Wednesday, July 30, 2008

15w1d: Book List

I snagged this from Poppy's blog.

"Here's how it works:
1) Look at the list and bold those you have read.
2) Italicize those you intend to read.
3) Underline (or mark in a different color) the books you LOVE
4) Reprint this list in your blog.

The premise of this exercise is that the National Endowment for the Arts apparently believes that the average American has only read 6 books from the list below."

Sadly, I used to be of voracious reader, but work has taken over my life for years now, and I rarely read books anymore. I spend too much damn time on the internet: either infertility stufff, and now pregnancy stuff, and of course my daily fix of New York Times, LA Times, San Diego Union, and CNN... Besides that I read magazines and medical journals, pretty much. Besides, I go into bookstores and feel overwhelmed by the sheer number of books, and too afraid to buy something for fear that I'll read a few pages and decide that I don't want to finish it. For that reason, I think I'd be better off going to the library. What I really like is for someone to tell me, "Hey, you should read this; you'd really like it."

I don't feel like putting the ones I intend to read in italics, so I'm not going to! Don't wanna see this list in 5 years and feel like a failure!

1 Pride and Prejudice - Jane Austen
2 The Lord of the Rings - JRR Tolkien - no, but I have read The Hobbit (didn't care for it much, and that's why I never read the rest.) Ironically, my middle name is a character in the Lord of the Rings Trilogy, but I have never read the books...or seen the movies!
3 Jane Eyre - Charlotte Bronte
4 Harry Potter series - JK Rowling - no, and I haven't seen the movies, either. I guess I'm just not a fan of the fantasy genre.
5 To Kill a Mockingbird - Harper Lee
6 The Bible - parts of it... for a college class, actually.
7 Wuthering Heights - Emily Bronte
8 Nineteen Eighty Four - George Orwell
9 His Dark Materials - Philip Pullman (I have to admit, I've never even heard of it).
10 Great Expectations - Charles Dickens
11. Little Women - Louisa M Alcott
12 Tess of the D’Urbervilles - Thomas Hardy
13 Catch 22 - Joseph Heller
14 Complete Works of Shakespeare- some of them, certainly not all.
15 Rebecca - Daphne Du Maurier (I don't actually remember anything about it.)
16 The Hobbit - JRR Tolkien
17 Birdsong - Sebastian Faulks (Never heard of this one, either.)
18 Catcher in the Rye - JD Salinger
19 The Time Traveller’s Wife - Audrey Niffenegger (??? I am starting to feel illiterate.)
20 Middlemarch - George Eliot
21 Gone With The Wind - Margaret Mitchell
22 The Great Gatsby - F Scott Fitzgerald
23 Bleak House - Charles Dickens
24 War and Peace - Leo Tolstoy
25 The Hitch Hiker’s Guide to the Galaxy
26 Brideshead Revisited - Evelyn Waugh (Again, ???)
27 Crime and Punishment - Fyodor Dostoyevsky
28 Grapes of Wrath - John Steinbeck
29 Alice in Wonderland - Lewis Carroll
30 The Wind in the Willows - Kenneth Grahame
31 Anna Karenina - Leo Tolstoy (I quit somewhere along the way.)
32 David Copperfield - Charles Dickens
33 Chronicles of Narnia - CS Lewis
34 Emma - Jane Austen
35 Persuasion - Jane Austen - (In fact, I have read everything and own everything by Jane Austen, including her short stories.)
36 The Lion, The Witch and The Wardrobe - CS Lewis
37 The Kite Runner - Khaled Hosseini - saw (& really enjoyed) the movie, and now not motivated to read the book
38 Captain Corelli’s Mandolin - Louis De Bernieres
39 Memoirs of a Geisha - Arthur Golden - read the book, and now not motivated to watch the movie.
40 Winnie the Pooh - AA Milne - Uh... unless there's some fancy adult version that I'm not aware of...
41 Animal Farm - George Orwell
42 The Da Vinci Code - Dan Brown - Read first chapter and got distracted thereafter.
43 One Hundred Years of Solitude - Gabriel Garcia Marquez
44 A Prayer for Owen Meany - John Irving
45 The Woman in White - Wilkie Collins
46 Anne of Green Gables - LM Montgomery
47 Far From The Madding Crowd - Thomas Hardy
48 The Handmaid’s Tale - Margaret Atwood
49 Lord of the Flies - William Golding
50 Atonement - Ian McEwan - Saw movie, and now not motivated to read the book.
51 Life of Pi - Yann Martel
52 Dune - Frank Herbert
53 Cold Comfort Farm - Stella Gibbons
54 Sense and Sensibility - Jane Austen
55 A Suitable Boy - Vikram Seth
56 The Shadow of the Wind - Carlos Ruiz Zafon
57 A Tale Of Two Cities - Charles Dickens
58 Brave New World - Aldous Huxley
59 The Curious Incident of the Dog in the Night-time - Mark Haddon (???)
60 Love In The Time Of Cholera - Gabriel Garcia Marquez
61 Of Mice and Men - John Steinbeck
62 Lolita - Vladimir Nabokov
63 The Secret History - Donna Tartt (???)
64 The Lovely Bones - Alice Sebold
65 Count of Monte Cristo - Alexandre Dumas
66 On The Road - Jack Kerouac
67 Jude the Obscure - Thomas Hardy
68 Bridget Jones’s Diary - Helen Fielding
69 Midnight’s Children - Salman Rushdie
70 Moby Dick - Herman Melville - most of it, but not every last bit.
71 Oliver Twist - Charles Dickens
72 Dracula - Bram Stoker
73 The Secret Garden - Frances Hodgson Burnett - I think I liked The Little Princess even more!
74 Notes From A Small Island - Bill Bryson
75 Ulysses - James Joyce
76 The Bell Jar - Sylvia Plath
77 Swallows and Amazons - Arthur Ransome (???)
78 Germinal - Emile Zola
79 Vanity Fair - William Makepeace Thackeray
80 Possession - AS Byatt (???)
81 A Christmas Carol - Charles Dickens
82 Cloud Atlas - David Mitchell (???)
83 The Color Purple - Alice Walker
84 The Remains of the Day - Kazuo Ishiguro
85 Madame Bovary - Gustave Flaubert
86 A Fine Balance - Rohinton Mistry
87 Charlotte’s Web - EB White
88 The Five People You Meet In Heaven - Mitch Albom (???)
89 Adventures of Sherlock Holmes - Sir Arthur Conan Doyle
90 The Faraway Tree Collection (???)
91 Heart of Darkness - Joseph Conrad
92 The Little Prince - Antoine De Saint-Exupery
93 The Wasp Factory - Iain Banks (???)
94 Watership Down - Richard Adams
95 A Confederacy of Dunces - John Kennedy Toole
96 A Town Like Alice - Nevil Shute (???)
97 The Three Musketeers - Alexandre Dumas
98 Hamlet - William Shakespeare
99 Charlie and the Chocolate Factory - Roald Dahl
100 Les Miserables - Victor Hugo - Yes, in junior high, but I think it was an "abridged" version (still several hundred pages, though), so I won't count it.

Bedtime; I guess I'll have to update on pregnancy stuff later!

Wednesday, July 23, 2008

14w1d: All is Well

I have been away for far too long. One problem is, I'd rather catch up on all of your blogs rather than write my own. Still, I want to keep this blog as a pregnancy journal, too, so I need to get back to it.

Today was 14w1d and I had my second "normal" OB appointment. My regular OB was booked, so I saw a second nurse midwife. It was a quick appointment in which they basically took my vitals (BP 90-something/50-something), had me pee in a cup, and weighed me (up 3.6 lbs by my home digital scale, essentially the same on their scale). The midwife then came in and answered a few questions that I had. I then asked her to show me how to palpate the uterus at this stage. As she explained it, I'm not supposed to be feeling for a firm edge, but rather for something soft, almost like a loaf of bread. My fingertips should really only be pressing in an inch or so. It is pretty subtle, and I'm not sure that I can find it again. She said that the size of my uterus is appropriate for 14 weeks.

My favorite part of the appointment was hearing the heartbeat again. I love that sound! She used an external Doppler and found it easily. I was slightly distracted because she kept asking me questions about my job during that part, and it felt kinda rude to say, "Um, can we just be quiet and listen for a minute, please..." She didn't actually measure the heart rate, but it definitely sounded nice and fast.

I confessed to her that I have cheated a bit on the deli meat restriction in that I have eaten a few turkey sandwiches here and there. She said it should be fine, and that the real prohibition is going to a deli where the meat sits out and they carve it in front of you. Still, the sandwiches I have eaten are usually from an internal catering team, so who knows how safe they really are. I'm feeling pretty relaxed about it, though. I have never gotten food poisoning from a sandwich, as far as I know. I did ask her to order a CMV antibody test on me. I will feel a lot more relaxed running around the hospital next month if I know for sure that I have a pre-exisiting immunity to CMV. It's the primary infection that can be most dangerous to a fetus, so I hope to be IgG positive (ie already immune) so that I won't have to worry about it. I will get this drawn on the same day as my AFP test. I have to do it a few days earlier than normal (a week from Friday at 15w3d) because I will be out of town thereafter for about a week.

My new job is going well. My main complaint is that I have an office but NO COMPUTER!! It was ordered July 1st or so (why not earlier, I don't know -- I reminded several people about it many times during the month of June) but then it was ordered via an incorrect mechanism and it still hasn't arrived. It is driving me insane to work at borrowed desks, etc. Half the time some aspect of the system is not set up on that computer, there is no printer connected, etc etc.

I still need to tell our breast oncology group's leader (Dr. P) about the pregnancy. I decided to wait until today's appointment, but now that it is done and all is well, I am eager to tell her. Otherwise, I'm afraid that I will leave for my week-long conference on August 2nd and return on August 11th looking really obviously pregnant (17 weeks). To my eyes, I am already getting pretty thick through the waist, but it is not an obvious "baby bump" quite yet. I still wear my normal clothes, and I think it just looks like I have gained some weight. I bought several of those juniors-style flow-y shirts that will help me look more pregnant than chubby, but I don't want to wear them to work until I tell Dr. P first. I just need to decide if I want to set up a formal meeting, or just hope to pull her aside in the hallway at some point. A formal meeting seems a bit awkward, but she's not the type of person to ever be just sitting alone in her office and available to chat for a few minutes (my preferred way of dealing with it).

I'm not sure whether my colleagues will merely divide up my patients during maternity leave, or whether they will hire back the temporary physician who just left when I started (a 70+ year old retired oncologist who had filled in for an entire year.) I feel bad for making the patients see so many different doctors, so in some ways he would be the ideal person to see the again.

Anyway...must go to bed. I am actually driving my parents and sister to the airport in the morning before work, so I will be up nice and early!

Wednesday, July 9, 2008

12w1d: Nuchal Translucency Screen

I feel bad for not posting more often, but I've been pretty busy lately with the new job. I hope that I still have some readers out there!

The good news is that I was able to move Blueberry's nuchal translucency screen from next week to today. The wonderful news is that everything looks great!

The baby was measuring on-target at 54.5 mm CRL, corresponding to 12w0d; that is just one day off... great! The heart rate was either 151 or 161 (too hard for me to see clearly). The nuchal translucency itself was 1.4 mm. Before screening, my age-related risk of Down Syndrome was 1 in 301, and this decreased to 1 in 1359 with the NT and bloodwork results. Before screening, my age-related risk of Trisomy 13/18 was 1 in 645, and this decreased to 1 in 5858 with the NT and bloodwork results. Needless to say, we are thrilled.

S was able to rush over from his work for the second half of the ultrasound, and it was fun to see the baby again with him. I got to see a few kicks and waves before S arrived, but the baby seemed to quiet down a bit after he got there. (Sleeping, maybe?)

And now for some pictures:

The first one shows the baby in profile, head on the right side.

The next one is a more magnified view of the head and neck, with the top of the head on the left side. This is the view from which they measured the nuchal translucency.

This one is my favorite and shows a tiny bent leg and foot. I wonder if the bright white areas in the spine, femur, shin, and foot are the beginning of ossification of the bones?

In other news, the cervix looks nice and long (over 5 cm), and the placenta is in an anterior location, which means that I may not feel kicks and other movement quite as early as some people. Oh well, at least I'll have a reason not to worry if that happens.

I started feeling a bit pudgy through the waist area over the weekend. I have gained somewhere between 0.6 and 1.8 lbs (my digital scale fluctuates from day to day). I don't think that anyone else can see a major change, but I can notice a difference. It's not a baby bump, yet, though. My guess is that the uterus is probably starting to fill the pelvis, pushing my intestines, etc upward, maybe?

Oh! This Monday I had lunch with a colleague of mine. She is a year ahead of me in terms of training, but is actually 40 years old. She got married about 2 months after me (12/06). Well, I had heard last week that she is pregnant, and I congratulated her. Eventually the conversation got around to the fact that I am pregnant, too, and that both of us did IVF! One really stressful thing about her experience is that her original IVF cycle was cancelled... due to egg retrieval being scheduled at the same time as last fall's massive San Diego wildfires!! OMG, I cannot imagine being all the way stimmed and then having to completely cancel the cycle due to a natural distaster like that. I bet it was a staffing issue at the RE's office (and this RE's office was actually in an area near the evacuation zone), but she was told that "they had poor results during previous San Diego wildfires" (2003). Yikes! I forgot to ask her whether she was able to get any reimbursement for the cost of all those wasted meds. Anyway, she cycled again in February and is currently at 20 weeks with a little girl! Congrats to her!

S's birthday is tomorrow. I hope he likes his present! I think I still need to get something else, too. I always feel bad because I have a hard time choosing gifts, but in the end it usually turns out OK.

Wednesday, July 2, 2008

11w1d: New Job

I don't have any signficant news on the Blueberry front. No new pictures or symptoms. I thought I had gained 1.4 lbs, but today I was back to -0.2 from baseline again. I'm sure that I'll be going up any day now, though. I don't feel a difference in my usual clothes, but there is a form-fitting dress that I'd like to wear to a party Friday night (someone's birthday celebration with a black and white them), and I'm not so sure that the dress is going to work...

I do now admit that my breasts have grown a bit (1.5", I think), but I don't need new bras or anything, and they have still never been sore. Although, thinking about the bra issue, the bras were probably a bit too big before I started, so now they fit just right. I guess I'm technically a real A cup now instead of something unmeasurable. (ha!) Seriously, I once used an online calculator to try to figure my ideal bra size, and it kept giving me an error because when I took [(bust measurement in inches) - (band size + 5")], the result was a negative number. Thus, the error message; you had to have a difference of at least 1" to qualify as an A cup. Other websites would claim that I was a AA, which I have never worn. I tried a professional "bra fitter" at Macy's and she claimed that I was a 32-something, but that made zero sense because I would never be able to fit into a 32-anything. (I'm a 34/36 girl.) Oh well, the change is kinda interesting. I know it is not permanent!

I had bloodwork drawn on Monday. This included both blood for the "Ultrascreen" (nuchal translucency test) as well as routine labs such as a blood count, hepatitis serologies, HIV serology, etc etc. I also got my insurance info today, so I was able to schedule the nuchal translucency ultrasound for Wednesday, July 16th....2 whole weeks away...argh! Unfortunately, the ultrasound clinic only had 2 slots available, and the other is not at all feasible for me (during one of my clinics). If I have to keep the 7/16 appointment, S will not be able to attend. Well, I guess I will just call them every day or two in hopes that they have a cancellation that works better for us.

Well, I always do check my own labs after I have bloodwork drawn. (Shhh! Not to worry; I'm not going to sue myself for breach of privacy.) The labs were mildly interesting because it showed that I have a mild anemia (hemoglobin 11.6; hematocrit 33.0%, but normal sized blood cells (MCV=92)). I know for a fact that back in April and May, my blood counts were completely normal. With this in mind, I suspected that this is the "physiological anemia of pregnancy," which occurs when a pregnant person has an increase in plasma volume, but a proportionally lesser increase in red blood cells. The consequence is that there are fewer red blood cells per given volume of blood, and you appear anemic by labs. Iron deficiency is pretty much ruled out given that the red blood cells are normal in size; iron deficient red blood cells are small.

Well, of course today I got an answering machine message from the OB/GYN nurse practicioner informing me that I am anemic and that I need to start iron supplements. Ummmm, no I don't. Granted, I could become iron deficient at some point in the future, and the iron probably wouldn't hurt me (other than causing constipation), but it's pretty surprising that the OB/GYN people aren't familiar with the physiological anemia of pregnancy.

Working in hematology, we get referrals all the time about people who are anemic and whose doctors just reflexively put them on iron and were confused when the anemia didn't improve. Iron deficiency is a common cause of anemia, but there are dozens of causes, and iron won't help anemia unless you are running low to begin with. So, I am not sure if I should just do what they say, or gently inform them that as a hematologist I disagree with their recommendation. I will probably just ignore it for now and mention it at a future appointment. See what a pain it must be to have me as a patient!

Monday (June 30th) was my last day as a fellow, and Tuesday (July 1) was my first day in my "real job." It was somewhat easy in that it is at the same locations where I have already been working (a VA hospital and a university cancer center), but of course nothing was quite ready for me to start. For example, the computer system needs to be changed so that I no longer need someone to co-sign my notes, and so that I can co-sign other people's notes. Also, today at the university cancer center, I had the opportunity to check out my new (sadly, windowless) office. There's a desk and a phone and... no computer. I've been asking about this for weeks, but nothing has happened yet. Supposedly, "a computer is being ordered today." In the meantime, I am using the desk of a woman who is out on vacation. Lots and lots of stuff to organize, but none of it interesting enough to share with you all here.

Has anyone seen the television show "Hopk.ins" on ABC? I was watching the first episode on the DVR, and was surprised to see that a resident that I used to work with (I was a 4th year med student, he was a second year surgery resident) is one of the featured doctors. He has a wife and 3 young daughters but he is now apparently having serious marital problems and he and his wife are contemplating divorce. It was kinda depressing to see that part. Also scary that I worked with him in September 2000 and he is STILL a resident (PGY 9, I think... in Cardiot.horacic surgery.) I looked in my Palm P.ilot, and yep, I still have his pager number in there from when we worked together. How random. I remember the other two doctors, too, but I never worked with either one of them directly.

I hope everyone out there is doing well. La la, I'd love to check out your blog but it looks like you've moved it(??).