Wednesday, February 3, 2016

You Don't Have To Be Retired To Enjoy Walking

A walk with baby in the desert sun

The first physical activity I resumed after my baby's birth was walking. Oh how I missed being able to walk without waddling in pain, which had become the norm during my last trimester due to massive fluid accumulation in my legs. The joy of walking pain-free again has been compounded by the absence of, for the first time since I knew I was pregnant, shortness of breath on any and all hills! We have been taking long walks every day (weather permitting) during my maternity leave. Other folks run by, logging the miles and most likely hurrying to get done with their workouts. Most of the time, they carry a look of suffering on their faces. But we are not on a schedule.

He is hoping we will hurry up

Walking at least 30 minutes most days has been linked to all sorts of health benefits, but I've also noticed other advantages to making this regular practice a priority in my life:

It's meditative. Are you one of those people (like I am!) who understands the benefits of meditation but has a hard time incorporating it into your daily activities? Try taking a quiet walk to have a meditative experience that also gives you other benefits. It's win-win. This applies more to solo walks, which can be a nice change from walking with a partner. The key is to clear your mind by dismissing thoughts that emerge (without judgement) and focus on noticing your surroundings, your breathing, or possibly a mantra. Check out this site for a beautiful guide to walking meditation written by Thich Nhat Hanh.

It connects you with your community. I love walking in my neighborhood and noticing the diversity of homes and front yard landscapes. It's a fun practice to walk a different route or take a different street each time so that you have the opportunity to notice new things each time. When we do these types of walks, we also make an effort to smile and wave at other walkers and neighbors. I also enjoy the exposure to nature when we walk on trails or in mountains and canyons.

It's a good foundation for an exercise program. Walking is a great first step in an exercise regimen for those who have not been previously exercising, who are overweight, etc., but it is also beneficial for more athletic people. It promotes recovery and natural movement patterns (especially when walking on uneven surfaces such as trails) with very little negative effect on other training performed during the week. Low intensity walking can help to promote fat burning when combined with other intense activities such as strength training in already trained individuals.

I started walking as much as I could tolerate the day after I came home from the hospital. While I admit that a big component of this was an impressive amount of diuresis, I had lost all of my pregnancy weight (50 lbs!) by 2-3 weeks postpartum with walking as my only form of exercise. However, the lasting effect is that I have managed to maintain that weight loss and even begin some good body recomposition postpartum with continued long walks and a minimal kettlebell lifting program. And walking is a way to move that doesn't add stress to my (already stressed and sleep deprived) system.

It facilitates brainstorming/creativity. When we walk together, my husband and I have the best and most productive conversations. We talk about home improvement projects, finances, trips we want to take, philosophies on parenting... I could go on. I always come up with great ideas, including subjects to write about on this blog, during our walking sessions.

What about you? Do you walk regularly? Share the benefits you've encountered here!

Thursday, January 21, 2016

Controlling the things I can control

My eye twitch is back. That nagging flutter of my left outer eyelid last reared its ugly, annoying head during the sleep-deprived days of third year anesthesia residency and ICU call nights. Before that, I remember its presence while frantically finishing laboratory experiments and writing my Master's thesis in chemical engineering. Fifteen years ago.

But the reason it's here again is so worth it!

I demand your attention!

Infant care is a new kind of stress, one that I have not experienced before. The sleep deprivation is different than residency because it's more of a low level every night as opposed to a punctuated period every X number of nights while on call. And there is no period of reprieve post-call where you can take a nap and be free from all caregiving duties. You are essentially "on call" for your baby. 24/7. Every day.

I was feeling particularly overwhelmed by the feeding/burping/changing process, which seems to occur on an all-day cycle that starts up again soon after it is finished. I had hoped to breastfeed her of course, to seamlessly provide food for her on demand, but my pituitary tumor surgery left me with a deficiency of prolactin (the major hormone responsible for milk production). I knew there was a possibility that I would not be able to produce any milk, and my fears did unfortunately come true after an initial and encouraging period of good colostrum. Mourning this lack of ability and coming to terms with needing to use formula made it initially hard with my "mom" blinders on to see the potential for optimization. I was drowning in the equipment and foresight needed to carry out this repeated task smoothly. My husband, in his logical wisdom, said, "Just engineer it." He came up with an assembly line system of bottles and pre-measured containers for her formula, so it can be prepped within seconds of her demanding cries.

All of the necessary items for her care are stored in easy to reach stations throughout the house. Certain tasks, such as diaper changing, are performed only in specific locations. When the volume of available formula dips to a certain level, I push the button on my phone to order more. Throughout this experience, I've learned more about myself because it has required a shift from my usual nature, which is more intuitive and less planned. I've always been more of a procrastinator... and a spontaneous shopper. I like to walk into my closet and pick my clothing for the day based on my mood. I choose to make dinner for the evening based on what I "feel like" eating. However, I've come to find that this M.O. results in more stress (usually in the form of a fussy, crying baby) when complex tasks need to be performed in a timely manner and another person is dependent on me to complete them!

So the way I've mitigated this unique kind of stress is to be as prepared as possible for the basics, control the things I can control, and do as much as possible to focus on the present moment. I can't control when she cries for food. And I can't control the fact that my body was not able to produce it on demand. But I can streamline the processes needed for her care, and I can change my attitude toward said processes. There will no doubt be many things in her life that I cannot control, so I'd better get used to identifying those that I can.

Monday, December 28, 2015

PB Top Posts of 2015

Another year of practicing balance comes to a close! My year, and most of my writing, was dominated by the theme of pregnancy and baby. The culmination of my "project" for the last few years arrived just over a month ago, and we couldn't be more thrilled! Future posts are sure to include the new wrinkle of parenting into my practice of balance.

The other big change this year was joining the list of writers at Mothers in Medicine. By far the most widely viewed thing I wrote overall was my piece there about the hazards of being pregnant in the OR. It got syndicated by MedPage Today's daily news blast, and there was a great conversation about readers' own experiences in the comments.

Anyway, here is the list of the five most popular posts (by number of page views) on my blog this year. Enjoy, and happy new year! Let me know what you think of the list! Any favorites that were left off?

5. How pregnancy changed my body image

4. My introduction of Mothers in Medicine

3. The (so far) one and only "Dear Dawn" post about how to pick a medical specialty

2. My birth story (with bump video), and how it taught me to take things as they come

1. The original reveal of my pregnancy and the difficulty of dealing with shoe-drop thinking

It's been a great year!

Monday, December 21, 2015

Childbirth: The Ultimate Exercise in Going with the Flow

Witness the transformation

I was 37 weeks pregnant and had just completed a busy Monday in the OR, my last scheduled shift before maternity leave. After consulting both my regular OB and a high-risk OB specialist, the plan was to induce labor at 38 weeks due to my significant swelling and increasing blood pressure, so I had already given away any lingering work shifts in the month of December. While relaxing in front of the TV that night, I found my fetal kick count to be significantly lower than normal. I spoke with the on-call OB team, and after going back and forth, we decided it was best if I go to the hospital for further fetal monitoring. I threw on my slippers and jacket (was already in pajamas) and said, "See you in an hour or so," to my husband. I never made it home that night, and six days later I brought my baby girl home from the hospital!

At least we had bought the car seat and installed the bases. The crib was set up, but other things like the stroller were still sitting deconstructed in boxes. I had planned to complete many last-minute preparations that week. I was even excited about the fact that I would get to eat a huge pre-induction Thanksgiving meal that Thursday and that the date of induction (if my calculations were correct) would mean her date of birth would include both my husband's and my favorite numbers. In hindsight, I can't believe I was thinking of unimportant such things!

That night, the fetal monitoring showed that she was ironically doing just fine. It was me they became worried about. My blood pressure had soared to 160/100 and I had developed protein in my urine. If we induced immediately, the preeclampsia would most likely not cause me long term liver or kidney damage. The only wrinkle was that my husband, who had operated his own patent law practice for 10+ years without ever having to go to court, had a scheduled court appearance for the next day! He had chosen the date back when we thought I would be having the baby around 40 weeks like "normal" people...

The hospital OB team and my personal OB worked to time my induction such that it was very unlikely that any "action" would happen before his brief court appearance was complete. He dutifully brought my pre-packed (check!) hospital bag and my birth plan that morning before heading to court. Yes, I had a birth plan - but not the long, detailed essay that some women present to eye-rolling hospital staff, replete with all sorts of unrealistic demands involving birthing balls, hot tubs, candles and music. As an anesthesia trainee on the obstetric service, we used to joke that those women with the most detailed and rigid birth plans would inevitably be the women who ended up with "emergency" epidurals at 3 AM, or worse in the OR for a crash C-section. Instead, what I provided was a one-page preference sheet with a few important decision points and an outline of my complicated medical history.

I will tell you that even with my minimal birth plan as a "good luck charm", things still didn't go the way we had originally hoped. And yet, once she was born, none of that mattered one bit! She came out with meconium present and couldn't be placed on my chest immediately, the cord was cut to soon, etc. But she was healthy! I was lucky to have a careful induction with no complications and a quick period of active labor (only 45 minutes of pushing). We didn't have to go to the OR for a C-section. I only needed two stitches post-delivery. Again, she was alive and she was healthy! After experiencing a pregnancy loss, I admit that a fear had persisted deep inside me even into the late months that I would lose her without getting to see her face.

Our stay in the hospital after she was born was also different than envisioned. After spending two nights and feeling ready to go home, we found out she had elevated bilirubin and needed to stay longer. Poor babe had to spend a day "at the beach" (as the nurses have deemed it) under the UV lights to lower her bili levels, which if left high could result in brain damage. The hospital staff generously let me stay an additional night to be with her (even though I was officially discharged myself), but we had family members already staying at our house who had come to visit with anticipation of us being home from the hospital already.

Nothing went exactly as expected, and yet everything turned out fine. Nothing went exactly as expected, and yet everything turned out fine. This mantra applies to lots of things in life, come to think of it... The whole experience was an exemplary lesson in how to take what comes in stride without creating more stress. Because in these instances, resistance and rigidity would have posed potential risks to both me and baby. I wouldn't want anything to have gone differently!

Happy holidays everyone!