Sunday, November 2

Back in Business, or In Defense of Hypochondria

Though I got a kick out of Noah's guest posting, I feel compelled to correct a few assertions he made. First, the time I had him on the phone to the after-hours nurse, I had a fever of one-hundred-four, not 102, and it turns out I had a rather bad case of mastitis that by morning had evolved into a systemic infection. Second, that time he gave me CPR from a distance of four inches? Yeah, I went to the ER in an ambulance that night and had an EKG and a scan for blood clots. Turns out, it was that pesky gallbladder. Which, I might add, can feel remarkably similar to a heart attack during a severe episode.

All this is to say that though I may have had a track record for blowing things out of proportion, my pseudo-hypochondria has led to a number of less morbid but useful diagnoses. Like the time I had a large, painful lump under my tongue. Not tongue cancer; a blocked salivary gland. Or the time I called the doctor while I was pregnant when my hands and feet started itching.

Sure, itchiness during pregnancy is fairly run of the mill. Worrier that I am, though, I called about it. And boy was I surprised to hear a sombre "Oh" on the other end of the line when I described my symptoms. Although I had become used to my macabre hunches panning out into something far less serious than terminal, I had never actually experienced a health care professional express anything other than cheerful optimism at a diagnosis well done.

After a battery of tests (the results of which I received after a literally excruciating week), I was diagnosed with intrahepatic cholestasis of pregnancy. Whenever I had to explain to people why I was going to be induced three weeks early, they inevitably (though good-naturedly) would ask, "Coley-what?" or "Can you spell that?" So I usually boiled it down to "it's a liver problem that will go away after the baby's delivered, and it makes me itchy."

But there's a lot more to it than that. It's something I haven't talked about a whole lot, but I think the time has come.

The doctor gave me tidbits of information as the testing progressed so as not to alarm me, but I of course had already done a dissertation's worth of research on the subject. I knew exactly what I was going to experience, and I knew that if I was left to go to term, it could kill my baby. This was not the pregnancy experience I had envisioned or hoped for.

Any medical information you'll find sounds factual and benign, as that kind of thing always does. But being put in touch with other women who had dealt with ICP really helped me feel validated even as I was surrounded by people who had never heard of the disease.

Reality for me became a constant all-over itching that had to be managed with medications and a carefully orchestrated routine. Not only did I have to give up one of my favorite things (soaking in the bathtub), I had to take cold showers because the warmth caused an increased blood flow which exacerbated the problem (bile acids overflowing into my bloodstream and collecting in my skin). The last week or so, I sink-bathed because I couldn't deal with wetting and toweling off my entire body. Although it was the winter, I couldn't wear socks or scarves or gloves. Anything that sat close against my skin and served as a warming agent was virtually intolerable.

Noah did what he could for me, which was usually things like running to get ice packs for my feet and hands to slow the blood flow to my extremities, or providing a shoulder for me to cry on when things flared up really badly. Although I had little to offer by way of sympathy or empathy at that time, I now realize how helpless he must have felt. On more than one occasion, he stuck his hands and feet into an icy cold bathtub alongside mine, because he couldn't do anything else. Once he raced home in the middle of the night to stand next to me while I cried and shivered because I had become too warm under the sheets and woke up writhing in tortuous pain.

Yeah, because "itching" doesn't accurately describe the "itching" of ICP. There's no lotion or salve that calms ICP, because the source is subcutaneous. And really the only reason it's called an itch is because of the tremendous and overwhelming urge to scratch yourself. For weeks my main personal goal was to not scratch, because scratching obviously made it worse by increasing blood flow and agitating bile acids that had collected in my skin. But I didn't always succeed. There were times when I'd come out of the bathroom with violent-looking claw marks all over my arms and legs. I felt like I could empathize with a drug addict detoxing, because my skin literally crawled.

So I went through a few weeks of near-daily fetal monitoring and then was induced. As one of the lucky ones, the itching stopped almost right away. Unluckily, I had developed chronic cholecystectitis and had to have my gallbladder taken out and sent to pathology.

Since then, my immune system has been so shot that I've been sick what seems like 70 percent of the time. And not with anything uncommon or life-threatening, which is a relief. But also maddening. The day-to-day discomforts associated with illness of course suck big time, but I've never had an opportunity to really rest and get well. You can't exactly get short-term disability to get over recurring bronchitis, but you definitely can push your sick day limit to the max without actually getting better while doing so.

It's definitely taken its toll emotionally and mentally, as well as physically. Looming over everything is the fear that if I get pregnant again, this will recur. Because there's no guarantees. While obviously I don't have a gallbladder anymore, I (thankfully) still have a functioning liver, and that's where the problem starts. In fact, if you have ICP in one pregnancy, I've read that the odds are something like 90 percent of having it again.

Being a mother is a singular joy, particularly with Ethan being the delightful and cooperative little soul that he is. And yet I worry and have fears and doubts about the next time.

For now, I will try to find something positive about this hacking cough and sounding like an over-the-hill chain smoker who's been lighting up since the age of six.

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