Pregnant, MD: What’s Safe in Pregnancy Myth vs Fact, Part 1

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Photo Credit: Fiona Margo Photography

Hey mamas and mamas-to-be! There is a lot of confusing and alarmist information out there on the interwebs about the safety of lots of things everything in pregnancy. We all want to be safe, but also to not be deprived of allofthethings for 9+ months. This post is a quickie guide to set the record straight on some of the most common questions we pregnancy providers get. This, like all my posts, are not ever meant to replace the personal guidance of your own health care provider – when in doubt, as them! I’m breaking this down on the following very non-scientific scale:

Myth – Mostly Myth – Kind of Fact – Mostly Fact- Fact

No Coffee – Myth

Our family lived in Portugal when I was in Kindergarten and first grade, so that was about the time I started drinking coffee. No joke. So, when I was learning about pregnancy, you better believe I looked up all the information on this topic! I can’t tell you how many people I have talked to – even other doctors – who are under the impression people have to stop drinking all caffeine the moment they conceive. That’s just cruel.

My actual face if you told me not to drink coffee while pregnant.

The truth is, The Cochrane Review looked at the research and the best studies have shown no difference in pregnancy outcomes with moderate caffeine intake. What’s “moderate caffeine intake”? About 200mg caffeine daily. That’s one tall Starbucks brewed coffee or an espresso drink with 2 shots. Strong black tea has about 50mg per cup and regular or diet soda (bad for other reasons….but) about 35mg. Energy drinks vary widely – if you want to look up your specific fave bev, check out Caffeine Informer.

No Hot Tubs – Mostly Fact

This one is legit. Studies have shown that raising your core body temperature can increase the risk of miscarriage in early pregnancy and other complications later on in pregnancy. This is true whether it’s a high fever from being sick or you are in a hot tub, sauna, hot yoga, or even hot bath or shower at home.

Does this mean you can’t take a quick hot shower ever? No! You can go in any of these warm environments for a little while. What’s a little while? As soon as you feel hot, break a sweat, or of course if you feel light headed at all, leave and cool off immediately. If you can’t trust yourself to make that judgement, avoid altogether.

No Hair Treatment – Mostly Myth

The old types of hair treatments for dying and perming had toxic chemical derivatives which were potentially dangerous, especially in first trimester of pregnancy.

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Definitely got my hair did before these pics.

Newer dyes should be free of these chemicals and are ok. Highlights that aren’t applied to your scalp are also fine – just stay in a well-ventilated area because your breathing can be more sensitive during pregnancy. Perms and straightening treatments again vary – ask your salon if they offer safe, natural alternatives to the older more harsh treatments. More info HERE on American Pregnancy’s Website.

No Nail Polish – Mostly Myth

You can get your nails did with no worries as long as the salon uses good hygiene practices. One of my favorite midwives from my training at UCSF, Judith Bishop, wrote a great summary HERE on this. Any kind of polish and even fake nails are ok. Beware though – the chemical smells might make your sensitive nose and stomach unhappy!

No Cheese – Mostly Myth

The key here is *pasteurized*. You can get Listeria, a dangerous bacterial infection that can cause miscarriage, from unpasteurized dairy products. Pasteurized cheeses that are within their expiration dates and have been properly stored are fine. Even soft cheeses. Most restaurants should be able to tell you if their cheese is “raw” or pasteurized – if they can’t skip it.

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No Lunchmeat – Kind of Fact

This again is due to Listeria concern. You should avoid lunch meat unless it’s been heating to steaming in the microwave, stovetop or oven. Not sure how you feel about warm lunchmeat, but this preggo is NOT for it! Opt for grilled chicken, tuna salad (no more than 2 servings per week though) or other choice if you don’t like warm sliced meat.

 

No Fish – Kind of Fact

Speaking of tuna…. The main concern with seafood is about mercury. Check out and print yourself THIS PDF from American Pregnancy if you want a quick guide to which fish are “highest mercury” aka, avoid entirely or just “high mercury” aka have no more than 2 small servings weekly or lower and you can enjoy at will.

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Photo by Skitterphoto on Pexels.com

What about sushi?? So, cooked sushi is always ok as long as you are paying attention to mercury issues. Raw sushi *theoretically* should all be flash frozen based on USDA safety regulations and therefore should NOT have the parasites that are of concern in pregnancy. However, you are putting your trust in the sushi fish purchaser and preparer in this care, so approach with caution.

 

 

 

 

No Strenuous Exercise – Mostly Myth

There are no strict guidelines regarding exercise in pregnancy because this is highly variable as to what is safe and normal for YOU. There are elite athletes who’s “norm” is to run 10 miles or lift hundreds of pounds of weights on the regular. There are couch potatoes who get winded walking up a single flight of stairs.

Seriously, though… Exercising in pregnancy is actually key to having a healthy pregnancy, easier delivery, and – get this – fewer stretch marks! The main guide here is how the exercise makes YOU feel. Yes, that’s right, you have to listen to your body. This is not the time to “push through” and override your body telling you it is hot, too winded or  overworked. You will need to be more cautious with yourself because your blood flow is altered, your body shape is changing and your muscles, ligaments and tendons will be affected by relaxin hormone eventually.

No Sex – Mostly Myth

OK, think about it. If having sex while pregnant was dangerous, do you really think humans would have survived this long? A lot of pregnant woman have their libido skyrocket thanks to increased blood flow to the lady parts (though if you don’t that’s nothing to worry about). It is ok and GOOD to have sex if you want to in pregnancy. Get. It. On.

A few words of caution though… If you have pain or bleeding during sex, stop. Have your doctor check you and tell you if it’s safe to continue having intercourse during your pregnancy. And if you’re pregnant and single – you need to be ultra careful about not contracting an STD. They can cause severe birth defects, miscarriage or stillbirth if contracted while you are gestating. Safe sex – good. Unsafe sex – bad.

No Smoking – Fact

This includes ALL smoking. Smoking cigarettes and being exposed to second-hand or even third-hand (if you smell it even though no smoke is around, that’s third-hand smoke) can cause complications in pregnancy. If you are smoking when you conceive, talk to your provider right away about how they can help you quit. If people around you are smokers, same goes. It is NOT sufficient for them to just go outside. If your sensitive sniffer can smell the smoke, you’re being exposed. 

What about pot? It’s legal now and stuff, and doesn’t it help with appetite? NO, not safe in pregnancy. Marijuana has been shown to increase rates of ADHD, anxiety and other cognitive disorders in children who were exposed in utero. Stay away.

No Alcohol – Mostly Fact

Saved the most controversial for last! So, here in the USA, all of the official guidelines from the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American Academy of Pediatrics, etc… go along these lines, “There is no amount of alcohol known to be safe in pregnancy”. So, pregnancy providers will tell you to abstain completely from the time of ovulation if you might conceive through birth.

The Royal College of OBGYNs (Britain’s version of ACOG) takes a slightly more relaxed tone, saying “The safest approach is not to drink alcohol at all if you are pregnant, if you think you could become pregnant or if you are breastfeeding. Although the risk of harm to the baby is low with small amounts of alcohol before becoming
aware of the pregnancy, there is no ‘safe’ level of alcohol to drink when you are pregnant”. None of the large studies done recently showed negative effects on the baby or child with having a few drinks per week. However, the risk of preterm birth with alcohol exposure and of the devastating fetal alcohol syndrome makes pregnancy providers approach this with significant caution.

I know you are looking for a straight forward “yes you can have a glass of wine now and then” or “no, alcohol is truly dangerous”. We don’t have that yet. As a health provider, I follow the lines of saying, no amount is safe. As a woman physician, I know a whole lot of doctors who have read the studies and comfortably go ahead and have a drink now and then in the later parts of pregnancy. Ultimately, you’re in charge of making that decision for yourself and your unborn. Think about whether the anxiety when your kid seems hyper at age 3 that maybe they have subtle effects because you had a glass of wine at that dinner party is manageable vs the benefit you’ll really get from said glass of wine. You should for SURE never get drunk or even tipsy – that’s a no-brainer.

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Photo Credit: Fiona Margo Photography

What else?

This is why I called this Part 1… Please, comment away with questions, Myths you want busted, funny examples of crap your mother in law told you was unsafe in pregnancy! Part 2 will be based on your input. Whatcha wanna know??

Dr. Annie is a married mom of 2 with 1 more on the way (bump captured by Fiona Margo in the above pics, if you’re in the PNW look her up!!) and family physician in California.

Dr. Annie Answers: Water Safety

TRIGGER ALERT, Child loss and drowning discussed in this post. It’s not fun to read about but it might, just might, save your kid’s life.

Yesterday, we got to enjoy a rare hot and sunny Washington day on our friend’s ski boat. After the husbands took turns reliving their glory days on wakeboard and mono-ski, we put out the “Sidewinder” tube and my good friend went out for a much more tame go with her son and our two girls.

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Everyone was safely ensconced in life jackets. My husband, ER doctor and former lifeguard, was perched on the back of the boat ready to leap in if anyone was jostled off. Both girls know how to swim without floaties. We never went over 15 mph. And still, with every bump, every turn over the wake, my heart was in my throat imagining one of them popping off into the water and drowning.

As a doctor, I know that drowning is the leading killer of children aged 1-4. If there is only time for 1 thing to talk about at the end of a well-child visit, that’s the one I target. It’s something most parents worry about whether they know the statistics or not. And yet – we still miss the biggest risk most of the time.

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Kids are not at high risk of drowning when we are all playing together in the pool. They’re not at high risk even when bouncing along in a life jacket behind a boat. It’s when we don’t think they’re going in the water at all that the danger is highest.

The day before our boating, I had lounged and gabbed with our friends on the beach – Rosie and Mimi 200 yards down the empty shore collecting seashells and I was honestly more worried that the bald eagle we kept spotting would come carry one of them away than the very real danger they could wander down to the water’s edge without us noticing and drown in moments. We ALL forget that it’s these unguarded moments that are the real danger. Even the professionals. 

The recent stories of toddlers drowning in the media – including the tragic loss of Bode Miller’s daughter and Nicole Hugh’s son – have started a new fight to promote water safety with the AAP and in the public eye. They highlight just how quickly the lives of even the best parents can be changed by drowning. And also, that you can do things to decrease the risk and improve chances of survival.

So, what can you do? Should we all keep life vests on our kids 24/7 when we are in walking distance of water? Should we just give up and never let them around water deeper than an inch? Leashes? Well…. I mean you could. But, there are more practical solutions.

1) Education

Talk to your kids about water safety from the beginning. I have erred on the side of scaring them about it because I’d rather they be a little timid as swimmers than over-confident.

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Strongly consider enrolling them in ISR Self Rescue classes sometime after age 6 months and before 6 years old. These classes teach infants to toddlers how to roll over and float safely if they fall into water.

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Photo credit: Brendan Nicholson

I think my friend, the super smart mama Dr. Elizabeth Nicholson (that’s her cutie above), says it best:

I’ve seen conflicting opinions of ISR over the years … As an Emergency Medicine physician, I am painfully aware of drowning risks. Each summer, I console at least one family after the loss of their child. Primary prevention, such as locked fences and sturdy pool covers are the most important, but we all know that even the most attentive caretakers have escape artists for children. It takes only seconds.

I wanted to have extra seconds to find my kids. I viewed drowning prevention through ISR like buckling a car seat or holding my hand in a busy parking lot. It might not have been fun every minute, but crucially important.

Our instructor is wonderful. She pushes the kids in a safe a supported manner. They are reassured during class and proud after learning new skills. Even with vastly different temperaments, both of my kids have learned the skills AND love the water. See for yourself!

 

 

Want to see it in action? Check out the video of the “final lesson”, falling in with clothes on below:

Look up the closest certified program to you here.

2) Tools

  1. Barriers: If you own a pool, a pool fence or safety-focused pool cover is a MUST. We moved into the gorgeous backyard oasis above, but all I saw was drowning risk until we got our All-Safe Pool Fence. If you’re inside and not in “swim mode”, keep the kids behind locked doors – make sure the locks are child-proof. A hook lock at home or simple stick-on child lock at a vacation rental can be applied to most sliders above child’s reach to be safe.
  2. Lifeguards: If you’re at someone else’s home or on a watery fun vacation without a fence, treat watching the kids like lifeguards do. Someone should always be the primary observer. If that person needs to go, they need to actively and explicitly hand off duty to another adult. When you’re in a group setting without this designation, it is WAY too easy for everyone to assume someone else is watching the kids – which is what happened to this family
  3. Life jackets: If the kids are just playing in the yard around an open pool or on the beach near the waves, they still need life jackets on and/or an adult “lifeguard”. 20045346_10100140255349096_1854036280355769801_o.jpg
  4. Pool alarms: Again, if this is your home or somewhere you go frequently, a good back-up measure is an alarm so you know it they’re in the vicinity.

3) Rescue

If you haven’t already, enroll yourself and your adult family members in a CPR class. Make sure to continue updating it when it expires. Drowning happens quickly and silently and you can’t be sure how long the kid has been in the water. If you get to them quickly, rapid initiation of CPR while someone else calls 911 can absolutely save their lives.

Adult & Child CPR Anytime Kit

You can look up classes in your area here or get at home kits. Don’t let this be one of those, “well I was meaning to do it, but we were just so busy….” items. Look it up today. Put it on the calendar for within the next month. Chances are you might literally save a life.

4) Spread the word

Tell. Your. Friends. If you see unsafe practices around water – say something. We can’t know how many lives have been saved by the preventive measures above, but it’s definitely significant. Not sure where to start? Send them this blog article or post a pic on social media saying “PSA: pool fences save lives” or whatever speaks to you. Just keep people talking about it. We should be talking about this AT LEAST as much as preventing SIDS or the proper carseat positioning in your vehicle or which screen time is the least evil screen time because it still remains the leading cause of early childhood death.

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Alternatively… stick to inland splash pads.

Dr. Annie is a married mom of 2 plus 1 on the way and family physician in the Sacramento area.

Dr. Annie Answers: A Parent’s Intuition

Many of the things that people have said they appreciate about me as a doctor are the direct result of advice from one of my best mentors. One thing – trusting a parent’s intuition – has literally saved the lives of multiple patients of mine, and now hopefully, also that of my nephew. He’s in the womb below, while I was also preggers with baby #2.

As a resident, I remember feeling so lost in the beginning about offering advice on things like breastfeeding or colicky babies or a kid with a weird rash. I had been around lots of kids, sure, but I had never been pregnant, had never tried to breastfed a baby, or to get a fussy toddler to take medicine.

I, for sure, gave some asinine advice in those early days and more than once had patients laugh in my face (sorry pregnant patient who I tried to tell to work on her core strength for third trimester back pain!!). What Dr. Pippitt told me was, “Of course you don’t know their kid better than they do, but you do know medicine better than most of them.” Her advice now seems so obvious – let parents be the experts on their own kids. This applies to people being the expert on their own bodies also, but I’ve found we misinterpret ourselves more than parents do their kids…. so paying attention to what parents think is even more important IMHO.

Since then, I, of course, have become a mom twice over. I know tons more practical advice and can be quite a bit more helpful in treatment strategies. But! I still know that every parent is the expert on their own kid. My bottom line advice for when to have something checked out, followed up on, checked out again is always “if you, as the parent, are still worried or feel something’s not right”.

The validity of this was recently driven home in a tragic way. My sister, back in March, called me on FaceTime to show me a lump on her 3 year old kid’s neck. I took one look at it and thought, “that’s not normal”. My sister and her wife agreed and took him in to their pediatrician right away. The doc told them it was nothing to worry about. But… they were still worried when it didn’t go away. They saw ENT who also said it was nothing. But… they were still worried. Finally at 2 month follow up, it was bigger, not smaller. A few weeks later an MRI and biopsy had confirmed it was Hodgkin Lymphoma, an extremely rare, but very treatable diagnosis in someone his age.

Their intuition was right on, and had they not followed up despite being told it was nothing, it could have been caught at a later and more dangerous stage.

So, the next time you find yourself with that, “something’s not right” feeling, go ahead and get checked. This goes for your own body too, of course. Make sure the provider you see is able to make you feel confident that your fear can be ruled out before you go. This doesn’t mean they will do every test imaginable every time – sometimes we can take a look at something and tell you with high level of certainty, “you don’t need to worry”. We did go to school for a long time to learn that medical side of things, after all. But, if your care provider doesn’t listen to or respect your knowledge about your own kid or your own body, find a new one.

Dr. Annie is a married mother of 2, aunt of dozens of other amazing kids and family doctor in the Sacramento Area.

Ps. If you want to support my sister & her family, you can find them on Caringbridge.com under starlinglynnalesker

Dr. Annie Answers: Getting Pregnant

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It’s kinda crazy to me that a lot of us spend so much of our lives worrying about NOT getting pregnant and then you go straight from that to worrying about getting pregnant. This, like many issues addressed here, can be influenced by many personal health issues. Talk about it with YOUR doctor. I’m just here to give some basic info. This advice also is less applicable if you’re using a sperm donor or other fertility treatments for any reason, but some of it still applies.

So you think you want to get pregnant…

Number 1: Start a prenatal vitamin. *Ideally* you’re already taking one if you are of childbearing age (aka teens through 40s). If not, start NOW. You should be on a prenatal vitamin at least 3 months, and ideally 1 year before you conceive. What if you’re already trying to conceive? Start now. Better today than next week. Just, the sooner the better.

Which prenatal vitamin is right for me? There are lots of brands, gummy options, drinkable options, etc… to choose from. Find one that you can tolerate taking. The basics it needs to have are 400-1000mcg of folate, 27mg iron, 1000 units vitamin D, and 100mcg iodine. If your diet does not have a lot of healthy omega oils, also get a 1000mg daily DHA/EPA supplement. I personally use Honest company prenatal and DHA.

Talk to your health care provider about any medications you’re taking and if they are safe while trying to conceive. Make sure any chronic health issues such as thyroid problems, diabetes, or high blood pressure have been checked and are in good control. Plan ahead for these!

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This depends a little on what you were using. You CAN get pregnant the month (or week) you stop any form of birth control. So don’t stop using anything unless you are A-OK with being pregnant right away. That being said, hormonal birth control is more likely to have a “wash-out” period where you don’t ovulate regularly and are less likely to conceive. DepoProvera, oral pills (especially if you’re skipping periods), the patch, the nuva-ring and Nexplanon/Implanon all have a 3-6 month expected wash-out. I have seen it take up to a year with Depo. IUDs are less likely to have wash-out, but we wouldn’t be surprised if it took 3 months or so.

So, let’s say you want to get pregnant “sometime in 2019”. Easy. Go off birth control after you have that New Year’s blow-out party. What if you have a more specific window? You can plan to go off birth control 3-6 months in advance of that window, but use condoms to prevent pregnancy until then. Know that condoms are only 85% effective at best and you could still get pregnant earlier than you think. So, if, for example it would be devastating to get pregnant in February (calculate due date from theoretical conception date out here), don’t stop birth control until after that.

How to get pregnant….

SO, um, there are of course some basics here I’m assuming everyone knows about human reproduction. If you’re confused on the what goes where, may I refer you back to wikipedia under “birds and bees”. If you’re not in a relationship where sperm is readily available or you can’t have intercourse for any reason – see a fertility specialist about how to get that all going.

If those exceptions above don’t apply to you… the most reliable way to get pregnant is also the simplest. Have unprotected intercourse every other day from right after your bleeding stops until you start bleeding again. Every. Other. Day. Not every 3 days. Not twice a day (but good for you if this is your issue!). This gives you optimal semen volume and you will never miss your fertile window because it lasts 2-4 days. Boom.

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Now we get to the people who are absolutely opposed to having sex every other day. For some couples, that’s not sustainable over the several months it can take to get pregnant. That’s totally fine! If that’s the case, I usually recommend the Glow Ovulation, Period Tracker App. This lets you track cervical mucus, basal body temperature, ovulation sticks and pregnancy tests, sexy time and everything else about your cycle. Take at least 1 month to track everything while still using condoms so you get some understanding of your cycle.

Then, go for that fertile window! Again, sex every other day or daily. What kind of sex? Pretty much whatever. Position doesn’t matter. Ideally, the person trying to conceive should have an orgasm during or after (though there isn’t evidence that this is necessary, it has little down side!). And if you’re gonna use lube, use this lubricant. Chill out for 5-10 minutes after sperm gets in there then go about your business.

Did you say cervical mucus? Sounds so gross, but is actually the easiest way to check if you are fertile. Just look at the TP after you wipe when you go pee. When you’re approaching fertility and fertile, you’ll notice a clear discharge like egg white. When this is super gooey/stretchy – that’s peak fertility. More nitty gritty here.

How long is this going to take?

If you’re under age 35 it is normal to take up to 1 year to get pregnant depending on your health and the health of your partner. Most couples will get pregnant within 3-6 months. If you’re over 35, the timing gets a little more pressured because fertility starts to decline significantly around age 37. In this case, we would usually only give you 6 months before further testing. If you’ve already been trying to conceive for that long – go see your doc.

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Photo cred: FionaMargoPhotography.com

Final note: Don’t sabotage your efforts.

If you’re in the exciting phase of ‘trying to conceive’, don’t do things that are going to stress you out and make it harder or threaten an early pregnancy. Ask your health care provider if any medications you’re taking are safe. Don’t go binge drinking. Don’t smoke marijuana. Don’t smoke anything for that matter. Have your sperm provider avoid hot-tubs, tight underwear and long bike rides. Eat lots of healthy fruits and vegetables and proteins and fats (first trimester is ROUGH ya’ll, you will need those nutrients stocked up). Exercise regularly. Avoid over the counter medicines other than tylenol and tums without asking your healthcare provider. And… enjoy the ride!

ps. Make sure you follow us for an update on my own adventure trying to conceive baby #3 coming soon 😀

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Dr. Annie is a family physician and married mom of 2 in the Sacramento Area.

Dr. Annie Answers: Open Letter to my Patients

Dear patients,

There are things you say to me on a daily basis that I wish I could make nationwide public service announcements about in the midst of prime-time TV. We are early in our blog-adventure, but I’m just gonna put these out there in the hopes that someday they’ll be shared widely (as a close second option to a televised career).

Things you don’t need to apologize for

In my opinion, women apologize out of habit for WAY too much sh&* anyway (I’m guilty too), and I get a fair amount of apologies from men too, but these? Let them leave your mind.

  1. Women of the world, I could not care less if your legs are shaved. Not a bit. Not at all. Nor do other doctors. Unless you’re seeing a gynecologist, the rest of us also see men – know what? Men NEVER say, “sorry, I didn’t shave my [insert any body part, ever]”, when they come in to get checked out. You have enough to worry about and apologize for – let this one go.
  2. Same goes for your choice of pubic hair management. There’s a whole large part of the population that wouldn’t ever consider waxing/shaving/electrolysis and you know what? We feel fine about caring for them too.
  3. While we’re here – no apologizing for menstruating!! We have seen blood before. Menstrual blood. Body blood. Birthing blood. All the bloods. It doesn’t phase us a bit – or else we would have chosen another profession.
  4. If you cry in the office, it’s because you need help and you do NOT need to apologize for those tears, ever. If you cry, it’s because you felt comfortable enough with me as a provider that you could open up about what is REALLY bothering you – whether physical, mental or emotional. That is one of the greatest gifts to a primary care provider. That is our goal. No apologies for that.
  5. Having ear wax. We all do. We can clean it out. Don’t use q-tips to clean it, they only make it worse. (But if you do have to use a q-tip, always lubricate it with olive oil or vaseline!)

 

Exercise and diet

I’m gonna post in detail about this later. The bottom line here is: you can get an excellent workout in 12 minutes with high intensity interval training. And almost no one should ever be on a low-fat diet*. The low-fat diet trend was WRONG. It is BAD for you. Fat does not lead to high cholesterol or heart disease if it’s the right kind of fat. Know what does? Sugar. What’s worse for you: Bacon or Skittles?? I bet some people would guess the Bacon. Wrong.

A picture is worth 1000 words

If you have a rash that comes and goes – take a picture! If your kid is walking funny but only sometimes – video it! Take notes of what’s going on and bring them. Your recollections and descriptions may or may not be useful, but those are.

Agenda-setting

A list of all your questions is so helpful for organizing what to get to. However, you should know that depending on where your provider works, they may have NO choice in how long your appointment is. Many institutions do not allow us longer than 15 or 20 minutes total – that includes the 5 minutes it takes you to check in and have vital signs done. So, while we for sure want to fix everything (trust me, that’s why we picked this job!), we just don’t have time. We may have to choose some things for now and some for later. Insurance also regulates now what can be done at a “Physical” or “Wellness visit” and most will not let us address ‘problems’, ONLY ‘preventive care’ at those appointments. It is not our choice. We can’t “change the coding”, or we could lose our licenses. Talk to your lawmakers about this!!!

Share, learn, love.

-Dr. Annie

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Dr. Annie Answers: Sunscreen Low Down

Anyone else feel utterly overwhelmed by THIS when you hit the stores lately? The choices are ENDLESS!!

Whether you’re still in flurries or the sun is shining, summer is coming! You all know by now that sunscreen is absolutely critical for you and your fam to prevent deadly skin cancer (if not, what rock have you been living under, seriously??). The huge array of options can be super overwhelming.

I’m going to try to simplify things here. There are 3 rules:

  1. Choose physical over chemical sunscreens.
  2. Choose creams/lotions over sprays.
  3. If your choices are limited, still choose some sunscreen over no sunscreen.

In slightly more detail….

Physical vs Chemical

There are 2 ways to block the sun’s damaging rays. One is physical blocking. This includes simple shade or clothing or reflective minerals that you put on your skin. The two primary ones are Zinc Oxide or Titanium Dioxide. The other way to decrease UV radiation is with chemical sunscreens. These are ingredients like Avobenzone, Oxybenzone, Dioxybenzone. Yes, these block UV rays. However, they have not been studied well in humans and in animal models, can be absorbed through the skin – aka, get into the bloodstream and cause problems with endocrine function (thyroid regulation, hormone regulation, blood sugar regulation). Gross.

There is an awesome guide for brand-to-brand ratings here EWG’s Guide to Sunscreens. Our family’s go-to’s are:

Screen Shot 2018-04-10 at 10.10.07 AMBare Republic Mineral Sunscreen

Easy to find at Target and Amazon, goes on nicely, badass bottle (I’m a sucker for good marketing). Sport and Baby versions available. Stick version convenient for little faces.

 

 

Screen Shot 2018-04-10 at 10.12.15 AMCalifornia Baby Super Sensitive Sunscreen

No, I don’t just love this because it says “California Baby” (ok maybe a little), it’s also ultra-sensitive for the rashiest kids. Again, stick version available.

 

 

 

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Blue Lizard Australian Sunscreen because you know the Aussie’s got the sunscreen game DOWN. This goes on easily – not just for babies ;^)

 

Arbonne Baby Care Mineral Sunscreen Screen Shot 2018-04-10 at 10.49.35 AM

 

 

 

 

Arbonne is sold directly through independent providers – I get my goods from my awesome niece (she’s an adult, we have a crazy big family) Megan Fikes

 

 

 

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Elta MD UV Clear Tinted This is the only sunscreen that has EVER not made my face allergic, and with slightly tinted look, is flattering and not white. I wear this every. single. day.

 

 

 

 

 

I can hear you now:  But lotion is so hard to get on a whining, wiggling kiddddd!!! 

Strategy: Before you even get dressed to go wherever fun, sunny place you’re going, apply to your naked child. This way you have a “base layer” in case of wedgies or – if your kids are like mine – unexplained nakedness. Then, just touch up when the clothes come off. Reapply (of course) every 2 hours or when they get out of a body of water and defrost/dry off for a bit.

Spray vs Lotion

When you, as an adult, put on that super-convenient aerosol-spray clear chemical sunscreen, have you ever gotten a *little* of the spray up your nose at the end? And you know how to hold your breath well. Game over for kids – they’re for sure getting it in their nose, eyes, mouth… lungs, stomach. I’m a laid-back parent about dirt, mess, hair dye, the occasional junk-food treat. But chemicals being inhaled and swallowed?? nope.

That being said… there are times and particular children that do require faster application. So IF you must use a spray, top choice is a manual spray bottle with mineral sunscreen, because, the environment. Choice 2 is aerosol mineral sunscreen. Really, just avoid the chemical ones unless it is literally the ONLY way to not have a severely sunburned child.

Kiss My Face SPF 50 SprayAlba Botanical Refreshing Spray Mineral SunscreenBare Republic Spray

Final Rule: Some protection is better than nothing.

Questions come up in clinic all the time about “how old does my baby have to be to wear sunscreen?”. The best, safest sun protection for babies is to keep them in the shade. This goes for all ages, actually.  Avoid the strongest sun, wear hats and loose layers when you can, seek shade.

This is most applicable for babies that are non-mobile. That is the primary reason that the typical recommendation is to start sunscreen when your baby is 6 months old. That is when most babies start to crawl and shade is less reliable. That being said – if you’re gonna be at a sunny farmer’s market with your 4 month old baby in the Ergo, they might pull their perfect sun-protective hat off and yes, you should put a little swipe of safe, mineral sunscreen on their sweet face and hands and toes if they’re exposed.

And if you’re in a pinch, forgot alllll the sunscreen in the bag (maybe because someone left that bag in the entryway when the kids were being loaded into the car…), and the only sunscreen available is some aerosol Coppertone at the gas-station. Yes. Use the sunscreen. Life is all about minimizing risk and doing the best we can.

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Dr. Annie is a married mom of 2, family doctor, amateur blogger and Nerium international independent brand partner. This post is her own opinion, is not sponsored by any products listed and does not replace the personal advice of your own physician.

Dr. Annie Answers: Momxiety

For as long as I can remember, I wanted to be a mother. As a child, I have clear memories of poking my little tummy out with a stuffed animal in my shirt, pretending to be pregnant.

Fast forward 20 years, I was married, at the end of residency, my 3 best friends (the other illustrious ladies of Lockers to Littles) had all just had their first babies and I got THE FEVER!!! It took 5 months (which is not actually a long time at all but felt like forrrevvvverrrr) but it happened! I was pregnant!

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That was where the excitement ended. I got morning all day sick from week 5 that was relentless. If you’ve had morning sickness – now imagine having it while having to examine infected toenails of vagrants or while talking to a chain-smoking person into quitting or while a woman in labor is herself vomiting and pooping on the bed. I lost 15 pounds in my first trimester.

Then came headaches, insomnia and fatigue combined, sciatica, pubic symphysis pain, round ligament pain so sharp I would cry out, then premature contractions and labor scares. I was NOT basking in my joyful pregnant glow. I was confronted day to day with women with infertility, pregnancy loss or worse so I felt unbelievably guilty about any negative pregnancy thoughts. But I. was. miserable.

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At 39 weeks 3 days of pregnancy, I was still having on and off contractions as I had been for 2 weeks. During my morning clinic, they got progressively stronger and were coming every 5 minutes. I called my afternoon clinic and told them I wouldn’t make it. Rosalyn Elizabeth was born 12 hours later. I was so excited! Labor and birth had been (relatively) easy for me. My baby latched well. I was finally going to get my motherhood bliss on!

735077_663767542506_803843932_n.jpg3 days later, post-partum anxiety and depression hit. Hard. I naively thought since I was used to working 30 hours at a time with no sleep that having a baby wouldn’t be that much worse. But, in parenting, there is no “post-call day” that you sleep for 8 hours and recover. Hormone sh*% hit the fan and I remember sitting up in bed in the night, tears streaming down my face, seriously contemplating leaving the baby with my husband and running away to Mexico. I wanted this baby so badly, but I had never been more depressed. What was wrong with me??

I thought I had “baby blues”. I struggled through. I hated motherhood. Week 6 hit and I had to go back to work. I couldn’t stop crying and was in a panic about how to get through a day of clinic when I broke down doing things like making toast. The day before, I scheduled a last-minute appointment with one of my attendings (the boss-doctors). It finally dawned on me that she had given us a lecture on post-partum depression. She had admitted that she had it too.

We had both been taught – AND taught others – about this but fell into it without recognizing it ourselves. I started Zoloft and though it’s physiologically not possible for the full effects to kick in that fast, within 2 days I was well on my way to being a (mostly) normal person again.

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When you are in the depths of that kind of depression and anxiety it is nearly impossible to even recognize there is another way to be. Of course you worry about your baby. Of course you feel guilty for not getting things done the way you used to. The issue is when this prevents you from living a relatively normal day to day life.One in seven women will experience postpartum depression. There is a lot More Information In This AAFP Article. It can hit any time between 1 day post-partum through the first year, but the peak is 2-4 months of baby’s life and it can harm not only mom but baby too. It’s harder for bonding, breastfeeding and nurturing when mom is suffering from PPD.

The screening tool for depression we use is SIGECAPS:

  1. Sleep issues? check.
  2. Loss of interest? how could you possibly do anything fun when the baby takes all your everything, so check.
  3. Guilt? Oh man, there is no guilt like mom-guilt.
  4. Decreased energy? duh.
  5. Lack of concentration? what was the question?
  6. Changes in appetite? Does EAT ALL THE THINGS count as appetite?
  7. Psychomotor retardation (aka do you move slowly)? Took 2 hours to get dressed, so, yeah.
  8. Suicidal thoughts? This one is less universal. But was there for me. Never in an active way, but did I think “wouldn’t they be better off without this useless lump of human?”, yes. I did.

A few positives, some of the time, yes, is “baby blues”. I hit all of the above. every. day. of that time. But I still couldn’t imagine a happier me. So when that serotonin finally hit my struggling brain cells, it was an absolute revelation. I wanted to shout from the rooftops “YOU DON’T HAVE TO FEEL THAT WAY FOREVER!!”. Yes, I still worried about my baby, but I no longer stayed up for days on end because I was convinced she would stop breathing in her sleep. Yes, I still felt a little guilty about not getting stuff done, but I no longer felt like the world would be better off without me if I didn’t get the laundry done.

That’s the thing about depression and anxiety treatment – it’s not meant to make you a zombie or to fix all your problems. The medicines correct imbalanced brain chemistry. The therapy helps you retrain your wayward thought processes. Treatment helps you get back to normal. In the case of moderate to severe symptoms, the fastest and most effective course is usually both therapy and medication. The medicines is safe (even while breastfeeding – in fact it sometimes increases milk supply). It does no harm to your long-term mental health. It is not addictive. It may actually save your life.

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There are a lot of resources for parents with anxiety and depression, but the most direct access to care is usually your primary pregnancy care provider. Your family doctor, OB or midwife can help you get therapy, medication and other treatment or testing. If this is you, ASK for help. If this is your friend, partner, sister, colleague – share this story with them.

As you may have noticed, I got “momnesia”, forgot all of the above misery and decided to have another baby. I had been able to wean off the meds after about 6 months and was back to my usual crazy awesome self. This time, week 2 post-partum, when the all-day crying jag hit, I knew what to do. I called my doctor and got on my Zoloft right away again. Wouldn’t you know, it went so much better, now I want a third baby!  I could never have been as effective of a primary care doctor myself had I not gone through all of this. We live and we learn and life is a beautiful adventure that way.

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Photo credit: Fiona Margo Photography fionamargophotography.com

Annie is a married mother of 2 and family physician in California.