Sunday, August 31, 2008

Ready to retire!

I only took 3 weeks off of work after Ben was born. He came home from the hospital on a friday and the very next monday was my first day back at work. I worked a week and then took a week vacation. Luckily, however, I didn't have any call for that month. Starting on Wednesday last week I was on the call schedule. I was on call Wednesday night. It was my first call as the OB senior...woohoo.
All last year I was the junior resident so I answered pages for all of the floor problems and was reponsible for putting in the epidurals. It is hard to explain the depth of my dislike for OB call as a junior. There is the fact that you get very little sleep, but the actual act of pushing around a 75 pound cart of epidural supplies all night was just annoying. Doing the actual epidural is kind of fun but 4am, exhausted, pushing that cart around was something I dreaded. I seriously tried to get out of OB call last year as much as possible - I would switch for general OR call - which has more work and less chance for time to sleep...but there was no epidural cart to push around.
I am digressing, because now I am a senior resident over here - so I don't usually have to push the epidural cart or answer all of the annoying minutia pages that keep you up all night. So, in general call for the OB senior involves time to study and sleep.
Wednesday night, however, was like one of the circles of hell over on the OB floor. We were in the OR all night doing C sections and they were all difficult to manage - for anyone reading who is familiar with obstetrical anesthesia - we had 5 csections - 4 were general's, one was a spinal that went to a general for a c-hyst, and 2 of the general's had such bad airways we used the fiberoptic and one aspirated - we had to transport 2 to the unit....for anyone else who doesn't understand how crappy my night was crappy.

Friday night, I was on again and it was much quieter - I got to enjoy the extra comfy senior call room bed for about 5 hours of page free sleep. I am on again today and so far it has been really nice...obviously I have time to blog! I am hoping that it stays relatively quiet - although funny thing about babies..they kind of just show up when they want!

Thursday I took Ben to the dr and he has gained 22 ounces in 3 weeks..he is now 6# 4 oz....hurrah - he is officially at term and has a respectable term weight. He also smiled in what I think was a social way cute.

Zeb also went to the dr on Friday....the pediatric urologist in anticipation for his impending circumsicion (which I think I am spelling wrong!). I have thought about whether or not to do this for quite some of my flaws is that I am remarkably judicious and can argue with myself endlessly.

On one hand, an uncircumsized penis is hard to care for in terms of diaper changes and in terms of infection risk througout his life - please forgive me if I don't quote studies here! However, the infection rate isn't that much higher. I must say I believe that Z has had at least one UTI that we treated with aggressive hydration secondary to a couple of days of very foul-smelling urine! There are social reasons - eliminating another difference between him and his dad, between him and the majority of boys in the locker room with him in high school. Women with sexual partners that have uncircumsized penis(es) have higher rates of infections, including hpv, and abnormal pap smears - yeah I am thinking ahead....way ahead...way...way...way....way ahead!

On the other hand - the infection rate isn't that much higher and good hygiene practices can really minimize that. Am a severing another tie to kyrgyzstan and his relationship to that culture? I have to worry that he may resent that when he is older. However, children resent their parents for something no matter what we is human nature.

I was really in a deadlock and decided that I wouldn't get him circumsized unless he needed anesthesia for another procedure. He now needs tubes in his ears and his adenoids out so we are going to do them all together. I know this used to be a controversial subject - I don't know if it still is, but I can see both sides of this one.


Shannon said...

Oh gosh - that WAS a night from hell! You survived, though and because of you there are more healthy babies and happy mommies in the world!

We struggled a lot with the whole idea of a circ, too, and ultimately decided to have it done. It truly is personal preference (as the parents, I mean) and there will always be those that are against it, but we make the decisions we think are best for our kids and that's all we can do. Hope Z does well with the procedures!

LaJoy Family said...

I do think it is personal preference too, Michelle. We have decided with all three boys to leave them "intact"...hahahaha! I balanced all the reasons in my head as well and Dominick put in his two cents that we should leave it be unless they started having issues. We said to ourselves that more guys in the world are not circumcised than are so it is not that big of a deal. Either way, we probably fret more over it than our kids will ever worry about it.

Tapsalteerie said...

We left our guys uncirced because honestly X really identifies with his penis looking a certain way and just seeing his cousin during a diaper change sent him into a frenzy (cousin is circed).

I think it's personal preference and deciding to or not to is between you and hubby... no one should be in your face about it.

Hope all goes well :)

Nanda said...

He's a cute little critter!
Interestingly circ rates are about 50/50 in the U.S. so if you leave him intact he sure won't be the only boy that isn't cut! Also it isn't harder to clean an intact penis- you just wipe it like a finger, and don't retract, because that can cause infections.
I like your idea of leaving him that link to his culture as well.

ICU too said...

I have to think that while parents do what they believe is in their child's best interest that many parents (even us in the medical field) don't always understand what the foreskin function is.
I think it's great that you decided to wait till he can be under general to have the procedure but just because he's going under for the tubes doesn't necessarily mean he needs to get circed.
I know you've weighed the pros and cons and I think you understand all those aspects. But, and this is just me personally, I think the foreskin is supposed to be there for a reason. It has all those nerves there and it's supposed to make sex feel so much better (I know as a woman I can't really experience that for myself). The foreskin makes a sleeve if you will, which makes it easier to glide during intercourse and makes lubrication unnecessary (yes I know it's difficult to think about our young children having sex one day). And really, by circing him while he's under, you're altering his future sex life and taking the choice to be circed or not away from him. The way I see it is, and I left my son intact after some debate, Zeb can always choose to get the procedure done later if he wants. But he may actually really like his foreskin and be glad it's there. I don't think you should take that away from him, he can decide when he's older. Plus, there's the risk of meatal stenosis and infection and everything you already know about.

It seems the cervical cancer and uncirced connection is not true. From Canadian Family Physician:

And this from 2002 (I wish I knew how to those tiny url's)-;jsessionid=LPLKSx771w32193tpVZ3P4dzjXh3J9xCdrqb4JN0rG2JJtxd8cb1!-2013963969!181195629!8091!-1?&fullimage=true

Here are a few links, from a very obvious anti-circ site, but I think the info is good and it helped me decide.

So I just wanted to pass that along. I'm going out on a limb and guessing Zeb is pretty attached to his foreskin and I bet he'd like to keep it. I hope you won't let the locker room issue be the deciding factor. I know plenty of boys his age both circed and intact. It's probably close to 50/50, or at least 60/40. He won't be the only one intact, not that guys in high school are going to announce they are checking out another guys package anyway! Ha!!!!

Hope you are doing well. Take care!

Karyn Purvis Insights and Gifts - sharing power