Showtime!

Maternity leave seems to have extended to blogging as well as employment. I feel that this is part of the nesting process, as priorities change and focus narrows as birth approaches.

I came up with the title for this post several months ago. As I was preparing for birth I was concentrating on the natural, instinctive cooperation between my body and baby. As the process of childbirth remains almost indescribable to those who have not yet experienced it first hand, first time mums will I suspect always feel that they don’t have all the facts as they approach this astounding phenomena.

As such, I tried to quell any anxieties I had by trying to focus on birth from the baby’s perspective; of arrival, of action and of his first breath.

For the past nine months he had been flexing in my womb, developing organs, practicing breathing (you can feel them do this by the way). He had been rehearsing.

Now, as labour commenced, this was showtime!

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What You Need to Know About Kidney Stones in Pregnancy

It turns out I spoke too soon and ended up with another hospital trip over the weekend.
But, as promised, I’m going to put the past month and a half’s worth of hospital visits, doctor’s notes and NHS time to good use.

When I was initially diagnosed with kidney trouble: renal colic and potential kidney stones on 1st June, I did what many of us with internet access do and started to research online the condition, medication and potential impact on my pregnancy. Whilst NHS Choices (UK) and the National Kidney Foundation (USA) provide detailed explanations of what kidney stones are, how they form, treatment options and comprehensive lists of symptoms, they have little relating specifically to pregnancy.

The reason it is so hard to find out about kidney stones in pregnancy is because they don’t occur frequently enough to be classified as part of a ‘normal‘ pregnancy (which, by the way, does not exist). Most online information revolves around prevention, which is great, as the famous Benjamin Franklin quote says: ‘an ounce of prevention is worth a pound of cure’. But we pregnant women already pile huge amounts of blame and pressure on ourselves regarding what we are doing and experiencing throughout gestation and reading that drinking more water might have prevented this current agony does not help. Besides, in pregnancy, kidney stones are about more than mere hydration.

My online research wasn’t giving me much so I wanted to convert the oral information given to me at the numerous appointments with obstetricians, general practitioners and urologists into a post for the benefit of others.

Why Does Pregnancy Make You More Susceptible to Kidney Stones?

Hydration is of course important at all times and during pregnancy a woman’s body does require more fluid for the changes and creations that are occurring. These changes result in the body working harder, including the kidneys.

1. Increased blood volume during pregnancy means increased filtration for your kidneys as they work to remove waste and return nutrients. With increased water consumption the kidneys ideally have enough fluid to filter effectively and prevent the crystallisation of minerals within the organ which can develop into kidney stones. Yet increased blood volume equates to more work and there are more minerals to filter.

2. There are several different types of kidney stone, the most common being composed of crystallised calcium. In addition to increased blood volume during pregnancy, there is also more calcium in your blood because of the developing fetus. Not only is your body absorbing more calcium during pregnancy, but your kidneys are also extracting more, potentially leading to an increased build up of this mineral either as crystals or, eventually, as stones.

3. In addition to your kidneys working harder for you with increased blood volume and calcium extraction, they are also working for your baby. Although the major organs are formed early on in gestation, the fetus still has no kidney function of its own until 10 weeks. At this time your baby begins to drink from the amniotic fluid surrounding it, produce urine and replenish the amniotic sac.

4. However, despite babies having their own kidneys from 10 weeks onwards, you body is still doing a lot of the work until the very last stages of pregnancy. Although the fetus is producing urine, there is still plenty of waste, excess water and other substances transferred between mum and baby via the umbilical cord. It is mum’s kidneys that are then filtering and extracting these extra materials prolonging their increased workload.

5. As with many medical conditions kidney stones have a tendency to reoccur. If you have had kidney stones in the past you have an increased chance of developing them again, especially during the extra strain of pregnancy.

Should You Worry?

I experienced a brief lull and calm after receiving a diagnosis. However, it didn’t last long as although I now had some comfort from what was causing the extreme pain I was experiencing, my thoughts turned immediately to what this might mean for my unborn child.

This was what fuelled my initial online search for information about kidney stones. Typing kidney stones and pregnancy into a search engine can result in some pretty concerning, yet entirely unrelated, findings. Predominately, the results generated will be to do with kidney infections, kidney failure or urinary tract infections. In comparison, kidney stones are not something to fret about. They can be incredibly painful, but it is mainly an issue that affects mum as opposed to baby. The main problems from kidney stones result from pregnancy rather than the other way around.

1. As I have detailed in another post dedicated to medication, there are very few pain management options available during pregnancy. It is usually this, rather than the condition, that results in the increased rates of hospitalisation for pregnant women with kidney stones, not the stones themselves.

2. Usually, kidney stones are left largely to their own devices. This should immediately reduce the rate of alarm because if there were risks to the fetus you can guarantee that there would be very swift action taken (as there would be in the case of infection). Whilst it is far from a pleasant experience, most stones are small enough to pass on their own.

Particularly large stones can cause blockages and then interventions will be investigated. Treatment of kidney stones is complicated by pregnancy as the most accurate method of detecting them is x-ray, which of course will not be used on an expectant mother. Some doctors believe that the risks are negligible but this is a conversation that you would need to have with the consultant or urologist. Ultrasound is the alternative and is still very accurate for detecting large stones, or their presence if the kidney is swollen or puffy.

In the case of blockage or infection (as with urinary tract infections which can be delightfully frequent in pregnancy) there can be a risk to your baby if your temperature rises or a fever develops for a prolonged period. It is always advised that you contact your health professional in the case of developing a temperature, whatever the cause.

Treatment

In these cases treatment appears to be the same for both pregnant and non-pregnant patients. Ultrasound waves may be used to break down the stone (given the much more alarming treatment term of extracorporeal shock wave lithotripsy – eek!) or surgery. Today, it is rare for open surgery to be performed with a ureteroscopy being the more likely.

Antibiotics will be used to treat infection, opening up an entirely different set of decisions for pregnant women and their healthcare providers. As with pain management the options are limited and it may be decided to administer them in hospital rather than with a take home prescription.

As usual, this post carries the disclaimer that I have no medical training and that any symptoms that are causing concern should be discussed with a health professional and not self-diagnosed on the internet. This post is intended to compile information and highlight options, not to advise.

Medical Update

Friday 13th is perhaps not the most reassuring date for a hospital visit.

I am so grateful for the NHS and medical teams in Scotland. At all my many hospital trips over the past few months the nurses and doctors have been attentive, listened and smiled.

This year celebrates 70 years of the NHS, providing free healthcare to the entire UK. There are funding, staffing and overtime issues, but we are better off with it than without and it is so important to remember all the medical staff who work so hard and such long hours to keep it going. I felt I had to give them a heartfelt mention.

Today’s Update

If there ever was a kidney stone, there certainly isn’t one now.

Thankfully I have had no flank pain for almost a month, and the ultrasound scan two weeks ago showed no swelling and all blood and urine tests have been clear of infection.

The suggestion currently is that baby is lying on a nerve or some other vessel which is what causes the sporadic cramping when I urinate.

Whether baby is responsible for the constant abdominal pain that was perplexing doctors 4 weeks ago is something I am still doubtful about. He would have had to have been lying on the same place for an awfully long time to generate such continual severe pain. (I know he doesn’t stay in the same place for long as, since I have started to feel his movements, I can feel him wriggle around in accordance to the flares up of cramping I am experiencing).

A nurse did scan my bladder and found a little retained fluid, but the doctor explained that the machine can pick up amniotic fluid by mistake. So essentially there is fluid in my abdomen which may or may not be meant to be there…

Fun Facts

As ever though, with each appointment a little more knowledge and understanding is gleaned.

Although you won’t find much information out there about kidney stones in pregnancy (I hope to post up something shortly to rectify this) there is a trend between pregnancy and kidney stones because:

1: your body produces more blood so you kidneys are filtering a higher quantity than usual.

2: more calcium is passing through your kidneys, increasing the possibility of it crystallising and forming a stone.

3: in addition to your kidneys working extra for you they are also working for baby for the first 10 weeks as the fetus has no kidneys of its own at that time.

We all know how important hydration is, especially in pregnancy but it really is the most effective prevention against developing kidney stones.

I also learned a fun fact about kidney ultrasounds today (you can see I have had too many appointments as I am now describing this information as ‘fun’).

I mentioned in a previous post about that ultrasound is considered less effective but of course considerably safer during pregnancy than x-rays. Today the doctor inform me that the ultrasound scan is 90% effective and that what the sonographer is aiming to identify is any swelling or puffiness of the kidney itself, or any signs of blockage within the tubes connecting the kidneys and bladder.

As long as there is no blockage, kidney stones will be left to pass by themselves (I have a whole post on pain management during pregnancy which you can find here) which is usual treatment for kidney stones in non-pregnant patients as well (although they have more options for pain management). It is soley down to pain management that leads to the hospalisation of pregnant women with kidney stones.

If stones are particularly large, there is swelling or a potential blockage, urologists will consider treatment. Ultrasound may be used to break up the stone or surgery may be considered.

The doctor today mentioned (to my surprise) that had swelling been detected at the ultrasound the temple would have considered an x-ray and that the risk to my unborn child is negligible… bearing in mind that I am a completely untrained with no medical background whatsoever… I’m not convinced by that, especially given the information from other doctors I have seen. But I do imagine that there may be extreme circumstances where the risk to mum not having the procedure may be more than the risk the procedure holds for baby.

Conclusions

The matter seems to be put to bed for the time being. We can move forward with the confidence and reassurance that both baby and I are healthy and that everything is functioning as it should.

Now I can relax, hope baby stops elbowing my bladder or whatever he’s doing to cause this periodic cramping and just enjoy the rest of my pregnancy (despite the unabating nausea…).

Disclaimer: I am not a medical professional. I am just relaying personal experience and the information that has been given to me by doctors, nurses and that I have uncovered through my own research. As I could find very little online when I first started this unpleasant process I hope that by creating these posts I might be able to assist somebody else. 

 

Prognosis, Prognosis, Will We Get a Diagnosis?

Since my last post, there have been no more surprise hospital visits, but a lot has been going on.

In addition to having an anatomy scan, with everything that has been happening we decided we wanted to know if there had been any effect on the pregnancy. Although we would have gone to term regardless, it gave us peace of mind, and just as the baby kicks had done, it made the pain of the past few weeks, disappear from my memory.

It is often banded about that you forget the pain of labour and discomfort of pregnancy once you have delivered your beautiful baby, and clearly that can happen during the pregnancy as well.

Upon feeling my baby kick for the first time, I couldn’t remember the intensity of the pain I had been feeling for weeks before.

At this time, I have been off sick from work for a month. I had a kidney scan last week, an ultrasound is the only safe way to view the kidneys during pregnancy, as I detailed in my posts on pain and medication in pregnancy.

Good news! There was nothing visibly concerning about my kidneys, so despite being in hospital with severe pain within my renal system a month ago, the cause (whether it was a kidney stone or not) seems to have passed and left no impact on these vital organs.

Where Does This Leave Us?

On Friday, I have another hospital appointment, this time at the urology unit.

The pain has thankfully decreased in frequency and intensity, but I still have seemingly random flare ups.

In addition to the obvious relief that two of my vital organs are functioning as they should and have come through unscathed, the results of the kidney scan mean that I can know park that suggested cause at the hospital door.

The aspect that has caused most confusion (and thus distress for this mum-to-be) is that with a kidney stone (as was first assumed) there is the intense pain that I experienced during my first hospital trip and then the pain decreases and passes along with the stone. What it does not do, is sit, constantly in the centre of your lower abdomen.

This is what was happening for the first 2 weeks, between our two midnight visits to hospital. As I mentioned, it has lessoned since then, from being constant to arising every few days.

This past week especially, it appears to have been most intense when urinating, as an acute cramping sensation. This has not been accompanied by any of the usual symptoms of a urinary tract infection (UTI), a burning or stinging sensation whilst passing urine.

So, whilst UTIs are really common in pregnancy, I think you can sense the scepticism I am feeling towards that prognosis.

We’ll see if we can get a more concrete idea of what is occurring on Friday…

Pain in Pregnancy: It Isn’t Always Wind!

Late Friday night I was admitted to the maternity ward with severe abdominal pain.

It had begun on Thursday, and I assumed that it was the usual pregnancy fun; bloating, trapped wind and the general nausea trend. During the second trimester you can also experience the gradual reduction of your stomach capacity as your uterus increases with size.

So discomfort after eating was not a huge surprise or of noted concern.

‘It’s Just Wind’

I woke up on Friday morning with the same discomfort, still assuming that it was attributed to ‘normal’ (we discussed how inappropriate that term is in my last post) pregnancy effects.

I went to work as usual, guiding tourists around the city. This appeared to escalate the discomfort to intense pain, shooting up my left side from my lower abdomen to under my ribs. After almost vomiting from pain, I finally limbed my way back to the tour office.

Almost in tears, I entered the staff room and was met by concern from some of my colleagues enjoying a cup of tea. As I told them what was wrong, I started to cry. They lovingly reassured me that ‘it’ll just be wind’.

Trapped wind is very common in pregnancy and really can HURT! But I still felt embarrassed and silly for making a fuss about something so typical and that I had experienced on many occasions.

This sense of shame worsened as the pain failed to abate, even with peppermints, ginger tea, and reduced movement. I was observing trainees on tours in the afternoon, but even though this is considerably less effort than delivering a tour, the pain continued to worsen, accompanied by severe nausea.

I had assumed that once I got home, I would be able to relax and finally get some relief. However, the pain continued to increase until I was finally in tears. This is not a usual response from me, it alarmed my husband and made us wonder if it really was ‘just wind’.

A Midnight Trip to Hospital

After a call to NHS 24, we were given an appointment at the Out of Hours clinic, were two lovely doctors examined me and concluded that it defiantly wasn’t bloating or wind, but an infection of some kind.

They considered it best that I get seen by an obstetrician to be on the safe side, and get confirmation that baby was absolutely fine. To be honest, I was reasonably confident that this pain was occurring around the baby, and not actually related to it, as I had no cramping pains or spotting.

We were at the Maternity Unit for almost 4 hours, with a series of urine and blood tests. It was concluded that it was likely that rather than an infection, I had a kidney stone and the immense pain I was experiencing was the resulting symptom. The official term for this pain is renal colic, which sounds about as pleasant as it is.

Kidney Stones in Pregnancy

The risk of developing a kidney stone is apparently increased during pregnancy. Given the increased workload for the kidneys during gestation, due to the mother’s increased blood volume and the fact that the baby has no kidneys of its own until about 10 weeks. The amount of fluid you need to intake is increased as well, which makes hydration increasingly important to ensure that the kidneys are filtering your blood effectively.

You can get more information about kidney stones here and of course on the NHS website.

A New Lesson

To be honest this post is a little more personal than I was envisioning when I started blogging. I never intended to be sharing hospital trips on the internet. However, I felt that it was important to share this particular experience because although my colleagues are right and a lot of the time the discomfort you are feeling is part of a ‘normal pregnancy’ experience, sometimes it isn’t.

A lot of the time pregnant women will be told that how they are feeling is just part of being pregnant, to grin and bear it, and it can feel that your experience is minor to someone else’s. But as I stated in my last post, Samuel’s aunt gave me great advice: not to diminish how you feel because someone else is feeling something else.

It is great to share experiences, they can be reassuring and beneficial, but never take someone else’s opinion or advice over your own instincts.

The other thing that pregnancy women are told, usually in preparation of birth, its to know and trust your body.

I have experienced bloating and wind A LOT during this pregnancy, and deep down I could tell the difference. Although my colleague had originally reassured me that it was ‘just wind’, she also could see that by the end of the working day, my condition was not improving and suggested that I seek medical advice.

I delayed in doing this because I was worried about being embarrassed again, of calling out of hours and being told it was ‘just wind’. No one likes to feel that they are making a fuss over nothing, or that they are overreacting. My colleague had not given any impression that she thought this, as I say her reassurance was very lovingly given, but it didn’t change how I felt about myself.

So that’s my lesson, especially to first-time mums. Know your body, trust your body, and have the confidence in your conviction that your body is reacting differently, or more intensely, because it is reacting to something new.

You can follow my medical adventures here.

Changing the Narrative Around Medicated Mental Health

I have one distinct memory from that first time I took anxiety medication. I got on a bus. That was it. No elevated heart rate, no sweating, no nausea. For the first time I realised the way I had felt for most of my life, was not usual. I wasn’t supposed to get worked up about getting on a bus, I was meant to just get on, buy a ticket and sit down.

I was first prescribed anxiety medication sometime during the disaster of a relationship that was the tipping point for my slide into depression. For some reason I didn’t take it for months. I think some of the reluctance to take it came from a notion that I wasn’t ill enough. As if, because I wasn’t yet suicidal, I wasn’t worthy of treatment. At the time, I thought my experiences were almost insignificant compared to the trials of other people.

A great many, myself included, have had to struggle to get people, primarily ourselves, to understand that they are ill. We look healthy and the same as when we are not suffering from mental illnesses, but we know that we are. Yet, sometimes, it can feel that you are constantly trying to ‘convince’ others of the same truth. For those of us with mental illnesses, such as anxiety, one of the greatest fears is that we will not be believed.

The comment I now hate hearing most is that everyone feels stressed, or that everyone has low days. I became convinced that I must be a ‘drama queen’, an ‘attention seeker’ and just not able to handle what all my peers could. Fortunately, I now know that isn’t true, but it took me a long time to gain that knowledge.

After that relationship ended a number of things happened, and I finally started taking the medication. I think I was worried about yet more comments from friends and colleagues. So when I told my friends about what I was taking and they said how they had studied it at vet school, it felt so casual. Completely devoid of judgement. I suppose they had studied it, and so understood what it was for and didn’t see it as a big deal.

Medicating mental health remains a personal challenge. A great many of us are not adverse to medication, and applaud others for treating their own mental illness through it. We compare it to the logic of taking painkillers, antibiotics or any other medicine that we consider necessary to treat physical ailments. Yet when it comes to taking it ourselves…

What makes us shy away from treating our own mental illness as we would a physical one? Are we guilty of viewing it as weakness, as if ignoring our struggles stop them from impacting daily on our lives? Do we feel that by drowning out the cruel voice of our own mind we are defeated by it?

If it is considered that the first step to recovery is acknowledgement, then the second has to be changing the narrative surrounding medicated mental health. The idea that someone is weak, dramatic or attention seeking for acknowledging mental illness is interfering with treating and recovering from that illness. It needs to stop.