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Dapsone is better than Prednisone because?
Mar 25th, 2008 by Tiff

Today I got a fax from our paed.

It was a plan, some pathology results and a script.

That’s right, my friends, you can doctor a patient via fax now.

Don’t get me started.

Yes, I am disgusted.

Anyhoo, the plan; was to wean Ivy off Prednisone because she is at risk of diabetes and brittle bones and a plethora of other nasties the longer she stays on the pred. Our alternative is a drug called Dapsone.

Never heard of it?

That’s because it is not widely used these days. It is mostly prescribed for Leprosy (We don’t call it that anymore, we call it Hansen’s disease because that just sounds so much better).

Dapsone can also be used for other skin diseases, one of which is pemphigus.

The paed has sent a general information sheet about Dapsone, which tells me very little about what my baby girl is about to ingest. It doesn’t matter though because I have researched it and have all that I need to know that this is one scary drug.

Lets throw around a few terms I have learnt about today, shall we?

Yes, let’s.

Agranulocytosis. This means a deacrease in granulocytes or leucocytes or in layman’s terms, it reduces the number of cells that can fight infection. Great for someone who is immune deficient, wouldn’t you say?

How about, aplastic anaemia, which is the decrease of red and white blood cells in the bone marrow or dyscrasias -  the abnormal mix of blood lymph and bile in the body?

They sound like crackin’ side effects,  don’t you think?

Then there is hemolysis which is the disruption of the red cell membrane, causing release of haemoglobin. This means that the red blood cell essentially explodes and cannot carry iron anymore and it has a great sidekick: methemoglobin, which means the haemoglobin can no longer carry oxygen.

It sounds good.

A real easy sell.

Add to that the risk of liver disorders, nausea, vomiting, abdominal pains, pancreatitis, vertigo, blurred vision, tinnitus, insomnia, fever, headache, psychosis (now that’s an extra special one)  and a whole lot of other exciting things, including carcinoma and I am really starting to see that this is a wonderful medication for Ivy.

Not.

So, what the paed is saying, is that this medication is the better choice over Prednisone and all I am wondering is how he can say that?

Just one last thing, if you are a ‘learning doctor’ out there, or even if you are an ‘already doctor’; If you say you are going to be in contact on a certain day, be in contact.

Don’t send through a fax and think that will be adequate. Because it won’t be. Especially if the patient involved is little and is about to take Dapsone and has any parent worth their salt. It will just make them angry.

Very angry.

Birth…
Mar 25th, 2008 by Tiff

…for me, has not been straight forward. Ever. You can read all about my last two attempts at birthing my babies here and here. I never thought it would be hard. My own mother birthed me with no drugs and no tears and went on to birth twins vaginally in two hours and another baby in much the same fast and furious act, all the while maintaining an intact perineum. My mother was made to birth. Of course, I assumed that I would be the same. I also thought that I would plan and fall pregnant the very month I chose to conceive (just as she had). Hard, hard lessons learnt here, my friends.

Lesson number one; never assume anything.

My first crazy step into this birthing business came at 12:29am on Friday, 14th June 1996. (OMG, I am almost a mother to highschoolers!!! AAARRRGGGHHH!)

It was twins, sex unknown, 35 weeks gestation, known transverse lie, no other way out but through the hood (read caesarean here) and my waters had just broken with a loud pop!

Everything was wet, David’s Pyjamas soaked in seconds. Heck, even the dog was soaked through. The matress, the floor and the hallway (where I had run up and down, flailing my, almost 24 year old arms, to the sky, wailing about not knowing what to do. Actually, I did know what to do but panic had set in).

David phoned the hospital, woke his parents and stacked the passenger seat of his brand new car with towels. So high, in fact, that when I took my position in said seat, my head tipped the roof.

It was the start of the clean car demise. The first of many bodily fluids to hit the woven fabric of the car’s interior.

Second lesson: Never buy a new car just before you have a baby and expect it to stay clean. Not. Going. To. Happen.

The hospital was not far but the tightenings were ripping through my back. Such was the nature of a malpositioned labour. It was very early in the morning but the midwife met us at the door. We must have looked a sight. David and I with a bunch of towels wedged between my legs.

I remember the midwife’s words like yesterday, “Well, if you need a towel down there you definitely won’t be going home”. No truer words ever were spoken.

They checked to see if the fluid I was gushing was liquor then set me up on the CTG, put a drip in my arm, smacked my hand when I grabbed my back in pain, told me I was not in labour and to go to sleep and promptly left the room. Where I writhed and cried and had David punch my back until it was numb. Dave was exhausted and wanted nothing more than to curl up on the little lounge by the bed and sleep.

Another lesson learned, babies equal no sleep. Ever. Again.

The trouble was, the doctor did not want to come in and so in a giant leap of mismanagement they sat on me, with broken waters and two babies in the sideways position.

Can anyone say trouble waiting to happen?

Morning comes and with a change of shift we meet Jacqui. She is the midwife I will never forget. She was kind and attentive. She came in, looked at the reems and reems of CTG paper and asked how long I’d been in labour. When I commented that I had tightenings all night she called the new doctor.

She was a lovely English resident, who I had met before. She had red hair and freckles, oh and the pale skin.

She explained that she needed to do a vaginal examination. Of course, being my first (and not yet a nurse - only a student) I had no idea what she was talking about. I smiled though and gave consent, eager to get the ball rolling. Oh. My. GAWD!!!!!!!!!

*breathe Tiff breathe*

There was silence for a moment and then the doctor’s face appeared before me…

She was as white as fresh snow, as white as a new sheet of paper. She was almost transluscent, her red hair now looked especially red and her freckles stood out like warning signs…

(almost to herself)…”3cm dilated, anterior…I think I just shook hands with twin 1, this is now an emergency”.

From there everything moved incredibly fast. I missed my first birth because I had a general anaesthetic. David was not allowed into the theatre. I was shaking so hard I could not think straight.

I woke to find I had been ripped from hip to hip, had a bleed and two polaroid squares on my, now deflated, belly.

“Are they okay?” I cried out to the straight faced recovery nurse “What sex are they?”

The face stared back at me. “Two girls” she said and that was it.

They were in the NICU.

Maddy took five minutes to resuscitate, Immy nine. Maddy was okay, in headbox oxygen but stable. Immy was not in good shape. She had been wedged into my pelvis, with her arm and shoulder prolapsed through my cervix, her head  and neck pushed at a terrible angle on my pelvic brim. She had a pneumothorax (collapsed lung) and apgars of 1,3 and finally 6. She was in oxygen that was already up to 72% and looking to be transferred to a tertiary hospital.

In hindsight, I was so niave, I had no idea, really what was going on and in blind faith I expected that all would be okay. There were issues with breathing and body temperature and infection, breastfeeding just didn’t happen. None of us had any idea what we were doing and all the midwives seemed to patronise the ‘young mum’ with pats on the shoulder and you’ll be fine. Yeah. Hindsight is a wonderful thing.

Two weeks later we were released from the hospital. Actually, they said I could go on day five but I refused to leave without them. I held Madeline Rose 72 hours after she was born and Immy  - Imogen Martine, another 24 hours after that. Bonding had been…difficult to say the  least but we were getting there. Life was such a flurry of horribleness on the outside. My sister was pregnant too and living in my home, stealing from me every chance she got, my mother and father were still slugging it out over their recent divorce. Overwhelming is a word that comes to mind when I think about that time. However, we made our way into the world. parents of twin girls and with SO much to learn.

I felt incredibly saddened by Imogen and Madeline’s birth and it took me a very long time to come to some peace with what had happened. I felt I had lost a rite of passage and had been deprived of a normal birth process. It was a good four years before I could talk about their birth without crying. In the meantime, I had fallen pregnant with Lily, our just meant to be baby. Another story though…

This was written (late again) as part of Sarcastic Mom’s birth story carnival. What? It’s still the 24th somewhere!

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