Sunday, May 24, 2015

sum, sum, summertime!

breakfast beignets!
That’s almost always the first question anyone asks when they find out a woman is pregnant, right? I waver back and forth between whether it’s “no big deal” to wait until delivery day to find out the baby’s sex and being on the edge of my seat. I personally have gone from being certain one way or the other at least four times. I’ve had two random women tell me it’s clearly a boy by the way I’m carrying – whatever that means. My supervisor is sure it’s a girl, and my nanny has gone from confident it’s a girl, to a boy, to pure despair that she has no idea. But I’m not anxious about it, or worried about having what we need for a specific sex; instead, I am just super, duper excited to see who joins the fam. And I get more excited about it the closer I get to my due date. We have a nice long list of names picked out for both sexes at this point; there’s gotta be a winner in there somewhere.

We’ve got a couple birthdays coming up in the family – Kraemer’s and Calder’s are within days of one another once we hit the end of June. I’ve been thinking of it for months but have never really felt the energy to plan and was also never sure whether I might have a newborn by then. I’m feeling more confident in a term baby at this point, but that could still mean delivery the first week of July. Even if I get up the energy to plan a party, the question is finding the time. There are still things on my to-do list from 1.5 years ago (no joke.) I’m assuring myself that as long as I provide a cake, regardless of whether there are guests (DC folks? Cake, anyone?), I’ll have met my duty. Calder won’t complain, right? 

kickin' it
Calder is still communicating primarily through some sign language and a lot of “ee-ing.” He regularly signs things like, “sorry,” “please,” “more” and has a few others up his sleeve, like “ball” and other things he may encounter throughout the day. He says “Cr-cr” for cracker and says “ga-ga” for, well, just about everything. He’s 23 months – I guess something like 19 adjusted. I’m not worried, and I don’t really plan to start worrying (can you *plan* your worrying?) until he’s 3ish. Even so, we are switching the speech therapist currently seeing Calder through the Strong Start program; this was precipitated more because our new nap schedule does not coincide well with the current therapist’s availability than anything else, yet I’m interested to see what a different therapist’s approach looks like and whether it engenders more progress than the last.

intro to swinging (as baby swing intro did not go so well)
patio surgery

beach boys tribute on the water
I have officially made it further in my pregnancy than before; passing the 24-week mark felt rather surreal! At the time, it felt a little bit as though I was embarking on an entirely new journey because, well, in some respects, I was. I’ve said before that though it surely sounds funny, there was a sadness that came with Calder’s early delivery that was separate from the anxiety and despair and …. well, all that stuff… that came from the scariness of being in the NICU. There was also this mourning I was doing for my pregnancy. I was sad I was no longer providing the safe, warm womb where my child could continue to be properly nurtured and sad that I did not have that little companion for as long as I had expected to – I always say, expectations are everything! So this time, despite all the “fun” side effects that come with the third trimester, where at times I will admit that, like any “typical” expectant mom, one who has not birthed a micropreemie, YES! Yes, I do sometimes feel eager for delivery day so that I can just be done with this pregnant body of mine! On the other hand, my (somewhat) atypical perspective serves to keep me in check, and I will endure as happily as possible whatever my body decides to throw at me.
Last pregnancy we did not have time to do a lot of things, one of which being a childbirth class. I’m quite sure it’s not necessary, that plenty of women deliver plenty of babies without doing any research prior to pushing, but as I’ve tried to explain to Kraemer when justifying the pending bill, there is more to it than pushing and Dad playing catch. We make decisions on most big purchases together, but I told him he didn’t get to fight me on this one. I expect that it will give me some peace of mind, along with information on things I don’t even know I don’t know, not to mention on a few questions I have related to epidurals, things specific to delivery at our hospital, etc. Or at least let’s hope so, or I’ll never hear the end of it from my husband. J

Saturday, April 18, 2015

Stepping Out

I ran across this site with a bunch of quotes from famous (or halfway famous) folks and was surprised by the depth of a few. 
"Before I had my child, I thought I knew all the boundaries of myself, that I understood the limits of my heart. It's extraordinary to have all those limits thrown out, to realize your love is inexhaustible." - Uma Thurman

How true. And what a wonderful discovery!

As of April 3ish (21mos, 17.5 mos adjusted), Calder weighed 22.5 lbs. At first blush, this sounded pretty good to me – but when you go to the charts, which we inevitably always do, just to be SURE he hasn’t stopped growing altogether – you find that he’s still barely *on* the charts. Thankfully, I’m at a place where I really don’t mind. As long as he isn’t totally stagnant, or regressing, I’m feeling pretty content. He looks fine to me. Sometimes, and I admit I don’t have much of a barometer, he even looks big.

At this stage, we have also fortunately wrapped up our last Synagis shot (for real this time! And thank heavens.) and we are gearing up to take the man out into the wild, wonderful world. As anxious as we are for him to experience all the world has to offer – namely kids his age and normal kid entertainment around here, like the park – we have been very cautious about popping his bubble. Calder has now been cleared by his doctors for public introduction but not for playgrounds and other spots swarming with children without any measures in place that control for whether they’re sick or not.

As we await full clearance, however, we’re going to do what we can. This past weekend we headed to the DC zoo (yes, there was lots of keeping him from touching everything at kid-height and lots of handsan involved.) At one point, as we were leaving the lions, Calder became interested in a relief about his height of various zoo animals. As he ran his hands along it, another little boy, a bit older, walked up and put his hands on it as well, getting right next to Calder – apparently too close for Calder’s taste. He leaned over and gently pushed the kid on his arm! Me being a total newbie to the play environment, I’m thinking, what do I do here? Of course tell Calder he shouldn’t do that – do I also apologize to the parent? Make eye contact and shrug, “kids?” We tried to explain to Calder the concept of playing nice. Ha. Clearly, we have some socializing to do. Other parents have assured me that no kids under 3 have manners or social skills, that Calder isn’t the only one a little clueless about or at times uninterested in playing with other toddlers.

Miss Virginia has also started to take Calder to the library two days a week for story time. At his first visit, while all the other little ones sat calmly in their parents’ or nannies’ laps, Calder sped back and forth up to the reader, craned his neck so that he could get underneath the guy (since he was reading, looking down) and gave him a gigantic silly smile. Sounds like my son.

i see a cheetah!
Things haven’t been completely uneventful on the pregnancy front, unfortunately. Though the phenomenon is tough to describe, I experienced an intense bout of what I can only call itching beneath the skin underneath my shoulder blades and rib cage. These days I relate every last sensation to my doctors, but thinking it wasn’t urgent, sent a message rather than made a phone call. A few hours later the triage nurse dialed me up and asked whether I could come in immediately; there was concern the itching was related to a condition (cholestasis of pregnancy) that could seriously compromise the baby. Fortunately, the blood results came back negative and the itching episodes ceased, eventually, so guess we’ll never know.
cherry blossoms are not to be missed
aww, mom!
too cool for school in the center
Not too long afterward, one of my biweekly ultrasound visits showed a significant shrinking of my cervix, plus funneling, which led to one doctor passing me to the next, until I’d consulted with four, resulting in increased bed rest restrictions. This precipitated a discussion about steroids and if and at what point I should receive them. The steroids are most effective two to seven days after they are administered and are typically prescribed to women between around 24 to 33 weeks pregnant who are expected to deliver within seven days. The question is, how do you make that call? As one of the doctors said to me, it really requires a crystal ball. If the woman does not then deliver within that time frame, but another assessment determines the risk remains, she can get multiple doses. But what are the risks involved? Do they outweigh the benefits? How many doses are too many? None of the four docs seemed to have very good answers to these questions, although a couple of them essentially told me what I’d been reading online, that multiple doses aren’t generally recommended, and that there isn’t enough research on the subject (a common refrain.) 
Dad flies a mean kite

Though I shouldn’t be, I’m still regularly amazed in the difference in opinion of various doctors. I saw four doctors at the same practice each with a – sometimes drastically – different approach to a concern. That's when I turn to the net. For anyone reading this post considering corticosteroids (betamethasone and dexamethasone) for possible preterm delivery, I found one or two pretty good articles that provide basics and an overview, as well as a couple studies. A few reported documented negative effects, including a discussion of women getting the drugs needlessly, one stating outright that repeat doses are not recommended, while another pointed out that the positive effects are still present via multiple doses. Then there was a site that sorta put it all together, a combined discussion of several studies.  It was a lot to think about. Ultimately, we decided to forego the drugs for now.

happy man

Thursday, March 5, 2015

snow day!

but it's still snowing, we better take shelter.
Today was a snow day for the government and pretty much everyone in DC/MD/VA. At lunch time Kraemer took Calder to the neighborhood hardware store in our hiking pack, bundled up and sheltered by an umbrella. They were predicting between 4-8 inches, which we easily accomplished. I heard we got 9. Calder enjoys getting out of the house any way he can, but his face was still icy by the time they returned from their mission. We are all simply itching for spring.

Calder had yesterday what I am hoping is his last Synagis shot. Synagis does not prevent infection but has the potential to make RSV infections less severe in high-risk infants. As I’ve said before, the cost is astronomical, and insurance is picky about who they authorize to receive it, but Calder qualifies. I’m grateful for it (and more so for the fact that we haven’t had to deal with RSV yet, knock on wood), yet taking him to these appointments is excruciating. He is smart enough to know what’s coming and claws your shoulders, hanging on for dear life so that you cannot put him on the scale (dosage is according to weight.) Poor sweet thing. Then I have to hold him and his hands down while two nurses each inject a vial into each thigh simultaneously. Excruciating. Last year the season was a long one so he still got a shot in April – I’m hoping we get to call it quits this month instead.

in fact, let's get outta here.

guys, i'm serious!!! (we left)
Calder learned to sign “please” a couple months ago and now thinks that works for everything. “What would you like, Calder?” “Please!” He understands nearly everything I say to him, even before I expect him to understand it. Last week I was saying, more out of habit than anything else, as I do always try to narrate my actions for him, “Now we have to get your bib,” and instead of standing while I retrieved it, he scurried off to open the drawer, pull out a bib and hand it over to me. Our nanny speaks to him absolutely nonstop, nearly all of it in Spanish, so his providers have been surprised at his Spanish comprehension as well. He’s going to be bilingual and I’ll have no clue what he’s saying once he starts spouting words. His current project is learning how to clip himself into and out of his booster seat at the table; I’m happy to teach him how to snap in but not so much how to snap out. His mind works a mile a minute, and Kraemer and I enjoy just watching him go; he’s our entertainment. Sometimes I feel like a kid at the zoo watching a monkey.

sporting Mom's sweater,
handknit by great-Gram, circa early 1980s!
embracing his feminine side.

Re: my pregnancy, just like that, everything seemed fine and dandy again! At my next appointment, Dr M seemed far less concerned – perhaps it was because my cervical length was 3.7, which is just fine compared to when you really start to worry, knock on wood. (Since then, I had another measurement the next week of 4.19, even better.) He did not seem at all phased to learn we were going to pass on the surgery. That said, he maintained that I needed to telework, although concluded that if I wanted to negotiate with my supervisor to go once a week, that should be fine. The idea is to stay off my feet as much as possible and keep gravity from working against me. Overall, he told me that in terms of restricted movement, I needed to just take it easy and, when I asked about specific activities (like picking up Calder) use my best judgment. Interestingly, he told me his goal was to get me to 30 weeks, which caught me off guard as, hey, dude. My goal is 40!

already breaking the [piggy]  bank

Wednesday, February 18, 2015

A Whole New Ballgame

Because I know that some folks come to my blog who are moms or dads of preemies, I thought it might make some sense to chronicle a little bit of my experience as a preemie mom blessed with a subsequent pregnancy. Note that this particular entry will be all about being preggers, and the only Calder-reference will be photos, so if you are here for the latter, you might do best to skim. J

We love bath time!
Yes, I am *almost* always this happy.
This week I switched to a practice with a doctor who specializes in high risk (an MFM, they say, Maternal Fetal Medicine physician). I felt it essential. Plus, when it became apparent I’d be coming in at a minimum of every two weeks to have my cervical length measured, a practice and hospital (should there be bed rest… or a NICU in our future) in Fairfax looked increasingly unrealistic. Long story short, it took me some time to identify someone and get in to see him, so my first visit with Dr. M was yesterday, at a bit over 17 weeks. Part of me feels very reassured and gratified that I made this switch while the other part of me is, let’s say, totally bugging out.

A little art with breakfast, thank you very much.
Those who’d talked to me about Dr. M had told me he too is laid back and “won’t make you unnecessarily nervous about your pregnancy.” Well then. I suppose it is a fundamental difference between how a high-risk specialist and an OB with other specialties approach pregnancy (another NICU mom today verified my experience in this department, telling me to “buckle up”), because his strong recommendations were certainly more conservative than I was prepared to hear. For starters, and the biggie we’re dealing with now, is cervical cerclage. If you don’t know what cerclage is, be glad. In short, you get your cervix stitched up. Super! You can get a preventative cerclage, which is essentially what Dr M is recommending for me; however, those are typically done between 12-14 weeks, and I’m closing in on 18, which is more typically when you would call it an emergent (emergency) cerclage. 
I brush my own hair...
flush toilets...
And bang on things.
I’ll spare you the details, except in the case that you are interested (this article really spells it out nicely, and there are a host of studies, none of which I know more about than their abstracts, which is a total bummer). Long story short, the procedure is riskier now than it would have been at 12 weeks (mainly of infection or causing your water to break early, either of which can cause the worst of the worst), and we have a very big decision ahead of us. Of course, there are benefits to cerclage or we wouldn’t even be discussing it, mainly that studies show it can extend your gestation period by nearly 14 weeks. Pretty magnificent! I am getting my cervix measured tomorrow morning and am scheduled to talk with the doctor around noon, and we’ll have to make our decision by the end of the day.

Found the dry spot.

I LOVE to be outside!
The rest of his advice isn’t nearly as grim but surprising just the same, given where I’d left it with the last practice. Of course, this man sees only high-risk pregnancies and has a very clear picture of where they can lead. All travel more than 30 minutes from the hospital is out. Exercise is out starting yesterday. Slightly more surprising is general restricted movement; Dr M doesn’t even want me going to work anymore. At all. I cringe whenever I think about it (I’m already feeling cooped up since we keep Calder isolated and I knew I wouldn’t be traveling until after the pregnancy), but you can believe I’m 110% willing to help stave off the alternative!

Right before I went into my appointment I ran into a mom I’d met through a preemie listserv who just happens to work at the State Department with me, a mom who knows exactly what I’ve been through, plus some, I’d say, and when I told her I was pregnant, followed by, “I’m a little nervous,” I could see it immediately in her eyes: she got it. She said to me, “Of course you are.” And I was grateful. Of course I do not want to be stressed out, I know that’s the best route, but it’s also much easier said than done.

Monday, February 9, 2015

Double the Trouble

We’ve got a bun in the oven! We are about 16 weeks in and due at the end of July. The decision was both an easy and hard one. Yes, I am considered high-risk given my history; having had one preemie increases the chances I could have another. And yes, as many of you know, having a child in the NICU is … hard. And not something you ever want to do again. But having a child period is a great joy, and when you have a child like Calder, how could you resist wanting a number two? :) I make light, but let's just say we gave the decision a lot of thought.  

I am getting ready to switch practices in about the next week, where I will begin seeing a group of docs at GWU that specialize in high-risk pregnancies. This also means I will deliver at GWU, which has only a Level III NICU as opposed to the Level IV we had at Fairfax; I didn’t want to leave the wonderful care I knew we’d find at Fairfax but a) even though I have weighed the NICU into my decision greatly, I am very optimistic we won’t need it, and b) I’ll be seeing the doctor possibly weekly and at the least, every two weeks, and there is a possibility I’ll need to be on bed rest, so Fairfax, which is not close, was looking increasingly unrealistic. If the baby were to need a higher level NICU, as Calder did, my understanding is that s/he would be airlifted to Children’s, a Level IV, which, having been frequently for Calder’s specialists and having heard many good things about the care at that NICU, too, we’re comfortable with. So, assuming I like these docs, I have found an option in the District. I’ll be receiving a weekly dose of Makena, which is relatively new on the market (I think approved by the FDA in 2011) but has been found to decrease your chances of preterm delivery, at least by a little, so at the moment, the decision is, yes, we’ll take it. I am very hopeful though that the shots will not leave me sore in the hip/leg for three days, as I hear they do, or any of the other lovely side effects hormones tend to cause when injected into your body but yes, I do realize that all sounds like drivel compared to what it could help prevent.

Calder is really doing wonderfully. After all that sickness in the fall, we have really managed to ward it off very successfully this winter. (Knock on wood.) In no small part, of course, because we’re keeping him isolated. After that MONTH of sickness, maybe longer, I decided that regardless of what the doctor told me (“He’s a normal kid now.”), I personally could not handle him being sick again. The one night had scared me half out of my mind, not to mention that none of us were sleeping, and that gets old fast. Low and behold, when we went in to see the doctor in early January for his 18-month appointment, this time a (different) doctor said, “I am SO glad you are keeping him isolated. This flu season has been very bad, for both the flu and RSV, so I would recommend that you continue to keep him isolated.” Can I call that a mother’s intuition, or just selfishness?

We did take him to Cincinnati for Christmas, despite the big flu scare. I'd been monitoring the news and CDC flu map for weeks, and had friends warning me of its severity, so once we arrived at my parents' house, well, we stayed put. But that didn't mean Calder had any less fun. In fact, usually relegated to our row house in DC, Calder was probably in heaven in his new environment.

No one's glasses are safe!
Last one of these, right, guys?
He also had his annual evaluation with Strong Start, DC’s version of Early Intervention, and he demonstrated a delay in two areas, which means he will continue to receive services. Fortunately, neither delay was deemed significant, and I’m not worried. His speech therapy has been increased to once per week, we added occupational therapy weekly and his physical therapy has dropped to just once a month. We’re mostly working on his eating, things like feeding himself and being open to different textures, and communicating, as he still has no words, though he certainly makes plenty of sounds. ALL of his therapists tell me at every visit how his development will absolutely skyrocket as soon as he can be around other children, which I get, but we are going to keep that big booster on hold for just a few more months. His physical therapy has pretty much been dropped because he is a walking fool! He has been walking since about mid-December, I would say, and can’t seem to get enough. He is even a fan of his shoes. We do what we can to keep up. :)

Running the Capitol