Monday, June 12, 2017

An Rh Sensitized Pregnancy: Aftermath (Part 5)

At the end of it all, after all my worries about induction and further transfusions, my baby was born normally. Naturally. Spontaneously. (Well, mostly. I did have a membrane sweep.)

And four days prematurely.

After my son's birth, he spent some time with me, then was ultimately taken to the NICU. He was more or less fine at birth--clearly not anemic, no signs of shock, dealing great with the transition to being in the outside world. But because of my Rh sensitization, he would need monitoring for awhile.


Much of the next few days was a blur. I was recovering from birth, but despite my exhaustion, I barely slept that first night. Even without my baby in my arms, I was feeling the birth high! I eventually slept, but roused myself to use the breast pump every three hours or so. (I was determined to breastfeed! And determined that my baby would not drink a single drop of formula.) I visited the NICU frequently to see my little guy, and tried to nurse every time I was there.I slept as I could, and while I was sore, I never really needed pain medication of any kind.

I stayed in the hospital for two days, eating mediocre hospital food (although they get bonus points for having vegan options beyond side dishes!) and pumping and shuffling back and forth from the NICU to my lonely little room.

Coconut Baby, meanwhile, was in the NICU. Initial tests had shown his red blood cell count to be within the normal range, so he was definitely not anemic. His blood sugar was fine, although that'd be monitored for awhile due to my gestational diabetes diagnosis. Baby did, however, have an unknown quantity of my antibodies floating around in his system, and they were breaking down his cells at a faster than normal rate. The result? Jaundice. Baby's bilirubin count was very elevated, and still going up. At some point when I arrived for a visit in the NICU, he had been put on phototherapy, with two big sets of bili lights shining on him from above and a lighted blanket down underneath.

He had blood tests twice a day, to monitor his bilirubin level and RBC, as well as his blood sugar. He had to wear a little mask to protect his eyes from the phototherapy lights. He had an umbilical IV and a feeding tube, although for the first few days they switched him to IV nutrients (as opposed to my milk; instead, I steadily built up a stash of pumped liquid gold in the NICU fridge). He was so tiny, and there were so many wires attached to him, although I recognize that many NICU babies fared far worse. He was very sleepy, from the combination of being newborn, slightly premature, and jaundiced, but aside from that, he was doing well. Breathing fine, no temperature problems, no heart issues. I was barely allowed to hold him; he needed to stay under the lights.


I only got to spend two nights in the hospital, and after that I was forced to spend the better part of every day away from my new little squish. Although I tried to take the opportunity to enjoy being with my older boy, my heart felt torn in half. I continued pumping every three hours, and every day when I visited the NICU I brought all the milk I had made. Baby kept getting blood tests, kept receiving phototherapy. I tried to nurse when I was there, and he received my milk in bottles when I was at home. His bilirubin remained high, and the doctors warned us were were edging toward baby needing a transfusion after all. But instead of just giving him blood--he wasn't anemic, after all--they'd be doing an exchange transfusion. Essentially, the idea would be to swap out most or all of his blood for fresh blood, blood that didn't contain my antibodies.

It was a terrifying prospect.

Instead, we authorized the doctors to give him a dose of IVIg (intravenous immunoglobulin), which would help protect Coconut's red blood cells from my antibodies; this, in essence, would slow the breakdown of the excess cells, hopefully either lowering his bilirubin count or at least leveling it out for awhile so his body could have time to catch up with the load.We were told that IVIg is normally not particularly effective in cases of Rh disease, but that it was certainly worth a try. Anything to try to avoid an exchange transfusion.

Thankfully, it worked. Coconut's bilirubin dropped dramatically after he received the course of IVIg. He still had to stay on phototherapy, but they were able to remove one of the banks of lights. A few days later, we authorized a second dose of IVIg, which further helped his body get on top of things.

Finally, after eleven days in the NICU, Coconut was allowed to come home with us. The monitoring wasn't over just yet, though. He needed a blood test three days later, and then another four days after that. We continued doing weekly blood tests for weeks, monitoring his bilirubin (to ensure it kept dropping), his red blood cell count (to ensure it didn't drop), and his reticulocyte level (which was an indication of how quickly his body was producing new red blood cells). Those days were the worst part of Nathan's week; he hated the heel pricks (who could blame him?), not to mention getting his blood pressure checked and all of his other vitals taken.


Finally, though, when he was approximately six weeks old, the doctors released him. Officially. Bilirubin was nice and low, indicating that his body was able to handle it on its own. Red blood cell count was up, indicating that my antibodies were leaving his system. Reticulocyte count was way up, indicating that his body was finally making plenty of new red blood cells.

Six weeks after birth, my baby was finally free of the effects of my Rh sensitization.

In the end, I feel like I was really quite prepared for the issues I encountered during the pregnancy itself, although the reality of the blood transfusions was far more intense than I had thought they would be. Where I felt unprepared was when it came to the aftermath. No one had really warned me of the issues we'd be dealing with after birth; I had naively believed that once baby was born, he might need a transfusion if he was anemic but that would be that. I hadn't realized that jaundice was a major concern. No one told me my antibodies could linger in his system for up to three or four months. I was unprepared for the frequent, heartwrenching blood tests, or the reality of having a NICU baby.


We got through it, though. It was so much harder than I expected, but it was quite worth it in the end. Of course! Being Rh sensitized made for, quite frankly, a pretty awful pregnancy and birth experience. Thank goodness for the modern medical procedures that enabled this baby to come into the world and into my arms.

***

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Sunday, April 30, 2017

The Birth of Coconut Baby

When I was just past the 36 week mark, I saw my doctor for my final prenatal appointment.

Of course, I didn't know at the time that it was going to be the last one!


As has been par for the course in this pregnancy, I had an ultrasound first. Well, technically I had a biophysical profile, since it was followed up with a nonstress test. I wasn't expecting that, but as with so many things this pregnancy, I didn't question the necessity. I was high risk and in my final month, after all; if my doctor thought a nonstress test was needed, then I was just going to go with it. Besides, I'd already spent so many hours on the fetal monitors that twenty more minutes didn't even faze me.

Unfortunately, this particular ultrasound was not reassuring. Despite the fact that it'd been only about two weeks since my baby's last blood transfusion--a big one, and which we were hoping would indeed be the last intrauterine transfusion--baby's MCA reading (the measurement of how fast the blood was flowing in one of the arteries in the brain, which can be an marker for fetal anemia) was showing high. Not dangerously high, but much higher than my doctor wanted to see, especially so soon after a transfusion.

We did the rest of my appointment, and my doctor asked me to come back again on Friday for a follow-up ultrasound. We had already scheduled an induction for a few weeks away, aiming to get baby out around the 38/39 week mark (which is when they estimated another transfusion would be necessary), but my doctor warned me that the high MCA reading meant we'd be moving the induction forward by at least a week. Depending on how the ultrasound looked on Friday, we might need to induce that very day.

This obviously was not what any of us wanted, but I know how bad anemia can be for a baby, so I readily agreed. We'd hope for the best on Friday, and plan for induction the following week. I told my husband and he told his job, and we all planned as best we could.

I then asked my doctor if we could sweep my membranes at my next regular appointment. In case you've never heard the term before, a membrane sweep involves a doctor (or midwife) doing a cervical exam, and then if conditions look favorable (meaning, a certain amount of dilation has already occurred and the cervix is already somewhat effaced), gently lifting the amniotic sac away from the cervix. If the body is close to being ready to go into labor, this can sometimes kick things into gear. At the very least, we were hoping to encourage my body to keep making the hormones that would continue to thin my cervix out so that induction would be more likely to be successful.

My doctor agreed that it sounded like a good idea. "I can sweep them today if you want," she offered. And so she did.

Neither of us expected it to actually work, though!

The sweep itself didn't hurt at all, which I was a bit worried about. It was uncomfortable, sure; cervical exams always are. But it didn't hurt. Before I left her office, my doctor warned me that I might experience some spotting, and that some crampy feelings were normal after a sweep. So I didn't think anything of it when I did indeed find a bit of bloody discharge, or when I noticed cramps during my middle-of-the-night bathroom runs. It felt like menstrual cramps, exactly what I was expecting based on what I'd read.

The cramps did get a little worse as the night progressed, but they were nowhere close to bad. Certainly not anything I couldn't sleep through. They didn't feel like labor contractions. It was just the sweep, that's all.

Sometime the next morning, they did start feeling a bit more like contractions. Similar to my first birth, I at first assumed that I was finally feeling the Braxton Hicks contractions. After all, I had been having them for weeks. Regularly. They had caused problems leading up to the last cordocentesis and transfusion, after all; they'd been so regular that the doctors had put me on magnesium sulfate to try to slow them down (but to no avail). So surely that's all these contractions were. I was finally starting to feel them.

...Or maybe it was early labor?

A few hours later, I lost part of my mucous plug. It was at that point that I started to take things seriously.

My contractions started to get a little more uncomfortable. Still nothing I couldn't function through. I took my older child to swim class, where I found myself swaying my hips through the contractions. I was still able to drive, but sitting still was getting a bit uncomfortable.

I downloaded a contraction timer app to my phone. Bug and I went home to have lunch, and the contractions were getting worse. When I finally started timing them, I found they were coming every 4-6 minutes, and were about 30 seconds long.

The husband and I scrapped our plans for doing some baby gear shopping at Target. We went out for an early dinner of Thai food (spicy!), but my appetite was already starting to fade, and I ate barely any. I debated calling labor & delivery for advice, but my contractions were getting longer and stronger. I opted instead to just head straight to the hospital.

The drive to the hospital sucked. There was traffic, and instead of 20 minutes we were in the car for at least 45. I couldn't lean back in my seat. But sitting up straight and leaning forward (as much as one can lean forward with a big belly, anyway) were uncomfortable, too. I kept timing the contractions, and they continued at about the same pace, although they were 45-60 seconds long at this point. Every time one hit, I did my best to wiggle as I could, trying to work through them, but that's hard when you're strapped into a car! I found myself thinking fondly of my son's birth, which took place at home. Why would anyone choose to drive to the hospital while already in labor?!? I knew the nature of my pregnancy meant that a hospital was the best place for me and baby--whom we had been calling Coconut--but I couldn't help but be a little wistful for the idea of another home birth.

When we got to the hospital, I was checked in and shown to a room. I changed from my pants into a loose sarong; no hospital gown for me! They put me on the monitors and I waited for someone to come check my progress. I had put into my birth plan that I wanted to minimize cervical checks, but I was okay with a few of them (emphasizing that consent was required!). When the doctor finally came in, I was a bit disappointed to find I was only at a 5. I had already been at 3 the day before, when the membrane sweep occurred. And I'd been having contractions for hours already! The rational, birth-obsessed part of my brain tried to counsel me about the dangers of putting too much stock in exams--your cervix is not a crystal ball, after all, and just because the progress seemed slow didn't necessarily mean that I'd be in labor for days. Those contractions were working, and they were likely helping baby get into a good position and doing other things not readily apparent by the surface numbers. I was definitely in active labor; no doubt about that! Never mind the numbers!

And then further bad news: Coconut was technically coming prematurely (by four whole days), and so the doctors wanted me on the monitors continuously. My room had a nice, deep tub for laboring in, but clearly I wouldn't be using it. I was stuck with bouncing on the yoga ball, moving my hips, and being massaged by the soothing hands of my husband and doula for pain relief.

The nurse put in a heplock, and it was a sign of how far I'd already drifted into the haze of labor that I barely even cried. It took two tries, and I cried a bit for the first attempt and barely even flinched for the second. (For the record, getting an IV always makes me cry.) I just kept doing my thing.

Time passed. I bounced on the ball, tried a few different positions for labor. I couldn't move far because they didn't have wireless monitors, but I ended up ultimately finding my place on the bed, kneeling and leaning against the raised backrest. Husband and doula massaged my lower back as I moaned and swayed through contractions. Husband also fed me ice chips and offered coconut water. I had actually brought snacks to the hospital, intending to eat despite their silly, outdated nil per os rule, but I wasn't hungry at all by that point. I could barely drink and suck on the ice.

As time passed, I started to get exhausted. It was evening, past dinner. I hadn't eaten since lunchtime, and I had no interest in eating. My husband tried in vain to get our son to fall asleep. (Did I mention that he was there? Bug was super interested in being present at the birth, so we ultimately decided to bring him with us!) I continued working through contractions. Time became rather hazy.

The contractions were hard, and I was feeling discouraged. I was starting to feel flushed, but then I was also feeling cold at times, too. (Transition, anyone? The rational part of my brain recognized it, but I didn't say anything aloud because I didn't want to get anyone's hopes up, least of all my own.) I was in pain, and I was so very tired. I started to doubt myself. The contractions seemed nonstop. I couldn't get any real rest in between them, and my limited range of motion made it feel like I wasn't coping well.

I asked for pain meds.

Not an epidural, but something short-acting, just something to take the edge off so I could rest a bit. I wasn't sure I'd have enough energy for pushing if I didn't get some rest.

...And the nurses told me no.

When the nurse came in, it was apparently pretty clear to her that I was past the point of medication. She offered instead to check me, so we could see how far I was.

No one was more surprised than me to hear that I was at a 10!! I was given "permission" to push whenever I wanted. I realized I was feeling a little pushy, but not much, nothing like I remembered with my son's labor/birth. I tried bearing down a bit, but I was just so tired, and it's even harder to push when your body isn't helping you out.

So instead, I opted for an intervention: I gave the nurse the okay to break my water. I had been hoping to let that happen on its own. With my Bug, my water didn't break until literally a split second before I pushed him out. I was secretly hoping that this baby might be born in the caul, since Bug had been so close. But it was not to be. I wanted this baby out, and I wanted him/her out now! Under the circumstances, breaking my waters seemed a small price to pay.

According to my husband, the nurse soon returned with a rather scary-looking tool. I have since described a standard amnio hook to him, and apparently the tool they used at my hospital was not that. Regardless, they broke my water, and I soon felt a gush all over the backs of my legs and feet (I was still kneeling on the bed).

The difference was immediate.

With one of the next contractions, I felt an intense urge to push. And by urge, I mean my body started pushing, and there was absolutely nothing I could do to stop it at that point. My husband says that you could see the difference in the contractions, in how my belly looked once that urge to push set in. I sat up as straight as I could on my knees and pushed! I groaned as I pushed, trying to keep my noises deep and my jaw open and loose.

I pushed for another contraction or two. Apparently, I was making rapid progress, because the nurse asked me if I could try to slow it down a little. I don't remember my exact words, but my response was a resounding no! I guess no one expected baby to come quite so quickly after my waters were broken, and most of my birth "team" (on-call OB, more nurses, NICU pediatricians, etc.) was not yet in the room.

Since there's obviously no way to stop a baby once it's coming, the nurse apparently yanked the "call the nurse" remote out of the wall, which sets off alarms in various parts of the hospital. I was lost in my labor haze, so I didn't notice as the room flooded with people. Another push, and baby's head was out. I immediately felt a sense of relief, but I wasn't done yet. One more strong push, and baby was earthside!

It was 10:28 P.M. No wonder I was so tired!


I fell against the bed in relief, so glad to be done. I don't know who caught him, but my husband got to see him before me, and he quietly announced to me that we had another son! My firstborn, apparently, was standing by, completely enthralled with the process. Someone milked the cord, getting my potentially anemic baby as much of his blood as they could in a short period of time. The cord was cut, and the NICU pediatricians gave him a quick once-over before giving the okay for me to hold him. (Because of my high risk pregnancy, my Rh sensitization, they wanted to make sure he was not visibly anemic or in shock.) Someone helped me to sit down normally, to lean back, and I got to hold my precious new boy in my arms.

Everything was still very hazy at that point. I know I held him for about thirty minutes before someone told me I needed to try to birth the placenta. I think the pediatricians took my Coconut again for a few minutes while the nurses helped me into a squat. A few pushes brought the placenta out, and then I reclined again and greedily reached for my boy.

I gave the okay for someone to give me a small infusion of Pitocin at that point, to ward off any potential excess bleeding. I nursed my littlest boy while my husband and bigger (but still little) boy crowded around.

Other immediate postpartum stuff happened, but I can't remember what all that was or in what order it occurred.. Placenta was examined, and I received the okay to take it home with me (or, rather, to send it home with my husband). My bottom area was examined; I had one small tear, but it was very much a surface tear, not even bleeding. I opted not to suture it. I switched my baby to my other breast and nursed some more. I ultimately allowed the vitamin K shot, even though I had been planning to decline in favor of drops. Coconut Baby got his Apgar score: 9/9. Bug started showing random things to the baby and trying to explain what they were; he was taking his role as big brother seriously right from the start! My doula took a few pictures, and eventually, quietly, bowed out. D bagged up the placenta and put it on ice. I kept nursing, cuddling, absolutely amazed at this new little person I had brought into the world.

Coconut Baby was 6 lbs., 6 oz. He had a full head of hair and the tiniest hands and feet.

After an hour or so, the NICU pediatricians unfortunately had to take my baby away. He wasn't in immediate danger from my anti-Rh antibodies, but he did need to have some lab work done, along with frequent monitoring, and his temperature was a little low despite being skin-to-skin with mommy.

The room slowly cleared out. D took Bug home (it was after midnight by this point), Coconut was in the NICU, and the nurses cleaned me up a bit and arranged to move me to a recovery room. My arms were painfully empty, and the birth haze had lifted enough to remind me just how exhausted I was. Still, I was wired, and I sent out some text messages and called the moms to announce the good news.

It had been a hard birth, much harder than I remember Bug's birth being. But I did it, and despite the circumstances--being stuck in a hospital, tethered to the fetal monitors, high risk pregnancy turned late preterm birth--the birth was pretty much everything I could have hoped for. Very few interventions, and those that did occur were with my full consent. Natural, medication-free vaginal birth. Almost immediate skin-to-skin, and nursing in the delivery room.

Beautiful, perfect baby. My rainbow after two losses and a high-risk pregnancy. Bliss.

Thursday, April 13, 2017

An Rh Sensitized Pregnancy (Part 4)

Just the other day, my baby received what will hopefully be her/his final blood transfusion before birth.

So. Worn. Out.

By now, you'd think I'd be an old hand at this. This was transfusion number three, after all. Five days after another procedure day, although that one was just a cordocentesis. Just. I swear, I could draw constellations on my belly and arms from all the needle marks right now. My poor arms, in particular, seem to finally be getting visibly tired of being pincushions; the blood draws from both of these most recent procedures have left bruises, and that's unusual for me. Bruises that are still faintly visible a week later. Normally, I handle blood draws like a champ. I've had a lot of them this pregnancy, after all.

Each one of these procedures is an all-day affair, with me arriving early for my ultrasound and blood draw #1 (there are always at least 2 blood draws, and 3 this time around), then spending hours waiting for the actual transfusion procedure. The wait usually has more to do with the blood bank than anything; when providing blood for an intrauterine transfusion, blood for a baby still in the womb, they do their homework and make sure the blood is the best possible match, the purest and cleanest available. Most days, as a result, the transfusion doesn't happen until after lunch.

In the meantime, I get to have an IV inserted (honestly, one of the worst parts; I cry every time) and spend some time on the fetal monitors. When I'm lucky, I only get monitored for 20 minutes. The last few appointments, I've been apparently having hardcore Braxton Hicks contractions. As in, very frequent, apparently pretty intense, although I have yet to actually feel a single one. Consequently, I've had the non-pleasure of spending hours on the fetal monitors. I've gone through several books, wasted more time scrolling Facebook than I care to admit, and played a ridiculous amount of phone games. All the while stuck in bed (is this what a standard hospital birth feels like?!?), wearing my hospital gowns (I always demand two, one for the front and one for the back), requiring permission for even the simple need to get up and go use the bathroom.

Oh, and because of those contractions, they've put me on magnesium sulfate for an hour or two leading up to the procedure, in the hopes of reducing the duration and frequency of them. Woooo, something else in the IV.

I really, really hate IVs.

Apparently, magnesium sulfate has no effect on me though. Because the contractions didn't stop, or even slow at all. It didn't make me sleepy, or light-headed, or overheated, or physically unstable; the nurses were quite surprised that I was, in fact, still capable of walking to the bathroom on my own (although they insisted someone accompany me). The only side effect I noticed was that my vein up above the IV kind of hurt while the magnesium was going in.

Also because of those contractions, I've had to consent to several cervical exams. They don't hurt so much as they're just awkward and uncomfortable, but I do understand their need to verify that I was not, in fact, in labor. Because I totally wasn't. Yes, I am ever so slightly dilated (good to know? Except I don't care, because cervical exams prior to labor tell me absolutely nothing about when labor will actually start, assuming it gets to start on its own. As the natural birth community reminds me, my cervix is not a crystal ball), but that's absolutely normal for being in my third trimester. I'm only half effaced, and baby is still very high up.

No other real signs of labor, anyway. Baby shows no more reaction to my Braxton Hicks contractions than I do. No decels. No discharge, no fluids leaking. Definitely not in labor, but I consented to the exams anyway. Like a number of other things in a high risk pregnancy like mine, this wasn't worth fighting about. I've got other, more important areas where I need to stand my ground.

And have I mentioned yet in this post that I'm not allowed to eat or drink in the hours leading up to the procedures? Yep, our old friend nil per os rears its ugly head. Sure, I can sneak a bit of water when nobody is looking, but once my water bottle is empty, I'm stuck. Sure, I can sneak a mid-morning snack (and yes, I totally usually do; research shows that aspiration during/after general anesthesia is relatively rare, and rarer still is it actually life-threatening... I'll take my chances, thank you very much), but there's no way I could get away with a full lunch. Even if I wanted to.

Anyway. The procedure itself usually takes about an hour. An hour on the table, being poked in the abdomen with needles. An hour of listening to the medical speak surrounding me. An hour of yoga breathing. An hour of keeping my eyes closed, even though the room is kept relatively dim so that the doctor can see the ultrasound screen. An hour of keeping the tension confined to my hands so that the rest of my body can stay loose. An hour of breathing in the essential oils I rubbed into my hands prior to the procedure (a blend of geranium, lavender, Roman chamomile, ylang ylang, and lemon, in case you're wondering), letting their scents keep me calm.

Then I get to spend a few hours in recovery, monitoring the baby's heartbeat as well as watching me for signs of premature labor. (After all, these procedures necessitate puncturing my uterus with a needle! No one would blame it for getting irritable.) Because my baby is so wiggly, they've had to give medicine to sedate her/him these last few times, which means that part of recovery is waiting for baby to wake up and start moving again. We already know by heartbeat that baby is fine, but the doctors want to know that there's movement, too. As do I, of course!

It's all for this little squish!

But now, hopefully, the transfusions are over. Done. Baby is tanked up with fresh blood and hopefully good to go for a few more weeks. We're down to the waiting game now. Soon enough, this baby will be earthside and all of this--the stress, the appointments, the blood work, the unpleasant procedures--will have been worth it. We're counting down the days.

No one is counting down more fervently than I.

***

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Wednesday, April 12, 2017

Review: The 4X4 Diet

Personal trainer Erin Oprea never set out to create a “diet” program or write a book, and she certainly never thought she’d have devoted celebrity clients.

But there’s a reason for her popularity. She helps clients–and now readers–develop a clean eating style using just four principles, and her simple workouts make exercise both fun and effective.

In The 4X4 Diet, Oprea lays out the basic principles that she uses to keep herself and her family fit, and which also keep her clients coming back for more. The book is separated into four sections. The first is a part introduction, part motivation. The second details Oprea’s rules for eating clean: no starchy carbs at night, less sugar, less salt, and less alcohol. These four rules are accompanied by explanations of why they’re necessary, and readers will appreciate Oprea’s straightforward and simple reasoning. She also provides a list of necessary kitchen items and a number of recipes that will help readers get started with healthier eating right away.

The third part focuses on the workouts. Oprea’s workout of choice is the tabata, which is essentially a mini-workout made up high-intensity exercises alternated with short rest periods. String a few of these together and the result is a workout that is still relatively short (following her advice means working out for less than 30 minutes) but surprisingly effective. Oprea provides three levels of tabatas, with numerous examples of each level; there are detailed instructions on how to do the moves, making them accessible even to fitness newbies, and there are plenty of pictures.

Part four puts it all together into an actual diet plan, although Oprea is quick to remind readers that this is a lifestyle change, not a temporary “diet.”
“All of this can be done in just four weeks. Each week, you’ll incorporate a new clean eating habit and slightly more challenging tabatas. And each week, you’ll feel cleaner, leaner, healthier, and stronger. That momentum will keep you going not just for four weeks straight but for the rest of your life.”
There are pros and cons to this book. Readers will love her simple rules, as well as the fact that she embraces “cheat” meals. At the same time, the meal ideas she offers are pretty heavy on eggs and meat, so readers who dislike those foods, or who choose not to eat them for other reasons, may find themselves struggling with how to make it work for them. Her rules are good ones, though, and a clean diet like hers could very well aid in weight loss, so long as readers actually stick with it over time (and minimize those “cheat” meals). The workouts are extremely challenging, and some readers will love jumping right in, while others might have a hard time staying motivated. It’s wonderful that she only uses very basic equipment; readers can either work out at home and have to buy only a few things, or do the workouts at their nearest gym.

Overall, the book is quite short, which will help those interested get started with their new lifestyle right away; a large chunk is devoted to the individual tabatas, which don’t all need to be read through before beginning the program.

For those who need help improving their diet in small ways and who want a simple–but challenging–workout plan to get started with, The 4X4 Diet is a great resource.

*****

I received this book from Blogging for Books in exchange for an honest review. The opinions expressed within are completely my own.