For those of you who may not be aware already, I am pregnant. If you’ve seen me, and wondered if I was pregnant based on my growing baby belly but chose not to ask because you go with the policy to never mention it until the baby is coming out or it’s confirmed by the mother, you are a very intelligent person. I'm due in August, and feeling the fatigue of a marathon about now, but I will be induced at 37 weeks at the latest, so we'll probably have a late July baby. I received a tidbit of knowledge from a fellow member of my Moms with a DVM page that I’ve realized fits the bill: “Pregnancy number 1 is a new car, and pregnancy number 2 is an old beater.” That has very much been the case with this pregnancy. It’s been completely different, and we did not take the decision to get pregnant again lightly. Most of you are aware of the cancer diagnosis and treatment I went through in 2017 soon after my son was born. After enough time had passed for me to feel like a relatively normal human again, all of my specialists concurred that pregnancy would be safe and would not put me at added risk as far as cancer recurrence. So it was time, and I always knew we wanted at least two children, and I did not want to get used to sleeping. Otherwise, baby number two might not happen. About a minute later, we were pregnant again and full of excitement. One thing that encouraged me to get pregnant again so quickly was the fact that I was practically a superwoman my first pregnancy. I had no nausea and endless energy. I got up at 4:45 A.M. every morning and ran four miles a day. I did this every day up until week 36 when it just became too uncomfortable to run (which was only two weeks before my son was born). I had hypertension before my first pregnancy, but the hypertension went away while I was pregnant until I developed preeclampsia at 38 weeks gestation. I was delivering calves five days before my son was born. Even though I was a couple years older and had been through cancer treatment, my expectations were that this pregnancy would have very little effect on my professional life just as it had been the first time around. I was wrong. The first trimester was relatively uneventful. Sure, I had a bit more nausea this time around and some morning sickness, but nothing my ginger candies couldn't handle. However, my hypertension that I've had for about seven years (ironically, about the same amount of time I've been a practicing veterinarian, but let's not make assumptions *wink wink*) did not go away with this pregnancy. In fact, when I was about four months pregnant, I landed in the ER for hypertension. I got put on blood pressure medication for the first time in my life. After a couple of days on the medication, I felt like a million bucks. I wished I'd been put on medication a couple of years ago. For a period of time, the medication kept my blood pressure at near-normal levels. I was able to continue to work and exercise regularly as I had been. One late afternoon after a series of doctor’s appointments when I was about five months pregnant, I was shopping for something for the clinic in Menard’s when my associate called. It was close to 5 P.M., and I was about to go on call. A client had called about a ewe that sounded like she was aborting. They wanted someone to come out and take a look. I got the address from him and left the store. This farm call actually felt like a relief compared to trying to find this special kerosene heater for the clinic. Venturing into any given home improvement store always feels like the seventh circle of hell anyway. I never know where to find anything, and many times after asking for help, end up walking out empty-handed. I can’t be the only woman that feels this way. But anyway, I digress. I took the back roads to get to the farm call. I pulled two dead lambs out of the ewe that was in the process of aborting and recommended the clients submit the lambs to the diagnostic lab for testing. I took what I felt were normal precautions as far as PPE (personal protective equipment). I did not have my coveralls on my vet truck with me that afternoon, but I wore gloves and washed my hands and boots after I left. My jeans and hooded sweatshirt, however, got soaked in amniotic fluid. I showered immediately when I got home, but that was after I had spent thirty minutes in my truck driving home. I honestly didn’t think much more about that farm call until I received the pathology report on those lambs almost a week later. As I scanned through the report, my eyes widened as I read the words, “suspect Coxiella burnetii.” Obviously, that doesn’t mean much to the average person, but Coxiella burnetii is the causative agent for Q Fever in humans. It is a zoonotic disease, meaning it can spread from animals to humans, and a fairly rare disease at that. As I scanned my brain for the foggy details that I learned about this disease in veterinary school, I did what any sane human would do: I Googled It. Memories came flooding back, and as I read more my memory was jogged that this illness can cause miscarriage, stillbirth, or pre-term birth in pregnant women. I didn’t panic right away, but as I saw appointments and thought about it more and more throughout the day, I became uneasy. I called my OB’s office to let them know about the potential exposure. My OB called me back within the hour, “Well, this isn’t something we’ve dealt with before.” However, clearly she had read up on what protocols needed to be followed. She wanted me to come in right away and have blood titers drawn. I finished my appointments and headed in for the blood draw. She also started me on antibiotics as the lab results would take a few days. The rational side of my brain told myself that this was a very rare illness, and the odds of me being exposed to Coxiella burnetii and contracting Q Fever were slim to none. But worried pregnant lady side of my brain was starting to panic. Also, one must remember that in the previous two years, I had not fought just one rare illness, but two: a rare cancer and Guillain-Barre Syndrome. I had already been hit by lightning twice, so to speak, so getting diagnosed with another rare illness didn’t seem too far out of the realm of possibility. I called the diagnostic lab and found out that they could not run the special PCR test for Coxiella on these lambs, so we sent the lamb fetuses to K-State for the confirmatory test. I would pay for the testing myself just so I could know. In the meantime, I consulted with my colleagues on this disease, which included a combination of large animal veterinarians and pathologists. The more research I did, I learned that Coxiella is actually spread via aerosol transmission, so the PPE I was wearing (gloves) would not have protected me in this case. I would have had to have been wearing a N-95 mask. One veterinarian in the food animal department at the University of Missouri VHC (my alma mater) had mentioned that I should probably avoid sheep and goat dystocias (farm calls for difficult births for these species). While Coxiella was rare, sheep and goats shed a number of zoonotic pathogens that can be dangerous for pregnant individuals. I felt stupid for not even considering this and putting my baby at risk. A few days later, a close friend and classmate of mine who works for the diagnostic lab texted me at about 9 P.M. to say the lambs tested negative for Coxiella. I could finally breathe a sigh of relief. In the meantime, it was spring and the sheep and goats in the area were having babies like crazy. In fact, my in-laws next door had many nanny goats kidding at the time. Luckily, I have hit the jackpot as far as in-laws go, and they were very understanding about the fact that I could not assist in goat dystocias on the farm this year (I have very small hands, which are perfect for delivering goat kids). Unfortunately, others were not so understanding. While on call, I received a number of calls for sheep or goat dystocias which I had to refer. I would always explain to the producer the situation, that I couldn’t go on those calls because of the diseases they shed, and would then give a list of providers in the area that could help them. Most of the time I was met with understanding, but oftentimes I was met with sighs, being hung up on, and I was even cussed out and bashed online over it. While I stood my ground and knew I was doing the right thing in acting in the best interest for myself and unborn baby, situations like these would twist the knife in the guilt that I already felt over not being able to “perform” my job to its fullest. However, I powered ahead and kept doing what I could. Then, at about six months pregnant, I landed in Labor and Delivery with hypertension again. Oddly enough, my blood pressure had spiked after a relaxing weekend at home and being off call. I was relieved to hear I did not have superimposed preeclampsia and this was just a worsening of my hypertension. However, my OB came into my room before I was discharged and gave me marching orders. I was not to do anymore large animal work, and I was not to exercise anymore. First no sheep and goat dystocias, and now no large animal work at all? "Really?" I said in disbelief. "Yes," she said. "I'm going to try to keep you at home and out of the hospital." It took me awhile to process it. At this point, it was April and our busiest time of year for large animal. I had hired a new associate, but he wouldn't graduate and wouldn't start until June. "How am I supposed to not do large animal work during our busiest time of year?" I thought to myself. I, of course, took this seriously and wanted to do everything in my power to keep myself and my baby healthy, but I didn't know how to accomplish that without feeling like I'd failed my clinic and my employees. I also had to wrap my head around not exercising for the next 3-4 months. While running had been a bit more difficult during this pregnancy due to various aches and pains, I had grown to love the exercise class I attended three days a week. Exercise and fitness have always been a big part of my life. It's one of the ways I manage the stress of this job, and I like feeling fit and strong. I mourned the loss of that outlet. During my following routine appointment with my OB, I asked her point-blank if she thought I would end up on bed rest. She basically told me that while there's a remote possibility I could make it to the end without bed rest, the reality is that bed rest was almost inevitable for me. It was just a matter of when. Together, with my team, we worked around my limitations, but even the companion animal side remained busy at the clinic, and I struggled to keep up. I would rest and put my feet up as soon as I got home, which wasn't actually difficult for even an active person such as myself because I was completely and utterly exhausted. I knew I couldn't keep up this pace, but I didn't know how to make the madness stop. Then, one evening when I was texting my new associate to clarify his starting day, he told me he was finishing his last block in a couple of days and could start the following Monday. This, I believe, was an answer to my prayers. I have always felt The Lord has good timing, and this is a perfect example of that. What started as, "How am I going to do this?" became "I can do this." I just needed some help. While my new associate wouldn't be a licensed veterinarian for over a month and would require supervision, his ability to start working early significantly lifted my work load. Dr. Potter continued to work hard as well, picking up my slack and taking care of all the large animal work. Ironically, after my new associate started working, my blood pressure readings started to stabilize. In fact, I had a few readings completely in normal range. My energy levels improved, and I felt more like myself again. Since then, my blood pressure readings remain decent, and I even got the okay to travel and take our beach vacation the past couple of weeks. I still have days where my blood pressure runs high. I feel huge, and I am growing out of my maternity clothes with three weeks left to go. I'm sporting compression socks, and I'm wondering at what point I'm going to have to come to work in sweat pants and flip flops. Today, while crouching on the floor in an awkward position to draw blood from one of my larger canine patients, I thought to myself, "You've got to be kidding me. Why are you still doing this? Are you going to even be able to get up off the floor?" Seriously, the positions veterinarians and assistants have to work in can be a bit ridiculous at times. Kind of like a game of Twister, but with needles, blood, urine, and animal fur. But the truth is, I do it because I love it. I guess the take-home from my experience is realizing that every pregnancy is different, and like many things in life, you kind of have to roll with the punches. While I feel a huge obligation to my clinic, I also realize that I only get one opportunity to do this thing (pregnancy) right, and the most important thing at this point is to keep myself and this baby as healthy as possible. Slowing down and coming to terms with my limitations have been both frustrating and humbling. But I'm also thankful that I was able to get help when I most needed it, and I am still able to work. While this pregnancy has been challenging for me, I am also aware that it could be so much worse. I may still end up on bed rest or face some unforeseen complications, but I'm feeling like I've figured out how to be pregnant (at least for the time being). Managing a veterinary practice and managing a high risk pregnancy has been quite the journey so far, but I know it will all be worth it in the end.
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Jessica Stroupe, DVM
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August 2017
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