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. 

 

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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…

Medication in Pregnancy

I thought it was about time I put all these hospital visits to good use. I have now been prescribed pretty much everything you can be prescribed for pain during pregnancy (in the UK), and had numerous doctors explain to me what medications I can and cannot take.

I hope that this post will help you gain a little more information about medications during your pregnancy experience and reduce the amount of scrolling through the world-wide web.

This post covers Paracetamol, Ibuprofen, Codeine and Co-codamol.

Where This Post Began

For those of you who have been following my pregnancy journey, you will know that 3 weeks ago I was in the Out of Hours clinic at the hospital, and then the maternity unit in the next town. This resulted in a diagnosis of renal colic, likely resulting from a kidney stone.

I discussed how pregnant women can become more susceptible to kidney stones (although there is no increased risk associaed with pregnancy) because of the extra pressure all your organs undergo during gestation.

Kidney stones can take a while to pass by themselves and treatment, both of the stone and of the accompanying pain, are limited during pregnancy. X-rays are the most reliable screening test (although ultrasound can be used with mixed results), but of course radiation would never be used anywhere near a developing fetus.

Pain Relief: Paracetamol, Codeine and Co-codamol

Due to the extreme agony of renal colic and the limited options for pain relief in pregnancy (under usual circumstances Paracetamol is the maximum and then recommended to be used as little as possible), it is very common for women to be admitted to hospital if they develop stones during pregnancy.

Medications containing Codeine should only be used under  prescription during pregnancy because it contains opiates, and should not be taken at all during the first and third trimesters as it is during these developmental stages that baby will be most effected by its use.

I was prescribed Co-codamol (which combines Codeine and Paracetamol) because if you have ever had renal colic you will be aware that regular painkillers just don’t touch it.

Unfortunately, I did not react well to these tablets (and to be perfectly  honest was not keen on taking even prescribed medication with opiates in it). They made me dizzy, disoriented and extremely nauseous. They numbed the pain beautifully, but made me completely disfunctional.

When you react negatively to Co-codamol, you just plain react badly to it. Attempts to reduce the dosage and prescriptions of straight Codeine, are unlikely to have any different results.

What are Your Alternatives? 

Whilst the tablets reduced the pain  enough for me to deliver walking tours, the side effects would have made me a health and safety nightmare. With my additional reluctance over what the tablets contained, I stopped taking them and headed off to the doctor.

She prescribed just straight Paracetamol and told me that to make it effective, I would need to keep on taking it every 4 to 6 hour. As you will note from the link above, this is not ideal.

Ibuprofen should also always be taken with care, not for prolonged periods, and is ideally completely avoided during pregnancy.

So in answer to the initial question, there are very few alternative options.

When (as in this instance) screening tests make you certain that the pain is not related to baby (always a relief to any expecting parent) it is the case that the pain is not a complication of the pregnancy, but that treatment of the cause is complicated because of the pregnancy.

Personal Update and Notes on Buscopan

This was my final alternative for the pain I was experiencing. For two weeks following the initial hospital visit, the pain became gradually less severe and to my relief I was able to manage it without going near Codeine.

But last week, suddenly the pain spiked once again and rather than occurring centrally, moved around to my back, concerning me that it was kidney related. Once again, we ended up with a midnight trip to hospital, numerous blood tests and multiple medical opinions.

There seemed to be some surprise that I had received the diagnosis of kidney stones without any screening tests (as I mentioned above, you won’t be x-rayed during pregnancy due to radiation, but ultrasounds can be used, although they are less effective in this area).  Currently, I have been re-diagnosed with constant, considerable abdominal pain of unknown cause.

After a lengthy but pleasant discussion with the doctor, there was one final painkiller we could try, Buscopan. This was because of the new conclusion that the pain wasn’t renal and the guess was that perhaps it could be bowel related.

Buscopan is usually used to treat conditions such as irritable bowel syndrome (IBS), menstrual cramping and other forms of cramps and internal spasms. For the majority, it has no side effects making it a suitable alternative for those who react negatively to Codeine. There is, however, a very long list of instances in which you should not take Buscopan, and like Ibuprofen it is not a solution for long term pain relief.

Where We Are at Present

Ultimately, it is feasible that 3 weeks ago when the first round of hospital trips and tests began, I did have something (the professional jury still seems to be out as to whether it was a stone or not) irritating my kidneys, but although I am still experiencing considerable abdominal discomfort, it is now unlikely to be kidney related.

I am relieved, kidneys are vital organs and no one wants there to be something wrong with them. Whilst it is daunting to be experiencing unexplained abdominal pain, it is reassuring to know that all the blood tests have come back clear, showing that the kidneys are functioning properly. These blood tests also indicate that there is not infection or inflammation, which suggests that if there was a kidney stone, it is not the cause of this current pain and that it isn’t a urinary tract infection (UTI) or anything else too be overly worried about.

This is good news because it is when these (otherwise unrelated conditions) result in infections or fevers that they can start to impact the developing fetus.

I can gain comfort from a referral to get an ultrasound scan on my kidneys next week. 

As ever, if you are experiencing any medical concerns, always seek professional assistance. 

 

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.