An Ode to My (Probably Overreactive) Rage

Wednesday, February 4, 2015

I'm currently sitting in my preferred corner of the sofa, drinking a steaming cup of hibiscus tea. There's a kitten playing with a balled up receipt (which he has decided is the BEST TOY EVER, at least for the next 5 minutes) and a giant orange cat curled up behind my head, softly snoring. It's quiet, except for the sounds of my handsome husband making dinner (he's kind of the best). I should have nothing about which to be angry and yet... I am cranky.

I am cranky because there are people at my school, a school of OSTEOPATHIC MEDICINE, who think that osteopathic medicine is a bunch of crap and loudly declare their opinions to anyone within earshot. If you didn't want to be a DO, then you shouldn't have come here. End of story. You're sitting in someone's spot who, at the very least, wouldn't spend their entire existence wishing they were at an MD school. You make the rest of us, who on some level really like osteopathic medicine, or at least are grateful to be here, feel like punching you in the face. Get off my lawn. Go home.

I am cranky because there are a ton of people in the world not vaccinating themselves or their children. I am all for doing whatever you want, so long as it doesn't harm anyone else, but I am 100% sure that not getting immunized against completely preventable diseases (excluding the flu, but still, go get a flu shot) is fucking harmful. And for all of those people who say that their kids are fine and they're fine, well that's fucking great, but guess who isn't fine? The infants who can't get vaccinated until their older, the immunocompromised people (like myself) who, even if they do get immunized (which I do, thank you very much) still get sick a lot more often than we should (yay autoimmune disease!), pregnant women who can't receive certain vaccines, and anyone who is currently getting treated for cancer with chemotherapy, because clearly, having cancer isn't bad enough, they have to worry about getting fucking measles now. You aren't getting immunized for YOU, you're getting immunized for the good of society and herd immunity. Here's the thing about herd immunity... enough people need to be immunized for it not to break down (LIKE IT HAS). For example, you want herd immunity to protect the infants and the chemo patients from getting measles? Then you need 83-94% of the population immunized to accomplish that. From one person infected with measles, you will see anywhere between 12-18 new cases. That is not okay!! Like charts? Here's a chart.

If oyu like academic papers, read this: Epidemiology Reviews, 1993
Also seen on Wikipedia, as well as this NOVA website and this CDC presentation
For you non-epidemiology folks, R0 is the basic reproduction rate and is used ot measure the transmission potential of a disease. For influenza, the threshold ranges, but generally is assumed to be between 80 and 90% for herd immunity to be effective. In the US, we are nowhere near that. So yes, even though our flu vaccine this year was only about 23% efficacious, that is still better than 0%, and again, you're not getting vaccinated for you; you're getting vaccinated for all of those people who can't get the vaccine themselves. But alas, no matter what you tell these people who think that's it's totally cool to not vaccinate themeselves or their kids, they won't change their minds and the rest of us have to refrain from commiting a felony when we read some ridiculous quote from an anti-vaxxer parent (or worse, this doctor, whose interview I cannot even listen to because it turns my stomach).

I am cranky because I disagree with the clinical guidelines on miscarriage and testing. Because 25-40% of pregnancies end in miscarriage, it is decidedly a "common" event and so medically, practitionres don't start doing any kind of testing for possible causes until a woman has had THREE miscarriages. THREE. I cannot imagine doing this three times. Once was bad enough. If I have to do this three times, I may just find a bridge and jump off of it, because I cannot take it. Fortunately (?), I have a reproductive endocrinologist who is gung-ho about testing and me being pregnant. He called and ordered a lupus anticoagulant panel, because there are certain antibodies that can increase the risk of recurrent miscarriage and he wants to know if I have them because guess what? You can treat that in a relatively easy manner (most of the time). Even if I have the antibodies and they didn't cause this miscarriage, it's important to know that I have them for future pregnancies. I'd also like to make sure that I get plenty of progesterone monitoring done before and after I get pregnant next time, because there's sometimes a problem where your body doesn't produce enough progesterone to support a pregnancy. Guess what? That's easily fixable too.

It makes me so angry that there are women out there who have lost babies due to something called an incompetant cervix, which means that a woman's cervix opens way too early and if not fixed, the pregnancy will be lost, often in the second trimester (when miscarriage risks are supposed to go way down.) You know how that gets fixed? Monitoring and putting in a cerclage (sutures to reinforce the cervix that are then removed around weeks 36-38). Even if a cerclage isn't put in, so many women aren't even being screened for this potential defect. Why? I have no idea. Probably lack of resources or clinical data showing that it's rare, so we shouldn't do it. To that I say, try telling a woman who's lost a baby at 20+ weeks that and see what she says. You can bet I'll be pushing for monitoring to the utmost degree when I get pregnant again. In fact, when we meet with my reproductive endocrinologist again (Dr. S), I am going to talk to him about Clomid, a drug that induces ovulation. Now, my body seems to ovulate just fine (thank the good Lord I don't have that issue), and I was able to get pregnant without any interventions last time. However, having PCOS can make the quality of your eggs go down, and Clomid can help improve that. Of course, no one MENTIONED this to me, so I didn't know. There also seems to be clear-cut guidelines on whether Metformin (a diabetes medication used to treat PCOS) should be continued through the first trimester to decrease risk of miscarriage. The doctor who treats my PCOS said yes, the maternal-fetal medicine doctors and my OB said no. I stopped taking it. Maybe I won't do that next time. Who knows? What I do know is that no woman should have to lose three babies before someone decides its a problem. It's almost like medicine gives you one "free pass," like your first baby is a practice-run, and if you get a live, healthy infant at the end of it, then you win! If not, better luck next time. (And yes, one of the doctors in the practice actually said to me, "Better luck next time," and I wanted to throw something.) Unacceptable.

I'm cranky because my body still hurts, and my heart hurts more. I am taking medication to sleep, and it makes me drowsy during the day. I get really emotional and heartsick when I see pregnant bellies, even though I know that makes no sense. I picked out a baptism card for Sarah's baby today and had to evacuate the card aisle at Target before I had a meltdown standing next to the baby shower cards. I'm tired of feeling like I will never feel okay, and I'm tired of waiting for my body to get its proverbial excrement together so I can move on and start over. Right now, I am living in limbo, where my body hasn't quite figured out what is going on, and it sucks.

 I am cranky because it is cold and I hate it. And yes, I know that I live in the northeast and it's winter, but the air hurts my face and it hurts to breathe and it makes my joints hurt and going outside is painful. The salt on the road makes my car continuously look disgusting, and I never want to go outdoors. I should have been a hibernating mammal.

I am cranky because I am behind on schoolwork and I didn't do as well on my renal and respiratory exams as I wanted to. Given the situation in my life, I should be grateful that I passed the ones that I did and that the one that I failed won't permanently screw me in the long run, but I know that any other week, I would have been FINE. I would have bitched and moaned, but I would have at least passed them all, and probably high-passed one or two. I can't seem to get into this block either, because everything seems useless and stupid in the face of what I'm dealing with, but I suppose at some point, I will have to put on my big-girl pants and get a move on. T-13 days to OMM exams and T-17 days until our GI exam. Time's a-wasting.

I am cranky because I have yet to call a contractor/handy-man to install our foyer lamp, or hook up the ice machine, or any of the other 938 tiny things that need to be addressed in this house. Our third bedroom is still a disaster, the office remains mostly unfinished. There is 1 piece of art on our walls. These are all extremely minor things, but they are grating on my nerves.

I am cranky because most of these things that are making me cranky are stupid things, and I should just get over it, but I can't because I am not in my best mental state and I just want to hide in bed until life works itself out. Cool? Cool.

And on that note, I'm going to go and actually study. But I won't like it.

TL;DR - If you didn't want to go to DO school, get out and get off my lawn, vaccinate your damn kids and yourselves, miscarriage is awful and I want all the testing even if I've "only had one", med school and winter make me angsty.

- A

1 comment:

  1. I am 100 percent with you on the vaccines. I am so glad to hear that you are pro them because we have heard a lot of DOs in our area side with the anti-vaccine movement lately.

    ReplyDelete

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