Wednesday, 21 October 2009

And They Call It PUPPy Love

1st September - 20th October 2009

So far in these blogs I've skirted round an issue that's been an overwhelming presence in the run up to and first few weeks of parenthood.  It's kept us awake at nights.  It's caused more fights and arguments than anything else.  It's been a source of worry.  It was even the reason that Nicola was induced (relatively) early.  (Two days past due, rather than two weeks.)

Nicola has had PUPPs.

No, this isn't a reference to the Shappi Khorsandi joke.  ("We're having a surprise."  "No, you're having a boy or a girl.  It would only be a surprise if you had a puppy.")  PUPPs (variously PUPs, PUPPPs or PEPs) is an extremely unpleasant itchy rash.  For the medical acronym fans amongst you, it stands for Pruritic Urticarial Papules and Plaques of Pregnancy, or Polymorphic Eruption of Pregnancy (hence the many names).

It started innocently enough.  Towards the end of August and the start of September, Nic got a few berry bug bites.  Or what we thought were berry bug bites at the time, anyway.  (Berry bugs are microscopic parasites that thrive in berry fields at around harvest time.  They're annoyingly common in central Scotland.  Aren't you learning a lot today?)  In top annoying fashion they had decided to bite Nic on the stretch marks.  It was itchy, but not absurdly annoying.  Just one of those things.  Ringo was blamed for bringing them in (unfairly it would later turn out) and lost his lap privileges.

The bites didn't go away though.  They got worse.  And worse.  And worse.  The bites spread up and down the stretch marks, turning them into rivers of raw, itchy skin.  Then bumps started coming up on Nic's hands and thighs.  Then those bumps started to spread up her arms and down her legs.  And all the time the itching got worse and worse.

At this point, maybe two weeks before Alex was due to be born, it was pretty clear it wasn't just berry bugs.  A quick check on that source of all truth and knowledge, the internet, brought up PUPPs.  Itchy rash?  Check.  Starts on stretch marks?  Check.  Third trimester?  Check.  First pregnancy?  Check.  Not itchy on palms of hands or soles of feet?  Check.  (Itchy palms and soles of feet is a sign of something more life threatening to do with liver function.)  Photo of PUPPs that looks exactly like Nic's tummy?  Check.  We have a winner.

What a pity the GP didn't agree.

Now GPs have a hard time of it.  They need to know a little about a lot of things, and PUPPs is relatively rare.  And I imagine people coming in clutching print-outs of diseases from the internet must make their hearts sink.  Still, I don't think Nic appreciated being laughed out of the surgery, along with instructions to put some camomile lotion on.  (And unspoken ones to not waste the GP's time again.)  The camomile lotion did not help.

By now, Nic is unbearably itchy.  Any pressure on her skin, such as from a close fitting top, causes her to itch more.  Any amount of heat sets her off too.  She has taken to sleeping under just a single sheet, while I'm tucked under our heavy duvet.  (Nicola is usually the one who feels the cold.)  Any time she isn't scratching, she's submerging her hands, feet or whole body in icy cold water until she goes blue.  She doesn't like being cold, it's just better than being itchy.  After a couple of days she learns to combine scratching and freezing into one simple, time saving act of misery.  I come through to the bathroom to find her standing in a tub of cold water, scratching madly, bleeding slowly from broken scabs and weeping.  Something needs to be done.

We call up the maternity ward at Borders General.  They agree to see Nic and we drive down there.  The ward is incredibly hot.  Obviously this aggravates Nic's itch.  We spend an hour or so waiting for SHOs, registrars and consultants to see us.  (They genuinely have more important things to be doing.)  Everyone is very polite, but not a great deal of help.  Nic is eventually given a prescription for a topical steroid cream.  We have to wait another two hours for the damn cream to turn up.  By the time it does, Nic is ready to kill me.  (I am doing my best not to retaliate, but it's hard.)  We head home, glad to be out of the furnace that is Borders General.

The steroid cream doesn't really help much either.  Nor does the topical anti-histamine.  Nor the oral anti-histamines.  A cold bath infused with oats is perhaps more a distraction than a cure, but it does provide brief respite.  Standing in the cold until the shivers start is marginally effective, but comes with  obvious negatives.  All the PUPPs information we can find basically suggests that nothing will help except giving birth, at which point the rash will clear up in 1 to 2 weeks.  Great.  Now all we need to do is persuade Alex to come out.

Alex doesn't show any signs of wanting to come on his own.  By his due date Nicola is exhausted, angry and miserable.  She can't sleep because she's either itchy or freezing.  The levels of sympathy from me have tailed off the more she's been angry.  It's hard to be helpful or sympathetic when it feels like any suggestion, sympathy or aid is met with venom.  When the doctor suggests an early induction we leap at the offer like an MP at an expense account.

I'm not going to go over the induction again, except to add that throughout it Nicola was draped in wet paper towels in an effort to keep her cool.  But we could get through that, because giving birth was the magic bullet.  Everything was going to be better afterwards, right?  Right?

I think you can guess the answer to that question without any help from me.

Imagine breastfeeding whilst being intolerably itchy.  Imagine not being able to wear anything other than your pyjamas for the first two weeks because otherwise you flare up into a red wealed mess.  Imagine only being able to sleep for one and a half hour chunks because of your newborn son, but then not being able to sleep for even that long because you're freezing cold.  Imagine not being able to cuddle your child because his body heat is unbearable against your rash.  That was Nicola's life for the first two weeks after Alex was born.

I can't say I had a whole lot of fun with it either.  It's hard to see the one you love miserable.  It's harder still when you try and comfort them, only to be slapped away because your hands are too hot.  What do you do when your wife is crying because she's so hot and itchy, but can't face going outside again to cool off?  As time goes on, Nicola gets more and more tired and unhappy.  As she gets more tired, her temper gets shorter and shorter.  She rages at anything and anyone.  Not because she means ill, but just because she hasn't slept well for months.  Bloody PUPPs.

After two weeks we go back to Borders and suffer the furnace for another couple of hours.  We leave with a short course of oral steroids for Nic.  For a glorious couple of days they seem to work.  Nicola is less itchy.  She can bear to be at a normal temperature again.  She even sleeps under the duvet for a night.  But then they stop working as well, then run out.  The itch returns.  The heat returns.  The whole, foul, misery inducing package returns.  Another trip to the Borders, another short course, this time with a referral to a dermatologist at RIE.

Still no joy.  The second course doesn't even have the decency to give us a couple of days respite.  We're due to go up to Aberdeen to see Nicola's folks.  Just before we leave, Alex pees all over Nicola.  Unknown to me, he's weed on her only loose fitting but smart outfit.  So I just find it funny.  (Hey, people that aren't me getting urinated on IS funny!)  Nicola doesn't find it funny.  Nicola doesn't find it funny in a quite spectacular fashion.  She savages me with a venom I've never seen before.  Only the fact that I'm holding Alex and don't want to argue in front of him stops me from retaliating and raising it to a relationship destroying argument.  We make a guarded peace in the car.  Neither of us are really to blame, but it's hard to forgive when you both feel so hurt.

Another day, another hellish hot hospital.  This time we're going to see the dermatologist in Edinburgh.  We arrive early and, miracle of miracles, are called to our appointment early too!  The dermatologist also seems to know what he's talking about, which is a bonus.  (So far, only 50% of the paediatric medical professionals we've spoken to have actually heard of PUPPs.  Non-maternity medical staff have a 0% awareness level.)  He asks a lot of questions, most of which make sense.  At this point, we're well out with the normal post-natal range for PUPPs.  It's normally 1 to 2 weeks.  Nic has had it for five.  The dermatologist is pretty sure it is PUPPs and not anything else, but he orders blood tests and a biopsy, just to rule out some more serious conditions.  He also asks about Nic's steroids.

"I'm on two tablets a day."


"Yes...  Is that bad...?"

"That's practically a homoeopathic dose!  Let's move you up to, erm, six for now.  That should sort it."

And thank the gods, it seems to be working!  Nic has been far less itchy for the last five days.  She's slept under the duvet three nights running.  I can't express how much it means to be able to cuddle my wife again.  Such a simple thing to be able to do, but it makes such a difference.  We've even had the heating on!  Will wonders never cease?  I just hope it keeps on working.

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No photos for this entry.  Trust me, you don't want them while eating lunch!  So here's a picture of Alex doing his Buzz Lightyear impression, just for laughs.  To Infinity, And Beyond!

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