Lil' Pep, Big Lagoon

We have been having SPECTACULAR weather in the last week or so. It was another sunny weekend forecast, and on Saturday, we headed north about 20 minutes (just past Trinidad) to paddle around in Big Lagoon County Park.

It was a fantastic time. We rented a tandem kayak from Kayak Zak's and brought Pepper along to enjoy the trip.

Getting ready

 

 

 We rented a life-jacket for our petite pup

 

... and paddled around the perimeter of the lagoon, without any canines (or humans) in the water

It got a bit windy/cold partway through, but, although wet, we made it through the waves to the sand spit, and enjoyed peering at the Pacific Ocean on the other side. 

 lunchtime! 

headed back...

 

Fun times!

munchie heaven

Someone brought some Zesty Salsa Wheat Thins to work a few weeks ago, and they were a hit! Already a big Wheat Thin fan, I am even more of a fan with these tasty varieties. We got a box each of the Spicy Buffalo and Zesty Salsa versions, and they're almost all gone. They go perfectly with my snack of choice... cheese.

Speaking of Wheat Thins, here is a commercial which Kelvin finds hilarious but which I don't quite "get."


 

Botanical Excursions

We had a glorious weekend of sun this past weekend, which was a huge blessing. It was the first time I wore flip flops since we moved here!

On Saturday morning, we went to the Farmers' Market for the first time this season (I think it opened a couple of weeks ago).  I LOVE this market. This time, I came away with a mini basil plant. While I managed to keep some succulents alive this winter, my bromeliads are looked a bit peaked, and I'm not sure how well my basil will fare. I've never actually tried to grow anything before, but am kind of excited! The seller recommended keeping it indoors at least for another month due to weather fluctuations, and then considering transplanting it outside, to a sunny spot to keep it warm.  I LOVE basil, so let's hope I keep it alive.

We then checked out the Azalea Reserve in McKinleyville but, alas, the flowers weren't quite in bloom yet.  As they didn't allow "dogs on the trail," I figured that "dog in a sling" got around that restriction. It was still a pleasant walk.

 The annual wildflower show was held at the Manila Community Center...

... and then we enjoyed a nice walk in the nearby Manila Dunes Recreation Area.

 

dune bloom

 

 Pepper loves sand/the beach.

 

 

 

crab shell

check out these friendly Newfoundlands next to our Pep!

I don't think I posted this before, but here is a photo K took of a trillium flower (common in this are) on our hike in Prairie Creek Redwoods SP.

 And, again, I have to show off my lavender collection (natural sleep aid and, as a result, my new favorite flower!)

Sleepless Nights

 

As I think I have mentioned before, I have really struggled with insomnia since moving to Humboldt County. I don't have the "onset" insomnia (i.e. difficulty falling asleep) that some people have (falling asleep is NO problem, as evidenced by these pictures...); rather, I have "maintenance" insomnia, which means I can't stay asleep. I wake up about 4-5 times in an average night and have probably slept through the night about three times in eight months. Granted, I'm usually able to turn over and fall right back to sleep, even after getting up to use the bathroom, but it still makes for very interrupted sleep, and I don't usually feel rested during the day, leading to exhaustion the next day, and inability to stay up past 9 or 10 pm.

Pep's preferred sleep position!

(yes, she really sleeps like this!)

I must say that I have newfound sympathy for patients of mine who come in complaining of insomnia and requesting treatment.  I used to think that benzodiazepines and Ambien were the devil, but now I'm not so sure; however, I have never tried either. One lady told me that she hasn't slept through the night in over 20 years, ever since she was militant about waking to breastfeed her under-weight newborn every 2 hours. I can see why people become desperate from not sleeping.

I'm not sure the "cause" of my insomnia. Sleeping through the night has never been a problem for me, before this year. Maybe it is sharing a bed? (a few friends have suggested getting a larger, i.e. queen- or king-sized bed). Maybe it is actually not being sleep deprived every day from 30-hour calls of residency?

My first recommendations for patients with concerns about their sleep include optimizing "sleep hygiene," which includes the following:

- Sleep as long as necessary to feel rested (usually 7 to 8 hours for adults) and then get out of bed (after residency, this is actually possible)
- Maintain a regular sleep schedule (nearly impossible for me due to being on call)
- Try not to force sleep-- if you are not sleepy, get up and do something else that is not super-productive until you are drowsy (not a problem)
- Adjust the bedroom environment as needed to decrease stimuli (eg, reduce ambient light, turn off the television or radio)
- Resolve concerns or worries before bedtime (not an issue)
- Exercise regularly for at least 20 minutes, preferably more than four to five hours prior to bedtime (easily done)
- Avoid daytime naps, especially if they are longer than 20 to 30 minutes or occur late in the day (who has time for naps?!)
- Only use the bed for sleep and sex; avoid watching TV or reading in bed (I am kind of guilty here... I like to read in bed)
-  Avoid using the computer, phones, or other electronic devices before bedtime as these can stimulate the brain (I could be better about this one)

afternoon nap time (a no-no, I know)

Avoid caffeinated beverages after lunch (hard for me to do esp when I'm so fatigued)
Avoid sugar, as highs/lows can cause un-restful sleep (sugar is a weakness of mine)
Avoid alcohol near bedtime (eg, late afternoon and evening)- (actually, I sleep pretty soundly after a glass of wine!)
Avoid smoking or other nicotine intake, particularly during the evening
Try to increase foods rich in magnesium (which is a natural sedative), like legumes and seeds, dark leafy green vegetables, wheat bran, almonds, cashews, blackstrap molasses, brewer's yeast, and whole grains.

While there are a few things I could improve, I really try to do most of the above. I have tried restricting liquids after dinner as sometimes having to go to the bathroom annoys me in the middle of the night. I try sleep-depriving myself, i.e. forcing myself to stay awake until 11 or later, so as to try to prevent the awakenings which often start as early as midnight or 1 a.m. I have tried the occasional benadryl but I don't really like taking meds. I have done some "herbal" research, finding that valerian, melatonin, chamomile, and lavender all have soothing, sleep-promoting qualities.

I bought some melatonin from Costco but am afraid to take it when I'm on call. I recently visited the local herb store, Moonrise Herbs (great resource for "natural" remedies), in Arcata for some suggestions, and came away with a sleepy-time tea (with chamomile and other herbs) as well as lavender essential oil, which I place on my wrists prior to bed. I swear this has helped with sleep quality; it also helped me fall asleep after getting back from a late-night c-section, which often leaves me wired and restless.  K worries I'm going to become one of those organic, herby hippies who don't bathe or shave, and refuse to vaccinate their (future) kids, but he is wrong. I just want to sleep!

Lavender flowers

So let it be said that, when something works, you want to stick with it. I'm now slightly obsessed with lavender-- check out my assortment of scented beads, fabric spray, scent diffuser, dried herbs in sachets (with the mini bottle of essential oil in the middle).  I'm already getting drowsy..... :)

Please let me know any other sleep suggestions you may have!

Water Birth

* Caution! Medical post involving bodily fluids!*

On Sunday, I did my first "water birth."  What an experience, let me tell you!  If you aren't that familiar with water births, it is a method of delivering a baby into a tub of warm (90-100-degree) water rather than "on land," to theoretically give them a less traumatic entrance to the world, decrease maternal labor pain and possible tears, among other benefits. While I had been present at one other water delivery, this was my first one to do on my own.

While apparently over 3/4 of hospitals in the UK offer waterbirths to their pregnant women, it is much rarer in the U.S., and we definitely did NOT have the waterbirth option at UC Davis (unless you count inadvertent "toilet births" like Kelvin [without gloves] experienced as an intern in triage when a woman went to leave her urine sample!). It should be offered to "low risk women," i.e. women without a history of shoulder dystocia, suspected macrosomia (large fetal size) or any high risk obstetrical complications (preeclampsia, diabetes, HIV, hepatitis [due to infection risk]) which are what often, here, involve me in their labors. Women at Mad River have to "rent" the circular tubs (which get filled with warm water and then plugged in to retain the heat) from an outside supplier, and have to agree to exit the tub for any provider concerns (about fetal well being or bleeding, etc.) during labor.

I have to say that I have mixed feelings about the water birth. It is a great experience for a family in that the mom's partner can also be in the birthing tub. After the baby's head comes out, the idea is to bring him/her gently to the water's surface (babies don't usually breathe until they surface), and lay him/her on the maternal tummy without lots of stimulation (i.e. avoiding the usual rubbing and bulb suction). This leads to faster/closer bonding among the whole family unit and a more peaceful delivery. It is ideal to do delayed umbilical cord clamping, which I like to do anyway.  I had to be comfortable with (very) intermittent fetal monitoring, which was pretty new for me. While at UCD, most everyone was on continuous external fetal monitoring (unless they opted out; we did have an "intermittent protocol," which people were rarely offered), here we did basically intermittent monitoring (i.e. periodic [waterproof] doppler assessment of heart rate) for the entire course of labor (I think she was on the monitor for 30 minutes out of the 9 hours she was there!), even while the mom was pushing. Fortunately, this baby behaved very well, but difficulty in fetal monitoring is one reason a water birth can be challenging and/or anxiety-provoking for the doctor, who has to always convince him/herself of "fetal well being."

I will say that it was quite messy. It is difficult to examine a woman's cervix under 2 feet of water (in a dark room, to add!), and you wear these long veterinary gloves, but water still seems around and usually trickles down your sleeve/back.  While the woman is pushing,  poop often comes out (like it does on land) but then floats around the pool until someone scoops it out.  It is quite hard, as the provider, to protect the perineum without getting a back spasm from leaning over the tub or getting drenched/falling in. After the baby comes out, there is usually quite a bit of blood which makes it even harder to see anything (i.e. the perineum or the placenta), and which then settles to the tub bottom, staining the water dark red/brown.

While you can deliver the placenta in the tub (and you can actually deliver the placenta still attached, if desired [lotus birth], as it can be done on land), most people have the mom (shivering, and a fall risk) get out of the tub to the bed after cord clamping, to complete the third stage of labor and any repairs.   As women who opt for a waterbirth are considered "low risk," many don't even have an IV, so you can consider intramuscular pitocin for uterine bleeding, or opt not to give it at all (NOT give post-placenta pitocin?!?!? This was NEVER done at UCD!).

Lotus birth

I was glad to be a part of the birth. As someone who wants to avoid an epidural (if/when I have kids) in labor and try for as natural a birth as possible, I think that laboring in the tub is an amazing form of anesthesia.  However, I'm not 100% convinced that I would want to give birth in water for a few of the reasons above.  What do you think?

Abalone Feast

If you recall from a post back in October, I had been wanting to try abalone, a type of mollusk, since moving to the north coast, where abalone diving is a revered pastime.  The father of one of the kids Kelvin and Josh coached in basketball this winter/spring gave us some abalone to try which was kept frozen until a special occasion.

Mendocino Red Abalone

Last week, Josh and his friend Mio came over to share in the feast!

We tempura-d various veggies and (pounded) abalone, which, although a bit chewy, was tasty (but does anything taste bad coated in crumbs/flour and fried in peanut oil?!).

Josh, slicing

 

 

Kelvin, slicing

Mio also sauteed the abalone with garlic, white wine, and fresh clams, which was also delicious!

 

 

Somehow, I was able to get away with eating (and taking photos) rather than cooking, which makes the evening a doubly huge success!

Russ Park and a swim in the pond

We continued to have great weather on Sunday and headed south to the Victorian town of Ferndale.
We hiked in Russ Park, a city hilly park with nice views over the surrounding farmland-- Ferndale is dairy country!

We came across Zipporah's Pond.... where I took this nice pensive photo of K and Pep...

... which was followed by a (doggie) swim in the pond (I think Pepper thought the pond scum was grass?). She, however, proceeded to paddle around quite expertly, putting to rest our doubts of her swimming ability!

Bedraggled

 

shaking off the water

Farmland vistas

We also stopped by Centerville Beach, where Pep enjoyed frolicking in the sand. We wondered whether, after her pond swim, she'd want to catch a wave or two, but she seemed to be a bit alarmed by the sound of the crashing, and came close to the tide, but then would dart away.

Here's to (perhaps?) the start of real spring/summer in Humboldt County... hoping for more sunny weather like we had this weekend!