Food Safety in Pregnancy

I recently had a pregnant patient email me and ask about which foods to avoid in pregnancy- do I really have to avoid deli meats?  I explained the rationale behind it- that certain foods have a higher risk of foodborne illness, for pregnant and non-pregnant folks, but that we want to try to avoid that risk particularly in pregnancy.  I referred her to the FDA site on food safety in pregnancy:

http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm083308.htm

I was emailing her as I was eating my cold roast beef sandwich for lunch. 😛

The truth is, I don’t follow the guidelines exactly.  Would I eat raw oysters, or put alfalfa sprouts in my sandwich?  No, but would I eat raw sashimi at a reputable Japanese restaurant?  Probably.  I certainly don’t want to put myself or my fetus at undue risk, but I also don’t feel the need to be super paranoid, either.

I was surprised when one of my colleagues, also an OB/Gyn doc and pregnant, said she still has a daily latte.  Unlike my husband who LOVES coffee like it’s crack, I’ve never been a coffee person.  I’m sensitive to the effects of caffeine (which my 23andMe DNA test confirmed), so although I’ll enjoy a cup now and again, I’m not so keen on how I feel after.  I get a delayed reaction of feeling really jittery, and it’s not pleasant.  It’s easy for me to avoid caffeine, but I can see how it can be hard for people like my husband who love their coffee.  ACOG (The American Congress of Obstetricians and Gynecologists) says up to 200 mg of caffeine per day is acceptable.  I would still prefer to avoid daily use, though.

Alcohol of course I avoid.  I do miss those handcrafted cocktails at some of my favorite places in SF like Trick Dog and The Alembic.  Taking a little sip of my husband’s cocktails does help me get my fix.  And I do drink the occasional kombucha.  I avoid the ones that have the required 21 and up labeling for 0.5% or more alcohol content.  The others are supposed to have just a trace of alcohol, so hopefully for my baby’s sake that’s ok.

To my patient asking about the deli meat, I was obligated (particularly since my response was in writing where it’s documented in her chart) to tell her that yes, according to the FDA recommendations, it’s best to avoid unless it’s hot.  But do I have patients that aren’t as with it, and don’t read the recommendations from the materials we give them?  Certainly.  I can’t specifically go over every little thing with each patient at their prenatal visits, so while everyone knows to avoid alcohol in pregnancy, I’m sure I have patients who don’t know to avoid deli meat and in the end their babies do just fine.  Ultimately, it’s every woman’s personal decision- like mine to go ahead with the cold deli meat, or my colleague’s to have her daily latte- about how closely she wants to follow the guidelines.

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Yosemite

I’ve gotten kind of out of shape lately, so my legs are super sore from hiking in Yosemite, but it was worth it.  Getting this view while eating lunch was priceless:

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We took the Mist trail, which takes you to the top of Vernal Falls, and then if you go a little farther, you get this view of Nevada Falls where we stopped to eat lunch.  Yosemite is one of my favorite places in the world, and I hadn’t been there in years.  Such a treat to have it within driving distance.

Still Surreal

I’m 16 weeks now, and I thought this whole nausea business would be done by now.  It started at 7 weeks, peaked at late 9 weeks, and started to improve at 12 weeks.  So I figured by 15 weeks or so, it would be gone.  But I was wrong.  Though I can eat more than I did a month ago, I still feel sick if I eat too much.  So it’s been frustrating dealing with it day after day, having to stop myself short of feeling full each meal.  Or in many cases not being able to help myself, and then later feeling gross.

Some of my patients have said that in the early second trimester, they don’t feel like they’re pregnant.  They don’t feel nauseous anymore, but they’re not feeling the baby moving yet.  One of my patients, who’s an Internal Medicine doc herself, got all paranoid and even though she knew everything was probably fine, just wanted to take a peek at the baby on the ultrasound to make sure.  With the nausea gone, all of a sudden this weird security blanket was taken away.

For me, even though I still feel the nausea, I have to say it’s a strange experience to still feel like this is all surreal.  I’ve heard the baby’s heartbeat multiple times on my handheld Doppler device, and seen it on the ultrasound a few weeks ago.  But probably because I’m not showing yet and can’t feel the baby moving yet, it still doesn’t quite feel real.

And to be perfectly honest, even though I’m supposed to feel all warm and fuzzy feelings towards this baby growing inside of me, I don’t.  I can’t help but be annoyed at this little parasite who is still not letting me fully enjoy my meals.  I’m sure these feelings will change, but I’m just keeping it real about how I feel right now.

Happy St. Patrick’s Day!

March 17 is special to me not just because everyone wears green and drinks Guinness.  And according to my patient’s 5 year old today, the leprechauns messed up the whole classroom, so she and her classmates had to clean it all up.  I didn’t have a work-appropriate green shirt to wear today, but I wore green underwear because I still have a fear of being pinched.

What’s really special about today is that it’s my 3 year anniversary of starting the Primal lifestyle.  And it happens to be our friends’ 3rd wedding anniversary.  The day my husband and I attended their wedding, I decided to just go for it.  Ok, I might have had a little taste of their wedding cake, but that was the day I officially decided to cut the carbs and sugar.

Three years later, I must admit that I haven’t stayed faithful to the diet lately, just based on how I’ve been feeling.  But it’s still something I now consider to be a permanent lifestyle.  I may veer off the path sometimes, but it’s no longer just about the food.  I now meditate each morning, make it a priority to get enough sleep, and make an effort to exercise regularly.  I am conscious of what I put in my body besides food, like using glass instead of plastic containers to store food when possible.  I think about the beauty products I use.  I appreciate getting out into nature, and the company of my friends and loved ones.

And despite my recent non-adherence to the diet, I still fully believe that it’s a healthier way of life.  And that is why I always return back to it.

Things patients do that drive doctors crazy

Hopefully those of you reading this are courteous to your doctors, but I just feel like venting.  There are various things I see/experience regularly that are very annoying, and I’m sure other doctors feel the same.  Here are some tips to avoid pissing off your doctor:

1. Don’t be late.  The office appointments are scheduled every 15 minutes, so if you’re late, that means that you’re making the patients after you (who showed up on time) wait longer.  We understand if there was a legitimate reason.  Typically the reason for patients being late is something that could have been planned better in advance.  Also, I know that you’ve probably been on time before, and still had to wait a while to see me.  For that I apologize- there are a number of factors that cause that, like the previously mentioned late patients, patients who were complicated and required more time, etc.  We really do our best to stay on time, and appreciate if you could help us out by being punctual.

2. Don’t come with a laundry list of unrelated complaints.  I can tackle two or three top issues, but it’s unreasonable to expect to discuss all of your gazillion complaints adequately in a 15 minute visit.  It takes a while to delve into each issue- to ask you about the details, examine accordingly, and decide what to do next.  If you bring up too many complaints, what will happen is that we will not be able to discuss each one in the detail it deserves.  Please, we appreciate it if we can keep it to a few key issues, and if you really have other issues that you need to discuss, then please come back for another appointment.  If possible, we can try to help you by making a phone appointment for the second appointment if appropriate.

3. Don’t tell us what to do.  So you Googled your symptoms, and you think you need an MRI.  We understand that many patients look up stuff online these days.  But if you straight up tell your doctor that you want an MRI, my reaction in all honestly will be anger.  I went to 4 years of medical school, 4 years of residency training, and have gained however many years of clinical experience in my field since then, and you think that after Googling your symptoms that you know what you need?!  The results will be much better if you tell me in detail your symptoms and why you’re worried, and then ask- do you think an MRI is appropriate for this?  And if I say no, listen to why.  I have good reasons behind it.  We’ll try the initial steps, and if your symptoms persist and we don’t get answers, then we can go to the next step.

4. Put away the phone.  Lately, this has been more of an issue with the partners of my patients.  If you are coming into the exam room as a guest, then be part of the conversation and stop looking at your phone during the visit.  Otherwise you might as well stay in the waiting room.  I understand if some women pull out their phones to look at their list of questions, or need to use their phone to distract themselves during the Pap smear.  Or even if you forgot to put your phone on silent and it rings, I get it.  But when you actually take the call and don’t immediately say, “I’m at the doctor’s, let me call you back” that is appallingly rude.  As an aside, I’ve also noticed some people lately who are too quick to text/post on Facebook the delivery of their baby.  As in, I’m stitching their vaginal laceration, and they’re already texting.  Enjoy the moment- life is happening RIGHT HERE.  The social media updates can wait.

5. Stop emailing about every little question.  I think the ability for patients to email their doctors is great.  For appropriate non-urgent questions, email is often more convenient than phone, since it doesn’t require playing phone tag, which often occurs when I try to call back patients who have called the office.  But we doctors get weary when some patients have to email about every little thing.  Yes, I know you’re pregnant and you’re worried about what’s going to affect your baby.  But there is this little thing called Google.  Although you can’t trust everything on the Internet, sometimes these types of minor questions have reliable places where you can find answers.  Also, if you’d listened to me in the first place and got that pregnancy book and subscribed to the pregnancy email newsletters and text4baby, these questions may have already been answered.

6. Don’t call or email and ask for an off work note.  Every so often, I get a message from a patient who called, or an email saying, “I haven’t felt well, please write me a note for off work yesterday and the day before.”  Although I generally oblige, it does irk me.  If you were that ill, you should have needed to be seen in the office or at least had a phone appointment to discuss, and preferably at the time of the illness.  Shoot, I would love to so easily call my doctor and ask for an off work note when I feel mildly ill.

7. Remember that doctors are people, too.  Thankfully, this happens rarely, but sometimes a patient is so mean and rude that she makes a doctor cry.  One of my colleagues recently had a patient that made her cry after the visit ended.  The patient went to complain after the visit, and when she and her friend spoke to the office manager, it turned out the friend had recorded the encounter.  The unbelievable thing was that the recording implicated them, in that they had discussed PRIOR to the encounter that they were going to make a fuss.  This is unusual, but in general we do get patients once in a while who are really rude to the receptionists, medical assistants, and/or the doctors.  This is not acceptable behavior.

Most of you out there are courteous patients that your doctors appreciate.  Maybe you’re one of the ones we really enjoy seeing, and who brighten our day.  I do want to acknowledge that most people are not the above people, and for that we doctors are grateful.

For the other docs out there, anything else you’d add?

Gentle Birth Method

I decided to check out this book, Gentle Birth Method, by Dr. Gowri Motha.  It’s very Hollywood.  I found it on Gwyneth Paltrow’s GOOP website- was curious what she had said about steaming vaginas.  As an aside, she’d mentioned the V-steam procedure at some spa in Santa Monica.  Hopefully most of you ladies out there find the thought of putting steam up there horrifying, but in case you were so inclined, I would say it sounds pretty questionable.  All you need is a gentle soap to clean externally.  Avoid douching or anything else to “clean” the vagina.  It does a good job of that on its own.

I stumbled across the book on GOOP, which is written by a Sri Lankan-born obstetrician who practices in the UK.  Based on her experiences, she felt that there were too many difficult labors and Cesarean deliveries, and came up with her method involving dietary changes, exercises, and also ways to emotionally prepare for the labor and delivery.  She draws upon Ayurvedic practices for these recommendations.

What struck me about her recommendations and what made me buy the book is that she recommends avoiding sugar, refined carbs, and wheat.  Why?  She believes they contribute to babies that are too large for women’s pelvises, therefore leading to protracted labors and higher rates of C-sections.  Sounds pretty plausible to me.

Now, that’s more or less where the similarity to the Paleo diet ends.  She’s more strict with certain foods- no bananas (mucus-producing), no grapes or mangoes (high sugar content), no citrus fruits (so far I haven’t read why).  She also recommends avoiding red meat.

Some of the claims seem a little far-fetched.  She says that if you follow her plan, you might be one of the ladies she profiles in the book, who comes into the hospital in labor with her first baby, looking too comfortable to be in active labor, but turns out to be 9 cm dilated.  While I would love to be that woman, I will probably not be so lucky.  But I figure that I could potentially pick up some tips that can help with the process.

I have respect for anyone who has been a practicing obstetrician.  As I read the book, I may not end up agreeing with everything she recommends, but she has clearly been through extensive training and has had a lot of direct patient experience to shape her recommendations.  And it makes sense that doing certain exercises can help keep the body in shape and prepare better for labor.  And mentally preparing is important as well.  I’ve definitely seen women who were not mentally and emotionally prepared for the severe pains of labor, the hard work of pushing the baby out, and in some cases of then having the responsibility of caring for the baby.

It’ll be interesting to see what I learn from reading more of the book.  By the way, in case any of you are interested in purchasing it, I found cheap used copies on Amazon.

NT Ultrasound

I had my nuchal translucency ultrasound this week, and the preliminary results for Down syndrome and trisomy 18 were negative!  It was also a nice plus to see the little one swimming around in there, looking more like a baby.  The last time I had an ultrasound, it was just a little nubbin with a heartbeat.

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My husband says it looks like him.  I say it looks like a typical fetus.

Welcome MDA Readers!

Welcome to those of you checking out my blog through Mark’s Daily Apple.  My husband had told me he emailed Mark and crew to spread the word about my blog.  What he didn’t tell me was that Mark had written back that he was going to include my husband’s email in his post today.  Thanks to both my husband and Mark!

Also, I appreciate the advice I’ve already gotten about things that have helped other women with nausea and vomiting in pregnancy.  The good news is that this past week (Week 12), I’ve started to feel better.  I’ve gone from eating bird-sized portions to half-human portions.  Definitely a welcome relief.  Hopefully other women can benefit from the helpful advice in the comments as well.

My husband and I were lucky enough to spend the weekend in Santa Cruz.  It was so nice to drive there and back on Highway 1, with gorgeous views of the ocean.  It’s a strange thing to see a bunch of cows on the side of the road, and see the ocean behind them.  Despite the rain (and the event we were attending), we were able to get some outdoor time and because of the rain, saw plenty of rainbows.  In fact, on one morning walk, we saw rainbows as well as dolphins in the distance in the ocean.  Definitely not things you see every day.  I just need to add a leprechaun to the story to make it sound totally made up!

On a completely separate note, I wanted to mention an interesting medical news blurb I came across recently.  I get daily emails from the American Medical Association (AMA) with headlines and short blurbs about general medical news, as well as from the American Congress of Obstetricians and Gynecologists (ACOG) with OB/Gyn-related headlines in the current news.  On the same day that they reported about early exposure reducing children’s peanut allergies (which I’m sure you can easily learn more about elsewhere), they also had a headline about mother’s voices and heartbeats helping their fetuses’ brains develop.

They exposed premature babies to sounds of their mother’s voices and heartbeats.  Compared to those who did not have this exposure, they developed a larger auditory cortex.  The study suggests that in utero, the sounds of its mother’s voice and heartbeat help the hearing centers of the fetus’ brain develop.  Fascinating stuff!

http://well.blogs.nytimes.com/2015/02/23/mothers-sounds-are-building-block-for-babies-brains/?_r=0