Maggies six month birthday

is coming up next week. She is huge bigger than a sack of rice!
and I am thankful for our good babysitter and how fat she is.
and how fat my child is.
They are both happy and fat. I guess she will continue to stay as long as she can get veggies to eat.
Yes my babysitter likes to eat veggies!

My baby is eating about 3-4 tablespoons of oatmeal or mixed cereal for lunch and breakfast mixed with formula and dinner is rice soup with bits of meat and vegetables. She can roll over and sit up tripod style. She can kinda wiggle a little but cannot crawl yet. Everything is gummed and explored orally and yes, she has one tooth on the bottom! I saw its jagged edge emerge over the last few weeks. And my happy fat baby has become a screaming awake baby at night sometimes 5-6 times a night. And I have become more grumpy at work!
ack!
Not good but its annoying as I am very tired at times.

But I am also very happy and thankful I have been given the opportunity to have another child.
David made me wait 7 years but its been worth it. I love children. I know in Buddhism its just karma links but I love my children and feel they are so precious.
I would rather have them than have an office building or a condo or millions.
They are worth more to me.

Maggie is precious to her grandparents. My sister I hope will have children in the future but she has to find a guy first. Its not easy. And a job first also. Not easy either in this scary economy.
David adn I decided today if healthcare becomes more socialized we will go to Holland which honors the us medical licenses, and live there. Or go to England where they get paid more then I do here- 175000 and everything is covered for. Basically we could work until 5pm then just forget it. We dont have to see everyone and do everything.
Which would be great- to have more family time and less pay but more pension and you cant be sued since you work for the government. Nice. Very nice.

Or just go to wall street and find a job there. They dont seem to be suffering like doctors will at all. 30% medicare cut is going to close a lot of private practices. Well some doctors werent accepting it anyways but a lot more wont now.

On the bright side, I have lost 9 pounds since I started step1 of the south beach diet. Its amazing. I only cut out the rice as much as I can and bread and potatoes and fruit and juice except for a little. I even eat a little cake everyday. But I still lose weight. Its amazing! I think I am just very carb sensitive.
I need to pick up my labs I did at FElix Chus last weekend. Fasting of course so we'll see what happens.

trying to lose weight

and not succeeding!
Maggie is having fun eating oatmeal or mixed cereal. Today I gave her organic pears with rice.
I do have to get rid of my nonorganic baby food. I bought it on sale and I feel guilty I cant gave it to her.
I put Maggie in a chair today she looks great!
She really needs sleep training. Some days she sleeps great and other days horribly. I need to read the weissbluth book again. Its very helpful and Michael sleep trained to it before.

Well a shorter entry today. We decided to put Michael in Pierce camp this year. All camps are expensive but the alternative is that he plays video games everyday or goes out biking everyday by himself which is not safe around where we live. So he has to go to camp since all the neighbors wont be around. Half the kids are going to sleepaway camp if older and if his age, going to Pierce.
We wanted him to go to OAsis but they dont pick up near us but 5 minutes away. CAmp ends at 4 pm but we both come home at 7pm. Its impossible to come home earlier. Usually David doesnt get home until 7:45pm.
Its the price we pay for a dual income family. Although not sure how other families manage on only one income. Its expensive to live in nyc!! very!
Not to mention the price of a stayin nanny ranges something like 19000 to 20000 a year.
Its insane but what can you do. We have to provide for our children something which I detest a little but noone else will look after them. Both our mothers dont want to take care of the children fulltime and they are too old to do so. Its too stressful on them.


I need to lose my weight so I can fit into my old clothes again!
More on the difficulty of disciplining a 8 year old later but Maggie is a wonderful little girl. I think she will be easy to discipline. Its like she came to this world so my life would be easier and sweeter. She still looks like Ava Maggie to me though!
Ava Maggie!
She looks exactly like my motherinlaw except shes smiling.

Got some SD cards from microcenter today so I can take more photos of Maggie! Yay. 8MB so I can fit lots of photos and only 24 dollars. Well not the cheapest thing I found some cheaper on internet but those deals always run out. And I need more photos.

time to hit the sack!
I still feel guilty for working but not sure that will ever change.
Ah well.

health care policy

I already am paid so low comparatively to others that it doesnt matter to me much. Although taxes this year were painful nonetheless.
David is absolutely livid about the bill which he feels will decrease his productivity which in a state of rising costs we dont need. I think its a good bill but ultimately who will pay for all these things. I see so many patients trying to sneak on disability its scary.
Many people were placed on it already when they get to you- you just have no say in whether they continue on or off.

Maggie had some constipation this week on rice cereal and banana. I have scaled back and added dilute prune juice which online people and Dr.Sears said to give 1:1 but we are giving more like 1:3 prune juice versus water. She had a big poop today and now is all smiles. People at work some waited until 6 months for starting cereal and some people never started their kids on it.
I guess I could have skipped this step.

This weekend was a mess but Ill talk about it another time. I have some surveys to do and some breast milk although drying up at fifth month to pump. Ouch! Ava Maggie is squeezing my right biceps as I type. She also will grab the rice bowl as you are eating and plunk! there goes a piece of curried beef. This weekend was spent foraging for vegan people mom and Gloria. There was a lot of foraging time consuming going on and we got locked out late on Sunday. I chipped my tooth on SUnday - later on found out it was a cavity filling and had to take part of Monday off to see a dentist. Its hard to find a good one! Mike went to a party on Sunday and watched a movie. Not very eventful for me.ON the flip side, David had a great vacation in Boston at conference. Next time I'm going away!... yeah right. Not going to happen- would be beset with guilt.

Enrolling Ava Maggie in dentla insurance. Had forgotten to add her to my plan.
Upcoming expenses- son for summer camp and fixing the air conditioning which since it is central will cost a pretty penny. Plus the faucet in the kitchen will not stop dripping. We need to empty the bin constantly.
Maggies favorite flavor is her right hand and her index finger. Yum!

Working and taking care of Maggie

I take care of her at nights still. Some nights are worse than others.
She sometimes sleeps thru the entire night and some days is awake a few times.
During the day she usually likes to leave me squishy presents- like poopy ones but she likes to smile as she is leaving them. Usually I can only tell by the pungent smell.
Otherwise there is no other clue the present is there.

David likes to refer to himself as the janitor and I am the night watchman- and we take care of Queen Maggie and King Michael. They have full room service although sometimes they complain and obviously we are bad servants who dont deserve a tip sometimes.

Queen Maggie started rice cereal this week and likes it. I have to add some oatmeal or mixed cereal next week. Cant wait to give her regular food! She already looks hungrily at what we eat with great interest. I would like to give her food off my plate but the dentist just told me today that causes cavities since I have cavities.

Since I have gone back to work I have noticed she is quieter, and some rashes on her face nad her bottom have popped up. I think the babysitter is being lazy but I cant really tell. I need to get some nannycams off ebay. I feel guilty but what can I do. I have bills to pay and stuff to buy every week. Its expensive to live here. Already many of my patients switched off my panel- about 30 on one insurance and some blame me for taking time off. One is so angry she calls me eggroll behind my back.
Its the working moms dilemma. Youre damned if you do and damned if you dont.
Ive cleaned her and now I can bask in the early spring sunshine lovely. Its 6pm and there is still this nice yummy yellow sunniness coming in thru the windows. Very nice! I just need a cookie and ice cream now.

Musings

We're trying to ferberize Maggie. Day one yesterday went kinda well. She fell asleep fast but woke up overnight about three times. I think she is sleeping too much during the day. I was so tired the whole day driving to my new spot in Astoria. I traveled with a GPS system and was still afraid of missing my stop.
I also have the world nastiest cough which I tested yesterday with the help of a colleague who told me it was strep negative but it is still present. Also a bit constipated so eating figs and strawberries.
I had some yogurt and oatmeal today but somehow still felt hungry. Even breast feeding a few ounces a day makes me so hungry.
Need to pass out now. I will awaken at 2AM and take that shift. David takes this shift from 9 or 10 or so until 2 am.
I like Astoria- its interesting to see Bengali Lebanese Spanish patients - they have interesting problems and the area is young and vibrant. This supermarket trade fair is awesome. Lots of different spices and things. I just dont need so much I dont know what to do with it.
I've also read the happiest baby on the block- more for newborns. Ferbers book is very scientific- and very comprehensive a bit dense for reading. Weissbluth is straightforward crying it out. Its hard to do. Actually I read somewhere we cant do Ferber until six months age- but there is nothing else to do and she likes to scream out of fatigue everyday.
well the weekend is in site! Mike is having his dental this weekend and I need to schedule mine. Maggie had her shots last weekend- age 4 months! yay Maggie!
SHe doesnt talk as much since I went back to work- I feel badly but what can I do. Buy some nannycams thats what.
David will be away this coming Saturday April 10 at conference in Boston and there is the Queens COunty Farm Museum Fair. Ive asked my sister and my mother to come help out that weekend and hope my sister can get up early. She has bad inertia.
Ive asked for vacation but it really doesnt look promising. I think I took too many days off and the upstairs got pissed. But it was my leave and I was entitled under law to take it. Well we'll see.
Ava Maggie started rice cereal this week with some formula. Wearing her ikea bib she looks so cute. Ill have to take some pictures. I got these expensive Munchkin spoons (4 for 8.00) from Duane Reade- couldnt find any other ones and came home yesterday and fed her some rice cereal. She liked eating it and some came out but I shoved it back in.
I have her eating it twice a day. We can start oatmeal later on or mixed.
Next month as per peds we can start baby food like vegetables and fruits and month after we can give juk- or as its more commonly known Cantonese rice soup.
Shes wearing Huggies size 3 and they are getting tight. Her measurements at four months are 24 inches length and 18 pounds-
shes pretty big for her age. A bit pudgy. Gotta pass out now. Night!

Ava Maggie

well Aimee this friend of mine from high school has created a blog for her child. I feel bad I didnt do this for Michael but the thought never occurred to me. I was more thinking along the lines of scrapbooking so never considered this.
I actually was reading her birth story and thought it was interesting to document my birth story. I'm pretty neurotic as I am an internist- I guess it goes with the territory. I was trying with my second baby to have a VBAC- vaginal birth after C-Section. I had some misgivings about this birth- due to my age (37 i.e. old!) and my ability to have a VBAC. After all 1 in 400 women rupture their uterus which is a less than desirable outcome.


First child Michael's story

But after having my first child Michael, I felt I needed to try for a VBAC. The painful recovery process the first time made things very hard. I was sweating on a Saturday and went to sleep because I had severe back pain but didnt think it was labor yet. When I woke up on a Sunday I realized I had passed out all night and felt my breath coming faster and faster.
I went to Mount Sinai Hospital and they told me I was 8 cm dilated. After three tries by the anesthesia resident the anesthesia attending placed an epidural on me. My friend later on told me, "Two type of people never get the right care. Lawyers and doctors."
I think I intimidated the doctors because I knew what they were doing. But this could not be helped.
After the epidural they placed an IV and I was stuck in bed in this awful position. I didn't know I could have disconnected the IV and walked around and bend into all these positions. I didn't know all this. It's weird but I hadn't really researched it. I had no idea. I guess I was afraid and in denial a bit.
So after about 1 hour of pushing they tried to place a probe- I think a ph scalp one maybe. The doctor was a OB/GYN resident of mine when I was a med student at Elmhurst. Big mistake. She was thin tanned and even more neurotic than I was.
She couldn't get a scalp pH and told me there was meconium which meant the baby was in distress. She freaked out. I don't remember the result of the stress test- anyways it doesn't matter. She recommended a C/Section and by this time I had been without water and without food for while. I was too tired and feeble to put up a protest. I didn't know they wouldn't let me eat before giving birth once I was admitted- so I didn't eat before going into the hospital. Big mistake.
I was dehydrated and told them if I got some IV fluid the baby would turn and come out. But they didn't listen and my husband got afraid and I got scared- so I had the C/section. In hindsight I should have stuck to my guns and not had it. But I was young scared and inexperienced.
After the C/Section I had severe pain for 2months and my wound got infected. I stayed in the hospital for 2 weeks on triple antibiotics and was really unable to sleep or breastfeed properly. I got stressed out. I was on leave from residency and had some time off before I started my fellowship but I was still really stressed.


Conceiving and Chinese Medicine

So this second baby I was determined to have my VBAC. I prayed about it. I didn't know how I was able to do it. My first baby I conceived the first time we tried and didn't use a condom. The second baby I was worried about fertility due to age but needn't have worried. I went to see a Chinese medicine doctor who told me to take some herbs and my mother told me to eat a whole bag of dried longan- a Chinese herb which she said would make the womb hot.
I ate it and I did feel more heat in this area.
People may think its funny that I believe in Chinese medicine since I practice Western medicine but the fact is my mother used to give me Chinese herbs all the time as a child growing up. My grandmother practiced acupressure for years in China and Taiwan. That was how she earned her living. But that is a story for another time. Suffice it to say I never differentiated between Eastern and Western medicine. I thought they were the same- something I drank that tasted horrible to make me feel better somehow. I just thought they acted in different ways. I've had moxibustion as a child, cupping as a child, acupuncture about 10 times, acupressure as a child when I was febrile performed on me by my grandmother- I believed in Chinese medicine wholeheartedly.

We tried about 11 times and I got pregnant. But I was very nervous still about risk of Downs Syndrome and autism. But my baby is fine and has no problems. I needn't have worried. But again my neuroticism.


Finding a VBAC friendly doctor

In the beginning I asked my neighbor for her advice and she told me to see another North Shore OB. But this OB told me to have a C-Section when I told her my story. I knew then I was going to have to change doctors. It was a painful process. I felt scared. A lot of physicians are afraid of lawsuits when a VBAC goes bad- ie uterine rupture or something else occurs like fetal distress and death. She said, "I love surgery! You'll just have a C-section now and if you want another child, have another C-section. " I didn't want to have another two C-sections- I didn't want even the one I had had! I was appalled that she wanted to operate so easily on me. I felt that if I was a layperson, I would have felt compelled to have the section.
Luckily I was medically trained and knew the risk and was more defiant.
I started my prenatal care at St Lukes Roosevelt. I didn't really have any OB friends to ask who to go to- so I found this website which recommended Dr.Renuka Paka as VBAC friendly. They were very nice- the nurses. I gave one midwife a hard time when I felt I needed to investigate proteinuria but they reassured me there was no preeclampsia present and proteinuria and edema was not a criteria anymore for preeclampsia but more other clinical symptoms like hypertension. I didn't know this. The nurses always called me back in a timely fashion and I didn't have to wait long in the waiting room. Transferring my records wasn't a problem. They did all my tests and got results. I did my amnio and fetal anatomy scan at LIJ since there wasnt any appt available at St Lukes or anywhere in Manhattan when I needed to do it. They were able to get the results easily at St Lukes. Front desk efficiency was excellent.

One problem was I was going to have to move to Manhattan for the birth. I was told to do this around 38 weeks. I lived in Queens at the time and this was hard. There wasn't a lot of space at my parents house and it made everything difficult.
But the problem of knowledge- I made sure I knew everything. I signed up for realbirth's VBAC refresher course when I was 2 months and ran into two high school friends there. It was so funny to see them at that time. I didn't know you had to bring your husband I didn't bring anyone. I took it again when I was 8 months and reviewed everything. This time I brought my sister since it was on a Sunday and my husband works on Sundays. She took notes and I tried to remember everything. It was only us and the instructor the second time so it was a nice small class just around me. I felt comfortable and knowledgeable. It was very reassuring. Looking back it was the best $200 I ever spent. It was also great to see old friends. Sometimes old friends even with their gap silence conversations are the best. They understand without too many words.

I also at this time lost my babysittter. We felt we had to fire her because she locked my 7 year old out of the house. He came home one day and not only did she not pick him up but she wasn't home when he knocked on the door. This was child abandonment and we felt scared Mike would be kidnapped by someone and we might never see him again or we might lose him to ACS.
I was training a second babysitter out in Queens when the contractions started. I was due on Friday and they started on a Wednesday.

I also tried to pamper myself a little this time while pregnant. After the VBAC refresher I went with my sister to eat at Kyotofu which had great tofu desserts and vegan curry. The atmosphere was light bright and happy. I also went to Candle Cafe and had tempeh sandwiches along with peanut butter jelly shakes. It was delicious vegetarian filling and tasted great. I really need to restart the vegetarianism again.


Giving birth two days early NOT in Manhattan

It was Thanksgiving week and I had to train the babysitter. Noone else wanted to do this job.
It was 4 in the morning when I felt pain. I sat down, stood up and walked around. I ate and drank. I felt fine. I did some deep breathing. I wrote down on my palm treo all the times the contractions came. I passed some blood and mucus and thought- oh that was the mucus plug.
At 6:25 am I felt I couldn't breathe easily and woke my husband up. The contractions were coming faster and I wasn't able to write on my treo anymore. I kept hoping I was not giving birth but it was coming. My husband used some sterile gloves and felt me. I was not going to the hospital until I was ready to push because I didnt want another C-Section if I was too early.
I said, "How many cm am I dilated?" My husband David said, " I'm not sure how many cm but I feel a head thats hair I feel!" I said " Oh!" That meant that I was fully dilated and ready to push (either 12 cm or something like that)
I didn't know where to go but my husband brought me to LIJ since they have SChneiders Childrens Hospital there.
I remember the guard helping me into a wheelchair and some of the nurses being mean. Yelling at me that I should know better when I am an internist to not go to a hospital where I didn't do prenatal care. I felt bad and hurt but I really had no choice in this process. Eventually I ignored them. The pain was coming and they talked about giving an epidural but my contractions were too strong and too close and they were afraid of hurting me.
I was screaming in pain and I remember the OB attending on call Dr.Jonathan Herman telling me he would try to do VBAC.
He was trying to get me to push. I remember pushing incorrectly and the nurses would try to get me to correct my pushing to be in my pelvis and not my legs. I pushed for three hours and my baby came at 9:23am. I didn't think she would come. The three hours were so long and painful. Its the worst pain of my life. I had some rectal pain while her head was crowning and then she came. She was so small and beautiful and perfect. Well I suppose all mothers say these things.
It was afterwards that I found out this doctor liked VBACS infact he told me his sister-in-law had had seven VBACS which were all successful. He did have to cut an episiotomy but I was stitched up nicely.


Postpartum Care
I left the hospital after two days. I still felt weak but not painful. This time I had burning pain from my tailbone which I think I had broken. I had an Xray which was inconclusive. My breast feeding went fine although my baby was a little hungry so I made a mistake of giving her formula. She found it hard to latch on in the future.

Strange! His office was around the corner from my previous OB who refused to do a VBAC on me. I had to meet him in the hospital though. It was predestined for us to meet. I don't think he understood what a favor he did for me. For this Dr Herman I thank you.


There is more to write but its got to wait for another day. Today we lose one hour of sleep and the baby is screaming. We're trying to sleep train her but its not working.
I need to pump my boobs - which I give alongside formula.
My husband is trying to sleep on our new couch we got from Macys-
I guess I should stop typing for another day.