Anemia Frustration

First a discouraged post, and now a frustrated one. And kind of boring, too: I can barely get through the proof-reading of it.

Edward. To review: at his six-year check-up this summer, he hadn't grown since his five-year check-up, and he had also lost a couple of pounds. The pediatrician sent him for blood work, which showed anemia: his iron is supposed to be mid-11ish at minimum, and he's low-9ish. That doesn't sound very severe to me, but apparently anemia can indicate Scarier Things, especially when combined with not-growing.

First the pediatrician had us add an 18mg iron supplement to his diet, and we started giving him citrus fruit/juice whenever he had the supplement (or one of the iron-fortified cereals he eats daily) (vitamin C helps the body absorb iron), and we were careful to separate all the iron stuff from calcium (calcium anti-helps the body absorb iron).

We re-did the blood test after two months, and it was the same. So the pediatrician added an additional 14mg iron supplement to his diet. The 14mg and 18mg supplements are each listed as about 100% of the RDA for his age, plus he's eating the iron-fortified cereal that's listed as another 100% of the RDA. Plus of course he gets iron from other foods such as meat and legumes.

We re-did the blood test again this week after another two months, and he's budged up two-tenths of a thing of iron---so, if it was 9.1 before, it's 9.3 now. The pediatrician says great, it's working, let's add another 14mg of iron, for a total of 46 mg of iron supplements per day.

I'm thinking that a 200% RDA iron supplementation with a diet that already contains a good deal of iron-fortified cereal should have resulted in more of an improvement than .2, after over FOUR MONTHS of it. I realize it can take awhile for iron levels to rise, but it's BEEN awhile now.

When I said to the pediatrician that this worried me that so much iron was giving us so little result, he said no, it's looking good, and may just take time. Which, I knew it would take some time, but this seems like ample time. I feel frustrated because this has been six months and three blood-draws and three co-pays to hear the results, and I'm getting uncomfortable with this level of iron supplementation. Plus, Edward still hasn't gained any weight since age five. And I'm worried because what I've read online is that anemia that isn't affected by diet is the kind to worry about, so if there's something else going on I don't want to just let it KEEP GOING ON.

Here's my plan. I'm going to make his 7-year check-up with the other pediatrician in the practice. (We see both doctors, just whoever's available, so this won't be weird.) We've been seeing the same pediatrician for this whole iron thing, which makes sense so that one doctor can be tracking the story. But if I see the other pediatrician for the check-up, I can run it by him and see what he thinks.

I'm also hoping that some of you have experience with this and can say things like "Oh, it's because that level of anemia is like a 99.5 fever: it's not really anything to worry about" or "It seems like .2 wouldn't be significant, but actually it is" or "WHAT? This is nuts! The absolute cut-off for iron supplements at his age is 30mg!! Something is wrong here!"

Preschool = OPPORTUNITIES

I am so discouraged with how this whole Preschool = Abundant Time thing is working out. When we signed Henry up about a year ago, I started counting weeks until it would begin in the fall. Three and a half hours! Three times a week! UNIMAGINABLE FREEDOM!!! I will have so much more time to blog, and without being interrupted several times a minute!

Here is how things went today, and this is typical:

8:30 Take Henry to preschool
8:35 Exercise, and undo negative effects of exercise
9:40 Grocery store, and putting away groceries
11:00 At my computer, with an entire hour remaining

I am not complaining about that hour. No indeed. An hour all by myself in the quiet house is SUPER KEEN, and there is no denying THAT! But as usual it is about COMPARISONS. One hour compared to nothing is WONDERFUL. One hour compared to the anticipated three-point-five hours is...depressing.

Each time, I have to walk myself through it. I didn't "lose" an hour and five minutes exercising; I GAINED the opportunity to exercise! *finger to dimple*! I didn't "lose" an hour and twenty minutes buying groceries and putting them away; I GAINED a grocery store trip in total peace and concentration! *smile that does not reach eyes*!

Things I Like About Exercise

Over the years I have gone in and out of exercise, and I assume that pattern will continue. There is no reason for me to think that one spurt of exercise motivation will be different from the others and will suddenly last forever and be easy and wonderful. No, it is always unpleasant and I always hate it, and there is never one single session that I look forward to. But I try not to discuss every single start-up and fade-off, because that gets boring, and also because most such accounts seem to lack introspection: everyone's new health kick is FINALLY THE ONE THAT WORKS. Step aerobics and low-fat 4eva!!! Tae Bo and Zone 4eva!!! Pilates and whole grains 4eva!!! Zumba and low-carb 4eva!!!

But I am on an ON cycle right now, and it has been long enough to be an Actual phase rather than one of my many, many Attempted phases, so that's nice also. The temptation is to only complain about everything I HATE about exercising, and so I am RISING ABOVE that and forcing myself to do the opposite. Here is what I LIKE about exercising, typed while CLENCHING MY TEETH.


1. My knees can get kind of achy if I don't exercise, which brings to mind ads for chairs that will help me to stand. If I exercise too much, they hurt even worse. But if I exercise the right amount, they feel better.

2. Working on my balance problem. My brother still occasionally mentions the time I was in high school and tripped WHILE STANDING STILL. (Hello, there was a PATTERN on that linoleum.) When I've been exercising, I notice I'm quicker to regain my balance if I lose some of it.

3. Feeling like I'm all Ms. Muscles McBallet. Instead of just bending over (lift with your back!) for the pan lid, I fling one leg out behind me and lever down like one of those drinking bird toys. If I'm waiting for something to boil, I crouch a little because it'll help improve my thigh muscles which in turn will help me the next time I exercise. This is why I think Jillian is so idiotic: for some of us, taking the stairs isn't some pathetic cop-out we should feel ashamed of trying to fool ourselves with; instead, it's what makes us feel like one million small movements are worth doing, so we do those one million small movements instead of NOT doing them.

4. Feeling all awesome. When I'm walking along, or when I'm folding laundry, I feel the muscles! engaging! and the cardiovascular system! kicking in! Again, see point about Jillian and how crappy her advice truly is. Her message is "Be perfectly 100% ultimately fit in every way, or else DON'T BOTHER, YOU PATHETIC FOOL." I reject it. I feel all awesome and motivated to do more when I do a bunch of small things. I don't feel awesome and motivated to do more when someone yells that doing small things is pathetic and useless.

5. When I have to do something active, like walking up a hill or taking some stairs, I notice my muscles feel all happy about it, rather than feeling resentful and tired.

6. Having more overall pep/perk. When I'm going from the kitchen to the computer room, or from the computer room to the kitchen, I often break into a run. This was startling to the children at first, but they have become accustomed to it.

7. Sleeping better. I fall asleep more easily. If I wake up at 3:00, I'm less likely to stay awake watching a mental slideshow of Every Time I Screwed Up.

8. Feeling like I am Improving. I am getting better at what I'm doing. This happens in other areas of life as well, so it's not that it HAS to happen in this arena---but it's nice, for a change of pace, to have it happening in a physical realm. At first I could barely do 10 minutes; now I can do 30! At first I couldn't figure out WHAT this exercise was supposed to do because I couldn't feel ANYTHING; now I think OH, I get it!

9. Being able to say at a doctor appointment that YES, I DO exercise.

10. Feeling like I'm doing things to delay death. My guess is that I'm not actually doing much to delay death: most of our ancestors had jobs that kept them physically active until they died at 52, but of course they were also eating a ton of local organic unprocessed whole foods, so maybe THAT'S what shortened their life expectancies. But our current culture believes that I AM going to live longer because I exercise a fraction of the amount my farmer ancestors did, and so I believe that I might be, and that is a pleasant belief. I am exercising, so I will live longer wheeeeeeee! Or shorter---we'll have to see how this all pans out, considering right now we know almost nothing about anything! But if I'm wrong I'm in good company wheeeeeeee!

11. Whether it prolongs life or not, "use it or lose it" is a saying that seems to hold true over the ages, and whatever years I DO have are more likely to involve better balance and an easier time getting a pan lid out of the oven drawer. Unless I get REALLY into exercising and destroy my joints.

12. Watching movies while I exercise is the only way I can make myself do it at all. So this means I am suddenly seeing movies! LOTS of movies! I saw Inception! I saw The Kids Are All Right! I'm watching Friday Night Lights! I kind of know what other people are talking about, sometimes!

I Upside-Down-Heart Exercising

The things I hate about exercise are too numerous to...enumerate. Which isn't going to stop me.

I hate being hot. I hate sweating. I hate hearing it wouldn't be boring and hateful if I'd just find the kind of exercise I LOVE, DUH! I hate how the first month I start exercising I put on ten pounds, and I don't lose it until I (inevitably) quit exercising. I hate how no amount of exercise is ever considered "enough": you always need to be doing MORE.

I don't know if I could choose my absolute least-favorite thing about exercise, but today the honor goes to how much TIME it takes. When Henry started three-morning-a-week preschool last fall, I had a little talk with myself. I was pretty stern. I informed myself that with three mornings all by myself in the house, I certainly could spare 30 minutes three times a week to exercise.

And is it 30 minutes? Is it hell. From the moment I pull out the Wii Fit board until the moment I'm dressed in non-gross clothes again, it's 60 minutes. And that's to get an amount of exercise many people would consider completely negligible, and may I just as an aside kick their legs out from under them as they head out for their lazy little 5-mile run because they're taking it easy today.

So, to exercise just enough that my doctor assumes I'm lying to her, it costs me three hours per week (plus ten pounds). That is a lot of time. And in case you are feeling tempted to argue with me, let me say it again with more of a "now is not the right moment for a receptive response to that argument" spin to my eye contact: THAT IS A LOT OF TIME. Three hours a week is a lot of time. Do you want me to add "to me" to the end of that sentence? I will at the end of the paragraph, but right now I'm to riled up to add that qualifier. I suppose if I were sitting around bored, flipping channels and then going to bed early because I couldn't think of anything else to do, it might not be that big of a deal to me. But I spend every day almost PANTING with things I need/want to do. I hate bedtime because I'm always in the middle of something. Three hours is a lot of time to me.

It means giving up three hours of things I would rather do, every single week, for a benefit I have to take on faith. I am forced to assume it's worth it. I am forced to assume the exercise benefit is better for my health than the extra ten pounds is bad for it. I am forced to assume that if I am someday fortunate enough to be an old lady, I will be more grateful for the three hours a week I spent exercising than I would be if I'd spent the three hours a week blogging or reading or cleaning or doing ANYTHING AT ALL I'D RATHER DO. Which I AM assuming, which is why I'm more than four months into this latest effort. But I am not HAPPY about it, and I'm not going to call it "me time" or "time for MYSELF" or whatever: this is a sacrifice, and I hate it. It's CHORE time. If I were someone who used the expression "Me time," I'd reserve it for things I LIKE DOING. Such as writing about how much I hate exercising.

Penicillin Allergy

Upside of Googling images of rashes: really puts child's scary rash into perspective. Downside of Googling images of rashes: OMG OMG OMG AAAAAAAAAAAAAAAAAAAAAAAA.

This morning Edward has what looks like a bunch of mosquito bites on his leg, joined up the way they get when there are a lot of bites close together. And he's on amoxicillin, and the stuff I read about allergic reactions said it's very hard for a layperson to tell the difference between a scary-looking but non-allergic rash and a scary-looking but allergic rash, so I'm not giving him this morning's amoxicillin until I get it checked out, and I'll call the doctor's office as soon as it opens. And I gave him benadryl.

I also got everyone else ready early, in case we suddenly need to zoom to the emergency room. It makes me feel better to feel READY, even if I think the likelihood of needing that readiness is LOW. I'm trying to imagine how I'd feel if I had to go to the ER but Elizabeth's hair was still like cotton candy, and she wasn't dressed, and no one could find shoes, and Henry had breakfast on his face. No, better to get ready just in case. It's not like we'll WASTE the getting-ready: they still need to do it.

********

Rash has spread to his cheeks and ears. This part isn't mosquito-bite-like, just very red and rashy. Mosquito-bite stuff spreading up his legs and down his ankles. He's itchy, but cool washcloths and the benadryl seem to have helped quite a bit. Still no breathing issues, and no rash on his torso.

********

We're back from the pediatrician's. It was a little dramatic: I called the nurse at opening time and told her what was going on and she said "...How soon can you get here? Can you come in right now?" So it WAS good I had everyone totally ready. Apparently saying "amoxicillin" and "rash" together is like saying "middle-aged man" and "chest pains" together.

And it looks like it is indeed a penicillin allergy, luckily without any breathing issues involved this time. But now he has a red sticker on his chart. I asked if he could go back to school today and the doctor said yes---but he hesitated before saying it. And then when I got home and started to write the note to the teacher I reconsidered and decided to just keep him home. I'd like to watch him, and also he looks DREADFUL: anyone seeing him would assume he had an apocalyptic disease and was spreading it to all the other children. The school would have the doctor's note, but the other parents wouldn't know.

Interesting thing the doctor said: that some people are only allergic to the LIQUID form of penicillin, but can take the capsules later on with no trouble. Hm. But probably most people wouldn't want to EXPERIMENT with that.

Here is something I'd like to know: is penicillin allergy hereditary? Paul's mother claimed that Paul was allergic to penicillin, so of course Paul has had to say so to all his doctors over the years, and it's been a bit of a hassle. (When he went in with strep last week, the doctor said "Any allergies to medications?" and he said "Penicillin" and she said "WRONG ANSWER.")

But Paul's mother also diagnosed Paul's sister with many food allergies, and never got doctor confirmation for any of them (and either his sister outgrew them all or else she never had them to begin with), so it's a little hard to say---especially since when I was looking things up online I found there can be a very scary-looking non-itchy rash from amoxicillin that DOESN'T mean allergy. And yet if I'd seen that rash on one of my children, I definitely would have assumed allergy. So I'm wondering if that's what she did. When she was alive I tried to ask her more about it, but she just kept stating that he WAS allergic, be-LEEEVE her he was allergic, and I got nowhere.

...I've been kind of rambling all around, and it's losing the questions which are the POINT of this post, so I'm going to put them here, on their own:

1. Are penicillin allergies hereditary?

2. Wait, I guess that was my only question.

Waiting to Be on the Phone for the THIRD TIME Today

I lay awake last night going over and over in my mind all the unpleasant hurdles I was going to have to navigate in order to get the new UTI treated. First: do I make an appointment, or do I try to get the doctor to call in a prescription? I'd prefer the latter, but it means dealing with attitude from the receptionist; and should I give her attitude back? what KIND of attitude would be most effective? (Effective = makes her burn with shame at the way she was treating a patient, followed by making her eager to appease me by helping me---as opposed to riling her up and making her accidentally drop my message into the wrong pile and/or into the trash.) Let's rehearse all the attitude-giving options here, in my mind, in the dark, at 1:00 in the morning.

Then, if the doctor is willing to call in the prescription with no appointment, there is often a many-hour wait before he or she DOES SO (once it was 2:00 in the afternoon, when I'd called at 8:30), so that in the past I've decided I might as well just make the appointment because it's FASTER.

But if I get an appointment, they will rebuke me for taking the Azo painkiller, which dyes the pee so they have to diagnose me through traditional methods (i.e., letting me describe my Absolutely Classic UTI Symptoms) instead of by dipping a strip of paper my insurance will charge me $20 for.

Then I will have to be firm about them NOT sending the pee away for $450 worth of lab work, which my insurance charges me $140 for---and even when I have been firm in the past, I have lost. So I will have to be firm far beyond the natural limits of my temperament type, which will make me cry.

The whole thing will end unpleasantly no matter what, and I'll be exhausted from having to struggle so hard for a treatment plan I consider reasonable, over a treatment plan I consider an excellent example of why heath care costs are so crazy. It COULD be a bladder/kidney issue instead of a UTI, I realize, and it COULD be a UTI that's resistant to the antibiotic they prescribe---but I am youngish and healthyish, and I have had these many times before, and they can FULLY COUNT ON ME to call back if I don't feel better or if I get scary lower back pain or ANYTHING.

(Perhaps you are even now scrolling down to the comment form to suggest I switch practices or doctors. If so, I think you are overestimating the size of my town and underestimating my ability to think of easy solutions.)

By this morning I had decided on the following things:

1. I would make an appointment.

2. I would not take Azo, despite the suffering, so that they could do their strip-dip.

3. I would not, however, pay for lab work. I would continue to say, "No, I'm sorry, but I can't pay for that" as many times as necessary. I would patiently endure their disapproval, and store it up to feel angry about later.


I called, and at first it felt as if things were going the most perfect way they possibly could: they didn't have any appointments today. They had me speak to the nurse, and they used the word "instead." I spoke to the nurse, who said she would speak to the doctor and see what they could do, and then call me back. I was going to get my prescription called in, without even having to fight with the receptionist first!

I was of course Theoretically Annoyed. Oh, I see, when _I_ ask for it to be called in, it's impossible and unreasonable and I'm trying to get away with something, but when THEY'RE busy and it would be more convenient for THEM, suddenly it's a good plan. But not VERY Theoretically Annoyed, because of being Actually Hugely Relieved. Plus, I could take Azo, so I did!

Then the nurse called back. The doctor there today is the one who previously insisted on sending away the pee sample for lab work despite my repeated protests, and assured me that insurance WOULD cover it. I was so thrown by this claim, and by the failure of my repeated protests to accomplish anything, that she won that round. And now, today, she declines to call in a prescription. She will need to see me, and she has no appointments until 2:00. Does anyone have anything earlier? No, that is the only appointment available in the entire day with any doctor.

I told the nurse that I had taken Azo, and she said that was fine because they could still send the pee for lab work and get a result that way. I said I would not have the lab work, because it was $140. We both said "Hmm" a few times. She said she'd run this new information by the doctor and call me back.

So not only am I waiting for a phone call (my THIRD in one morning), but I'm CHEESED OFF. I get these several times a year, and have for years and years. I have never been wrong about it, NEVER. A $450 set of tests is ridiculous for a routine UTI with no worrying symptoms. I wasn't trying to get out of needing an appointment, but I DON'T need their ONLY appointment of the day, if they won't be able to do the strip-dip OR the lab work, and if it's 5 hours from now.

If they think I'm getting too many of these (which they DON'T, despite me suggesting it seems like QUITE A FEW), or if they think there is something alarming that needs looking into, in THAT case I would be happy to cooperate with lab tests for further exploration of the problem. But $450 (plus the $20 strip-dip, plus the $130 appointment) to determine (1) that I have a UTI and (2) that it is not resistant to the prescribed antibiotic (test results back in 48 hours, by which time TRUST ME I WILL KNOW if it is not responding to the antibiotic) is WHAT IS WRONG WITH THE ENTIRE WORLD. Global warming? Due to unnecessary lab tests. Pollution? It's all the unnecessary lab tests. Crime and violence? PEOPLE ENRAGED BY UNNECESSARY LAB TESTS.

[Edited to add: I called my GYN, just to SEE. What I did was, I first made an appointment for an annual exam, because I'd rather go there anyway than to my primary. THEN I sprung my question. They only treat UTIs for women who are pregnant. So. Good to know, anyway.]

[Edited to add more: The doctor insisted on seeing me. I left with a prescription, and I refused to have the lab work done. She prescribed me an antibiotic my usual doctor says is not as effective; it would not surprise me to find that she is hoping I will be taught a lesson, since she kept mentioning that without the lab work she really couldn't make decisions for my care. So as usual, the whole thing ended up unpleasant no matter what: I'm glad to have successfully declined the lab work, but I'm upset and discouraged about everything else, and already greatly discouraged/upset in advance about the NEXT time this will happen, and about how very little control/choice patients have.]

New Year's Eve Report

New Year's Eve was fun! I used to think it was fun back in high school, and in college when I was home over Christmas break: my dad would move the TV and VCR into my room, and I would RENT several VIDEOCASSETTES from a VIDEO STORE, and I would buy a bunch of snacks. I'd stay up late watching the movies and eating, and mooning into my diary.

This tradition continued on and off until my first baby was born. Oh, wait, actually we stayed up late that year, too, because it was turning to 2000! We were living with my parents, and we all stayed up in case we were going to suddenly need to learn to farm the backyard and fetch water from the river.

After that, there were many years of not staying up: I was either pregnant or nursing or caring for very small children, or in fact always two of the three, and didn't want to stay up.

I can't remember which year it was that Rob asked to stay up and I said yes, but I do remember being really, really tired and not at all enthusiastic about it. I think it was the year the twins were toddlers and I was pregnant with Henry. The memory is understandably fuzzy, but I do remember how proud Rob was to stay up.

We've stayed up every year since. First it was Rob and me, and the last two or three years it's been Rob and William and me. Next year I'm going to let the twins try it. My prediction is that Elizabeth will stay up easily, and Edward will fall asleep on the couch by 9:00, after an hour of asking NOW is it almost time? Paul goes to bed early: he's not interested in staying up (though he's glad I do it, because it's fun for the kids), and that way he can let me sleep in the next day.

Now that my youngest baby is four years old, and I'm neither pregnant nor nursing, it's finally fun to stay up again. Rob and William and I went to the grocery store the day before and bought a bunch of snack food: Doritos, Lay's, powdered doughnuts, pizza rolls, Kit Kats, boneless wings, mozzarella sticks, soda, champagne. (The cashier: "Wow, having a party! How many people?" Me: "...Three." Cashier: *awkward moment*)

On New Year's Eve we got out the snack food at about 8:00, and William learned his annual lesson about the benefits of eating slowly over the hours rather than cramming as much into the tum as possible right away. They played Wii and I messed around on my computer with resolutions. At 11:30 we turned on the TV and watched Lady Gaga and Ryan Seacrest and Dick Clark. (It is time to let Seacrest do the countdown. He's starting to remind me of Prince Charles.)

At midnight I turned all the new calendars to January, and the boys got ready for bed while I put away all the snack food, and then I stayed up just a little bit longer to finish the champagne while mooning into my journal. I'm not saying it's HUGE! CRAZY! EXCITEMENT!, but it's become a holiday I look forward to for its pleasant little rituals.