Neurologist 12/7/16

Bright spot of the visit: everyone in the office went nuts over Kira, 9 1/2 months old and a big beautiful personality. ❤️

By purely physical-examination standards, I’m still doing well. All the basic neurological tests were fine, as they always are. He did ask me to get another MRI, with contrast, which I intially balked at because of the aforementioned breastfeeding reason, but after explaining that Kira would most certainly not agree to drink 24 hours’ worth of her breastmilk feedings from a bottle, he said that just dumping 1 or 2 feedings afterward would be sufficient. THAT she can do. So, an MRI is on the horizon, likely for early January to fit in with our plans to conceive Baby Glotzbach #2.


Pick your poison

I posted before about the tremendous, crushing, out-of-this-world fatigue I experienced in the summer of 2011, shortly after my diagnosis. On a scale of 0-10, 0 being “no fatigue” and 10 being “dead,” I would have rated myself an 8 or a 9. No joke. There were days, after the brutality that is a 10- or 11-hour day as a UPS driver in the Central Florida summer heat, that I wondered how I was even still alive. 

Then I became pregnant in May of 2015. This meant a first trimester—which is notorious for its fatigue, and for good reason—in, you guessed it, the Central Florida summer heat. Still delivering for UPS. It was very familiar to 4 years past, and very difficult.

My third trimester fell in the winter months of December, January, and February so I didn’t have the heat to contend with, but as the third trimester is almost as tiring as the first, I still had the fatigue. (And yes, I was still working.) 

I’ve never been good at the “which is worse?” game, but if I had to decide I’d say that the MS fatigue and the first trimester of my pregnancy were about equal. Equally exhausting! 

Stay out of my spinal column 

I am unusual among persons diagnosed with MS in that I have never been subjected to a lumbar puncture for the purpose of diagnosis or any other reason. I was diagnosed via an MRI in 2011 that showed such a large spinal lesion and two smaller brain lesions that it was unmistakable. 

I hate the idea of a needle going anywhere near my spinal column so much that it was in part why I wanted nothing to do with an epidural during childbirth. There is no way I would want a lumbar puncture; the very idea makes me queasy. No, you certainly will not insert a huge hollow needle into my back and withdraw cerebrospinal fluid, thanks very much. Just no. 

Thank goodness for modern diagnostic practices based on imaging and observation of symptoms alone. A needle in my spinal column. WITHDRAWAL OF FLUID. Are you kidding me??

Just say no (to contrast dye) (just this once)

I last saw my neurologist in December of 2015. I was 7 months pregnant and they said that they would like me to have an MRI in March, after I gave birth, just to see how things were going since a relapse is more common in the weeks following childbirth. Since I’m almost always very agreeable with any request a healthcare provider makes of me, I said sure no problem. We’ll call you to set it up, they said. 

March came and went without a call. As did April, and May, and now most of June. My next appointment is on July 12th and the subject of the MRI will likely come up again. 

During December’s discussion, they said that since I was planning on breastfeeding my baby, I would need to “pump and dump” my breastmilk for 24 hours following the MRI due to the contrast dye I’d be injected with. “No problem,” I said. Naïve, pregnant me assumed I’d be able to pump 24 hours’ worth of feedings well in advance and just feed baby-to-be from the bottle until I was in the clear. Baby-to-be would happily drink my lovingly-pumped milk, I’d have my MRI, and life would be roses. 

Ha. Ha-ha-ha-ha. That is the sound of my maniacal laughter at the whimsical notion of Baby-to-be disappearing and the reality of Baby-that-is taking its place. Baby-that-is is a lovely 4-month-old girl named Kira who laughs in the face of a bottle. And sometimes cries. And absolutely refuses to drink from one. Well, I take that back—she’ll occasionally sip from one, maybe even drink an ounce here and there. But 24 hours’ worth? An entire day??


So I’ll politely explain the situation and say “no” to an MRI with contrast until she’s weaned. Sorry-not-sorry.

I’m sure they’ll be thrilled. 

Sorry, doc…for me, breast is best

I’d always wanted children, and being diagnosed with MS didn’t change that. I’d also always wanted to breastfeed. It was important to me for several reasons: the health benefits to my baby, the convenience factor—no mixing bottles, etc.—the benefits to me as a nursing mom (faster postpartum weight loss, delayed hormone crash, possibly delayed return of menstruation and fertility) and the bonding time for both of us.

When I discussed my family plans with my neurologist, he assured me that of course having children would be no problem, and I could go ahead and go back on Rebif afterward. When I mentioned that I planned to breastfeed, he suggested that that would be perfectly appropriate, and—from what I remember him saying—around 3 months or so. (I am not directly quoting but that was the gist of what I remember being said.)

Um….no….I don’t think I’ll be doing that. That doesn’t work for me.

Rebif worked fabulously for me while I took it. For four years, I experienced zero relapses. The first came only after I had stopped Rebif for six months. I have no problem returning to it someday, as I know it worked and the benefits outweigh the annoyance of thrice-weekly shots (as discussed in an earlier post). But right now, for me, nursing my daughter is more important than jumping right back into an MS treatment regimen. I’m planning to breastfeed exclusively for the first six months of her life, and would like to continue after the addition of solid food until she’s a year old.

I guess it’s a calculated risk. From prior experience, obviously the chance of another relapse is higher if I stay off the injection. However, breastfeeding and the hormone levels that go along with it continue to offer some protection. And since I’d like to have even more children, if I were to get pregnant again after weaning—which would mean even longer off Rebif—that same hypothetical pregnancy would offer further protection still.

Kira needs her mom; a mom who is not disabled would be preferred. But I’ll be 35 in August of this year, and my fertility window sadly won’t be open forever. And Kira herself will only be this little just this once…let me feed her, doctor. Let me enjoy this closeness as in just these short months of her total dependence only I can feed her. The breast is the best for us.

A Labor Story

My due date of February 18th came and went. This was no surprise as I knew that a “due date” is nothing but a general guideline. I was told to have an ultrasound before my next appointment, which would have been at week 41, just to ensure that all was normal, Baby Glotzbach (gender unknown) was still doing well, amniotic fluid levels still good, etc. As I hadn’t seen my baby since the 20th week, I was happy to comply. I scheduled it for the following Wednesday, the 24th.

On Monday the 22nd, very late at night, I started to shed my mucus plug. I’d had Braxton Hicks contractions the last 12 weeks of the pregnancy but the contractions had become more like real labor ones as of late, so the beginnings of the loss of the plug didn’t surprise me. Finally, we’re getting things going, I thought.

Late Monday night/early Tuesday morning of that week was also when the early labor contractions got strong enough that I had trouble sleeping. I took the first of many middle-of-the-night showers then; the hot water helped soothe the discomfort.

My contractions were less strong during the day Tuesday; I was able to nap a little and take my usual walk around the neighborhood that afternoon. I also hoped that walking would move the process along with the combination of exercise and gravity. Tuesday night was a repeat of Monday night: increasingly intense contractions and more hot showers.

Wednesday morning I was fatigued and uncomfortable to the point that my husband called both the radiologist’s office to cancel the ultrasound and the birth center to advise that I was in labor. They told him to have me call back after noon if there was much change. By that point, as had happened the previous afternoon, I was more comfortable so I didn’t call.

Wednesday night was the worst yet; no sleep for either me or hubby and 4 (or maybe 5) hot showers where I had to lean against the shower wall and breathe deeply through contractions which ranged from 5-10 minutes apart. I was counting the hours until 11 a.m. Thursday and my next appointment at the birth center, where I’d already determined I wouldn’t be leaving without having had the baby!

Thursday morning: going on day 3 of little to no sleep and facing an hourlong drive to the birth center, I was crabby and exhausted already and little did I know how much more of a marathon awaited me! My midwife was waiting for me, already in her scrubs, and the first thing I said was, “Hi! I’m not leaving!” When she checked me she said I was 7 centimeters dilated and the amniotic sac was bulging—nope, not leaving! I could tell I’d made progress over the week, but I was surprised (and excited!) that I had made that much.

We unloaded the car of all our luggage—I don’t use that term lightly; we had the bag for the baby, the bag for me, the bag for my husband, my (large) purse, and a cooler of food and drinks; we looked as though we were moving in—and went to get lunch up the street and take a walk by the lake. In the restaurant, of course being hugely pregnant, patrons asked the usual question: when are you due? I replied “A week ago, and I’m actually in labor right now!” I got a kick out of people’s reactions.

Once we returned to the birth center, I spent the next several hours in the jetted tub. It felt so good, almost good enough to not be bothered by the increasing contractions. They were intense and painful but I didn’t doubt I could deal, especially since I (mistakenly) assumed that since I had been at 7 cm at 11 o’clock, things would progress quickly. Oh, the things us naïve first-time moms tell ourselves. I really thought—and this was bolstered by my midwife’s opinion—that I’d have a baby by that evening.

After a few hours in the tub, I got out and walked around the room some, trying to get more comfortable. I tried leaning against the bed; I tried kneeling on the bed; I tried lying down ON the bed—that was pretty bad, because I was so tired that all I wanted to do was lie down, but the contractions were the most painful in that position. My water still hadn’t broken and my midwife asked if I wanted her to do it, but I said absolutely not—I was still insistent on NO intervention at all. And, ok, I was afraid it would hurt—a rather silly fear, given that I was in the middle of a natural drug-free childbirth, but I’ve been known to be irrational on occasion and sleep deprivation didn’t help matters.

By 4 a.m. Friday morning, I had not had the baby and I’d started to feel like pushing, which I attempted to do in a somewhat all-fours position on the bed. My midwife checked me, found I was 9+ centimeters….and while she was up there, ha-ha, casually went ahead and broke the sac. You guys….the amount of amniotic fluid that POURED out of me was UNREAL. It gushed and gushed like a faucet! I totally screamed out loud, out of sheer surprise—of course, obviously, I’d never felt anything like that sensation in my life. I went into the bathroom and looked in the mirror; my bump had literally deflated like a balloon.

Once the water had broken, did the real contractions ever start! The intensity ramped up instantly. For the next several hours I continued to dilate—the cervix had receded a bit because the amniotic sac had been holding it open—and tried to rest between contractions if I could, which didn’t amount to much rest at all. By this point I’d basically been awake, save for cat naps earlier in the week, for 96 hours straight. I was more dead tired than I’d ever been, and for an MSer with incomparable fatigue at various times, that was saying something.

Finally at around 7 a.m. Friday I began to push in earnest. Despite emptying my bladder at regular intervals, it continued to empty itself, vigorously, onto the bed as I pushed—if I wasn’t so tired I would have been horrified—I was a little horrified anyway, and was just thankful it wasn’t poop. (I did end up being part of the like 5-10% of laboring women who did manage NOT to poop at all during delivery, thank the Lord, Mary and Joseph.) As baby was not making his or her appearance in the position I was attempting, on all fours on the bed, my midwife suggested we try something else. She suggested I sit on the toilet, which I tried for precisely ONE contraction, then said no more—it was very painful and I didn’t have any leverage, anywhere to put my hands to brace my arms—it was a no go. So she suggested the birthing stool, which I agreed to; gravity would help but I’d have a way to brace my arms as I pushed.

And, the stool was the ticket—at 9:18 a.m., on Friday, February 26th, a GIRL was born—Kira Elizabeth, 7 pounds, 4 ounces of perfection. She flew out of me with the final push after her head came out, born with eyes wide open, and cried right away. She was nothing but smooth and wet and slippery; no vernix, no wrinkly skin (which amazed me given the amount of water she’d been swimming in!). After 3 days of early labor and 22 hours of active labor, she was finally, finally here. (And did I mention perfect?!?)

Save for the time it took (I never expected such a long labor, given how active and in shape I was), the whole process was exactly what I’d always wanted: a completely normal, uncomplicated pregnancy; a relatively calm birth without intervention, management, or manipulation by other people; and a gorgeous, healthy daughter (by far the best part of all, since I had badly wanted a girl). It was the experience I’d always dreamed it would be, well before multiple sclerosis was ever a factor in my life. I’m so grateful that having MS didn’t impede my ability to experience this, and so glad that having kept up my physical and mental strength since my diagnosis enabled me to endure and persevere!
Thanks to my loves at Heart 2 Heart Birth Center in Sanford, Florida, and especially special thanks to my midwife Karen Bove—without whom this could not have been possible. ❤️