Category: Nursing

Endometriosis – The Need-to-Know

Introduction

Endometriosis is an extremely common disorder that affects ladies in their reproductive years.  It occurs when endometrial tissue (in other words, the lining of the womb), grows outside of the cavity that contains the uterus.  It can implant and grow anywhere within the abdominal cavity, and has occasionally been found to grow even further through the body.

These growths can result in scar tissue which causes organs to bind together.  This scar tissue is known as ‘adhesions’.  Often, ladies with endometriosis don’t have any symptoms, however it can cause severe menstrual cramps, pain during sex and infertility.

Surgery is the only effective treatment option – particularly in order to preserve fertility.  Alternatively, medication can be used to alleviate the symptoms of endometriosis.

Causes

The most common theory as to the cause of endometriosis is the concept that the backward flow of menstrual discharge (through the tubes and into the pelvis) causes endometrial cells to implant on the ovaries or in the uterine cavity.  Another possible cause is changes in the immune system which is responsible for clearing abnormal cells and bacteria from the body.  There also seems to be a genetic link.

Characteristics

Endometriosis in the early implant stage looks like small, flat patches of dark ‘paint’ sprinkled on the pelvic surface.  Endometriosis can invade the ovary, causing blood-filled cysts that are often called “chocolate cysts” due to their dark colour.  These cysts can be small, or large and can burst.  Endometriosis can bind the uterus, fallopian tubes, and intestines together.  It can move into the tissue that separates the rectum from the vagina, and occasionally could even grow into the bladder wall.

Symptoms

Menstrual cramping is one of the most common symptoms.  Other symptoms include pain during sex (usually caused by the scar tissue binding organs together), abnormal bleeding, and infertility.

Diagnosis  

Endometriosis
Endometriosis

Diagnosing endometriosis cannot be done based on symptoms, and it is essential to visit a qualified doctor (preferably a fertility specialist) for diagnosis.  Some of the testing for endometriosis will include a pelvic exam, a laparoscopy (surgical procedure enabling the doctor to see into the pelvis with a camera), ultrasound, and blood tests.

Treatment

There are a few treatment options for endometriosis:  hormone medication can be used to simulate pregnancy or menopause (both of which inhibit endometriosis), the oral pill, surgery and lastly, pregnancy.

Get Help

Endometriosis is a disease with vast emotional consequences for women.  The pain is often debilitating, while women may avoid sex and blame themselves.  Endometriosis affects millions of women around the world, and it often goes unnoticed.  Contact the Endometriosis Society of South Africa (ESSA) for further information.

A New Method for Improved IVF Outcomes

The latest research in the world of infertility is how scratching the endometrium (the lining of the womb) in the few weeks prior to undergoing IVF treatment can increase pregnancy rates to as much as 49%.  This is a massive jump from the usual expected 29% success rate for the majority of IVF cases.

It is found that this scratching also increases the live birth rate from around 23% to 42%.

The concept is still under trial, however, and is not currently being routinely practiced – however, it seems that this is the route that most IVF clinics will follow.

It is unclear why endometrial scratching works, however it is thought that it may increase white blood cells in the area, thereby increasing the amount of growth factor in the area and controlling the implantation of the embryos.  Another thought is that it may result in gene switching – some scientists speculate that genes responsible for the embryo implantation are not ‘switched on’ at the right time, and that perhaps endometrial scratching can assist with this.

Check The Telegraph and Create Health for more information.

ivf

The Truth Behind Labour – Back Pain

Often, there is so much information to take in with regards to labour, that many people don’t know the facts from the falsehoods.  Here is the truth about: Back Labour.

Back Labour

Many women experience intense lower back pain when in labour.  Often it can be a constant ache, or it can come and go.  ‘Back Labour’ is usually due to your baby’s head pushing against the sacrum and lower back.  It is also thought to occasionally be caused by a baby in the ‘occipito-posterior position’, in other words, when baby is facing the stomach as opposed to the back.

A comparison of the most common head positions a baby may present with.
A comparison of the most common head positions a baby may present with.

Most women don’t describe back labour as being extremely painful; it is more often described as an intense ache.  However, if it is constant pain, it is more difficult to ignore.  Women can try prevent having back labour during their pregnancy by regularly performing pelvic tilt exercises, sitting on a birthing ball often, and keeping her knees lower than her hips when sitting during the day – these exercises are to try and prevent the baby from taking on an occipito-posterior position.

There are a few ways that are thought to help ease the pain of back labour.  Kneeling on all fours is found to be of big help, because gravity moves the baby’s head off the lower back and sacrum, therefore decreasing the discomfort.  Bouncing on a birthing ball and performing pelvic tilt exercises also helps minimize the pressure in your back.  Massage of the lower back helps many women, so make sure you have a loved one or doula present to help with this – counter-pressure on the lower back seems to help relieve the pain in a big way.  You could try massage with a tennis ball against the lower back during or between contractions.  Warmth also helps the pain, so try get into a warm bath or shower, or use a hot water bottle on your lower back.

5 Things You Probably Don’t Know about Infertility

Infertility is one of those things that no one really speaks about – there is a big taboo attached to it, and I truly wish this wasn’t the case.  It is estimated that around 1 in 10 couples struggle with infertility, however, it could be even more common than this as many people don’t seek help.  Here is a list of things you probably didn’t know about infertility.

1.  Being overweight can affect your chances of falling pregnant.

Obese or overweight women have a lower chance of falling pregnant than women of a healthy weight.  Overweight and obese women are likely to take longer than a year to fall pregnant.

2.  Smoking has a link to infertility.

Smoking is believed to cause tubal and cervical changes, it is also attributed to early ovarian aging and miscarriages.  In men, smoking damages sperm – making them less likely to fertilize an egg.  The effects of smoking on your fertility can last for up to 3 months, if not longer.

3.  Contrary to popular belief, being on the pill will not affect your fertility in the future.

The pill is a reversible birth control method, and the effects are not long-lasting – therefore, they won’t affect your future fertility.  Even if you’ve used the pill for years, ovulation will start again within a few months after stopping the pill.  The pill is just a synthetic version of the hormones already produced by your body

4.  Male versus Female

It is often thought that infertility is mostly attributable to female factors.  This is not necessarily true, and more often than not, infertility is caused by contributory factors from both the male and the female in the relationship.

5. Secondary InfertilitySecondary infertility refers to a couple who have one child together, and then struggle to fall pregnant again.  Secondary infertility is more common than primary infertility (struggling to fall pregnant for the first time).  The rule of thumb for seeking a medical opinion for possible infertility is to give yourself a year trying to conceive if you are under 35 years of age, and 6 months of trying to conceive if you are over 35 years of age.  After these time periods have passed, it’s best to get help.

No Crazy for Me Today!

Myself, Cindy and Ariel used to sit outside the main entrance of our training hospital on concrete steps. Firstly, because the cafeteria smelt like cabbage and secondly, because the Canteen only sold Food Poisoning. The psychiatric patients on the second floor often looked down at us sitting in the freedom and tended to take a liking to me and would wave at me constantly.

I kept seeing the same patient for a couple of weeks. He would wave at me every time he saw me and he would gesture over and over that I must come up and visit him. No thanks, not ready to be murdered today!  One day, I found him walking around outside Casualty looking dazed and dishevelled with toilet paper stuffed in his ears.  I’m not sure what ever happened to him.  He eventually stopped sticking his head out the window to say ‘hi’. Maybe he was discharged. Or paralysed by a tazer or all the anti-crazy pills. Or maybe he is sitting outside my bedroom window right now, watching me.

The Psychiatric Ward was very interesting and very scary. Rebecca and I would often sit outside the Psych Ward during a tea break. We would sit watching the patients walking around expressionless, take photos, prod at them with a pole.. That sort of thing.

These patients often try to escape through a locked gate (get the logic in that?) but this doesn’t turn out well because security guards would beat them down with batons. If the patients weren’t running at the gate like a battering ram, they were running up and down the corridors with security guards chasing after them.

Once, I had to enter the psychiatric ward ON MY OWN. I walked in and a big, sweaty man ran straight up to me, introduced himself and gave me the biggest hug. He smelt like baby vomit. He then grabbed my hand and gave me a tour of the place. “This is where we eat, this is where we get tazered, this is where we can smoke, this is where the elephants eat the pineapples..” I’m pretty sure I had a couple tears running down my face at this stage as I walked towards the bright light at the end of the tunnel..  All I could think was “I don’t want to dieeeee!”. I eventually got away from baby vomit guy and walked towards the nurses station. The really crazy patients are locked in their rooms behind bars and all you hear is simultaneous screaming and laughter as you walk past each door.

I wish everyone could experience this just once – SO. MUCH. FUN.

A New Beginning (Again)

It’s no secret that I’ve been exceptionally miserable for the last couple of months as I ventured into a new job (see here).  I’ll be the first to admit that taking this job was one of my biggest mistakes learning curves ever.

Being a 20-something amongst 60-somethings was not easy, as most of my colleagues saw me as a threat.  Every day has been a battle as no one really speaks to me, I get treated like absolute dirt, and have encountered many difficult situations with these people.  Some of the stories I can tell are so bad it is almost unbelievable that things like this actually happen, and that people can do these things.  It is also a very negative environment – everyone is miserable, no one smiles, no one wants to be there.  I’m usually a happy smiley, giggly person but it just gets lost here.  I’ve lost count of the number of times I’ve gone to hide in the bathroom and cried or came home, crying. (Poor Ross!)  I can be overly sensitive though, which I something I need to work on, but nonetheless, life has been made unbearable.

I ended up working longer hours than expected, working weekends and public holidays (which is something I’m used to but it never gets easier).  I also entered an extremely toxic environment.

That wasn’t the problem though.  I’m bored.  Out of my mind, bored.  I miss using my hands.  I came into the job thinking I’d be involved in theatre, using my hands, along with afternoon consultations, education and counselling but it turned out to be a plain and simple office job where I sit behind a desk consulting all through the day, saying the same thing to couple after couple, and filling my time with paperwork.  I don’t feel passionate.  I can’t see myself doing this for another month, let alone 10 more years.  I don’t love it.  I’m not happy, I am becoming miserable just like the rest of them.  Don’t get me wrong, I have some great experience in the field, and a way better understanding of infertility than I ever thought possible – but it’s just not me.

Then, I blogged this picture which summed up exactly how I felt, and I knew I had to keep looking:

jobsA few days later, something magical happened and I was offered a job at Netcare Sunninghill Hospital at their Stork’s Nest clinic where they were looking for a midwife (my first true passion).  I am happy to announce that I have accepted the offer.

netcareI will be taking a bit of a pay cut but I believe it is worth the sacrifice in order to find my happiness. It may be really clichéd, but I have learnt the hard way that money really won’t make you happy, no matter how hard you try to convince yourself it will.

I will be involved in all aspects of pregnancy – from antenatal care, and antenatal classes to breastfeeding/lactation advice and teaching in the wards, baby immunizations, well baby clinic and postnatal care.  I will work Monday to Friday from 7:00 to 15:00 and NO weekends, NO public holidays.  Once a week, I will work in the evening hosting antenatal classes – that is fine with me!  Bliss.  It also looks like a very happy place – it is bright and bubbly and it’s just what I need.

The difficulty is that I know I’m difficult to please and for all I know, I may be completely miserable in this new job too (not that I think this, but you never know).  Afterall, this is not the first time I’ve been unhappy in a job, and I’ve always struggled to know exactly what to do with my life.  However, I have to try.  I refuse to settle and stagnate.  I will keep looking until I find what I love to do.

My Tips for a Successful Birth

1.  Attend antenatal education classes.  The lessons learnt here are invaluable as you will learn everything you need to know about pregnancy, labour and childbirth.  It also provides an arena for you to ask questions and receive immediate feedback.  Most antenatal classes are ‘couples’ classes so that your partner can feel involved and learn about the process too.

2.  Follow a healthy diet, which is proven to lessen the incidence of high-risk pregnancies.  Eating well can also prevent pregnancy symptoms such as morning sickness.  Take pregnancy-appropriate supplements and vitamins to guarantee you are well nourished and to ensure your baby is developing appropriately too.

3.  Perform appropriate exercises during pregnancy.  Pilates is a great example of beneficial exercise as it can help strengthen the pelvic floor muscles to help during childbirth.  Exercising in water provides gravity-free resistance with less risk of injury on joints and muscles, while increasing muscle tone, your strength and your flexibility.

4.  Go for regular check-ups with your gynae or midwife to identify any problems and to make sure baby is growing well.  This will help you feel reassured when it’s time for baby to arrive.

5.  Develop your own birth plan.  Your birth plan should outline everything you want and need out of birth and be sure to show this to your healthcare provider.  Your birth plan should cover all aspects, such as whether you want a medication-free birth, what type of birth you’d like, even what music you want playing when you give birth.  Remember, however, that not all births go according to plan – so be prepared to alter your birth plan if required.

6.  Bond with your baby and establish a relationship with your baby, before you have given birth.  Speak to baby, get your partner to give gentle massages, play music for your baby.

7.  Be prepared in advanced.  Have baby’s room ready, and be sure to have all the necessary equipment you’ll need for a newborn.  Pack your hospital bag in advance.  Being prepared will help you feel more calm as your labour nears, and not having a mad rush at the end of your pregnancy is essential to a calm and stress-free experience.

8.  Choose the birth option that suits you best, be it home birth, hospital birth, water birth, vaginal delivery or a caesarean section.  Research all the different types of birth and decide which one you are most comfortable with.  Be informed and make your own decision without being influenced by others.

9.  If you decide on a vaginal delivery, be sure to perform perineal massage to reduce the risk of episiotomy or tearing.  You should also practice Kegel exercises.  These activities will help increase elasticity as well as strengthen and tone the perineum for childbirth.

10.  Formulate your own positive expectations regarding birth.  Don’t expect pain, as you will then experience pain.  Dreading the idea of childbirth is sure to contribute to a negative experience.  Recognize birth as the welcoming of a beautiful and joyous addition into your life.

11.  Have a support person with you on the big day.  Whether your partner, a family member or even a doula, don’t labour alone.  Knowing you have someone to support you will help you relax and feel more confident.

12.  There are a variety of techniques to use during labour to make it easier and more manageable.  Consider massage, aromatherapy, and music therapy to help relax you.   A calm, quiet environment will help you feel more in control.  Water acts as a powerful pain management method.  Climbing into the bath once you’re in the active phase of labour (around 4-5cm dilated) will help greatly with your contractions.

13.  Consider different birthing techniques to help you during labour.  Hypnobirthing is a fairly new concept using active birthing, which alters the way in which you view birth.  For example, you view pain as ‘pressure’ and contractions as ‘waves’.  You allow your body to take over the process of birth.  Waterbirth is becoming more and more popular and provides a quiet, serene atmosphere for your baby to be born into.

14.  Don’t compare yourself to others.  Everyone is free to make their own choices, and everyone has different experiences of pregnancy, labour and birth.  Guilt is commonplace with pregnant women.  The important thing is to do what makes you happy and comfortable.  Try not to question your own decisions.

15.  Most importantly, believe in yourself.  Know that you can birth successfully.  Have a positive attitude.  You have essentially had nine months to prepare for the big day.  You can do it!

5 Things You May Not Know about C-Sections

Check out this great article by Sister Lilian on c-sections and a few things that you may not know about them.

What I found interesting is that the WHO (World Health Organization) recommends a maximum c-section rate of 15%.  In South Africa, the c-section rate is a whopping 70% – one of the highest c-section rates in the world.  This is due to a number of factors.

One of these factors is the avoidance of lawsuits.  Obstetricians are the most insured doctors, and often, they will perform caesarian sections at the slightest hint of something ‘abnormal’ in order to avoid being sued.

The ‘caesarian section versus natural birth’ debate is a very contentious issue, but I love the fact that Sister Lilian ultimately simplifies it all into this paragraph.

Of course, most importantly, at the end of the rite of passage that is birth, both woman and child should be safe and well. But, there’s more to birth than only a healthy baby and mother. A woman who feels good about her birth tends to find mothering easier, and there’s less chance of postnatal depression! From Baby’s perspective, it often means better health and less need of therapy to help with milestone development.

Just think before you decide! – Sister Lilian

What does it matter how we give birth – as long as we have a healthy mom and baby at the end of it?  Informed consent, and taking responsibility for your health is vital to ensure the best outcome suited to you as an individual, and as a mother.

Locked-Up Loonies Part 2

Ah, Maxwell. Such a smooth talker, who suffered from Schizophrenia.

The day I met Maxwell, he came up to me and without even introducing himself asked: “Are you married?” When you’re a female working in male lock-up ward, you are always married. Otherwise, they’ll steal you and take you back to their bedroom and stuff you under their mattress.

Maxwell told me many stories of his wives, his BMWs, his riches. None of them were true. What was true, however, was that Maxwell had an affinity for us female nurses. One day, Maxwell was elegantly lying across a table and when I walked past him, he called me a “beautiful, sexy angel”. Whenever I walked past an open doorway and looked in, Maxwell was staring back at me. It started getting awkward when he would suddenly appear next to me when least expected (surprise!) or when he would attempt to hold my hand.

While working in our hours at this hospital, we had a room in which we could sit and type up our findings of our patients. The assignment load was huge, and we could use any spare moment to work on our projects. We had spent a big part of the morning working on these assignments, and then all went out to grab some lunch together. On returning to the room, we walked in, sprayed deodorant, had some girly talk and sat down at our computers. Suddenly, in my peripheral vision, I saw a dark silhouette in the corner of the room, glaring at us. Maxwell. Under my voice, I muttered: “Whatever you do, don’t look at the corner of the room”. My friends looked anyway. Caroline screamed. Some of us jumped a metre in the air. One friend ran out to call security. Maxwell simply asked “Why didn’t you invite me for lunch?” Needless to say, security had to tackle him and pull him out of the room while his nails dug tracks in the carpet.

Later on that day, my super nifty bladder failed me and I needed a pee-break. I walked out the room and had the distinct feeling of being followed. I started walking faster and just before I got to the bathroom, I had a quick glance over my shoulder. Maxwell. He grabbed me and pinned me against the wall. I let out a meek: “Sister?… Doctor?” trying to find someone in charge who could possible take away the bright light at the end of the tunnel. Luckily the Sister-in-Charge found me, grabbed some Haloperidol and put Maxwell out of his misery. *side note: I wish I could have received the Haloperidol*

They started drugging Maxwell heavily. Apparently I was a bad influence on his psychosis. Maxwell took a bad reaction to the sedation one day and we needed to move him to a room closer to the nurse’s station. Only problem is, we were 4 skinny nurses and one 90kg man. You do the math. This resulted in us putting a sheet under Maxwell and sliding him along the floor all the way through the ward to get him to the room, leaving a trail of drool behind us.

Maxwell slowly started getting better, but he still loved us nurses. One day, we were leaving work, and as we got to our cars, we looked behind us only to find Maxwell following us with a packed suitcase and a bottle of juice. He insisted that he would be coming home with us. Once again, security had to tackle him and take him down. You would think security could have just not opened the gate for him in the first place, no?

The last time I saw Maxwell, I was no longer working in the ward but at a Psychiatric Outpatient Clinic. I saw him running on one of the fields, non-stop. He had lost a lot of weight, and was looking good. I asked a Doctor why he was running so much. The Doctor replied that Maxwell believed he had been entered to run the Comrades marathon.

Locked-Up Loonies (Part 1)

I’ve been reminiscing of my days as a student, and just had to share this story with you all.  One of the hardest moments in training to be a kick-ass nurse is the specialization in Psychiatry. Not only because you remove all the masks you are wearing to disguise who you really are, but because you work with people who want you to die.

We were all nervous, yet excited, to find out where we would be placed within a certain Psychiatric hospital. I was particularly nervous because I am very scared of the unknown. I went (with Ariel) to our beautiful, very understanding lecturer and asked her not to put me in a specific ward. What happened? I was put there anyway..

Male lock-up Ward.

That’s right. Big, scary men. Big, scary, *crazy* men who are so out of control, they are under constant guard and are locked inside. Now, maybe this was my lecturer’s way of showing me what I can accomplish. Or maybe this was her way of enjoying some of my suffering. Sadist.

We walked towards the ward holding hands. The glass windows were shattered. There were men standing at the windows watching our every move. The big white gate was unlocked by security for us. I walked through that ward with my back to the walls at all times, and when I came to a corridor I would dive across (stealth style) to the other side, holding my pepper spray like a gun. The Sisters decided we should all meet our patients. We walked into the lounge where they were sitting. One by one, they introduced themselves. A lot of them seemed totally normal.. Except for the occasional one that would just walk out the room or randomly start screaming. My favourite patient was a man named Sam, who suffered from Schizophrenia. At his turn to introduce himself, he promptly stood up and shouted: “Secret Prime Minister, Third Division”, waved, and sat back down. He came and greeted us all individually, and excused himself. He walked out the room and back in through another door and introduced himself all over again. Later on, he came up to me and said “If I knew you were coming, I would have shaved.” He walked off like a man on a mission to go shave, until I found him in the courtyard picking at blades of grass.

While watching over the patients during lunch (making sure the anorexics ate and that the depressives didn’t slit their wrists with the plastic cutlery), Sam came up to me with a couple sachets of black pepper and informed me that it’s brilliant for preventing heart attacks. Ah, where would I be without my Sam? After I got to know Sam a little better, he informed me that his mother gave him a blowjob. And that he enjoyed it. Sam was so very sweet, he would try feed me his food, or steal me an apple from the kitchen because he was always convinced that I must be hungry. Exercise time with Sam was the highlight of my stay at the hospital. Exercise releases endorphins (feel-good chemicals) but in Sam’s case, they made him perform very.. erm, effeminate moves. Halfway through exercise time, he would stop and sit on the floor. However, when it was his turn to demonstrate an exercise move, he would jump up excitedly and perform weird dance moves ala Michael Jackson on tiptoes, hands on waist, shaking his hips.

Another man I met was Harry. An old guy with Alzheimers. Harry loved to exercise, despite barely being able to walk. I can still hear Harry chanting in his ex-smokers, Portugese-accented, voice: “Wunnn, Toooo, Sreee..” Harry was extremely hyper-sexual and grabbed my bum every time I walked past him. I didn’t know this at first and went up to speak to him on our first day there. He looked at me slowly, told me I was beautiful and put his arm around me. In the next instant, he had a crazy moment and tried to strangle me. Harry used to sit on his own swearing in Portugese. God forbid you ever got close to him, he would either try slap you or try to have sex with you. Good thing my pimp hand was strong. I think Harry knew how to piss me off as well: by sitting down. Once Harry sits, there’s no chance he’s going to get back up easily. He would shout “Nurse! Nurse!” until I would come pick him up. I would stand with my weak little arms under his sweaty pits, inhaling his dry urine smell, while he tried to nibble my earlobe. *shudder*

Sam and Harry were a breeze in comparison to another patient we encountered: Maxwell. Stay tuned for Locked-up Loonies Part 2. ;)