Diane, Author at Cherokee Women's Health

What’s the Plan, Mom?

When you find out that you’re pregnant, your world dissolves into a various shades of joy, curiosity, and worry. There’s a lot to learn about pregnancy and labor, especially if it’s your first child. One way many moms sort through the madness is to create a birth plan. Birth Plans—Remember, it’s Just a Guideline A birth plan is a short (typically 1 page or less) document that communicates your desires for labor and delivery to your medical team. It lets expectant mothers sort through their preferences and clearly articulate what type of childbirth they’d like. It’s important to remember that a birth plan is only a guideline. Delivery rarely goes as expected, and your medical team may be forced to make decisions that go against your written plan for the health of you and your baby. But if you’re trying to make sense of all the information you’re learning about labor, a birth plan is a good place to start. What to Include in Your Birth Plan Write your preferences clearly and concisely. It’s best to discuss your medical questions and preferences with your obstetrician and your family before writing anything down. Clearly communicate your preferences with your medical team ahead of time, before labor pains become the top priority. Family: Who would you like in the delivery room with you? Labor coach: What expectations do you have of the nurse who will coach you through labor? IV: IV’s are typically not necessary during labor, but some women need them to receive fluids and prevent dehydration, or to quickly administer medications during labor. If you want an epidural, you will need an IV. Blood tests: Though typically only necessary for high-risk pregnancies, blood tests may be needed to ensure labor goes smoothly. Inducing or augmenting labor: Know how you feel about starting or speeding up the delivery process. Pain relief: From breathing exercises to epidurals, there are plenty of natural and medical pain relievers for moms during labor. Delivery positions: Positions vary from sitting or semi-sitting to lying on your side or squatting. Episiotomy: Making a cut to widen the vaginal opening is not necessary for all women, though it may be necessary during difficult labor. Cutting the umbilical cord: Waiting several minutes to cut the cord may help your baby receive more blood supply. Some fathers like to get involved by cutting the umbilical cord. Skin-to-skin contact: This can help create intimacy between mother and child or father and child. Cesarean section: Whether you’ve scheduled a C-section or you’re simply planning for an emergency situation, consider what types of pain relief you’d like in the event of a Cesarean birth. Breastfeeding: Beginning breastfeeding is often most effective in the 30 to 60 minutes after birth. Skin-to-skin contact stimulates your infant’s impulse to breastfeed, making it more likely to be a success. To learn more about creating a realistic birth plan, talk to your obstetrician or midwife at your next appointment. Or, call us today at 770.720.7733.

What is Overactive Bladder Syndrome?

Overactive bladder syndrome, also referred to as OAB, is an uncontrollable need to urinate, often at the worst possible times. For most of us, when the bladder fills to about half its capacity, the urge to void is triggered. Much like a snooze button on an alarm clock that lets us sleep awhile longer, we can hold off until we’re closer to a bathroom, or the timing is more convenient. Not so for OAB sufferers. Their urgency is more like the constant demand of a malfunctioning alarm clock without that button — intense, shrill and non-stop until it’s turned off. OAB sufferers feel more like their bladders are overflowing. They don’t have the luxury of waiting, needing relief immediately. If they’re unable to void right away, leakage may occur. OAB is unbiased. Whether you’re at work or play, it disrupts concentration, performance and pleasure, negatively impacting your life. In time, those afflicted with OAB may become depressed, withdrawing socially. What Causes Overactive Bladder? No one really knows, but it’s believed that involuntary contractions of the detrusor muscle in the bladder transmits false messages to the brain. Symptoms Contributing factors: Age may contribute to, but does not always cause Overactive Bladder Syndrome. Never assume you’re doomed to live with OAB based on the number of years you’ve roamed the earth. Speak to your gynecologist. Don’t be ashamed. They’ve heard it before—often. They can help. Diagnosis You will need to provide your doctor with your medical history, including all drugs, vitamins and supplements you are taking. A physical examination will also be necessary.Sometimes, a urine culture, ultrasound, and neurological tests may be needed to rule out any sensory or reflex problems. If necessary, you might need more extensive analysis such as: You may be asked to keep a journal that includes information like fluid intake, urinary outflow, any leakage, and a time chart of bathroom visits to assess your condition more accurately. Treatment Options Medications and Treatments Other treatments may include: For more resistant cases, surgery, bladder augmentation, or the use of catheters may be necessary. Overactive bladder does not have to isolate you. Help is available. Speaking to your OB/GYN is always the first step to overcoming the problems associated with this syndrome, restoring your confidence, happiness, and quality of life.

Leaky Bladder Symptoms and Remedies

One in five women endures the symptoms of leaky bladder, or urinary incontinence. Yet often, a suffering woman does not acknowledge it as an issue. She may be self-conscious about mentioning the condition to her doctor, or she may assume it’s a normal part of being a woman. Two of the most commonly accepted situations are incontinence after pregnancy and incontinence during exercise. The truth is, although urinary incontinence is common, it is not considered normal. Needing to urinate frequently, as well as urinary urgency, are signs that one may be dealing with a leaky bladder. Fortunately, for a woman experiencing these symptoms, she can find both surgical and non-surgical options in treatment to minimize or even eliminate these symptoms permanently. What is Urinary Incontinence? Weakening of the pelvic floor can affect bladder control and urethra function, causing issues with urination. Women suffering from urinary incontinence find themselves running to the bathroom frequently. Strong urges to use the restroom, even after urinating, is another sign that a woman may be dealing with urinary incontinence. It is important to not brush off the occasional leak experienced while exercising or shifting position, because there are treatments available for women dealing with urinary incontinence. Types of Urinary Incontinence One important step in the diagnosis process is identifying the type of urinary incontinence, in order to find the best treatment option. Stress Incontinence This type of incontinence occurs when urine leaks out of the bladder during certain strenuous activities. Jogging or other exercising can cause urine leakage. Coughing and laughing can also bring on an unexpected leak. More severe symptoms of stress incontinence may include urine leakage during low stress activities such as changing position or walking. Many pregnant women can experience stress incontinence as the growing uterus puts pressure on their relaxed pelvic floor and the organs shift to make room for baby. Sometimes the symptoms are dismissed as an annoying pregnancy symptom, but if they do not subside after delivery, they may need medical assistance to prevent symptoms from worsening. Urge Incontinence Commonly referred to as overactive bladder, or OAB, urge incontinence is a continued sensation of needing to urinate. This sensation is often an overwhelming, powerful urge which sends women dodging for the nearest restroom. Urge incontinence is different from stress incontinence in that it occurs suddenly, without pressure on the bladder from strenuous activity. In addition to strong urges to urinate, women with urge incontinence may find themselves waking up at night to use the restroom, interfering with a full night’s rest. Sometimes, there may be an underlying condition that is causing the undeniable urges to urinate. An honest discussion about symptoms with a doctor can help them determine any underlying conditions so they can better treat you. Preventing Urinary Incontinence Many situations can result in urinary incontinence. There are some factors that do make a woman more prone to the condition, including pregnancy and childbirth. Women who want to lessen the chance of experiencing urinary incontinence can follow the advice below: Leaky Bladder Remedies Don’t be ashamed or embarrassed to mention your symptoms to one of our double board-certified FPMRS specialists. Treatment options will be chosen based on the severity of the symptoms but can include:

Postpartum Depression? You’re Not Alone

The birth of a child is a time of joy and excitement, but for many new moms, it can also be a time of anxiety, stress, and inexplicable sadness. Postpartum mood disorders affect 10-15% of all new mothers. Postpartum depression can develop in the weeks after birth, and some begin women showing signs as late as 6 months post-labor. If you’re experiencing symptoms of postpartum depression, it’s important to realize that your feelings are valid. Reach out to get the help you need for the sake of you and your baby. Signs You May Be Suffering From Postpartum Depression The postpartum blues, or “baby blues,” are feelings of stress, depression, anxiety, and frustration that many mothers experience in the days after childbirth. The baby blues rarely last longer than 1-2 weeks, and don’t require medical treatment. Postpartum depression, however, is a more serious condition that usually requires medical care. Signs of postpartum depression include: Every mother experiences postnatal depression differently. Some women may have each of these symptoms at one point or another, while other mothers may experience only a few. If your symptoms last longer than two weeks or become a barrier to living life normally, don’t hesitate to contact your doctor. If you have thoughts of suicide or of harming yourself or your baby, seek immediate assistance. Help is Available If you think you may be experiencing postpartum depression, there is hope. Postnatal depression and anxiety are both temporary and treatable. Call Cherokee Women’s Health to schedule an appointment today.

Zika Virus and Pregnancy

The Zika virus is frightening, especially for expectant mothers. Though the virus itself has mild symptoms, the transmission of the virus from mother to fetus is linked to birth defects in infants. Carried by Aedes mosquitoes, it can also be transmitted by sexual contact. Protect Yourself from Zika No vaccine exists for Zika, but by taking precautions, you can minimize your risk of contracting the virus. The Centers for Disease Control and Prevention is urging pregnant women and their partners to take strong precautions against mosquito bites. What Bug Repellent Is Safe to Use When You’re Pregnant? No repellent is right every time, and no repellent is 100% effective. The Environmental Working Group (EWG), which specializes in research on toxic chemicals, has published a complete guide to Bug Repellents in the Age of Zika. Avoid Travel to Certain Areas The Zika virus has not spread to most of the US; however, all known cases of Zika in the United States are due to travel. The CDC recommends that pregnant women avoid travel, especially to areas with known outbreaks of the Zika virus. If you’re trying to get pregnant, both you and your partner should avoid travel. If you have recently traveled, schedule a visit with your OB/GYN. Your healthcare provider can test for the virus, even if you’re not symptomatic. The Zika virus stays in the blood for about a week, and in semen for slightly longer. Based on current information, Zika causes no risk to future pregnancies once it has run its course. Zika Safety The CDC recommends special precautions for the following groups: Women who are pregnant: Check the CDC recommendations for travel to specific areas such as: Cape Verde, Mexico, The Caribbean, Central America, The Pacific Islands and South America. Women who are trying to become pregnant: Before you or your male partner travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection. You and your male partner should strictly follow steps to prevent mosquito bites during your trip. If you have a male partner who lives in or has traveled to certain areas, either use condoms or do not have sex (vaginal, anal, or oral) during your pregnancy. See CDC guidance for how long you should wait to get pregnant after traveling to specific areas. Men who have traveled to an area with Zika and have a pregnant partner should use condoms or not have sex (vaginal, anal, or oral) during the pregnancy. Symptoms of Zika Virus The symptoms of the virus are fairly mild in adults, typically only lasting a few days, but can cause developmental defects in infants. Symptoms include: Fever Rash Joint Pain Red eyes Muscle pain Headache Contact your OB/GYN immediately if you may have come in contact with the Zika virus. At Cherokee Women’s Health, we’re dedicated to keeping you and your baby healthy throughout your pregnancy. Call us today at 770.720.7733 or simply schedule an appointment online if you think you may have been exposed to the Zika virus.

Recognizing Preeclampsia During Pregnancy

Because preeclampsia only affects women during pregnancy and the postpartum period, many first time mothers are unaware of the effects and symptoms of preeclampsia. Proper prenatal care with an OB/GYN is typically enough to catch the early signs of preeclampsia; however, new mothers should be aware of the symptoms and notify their doctor about any changes in their health. What Is Preeclampsia? Preeclampsia is pregnancy induced hypertension that affects mothers and infants during late pregnancy. Symptoms typically develop after week 20, and can show up as late as 6 weeks postpartum. Researchers have yet to isolate the cause of preeclampsia, but the disorder affects 5-8% of all pregnancies. Preeclampsia is most common in first time mothers. It is one of the leading causes of illness and death in mothers and infants, but identifying the problem in its early stages allows for the best possible outcome. Recognizing the Problem Although some women show few symptoms of pregnancy induced hypertension, preeclampsia is typically characterized by high blood pressure and protein in the urine. Your obstetrician will monitor your pregnancy for signs of preeclampsia, but it’s important to tell your physician if you’re experiencing any symptoms. Symptoms of preeclampsia may include: Preeclampsia develops rapidly, so it’s important to notify your doctor as soon as you experience symptoms. But with early detection and proper care, your physician can provide the best possible outcome for you and your baby. To learn more about preeclampsia or to schedule a prenatal appointment with one of our board-certified OB/GYNs, call us today at 770.720.7733 or schedule an appointment online.

Fitness During Pregnancy

Regular fitness is one of the best ways for women to stay healthy during pregnancy. Staying active during pregnancy can improve mood, reduce pregnancy pains, and boost overall health. If you’re training for a marathon, you’d better leave it for your baby’s first birthday. Otherwise, it’s time to get active! Regular Fitness During Pregnancy Staying active keeps both mom and baby healthy and strong Decreases the risk of gestational diabetes and long-term obesity Reduces backaches, bloating, and swelling Contributes to faster postpartum recovery Improves energy levels Increases endurance, strength, and muscle tone Improves posture How to Stay Active While Pregnant Whether you’re a CrossFit champion or a full-on couch potato, it’s important to find the right level of fitness for your pregnancy. The American Congress of Obstetricians and Gynecologists recommends moms-to-be exercise for at least 30 minutes most days. For fitness newbies, this can work just as well broken into three 10-minute sessions throughout the day. Try a brisk walk after each meal (don’t forget to give yourself time to digest). Other safe pregnancy workouts include: Swimming: Water makes your body feel lighter, so it’s easier for pregnant moms to get moving. Bonus: swimming can help reduce nausea, swollen joints, and sciatic pain. Running: Hardcore runners don’t have to go from 60 to 0 when they get pregnant. Speak to your obstetrician about adjusting your training during pregnancy. But pay close attention to what your body tells you; pregnancy loosens joints, increasing risk of injury. Low impact aerobics: Don’t be afraid to sign up for that dance fitness class. Just don’t ignore your body when it says, “Ok, enough is enough!” Indoor cycling: A good workout that’s easy on the joints, indoor cycling adds stability during a time when a growing stomach makes balance a daily struggle. Weight training: Choose lighter weights and increase your reps to weight lift safely with a baby on board. To protect yourself from injury, consider using a weight machine, which limits your range of motion. Pilates and prenatal yoga: Both exercises improve flexibility and strength while promoting relaxation. They also improve posture, which relieves back tension from a burgeoning belly. As you grow, ask the instructor to modify moves and make certain poses safe for you. And whatever you do, avoid Bikram yoga (commonly known as hot yoga). It’s important that pregnant women listen to their bodies when finding the right pregnancy fitness routine. Use common sense – if the exercise makes you feel energized, it’s likely healthy. If the activity results in discomfort, it’s more likely unhealthy! If you have further questions about the right kind of exercise during your pregnancy, call Cherokee Women’s Health at 770.720.7733 or simply schedule an appointment online.

Cherokee Women’s Health Specialists Awarded AlUM Ultrasound Practice Accreditation

The Ultrasound Practice Accreditation Council of the American Institute of Ultrasound in Medicine is pleased to announce that Cherokee Women’s Health Specialists has been awarded ultrasound practice accreditation. Cherokee Women’s Health achieved this recognition by meeting rigorous voluntary guidelines set by the diagnostic ultrasound profession. All facets of the practice were assessed, including the training and qualifications of physicians and sonographers; ultrasound equipment maintenance; documentation; storage, and record-keeping practices; policies and procedures to protect patients and staff; quality assurance methods; and the thoroughness, technical quality and interpretation of the sonograms the practice performs. Dr. Michael Litrel FACOG, FPMRS of Cherokee Women’s Health said “our guiding mission is to maintain the best standards in health care to help our patients achieve the best possible outcomes. Meeting AIUM standards may seem like a ‘nice-to-have’ feature, but for our practice, it is a must have. Our patients deserve the very best from us whenever they step through our doors.”

Painful Periods and Endometriosis

Endometriosis is a condition where tissue from the lining of the uterus, called the endometrium, forms and grows in places outside the uterus. These growths may lead to pain and infertility. Up to 50% of women who have endometriosis may experience infertility. If you had painful periods as a teenager, it is very likely you have endometriosis. This problem often goes undiagnosed because women “get used to” the pain. Symptoms of Endometriosis In endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together. Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available. Causes of Endometriosis The exact cause of endometriosis is not known. However, possible causes include the following: When to Call Your Doctor If you develop sudden, severe pelvic pain, call your doctor immediately. Call a doctor to schedule an appointment if: Treatment Options There is no cure for endometriosis, but treatment can help with pain and infertility. Treatment depends on how severe your symptoms are and whether you want to get pregnant. If you have pain only, hormone therapy to lower your body’s estrogen levels will shrink the implants and may reduce pain. If you want to become pregnant, having surgery, infertility treatment, or both may help. Not all women with endometriosis have pain. And endometriosis doesn’t always get worse over time. During pregnancy, it usually improves, as it does after menopause. If you have mild pain, have no plans for a future pregnancy, or are near menopause (around age 50), you may not feel a need for treatment. The decision is up to you. Medicines If you have pain or bleeding but aren’t planning to get pregnant soon, birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that you need to control pain. Birth control hormones are likely to keep endometriosis from getting worse. If you have severe symptoms or if birth control hormones and NSAIDs don’t work, you might try a stronger hormone therapy. Besides medicine, you can try other things at home to help with the pain. For example, you can apply heat to your belly, or you can exercise regularly. Surgery If hormone therapy doesn’t work or if growths are affecting other organs, surgery is the next step. It removes endometrial growths and scar tissue. This can usually be done through one or more small incisions, using laparoscopy. Laparoscopy can improve pain and your chance for pregnancy. In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) is an option. This surgery causes early menopause. It is only used when you have no pregnancy plans and have had little relief from other treatments. We Can Help As OB/GYNs, we specialize in protecting your fertility and providing treatment to relieve physical suffering. Our three board certified specialists in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) provide an exceptional level of expertise you won’t find in any other OB/GYN practice in the Southeast. Please contact us today to schedule your appointment by calling 770.720.7733 or schedule an appointment online.

Founding Midwife Susan Griggs APRN, CNM

Nurse Midwife Susan Griggs, a Pioneer in Midwifery for Cherokee County, Announces Retirement Certified Nurse Midwife Susan Griggs was the only midwife in the practice when she joined Cherokee Women’s Health, as well as the only midwife delivering at Northside Hospital Cherokee. A pioneer in midwifery for Cherokee County, local resident Susan Griggs has helped deliver more than 1,000 babies at Northside Hospital Cherokee. First Midwife to Deliver Babies in Cherokee County Susan was the first midwife to deliver babies in Cherokee County, a crucial service that has helped save the lives of many babies. Providing much-needed education on the importance of prenatal care and contraception – as well as the importance of midwives – Susan leaves quite a legacy. In May 2022, the certified nurse midwife of Cherokee Women’s Health and local resident of Woodstock, stepped down from her role and into a new one: retirement. “I would like to thank my patients for letting me take care of them. It has been a privilege to deliver over 1,000 babies at Northside Hospital Cherokee. I’ve enjoyed the opportunity to provide gynecologic services and family planning for so many women in the community.” – Certified Nurse Midwife Susan Griggs Susan Joined Cherokee Women’s Health in 2007 Griggs came to the Northside Hospital-affiliated women’s health care clinic in 2007 after spending many years at Northside Atlanta and other hospitals around Atlanta. “Dr. Litrel and I both trained at Emory at Grady Hospital. I knew he had trained with midwives, and he wanted an experienced midwife on his team. Not all doctors work with midwives or know what we’re about, so we established a good relationship from the beginning, and it was a good match. The nurses had also worked with midwives, so they were very welcoming.” Co-workers added that it was Susan’s vision and leadership, along with Dr. Litrel, that formally established the midwifery program at Cherokee Women’s and Northside Hospital Cherokee. “Susan and I supported each other, and we’ve worked together intimately for a long time. She has helped mentor other midwives and nurses and has helped us build a strong team of midwives to incorporate into our practice.” Dr. Michael Litrel Susan adds, “I was the first midwife to be established at Northside Cherokee and deliver babies. As such, there were a lot of educational needs. This was something new in Cherokee County, so I did a lot of teaching. I also learned a lot from my colleagues. At Cherokee Women’s, there was – and continues to be – a great appreciation for midwives. It was very collaborative, which is what we all strive for. We want to help each other and learn from one another, and I’ve seen that growth and change over the years. It’s very empowering.” When asked about the role of a midwife, Susan shares, “Midwives learn and teach the natural process of labor and delivery. Just being a presence with the mother throughout the natural labor process is important. Doctors are always right there for a higher risk situation or for an emergency. Working collaboratively ensures the best outcome for the patient and baby and an overall positive birth experience.” Susan was Instrumental in Expanding OB Services at Cherokee County Health Department Susan also leaves behind a legacy of a long-term involvement with the Cherokee County Health Department. When she joined Cherokee Women’s Health, the Cherokee County Health Department only served women with gynecological needs. Susan was involved with the program as it expanded to include obstetrical services, which would have long-lasting, positive effects across the state of Georgia. Cherokee Women’s Health was founded in 1993 by a prominent Atlanta OB/GYN, Dr. James Cross. He was the first OB/GYN in the county with the sole purpose of improving the infant mortality rate. Within two years, he had reduced the infant mortality and morbidity rate by almost half. Dr. Michael Litrel joined the practice a few years later and became increasingly aware that more work needed to be done to help the women in the area who were without health insurance. “We knew we had to act and make a change because as women would show up at the hospital, their babies were dying, because they had no prenatal care at all. It was such a sad situation. Something had to be done, shares Dr. Litrel.” Susan and the doctors at Cherokee Women’s got involved by seeing patients at the Health Department that otherwise received no health care, usually due to cost. “Eventually, Susan would be the one to go to the health department and we’d supervise,” Dr. Litrel said. “It was a very synergistic process. We trained Health Department staff so those that didn’t have health insurance could receive care.” Cherokee Women’s was – and is – the Only Group to Deliver the Health Department’s OB Patients at Northside Hospital Cherokee Women’s Health began delivering the Health Department’s OB patients at Northside Hospital. They were – and continue to be – the only group that cares for Health Department patients. To qualify, patients had to go to at least one pre-natal visit at the Health Department. They would then be enrolled in the state program so when they went to the hospital in labor, they would be delivered by one of Cherokee Women’s midwives or doctors. At one time, Cherokee County had a 2.0 perinatal mortality rate, among the lowest in the state. Dr. Litrel says, “The new program that we implemented with the Health Department helped bring those numbers up dramatically. “We’re so thankful for all the people who got involved to make such a positive change in the community. It’s awesome to be a part of it.” Cherokee County is one of the few counties in the state (out of 159) that offers free obstetrical care through the Health Department. In fact, the program was so successful that several other Georgia counties followed suit and began the same model at their Health Departments. Unfortunately, many counties in Georgia still don’t offer

Pregnancy Pain

If your pregnancy pains incite panic, you’re not alone. Moms are hardwired to protect their babies, and it’s easy to jump to the worst case scenario when experiencing unexpected pregnancy pains. But pregnancy means your body is stretching to accommodate new life, and sometimes those internal gymnastics result in some less than pleasant feelings. It’s not always fun to be a human trampoline! So when is pregnancy pain something to get concerned about? Common Pregnancy Pains Pregnancy pains are nothing new. Between the uterus expanding and infant elbows jutting into your internal organs, pregnant mothers undergo a lot. The most common causes of sharp pain during pregnancy are uterine cramping, gas and bloating, constipation, and second trimester round ligament pain. Home remedies will typically alleviate these discomforts. Try: Pregnancy safe stretches Walking or light exercise Breathing exercise Experimenting with sleeping positions and sitting positions. When to Call Your Obstetrician While many pregnancy pains are nothing to worry about, they can be a warning from your body that something isn’t right. Contact your obstetrician immediately if: You experience bleeding, chills, fever, or you are leaking fluid Pain lasts longer than several minutes or fails to abate after resting or adjusting The pain makes it difficult to move, breathe, or speak Sharp pain is localized on one side of the abdomen or uterus The pain comes and goes in cyclical fashion and increases in intensity Your midwife or obstetrician is with you for every step of your pregnancy. If you have concerns about pregnancy pain you’re experiencing, call us today at 770.720.7733 or request an appointment online.

April Fools

by Michael Litrel, MD, FACOG, FPMRS The year my sons were seven and ten, I asked for my wife Ann’s help playing an April Fools’ joke on them. Sunrise on the big day found me crawling like a Ninja across the floor of my eldest son Tyler’s bedroom. With barely a sound, I rolled on to my back and shifted my body directly beneath his bed. I took a deep breath, and then, using all my strength, began shaking the entire bed frame. Ann’s timing was perfect. She burst into the bedroom. “Tyler!” she shouted. “Get up! It’s an earthquake – it’s an earthquake! Go downstairs – HURRY!” Tyler hardly moved. “It’s okay, Mom,” he mumbled, still half asleep. “It’s just Dad under my bed.” I was demoralized, with only bruised knees and a scraped back from my efforts. But it was not going to be for nothing. Nursing my wounded pride, I hushed Ann and went to the next room. “Let’s try it on Joseph.” But by the time I had crawled under Joseph’s bed, Ann reported that Joseph was smiling, his eyes closed, pretending to sleep. Luckily, I had prepared a backup trick the night before. I’d slid a rubber band around the kitchen sink nozzle so it would spray as soon as the water came on. It pointed up to the exact spot for dousing whichever of my beloved offspring washed his hands first. Tyler came downstairs still half asleep. “Would you please wash your hands before you eat,” I reminded him. It was hard to hide the eagerness in my voice. I watched Tyler as he came to the sink and reached for the soap. He stopped, looked at the faucet, and yawned. “You know, Dad,” he said with a trace of patronization, “if you use scotch tape, it won’t show as much.” I wasn’t in the mood for advice. “Just be quiet, and let’s wait for Joseph,” I replied testily. “AAUGHH!” screeched Ann. Oops. While I was distracted, Annie had turned on the water. Her pajamas were soaked. I apologized profusely, but Ann was not amused. Well, at least I’d gotten someone. But my real quarry was Tyler. He was just too cocky for his own good. I spent the day mulling it over, playing a few jokes to pass the day. Pregnant patients made the easiest targets. “Gosh, I hope you have two girls’ names picked out.” Or, “Wow, we haven’t had triplets in the practice in four or five years.” Back at home that evening, Tyler wouldn’t fall for anything. I found myself growing amateurish in my desperation. “There’s a spider on your shoulder!” “Your teacher just called. You’re in trouble!” Tyler just rolled his eyes. April Fools was obviously beneath him. Indeed, he hadn’t played a single joke on me all day. I finally gave up and trudged upstairs to bed. Just as Ann and I climbed between the sheets, we were met with an impediment. Tyler had short-sheeted our bed. Ann was dead tired. She began to complain and laugh simultaneously as she stripped the bedcovers to remake the bed. I tried to shush her so Tyler wouldn’t have the satisfaction of knowing his trick had succeeded. But it was too late. I could hear him snickering outside our bedroom door. My mind was unsettled. Although I was tired, I lay awake in bed for a while, unable to sleep. Finally, after some honest introspection, I came to a resolution which allowed me to drift off at last. Just wait ‘til next year. Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family. A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

Author name: Diane

What’s the Plan, Mom?

What is Overactive Bladder Syndrome?

Leaky Bladder Symptoms and Remedies

Postpartum Depression? You’re Not Alone

Zika Virus and Pregnancy

Recognizing Preeclampsia During Pregnancy

Fitness During Pregnancy

Cherokee Women’s Health Specialists Awarded AlUM Ultrasound Practice Accreditation

Painful Periods and Endometriosis

Founding Midwife Susan Griggs APRN, CNM

Pregnancy Pain

April Fools

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WARNING: Mature Content