Ever taken a close look at those old-school pics of Mickey Mouse? If you have, you’ll notice he’s wearing gloves. I can’t explain that, really, since he’s a mouse and generally in the entertainment business. Furthermore, his hands are, proportionally, HUGE. They’re almost as big as his whole head. It looks like ‘ol Walt drew this mouse, then put rubber exam gloves on it and inflated them to about 3 times normal size and said, “Yes! That’s it exactly. Just what I wanted. Now I’ll make his feet huge, too.”
Not to speak for her, but I think one of my pregnant patients now nearing the end of her 3rd trimester feels a little bit like Mickey right now. She recently emailed me to say that she thinks, maybe, she’s going crazy. “And don’t tell me ‘you’re just pregnant’ like you’ve been doing now for 6 months!” She says her hands have swollen up so much she can’t wear her wedding ring. Her fingers tingle and sometimes pain shoots through them, to the point of waking her up.
Incidentally, in my field, we make a distinction between people with symptoms that awaken them from sleep. There is a slight possibility that I put a bit too much emphasis on this clinical factoid as a result of my life-long love affair with the activity, but even docs who voluntarily wake up before 11am interpret the disruption of sleep as generally clinically-significant. So, my patient can’t sleep because of her hand pain/numbness. Must be serious.
Well, actually, it probably isn’t. Medically, at least. First, of course, I have to make sure she doesn’t have pre-eclampsia, which is very serious. In pre-eclampsia, the patient swells significantly, but also starts losing large amounts of protein in their urine and their blood pressure elevates dramatically as well. The risk of placental abruption (where the placenta tears away from the uterine wall) is extremely high and the threat to the live of the baby is very real. The WORST fetal heart strip I ever saw occurred as a result of an abruption after a night of preeclampsia. Worst, or, say, dramatic. TLC coulda gone miles with it.
But my current patient doesn’t have the other risk factors for preeclampsia. Absent this sketchy diagnosis, things look pretty “good”, actually. That is, she may be hating life, but odds are still heavily in her favor that she will come in for a nice, soft prego landing sometime in the next 3 weeks. Additionally, the cherubic baby is likely to emerge unscathed, look quizzically at the new mom still huffing and puffing and glowering, then turn to me with a look that says, “What’s her problem?”
So, it’s probably not serious, but the patient is miserable. Any idea what she has? Any idea how to help her? It would be good if I could avoid merely telling her she’s pregnant…and that her hands are similar to those of a cartoon mouse.
**A little perspective note: Have you ever contemplated how incredibly HUGE a toddler’s head is? We don’t realize it because we’re used to the way babies look. But if you watch a toddler raise their arms, the disproportion to adults is striking. The top of a kid’s head reaches past their elbows. Raise your own arm and think about how your head would look if it reached up to your forearm. So, there you have it, visual PROOF that our heads shrink with age. Now I know why I’m so much stupider than I used to be.