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Monday, October 25, 2010

Priority Score Confusion
Wednesday, October 20, 2010

Working from home sucks; aka "Preeclampsia for Dummies"
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Dr. O

After a frustrating year on the tenure-track job hunt, my eyes are still on the prize, and I've learned that sheer will might be the most important quality required for this career track.

My posts are presented as opinion and commentary and do not represent the views of LabSpaces Productions, LLC, my employer, or my educational institution.

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I'll miss you!  But I will definitely catch your other blog! . . .Read More
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Monday, October 18, 2010

Okay, so I've never minded working from home before, especially when I can't get a damn thing done in the lab and need some peace and quiet. I also love the local downtown bookstore, which feels more like an old college library, for grant- and paper-writing. But there's a difference between hiding out to get some much-needed writing done, and being told, rather unexpectedly, that you have to work from home. Well, as of this afternoon, I am being "forced" to work from home, and I've decided that it sucks.

A few of you may know from my tweets on Friday that the docs are concerned about my blood pressure, which suddenly decided to skyrocket this past week (145/92 mm Hg on Friday). It's freaked me out quite a bit, since my blood pressure has always been relatively low (~105/60 mm Hg) and has been even lower throughout most of this pregnancy. So I spent the weekend laying on my side with my feet elevated, doing my best to relax, evidently to no avail - I was still up close to the danger levels this morning. The docs are now calling my "condition" gestational hypertension, since none of the other symptoms of preeclampsia (hemolysis, elevated liver enzymes, low platelets, and proteinuria) have shown up yet. Hubby and I are still trying to digest what all of this means, of course, other than my body has become a somewhat hostile environment for the little Monkey. So what does a scientist do when something like this is happening? Hit the literature*...

Combined, hypertensive disorders affect about 10% of pregnancies, and include chronic hypertension (when the mom was hypertensive before pregnancy), gestational hypertension (hypertension "induced" by pregnancy), and preeclampsia. Unfortunately, most of the literature that I found on PubMed focuses on either preeclampsia or chronic hypertension. However, gestational hypertension is usually followed by the onset of preeclampsia (yippee), so I figured this information would still be rather informative to understand. The predominant theory (as far as I can tell**) is that preeclampsia results from "defective arterial remodeling during trophoblast invasion". In much simpler terms (which I require since I'm more of a bacterial than human physiologist): when the little Monkey, as an embryo, implanted into my uterus 7 months ago, and the placenta began to form, something happened to prevent the placental arteries from forming normally. This "something" was most likely my own immune response to the pregnancy, specifically to Hubby's antigens found in the fetus and placenta. (Damn my hyperactive immune system) The abnormal structure of the placental arteries eventually led to the placenta becoming hypoxic (low oxygen), which caused the release of inflammatory factors into my blood. These factors eventually caused increased blood pressure, which usually doesn't become apparent until the last half of the pregnancy (after 20 weeks), and often well into the third trimester. So here I am at 34 weeks, dealing with a sudden upshoot in blood pressure, months after the initiating events occurred.

So now that I know where this all might have started (and that I couldn't have done anything to prevent it), what happens from here on out? Well, hypertension can have a lot of effects on a body, especially a pregnant one. Without getting into any of the gory details (which, frankly, I don't understand all that well), hypertension can lead to kidney and liver damage, as well as make the body a not-so-nice place for the baby to continue to grow. This latter scenario is what the docs are most concerned about at this point, since I seem to be doing fine (except for the high blood pressure itself). The Monkey seems to be fine as well, although we're getting an ultrasound tomorrow to make sure he's still growing at a normal rate. But the docs don't seem to want to play around with this stuff for too much longer. I'm scheduled for weekly appointments from now until my due date, but, if my BP doesn't go back down, we may be meeting our little guy much sooner than expected (as early as 35/36 weeks). While a normal uterus is a wonderful place for a fetus to continue to develop, our little guy could be a lot healthier, and perhaps just as happy as a full-term baby, out here with us. The current goal is to keep my blood pressure as low as possible for at least 2 more weeks, then see what happens...

In the meantime, I'm sitting at home, trying to get some work done, and stay relaxed, all at the same time. I have job applications to finish up and send off ASAP, since I don't want to miss any deadlines while in the hospital or under sleep-deprived maternity leave. Plus I have a review article, which needs some serious work, that's been sitting on the back burner for a few months now. I also have a couple of manuscripts to start organizing. While not all the data for these papers is ready yet, some work can (and should) be done now to find out what I'll have left to do after maternity leave.

When all is said and done, I might be getting back to bench sooner than anticipated, since our guy might be showing up early. So working from home shouldn't be that big of a deal. But there's just something about being told you have to work from home. Especially considering the circumstances. And the fact that I had a couple of experiments I still wanted to do. Add on wondering if the little Monkey really is doing as well as he seems. Plus this stinkin' headache that won't go away completely (courtesy of the high BP). I normally enjoy these escapes from the lab. Right now it just sucks.

*References:

Jim, Belinda; Sharma, Shuchita MD; Kebede, Tewabe MD; Acharya, Anjali MD"Hypertension in pregnancy: a comprehensive update".Cardiology in review (1061-5377)18 (4), p. 178  (07/2010).

Wikipedia

**This is based the easiest-to-read and most recent information I could find this afternoon, so please let me know if you have more information or corrections. As I said, I'm a bacteriologist by training and am trying to digest a lot of new science in a relatively short period of time! ;P

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Blog Comments

Rebecca
UC Davis
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The most important thing for you and your "little monkey" is to take care of yourself. The work will get done. The papers will get written. Take a deep breath and relax. You get to become a mother. If this is your first, it only makes it that much scarier. There are some things in life more important than the next publication; yours and your baby's health are one of them. Try to relax and enjoy the last few weeks you might have before motherhood hits. Good luck.

leigh

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sending well wishes to you and little monkey!


JanedeLartigue
UC Davis
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Man, that really sucks, sorry to hear that and hope that everything goes smoothly over the next couple of weeks.  A friend of mine was on complete bed rest for almost 6 months of her pregnancy and nearly went stir crazy so I understand how hard it must be to completely switch off, but I reiterate the comments of Rebecca, the only thing that's important is the health of you and "Monkey".  Best of luck with everything, enjoy some mindless weekday afternoon TV!


Alyssa
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I'm sorry you're having to deal with this, and sincerely hope the bed rest will help and you won't have to be induced early. I too agree with Rebecca - do what you can for you and your baby right now. Everything else will fall into place when it needs too. Hang in there, little Monkey (and mommy)!


Dr. O
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Thanks guys. I've got to say, writing this post was quite therapeutic, and I'm feeling much better than I was earlier today. If anything, the science behind all of this has been quite interesting to learn about, and finding out I didn't do anything "wrong" to cause it sure does quell the Mommy guilt syndrome. I'm also starting to enjoy Hubby bringing me take-out (yummy Indian), and catching up on primetime TV shows I never get home in time to watch. I think I might be able to deal with this...for a little while at least.


JanedeLartigue
UC Davis
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Sounds pretty great to me, definitely revel in it!


Dr Becca, Ph.D.
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Yes!! Relax and do what you have to to take care of you and the little monkey!! So glad everything's OK :)


Gerty-Z
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My wife had the same gestational high BP, with the same bed rest at the end. Our little one managed to stay happy and cozy in utero until term. So, good luck! And take care of yourself so that you can take care of the little Monkey. There is plenty of time for the work, and this is more important. Also, we found Tivo very useful during bed rest time.


Tideliar
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Urgh, good luck and fingers crossed for all three of you


Candid Engineer
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Best of luck with everything- will be thinking of you relaxing and gestating. :)


Nikkilina
Washington University School of Medicine
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That sucks. Good luck!

The research you did was pretty interesting. I've always heard terms like preeclampsia bandied about, but only knew what it meant in big picture terms. Thanks for the info!


genegeek
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Good luck with the relaxation. I researched pre-eclampsia for my postdoc...and learned that placentas are really gross. One cool thing was that it does seem to depend on the placenta = when a woman with pre-eclampsia had delivered the baby but the placenta stuck around, the pre-eclampsia stayed. After the placenta removed, the pre-eclampsia resolved. In our lab, we did focus on the placenta but I don't remember any long-term problems for the babies, just concern for the moms. So take care and try to enjoy the forced relaxation.


Cricket42
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I had preeclampsia and the beginning of HELLP syndrome when I was pregnant with my twins.  After being on bedrest for 8 weeks, my girls were delivered 6 weeks early.  They are now perfectly healthy, normal 5 year olds.

The Preeclamspia Foundation is a good information source (http://www.preeclampsia.org/).

 

Keep your feet up, try to relax, drink lots of water.  Feel free to email me with questions or requests for support. Good luck!


Dr. O
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Thanks again everyone!

@Gerty, just to clarify (cuz Hubby was asking me after he read the comments today), your wife made it full-term to 37 weeks? Or did she get closer to her due date?

@CA, that's pretty much what I've been reading too...placenta gone = happy mom again. Not that I want to rush this delivery, but I sure won't be fighting the docs if they want to go get him early!

@Cricket, thanks for your comment...it certainly helps to know that people get through this. One of my coworkers was diagnosed out of nowhere at 37 weeks, was in horrible shape, and immediately got a C-section. Then I've known others who had to deal with this for weeks/months, like yourself. At this point, I'm still in pretty good shape, and Monkey is doing just fine (as of ultrasound this AM). And I know he'd be okay if they did have to go get him even this early. Keeping it all in perspective is the hardest part - it'll all be worth it when he's here!!


Tideliar
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My friend Tanya spent WEEEEEKS in hospital, furious at biology, her husband and her doctors. But has a beautiful 5 year old. Fingers crossed you stay out of the hospital bed, but yay for modern medicine :)


microbiologist xx
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Sorry to read about the high blood pressure. Hopefully things will improve or at least not progress into preeclampsia. I can tell you that the last week or two of pregnancy were not that productive in the lab. I gave it the ole' college try, but the insane swelling and lower back pain forced me to take too many breaks. So, subtract two weeks from the time your think your losing.

I'm keeping my fingers crossed for you.


Evie
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Aww.. sorry to hear you're stuck at home, but they do have your best interest in mind! Here's hoping it'll get all better in no time :)

Cloud

Guest Comment

This sucks, but if this is as bad as it gets, that's still pretty good overall, you know?

With my first, I got sent out from work early because the way the baby was positioned was compressing a blood vessel and I'd get dizzy if I sat down. I was fine laying down or standing up, but not sitting. So obviously, I also couldn't drive. Thankfully, this did not recur with my second, since I have no idea how we would have managed having my husband chauffeur me around with a toddler to care for. I ended up sending myself out from work early with my second, though, because I was having prodomal contractions most nights and I was exhausted.

I truly think that the suckiness of the last bit of pregnancy is nature's way of making sure that you are glad when labor starts.


Tideliar
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"because I was having prodomal contractions most nights and I was exhausted."

 

What's promodal contractions (and why are they/it/them tiring?)? Dr. O is the unwitting stimulus for my new fascination in ObGyn...


Cricket42
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Just wondering how you are doing with your PIH and house arrest bed rest?  Are you on a low sodium diet?  Those can be hard and I am willing to share any tips I picked up.

 

Tideliar, after my experience with it I am now obsessed with preeclampsia.  So much so that I thought of changing my field of research from insect physiology to something human pregnancy related.  I couldn't quite figure out how to make the switch though.


Dr. O
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Cloud - That sounds awful. I get frustrated about not being able to get comfortable ever these days...I can't imagine just not being able to sit at all! :|  I'm trying to remember this will all be okay. But I'm starting to worry about what happens when I can't work all that well at home and/or run out of things I can do at home, especially if this stretches out another 5 weeks until my due date.  I have ~8 weeks of leave available for maternity, and would like to have as much of that available for the after math as possible.


Dr. O
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Tideliar - I think prodomal contractions are akin to Braxton Hicks, except more intense. Your body starts Braxton Hicks fairly early on, around 20 weeks, to "practice" for labor. Most of the time, they're not even noticeable. As you get closer to labor, however, they get a lot more noticeable, while not true labor (ie, they're not regularly timed and getting stronger). I think that's when they are called "prodomal". I assume that, even if they don't hurt, they can keep you from getting a good night's sleep. Add on back pain, indigestion, and everything else your pregnant body is doing, and you end up walking around in quite a daze. ;P


Dr. O
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Cricket42 said:

Just wondering how you are doing with your PIH and house arrest bed rest?  Are you on a low sodium diet?  Those can be hard and I am willing to share any tips I picked up.

We're in a holding pattern right now. BP was staying steady at ~138/85 earlier this week, which is technically "normal". None of the tests have shown anything so far, and I feel fine most of the time. But when I try to get out of the house and get stuff done, run by the lab, etc, I end up with the headache coming back (prolly the BP going back up). Doctors appt tomorrow to check everything out again; if tests show something or BP is going back up, they might be inducing this coming weekend.

No low sodium diet ordered (yet), although I really hate salty foods in general (prolly one of the reasons my BP stays so low). Just trying to stay off my feet as much as possible.


JaySeeDub
Dub C Med School
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Prodromal, if I recall, can feel a lot like actual labor in terms of intensity.  And prodromal labor can start anywhere from a few days up to a few minutes before actual labor.  Cervix shifts and softens, etc.


Dr. O
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Thanks JSD!!


Tideliar
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:Tideliar, after my experience with it I am now obsessed with preeclampsia.  So much so that I thought of changing my field of research from insect physiology to something human pregnancy related:

Human insect hybrid baby research? That could be awesome!

Dr.O., I am now more scared  of pregnancy than I was. I was already scared...


Dr. O
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Tiddles, I didn't realize you were worried about getting pregnant. ;)


Tideliar
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Dude, I wasn't till I read this! I am so being careful to spritz toilet seats now!

You get pregnant from toilet seats right? Or is pregnant the one where a boy puts an apple seed in your belly button then pees in it to make the baby plant grow?

I can never remember :/


Dr. O
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Tideliar said:

Or is pregnant the one where a boy puts an apple seed in your belly button then pees in it to make the baby plant grow?

Hmmm, not sure I remember this happening 8 months ago. But then again, pregnancy has destroyed my memory.

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