D-MER: Dysphoric Milk Ejection Reflex

"Feb/25 2010," By Jude Doyland. From Flickr Creative Commons.

 

 

 

 

 

 

 

When Piglet was a month or so old, I began to notice something peculiar. We’d be having a quiet moment snuggled down in front of the T.V. I’d be watching some of the pop-culture drivel that makes me so happy, she’d be smiling and cooing. Then I would start to breastfeed and–OOF!–it would hit me. A heavy dusk settled in my mind and  a wave of misery washed over me. Anxiety rang in my bones. I was utterly hopeless… Then, just as mysteriously, after few minutes, it was gone and I felt normal again.

This wasn’t the long slosh through the swamp of post-partum depression, but something fast  and sharp–an action potential of misery. It didn’t even last for a fraction of the feeding. Strangely, I had not experienced this in breastfeeding my first child, and her (colicky) babyhood had been considerably more fraught emotionally for me. This was self-limiting and predictable, so much so that I would try to steel myself to it–to try to work myself into happiness before breastfeeding. But it was to little avail. The misery wave would wash over me… and, mercifully, pull back again. The feeling was so precise and easy to name that I typed it into Google:

Breastfeeding and Dread

…And so I found that my curious sensation had been given a name: D-MER, or Dysphoric Milk Ejection Reflex. A lactation consultant, Alia Macrina Heise, coined the term and started a website. The thinking seems to be that the interplay between dopamine and prolactin levels during breast milk letdown can cause sudden mood changes in some women.

I know, I know, some of you might think that this is just more evidence of the excessive pathologizing of ordinary problems and experiences, but I found the website helpful. Just identifying the shared experience rallied me. And D-MER was aggravating but not incapacitating to me–I imagine there are mothers out there who find it enough of a problem that it interferes with breastfeeding or causes them to wean. Generating awareness and treating these mothers may allow them to breastfeed as long as they want to. And that’s a great thing.

Luckily, my D-MER disappeared as mysteriously as it arrived, maybe two months later. Piglet and I are breastfeeding happily again, as much as she wants (ALL THE TIME).

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The Dogwood hasn’t bloomed…

…but, oh, the azaleas! Despite being a hot-weather gal, I’m digging the more seasonal (and less apocalyptic) weather this week. Let the heat return at the end of May. In the meantime, I’ll wear my medium-weight jacket and enjoy the blossoms of our early Spring.

Postpartum Graves’ Disease

Pills by Lucario(F) from Flikr Creative Commons. Not Methimaole or PTU. Looks like it might be Levothyroxine, though!

I realize this post may be completely irrelevant to the 99% of people who don’t have  Graves’ Disease, but I thought I’d share for those few who might be in my situation…

I went to my endocrinologist for a follow up the other day. As my internist and I had already surmised by my blood work, my Graves’ Disease has returned. My thyroid stimulating hormone (TSH) is super low. This means that I am hyperthyroid, as my body acknowledges that there is too much thyroid hormone and has stopped asking for more. My free T3 and T4 (the actual thyroid hormones), however, are just outside normal range.

That the thyroid hormones were elevated but not astronomical wasn’t surprising to me. While I’ve had some hair loss and a few other vague symptoms, I don’t feel THAT bad–and I know from experience just how bad it can get (racing heart, extreme muscle weakness,  shortness of breath, being hyper and cray cray). This was no biggie. The kind doctor would just put me on a smidge of the medication PTU, which counteracts thyroid hormone and doesn’t really pass into breast milk. We’d hope for another remission… OH, except in the handful of years between my last bout with Graves’ the medical establishment has become a tad more freaked out about PTU and liver failure. PTU, once the go-to drug during breastfeeding and during the entire course of pregnancy, is being reconsidered . It’s my understanding that it’s still used for some people and for the first trimester of pregnancy, but it’s not prescribed as widely.  And as for breastfeeding women? Well, we weren’t sure. Methimazole, the alternative, passes into breast milk. Hhhrmph.

I also consulted Piglet’s pediatrician about breastfeeding and anti-thyroid meds. She basically said she wasn’t going to pretend to know about something that she has no experience with (which was cool actually). By then my endo. had called me back and told me not to fill the PTU prescription she had tentatively given me… BUT she said she didn’t think I should go on methimazole either because it might cause problems with Piglet’s thyroid and would necessitate her having blood tests. So… since my levels aren’t THAT bad, she said we’d just watch things, and put me on meds only when my free T3 and T4 are higher. As I’m a serious pessimist, I was a bit worried about the best course of action if/when I get sicker. Then my friend sent me  Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. It states:

“MMI [methimazole] in doses up to 20–30 mg/d is safe for lactating mothers and their infants. PTU at doses up to 300 mg/d is a second-line agent due to concerns about severe hepatotoxicity.” (Recommendation 35)

So at least I feel like someone out there has written a new protocol. (Yay!). These may be the guidelines my doctor intends follow anyway, but I’ll bring it to my next appointment and see what she thinks.

I know that a great many people in this world don’t breastfeed, but I am always surprised by lactation-safety confusion out there. At least in this case I have  a little clarity?

P.S.  Kellymom has a page on thyroid disease and lactation, too.

P.P.S. When I went to link the “hyper and cray cray” link above to the energetic song  in the opening credits of Ghost World, Jaan Pehechaan Ho!!!, I realized that the song was also used in the Heineken Commercial, “The Date!” I guess the name of the movie it was originally in is called “Gumnaam.” How great is that song?!

Chemical Crack-up

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A co-worker who is pregnant with her first child stopped in my office the other day. She wanted to know if I did a lot of cleaning during my pregnancies. I told her that I went through periods where I slept with my head on the kitchen table and periods where I meticulously cleaned the baseboards with baby wipes and Q-tips. In other words, sometimes the house fell apart and sometimes I manically cleaned everything in sight in a fury of nesting… Now, I say “nesting,” but it feels like a misnomer to me. The word conjures cartoon bluebirds with sprigs of thistle in their beaks. Whatever the actual experience of an expecting bluebird, the picture is a tad twee. The jolt of energy and frantic preparation for a new child never fit this image for me. Instead of “nesting,” I would prefer something more militaristic and professional… like “preparation for deployment” or “operation cold storm.”

…But I digress. The co-worker wanted to know about chemicals. In a fit of cleaning, she had doused her bathroom with Lysol. Did I think all those fumes would hurt her baby? I told her I didn’t think it would hurt her baby at all, but it would probably be a good idea to avoid harsh cleaners, and to ventilate the room and wear gloves when she does clean.

It is a difficult thing–these chemicals, the unknowns. When Weasel was born, I was careful for her not to chew on books or furniture. I made sure everything she touched was washed well (in vinegar and water) and bought her an organic baby mattress. While I still try to clean with vinegar and other natural substances, I have become lax about washing things before use, about making sure my second baby doesn’t put books or toys of questionable origin in her mouth. And Piglet chews on everything. Is it okay for her to mouth the leather recliner? My sunglasses? What about my hands, which have recently been squirted with sanitizer? I had relaxed enough about her gnawing on things to let her chew on some children’s blocks… until I noticed that she had slobbered on them enough to start to wear away at them. There she was, smiling away, nom-noming at little bits of particle board and pigment made in China. Oh well.

This article from last week’s New York Times about babies and potential household toxins details the vast gaps in our knowledge regarding chemicals as well as the Sisyphean task of attempting to shield your children from potential chemical hazards.

What can you do? I’m happy to follow some of the basic (unwritten) guidelines my mother raised us with: Avoid pesticides. Use natural products when you can. Avoid anything with an overbearing smell, including air fresheners and candles. Toss recalled products or products with a known history of problems. Avoid cigarette smoke. Avoid anything too pre-processed or exceptionally artificial. Other than that those things, I can’t be bothered to think of it all too much. There is only room for so many chairs at my table of anxiety.  Pass the potatoes, please.

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Pretty Things (Even in Yonkers)

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DELLWOOD--I have no idea what this company does.

I have a pretty brutish, traffic-snarled commute through urban and sub-urban wastelands… But you know how, in otherwise bleak daily routines, you sometimes see strokes of grace? Well, I have a thing for scale. That’s part of what I enjoy about the aesthetic of New York City so much. And this corridor in Yonkers has its moments, with its storage warehouse and the factories looming in the stark light. And see the lettering on that “Dellwood” sign in the distance above? Isn’t it that just a dollop of sans-serif loveliness? …I don’t do it justice. The many of the buildings close up look really art deco and huge and bold. And, no, I wasn’t REALLY driving while taking these. I was behind that stopped truck and then just held up the camera quickly for most of the pictures I took. Anyway, Someone who is a better photographer should shoot these things properly

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The yellow building is my favorite one.

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The cemetery on the right makes for interesting contrast.

As It Turns Out

The Kingston-Rhinecliff Bridge.
Very open and "Extremely terrifying" per my traveling companion.

You can go home–to the place. But you may not be able to go home to the time or the person. The light may somehow be different. And there may be ice cream shops and Honda dealerships where there once were swaths of Upstate road filled with trash and wildflowers.  (“Trash and Wildflowers” = My future memoir. Or your Etsy shop where you applique jeans with 80s Laura Ashley dresses. Or an ironic Red Hook  jug band. Or a Joan Baez song.)

So it Begins…

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Photo by liberalmind1012 on Flikr Creative Commons

Wouldn’t it be amazing if this was the start of something awesome? …Or even something mediocre that demonstrated great discipline? Fact is, this is a long time coming, but there were some, um, barriers to me getting going. Namely:

  1. I am old and slow. I’m better at tinkering away on my typewriter and packing my penny papers onto the pony express to be blown across the plains. I am not a luddite but I have not completely acclimated to the age of abbreviation. I write much better in long form, pouring over drafts in lamplight… Also, because I am old school, I don’t like to write for free.
  2.  I am lazy/busy. I have two small children. (This is my new favorite phrase. TWO SMALL CHILDREN. Look, buddy, you may be sick, but I am sick with TWO SMALL CHILDREN. You don’t get any sleep? You don’t know the meaning with TWO SMALL CHILDREN. You know, I would put more effort in to my career, I would exercise, I would clean the house, but you know those small children. They cannot do many things like prepare themselves breakfast, however convenient and pre-processed it is. I love them more than anything and yet somehow never give them enough. They are geniuses (trust me, I am their mother, I know) but they are weirdly unable to drive or even open car doors. What is that, you say? You have four small children? …Well, you know, TWO SMALL CHILDREN is probably more time consuming. At least for me.)
  3.  Shame. I would love if I wrote a blog and people read it, but I have ambivalent feelings about being LOOKED at.  I have an elaborate Facebook timeline which plots the course of my life right down to exact locations and times. I post these things and then I want to die a little bit. I don’t know why. There is a minor thrill but also a good deal of queasiness involved in sharing.
  4.  “Every thought is also a prison…” I get stuck in my own thoughts, or re-hashing others’ thoughts. My opinions are quite fluid. I am constantly changing my mind. Writing and blogging crystalizes these thoughts, publicly, in theory, and marks them. But in ten seconds it may not be who I am or what I believe.
  5.  I can’t figure out WordPress. It is far prettier than blogger but it is far less intuitive for me.
  6.  My friends have much better blogs. (I will link to them in a sidebar if my embarrassment at my own work diminishes).
But then there are these other thoughts:
  1. I haven’t been in the mood to write fiction. The mood waxes and wanes, and it will return, but in the meantime, there is something in me that needs to hear the clicking of my fingernails on the computer keys.
  2.  I have started to read blogs. I like them. I am starting to appreciate the medium. I like house blogs and design blogs. I like that RN girl who contributes to the Well at the New York Times. I like my friends’ blogs. I read a lot in general and think about what I read–probably too much.
  3. I want a site to link my writing. Maybe.
  4. I want to. Just because.
So I am. We’ll see how it goes.