Thursday, June 21, 2007

That's Right... I'm Going to Complain

I have been loathe to complain about my pregnancy on this blog. Yes, I had a post about rhinitis of pregnancy and have alluded to my vomit fests and my tingling/numb thigh, but I really have tried not to go on about it.

I have been loathe to complain about my pregnancy thus far because (a) I am just so thrilled to be pg that I kind of haven't minded the physical stuff very much (and I liked having symptoms because they were reassuring), (b) I tend to downplay my physical ails to most of the world as a general rule so I've continued to do that during pregnancy, and (c) because my symptoms haven't been truly debilitating so I don't feel like I have a right to complain.

But I'm going to complain about the psychological ails because I am not as equipped to cope with them... namely, anxiety. I have always been prone to anxiety. Not enough to be diagnosed with a disorder. I've done scales with a therapist and everything and they never qualify me for a diagnosis. But despite that, I am a pretty anxious person.

What are you supposed to do with anxiety when you're pregnant? I can't go for a hard run, which is my favorite anti-anxiety strategy ordinarily. I've been exercising daily by walking, but walking just isn't the fix that running is for me. I can't have a glass of wine or overindulge on chocolate (sugar crosses the placenta). I am really not cut out for meditation, I don't think, but at this point, I'd probably try anything if someone has a good concrete, safe-for-pregnancy suggestion for me.

Safe-for-pregancy. That's a laugh because that's the cause of my big anxiety at the moment. Before conceiving, I tried to do everything right. (I realize that's a big part of my problem. I'll get to that later.) One of the things I did was make an appointment with my PCP and have her switch all my meds to safe-for-pregnancy Category B meds. For example, she switched up my inhaled corticosteroid asthma medicine from Adv*ir to Fl*vent, and told me that Fl*vent was "Cat B."

When my MWs told me that Fl*vent was Category C, I wasn't too alarmed because I remembered the conversation I had with my PCP. One of the MWs even said that her reference book was an older book, so maybe it had been changed to Cat B, but that I should check it out with my PCP.

Well, I did. I wasn't wrong that my PCP had told me it was Cat B. She had even written that in my chart. She was wrong about Fl*vent being Cat B. It is clearly Cat C, according to every single source she looked it up in. She must've read it wrong somehow. Apparently, animal studies have shown Fl*vent to cause slow embryo growth and birth defects (specifically, cleft palate) in mice, rats, and rabbits. There are no well-controlled studies on pg women to say either way if the same is true of human fetuses. Hence, the Cat C classification.

The appointment got frustrating after that. My PCP first tried to switch me to a whole new class of Cat B drug called mast cell stabilizers (Crom*lyn). I asked if those were related to Singul*ir, because I'm severely allergic to Singul*ir. (Yes, I'm allergic to an allergy medicine. What can I say?) Even though Crom*lyn is not related to Singul*ir, me noting my propensity for allergic reactions scared her off of switching me to a whole new class of drug that I've never tried before. She switched me instead to the Cat B/C inhaled corticosteroid Pulm*cort. My MWs and severa sources list Pulm*cort as Cat B. Pulm*cort is considered safe to use during pregnancy because there have been controlled studies involving pregnant women who used it and no teratogenic effects were found. However, my PCP said it wasn't Cat B, it was Cat B/C because some sources still considered it Cat C. So, the rub is... everyone agrees that Pulm*cort is less effective than Flov*nt in treating asthma, but there is not universal agreement that it's Cat B. Still, I'd rather take that than Flov*nt.

My PCP passed the buck and has referred me to a pulmonary specialist who has the wackiest hours ever and I haven't even been able to speak to someone about making an appointment yet. So, during pregnancy, I apparently must see 2 specialists that I never needed to see when I wasn't pregnant: an endocrinologist and a pulmonary specialist. It's making me feel like I'm too sick to be pregnant. If that's true, why didn't someone tell me that before I got pg? My R.E. and my PCP both knew I was TTC. No one told me I was too sick to do that.

So, my PCP prescribed the Pulm*cort Turbuhal*r for me, but I don't have any Pulm*cort yet. That's because apparently the company now only makes the Pulm*cort Flexhal*r, which comes in different doses than the older, no-longer-sold Turbuhal*r. So, my pharmacist can't give me any until my PCP calls back and tells him which dosage of the Flexhal*r to give me. So, basically, right now I have no safe meds for controlling my asthma in my house, except my Albuterol inhaler, which doesn't treat my inflammation.

In case you're wondering if I could just go off all the inhaled steroids, that's the other thing that all my medical professionals seem to agree that I shouldn't do. It's a risk-benefit thing. The potential complications of me having a severe asthma attack during pregnancy are much worse than the potential complications of taking a Cat C medication. An attack during pregnancy could mean Flipper goes without oxygen and that of course could result in death or developmental disabilities. A severe asthma attack isn't likely if I go off the inhaled steroid meds though. They're anti-inflammatory meds, so most likely I'd just have tightness in my chest, shortness of breath, and wheezing. Could I live like that for the next 5 months if I had to? Sure. Would that be better for Flipper? Probably not. Me choosing to live with uncontrolled asthma will increase my risks of premature birth and all kinds of other bad things. So, again, it's less risky to take a Cat C med than to not control my asthma for the rest of the pregnancy.

(Oh, and I already tried going off it anyway, against medical advice. I didn't tell Lo. I just stopped taking the Flov*nt to see if maybe I was one of the lucky 1/3 whose asthma improves during pregnancy. Three days after stopping the Flov*nt, Lo told me she could hear me wheezing and that my breathing didn't sound good. She asked me point blank if I'd stopped taking my Flov*nt and I fessed up that I had. So, basically, the answer is... if I stop taking an anti-inflammatory med, my asthma is not going to be controlled. If only it were that easy.)

The worst thing is... now I'm really anxious. If the Flov*nt was going to do any damage, it's probably already been done during the first tri, when I mistakenly thought it was "safe-for-pregnancy".

Not being the most rational person on Earth, I have already convinced myself that I have given Flipper a birth defect. (I haven't slowed his growth though, because he has measured ahead at every u/s.) Now, if Flipper has a cleft lip or a cleft palate, that really isn't the end of the world. I know that. And if that had happened and it was just one of those random occurrences or something, Lo and I would be upset, but we would love our little Flip and deal with it and ultimately, it would be fine. But that's different from knowing that Flipper might have a birth defect that I CAUSED. I mean, really, shouldn't I at least wait until the kid is born before f**king up his life?

And I know there's a good chance Flipper is fine despite the Flov*nt. Lo keeps reminding me that I'm not a mouse or a rabbit.

But that just doesn't soothe me. Maybe I'm keyed up from the hormones so the anxiety is worse than usual. Maybe I just have been trying too hard to be perfect during this pregnancy and can't deal with the fact that I am not. Maybe I am just furious that my body isn't healthier than it is.

So, sorry, but I'm going to complain about this. Maybe I'll feel better after complaining. Maybe not. But it's all I can think to do.


S. said...

Co, hugs and sympathy. I'm surprised it's so complicated, when you can't be the only pregnant asthmatic out there who's dealt with this stuff! And I'm sorry you're having to worry now.

The pregnancy hormones themselves are whacky. I had severe meltdowns at least weekly--A. still tells the story of the pluot that made me cry.

Trista said...

Kristin had to take a class c maintainance drug during her pregnancy (can't remember what it was, but she couldn't go off it) and she read that the reason it was class c was because it gave rats extra digits... so all through the pregnancy she dreamed of a baby with rat hands that had extra digits on it. It sounds silly now, but at the time it was incredibly stressful.

I'm so sorry that you're having this same kind of stress.

Jude said...

Pregnancy is 40ish weeks of making rational, together women feel incompetent. I believe this with my whole heart.

I think that EVERYONE is anxious during pregnancy, especially when someone has gone through fertility treatments or have had pregnancy losses, etc. It's totally natural.

What to do? Well, I wish I had an answer but I don't. I really just acknowledge that I am more anxious, and that anxiety is because I love and want to protect my child.

You are doing a good job.

Melody said...

I can't contribute anything to the asthma meds discussion, but I just wanted to tell you to complain all you want. If getting pregnant is hard, you deserve the right to complain about it. If BEING pregnant is hard, you deserve the right to complain about it-- no matter how grateful you are to have all of those pregnancy ailments others covet. I am sorry for all of the mental and emotional anguish this is causing you.

Sandra said...

Having a full fledged anxiety disorder, this is well within my experience. Rescue remedy is completely harmless and many people find it effective. Talk to your mw about it.

If that doesn't work, I find motherwort tincture effective. The biggest risk I've heard of is addiction, but frankly, the stuff tastes so foul I've never managed to pick up an addiction. Seriously, it's THAT bad. Talk to your mw about that, too. I first had it recommeded by Miriam when I was recently off of rx anxiety meds and it helped me a great deal.

Jennifer said...

I took all my asthma meds through pregnancy. Singulair, Uniphyl, Flovent and Ventolin. I wasn't one whose asthma improved but thankfully it stayed controlled.

It was one of the few things I didn't feel guilty about...I felt that it was more important that baby got oxygen on a regular basis.

Co does have a point about you not being a rat...I had a conversation with my Respirologist about all of this when I was pregnant (I went for a second opinion). He told me that the amounts of drugs that are required to have those adverse reactions in rodents are so high that it would be impossible for you do take that much.

Like the others have said, pregnancy is 40 weeks fraught with completely irrational fears and behaviours.

BTW, I saw a study done that showed mothers who consumed chocolate during pregnancy had happy babies. Go on and eat that chocolate ;)

oneofhismoms said...

I'm anxious, too. My answer (totally pregnancy friendly, too) YOGA, YOGA, YOGA. I think there must be a studio, like, eleven feet from your apartment.

Gretch said...

I'm sorry all the asthma-related drug choices and inconsistent info is increasing your anxiety level. Anxiety is no fun. Hoping you're able to get the appointments (and a little bit of reassurance) you need, soon.

In the mean time, try to focus on how well Flipper is doing (as evidenced by measuring ahead of schedule and the good nuchal results, etc) and that, as Lo so helpfully points out, you aren't a rabbit OR a mouse!

Sending lots of positive and relaxation thoughts your way!

A lurking doula said...

swimming is a GREAT way to get your endorphin high during pregnancy! if you go for a nice, vigorous swim, it can leave you feel better anxiety-wise, and provide some nice, gentle support for your tired muscles, shifting bones and softening ligaments as well! Congrats!