Sunday, August 15, 2010

Spinals and Epidurals

At my job I spend hours on my feet. Today one of my co-workers complained about her chronic back pain. She said that every time she works her lower back hurts her badly. I asked her if she'd ever been injured. She shared with me that during the cesarean birth of her second child, she received a "spinal" that was administered incorrectly.

According to my co-worker, the anesthesiologist was inexperienced and injured her. This caused her to not have any feeling in her lower body until three hours after the birth. She said she had to get x-rays before and after leaving the hospital due to her back pain.

My co-worker said that she was in pain for weeks and months following the birth. It subsided with time but was very bad during her third pregnancy. With that birth she still opted to receive an epidural. She was very concerned about it, but went ahead with the procedure since her confidence was buoyed by the technician having 30+ years of experience. She also said the epidural was administered in a different location on her back.

I recall one of my aunts telling me how ever since receiving a spinal during her births she has experienced back and leg pain. For her the pain is worse with cold weather.

Information from brighamandwomens.org explains the difference between a spinal and an epidural:

What is a regional anesthetic?

Spinals, epidurals and combined spinal-epidurals are regional anesthetics. A section or "region" of the body is numbed by the medicine that is injected into the spinal canal. The legs, the torso and part of the chest are the areas that become numb.

What's the difference between a spinal and epidural and a combined spinal-epidural?

The spinal cord and the nerves are contained in a sac of cerebrospinal fluid. The space around this sac is the epidural space (see section on 'Regional anesthesia'). Spinal anesthesia involves the injection of numbing medicine directly into the fluid sac. Epidurals involve the injection into the space outside the sac (epidural space). Spinals and epidurals have the same effect (i.e. numbs a large region of the body) because they both involve numbing of the nerves as they branch off the spinal cord. Since the spinal injection is more "direct", the effect is immediate. Spinals are usually the first choice of anesthetic for women who are not in labor but need a Cesarean delivery. Epidural anesthesia takes a little longer to establish desired affect. Because a small tube (catheter) can easily be placed in the epidural space, repeated doses of medicine can be given to maintain anesthesia as long as needed. Epidurals are the primary way of relieving pain in women that request analgesia for labor. A combined spinal-epidural involves a spinal injection followed by the insertion of an epidural catheter. Quick onset can be achieved with the spinal part. Further maintenance of the anesthesia is achieved through the epidural catheter.

How is a spinal anesthetic given?

The procedure for spinal anesthesia is similar to epidural anesthesia for labor or for cesarean delivery (see picture). The difference is that medicine is injected directly into the spinal sac. A thin needle is used to reduce the chances of a spinal headache.

Wednesday, August 11, 2010

Potty Training

My baby is now 2 1/2 and potty trained! My husband oversaw the training. He was so eager to save money by not having to buy diapers that he spent a whole day sitting next to the toilet with our son.

The next day I went out and bought him some Spiderman underwear. I was disappointed that I couldn't find any training pants, the old fashioned kind of underwear that are padded. I guess these days they have been replaced with "pullups."

Personally, I detest Pullups and have never used them on my 7 children. I believe that they defeat the purpose, and it seems to me that most toddlers would rather soil their Pullup than spend the effort to go on the toilet.

And boy does potty training take effort on the part of parents, siblings, and the child! I am so glad that our toddler caught on quickly and he now takes his underwear off himself, gets on the toilet, or stands at the toilet, flushes it, gets dressed and even washes his hands on his own (most of the time!!)

He did have some accidents at first, however. And he also went through some emotional or psychological mourning over losing his diaper and departing with his waste. The first two days wearing underwear were great for him. By the third day he wanted his diaper back. He didn't soil it, he just wanted to wear it. He even undid the velcro fastners when it was time to go to the bathroom. Fortunately, he is back in the underwear during the day and just to be safe, I put a diaper on him at bed time.

Now if he'd just stop messing with his wee most of the day things would be perfect! I guess in underwear he is more aware of a certain part of his body than when he is wearing a diaper. I guess in time this too shall pass ;)