention.

All this happened before 10am.

FYI: some stats regarding "Codes": [Saklayn:]
- It's bad news. The survival rate is far, far, higher on T.V. than it is in real life.
- Only 30% survive at 24 hours.
- 13% survive 1 month.
- 6% survive 6 months.
- Survival to hospital discharge is only 10-15% for ALL patients, but <5%>15 minutes, patients don't live to 6 months.

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Seeing these many sick patients in the hospital has inspired me to compose a preventative medicine list.

Preventative Measures I Have Decided to Take:

1. Never smoke.

2. Don't become an alcoholic.

3. If it is ever slightly suspected that I might have sleep apnea (daytime sleepines, snoring, etc.), get a sleep study ASAP, and USE my CPAP every night. [Right heart failure is AWFUL, AWFUL. Preventing this is also coupled with #1 and preventing COPD.]

4. When I get to be 40 years old, taken an aspirin every day. [Prevent heart attacks and strokes.]

5. If there is any concern about my heart (ie: chest pain, exercise intolerance, etc), get a stress test.

6. If I start to feel really sick, don't feel bad for going to the hospital sooner than later.

7. Unless I am having a heart attack, take me to University Hospital for care. Other private hospitals are scary in their treatment decisions, and often doctors are not in the hospital overnight. Multiple residents are here overnight just waiting for admissions to come in.

8. If I develop a blood clot to my lungs, take my blood thinners every day. (to prevent right-sided heart failure from developing).

9. Double-glove during invasive procedures--take every precaution to not get Hepatitis C through a finger stick. End stage liver disease is one of the worst ways to go.

And finally . . .

If it looks like my condition is terminal, change my resuscitation orders to DO NOT RESUSCITATE. Staying stuck on a ventilator is NOT cool.

Perfect 10!

Levi just turned 10 months old! Of course, I was stuck in the hospital on overnight call. My wonderful husband, however, brought Levi over to visit brightening my particularly overwhelming day. Here is my big boy!




He greeted me with the biggest kiss (that's what I call it). :-) Does my heart good. :-)

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A little over 1 week earlier, we took Levi to his first circus. Here are some pictures of me trying to capture his amazement. Talk about sensory overload! He was particular fascinated by the lights and different little laser displays highlighting the acts.



Poor little boy was out well-past his bedtime. He couldn't make it the whole time; we left early to take him home. It was a great evening of fun for the DiChiaras! Really, everything we do is so much more joyful because we also get to "experience everything for the first time" through Levi's eyes.

Going Dry

Levi has decided. He's done with breastfeeding.

It has been a roller coaster these last 2 months regarding feeding-times. Actually, the day after my previous post about breastfeeding, I introduced formula for the first time to Levi--a few days shy of 8 months old. My frozen milk supply was practically depleted, and we had just taken Levi to the doctor to find out that he had not been gaining weight well. He had dropped from the 20th percentile to the 5th percentile. It was a big shock to me, because Levi always seemed content, sleeping through the night, and wouldn't drink more than 6 ozs of milk from the bottle when introduced previously. The doctor had said that everything was medically OK with Levi, and he just encouraged us to try to get more calories in him. We moved from solids two times a day to three times per day. We also knew that we had to try again to get him to drink more ounces of milk in a bottle. Since I was, to begin with, barely able to keep up in pumping, we introduced formula (Similiac Advance). My frozen stash of breast milk was almost gone.

Levi did not like his first formula bottle, but he took to it quickly after the second. Slowly, he move up to 7 ozs. in each of his 4 bottles. Things were going smoothly--he went easily between nursing with me, drinking breast milk from a bottle, and drinking formula from a bottle.

I was nursing him one evening, and he bit me pretty hard (a rarity for him). I jumped, pulled him off, and said, "No!" quite loudly. Poor little Levi just started bawling uncontrollably. It was such a pitiful thing. I think our little boy is very sensitive (where did he get that from?). So, for the next few (3 to 4) days (over a weekend, when I was home from work, nonetheless!) he refused to nurse AT ALL. In fact, he would start crying at the sight or would hesitantly start to latch, then pull away crying. Levi had declared a Nursing Strike. I wasn't sure if he was teething, or what it was. I read a little about it, and it looks like my yelp from the bite had traumatized him, and apparently, it is a common event. It was quite a stressful and sad 3 to 4 days. No fun feeling rejected, and I hated to return to the pump while at home. Still committed to nursing Levi, especially through the colds of the winter-season, I did some of the suggestions I read about to reverse the Nursing Strike. After some skin-to-skin contact in a prolonged nap together, Levi finally started nursing again. (Hallelujah!)

Knowing that in mid-Feb we'd be away from Levi for 5 days at Seminar, and he'd be 9 months old then, I thought it'd be the easiest thing for him to drink all formula and not worry about transporting 5 days-worth of breast milk to my parents in Atlanta. I had planned to get formula well-established and start a partial wean of pumping or nursing twice a day. That way, I wouldn't have to spend my entire vacation pumping. Providing for half of his milk-meals was a good compromise. I knew, however, that nursing was slowly coming to an end because Levi would be so distracted--popping off every few SECONDS to look around. It was becoming harder to nurse him consistently (it would take FOREVER), but I wanted to push through the winter season.

The down-fall all started when Levi got sick 4 days after going back to daycare. This resulted in a 2.5-week illness lasting the very end of January and the beginning of February. He started off with bronchiolitis, needing antibiotics (ampicillin) and an inhaler! That moved quickly into an ear infection needing more antibiotics (Augmentin). He then got real sick from the Augmentin, vomiting and diarrhea. So, we had to switch to Azithromycin, which he finally got better on--just in time for us to go on vacation mid-Feb. While he was sick, he was eating HORRIBLY, to very little. It was quite stressful because we had just learned of his low weight to begin with. Initially, he wouldn't nurse. Then, he started not taking the bottle well, and/or taking in only 6 to 10 ounces of milk/day. We were so worried about dehydration and had multiple conversations with his pediatrician. During Levi's ear infection, it seemed like he could only taking in about 3 oz with his bottle, then start crying. It was then that we decided to switch to a faster-flow nipple to see if that helped.

That was the beginning of the end of our nursing relationship.

I don't regret introducing the fast-flow nipple to him, because he really needed to start eating better, and that was more important to me than the actual source. Changing the nipple seemed to really help as he didn't have to work as hard to drink, and it resulted in him taking in double the amount he had been previously.

Since then, over the last month, Levi has slowly developed a preference for drinking from the bottle over me. He started getting fussy towards the middle-end of nursing when the milk flow would decrease, and he'd just start crying, impatient to stick with it. For the most part, we'd get through it, and he'd nurse twice a day. Because of the difficulty in nursing, and because of my busy work scheduling coming up in March and April, AND because I'm just sick of always pumping and not being around to nurse, I had already decided to start to do a long-wean: nurse just twice a day, and stop pumping at work. Such a relief!! For the record, I'm going to go back and add to my previous post on breastfeeding that using a slow-flowing nipple the entire time you supplement with a bottle is KEY to maintaining the nursing-relationship and prevent bottle-preference (and the reason I had done so up to that point despite his "older" age). I read that recommendation on several breastfeeding sites, including my favorite site: www.kellymom.com.

Anyways, since I have been living in the hospital this month, I have not nursed as frequently. Over the past 5 days, Levi has refused to nurse AT ALL. No matter his mood, sleepiness and presence or lack of hunger, laying down or position, he wants nothing to do with breastfeeding. In fact, he uses all his energy to turn the opposite direction or push away. And lately, if he latched, he started biting right away. So, that's it. No more. I have been pumping these last few days with greater spacing, slowly finishing my wean off the pump. Where I am right now, I believe the last time Levi will have breast milk will be on his 10-month old birthday (in just 2 days!!). I feel blest to have been able to provide breast milk for Levi as long as I have been able to, and I look back on nursing with fondness. Weaning definitely been harder on me than on him!!

Sweet things that I will miss:
- The private closeness we'd share.
- The pleasure of knowing that I am providing all his essential nutrition.
- Enjoying what he does with his "top" hand. In his earlier months, he would kneed my skin. Later, he would just hold onto the top of my shirt or bra. Or, my favorite, he'd hold onto my finger. In the last few months, his arm would flail around looking to grab onto what ever was nearby--a necklace, burp cloth (and would usually rub his face with it), try to reach out behind him and grab something off the table nearby.
- The last 1-2 months, his favorite thing to do with his top hand is to play with my hair. He would just run his fingers through it or just hold onto it for reassurance (he would never tug on it).
- Being forced to sit down and relax with him.
- Occasionally popping off to share a private smile or laugh.

In honor of breastfeeding, I have posted some random pictures, mostly earlier in his life, of nursing Levi (under a cover), or him cuddling afterward. :-)

Showing off my multi-tasking prowess. Nursing Levi (at 6 weeks) in public out at the zoo while eating ice cream.

Milk-coma.