Decisions, Decisions

Today's my first day back to work since having baby Katie, and my 7 a.m. rheumatologist appointment was a great way to start it off. As I sat in the waiting room nursing Katie, I was internally lamenting over the fact that when my appointment was over, I'd hand little Katie over to my husband for the day and get back to reading/writing/editing. Of course I instantly became used to holding her through the day, and, as any mom knows, it's immensely hard to cut back on that. That bond forms pretty darn quick and is amazingly strong. Any attempt to loosen that bond is made even more difficult by friends asking, "Do you HAVE to go back to work?" Financially, yes. (And then guilt sets in.) But when I overheard an older woman's plea to the receptionist at the rheumatologist's office this morning, I knew I had an important job to return to.

The woman's disability payments had been cut off suddenly, apparently due to a mix-up in paperwork. She was desperate, and I could tell by looking at her that she had been affected by RA for many years. She obviously had trouble maneuvering physically, and now I knew she was having trouble maneuvering through the healthcare system. My heart went out to her, especially when she had offered to hold Katie for me to make it easier for ME to fill out my paperwork! She was so sweet to me, but so spicy when it came to dealing with her current problem.

I internally cheered for her when I saw her massive folder of papers accumulated over decades of doctor visits. Every good patient should have one. And I smiled when the petite woman seemed 7-feet tall as she succinctly explained what had gone wrong and how it needed to be fixed. She was organized and assertive, just as we tell readers to be at their office visits. I don't know her outcome, but I have a good feeling she got what she needed and will be just fine.

I went in for my appointment -- my first since delivery -- and had an important talk with my doctor. This is where the tough decision comes in. I've been breastfeeding Katie almost exclusively, except for a daily bottle of formula to keep her used to it in anticipation of starting daycare next week. However, the doctor noted the swelling and tenderness in my fingers, wrist, feet and ankles. There's no denying it's there. I could go back on the DMARD now and stop nursing, or I can manage my arthritis conservatively and continue breastfeeding. My choice boils down to this: Prevent deterioriation of my joints and ease my pain, or give Katie the benefits of breast milk -- one of which may be reducing her future risk of developing chronic diseases. I opted for the conservative route, you'd think because maternal instinct is to take care of the baby before self. As it turns out, breastfeeding Katie may help me, too.

According to a 2004 study, women who have breastfed their babies for a lifetime total of more than 12 months (so a year for one baby or a total of 12 months among several children) have a reduced risk of developing RA. Well, that didn't hold for me. Among my three older children, I've breastfed for a total of about 48 months already -- 12 months or longer for each child. In digging deeper, though, I found a study from the University of California San Diego that shows women who have breastfed longer than 12 months have "significantly higher cortisol levels than women who breastfed for shorter durations or not at all." And that association was found to be stronger in women who had three or more children (phew!). Why is this good news? Because, as the researchers explained in the 2001 study, "increased cortisol and increased duration of breastfeeding may play protective roles in certain autoimmune diseases, such as RA." Apparently, cortisol – a hormone often associated with increased stress – may contribute to the beneficial effect of being a lactating mom.

So a lactating mom I am. And I'm also going to have to be a really good patient. That is, taking the conservative route takes work. As my rheumatologist said, I've got to stick to a routine, make sure I eat really well and regularly, take rest breaks, try to sleep well (even though it's disrupted with night feedings), keep my stress level down and get some exercise. The goal is to stave off a postpartum flare so I can stay off medication for now, all while protecting my joints from sustaining damage and keeping pain down so I can function as well as possible. It's not as easy as taking the medication, which gives me some confidence that my joints won't deteriorate and my pain will be minimal. With that confidence, doing all the good things simply makes me feel better. Right now, doing all the good things is how I will get by until, as the rheumatologist says, I cry Uncle.

Those nasty postpartum flares tend to happen most often between three and six months after delivery. I'm at two months now and truly hope being a good patient will get me through the coming months without a worsening of my RA, so I can be a good mom and worker, too.