"After Care" Summary

Had a visit with my doctor and she's convinced that I'm actually suffering from migraines and not sinus headaches. She asked if there's a family history of migraines and I said no. After talking to my parents later in the day, I now know that I was mistaken. My father's mother apparently suffered from occasional migraines. Well. That was news to me and suddenly cast a very different light on my experience.

As for the impaired hearing, she thinks I may be dealing with a blockage in the inner ear which hopefully my prescription for Flonase will help to resolve. Nevertheless, she is recommending a hearing test in order to get more information.

So. Now we wait. We hope for no further migraines like the one I had in early July. And we hope that the Flonase clears the blockage and restores my hearing.

In the meantime, I'm happy to be feeling well physically otherwise. Did I mention I tried Zumba for the first time last week? And I've been going to yoga classes 2-3 times a week for the last few weeks. I'm determined to focus on myself and my health in an attempt to tamp down a rising anxiety about a life lived in two countries and two houses and packing and travel and making and keeping friends in two places and having no career in either place and feeling generally uncertain about how to make decisions and proceed with life from this place of confusion. But more on that later....

And Now for Something...Meatier

I've spent the last 24+ hours trying to put a less than stellar (one might say "traumatizing") OB appointment behind me. I mentally drafted and re-drafted the post that would describe how unpleasant it was and the more I thought about it, the more it frustrated me. I don't want to come off as melodramatic or anti-Japan. And so, I've chalked up most of my frustration with the appointment to cultural differences.

When I was in graduate school (the first time when I was studying public affairs and policy as opposed to the second time when I was studying library and information science - I know. Two degrees?? What was I thinking. But whatever..) I took a few public health classes that I really enjoyed. In one of the classes we spent some time talking about successful public health campaigns and especially, how to reach "under-served" populations. From the perspective of the USA, one under-served population as you might imagine, is those people who are non-English speakers. Having been on the other side of the Dr.'s desk, so to speak, I now understand why. I mean, I got it conceptually, while I was in school. And I thought that improving the "cultural competence" of medical staff sounded logical.

But now I see how vital cultural competence truly is; it's not just a buzzword or politically correct token effort. Because if I didn't have a husband willing to go with me to these appointments, I would just stop going to see the doctor here in Japan. The frustration I experience, the embarrassment, the confusion - none of it feels worth it during a pregnancy that I feel is routine. Naturally, I'm no doctor and could be wrong about my own condition or that of the baby, but I'm telling you, even with husband to take me, I don't want to go back. I don't feel any sense of understanding or compassion or accommodation from the staff of a fairly large and modern hospital system. Instead, I get what I can only assume is the routine treatment and I'm just supposed to go with it. Accept that this is "how things are done here" and that's it. I understand that the situation might be a little different if we'd chosen a hospital or clinic in a more urban area, but as I said, this one is pretty modern and I figured it wouldn't really matter since in the 2nd trimester you mostly get weighed, have an ultrasound and call it good. I didn't expect that they'd want to see me every 3 weeks, nor did I expect things to get as "invasive" as they've gotten.

But I've decided it's just not worth it to dwell on it. Instead, I'll take from this experience only the parts I want to remember and I'll just do my best to block out the rest. So..... Turns out they think I'm a little iron-deficient (just barely below the cut-off for "regular" standards here) and I'm taking this as a sign. A sign I tell you. I am MEANT to have the Big America "New York" burger at McDonald's. I missed the Texas burger, but I won't be missing the beef in the New York burger you can bet on that! And that California burger looks yummy too. This might also explain why I was overjoyed to sample the Sasebo burger the other day. You can't imagine anything like this if you think of American fast food joints. The bun was perfectly toasted, the lettuce was crispy, the sauce wasn't too skimpy or overly sloppy, the egg was fabulous...I could go on, but instead, I'm going to call it another day and get some rest. Yesterday was draining and the baby and I surely need some more rest.

Maternity Care in a Foreign Land

My Japanese isn't especially good. I've made no secret of that. Despite my attempts to go to Japanese language classes while living here in Japan, my Japanese is just barely functional in say, a convenience store. "Could I please have one newspaper?" might be manageable.

Thus, when it was time for my OB appointment here in Japan (because of our travels I haven't been able to see a doctor for maternity care for just over 2 months) I took my husband with me knowing full well that I couldn't possibly follow a medical conversation with a doctor. I'm glad I took him. First off, it was nice to have some company while I spent over 2 hours in the hospital being shuttled up and down, back and forth to the lab for urine samples, blood work, what I'm told was an EKG (never had one so I couldn't say for sure), a brief meeting with the doctor who whipped out the Doppler (Yes! a heartbeat!) and finally the doula. We don't need a doula for birthing services as we will be back in the U.S. for labor and delivery. But apparently this doula's responsibilities also include maternity services much like a nurse in the U.S. might provide, such as nutritional counseling, information about weight control, etc.

This conversation with the doula was not my favorite part of the visit. She was shocked when I told her that my pre-baby weight was probably around 54 kg. and I'm now up to just over 60 kg. "54?!!" she yelled. I was so startled and confused by her yelling, that I thought maybe I was wrong. I refigured in my head and said, yes, 54. If you're not accustomed to metric terms, (and I'm not really) this means that I've gained about 12 pounds in my first 18 weeks. Not ideal by American standards but even more out of line by Japanese standards. As a result, I was given a chart with a request to weigh myself at home once a week and record it for future review by the doctor. They would like to see me every few weeks while I'm here. I don't know if that's standard, but I appreciate their thoroughness.

The doula went on to say that she isn't too worried since I'm not Japanese (I'm nearly 5'8" tall for heavens sake and as a result, bigger and heavier than most Japanese women). Still, by most American standards on was on the very low end of the weight chart for a woman my height before pregnancy, and while I gained quickly in the 1st trimester that's to be expected as I was eating as a self-defense to minimize the nausea and because at the end of the 1st trimester I was sometimes ravenous. This has all changed in the last several weeks and the weight gain has slowed, but now I'm more than a little paranoid.

The shock this woman expressed has been engraved on my brain. I'm sure my own doctor would have talked to me about weight gain and target weights, but I'm sure that she would have been far more sensitive about the whole thing. Not only does my own doctor know that I only gained about 25 pounds during my 1st pregnancy, but she also knows that was not overweight prior to pregnancy. I was stunned and hurt by the doula's reaction. It felt as though she was suggesting that I'm an overweight and out of control crazy American (not an unusual experience for a foreigner here in Japan). I'm sure many of my readers are familiar with this situation, and I actually expected it, but it was startling all the same.

The good news is that I've been able to explain to my husband how much this concerned me and we've made time in our family schedule for me to get back to my maternity exercise routine -something that had fallen by the wayside what with jet lag and settling back in here. Also, Gboy was able to explain what happened to his mother and I'm hoping that now when I say, "No thank you I'm done" when she offers me more food at dinner, she'll believe me. I appreciate her attempts to feed me, but portion control is out of the question when she just keeps dishing up equal portions to everyone at the table regardless of their hunger level.

By the way, does anyone have any speculation about why the hospital would want an EKG? I don't have any history of heart problems or anything else that I can think of which would even make that test relevant for maternity services.

Also, anything else I should be prepared for in my coming visits with the doctor? I've got an ultrasound scheduled for about 3 weeks from now.

Health care can suck everywhere

In the past I've mentioned some less than stellar experiences with doctors and/or the medical system in Japan. But I feel that I've tried to acknowledge how my lack of language skills, as well as my relative newness to living in the country, may well have factored into the less than optimal outcomes of my experiences there. To even things out a bit then, and to show that health care everywhere can be....lacking, I've got a story that I'll share regarding the American health care system.

A few weeks ago I went to see my doctor regarding some pain just below the tailbone. If you've ever had a pilonidal cyst, the discomfort is similar. I had a pilonidal cyst about 15 years ago. I was concerned that although I had surgery to correct the matter, perhaps it had returned (they can do that). I went to see my doctor a couple of weeks ago and while she couldn't see any evidence of a pilonidal cyst, she recommended that I get an x-ray to rule out any fractures etc. that might be causing the discomfort. I went down to radiology as soon as I left her office. Here's where the fun begins.

I didn't have long to wait before the radiologist or technician or whoever (let's call him the radiologist for the sake of conversation) came to get me. He escorted me back to the changing rooms and locker area where he started to show me around and then as we stood in the hallway to the changing room he asked, "Is there any chance you're pregnant?" I laughed and said in an off-hand kind of way, "Oh I suppose." Now some of you may understand that this is an incredibly loaded question for someone who's tried unsuccessfully for 14+ months to get pregnant. Not to mention that we haven't really been trying to prevent a pregnancy for the last few months and despite the fact that my period has not yet returned, we're nowhere near pregnant (several negative pregnancy tests at random intervals have confirmed this). Apparently breast-feeding really *can* be that effective as a measure of birth control. Either that or we're back where we started on the infertility treadmill.

Regardless, when I heard the question, it literally caught me off guard for a moment because as far as I can tell, there's pretty much ZERO chance that I could actually be pregnant, although in theory I suppose it's possible. But I think the radiologist heard my laugh and misconstrued my absolute disbelief as flippancy. He then proceeded to sternly warn me that, "This isn't a joke. This is a very serious matter. We can't take the risk that you might be pregnant." He went on trying to convince me of the gravity of the matter, but as it dawned on me that the hospital needs to limit its liability and sure there is the remotest chance I might be pregnant (ha ha) it also occurred to me that there were other people in the hallway who could likely overhear the whole conversation. I really had no desire to explain my entire reproductive history to the radiologist, never mind the crowd in the hallway, and I basically shutdown. He suggested that I go back to the lab, get a pregnancy test and then return if I had confirmation that I wasn't pregnant.

I headed back to my doctor to get the pregnancy test ordered, but only got as far as the main entrance of the hospital before I finally came unhinged. Not only was the radiologist out of line in as much as it's really not his business to give me a stern lecture about my apparent flippancy, but he then conducted the scolding in public. I was appalled that anyone might even suggest that I could be irresponsible with a pregnancy. He had *no* idea how hard we worked the first time to get pregnant. He had *no* idea how upsetting it was to test and re-test for months on end with no hope in sight. He had *no* idea what was actually going through my mind when I laughed at his question. And he didn't really stop to give me a compassionate moment to gather my thoughts before he launched into his speech.

Once I collected myself, I went to my doctor who agreed to order the pregnancy test. She gently explained that frankly, the dose of radiation and location in which I'd be getting it wouldn't really affect the outcome of a pregnancy. A viable pregnancy would still be viable and honestly, and unviable pregnancy would terminate regardless of the radiation. I went for the test.

It was negative. By then, I was too numb to even cry.

I returned to radiology and was greeted by a new radiologist who was escorted by my previous radiologist (presumably this was the hand-off to my new staff person). I cheerfully assured them that I was "cleared for x-rays" and the old radiologist, the jerk as I like to think of him, then had the nerve to say, "It's probably all for the best" just before he walked away. I almost hurled. "All for the best"? When was the bedside manner class and how did this guy miss it?

Needless to say, while I had previously been handling the whole, "still not getting pregnant" thing the second time around essentially by convincing myself that when the time is right it will happen, my interaction with this guy did set me back some. It's been really hard to forget the whole experience and yet I haven't been able to talk about it much. And perhaps what makes it all worse is that he was only trying to limit his liability. On the one hand, I get that's how things work in the USA. On the other.... how crap-tastic that I get to deal with emotional trauma so that he doesn't have to go to court.