Internal inspiration

The 2014 Dana was just inspired by the 2010 Dana. Sound odd? It shouldn’t. So often we look outside ourselves for insight and motivation. But I am convinced that we all have an optimal point of restoration similar to the feature on PCs. You know the one that allows you to turn back time on your PC? The set point that allows you to undo system changes so that your device can function more efficiently? Sound familiar now? So yes, the former me just inspired the current me. I’m excited to see what the blending of the two will create next!

Silencing the naysayers

So often the voice telling us “we can’t” is our own. You know the voice. The one that cleverly lies dormant in the recesses of your mind and rears it’s ugly head when you embark on a new journey. This voice is the reflection of self doubt and the value that we’ve place on the opinion and acceptance of others. There comes a time when we have to silence the naysayers, even when they resonate from within. We can be our own worst critics or our greatest cheerleaders. Opt for the later and tune out the rest.

The proposal defense

Inquiring minds want to know…what to expect during my proposal defense? On the eve of my pre-proposal defense meeting with my dissertation chair and co-chair I found myself searching the Internet on what to expect, how to prepare and information that I need to know going into the defense.

Why are these milestones shrouded in mystery? Why aren’t they part of the standard discussion that takes place around the table at T32? So often we spend countless hours reading, re-reading and critiquing the work of others-mainly F31 applications and occasionally manuscripts- yet this critical information is overlooked, lips are hushed and shoulders shrugged in response to inquiries.

Not wanting to be blind-sided during the proposal defense, I took the bull by its horns and asked point-blankly, “What should I expect during the proposal defense? How should I prepare? No one ever talks about this part and I simply don’t know”. After a very brief period of silent deliberation my chair, who had joined the meeting from her new institution in Delaware, chimed in and said, “Since you’ve completed the NRSA application the process will not be that difficult for you. You will need to prepare a PowerPoint presentation with slides that summarize the background and purpose of your study, the study’s aims, a bit about the framework, and then highlight any changes that will be applied in the dissertation study.  Afterwards you will open it up for discussion and asked for recommendations and suggestions from the Committee. One week prior to you sending out the draft to the full committee I will send an email and ask each member if there are major concerns or questions about the proposal. If so, I will let you know so that you can be prepared to answer any possible questions and concerns”.  Nodding in agreement my co-chair chimes in and indicates that he expects this time to be helpful and informative to the fellow. 

In other words, I reasoned to myself, I should not expect to be thrown under the bus during my proposal defense. With that in mind I quickly took inventory of all that I needed to do over the next seven days: incorporate edits from 3 of 5 members, move major content on transgender terminology to the introduction (an idea that we had considered earlier), incorporate more language on symbolic interaction, create a tighter connection between the sub-aims and literature on illness careers, make hard copies of an 80 or so page document for everyone, create a draft sociometric diagram to facilitate collection of social network data from each study participant, and…take a trip to the writing center. No sweat right?! I’ve got this all under control. I just won’t eat, sleep, or breathe anything other than this proposal during the next week. Vacation request will be sent and I will work feverishly during those work hours so that I can fulfill my primary job of mom to my two kids.

Sound overwhelming? It should. This journey is not for the meek at heart. It gets rough and rugged at times, especially when we get closer to a milestone.  Thinking about traveling solo? Don’t! Even the strongest and most resilient scholar needs mentoring and support. Find a writing partner and commit to co-writing and prepping together. Share your lessons learned shamelessly.  In doing so you will contribute to the success of others and give a helping hand in pulling back another layer of this mysterious milestone known as the “Proposal Defense”.

Preparing for the pre-qualification exam meeting

 Prior to sitting for the qualifying or candidacy exam you will have to meet with your dissertation committee and convince them that you are indeed ready to complet your exams.  This process varies across disciplines. Some require both a written and oral exam, while others may require one or the other.  Either way here are some key points to include in your presentation to the committee.  Remember the goal is to prove that, after completing all course work, you are now ready to move into the candidacy phase.

Objectives:
  • Provide exemplars of demonstrated PhD program competencies.
  • Summarize lessons learned from course papers and major projects and discuss how they fit with your proposed dissertation study aims.
  • Provide examples of how course work and projects have influenced your thinking as a scholar (be specific and provide concrete examples). 
  • Highlight any manuscripts that you authored or co-aurthored. Discuss how it ties into your proposed program of research.
  • Similarly you will want to highlight any poster or podium presentations and discuss the major outcomes of those works (e.g. a manuscript).
  • Highlight any grants or scholarships that you’ve received. Our faculty mentors always remind us that publications are currency in the world of academe so publish or perish.
  • Discuss next steps in training program–in other words what do you plan to do once you’ve completed your PhD? Your committee will want to know that you have a plan in place.

Writing the dissertation proposal

Ever hear the term ABD and wonder what it meant? Well in nursing and medicine it is sometimes used as the abbreviation for abdomen and/or abdominal, abduction and more. But in the world of academe it has a very different meaning, “All, But Dissertation”, which is a short way of saying that someone has completed all of their course work for a PhD program, but did not write the dissertation itself.

I am presently writing my dissertation proposal and can see how many people fall into this place of almost completing it, but not.  Writing the dissertation is hard work and it can be a slow process. The other day I described it as walking through molasses.  This is over and above any term paper that you can imagine and certainly isn’t anything that can be written in a couple of days or weeks.  It takes time, determination and discipline.

Having a cohort or support group of other doctoral students is also helpful. Trust me, this is not a journey that you want to take alone and support is key is your success in finishing.  I am nearing the completion of chapter I, the introduction.  This is likely the easier of the five chapters to write and the most likely to be revised after I’m done with chapter II-the review of literature and III-the methods chapter.

Here are some tips that I have gathered from multiple sources. One being a book titled, Surviving Your Dissertation: A Comprehensive Guide to Content and Process, 3rd ed.

  1. Give yourself privacy and quiet to gather thoughts and focus on the task at hand. Not always easy I know–I’m a single mom of two so I often have to break to tend to the children.
  2. Tackle the dissertation in small slices-working on one ch at a time is  helpful. I personally skip around at times, especially when I’ve hit a wall with one chapter. The key is to keep moving through the writing process.
  3. Discuss your thoughts and ideas with other people-cohort members or dissertation committee
  4. Establish a weekly writing schedule EVEN if it’s only 20 minutes per day. Doesn’t sound like a lot, but if you do this for 5 days straight then you will have written almost two hours in one week. Though it may be ideal to block out several hours per day to write it may not always be possible. When people can’t block out this time they tend to get frustrated and not write anything at all or keep putting it off until that “block” of time becomes available.
  5. Take breaks and take care of yourself. Something that I’m learning to do more of:)

If you have any strategies that work for you please post them here.

Thanks for reading and good luck!

 

A newborn shopping excursion to Target

11 days ago my son was delivered via c-section. Since this is a major surgery I am not permitted to drive for 2 weeks. The first few days inside were fine as the city was still climbing out from under the heaviest snow that we’d had in 18 years. But as the days go by cabin fever is starting to set in and I’m anxious to get out. The idea of not being able to drive or leave when I want and having to depend on other people to take me to and fro began to overwhelm me.

Fortunately a good friend stopped by yesterday to rescue me and the baby from our “house rest”. Our first outing was to none other than Target. Ordinarily I could stay in Target and browse for a couple of hours. Hit up the clearance racks and the end caps in housewares. Maybe even try on an item of clothing or two. But not yesterday. LOL. 20 minutes into the shopping excursion my son wakes up and is ready to nurse. Suddenly I was aware that there are no lactation rooms or breast feeding areas for nursing moms. The first time he wanted to eat I went to the cafe, found a table isolated in the corner and draped myself with the privacy cover so that he could nurse. We were there for a good 20 minutes and then he dozed off. Initially I thought that he would be okay until I was done browsing, but he’s 10 day old tummy was only satisfied for a short while. By the time he woke up again I was somewhere between the home improvement and furniture aisles. Not wanting to subject him to another long trip to the front of the store and back to that corner table in the cafe, I decided to park it in the display chair and prop my feet on the display ottoman so that he could eat. Although I was draped I felt like I was on display as well.

As I sat there I began to brainstorm, maybe they could turn 1 or 2 of their fitting rooms in the women’s department into nursing rooms for moms. That would be ideal and give moms and babies the privacy they needed. I also thought about the awkwardness of the shopping cart itself and the lack of room to place items in the cart especially when the baby’s car seat is in there. I ended up grabbing a smaller, hand-held basket that I placed beneath the cart. The positive side of that is that it limits the amount of items you can purchase and thus the amount of money you spend:-)

While I was very grateful to get out of the house and do some light shopping I was also slightly overwhelmed by my lack of a second pair of hands, which every new mom could use from time to time. Our trip to Target lasted almost two hours. At least 45 minutes was spent nursing my son. Yes, the third nursing session occurred in the health and beauty aid section near the pharmacy. At least it was more secluded than the display chair in the furniture department. LOL.

It’s been nearly 12 years since I had a newborn. I have forgotten some of the nuances that go along with shopping with baby. But I remain so happy for the experience of being a mom again.

Thanks for reading!

Questions to ask your doctor before C-section

Having gone through now two c-sections I feel that I have a pretty good grasp of what questions to ask the doctor prior to your c-section delivery.

I had my first c-section 11 years ago and my second only six days ago! So what has changed in those 11 years?

  • My age. I was 26 when I gave birth to my daughter and my recovery seemed speedier. At 37 I was considered advanced for maternal age and as a result, was at risk for greater pregnancy related complications and my son at risk for greater birth defects.
  • My OB. The doctor who delivered my daughter was not longer seeing OB patients, only GYN patients.

In my opinion there are many advantages to having the same OB manage your prenatal care and, if required, to perform your c-section. Should your doctor change OR if you are considering or must have a c-section here are some questions to ask your doctor:

  1. If you have previously had a c-section inquire about the hospital’s and your doctor’s personal philosophy and comfort level with performing VBAC. Hospitals are required to have certain staffing ratios and a specific composition of care team staff on hand to manage a VBAC. In my case, my doctor personally preferred c-section deliveries and by her own admission elected to have two of them. There were even a few instances where she strongly encouraged me to simplify things by just opting for a second c-section. If your doctor holds these beliefs they may not support your desires/wishes to have a VBAC.
  2. For when will my c-section be scheduled and are the dates flexible? My doctor scheduled mine for me one day prior to the original due date. We did not discuss my preference for dates, but given that my due date was sandwiched between Christmas and New Year’s Eve I figured that the date was a matter of when the OR suite and staff were available.
  3. How many support persons can I have in the OR room with me during delivery? Are photos and/or video recording allowed?
  4. What type of incision will you make? If your c-section is emergency or if your baby is in a transverse position your doctor may use a vertical incision. This may also be required in other instances. The most common approach is a horizontal incision that is slightly below the bikini line. Both of mine were horizontal incisions.
  5. Will you use stitches, staples or dermabond (glue)? I had dermabond with my first and staples with the second.
  6. If you have previously had a c-section ask the doctor if he/she will use the existing scar. During my prenatal visits the OB would jokingly say, you already have a scar, just have another c-section. This led me to erroneously assume that she would use my existing scar. Imagine my surprise when the bandages were removed and I realized that I had a brand new incision! The nurses on the unit and the doctor who made rounds that weekend could not explain to me WHY the doctor had made a new incision, but assured me that the doctor will assess to see if this is the best approach. I have this on my list of questions to ask at my follow-up visit and have done some research just to see if this was standard practice. It seems that in most instances the previous scar is used, but in others a new one is made. I couldn’t find any evidence based practice articles on the subject, but did consistently see that new scars heal faster. Either way, this is something to ask your doctor BEFORE hand to avoid any post-op surprises.
  7. What type of anesthesia will be used? I personally had a spinal block. With my first c-section I could not move my legs for 6 hours following delivery. The nurse anesthetist explained that the amount of time varies depending on the amount of anesthesia that was used. In my case I received duramorph and it made me itch both the first and second time. This is a normal reaction to the drug.
  8. How soon after will I be able to drive? I was told two weeks due to the spinal block anesthesia that was used. Make sure you have someone to help you in those two weeks following delivery as your baby’s first doctor’s visit will usually occur within the first few days after delivery.
  9. What are my weight lifting restrictions? I was told 10 lbs or nothing that weighs more than baby and car seat.

These are the questions that first came to mind. Hope these are helpful and good luck on your c-section delivery!

 

Planning for c-section delivery

The moment that I learned I was pregnant with my second child I was certain that I wanted to have a vaginal delivery.  Since my first pregnancy required a c-section delivery I knew that chances were likely that I would need a second one.  Still I wanted to try for a VBAC (vaginal birth after c-section).

When I initially met with my OB she informed me of the criteria for VBAC: low transverse incision (also referred to as the bikini cut).  Since my first delivery was done in this manner I knew that vaginal birth was a possibility for me. The remaining criteria that we reviewed included me going into labor naturally and not going over my due date.  Women who have had previous c-section deliveries cannot have their labor induced as other women because the drugs that they give to induce labor (e.g. Pitocin) can cause the previous c-section scar to ruputure.  The final criteria was a non-breech presentation.

As my pregnancy progressed I was excited about the possiblity of VBAC.  The baby was in the right position as I neared my third trimester and I had not encountered any complications such as gestational diabetes, pre-term labor, or pre-eclampsia. When I reached 36 weeks I began seeing the OB weekly.  At the 36 week visit I was quite disappointed to learn that while my cervix had softened it had not began to dilate and my hopes of VBAC began to fade.  The doctor advised me of some natural remedies that I could use to promote dilation (nipple stimulation with a breast pump, sex, walking and so on).  With the exception of sex (which wasn’t an option given my break up with the ‘father’) I tried everything she suggested PLUS squats, lunges, and painting! LOL.  37 weeks rolled around and I was hopeful that something had changed.  The doctor decided not to examine my cervix at that visit, but pre-scheduled me for a c-section just in case.  She then advised me that she would attempt membrane rupture if I had dilated any by 38 weeks.  Time was running out and my hopes for the type of delivery that I wanted were far from reality.

Wednesday, Dec 26th, two days before my son’s original due date and one day before the pre-scheduled c-section my city was hit with the biggest snow storm in 18 years.  The OBs office called to reschedule my appointment, but I insisted on making the 5 minute drive just to see if I had made any progress.  After an uncomfortable vaginal exam I learned that my cervix still had not dilated.  When the nurse practitioner left the room I cried and the last hopes that I had held onto for a VBAC faded permanently.  Despite all of my efforts I had not been able to experience the kind of delivery that I wanted.

The rational and logical part of me knew that having a healthy and safe delivery was most important for both my son and I.  But the reality of being a single mom who would be on driving, lifting and activity restrictions for two weeks following a c-section delivery heightened my anxiety.

Happily my son Reid was born Thursday, December 27th at 4:39 pm. He weighed 8lbs 4 oz and was 20″ long.  It’s hard to believe that he will be a week old already tomorrow.  We have been home for three days now and are getting adjusted to our new life.  As for me, I am trying to take it easy and rest so that my body can heal and that I can enjoy my new bundle.

While I did not have the type of delivery that I wanted, I have everything that I need.

Thanks for reading!

The doctor isn’t always right

Last fall I took my daughter to the urgent care center because she was having neck stiffness and shoulder pain. I thought it was musculoskeletal, but she was in tears so I wanted to be sure as life threatening conditions such as meningitis, which can often present as a stiff neck.  Anyway, the MD prescribed 10 mg of Flexeril. When the nurse gave us our discharge instructions I questioned her twice. Is this an acceptable dose for children?! I asked because I was recently prescribed 10 mg of Flexeril for muscle spasms and I am an adult.  I DID NOT get this script filled and am so glad that I didn’t bc according to Drugs.com: •Flexeril should be used with extreme caution in CHILDREN younger than 15 years old; safety and effectiveness in these children have not been confirmed.

Just bc the doctor orders it does not mean it’s right. ASK QUESTIONS AND RESEARCH your prescriptions!!!!

Read more about Flexeril at http://www.drugs.com/cdi/flexeril.html