Tuesday, April 26, 2011

Better Living Through Chemistry

(It's taken me two days to write this, so the time references are all off. I know you don't care, but For The Record.)

This morning, during the twenty minutes that the Bean deigned to sleep not on me (not that it isn't adorable, but pretty soon I'm going to form adhesions to the Boppy and the couch) I wrote my GP a thank you note.

Now, I am southern and everything, but I am not that devoted to the note-writing -- I'm not caught up with the baby gift thank-yous (or COUGH the wedding ones) -- but sometimes it is just Called For. And now, a few glorious days into my new life as a person who doesn't spend six or more hours a day gritting her teeth and feeling her eyes protrude from the pain of invisible vice-grips on her nipples, now is one of those times.

In short: Nifedipine is amazing stuff. My GP rules. I am ever-more angry at Dr. Russian's nurse, the practice as a whole, and, sadly, Dr. Russian herself.

(Ha! I just got back from several hours outside, where I walked around pain-free in only a tanktop! I nursed outside, even, without agony! Yes, it's beautiful and warm today, but it is usually hot as blazes in our apartment at night, thanks to a very enthusiastic heater over which we have no control, and that never stopped my nips from seizing up for hours on end.)

In long: I started having vasospasms over a month ago. Or at least, that's when I realized I was having them. It took me a little while to sort out that pain from the typical surface pains of early nursing and the pinching of Mr. Crocodile-Jaws's lazy latching (corrected by the Hippy But Not Dippy LC), but those things don't turn your nipples white even when you haven't nursed in hours or leave you cussing like a sailor while clutching your chest in an attempt to warm them up through two layers of cloth nursing pads, two shirts, a thick sweater, a wool shawl, and a coat when it isn't even properly winter any longer. Once I figured out that's what they were, I told myself to be patient, that it was all due to an injury from a bad latch that was fixed now, that I was exaggerating. I also managed to repress that my mother has Reynaud's and that we both have migraine, which is related.

After a week, I called my ob's office and asked about nifedipine. The nurse called back, all patronizing and unhelpful. "Oh, we wouldn't do that." Why not? No reason, just vague admonitions about taking medications while breastfeeding. Use warm compresses. I am, I said, and it's not helping. Use warm compresses. I lost it. Not pretty. Crying. Raised voice. Accusations that they didn't care about my health -- I'm going to stand by that one. The fact is that they did not care enough to, you know, do anything about the quarter or more of the day (and I mean out of 24 hours) that I was spending in pain. Only it wasn't pain, I guess, since the nurse kept referring to it as "discomfort." (This is the same woman who, when Sugar called in to ask if we should go to the hospital and I was having a terrible contraction in the background, told her that I "needed to calm down." Because back labor is so much less painful if you're quiet about it. Very helpful bitch, she is.) She called back later, probably because I was so obviously enraged, said she'd talked to the doctor (whoever was in that day), confirmed that they wouldn't prescribe for me but here was the number of the LC around here who is also an MD...who doesn't take insurance (reprehensible) and who charges you to read her website (seriously).

So I wrote to the HBND LC, and even though it was Friday afternoon and she takes Shabbat seriously, she wrote back immediately with a number of suggestions. I dutifully added more horse pills to the supplement brigade (calcium/magnesium and oatstraw in addition to prenatals, brewer's yeast, folic acid, and vitamin D) and tried to soak my nipples in hot salt water (which is awkward as hell and just left me with a damp, salty baby nursing the non-soaking side while the first side went bananas the minute the air hit it anyway). I heated nursing pads in the microwave -- they went from scalding to clammy in a nano-blink -- and tried unsuccessfully to position a heating pad over the first boob without letting it touch the baby as he nursed side two, electric boogaloo. Eventually, I gave up everything but the supplements, dressing like a wrestler trying to sweat down a weight class, and weeping. I made extra-warm flannel nursing pads and layered them until I looked like I was stuffing my already ginormous bra. I tried not to scream at the baby for crying, although every time he did so, the let-down reflex made my nipples crush themselves. My efforts to avoid cussing while nursing met with mixed success. (Mother of the YEAR, I'm telling you.) I refused to leave the house.

At six weeks postpartum, I had my ob check-up, at which my mention of vasospasms was ignored. When, at the end of the appointment, I mentioned that I thought it would be nice if they made a postpartum phone call to check in before then, Dr. Russian treated me to a strangely vehement tongue lashing, complete with raised voice and pointed use of my first name. I was accused of wanting them to do things "no one" does, of asking them to follow up with the baby (which would have been strange, considering how many times we went to the Bean's pediatrician for weight-checks). It was strongly implied that I had called the nurse too many times, despite the fact that every call I'd made had been for something on the hospital discharge paperwork, like a high fever, UTI symptoms, and a large and terrifyingly hamster-like clot. She kept returning to the idea that "this" was a job for family -- "We're not your family, Bionic, we're DOCTORS" -- as if I'd asked for emotional support rather than medical help. As it happens, many of my family members are doctors, and try as I may, I can't imagine any of them behaving that way to a patient, no matter how pushy and crazy the patient was. It was horrible, not least because it forced me to admit that her similar behavior during labor wasn't clever tough love intended to motivate me but just plain emotional instability. Farewell, Dr. Russian. I liked your shoes and your sass and your meat obsession, but if you aren't family, I don't have to put up with that shit.

As a confident, independent, properly-raised woman, it pains me to admit what a funk that visit left me in, but there you are. More weeping, more telling myself that this pain was something I just had to deal with, that it wouldn't even bother a good mother. I wondered how soon I could give up breastfeeding without hating myself for doing so.

Eventually, my pissed-off, entitled side beat the weepy bit into submission. I read up on nifedipine and discovered that the bitchy nurse was full of shit -- it's perfectly safe for breastfeeding and plenty common enough that problems would have turned up by now. Even the NIH thinks so, and they don't even think you should take aspirin because your baby might magically get Reyes Syndrome from the teensy bit that gets into your milk (not to mention that the Reyes/aspirin connection is not actually that convincing, says my father, whose field this is, after all). I trolled PubMed -- and yes, I will totally be using this as an example of why my students should PAY ATTENTION on the days we spend in the library, learning database searching -- and found several articles to the effect that Reynaud's of the nipple is real, is serious, and ought to be treated, if only because it hurts like hell and will keep people from breastfeeding. (I suppose it is too much to ask that it be treated just because it makes the mothers' fucking nipples fucking hurt, regardless of whether it might mean the babies get formula and therefore become dyslexic, asthmatic axe murders.)

I called my GP, whose receptionist told me to talk to my OB, but she agreed to see me anyway. (Meanwhile, Sugar went to see her ob/gyn, who asked after me. When Sugar mentioned the vasospasms, she said, "Why isn't she on nifedipine?" She assured Sugar it was very safe and said I should come see their practice if the GP didn't prescribe it. I had wanted to go to that practice in the first place, but they weren't accepting new ob patients when I got pregnant. Now that I'm a plain old gyn patient again, though, I am so there.) At the appointment, my GP listened to my description and the logic of my self-diagnosis and asked, "is there a treatment?" I trotted out my notes; she copied down my citations and wrote me a scrip for the dose I had found in the articles.

Sugar and I go to the same GP, and at times we have wondered whether her willingness to put us on or take us off of drugs we ask about means that we like her for the wrong reasons, because she does what we want rather than saying no. But really, why shouldn't she? We don't come to her with frivolous or dangerous requests, for one thing, but also, shouldn't we have some say in our own healthcare? If I want to try a drug that won't hurt and has a good chance of helping, maybe my desire (and pain) should be important enough that my doctor is willing to learn something new. My GP didn't do anything Dr. Russian couldn't have done. Even if Dr. Russian and her practice do not generally treat vasospasms (which, PS, they should -- 20% of women in childbearing years have some version of them), she could have listened to me, read the journal articles and/or consulted with colleagues, and done something to help, instead of turfing me to another doctor (on my own dime, too), and blaming me for needing help. As a child of doctors, I've spent a lot of my life arguing with people who claim that all doctors are arrogant. Besides my own family members, I grew up surrounded by doctors, and most of them were more like my GP than not. Most of them were like my father, who works insane hours seeing patients with tricky diseases, dictates notes late into the night, goes into the hospital every weekend (which requires sacrifices from families, too -- no camping trips or even full Christmas Days together), and still finds time to listen to his patients and their parents and think more about their needs than his ego. It pisses me off to no end (though I will end this post someday, promise) when a doctor acts like such a stereotype.

Enough ranting for the moment. The nifedipine is wonderful. The Bean is wonderful, too. He's smiling more and spending a higher proportion of his waking hours not screaming. We take baths together every night, which I love -- I haven't had a good bath buddy in 25 years. This morning, I think he really saw one of our cats for the first time. I'm so happy to be out of pain and able to focus on having a good time with him and bombarding my friends and family with pictures of his every move. Since you've been so good as to suffer through this interminable post, allow me to bombard you:


A Boy and His (Very Patient) Cat


  1. Awww..I love that his giraffe onesie matches his buddy! And I love that you are not in constant pain any more. Screw Dr. Russian--that's such a crock I can't even handle it. I hope that when the dyslexic, asthmatic axe murderers start their hunt for blood, they start with her.

  2. UGH! I am so sorry to hear about the way you were treated. You might think about putting your experiences with Dr. Russian up at thebirthsurvey.org. I don't know that it would change anything but might be cathartic anyway.

    The Bean is SO CUTE. I love the tie quilt and the giraffe/giraffe pose. So sweet. Congrats on finally being able to enjoy his adorableness pain free!

  3. ditto what isa said. i seriously want to punch dr. russian in the face for you.

    beautiful, beautiful baby.

  4. Christ alive, lady, your words have brought the memories of my nipple pain roaring back!

    To be honest, my nipples have never, ever recovered from the mauling they went through; first trying to establish breastfeeding while Harry was in NICU, using a vicious old bitch of a breastpump that only had one setting: violent. I used to hold the cup hovering over my boob, taking deep preparatory breaths, in exactly the same way I hover over a wax strip before ripping...
    Secondly, there was the vasospasms. I DID visit my GP at about 6 weeks into it complaining of bad breast pain, but he reckoned it was early days and it would pass off.

    Ehh. It did get better, finally. Not sure I realy remember at what point, exactly. But the sensitivity of my nipples is now so high that they are effectively a permanent no-go zone.

    Hmmm. Enough about me! I am so sorry that you suffered, pleased that you had more gumption than I did and got yourself a solution, and delighted with your adorable child!

  5. WOAH! That's quite a saga of being basically mistreated and fucked with. I agree that you are a mega badass for taking charge and getting this seen to, and I'm so pleased the outcome has been showers of rainbowy no agony!

    The bean is looking exceedingly handsome!

  6. WOW, Dr. Russian is a nasty piece of work. Glad you're getting relief. I have mild Reynauds (just hands and feet, not nipples), what you were dealing with sounds unbearable.

    Your Bean is so adorable! I just want to smooch him!

  7. I want to rip Dr. Russian a new one...how do people like that become doctors, much less OBs who have worried pregnant patients??? Grrr.

    So glad you are on the meds!

    And my god, is he cute!

  8. Just give me a minute to find a cheap plane-ticket and I'm over there with a pair of reinforced clothes-pegs for Dr Russian AND a pair for Bitch Nurse. Also, a slap upside the head each, for being colossally unprofessional and rude and Not Good Enough.

    The Bean is a darling.

  9. What a hideous beast Dr. Russian turns out to be. I guess that hiring someone who takes delight in evil as a nurse was a clue. Ugh. I'm sorry that you had to put up with that, and am pleased to hear that you will be putting up with it no more.

    Regarding doctors, yes, like most people, they come in all types: great, good, bad, and ugly. Unfortunately, they have rather more power than most people to make our lives miserable (or at least to fail miserably in making them better), which is probably the reason for the stereotype. Ugly doctors have a stronger impact on our psyches than ugly postal carriers.

    As for the bean, the cute is strong with that one.

  10. What a bitch!! It is fantastic that you took yourself to get the care you needed, though. I love the photos, especially he giraffe!

  11. Fucking doctors! Well, not all of them deserve that first word, but I'm sick of this kind of BS.

    I love the pictures, though. Not sick them.

  12. Oh the bean is adorable! :D

    Dr Russian won't have many clients left at this rate! What a saga, it's unbelievable that she and the nurse thought it was ok to demean you and act so unprofessionally :( shame on them!!

    Glad to hear you're getting some good treatment finally. I also have reynauds of hands and feet - I can't imagine the agony you must have been in. Kudos to you for excellent self-advocacy! :)

  13. Ditto all the nasty thoughts directed toward Dr. Russian. She doesn't deserve to have you as a patient! But damn, that is one cute baby.

  14. What a horrific and unbelievably unnecessary experience for you to have to endure at the hands of people who should have an obligation to behave, at the very least, like human beings. I am so sorry but so glad to hear that things have improved. What a gorgeous, gorgeous bean...

  15. YAY! I'm glad that it is now, magically/chemically all better. I too am mildly disturbed when people prescribe because I asked but... usually I'm right. Right? Right?

    Also to Dr. Russian: Fuck off and die. There you were thinking her job was to take care of you. My dentist is more compassionate and professional.

  16. never heard of vasospasms before, but they sound awful. dr russian and her staff also sound awful.

    glad you're finally feeling better!

    and the bean, well he's just gorgeous. love that smile! (and that quilt he's on is beautiful.)

  17. wow that sounds like quite the shit show! happy your GP was able to help. the nurses at my OB's office made me feel like I called too much as well (you know when my iron was 7...). happy you didn't just suck it up. your boy is absolutely adorable!

  18. Dr. Russian is a psychotic bitch and I am so very glad your GP got you the meds you need. Your little guy is gorgeous and I'm thrilled you feel well enough to truly enjoy him.

  19. What a fucking mess. I'm so glad you got some relief and I'm so sorry you were treated to poorly. I'm always nervous to call any doctors office for fear of being treated poorly. Isn't that sad?

    LOVELY pics:)

  20. My nipple Reynauds started around when I got pregnant this past winter, and I was having episodes about once a day. I talked to both of my OB's about it, and their answers were "my wife had sore breasts when she was pregnant, too." and "try some lotion". Neither took me seriously or listened to me say how painful it was. My doula and a midwife at the practice both had never heard of it and said they'd look in to it. (never heard back.) Even after I did my own research, I was brushed off. I ended up in the hospital with high BP, and (now I know) that due to the bp medictions they put me on, the Reynauds started happening every hour or so. So excruciating. After literally telling every doctor, nurse and intern who saw me that I had excruciating pain from Raynauds of the nipple, and wanted to try Nifedapine, and getting blank stares, Finally one resident took me seriously and called a meeting about it. It's stunning to me that this is such an unknown issue. I was finally put on Nifedapine, and yes, sweet relief. My current new high risk Dr also has a blank reaction to this issue... It's ridiculous.
    So, woman, I know how you feel!!! Good luck with it and I'm glad you're on the Nifedapine.

  21. Oh my god am I glad I found this! I had the same thing trying to breastfeed my son last year. I say "trying" because the pain eventually led me to stop, and even thinking about it 1.5 years later causes me to shudder & flinch. It never occurred to me (and I AM a doctor, seriously!) that there was a treatment (and didn't apparently occur to the LC, Ped, OB that I saw, & a good friend that is a "pain specialist" even though this IS their specialty and not mine!)
    I am pregnant with #2 now, & have been psyching myself up these months, determined to fight through the pain & try harder to BF; I think I'll write myself a rx if I need to (something I NEVER do).