rivka

I feel much, much better. The lunchtime dose of steroids was apparently the magic pill.

I am still being cautious. I am still planning to stay home tomorrow and sleep all afternoon. I am still keeping my finger over the speed-dial button for my doctor.

(Okay, the last one is an exaggeration, but we are watching this carefully and I will seek medical help if the upward climb is not steady.)

Thanks for the concern, advice, and good wishes.

So: that breathing issue I was having.

The inhaler I got last week worked really well for a while. It's not a "heavens open, choirs sing" experience like a nebulizer breathing treatment is. But I'd find that when the slow-strangulation feeling began to creep up on me, it was inevitably six hours after the last dose and time to use the inhaler again.

This morning I felt pretty well. We walked to church, although I then did a fair bit of coughing. We walked home from church, and afterward even though it had only been three hours since the last treatment I felt like someone was sitting on my chest. I decided it would be okay to take the dose at four hours instead of six.

I went and picked up the visiting oursin and had a lovely time chatting with her and showing her a bit of Baltimore. As time wore on I had more and more coughing, though, and had to keep my breathing very carefully shallow. When I came home at 3:45 it had only been two hours and a bit since the last dose, and I couldn't catch my breath and couldn't catch my breath.

I started noticing that it was quite an effort to take those careful shallow breaths: pull-push, pull-push. My head hurt. I felt lightheaded.

Michael and I spent some time debating our options. In the end, the whole family piled in the car and Michael drove me to Patient First, an urgent-care clinic. My breathing continued to be shallower and more labored and more uncomfortable. At Patient First, I got to jump the line and be taken straight back.

Hosanna! They gave me another breathing treatment, almost right away, and it was fantastically wonderful. It did turn out that all the incredibly hard work I was doing was paying off: my pulse ox was 97%. So I wasn't as oxygen-starved as I felt. I had the breathing treatment and a chest X-ray. I came home with steroids and antibiotics. The doctor swears that the steroids will make me instantly better. Here's hoping.

I was mightily impressed with the care experience. Everyone at Patient First was kind and seemed to take me seriously. The best part of their model: prescriptions are fully integrated into their service. It's not that the Patient First doctor writes a prescription and then you walk down the hall to the Patient First pharmacy to have it filled; the doctor talked to me, walked out of the room for a minute or two, and came back with my medications himself. Not samples, either, but regular medication packs labeled with my name and bearing full pharmacy education sheets. Not having that extra step makes a huge difference when you're really sick.

The breathing treatment lasted me from then until now. Those things really are awesome. It was so scary to just not be able to breathe like that, and to have it worsen so quickly from a previously managable level.

A couple of times in the past, I've had a simple upper respiratory infection spiral into a massive case of reactive airway disease: shortness of breath, wheezing, dizziness, brain fog, and prolonged fits of coughing in a spasmodic, wheezy, and completely nonproductive manner. The first time I was amazingly ill and wound up in the ER, and then on multiple daily nebulizer treatments at home. I lay on the couch like a zombie for a couple of weeks. I occasionally needed an inhaler for months before my breathing finally returned to normal.

The second time, the acute illness wasn't as bad. But I still wound up on home nebulizer treatments, and carried - and needed - an inhaler for months afterward.

I've been having episodes of wheezing and shortness of breath recently. Not consistently, but sometimes. Michael caught me having a can't-breathe-coughing-helplessly episode and browbeat me into going to the doctor. Fortunately, they've opened up a new urgent care clinic right near my office, for members of the university community only.

I went there this morning. My inconsistent symptoms obligingly appeared for the nurse practitioner. (More accurately, I started having them on my way in to work, and that reminded me that I'd promised Michael I would be seen, so I went.) She gave me a breathing treatment in the office. The heavens parted and choirs of angels sang hosannas as I found myself able to take deep, satisfying breaths.

The breathing treatment had albuterol and something else in it. She looked up the something-else to see whether it was safe for breastfeeding. Class B; fine with me. She wrote me a prescription for an albuterol inhaler, which I dropped off at the university pharmacy.

This afternoon I went to pick up my prescription. There was a bright yellow sticker on the inhaler box: "Not recommended for use while breastfeeding." I asked to speak to a pharmacist, who hunted through the package insert and found that the "not recommended" label was due to animal studies, that human studies are lacking, and that the manufacturers suggest that one "consider whether to stop breastfeeding or stop use of the medication."

Refused the prescription. Called the nurse practitioner, who has yet to call me back. Came back to my office and did some googling for albuterol breastfeeding.

According to the National Library of Medicine's LactMed database: "Although no published data exist on the use of albuterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk.[1] The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use."

So I don't know what the hell is going on with the Proventil package insert, or whether I should believe the folks who actually made the medicine or the database. I understand that for liability reasons they are on much safer ground if they tell pregnant and nursing women to never take anything, and online sources seem to be pretty much in agreement about the safety of albuterol. But. But.

The wheezing and coughing aren't really that bad. Crap. I don't know.

Michael brought home my antibiotic prescription at 6pm last night, and I took one right away.

At 8pm, when I nursed Colin to sleep, I had to grit my teeth to keep from yelling in pain when he latched on.

At 10pm I took a long hot shower and hand-expressed some milk. It hurt, but not as much as I expected it to.

At 11pm Colin roused when Michael and I came to bed, and I nursed him. It was a little uncomfortable but not too bad.

Middle-of-the-night nursing didn't hurt at all. And today I still feel vaguely ill and achy, but my breast doesn't hurt and I'm not shaking with chills.

Dicloxacillin, you are my new best friend.

Update to add: Ow pumping still hurts ow.

I don't think that I would be able to tell the difference between a 30-degree day and a 32-degree day, or food served at 140 degrees (as food-safety recommended) versus 138 degrees. So it amazes me that I can detect the difference between 98.6 degrees and 100.6 degrees just by brushing my hand against Colin's neck. It's screamingly obvious.

I think this is the boy's first fever. He hasn't gotten up above 102, but he seems awfully sick. And hot. Yesterday evening he was semi-asleep in our bed, and I went up because he started to whimper. He was tossing and turning, hair damp and plastered to his face, skin flushed pink. I slid an arm beneath him and felt heat radiating from the bed and from his sleep sack. "I can't believe Michael turned on the electric mattress pad when Colin is already running hot," I thought resentfully. But he hadn't. It was just Colin, burning up.

Tylenol doesn't bring the fever down. I took him to the ped office yesterday wanting to rule out an ear infection, because he'd been under the weather for several days before getting a fever and that tips my bacterial-infection meter. No; his ears and throat and lungs are clear. ("This is his first ever sick visit?" the nurse practitioner said. "Well, whatever's in your breastmilk, you should bottle that and sell it.") But the visit was worth the trip anyway, because they told me that he's old enough for ibuprofen now, and that is bringing the fever down to normal.

Hopefully today he'll be willing to do something other than (a) be held, and (b) nurse. I nursed him all damn night. And Alex wet the bed (!) at 2:30am.

You know what? I'm tired.

I had just dropped Alex off at school this morning when Michael called and said that he'd been throwing up. I picked him up and brought him home. Felt totally fine through my 10am meeting and 11am research subject and then started to feel ill. Threw up comprehensively. Came home and crawled into bed, feeling incredibly queasy, and discovered that Michael had thrown up an additional six times.

Since then, nausea and a couple of false alarms but no more vomiting for me. Michael is asleep. Nia (our nanny) has to leave now; she's managed to get Colin down for a nap and Alex ensconced in front of a video. But soon Colin will wake up and Alex will need something and I will have to be functional.

Posted a pathetic plea to Facebook for someone to come over later and get dinner for Alex and play with the kids.

Gods help me.

I am exhausted and burned out.

Yesterday was a lousy day. I expected to finally get the H1N1 vaccine at work - they'd sent out an e-mail saying that all faculty and residents in the department of medicine should come to grand rounds to be vaccinated. Even if you thought you'd already had H1N1, unless you could produce proof of typing. So I showed up, only to discover that they didn't really mean faculty - they meant MDs. "I have direct patient contact with immunocompromised people," I said. "Sorry," they said. "What do you suggest that I do?" "Find the vaccine somewhere else." Gee, thanks.

Worked late. Found out some things that, although not surprising, were tiring and discouraging. Came home to discover that I had forgotten that Michael would be spending the evening at a church meeting (including the dinner hour, so I'd be feeding myself and the kids on my own), that Colin was STARVING ZOMG NO ONE FED ME ALL DAY, and that Alex was STARVING FOR ATTENTION ZOMG NO ONE PAID ATTENTION TO ME ALL DAY. Tried to get Colin down for a nap and failed. Tried to get Alex to be quiet for ten minutes so that I could nurse the baby down and failed. Lather, rinse, and repeat for the rest of the evening. Colin did a lot of extraneous crying. Alex did a lot of extraneous loud neediness.

I honestly was ready to go to bed when Alex did. But a couple of friends called who are in very stressful situations themselves and instead I was up kind of late.

Colin woke me at five this morning. I got him back to sleep, but not myself. He was up for the day at six.

I am trying to write a grant in difficult circumstances, and I also have a lot of extra burdens at home because everyone keeps being sick, and "everyone" includes our nanny and our nanny's daughter which means that my childcare has been extremely shaky. I am stretched very, very thin.

Also: I have somehow managed to lose my Prozac. I can't find the whole bottle. Both Michael and I have looked. No idea how that happened, because it's supposed to live on my desk right next to my keyboard so that it's impossible for me to forget to take it. I've been without it for... maybe a week? I can't really remember when I took it last. Somewhere in the middle of everyone-is-sick-but-me hell.

I am, unsurprisingly, symptomatic: anxious and also very short-fused. When I'm off the Prozac I get absolutely furious about things not going my way, because the consequences seem so dire. Like, the only way the world won't fall apart is if everything is under my perfect control. Fun times.

Yes, I have e-mailed my psychiatrist to ask her to call in a replacement prescription.

Not loving my life right now.

Alex did better yesterday, nibbling graham crackers and dry Cheerios and showing more of her customary energy. She had some rice again for dinner, and then we bathed her and put her to bed and held our breath.

She slept through the night and woke up cheerful. She asked me for "a big breakfast." Thinking of how tiny her appetite had been, I offered her a big piece of cinnamon toast, and she accepted. But while it was cooking, "Mom, I want a bagel and cream cheese." "You said you wanted cinnamon toast, so that's what I'm making you!" She thought for a moment. "How about both?"

And, yeah. She ate the cinnamon toast and then she ate a mini bagel with cream cheese. More like inhaled. So I dressed her up in her Halloween costume and took her to school, just in time for the Halloween parade. (I did check with her teacher to make sure that there wouldn't be a ton of sugary treats, because I didn't want to over-tax her stomach. Her teacher reported that each kid would get one lollipop, so yay.)

Michael reports that he has picked her up and that she is tired but well. I gave her nanny free reign to let Alex watch movies this afternoon, so she can conserve her energy and hopefully make a stop at the church Halloween party tonight.

Colin is better too. He hasn't needed to use the bulb syringe for a couple of days, and he has figured out how to nurse without scraping his brand-new teeth on me. I am extremely grateful. He wore his costume to drop Alex off at school and was much admired; pictures of both kids later.

Alex woke up at 6am thinking she was going to throw up, but mercifully (a) it was a false alarm, and (b) she went back to sleep for another two hours. No fever this morning, and she's been able to manage about a pint of fluids and a few Ritz crackers. She still looks pretty peaked, though, and I'm not convinced that the fever is going to stay gone.

Poor kid. I hope she's better in time for Halloween parties and trick-or-treating.

Colin is congested and coughing but I don't think he has the flu. Man, are his new teeth (he has one and a half now) freakishly razor-sharp.

Nia-our-nanny is running a fever today too. I am home with the kids. Apparently, yesterday half of Alex's class was out sick. HALF. When I run down my Facebook feed it seems like everyone I know is either sick with the flu, or has kids with the flu, or just got over the flu, or is coming down with the flu. I guess that's what they mean by "pandemic," huh?

In other news, even though I was exhausted last night I broke out my birthday present, Dance Dance Revolution for the Wii. I haven't really played DDR before, so I spent most of my time on the lesson tracks, but even so it was totally fun. And a good workout! I think Michael's going to enjoy playing it too. Alex wanted to play but was totally unable to master the concept.

...At least, when Alex threw up at 1:50, 2:05, and 2:30, it wasn't my birthday anymore?

Okay, not a very bright side.

We are now on a program of a teaspoon of Pedialyte every three minutes. If she can go an hour or two without throwing up, I'll throw caution to the wind and let her try an ounce of it.

Fun times.