2.27.2010

Infections and IF

I tend to get a lot of questions on this topic, but yet, when I sat down to write this I was at a loss and didn't know where to begin.  For me, infection was the missing piece to the puzzle, and treating it successfully was the key to having our son.  If I am fortunate to get pregnant again, we will replicate this treatment plan. 

HOW DID I KNOW?
First off, Dr. Hilger's found infection (ureaplasma) during my lap with him.  He treated with 2 weeks doxy (and dh) and thought that was enough (2006).  Then I had tail end brown bleeding (TEBB) still and both cycles that I got pregnant with my babies I miscarried.  A phone consult with Dr. Hilger's confirmed that infection was likely still to blame and I needed more.  Then I chose to do a phone consult with Dr. Toth. Prior, I got on his website and downloaded his two free books that are on there full text.  I read and it sounded like me.  For example, there is a history of miscarriage in my family (mom and sisters); I have a history of bladder infections (so severe I was hospitalized more than once).  My miscarriages were increasingly "worse" (Gabby was sick from day one).  There is extensive history of heart disease and cancer in my family.  The list goes on.  I wrote notes to the side of the pages.  I filled out the self-assessment at the end of one of the books.  I scored high.  I filled out the history forms sent to me by the office and I had the phone consult ($375 if insurance doesn't cover).  Dr. Toth is very kind, spends lots of time talking to you, and confirmed what Dr. Hilgers already knew.

HOW DID I/WE GET THE INFECTION?
Infections can be passed vertically and horizontally.  I had family history, but I also had reason to think that I got it from a past boyfriend and also my husband.  So, there really is no telling-likely every way!  But I have learned through all of this that blame isn't important, it is about focusing on a solution.

WHAT DID WE DO ABOUT IT?
It is very important to do something about the infection, if possible, prior to getting pregnant again.  I was fortunate enough that Dr. Toth and Dr. Hilgers agreed that strong oral antibiotics were worth a shot (as opposed to having to go to NY for testing and then "full treatment" of uterine lavages, an IV for dh and I, and prostate injections for dh-this would take 10 days for treatment alone and would likely cost almost $20,000.  It was unclear what would be covered by insurance, but not much!).  The short reasoning for this full treatment is to really knock out any infection by putting tons of antibiotics directly on the source of the problem, combined with an IV to really hit every area hard.  Dh and I were put on 500 mg of Biaxin 2x's a day for 21 days.  During that time we were told to avoid.  We took a probiotic to protect our stomachs and the only side effect I had was metal taste in my mouth. Water helped.  (btw, it didn't take long for me to see a positive side effect-my menstrual blood became bright red-like open wound, fresh blood, bright red like I had no idea that menstrual blood could look like.  This was a sign of success-the question is could I keep the infection at bay).  Dh had no problems.  After that, we were told we could ttc while taking Biaxin every cycle on CD 1-10.  I told Dr. Toth and Hilgers that I only wanted to try this for 3 cycles (they had mentioned 3-6) because I had gotten pregnant quickly before and I figured if it didn't happen fast, I should move on to full treatment and not waste time with anbiotics that were only causing my bacteria to develop resistance.  (I got pregnant on the 3rd cycle).  Dr. Toth (who is very kind to be available via email) told me he would be happy to have me as a patient, even though had not come and seen him in NY, and he would follow and advise me through the pregnancy.  He recommended an IV after my hcg doubled-10 days clindamyacin-and Dr. Hilgers agreed.

HOW TO SET UP A LOCAL IV?
Since I knew ahead of time I would need an IV quickly should I get pregnant, through my mom (a hospital social worker) I found a local infusion company that could do the IV in my home (no hospitalization required).  The company wasn't national, but Apria is, and you can go to their website, enter your zip code, and find the local infusion center closest to you.  You can find out if they take your insurance.  You can find out if they place the line (mid line) or if you need to find a company that can place the line.  Ask them for recommendations if they can't.  If Apria isn't close, call the local hospital and ask them who they recommend to do infusions?  After that, Dr. Toth's office sent Dr. Hilgers' office the information to order the IV and Dr. Hilgers' office conversed with my infusion company to set it up.  They work weekends and knew I would want the IV immediately should it come to that, and they were willing and able to accomodate.  Likely a day wouldn't have mattered though.  I simply had to call when I needed them.  They were wonderful.

LIFE WITH AN AMBULATORY IV?
The IV was in ten days.  The mid line placement is a pretty big deal (lot of blood), but they numbed it and I had no idea I was bleeding everywhere until I saw the clean up.  I didn't feel a thing.  The pump was in a fanny pack that was black and not too noticeable.  I could cover that part of my arm with a bag and not get it wet, so I could still shower.  Instead of having the line go out the arm of my shirt by my hand, I threaded it back down my shirt (stomach) and it wasn't noticeable.  I went to work and had no problem.  It wasn't really that hard to sleep-I had it on the flood next to me.  I learned to change the bags every other day.  I learned to change the batteries, etc.  It was surprisingly not a big deal.  I.felt.wonderful on the IV for 2 reasons-I knew I was do everything I could to keep this baby, and I was probably more hydrated than I have ever been in my life.  I also felt clean-placebo effect-who knows?  But others have shared this sentiment.

A LITTLE MORE ABOUT DR. TOTH-
Dr. Toth and his lab are different because they are set up to test for every known pathogen; the lavages (they do uterine commonly, but also bladder) aren't available anywhere else that I can tell.  His theories are unique/cutting edge; not always well received by local docs to implement and there not a network of believers like Hilgers' Napro trained docs.  There are a few doctors that buy in, but not a formal network.  Dr. Hilgers went to Dr. Toth's office for two weeks to study his methods.  Dr. Hilgers isn't as hard core into the abx as Dr. Toth, but he does agree Dr. Toth is onto something and is working to replicate his lab.  It will take time.  For now, he tests for the heavy hitters in the same way Dr. Toth does (in house so no dammage during shipping, lets them grow longer, etc).  This way there is less likely to be false negatives.  Unfortunately a lot of folks test negative for bacteria locally and then they test positive using Dr. Toth/Hilgers methods-frustrating for sure!

AFTER INITIAL IV?
In my case, we chose to go to NY at this point and do testing after I was pregnant and had the IV.  This was because we had frequent flier tickets, a free place to stay, and wanted the peace of mind.  Later, I had a CT PCR test done locally and shipped to NY for Dr. Toth to analyze.  I had a third one that was done and analyzed by my local ob/gyn.  Even though they turned out negative, we chose to do the IV at delivery "just in case."  My local ob/gyn had to be on board and order this.  It was helpful to frame it as no different than the IV I would get had I tested positive for group B strep during my pregnancy.  This is well accepted among the medical field and seemed helpful.

I hope this information helps answer your infection related questions.  I am happy to answer any others, I just wanted to write a comprehensive post instead of you having to look back at multiple posts in my history.  I think infection is crazy common.  I am glad we discovered it.  It isn't just about IF, but overall physical health. Dr. Toth believe infections are related to heart disease and cancer.  He also believes that if you have an infection and get pregnant, you can have a very sick child-from ear infections to ADD and autism, and even a child that has infertility his/herself.  I wouldn't ever mind having a sick child, of course, but I want to do everything I can to prevent it if I can help it.  I hope this helps you all know where to go if you suspect infection or where to look to see if you have symptoms.  The way we were able to go about doing this was incredibly inexpensive (IV was about $100-$150 out of pocket and antibiotics were pocket change), thankfully, though it easily could have run much higher.

2.23.2010

A Year Ago, I Thought You Might Need To Hear This Message...

Tonight dh and I are working on another NFP talk.  A friend who does RCIA at a local parish is doing the session on the church's teaching on contraception and he wanted us to come speak.  As I went into my computer files to look over past talks and what would apply, I saw a file title "for my blog".  When I opened it, I "fell in love all over again."  The file was dated Jan. 14th, 2009, and I recall that day I received a fabulous email from my uncle and tucked it away for my future readers.  I wasn't public with my blog yet, but I knew if it was something I needed to hear, than there were others that would need to hear it as well.  I believe it is from daily reflections from Max Lu.cado or something similar (uncle isn't Catholic).

You’re not reading this by accident. No, God knew before you were born that you would be here in this moment. He planned to get your attention for just a few seconds so he could say this to you: “I’ve seen every hurt in your life, and I’ve never stopped loving you. You matter to me. I love you more than you will ever know. I made you to love you, and I’ve been waiting for you to love me back.”



God is saying, “I want the rest of your life to be the best of your life. I’m with you, and I’m for you. I want to save you from your past. I want to save you for the purpose I made you for. And I want to save you by my grace. If you’ll let me do that, I will give you peace with me, peace of me, and peace with other people. But you’ve got to open the door and receive the gift.”


If you gave me a Christmas gift and I never opened it, you would be disappointed. And it would be a worthless gift because I don’t receive the benefit of a gift I never opened.


Jesus Christ is God’s Christmas gift to you. Yet some of us have gone year after year and never opened the best gift of all – God’s gift of salvation. Why even celebrate Christmas if you’re not going to open the biggest gift? It doesn’t make sense to leave unwrapped the gift of your past forgiven, a purpose for living, and a home in heaven.


Jesus Christ says to you, “I can replace the frustration in your heart with peace. I can replace the guilt, resentment, shame, and grudges with forgiveness. I can replace the worry and anxiety with confidence and faith. I can replace depression or despair with hope. I can replace emptiness with meaning and purpose. I can replace confusion with clarity. But I’m not going to break down the door of your heart. You’ve got to invite me in.”


God says: “It makes no difference who you are or where you’re from, if you want me and you are ready to come in, the door is open.”

2.22.2010

Likely Bust Cycle

This cycle is totally a bust, and I am disappointed to say the least.  Everything was looking so good, then enter yeast infection and sister family drama, which lead to dh and I fighting.

I had two days of fertile CM.  And then it stopped cold.  Likely due to stress.  Then I question-am I pre peak or post peak?  It matters because of all the meds!  I had 6 days fertile CM last cycle (when we had to avoid!) but who knows what is normal as I have only been medicated two cycles since I had my son.  TCIE came to the rescue and advised me that taking hcg pre peak wouldn't hurt.  I was waiting back for a call from Hilger's office, since my fertility care didn't feel comfortable advising.  Dr. H's office agreed, saying hcg early wouldn't hurt, but I figure it would if I didn't take it in case we had a little life to support (we had used the second day).  So I took the hcg late 4,6,and today is 8, so getting a blood draw and doing the shot tonight.  I didn't take the estrogen I usually do post peak because Dr. H's office said it wouldn't be good-wish I had asked more-why it wouldn't be good and would it hurt a developing baby if I was post peak and didn't take it...

I was just sure I would relax and fertile CM would return.  Here I am P+8 and no sign.  So strange.  I do feel I am relaxed-in laws were in town this weekend and it was fun, had to stop all obligations and just visit etc, nice!  The only exception is lack of sleep, but I don't think that disrupted fertile CM before as I highly doubt I was sleeping well last cycle-pretty sure I haven't slept through the night but twice since December thanks to Charlie's "issues." :)

I have been having ab pain, so I wonder if my cycle is approaching and the 2 days was really "it."  Then I suppose there is a chance.  It only takes "one" right?!  I wonder, again, if the ab pain means another lap is in my future in Omaha soon.  My last was 2006...but I thought a pregnancy is supposed to help...

Oh yes, and since I didn't know if I was pre or post peak, I chose to continue amox so I wouldn't miss the CM.  And...herein enters yeast-again.  I am looking into other remedies today-apple cider vinegar, specific probiotic, something.  Any suggestions appreciated!

2.19.2010

Talking to Friends about IF and Miscarriage

I know that everyone has a different way of dealing with this topic, so this is just my two cents about what worked for me (and what didn't).

I have an unusual circumstance (I think) in that I am literally surrounded by people with IF.  Starting with my family, my mom lost a baby after me, in the 5th month.  And both of my married sisters have had more than one miscarriage, including an ectopic pregnancy.  (Yes, this family history plays a role in my IF-infection).  From their experiences, I formed my own opinion on how to handle pregnancy and miscarriage.  For example, when I got pregnant, I knew there would be a good chance of miscarriage.  However, I still chose to tell people.  My decision rule was this: I would tell anyone that I was expecting that I would also tell if I was miscarrying.  That way I would have the support I needed should something happened.  Dh agreed on this rule.  We told our parents, our siblings, and our best friends.  One thing I didn't anticipate up front is how many people I would want to tell if/when I miscarried.  I think that is because I am a very open person.  I am blessed with many friends that put up with me!  As I mentioned before, many of them have their own IF struggles.  I have friends from my high school group  (even though mostly single, have things they know will cause them at least some difficulty conceiving-a didelphic uterus, pcos, family history), friends from college (many still without children, but one that tried for years to get pregnant), a great group from church (many many have experienced losses, also secondary infertility, one ttc for many years before chosing to stop for many reasons), even elementary school BFF and the secretary at my work!  I continue to be blessed to meet others through friends IRL or online.  I really feel blessed for this amazing network of women!  It seems nuts as I list them here-I guess God knew I just wasn't strong enough to go through it without them all!

When I didn't tell the friends from high school or the college group about the first miscarriage, I felt like I was hiding something.  I would want to know if they were hurting.  Our miscarriage was very traumatizing for me (aren't they all?!).  It was surrounded by a roller coaster of emotions, one reason being because we had a heart beat and then lost the pregnancy.  (For new readers, click here-the post is called Michael).  I was gearing up to tell my friends about the loss, when we got pregnant again.  I remember having this crazy mix of emotions.  For the second pregnancy (click here or the post called Gabby), the hcg didn't double properly from the beginning and loss was imminent.  I lost her before I had told friends about the first one.  At that point, I knew I had to tell them, and quickly.  It was a huge part of who I was.  I wanted to "come clean" with everyone, but not in a way that would make them feel awkward.  I had been writing down the details of what had happened.  It was therapeutic.  It was also recording the story that is our life. It wasn't just facts, it was emotions.  I ended up attaching these "chapters" to an email.  I said something to the effect, that we were struggling, having had two losses.  It didn't feel right to not share this with them, as I would want to know if the roles were reversed.  I have written in length about the details if they were interested.  It avoided an awful conversation I wasn't really ready for, but I got it out.  I bounced the idea off my BFF first.  She was very supportive.  I am glad I did it.  Those "chapters" later became those posts on my blog.  The friends are an amazing source of support, but it doesn't define our friendship. 

As I continued to share with others, how and when I felt it appropriate and comfortable (and trying to be considerate of dh who is more private than I am), I learned of more and more people struggling themselves.  That helped build my community of support.  I honestly don't know if there is anyone I interact with that doesn't know this about me!  It is just part of me, it doesn't come out in a way that makes them feel awkward, just as it comes up and stated as fact.  I often learn they have had similar problems (hello-almost everyone who has drawn my blood!) and it is a way to share what has worked for me and let people know they are not alone.

During this time, I became on a mission to make sure that miscarriage or IF wasn't a dirty secret that people don't feel they can reveal.  There is no stigma.  It isn't our fault.   If people want to keep it private, that is their choice.  I totally respect that.  Different things work for different people. But talking about it, having that support, is therapeutic.  And even better, we may even be able to share information or learn about treatments that can help!  Just my two cents on how I have worked through a difficult topic.

2.17.2010

Lent

I have been inspired by all of your Lenten posts-my you all are lofty!  I won't be going quite so large scale, since I know myself and my "issues" with keeping things such as New Year's resolutions.  So I will try to make this doable for me, but still stretch myself.  I hope there is the natural accountability that comes with saying it out loud.
First of all, I always make it to stations the last Fri of Lent and that is it, even though I intend to go more.  Every year I find it so amazing, and love the one we use with the reflections that speak right to my heart.  I plan to go at least 3 times this Lent, hopefully more.  Since Charlie goes to bed early, and church is right down the street, this seems more doable this year.
Secondly, I am going to cut back on going to the store and the things I buy when I am there.  For most people, that would sound enjoyable, but it has become a easier for me to buy new items rather than work with what we have.  Also, I have beome a bit of a hoarder and its silly.  I actually get sick joy from owning a closet shelf of batteries and another of light bulbs so I can run upstairs and immediately change things to work again.  I also add things to the list as soon as we run out of them.  I am anal that way.  I am better at buying the ingredients than cooking the things I planned to with them.  Sometimes I don't realize what we have because its buried under other food in the freezer.  Dh will be very happy with this and the resulting grocery bill and it will force me to think ahead on meals and cook "real" meals more often that will be better for all of us. (Update-after reading on fasting, this doesn't seem to fit anywhere; sounds too New Year's resolutionish-will have to think on this-probably will do, but not really count at Lent?)
Third, I am going to limit tv and computer time.  I am still trying to think of what is reasonable.  This will give me additional time for prayer, and to spend with dh.  I am going off facebook completely, but that won't be too hard for me.
The usual fasting from meat and going to confession are on the list as well.
That is it; it feels like not much and daunting at the same time.  I know I have so many more things I could add, but since I tend to spend more time making a list than working on it, so I am just going to move forward with these and try to not overthink it.
Updated-ending with a beautiful prayer that I have always loved.  Came across it today in Word Among Us and so fitting for the start of Lent:
Lord,
May everything we do begin with your inspiration,
continue with your help,
and reach  perfection under your guidance.
We ask this through our Lord Jesus Christ, your son,
who lives and reigns with you and the Holy Spirit, one God, for ever and ever.  Amen

2.15.2010

Rough Day

Insurance companies are just evil.  I got a bill for my novarel.  $96.  I was hot!  And despite my blog venting, I really don't get hot that often.  It takes a lot, but once the train gets started, it takes awhile to put on the brakes.  (At least that was the analogy I used with dh this weekend.  Let's say Valentine's day was NOT like in the movies at our household). I called the insurance agency and they had the gall to tell me that Dr. H submitted the dx code that was IF.  I actually said BS to the lady.  I am not one to get mad at messengers, but she was starting to become part of the problem.  I was nice, but firm, after that and said the problem was on their end, NOT my the doctor's.  After looking into again she said the 2nd refill was under a different diagnosis code and was covered.  I told her it was merely a refill, nothing was actually resubmitted by the office, and she admitted it was a coding error then on their part.  I wonder if they get paid to make dx code errors.  Maybe that is too extreme, but I am really starting to wonder!

There is so much going on right now.  I am exhausted.  Charlie got the stomach bug right a few days before surgery to put in tubes.  He vomited for 4 hours, every 15 minutes, and not surprisingly he is being very difficult at meals-he has been traumatized!  The surgery was very minimal and he did great.  But there is still night waking (we were up 3 hrs last night!) and I am confused.  Has it turned behavioral?  Is he reflux not controlled by medication anymore?  The teeth are seeming to do a number on him too.  I wish it was just one thing at a time, but no, much more complicated than that.

Dh got stomach bug next and we had to cancel our Valentine's plans (we were celebrating early-Fri).  We had a nice day Saturday and took Charlie to his first basketball game at dh's alma mater.  It was a good time, but Charlie was exhausted the whole time and I felt bad for him, all that stimulation and all he wanted to do was sleep.  We planned it around his typical nap schedule, but he wasn't typical that day because of recouperating from the bug and surgery. (by the way, ped ENT told us it was fine to go and we used plugs to protect his hearing).

I dropped Charlie off at daycare today to work from home, only to have to pick him up a few hours later.  The sitter's daughter starting throwing up.  That is where we got the stomach bug in the first place, but I don't want to pass it back and forth.  He spent the day crying at my feet, and just having an overall rough day.  He is, at a minimum, exhausted like I am.  But kids have this crazy way of not wanting to sleep when they are over tired, so he wouldn't nap until later and napped shorter.  He pops up and shouts "all done" and you can't help but smile through the frustration.

Also I have MAJOR MAJOR family stuff going on right now with my sister and her kids and my parents and it is just ugly and sad.  I don't have the energy to go into detail now, but it has so many twists and turns it resembles a soap opera.  But it is my sister's life and even though she's nuts, it makes me sad.  And especially for her children.  It has also been a source of stress for dh and I lately, which just makes it worse.  He sees things black and white and forgets that it is my sister and his words are hurtful, even when I agree sometimes.

On a positive note, he did say I could hire someone to clean the house once to get the germs out and get us back on track.  And I got a call from my ob/gyn's office saying that my urine came back fine.  So strange.  They initially thought there was a UTI, but I guess when they cultured it out longer? it wasn't anything.  I don't know what the deal was, but I will take it.  The thought of something surviving those antibiotics...I shudder at the thought!

I hope everyone is having a better day than I am.  I need my child to eat and sleep so I can too and we can return to normal!

2.11.2010

Why Going to the Ob/Gyn Always Raises My Blood Pressure (and other randomness)

Today I had an appt with my relatively new ob/gyn (referred to as #4 in past posts, though I realized today he is technically #5-yikes!)  This is the one I switched to after the birth of Charlie.  For the story on that, click here.  I have a tip for any of you who might potentially be switching doctors. Even if you think you are only doing it once, instead of sending a copy of your medical records to your doctor directly, get that copy for yourself instead (and then ask any doctors you see to copy them from yours).  The reason being that there is usually a fee-sometimes cheap and sometimes ridiculous.  One of my past ob/gyn charged $16 and then 56 cents a page (why isn't there a cents sign on the keyboard!).  Anyway, thank goodness my state has a law that they can't charge over $50 as I have quite a chart!  I made the mistake of paying that $50 to have them transferred to a doctor, and then the doctor couldn't transfer them to my new ob/gyn because of HIP.PA.  They can only send records that have originated in their office.  A pain! 

Now I have had some bad ob/gyn experiences, but the worst is detailed here.  Because it is a long post (aren't they all?!) that includes my 2nd pregnancy, I highlighted the relevant part in dark blue.  I was going to my appt today for an annual as part of my "things to do before you start ttc" list (I had x-rays last week at the dental office, have consumed massive amounts of raw cookie dough and moderate amounts of alcohol-yes, sometimes at the same time). 

Going to the ob/gyn is always a bit of a nerve racking experience, and I am sure you ladies can probably relate.  First there is the fact that you have lots of information to tell them.  And it's all very important.  If you are like me, summarizing doesn't come easily.  And you know they don't have a lot of time.  And you don't want to come off psycho.  To combat this, this time I brought my records from the 2 ob/gyns that matter-the one I had miscarriages with and the one that delivered my son.  Then last night I drew up a summary sheet.  This idea was inspired by another blogger, and also because I was appalled at all the errors I read in my previous charts (information that supposedly came from me was misquoted).  I made myself limit it to one page, but I had to go front and back.  It started with a chart-diagnosis in one column, treatment in another, and how it was discovered and by who in the 3rd.  Then I had a short paragraph summarizing each of my 3 pregnancies.  I often have my docs fax each other, so their names and contact information was in the header.  I love organization and have a weird love of treating IF like an occupation (still waiting for the paycheck), so I was pretty proud of myself.  He genuinely seemed to appreciate it.  Secondly (have you forgotten point #1 already? I don't blame you, it was a lot of words ago!), the information is usually unpleasant to talk about.  For example, why must they ask "how many pregnancies?"  and "how many live births?"  That has to be the most insensitive question ever!  And then they confirm: "because of miscarriage?"  Seriously?  I mean, first I had to fill it out on the paper and then you have to make me verbalize it?  But it made me think, why else?!  And then I had that "duh" moment where I realize people who actually don't want to get pregnant but do, and in way too many of these cases, they abort.  Sobering thought.  Then I realized some of those women probably don't like that question either.  I imagine there is enough of us, between both camps, to get a petition going.  Anyway, between these two reasons, my blood pressure is always elevated at the ob/gyn!

The appt went as wonderfully as an annual can go.  First of all, I had to get rid of some pesky yeast (sorry TMI), as you can imagine that would put a damper on ttc; getting it was unavoidable since my 40 days of antibiotics (nothing spiritual about the # in that context; also not the norm-I take 10 days of biaxin cyclically, then doubled amox last month so 10 days due to long mucus phase, 5 day z-pack for infection tied to respiratory junk that stays in your system 10 days and then, bam, time for another 10 days biaxin cyclically again!)  I was a little dense though and let it get raging bad before I called Dr. H for diflu.can and it was not doing the trick.  So ob/gyn did see that on the slide and gave me another script (this time with 5 refills for future-good to have! Esp b/c I forgot to ask for one for dh-Dr. H always gives it to both of us).  Secondly, I was worried about bladder infection because despite the crazy load of antibiotics, I have had blood in my urine (my only symptom).  They tested and found something.  Interesting.  They are going to do further tests since they hate to put me on more antibiotics unless it's necessary.  Which leads me to wonder what the hell can survive all that has already been given?  Scary.  More on that later.  The third thing I wanted to get accomplished today was to remind my ob/gyn who I am since I have only seen him once, and what my ttc and pregnancy protocols are.  He totally wowed me by doing his homework before he walked in and confirming all of that before I opened my mouth.  He got triple bonus points for rejecting my gift of "Physicians Healed" since he already owns it, read it, loved it (he doesn't prescribe contraception-part of why I switched).  And he recently bought Dr. Hilgers' text book and is really enjoying it.  Hoping and praying that he will get trained in Omaha as he is Catholic, totally living it even as an ob/gyn, and we have zero napro trained ob/gyns in my area, shockingly.

So, the appt went great and all continues to be on track to ttc when fertile CM decides to appear (CD 14 and nothing yet) if I can get rid of this UTI and yeast infection!

2.06.2010

Poking Fun at Self with a Little "Office" Humor

The following made me think of my recent series of foot in mouth.  On the office this week, Michael Scott said "Due to circumstances beyond my control..." At this point Dwight interupts to clarify "impulsivity and inattention to detail!"-I had to literally laugh out loud at myself and the irony.  Unfortunately that means I identify with Michael Sc.ott-yikes!

2.05.2010

Working with Children-Preventing Challenging Behavior

This post is for teachers, those considering fostering or adopting or parenting in the future or are currently, those that know someone that does/is, those that work with children in another capacity, or those that know someone with challenging behavior.  Basically everyone. :)
I have mentioned to several of you in the past that my job relates to challenging behavior and supporting those that support individuals with challenging behavior.  Anyway, I hadn't been able to find a good comprehensive list of basic techniques to share, so I have been meaning for a while now to put one together. 
Because I thought it might be a helpful resource for others, I am including it below-sorry for the length, but when you are "there" you want lots of options!
These are research-based.  They are meant for use with all types of children, but are especially helpful if the child has any difficult behavior.  Let me say up front that I know these can seem really obvious at first glance, but as I am sure the parents and teachers can attest to, when you get emotionally involved it is easy for these ideas to go out the window.  It is nice to have a list you can go back to and remind yourself that even though you don't have control over all the variables, there are certain things you can do to to help the situation and set the child up for a greater chance of success.  The focus of this list is preventing challening behavior in the first place.  It applies to wide range of ages, though I kind of wrote it geared to younger children and parents.
Because they were off the top of my head, I was worried I was missing some, so I ran them by an early childhood educator.  She didn't add any new ones techniques, just elaborated on some in parenthesis, and I have included both of our thoughts here, unedited.  Since we are both "in the field," we may not have realized if something isn't as obvious to others, so feel free to ask me to elaborate and I will use your feedback to perfect the list.
Without further ado...

30 BASIC BEHAVIOR PRINCIPLES TO KEEP IN MIND


1. Have clear expectations that are developmentally appropriate (joining Parents As Teachers for those children birth through 3 might be a way to know what those expectations are for parents. Books such as “what to expect…” are helpful, too)

2. Talk about expectations; teach them, role play how to act appropriately. Make it a game and fun.

3. Reward the child with praise or whatever motivates (internally preferable to external) when they act appropriately. (hugs or clapping are good ones, but depends on the age, etc)

4. Give choices-usually two because more is overwhelming (and be sure you can follow through on their choice option)

5. Schedule, predictability, consistency (and consistency, and consistency, and consistency!)

6. Children thrive on routines-there should be a bath routine, a bedtime routine, a naptime routine, even a dinner routine (with prayer and handwashing and carrying our plate over or asking to be excused). (and as close as possible to the same time each day to help with the child’s internal clock knowing when things are coming – this is more important for younger children, children in transition and some little personalities that happen to be more sensitive)

7. Giving kids enough sleep goes a long way toward good behavior. Find out what is developmentally appropriate by resources such as babycenter.com or there are several good sleep books out there.

8. Ignoring and redirecting or distracting is the easiest way to deal with challenging behavior.

9. When you notice patterns of challenging behavior, prepare the child going into the situation. Talk about what they need to do beforehand.

10. If at all possible, set the environment up for the child to be successful. For example, make sure there aren’t toys in the bedroom if they can be distracting where the child wants to play and not go to bed; don’t have a house full of things they can’t touch, etc. Altering the environment to prevent challenging behavior (such as childproofing) makes your life easier.

11. Talking about what to do is preferable to talking about what not to do. (children’s brains actually have trouble processing your meaning when you say “don’t run”; what their brain processes first is the “run” portion – so try to state things in a positive way, such as “walking feet”)

12. Shaping means we might have to change behavior a little at a time and reward progress in the right direction, no matter how small.

13. Never underestimate the power of a good sticker chart.

14. Find out what motivates the child-is it your praise? Your attention? An item like trucks?

15. Transitions, especially from things children are having fun doing to things children don’t like to do are tough. In this case, sometimes a warning is helpful so they just aren’t snatched away. Five minutes, then one minute, then the timer goes off. Then you approach them from the front and not surprise them from the back if you are picking them up. You never respond to them throwing a fit by then giving them an additional minute or two.

16. Down time can be the enemy. Anticipate things like standing in line at the post office and bring things to do, sing songs, play I spy, etc. Have food, a big diaper bag with novel things, etc.

17. Children that are active may have a hard time standing still. It might be easier if the child is held, or has a chair to sit in, even cross legged on the floor with a book rather than just standing waiting. Sometimes these children need something in their hands, like a cup of milk, during a story to sit still.

18. Songs and books, even ones you make up, are a great way to teach things like patience, self-control, how to respond when you are frustrated, taking turns, interrupting, etc. I have about 3 CDs that cover all these things put out by people of faith and/or music therapists I’d be happy to share. Cathy Bollinger is one I like a lot.

19. Surround your child with good examples, role models in real life, good examples on tv, good characters in stories. Children are sponges, so you might as well have them soak in good stuff and make every story count/song/tv show count.

20. Children act out mostly when they are hungry or tired. Do not think that just one stop on the way home before dinner will be quick and easy. You will regret it unless you are armed with lots of snacks  (and we often forget they might be thirsty or needing to potty – if older- and not realizing/verbalizing that that is what is making them cranky)

21. When a child acts out, most important is why they are acting out, not in what form it occurs in. What is your best guess-the options are not many-it is either to get something, avoid something, or for stimulation (like banging head). Sometime it can be a combination. Of those three are they wanting/avoiding: an item, peer attention, or adult attention? Can you teach them a better way to get what they are wanting, a way that is more appropriate? (as they get older, the more options of ways they can respond correlate directly with their ability to solve the problem quickly – get them thinking, “what else might work?” and help it become natural to come up with MANY ways of solving a problem…that gives you more options of acceptable choices that you or the other party can agree to)

22. Quality childcare or preschool program (or elementary school teacher, etc) is paramount as children often spend a lot of time there and are really shaped by their environment. Do your homework.

23. Behavior is communicative. The better a child can express themselves, the less likely they will act out in frustration. Can you help give your child the words to use? If your child struggles with words, how about signs which you can help a child do by prompting them with your hands? Or would a picture schedule or something more visual be helpful-like some picture choices of food items with magnets on the fridge as snack options, etc

24. Some things, like time, can be very abstract and hard for little ones to grasp. Making it as tangible as possible helps, so setting a timer to count down time, or filling empty boxes with stars, and when all the boxes are filled up that means it is time for X (something they are looking forward to) might help make it more concrete.

25. Proximity is helpful. A child is more likely to act appropriately if you are physically close. (and down on their level, esp looking into their eyes when possible)

26. Discipline means you are teaching appropriate behavior, much like you teach anything; it isn’t the same as punishment. Good behavior isn’t a given, it is learned like anything else.

27. There is such thing as behavioral momentum. We want the gravity to pull your child toward good behavior, not bad, and we want the environment to be one that is encouraging, not discouraging.

28. Spanking a child tells them hitting is okay. It also only tends to work on the very good children that aren’t likely to act out in the first place. For children with behaviors, once it happens, the mystery is gone and they realize it isn’t really anything to fear. So next time the spanking is harder, then you find yourself doing it more often, you can’t keep raising the stakes with something like spanking or eventually you are beating a child or giving up. (K and T has some points pro spanking; I didn’t include them here because this list was made prior and represents my education and work experience, as well as my philosophy. As with everything, there are other views out there; but on this list this is probably the only one that is controversial in any way).

29. You should praise your child between 4 and 10 times for every time you say something negative or corrective. We often notice the bad and not the good and children find the best way to get our attention is do something so mom or dad corrects them.

30. If you are going to give up on something you started, give up early. We all have our days where we are tired and can’t follow through. Fine. But don’t hold your ground for a long time and then give it up after the child pushes. It will only encourage him/her to push harder the next time. (If you want to give in, ask yourself, “am I giving in because it is not really important, or because I don’t want to deal with the battle/tantrum, etc. If the answer is that you are trying to avoid a tantrum or don’t have the energy to deal with the battle, know that that is the answer to set you up for failure in the long run (and not the right answer, though sometimes happens for sanity)

2.03.2010

A Hard Look In the Mirror

Those of you who read my blog probably know this blog title is overdue.  Perhaps I can put "think before you speak!" on my dh's forehead?  I say that jokingly, but honestly as well.  I know that it won't happen overnight, but I do plan on making some changes.  Patience please.  We are all works in progress and I am no exception.
My words, like all of ours, have rippling effects. 
I have passion.  I have experiences I want to share.  I want to help others.  These are good things about me.
I also talk a lot, listen too little, speak without thinking sometimes, and don't always realize the weight of my words.  These are things I need to work on.
When I give speeches (at Creighton Symposiums, at our church's intro sessions, at engaged encounter weekends), I always start with the fact that I am not a good public speaker.  But I try.  I am present, and I do my best.  I pray that God will speak through me.  I hope that other's hear the message, despite the imperfect and rusty tool.
However, I think I have used that as a crutch for too long (and have developed additional disclaimers-I don't articulate well; I didn't proofread this but just sent it quickly, etc).  If these are struggles of mine, what am I doing about them?  I need to put time into my public speaking, into my writing.  I need to figure out what to do to become more articulate.  Lately, I realize I have just been saying that and then moving on like anything is acceptable since I have made that disclaimer.
I realize when I put forth a strong opinion, I might offend people.  I am not a people pleaser in that I don't just say yes or what people want to hear because they want to hear it.  I have always been a "what you see is what you get" person and used to say that was good because no one worried where they stood with me.  I was honest to a fault.  But, there is a way to go about sharing ideas that can interest people and there is a way that can turn people off forever.  I certainly do not want to do the latter.  And people with IF, particularly, can be in difficult situations and struggling.  And I would never ever ever want to make those situations harder and cause pain to anyone.
It is okay if people disagree with my opinions.  I welcome varying opinions on my blog.  Truely.  And feedback on my opinions.  If you disagree with me, but don't want to share it publicly, I invite you to comment anonymously or email me privately.  I am not big on debate, because I think that is about "winning" and not about "learning", but I have been getting excellent feedback lately that I really value.  Sometimes feedback might change my opinion.  Other times it may just change my wording or approach. 
Blogging has been eye opening.  In some cases, people who have not met me IRL have thought I am different than I perceive myself.  They can only think that because that is what I have put out there, most likely, so I need to think about how I represent myself.
I appreciate those that have contacted me privately, or been responsive to my contacts to them.