Okay, I can't figure out how to post a video in Wordpress (looks like I have to pay to upgrade - like I'm going to do that!), but I think I've got it up on YouTube. Check it out and see what happens when you try to give Becca vegetables. She's my girl, all right!
http://www.youtube.com/watch?v=ETP6lkVToDc
Apparently the dogs wanted to eat the mixed vegetables.
On our trip through South Carolina, though, we discovered something new that Becca does like to eat: brown rice from Doc Chey's. Check out this video:
http://www.youtube.com/watch?v=wfZ38sYOjMU
So the feeding struggle continues...but with more feeding and less struggle. We're making progress!
Wednesday, July 29, 2009
Tuesday, July 28, 2009
12 Month...er...13 Month...er...13+ Month Update
First off, let me apologize for being such a blog slacker these past few months. Life has been crazy, but hopefully I'll be able to write more regularly now because - and here's big news for our family! - as of Saturday night (as soon as I finish Courtney and Matt's wedding!), I will be a stay-at-home-mom! Wow! This will be a major shift for the church and our family, but I feel like Becca's care is suffering (particularly as we are working to give her all the extra developmental support that she needs), so I'm ready to be a full-time mom instead of a full-time mom and part-time pastor. I'm breathing easier just typing it. Of course, it will mean some financial stress and sacrifices for our family (yeah...UM minister on minimum salary...good times), but, hey, we've got health insurance and a roof over our heads, so we'll still be doing better than many. So, all of that is to say 1) Yay! I don't have to juggle a toddler with special needs while trying to work from home anymore! and2) Hopefully I'll be able to satisfy your Becca fix with more regularity now. Surely I'll be able to post at least weekly. We'll see. I know you need to hear about my girl as much as possible for your life to be complete. ;) And so, without further adieu, here's an update on Becca circa 1 year old.
Physical stats: at last measure (early July, perhaps), she was just over 13 pounds and right on 24 inches.
We've drastically reduced the frequency of doctor's visits over the past few months. She still sees her pediatrician (on the normal well-baby schedule) and 6 specialists, but the visits are getting farther and farther apart. A review of systems - or specialities, really:
Endocrine - She sees the endocrinologist about every 3 months, mostly for growth issues now. The last round of tests showed that her thyroid and adrenal functions are normal, so both of those medicines have been discontinued. We've tossed around the idea of growth hormones (because she is still so tiny), but we wouldn't start them until around her 2nd birthday. We're not sure what we'll do about them, though. Much of it will come down to what insurance will cover, as they are pretty expensive (I think I've heard), but I've developed a habit of asking every woman I meet who is just at or under 5' tall if they would have wanted their parents to pursue injections had they had the option. So far, most have said that haven't minded being short, but we'll keep kicking it around. (According to the charts and the curve she is on now, Becca's projected height is somewhere around 4' 10" or 4' 11".)
Ears - She sees the ENT every 3 months as well...I think. They are just treating her like any other kid with tubes at this point, though there may be plans to repeat a hearing screen or two just to make sure that all is still well. I'd like there to be that plan, at least. We'll see him again the end of August. And he damn well better wash his hands this time.
Eyes - Also at the endof August, we'll have our follow-up visit with the ophthalmologist. So far, her vision still seems great, but they want to keep an eye on her. (Hahahahahaha...keep an eye on her...I'm so punny.) Remember the whole question about septo-optic dysplasia? The consensus now is that depending on how you define the diagnosis, she may or may not have it. But it doesn't really matter whether she technically has it or not because all it would mean at this point is that she'd be in a higher risk category...and of course, we're already monitoring her for those risks. Hence all the follow-up visits.
Cardiology - I think we may have been released from the cardiologist. If so, it was pretty anticlimactic. She had an echo done last month to check for the pulmonary hypertension that caused her such trouble in the NICU, and I guess it continues to look resolved. I'm not sure because I actually never heard back from the doctor (which is unusual for him), and even when I stopped by the office, picked up a copy of the report, and requested that he call me, I still never heard from him. As far as I can tell from the report (very technical), everything looks good, and I'm assuming that if it didn't, they would have called and had us come in or schedule a follow-up in a few months. But it would be nice to get confirmation on that. You know me. But - if we are released, that's great!
Genetics - I think we see them every six months. I'm not really sure what they are looking for. Perhaps they just think she is an interesting case. Which she is, of course. On our last visit (in May? June?) they took blood and sent it to Baylor for a really fancy test. They basically looked at (almost) her entire chromosomal structure to see if anything was missing, mutated, or multiplied, thinking that it might give some explanation for either the septo-optic dysplasia or her general itty-bitty-ness, but, once again, everything came back clear. That also means that she's negative for the most common form of dwarfism, but there is still a tiny, tiny possibility that she might have the more rare and less severe form of it. Again, at this point, a diagnosis wouldn't matter too much. Either way, she's itty bitty, though if she does have a form of dwarfism, she's got some additional risks for other complications. It seems highly unlikely to me (and to the geneticist) that a baby who had such poor nutrition in the womb that clearly restricted her growth would also just happen to be a dwarf. But stranger things have happened, I guess.
We've got a new speciality on the horizon: plastic surgery. Yep, my little diva might already be a candidate for plastic surgery. (Don't worry, though - right now we're heavy on the plastics possibly and light on the surgery option.) As you have probably noticed, our sweetie is macrocephalic; that is, she has a darn big head. She always did; even in the ultrasounds in which every other part of her (and the composite) was hanging out in the 1st percentile, her head circumferencewas around the 18thpercentile. Her smart little body was directing the few nutrients it was getting to the most vital part of her body - her brain. (Now that I think of it, this is probably also why her belly was so big at first - because on the hierarchy of physical necessity, the other organs come in right behindthe brain. Limbs are clearly just accessories.) So it's always been ahead of her body. Now, though, it's a full size ahead of the rest of her, as in her hat size is 6-9 months even though she's just now moving into 3-6 month clothing. The growthcurve for her head is significantly sharper than both her weight and lengthcurves. All of this led to some concern about just what might be growing in the big ole head of hers, so last monthwe had a 3-D CT scan done of her head. (Which, by the way, was an interesting experience. She woke up from the sedation before we even made it back to the CT room. Oops. I had to sprinkle her with wiffle dust to get her back to sleep in order to get the pictures they needed. The high note, though, was that one of our former nurses from the NICU now works in the radiology department and got to take care of us. That was fun.) Aaanyway...they wanted to check for fluid on the brain (hydrocephalus) or "something else" - which meant "tumor," but everyone was afraid to actually say that to me. We weren't actually too worried, though, as we figured that if there was something majorly wrong going on inside her skull, we'd see somekind of behavioral symptom. But we wanted to check it out anyway, particularly after 3 physicians mentioned it. All was clear, though! But - andthis is where I finally get back around to the plastics doctor - her big head is really, really, really flat in the back now. I could go on and on about why this might be, but I've decided not to worry about why (and thus blame myself for what I may or may not have been able to prevent). The plastic surgeon, Dr. Kelly, is apparently THE guy in town re: infant head-shaping, so we are seeing him August 10th. Before you can even schedule with him, though, you have to have a 3-D head ultrasound, though, so we were able to kill two birds with one stone. So we may be looking at one of those cute little baby helmets that you've probably seen around. This process might get dicey, though. Apparently they are really expensive and most insurance plans won't cover them. John and I aren't really concerned with the cosmetic implications of her flat head (she's a girl; she can just grow her hair out anyway), but the doctors are worried that it is so flat that it is restricting brain growth. That would be a problem. So we'll probably only pursue the head-shaping if Dr. Kelly declares it to be "medically-necessary." The problem that I'm hearing about, though, is that often the doctors will consider it medically necessary but the insurance companies will not. So I've already been in conversation with our insurance case manager (who is wonderful!), and hopefully if Becca does need the helmet, she can help us get it covered. Apparently neither TennCare or Children's Special Services (a new program we found out that we are in the process of signing Becca up for) cover the helmets, so if it's going to happen, it's going to have to be through our private insurance. Because I'm pretty sure it can't happen from our private bank account - see paragraph 1. ;) Dr. Kelly might not even want to do a helmet anyway. As I understand it, within about 30 seconds of looking at Becca, he will decide that she either needs: a) nothing; b) a helmet; or c) surgery. I had absolutely no idea what the surgery involves, but I'll let you know if I learn anything.
She sees the developmental physician at the NICUfollow-up clinic every 6 months (typical schedule would be 12 months now, but they are going to see her at 18 months to check in...possibly because I always manage to come up with so many questions) - but I'm going to have to save the developmental update for later. Hopefully later tonight. But don't hold your breath. I'm employed for five more days, and I've got some work to do. We'll see. One anticipated benefit of the new stay at home mom (and not work another job from home) scenario - shorter blog posts. That'd be nice, right? :)
One picture, of course - here's Becca in the fabulous float my great-aunt Susie got her for her birthday. Becca LOVES being in the pool and really, really loves being in the pool in her "boat." She tries to bounce in it to make it rock. Very cute. And very fun for mom, too. :)
Physical stats: at last measure (early July, perhaps), she was just over 13 pounds and right on 24 inches.
We've drastically reduced the frequency of doctor's visits over the past few months. She still sees her pediatrician (on the normal well-baby schedule) and 6 specialists, but the visits are getting farther and farther apart. A review of systems - or specialities, really:
Endocrine - She sees the endocrinologist about every 3 months, mostly for growth issues now. The last round of tests showed that her thyroid and adrenal functions are normal, so both of those medicines have been discontinued. We've tossed around the idea of growth hormones (because she is still so tiny), but we wouldn't start them until around her 2nd birthday. We're not sure what we'll do about them, though. Much of it will come down to what insurance will cover, as they are pretty expensive (I think I've heard), but I've developed a habit of asking every woman I meet who is just at or under 5' tall if they would have wanted their parents to pursue injections had they had the option. So far, most have said that haven't minded being short, but we'll keep kicking it around. (According to the charts and the curve she is on now, Becca's projected height is somewhere around 4' 10" or 4' 11".)
Ears - She sees the ENT every 3 months as well...I think. They are just treating her like any other kid with tubes at this point, though there may be plans to repeat a hearing screen or two just to make sure that all is still well. I'd like there to be that plan, at least. We'll see him again the end of August. And he damn well better wash his hands this time.
Eyes - Also at the endof August, we'll have our follow-up visit with the ophthalmologist. So far, her vision still seems great, but they want to keep an eye on her. (Hahahahahaha...keep an eye on her...I'm so punny.) Remember the whole question about septo-optic dysplasia? The consensus now is that depending on how you define the diagnosis, she may or may not have it. But it doesn't really matter whether she technically has it or not because all it would mean at this point is that she'd be in a higher risk category...and of course, we're already monitoring her for those risks. Hence all the follow-up visits.
Cardiology - I think we may have been released from the cardiologist. If so, it was pretty anticlimactic. She had an echo done last month to check for the pulmonary hypertension that caused her such trouble in the NICU, and I guess it continues to look resolved. I'm not sure because I actually never heard back from the doctor (which is unusual for him), and even when I stopped by the office, picked up a copy of the report, and requested that he call me, I still never heard from him. As far as I can tell from the report (very technical), everything looks good, and I'm assuming that if it didn't, they would have called and had us come in or schedule a follow-up in a few months. But it would be nice to get confirmation on that. You know me. But - if we are released, that's great!
Genetics - I think we see them every six months. I'm not really sure what they are looking for. Perhaps they just think she is an interesting case. Which she is, of course. On our last visit (in May? June?) they took blood and sent it to Baylor for a really fancy test. They basically looked at (almost) her entire chromosomal structure to see if anything was missing, mutated, or multiplied, thinking that it might give some explanation for either the septo-optic dysplasia or her general itty-bitty-ness, but, once again, everything came back clear. That also means that she's negative for the most common form of dwarfism, but there is still a tiny, tiny possibility that she might have the more rare and less severe form of it. Again, at this point, a diagnosis wouldn't matter too much. Either way, she's itty bitty, though if she does have a form of dwarfism, she's got some additional risks for other complications. It seems highly unlikely to me (and to the geneticist) that a baby who had such poor nutrition in the womb that clearly restricted her growth would also just happen to be a dwarf. But stranger things have happened, I guess.
We've got a new speciality on the horizon: plastic surgery. Yep, my little diva might already be a candidate for plastic surgery. (Don't worry, though - right now we're heavy on the plastics possibly and light on the surgery option.) As you have probably noticed, our sweetie is macrocephalic; that is, she has a darn big head. She always did; even in the ultrasounds in which every other part of her (and the composite) was hanging out in the 1st percentile, her head circumferencewas around the 18thpercentile. Her smart little body was directing the few nutrients it was getting to the most vital part of her body - her brain. (Now that I think of it, this is probably also why her belly was so big at first - because on the hierarchy of physical necessity, the other organs come in right behindthe brain. Limbs are clearly just accessories.) So it's always been ahead of her body. Now, though, it's a full size ahead of the rest of her, as in her hat size is 6-9 months even though she's just now moving into 3-6 month clothing. The growthcurve for her head is significantly sharper than both her weight and lengthcurves. All of this led to some concern about just what might be growing in the big ole head of hers, so last monthwe had a 3-D CT scan done of her head. (Which, by the way, was an interesting experience. She woke up from the sedation before we even made it back to the CT room. Oops. I had to sprinkle her with wiffle dust to get her back to sleep in order to get the pictures they needed. The high note, though, was that one of our former nurses from the NICU now works in the radiology department and got to take care of us. That was fun.) Aaanyway...they wanted to check for fluid on the brain (hydrocephalus) or "something else" - which meant "tumor," but everyone was afraid to actually say that to me. We weren't actually too worried, though, as we figured that if there was something majorly wrong going on inside her skull, we'd see somekind of behavioral symptom. But we wanted to check it out anyway, particularly after 3 physicians mentioned it. All was clear, though! But - andthis is where I finally get back around to the plastics doctor - her big head is really, really, really flat in the back now. I could go on and on about why this might be, but I've decided not to worry about why (and thus blame myself for what I may or may not have been able to prevent). The plastic surgeon, Dr. Kelly, is apparently THE guy in town re: infant head-shaping, so we are seeing him August 10th. Before you can even schedule with him, though, you have to have a 3-D head ultrasound, though, so we were able to kill two birds with one stone. So we may be looking at one of those cute little baby helmets that you've probably seen around. This process might get dicey, though. Apparently they are really expensive and most insurance plans won't cover them. John and I aren't really concerned with the cosmetic implications of her flat head (she's a girl; she can just grow her hair out anyway), but the doctors are worried that it is so flat that it is restricting brain growth. That would be a problem. So we'll probably only pursue the head-shaping if Dr. Kelly declares it to be "medically-necessary." The problem that I'm hearing about, though, is that often the doctors will consider it medically necessary but the insurance companies will not. So I've already been in conversation with our insurance case manager (who is wonderful!), and hopefully if Becca does need the helmet, she can help us get it covered. Apparently neither TennCare or Children's Special Services (a new program we found out that we are in the process of signing Becca up for) cover the helmets, so if it's going to happen, it's going to have to be through our private insurance. Because I'm pretty sure it can't happen from our private bank account - see paragraph 1. ;) Dr. Kelly might not even want to do a helmet anyway. As I understand it, within about 30 seconds of looking at Becca, he will decide that she either needs: a) nothing; b) a helmet; or c) surgery. I had absolutely no idea what the surgery involves, but I'll let you know if I learn anything.
She sees the developmental physician at the NICUfollow-up clinic every 6 months (typical schedule would be 12 months now, but they are going to see her at 18 months to check in...possibly because I always manage to come up with so many questions) - but I'm going to have to save the developmental update for later. Hopefully later tonight. But don't hold your breath. I'm employed for five more days, and I've got some work to do. We'll see. One anticipated benefit of the new stay at home mom (and not work another job from home) scenario - shorter blog posts. That'd be nice, right? :)
One picture, of course - here's Becca in the fabulous float my great-aunt Susie got her for her birthday. Becca LOVES being in the pool and really, really loves being in the pool in her "boat." She tries to bounce in it to make it rock. Very cute. And very fun for mom, too. :)
Monday, July 13, 2009
Front Page News
13 ounces at birth, Becca is Tennessee's tiniest baby to survive
"No one was expecting Becca — who was born 12 weeks early at Vanderbilt children's hospital — to live. But the feisty baby proved them all wrong. Becca recently celebrated her first birthday, making the now-13-pound little girl the tiniest baby born in Tennessee to survive."
Nashville's paper, "The Tennessean," caught wind of Becca story around her birthday, and today she's on the front page! Claudia interviewed us last week (amid mission and beach trip preparations!), and I think she did a good job capturing our story and Becca's personality. Be sure to check out the online article with the audio slideshow - you can even her Becca making the Becca noise in the background. Here's the link:
www.tennessean.com
But she's also at
www.knoxnews.com (Knoxville's paper)
and
http://www.foxnews.com/story/0,2933,531981,00.html .
(Yes, my daughter is on Fox News. I'm okay with it. But who would have thought...?)
I love our famous little diva!
Sunday, June 21, 2009
Happy Birthday, Itty Bitty Becca!
It's official! Becca is 1!
We love you, Becca! Happy birthday, sweet girl!
(I'll post more on the birthday festivities later.)
We love you, Becca! Happy birthday, sweet girl!
(I'll post more on the birthday festivities later.)
Friday, June 19, 2009
Just because she's cute...
...and I don't have time for words right now.
From our trip to D.C. back in May - at lunch with Katy, Sarah, and Hunter:
And at the Natinoal Zoo - clearly Hunter liked it better than Becca!
And cozy with Sarah and Hunter in his nursery:
Oh, to be a Methodist preachers' kid in June...watching Baby Einstein while I packed the car for the FIRST Annual Conference of the summer:
And at the hotel - "Mom, you're not REALLY going to bathe me in here, are you?" (No; we took her bathtub with us. Now a necessary item, even if it isn't travel-friendly.)
So glad to be back home and back to the routine:
Sitting up like a big girl in the outfit she picked out herself - she LOVES red and polka dots!
Getting educated by watching CBS Evening News with Katie Couric during her dinner:
On to Annual Conference #2 - hanging out in her "boat" while we loaded the car at the end of our 4th trip this month:
Sitting in her other "boat," playing with Oliver the Octopus that her Great-great-aunt Susie gave her - she loved it so much that she refused to look up for several minutes! (Again, with the red polka dots, right?)
This is her new sand and water table from her Nana and G-Diddy. Note that it is not really a table now b/c it has no legs b/c Becca is tiny. Pretty sure that she won't be able to reach it when it is fully set up until she is gearing up for Kindergarten. But she had a blast with it anyway! Not every kid gets to sit IN her water table. There are perks to being itty bitty.
My eldest child has discovered the boppy:
Eating is still a challenge, so I gave up the other day and just let her play in her pears:
By the end of it, Becca was so covered in food that Sasha stalked her until I undressed her and gave Sasha her clothes to clean off. Sasha wouldn't let Buster near her. Sasha is what you call "highly food-motivated."
From our trip to D.C. back in May - at lunch with Katy, Sarah, and Hunter:
And at the Natinoal Zoo - clearly Hunter liked it better than Becca!
And cozy with Sarah and Hunter in his nursery:
Oh, to be a Methodist preachers' kid in June...watching Baby Einstein while I packed the car for the FIRST Annual Conference of the summer:
And at the hotel - "Mom, you're not REALLY going to bathe me in here, are you?" (No; we took her bathtub with us. Now a necessary item, even if it isn't travel-friendly.)
So glad to be back home and back to the routine:
Sitting up like a big girl in the outfit she picked out herself - she LOVES red and polka dots!
Getting educated by watching CBS Evening News with Katie Couric during her dinner:
On to Annual Conference #2 - hanging out in her "boat" while we loaded the car at the end of our 4th trip this month:
Sitting in her other "boat," playing with Oliver the Octopus that her Great-great-aunt Susie gave her - she loved it so much that she refused to look up for several minutes! (Again, with the red polka dots, right?)
This is her new sand and water table from her Nana and G-Diddy. Note that it is not really a table now b/c it has no legs b/c Becca is tiny. Pretty sure that she won't be able to reach it when it is fully set up until she is gearing up for Kindergarten. But she had a blast with it anyway! Not every kid gets to sit IN her water table. There are perks to being itty bitty.
My eldest child has discovered the boppy:
Eating is still a challenge, so I gave up the other day and just let her play in her pears:
By the end of it, Becca was so covered in food that Sasha stalked her until I undressed her and gave Sasha her clothes to clean off. Sasha wouldn't let Buster near her. Sasha is what you call "highly food-motivated."
Wednesday, June 10, 2009
Pre-conception visit
Hold on, now, don't get your panties in a wad...we're not talking ANY time soon. Becca's not even crawling yet, for Pete's sake!
But, John and I (mostly I, as the designated worrier in the relationship) wanted to meet with the maternal-fetal specialist to talk about what a future pregnancy might look like BEFORE deciding whether we'd like to try again or not. I need as much information as possible, and I feel like we got it! It was such a good appointment. We spent nearly 1.5 hours with Dr. Carpenter at Vandy (in the new 100 Oaks location...interesting) From Dr. Carpenter's bio:
Dr. Carpenter's clinical and research interests include fetal ultrasound and prenatal diagnosis, fetal growth restriction, immunology in pregnancy, and placental function. She received her undergraduate degree from Vanderbilt University and her medical degree from the University of Tennessee. She completed her residency and a Maternal-Fetal Medicine fellowship at the University of Cincinnati College of Medicine where she also was a Women's Reproductive Health Research Scholar.
Hello, exactly who we needed to talk to! (Remember, pre-eclampsia is a form of placental dysfunction.) Here's the recap I posted on a discussion board for preemie parents. I'm including the background paragraph just to give you a refresher and hit some points that may have gotten lost in the drama - some of which I have just now come to understand, as I was too overwhelmed by what was going on to really understand the medical part of it. So, if you want to cut to the chase, just skip the next paragraph.
The background: Becca was born at 27.6 with severe IUGR (370 grams, 9.5 inches). It all seems to have come back to the placental issues. At first it was really big, but by the time she was delivered, it was normal size and extremely "mature" (read: dying). It literally fell apart after they took her. There was also a velamentous (sp?) cord insertion, basically meaning that the umbilical cord was just barely hanging on to the placenta. That's a problem. I had a borderline result for an clotting disorder in pg, but was cleared of any issue outside of pregnancy. In the last few weeks of pregnancy, we saw reverse-end diastolic flow (super bad problems with blood flow through the placenta, keeping her from getting the oxygen she needed - an indication for immediate delivery), severe decelerations (of her heart rate - also an indication for immediate delivery, had she been big enough to be "viable"), high bp, protein in my urine, some facial swelling that we thought was normal pregnancy weight gain (b/c I had just started gaining weight b/c of prolonged morning sickness), and shortness of breath. I was admitted on 6.16, finally diagnosed with pre-e (I have moved out of state 2 days before and thus changed doctors, thank goodness), put on hospital bedrest for the duration of the pregnancy, set up camp (brought in the dvd player and everything!) but developed HELLP syndrome by 6.21. Becca was born by emergency c-section soon after. I was put on magnesium sulfate (to prevent seizures and stroke) and stayed on it for 24 hours after her birth, so I didn't get to see her until she was 26 hours old. My body fairly quickly returned to normal, and I was discharged when Becca was 3 days old. (Apparently, I was really sick, and many moms with HELLP have to stay longer, and some have permanent damage - from stroke or seizure or liver and kidney damage. Scary. Glad I didn't know that at the time.)
So, the doctor's conclusions: trying again is certainly not unreasonable, though the risk of another pre-term birth is higher than average. Her partner put my risk of developing pre-e again at 55%, though it's perfectly possible that I'll have a normal pregnancy or if the pre-e develops again it will be less severe and/or later - like full-term later. I'll be watched closely, and b/c I live an hour from the hospital (Vandy - closer to community hospitals, but with my risks, baby and I will both need to be at Vandy), if I start showing signs (protein, spike in bp, etc), there's a very good likelihood that I would be put on hospital bedrest, possibly for weeks. She's confident that I would be monitored closely enough that the chance of causing permanent or severe damage to my own body is very low, since they would deliver when my health was at risk and be equipped to stabilize me. (Of course, there is still a risk to me.) She told us that placental problems lead to pre-e (I had never heard that before!), so it may just be that this particular placenta would have caused the same cascade of events in any woman, and the next time around would be fine. Or, I could have a genetic predisposition to developing pre-e (of which HELLP is actually just a variant), even though there is no actual family history. Also, since I have PCOS, I am slightly more predisposed to develop pre-e, as would be someone with pre-existing diabetes or cardiovascular issues.
While she insists that there is nothing I could have done to prevent the problems from forming, there are some things I can do to try to tip the scales in our favor next time. The biggest thing, she said, is to get into the best shape possible. I'm carrying some extra weight (had lost 15-20 pounds pumping, but gained it back during the RSV lock-down of winter), so the closer I am to my ideal body weight when I get pregnant, the better my chances are. I'm hoping to lose 20 pounds in the next 6 months. Related to the weight is exercise - obviously, exercise will help me lose the weight, but she said that exercise can make a difference on its own - as in regardless of how much you weigh, your chances are better if you exercise regularly before pregnancy - something about oxidation. Yay for the Wii Fit! Not sure how they would recommend exercising in a high-risk pregnancy - last time it was kind of out of the question b/c I would throw up just walking, but she emphasized that before pregnancy, it's really important. Also, since having had pre-e and HELLP puts you in a higher risk category for later non-pregnancy-related cardiovascular issues, it's a good idea to get a handle on a good diet and exercise program now anyway, while I have the added motivation. Also, if you remember, my stress level during my pregnancy was ridiculously, off the charts high: preparing to move, working as a chaplain (on the perinatal loss team, even), doing a residency, working evenings as the ONLY chaplain in the hospital, 2-3 overnight on-calls each week, being pregnant for the first time, being told we were going to lose the baby...kind of insane, really. My life may not be easy now, and I definitely stay busy, but it's much more regular-life stress now, which is manageable. As far as how they would medically manage the pregnancy differently, she talked about baby aspirin (probably beginning at 8 weeks gestation) and calcium supplements. There is a theory that suggests that some other vitamins and minerals (A, D, and anti-oxidants, I think??) could make a difference, but, unfortunately, the latest studies haven't found benefits to them. I would, of course, be seen more regularly and at least co-managed by a regular OB and a maternal-fetal specialist (or I could go straight to the MFM folks - good thing about Vandy is that they are all in the same group, so communication is better than in some settings - like my last set of doctors!). I'm sure I'd be taking my BP at home, but she said that blood pressure meds don't stop the progression of pre-e; they just protect you from the effects of high blood pressure (stroke, etc.) - which is definitely important! - but wouldn't have solved my issues before.
Phew. I think that's about it. It was really, really, really helpful to talk through everything with her and see how she - the pre-eclampsia specialist - thought all the general information that I've read applies to my case specifically. I feel like I finally have some answers, even though she didn't tell us all that much new about what happened with Becca. It seems to make more sense now, though. Maybe I'm just now ready to make sense of it all in my mind. She was very patient with us, and I feel a lot better informed - both about what did happen and what may happen in the future. Again, we're not talking near future here. At the VERY least, we'll wait until after our trip to Malaysia...pretty sure I don't need to travel internationally pregnant now! In the meantime, I've got plenty on my hands with our crazy adorable Becca, about whom I'm hoping to post soon. Oh - Dr. Carpenter also gave me a Rx for Zithromax, so hopefully I'll be able to breathe again soon. Turns out my sinuses really don't agree with living in the country.
Gotta run - my little miracle is waking up! Will post pictures of her soon!
But, John and I (mostly I, as the designated worrier in the relationship) wanted to meet with the maternal-fetal specialist to talk about what a future pregnancy might look like BEFORE deciding whether we'd like to try again or not. I need as much information as possible, and I feel like we got it! It was such a good appointment. We spent nearly 1.5 hours with Dr. Carpenter at Vandy (in the new 100 Oaks location...interesting) From Dr. Carpenter's bio:
Dr. Carpenter's clinical and research interests include fetal ultrasound and prenatal diagnosis, fetal growth restriction, immunology in pregnancy, and placental function. She received her undergraduate degree from Vanderbilt University and her medical degree from the University of Tennessee. She completed her residency and a Maternal-Fetal Medicine fellowship at the University of Cincinnati College of Medicine where she also was a Women's Reproductive Health Research Scholar.
Hello, exactly who we needed to talk to! (Remember, pre-eclampsia is a form of placental dysfunction.) Here's the recap I posted on a discussion board for preemie parents. I'm including the background paragraph just to give you a refresher and hit some points that may have gotten lost in the drama - some of which I have just now come to understand, as I was too overwhelmed by what was going on to really understand the medical part of it. So, if you want to cut to the chase, just skip the next paragraph.
The background: Becca was born at 27.6 with severe IUGR (370 grams, 9.5 inches). It all seems to have come back to the placental issues. At first it was really big, but by the time she was delivered, it was normal size and extremely "mature" (read: dying). It literally fell apart after they took her. There was also a velamentous (sp?) cord insertion, basically meaning that the umbilical cord was just barely hanging on to the placenta. That's a problem. I had a borderline result for an clotting disorder in pg, but was cleared of any issue outside of pregnancy. In the last few weeks of pregnancy, we saw reverse-end diastolic flow (super bad problems with blood flow through the placenta, keeping her from getting the oxygen she needed - an indication for immediate delivery), severe decelerations (of her heart rate - also an indication for immediate delivery, had she been big enough to be "viable"), high bp, protein in my urine, some facial swelling that we thought was normal pregnancy weight gain (b/c I had just started gaining weight b/c of prolonged morning sickness), and shortness of breath. I was admitted on 6.16, finally diagnosed with pre-e (I have moved out of state 2 days before and thus changed doctors, thank goodness), put on hospital bedrest for the duration of the pregnancy, set up camp (brought in the dvd player and everything!) but developed HELLP syndrome by 6.21. Becca was born by emergency c-section soon after. I was put on magnesium sulfate (to prevent seizures and stroke) and stayed on it for 24 hours after her birth, so I didn't get to see her until she was 26 hours old. My body fairly quickly returned to normal, and I was discharged when Becca was 3 days old. (Apparently, I was really sick, and many moms with HELLP have to stay longer, and some have permanent damage - from stroke or seizure or liver and kidney damage. Scary. Glad I didn't know that at the time.)
So, the doctor's conclusions: trying again is certainly not unreasonable, though the risk of another pre-term birth is higher than average. Her partner put my risk of developing pre-e again at 55%, though it's perfectly possible that I'll have a normal pregnancy or if the pre-e develops again it will be less severe and/or later - like full-term later. I'll be watched closely, and b/c I live an hour from the hospital (Vandy - closer to community hospitals, but with my risks, baby and I will both need to be at Vandy), if I start showing signs (protein, spike in bp, etc), there's a very good likelihood that I would be put on hospital bedrest, possibly for weeks. She's confident that I would be monitored closely enough that the chance of causing permanent or severe damage to my own body is very low, since they would deliver when my health was at risk and be equipped to stabilize me. (Of course, there is still a risk to me.) She told us that placental problems lead to pre-e (I had never heard that before!), so it may just be that this particular placenta would have caused the same cascade of events in any woman, and the next time around would be fine. Or, I could have a genetic predisposition to developing pre-e (of which HELLP is actually just a variant), even though there is no actual family history. Also, since I have PCOS, I am slightly more predisposed to develop pre-e, as would be someone with pre-existing diabetes or cardiovascular issues.
While she insists that there is nothing I could have done to prevent the problems from forming, there are some things I can do to try to tip the scales in our favor next time. The biggest thing, she said, is to get into the best shape possible. I'm carrying some extra weight (had lost 15-20 pounds pumping, but gained it back during the RSV lock-down of winter), so the closer I am to my ideal body weight when I get pregnant, the better my chances are. I'm hoping to lose 20 pounds in the next 6 months. Related to the weight is exercise - obviously, exercise will help me lose the weight, but she said that exercise can make a difference on its own - as in regardless of how much you weigh, your chances are better if you exercise regularly before pregnancy - something about oxidation. Yay for the Wii Fit! Not sure how they would recommend exercising in a high-risk pregnancy - last time it was kind of out of the question b/c I would throw up just walking, but she emphasized that before pregnancy, it's really important. Also, since having had pre-e and HELLP puts you in a higher risk category for later non-pregnancy-related cardiovascular issues, it's a good idea to get a handle on a good diet and exercise program now anyway, while I have the added motivation. Also, if you remember, my stress level during my pregnancy was ridiculously, off the charts high: preparing to move, working as a chaplain (on the perinatal loss team, even), doing a residency, working evenings as the ONLY chaplain in the hospital, 2-3 overnight on-calls each week, being pregnant for the first time, being told we were going to lose the baby...kind of insane, really. My life may not be easy now, and I definitely stay busy, but it's much more regular-life stress now, which is manageable. As far as how they would medically manage the pregnancy differently, she talked about baby aspirin (probably beginning at 8 weeks gestation) and calcium supplements. There is a theory that suggests that some other vitamins and minerals (A, D, and anti-oxidants, I think??) could make a difference, but, unfortunately, the latest studies haven't found benefits to them. I would, of course, be seen more regularly and at least co-managed by a regular OB and a maternal-fetal specialist (or I could go straight to the MFM folks - good thing about Vandy is that they are all in the same group, so communication is better than in some settings - like my last set of doctors!). I'm sure I'd be taking my BP at home, but she said that blood pressure meds don't stop the progression of pre-e; they just protect you from the effects of high blood pressure (stroke, etc.) - which is definitely important! - but wouldn't have solved my issues before.
Phew. I think that's about it. It was really, really, really helpful to talk through everything with her and see how she - the pre-eclampsia specialist - thought all the general information that I've read applies to my case specifically. I feel like I finally have some answers, even though she didn't tell us all that much new about what happened with Becca. It seems to make more sense now, though. Maybe I'm just now ready to make sense of it all in my mind. She was very patient with us, and I feel a lot better informed - both about what did happen and what may happen in the future. Again, we're not talking near future here. At the VERY least, we'll wait until after our trip to Malaysia...pretty sure I don't need to travel internationally pregnant now! In the meantime, I've got plenty on my hands with our crazy adorable Becca, about whom I'm hoping to post soon. Oh - Dr. Carpenter also gave me a Rx for Zithromax, so hopefully I'll be able to breathe again soon. Turns out my sinuses really don't agree with living in the country.
Gotta run - my little miracle is waking up! Will post pictures of her soon!
Thursday, June 4, 2009
It's official!
Daddy was FINALLY fully ordained last night!
After years and years of preparation, John was ordained, and Becca helped! (For you non-Methodists - or UM's not up on the polity of your church - this is a big step...loosely akin to getting tenure, you could say.) No more "day trips" to Kentucky for residency meetings, no more residency retreats in which he is (almost literally) held captive, no more theology, call, and doctrine papers...he's DONE!
John, we are so proud of you!
Here are pictures: the first is the actual moment of ordination - notice Becca and her ducky wubbanub got to be onstage and lay hands on him, too! Standing to the right of me are Cindy Green, John's youth minister from South Ashland and Lee Padgett, the director of Aldersgate Camp - quite possibly John's favorite place in the world.
The second is the family shot with daddy's new stole - in Becca's favorite color.
Our dear friend Rebecca was also ordained, right before John. We worked with her at Christ Church, and now she's Waldo's mom. Congrats, Rebecca!
A few others in my commissioning class were also ordained. I am so happy for them! It was great to see them finish this process, having come in to the conference together. Congrats to Kaye, Phil, and William!
(In case you are wondering, I'm at least 2 years out from this milestone. Because of everything that has happened, I'm off their schedule. But it will definitely help not having both of us have to travel at the same time for residency stuff.)
After years and years of preparation, John was ordained, and Becca helped! (For you non-Methodists - or UM's not up on the polity of your church - this is a big step...loosely akin to getting tenure, you could say.) No more "day trips" to Kentucky for residency meetings, no more residency retreats in which he is (almost literally) held captive, no more theology, call, and doctrine papers...he's DONE!
John, we are so proud of you!
Here are pictures: the first is the actual moment of ordination - notice Becca and her ducky wubbanub got to be onstage and lay hands on him, too! Standing to the right of me are Cindy Green, John's youth minister from South Ashland and Lee Padgett, the director of Aldersgate Camp - quite possibly John's favorite place in the world.
The second is the family shot with daddy's new stole - in Becca's favorite color.
Our dear friend Rebecca was also ordained, right before John. We worked with her at Christ Church, and now she's Waldo's mom. Congrats, Rebecca!
A few others in my commissioning class were also ordained. I am so happy for them! It was great to see them finish this process, having come in to the conference together. Congrats to Kaye, Phil, and William!
(In case you are wondering, I'm at least 2 years out from this milestone. Because of everything that has happened, I'm off their schedule. But it will definitely help not having both of us have to travel at the same time for residency stuff.)
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