Face Rot

As I've referenced, I'm experiencing a bit of face rot condition. That's not the official name, but I like it.  I went to the dermatologist last week and it's perioral dermatitis.  For those who didn't take Latin, let's take a moment:

Peri - about, around, near
Oral - relating to the mouth
Derm - skin
Itis - inflammation of

Now a picture:

Can we collectively take a moment to say, "no shit!"  

(By the way, I didn't want to drag anyone else into this, so I took shots with the backwards iPhone camera.)

I'm almost never in pictures, so trouble finding a true baseline.  This was in the last week of December though, so when it had barely started on teh chin, but was nowhere else.  I was very amused by the hat.

Now that I've drawn you in, I'll take a step back and talk through the history of this face rot.  Outside of a typical level of teen acne, I've never really had facial skin problems.  It just kind of trucks along.  Around the time I figured out I was pregnant, I noticed this weird patch under my left lip.  Kind of a cross between acne and a rash.  But, I had bigger things on my plate, so other than using the hypoallergenic cleanser and hydrating it with a hypoallergenic lotion, I didn't do anything.  Then it spread to the right corner of my mouth.  Still haven't done anything.  And we get the left side above the mouth and the right side up towards the nose.  Making fun of it more with friends and referring to it as the skin rot, but still not doing anything.

Then, it spread to my left eye.  And the skin is sensitive there and so it actually kind of hurts:

So, after just three weeks of this I went in to the dermatologist and she told me perioral dermatitis.

It's apparently most likely due to stress and the normal treatment would be a couple of months of antibiotics.  However, that is not a good plan with two growing fetuses who we would prefer not to have to endure teratogenic effects.  So, she wants me to try a topical steroid called Desonide.  But, it is also a category C.  And while it may make it better, there is a distinct possibility that it will actually make it worse.  I called the OB and after some discussion, they decided I should wait until today when I would be 13 weeks to do it and to try to use it sparingly.  The reason to try it is that it has the risk of causing actual infections and as it is spread to the eye, it's a pretty significant inflammation. 

I dropped it off, but I'm still not sure about using it.  The internet makes it pretty clear that it REALLY can make it worse. Also, these shots are in the morning when it is at its best.  True to a stress-based condition, it gets worse throughout the day.

I can almost hear you asking, "why don't you just cover it up?"  And while my makeup skills are pretty lacking, I'm sure I could apply a base layer to really handle much of the redness and the fun crusty bits.  However, the dermatologist said in no uncertain terms to apply NO PRODUCT to it other than Cetaphil (a moisturizer).  I'm even supposed to be careful to not get any toothpaste in contact with the skin and even consider using toothpaste without fluoride for a while.




Zero Rot at the beginning of December!



 And a year ago, as both more evidence of the pre-rot and because Chiron was so tiny!

So, what's the conclusion?  First, the dermatologist is officially non-helpful and the label of the condition almost annoys me more.  Second, I'm apparently under stress of some sort without really recognizing it.  Third, I don't think there is any real good approach to managing it.  My current plan is to continue washing it with the Cerave and hydrating it with the Cetaphil and I'm leaning towards trying the prescription very sparsely and very tentatively at first.  On some level I'm hoping it will run its course and kind of fade away.  The dermatologist said it was highly unusual for this to show up having never happened before.

Anyone have any brilliant insights into skin care?  I definitely have never mastered these types of skills, so don't be afraid to state blatantly obvious things.  If it's beyond clean, moisturize and don't touch, I probably haven't thought of it.

And I'm sticking with calling it the face rot.



Random Tidbits V

No grand thought to communicate to the world (though I have a rant based on being told we were making Trajan gay that I've been considering for weeks that may come out soon, but I just get too agitated to really write it), so I thought I'd just spew some of the random contents of my mind and my phone.

• Mustard is really, really good.  Trying to surreptitiously drink mustard blend while waiting for your cheesesteak takes some skill, but can be done.

• Related to food, a few more thoughts on the weight gain attempt.
  I’m not actually the biggest fan of dairy.  It just makes me feel a little blah and almost nauseous, so I can’t use copious milk shakes to gain weight.  More avocados sounds like a very good idea!  And hadn’t thought of grits and now I’m happy.  As long as I’ve already confessed my weird relationship with peanut butter having not tried it until I was 23, I might as well confess that I’m not a fan of chocolate either. 
•  I'm not stressing too much about meeting all of Barbara Luke's specifications, but just trying to do a pretty good job of it.  And that's enough to make me happy.

• Also related to food, Chiron is still a very big fan of bread.  Tried it as toast for the first time the other morning and he voted an emphatic YES

• I was by myself in our house for a night (actually two nights) this weekend for the first time since before Trajan was born.  It was kinda crazy.  But I succeeded in organizing oh so much, wrangling junk, cleaning and just generally improving the universe that is our house.  And got two good nights of time in bed (I would say sleep, but I just seem incapable of sleeping more than two hours at a time at the moment).
  Included within this, I decided to pull out all my 2-6 clothes and put them in plastic storage bins.  They are many of my favorites, particularly work clothes, so I'm not quite ready to part with them, but decided I didn't really need them taking up space.  I was at a tight 6 this December before things started ballooning back up, so it's definitely conceivable that I will some day get back into this clothing as I was under two months out from breastfeeding when I started going up again, and thus the storing rather than getting rid of.



That's all those clothes.  And yes, these are just bottoms.  I probably own too many pairs of jeans particularly since I can not wear them for work!

•  Where were the boys, you ask?  They went to Houston and visited the zoo with Paul's parents!
  
  
• And Chiron has a new skill.  He can hit two blocks together while standing which thus means he isn't holding onto anything.  I think this means real walking rather than just cruising is probably coming before too long.

• In my cleaning up this weekend, I actually came across the information sheet from Trajan's 12-month well visit.  I'm backwards from typical and I have all the stats from almost every time my second child has ever been measured, but oddly didn't really have any of Trajan's, so this was interesting to me.  He was 32 inches tall (so 4 inches taller than X at that age) and weighed 23lb, 1oz (so yeah, heavier), but interestingly, his head was only 47.2 centimeters, so smaller than Chiron's!

I should write about my face rot as I actually went to a dermatologist last week, but I've exhausted my attention span, so I am positive I have anyone who has been reading as well ;-). I also attended a party for Trajan's school Friday night that was actually at the home of one of Chiron's neonatologist and had a really good conversation that I will perhaps write about sometime in the next few days. But seriously, the face rot, people.  It's not promising.

Eating ad nauseum

Ad nauseum roughly means to the point of nausea, right?

So, my purpose in writing this post is hoping that you, the wise elders of the internet, can identify a gap or something in my eating schedule and help with some weight packing on.  As I alluded to in my last post, I'm needing to work on my weight gain.

With twins, the powers that be dictate that they want you to have gained twenty pounds by twenty weeks.  Didn't pull this off at all last time, particularly as I lost almost twenty pounds with two GI bugs at 15-17 weeks, but am really trying to play things by the book this time.  So, you may be asking, how much are you up now?  One pound according to one doctor and two according to the other.  And this is at 12 weeks and change, so I need to gain 2.5 pounds each week to hope to make it by twenty.

Current eating schedule:
One of the Boost Plus recommended protein things plus a yogurt and some of whatever the boys are eating around 6:45 along with my 14 vitamin and minerals
A breakfast at 7:45 or 8 consisting of brisket tacos, cheesesteaks, chicken sandwiches or something similar
Snack around 9:30 that is often cheese and crackers
First lunch at 11
Second lunch at 1 and both lunches are full meals
Try to plan some leftovers from dinner or one of the lunches for about 3
Dinner at 5:45 or so at the house
Put Chiron down and come down every night to a smoothie that Paul has made with protein powder in it. 
Often another snack late as well as typically eating at least once during the night

So, what else should I be doing?  I've even added some eggs, which I am NOT a fan of since Barbara Luke is such a fan of them.  I've tried adding quantity such as taking a cheeseburger up from two patties to three and that's not enough.  So, experienced folks, what do you have for me?  I've been keeping a pretty good protein emphasis in line with "the book", but should I perhaps try more carbs for a weight effect?

Chiron's weight was fantastic at 29&6, so I think I did a good enough job last time and I know I'm making even more of a conscious effort this time, so I'm not greatly concerned, but I would love to see that weight jumping up a few pounds.  But again on the flip side, Aurelia was dead, so perhaps doing things different is something I should really concentrate on.

Also, anyone have any good during the night food ideas?  I really feel this is where I could be putting more calories into my day, but it's just a hassle.  Last time I mainly did protein bars at this time.  This time I've been just doing things like nuts, triscuits, dried fruit and other easy to just have in the drawer foods.  There is a fridge in Chiron's room, so I could put more of the Boost Plus things up there, but those disturb me as primarily corn syrup despite being sworn to in lots of twin resources.

And I think I may love cheesesteaks more than any other food on this planet.  Last time it was gyros, but this love is more convenient as there are close options including one that starts serving cheesesteaks at eight am!

P.S. I had weight gain problems with Trajan as well.  So, I'm definitely not a pro at the gaining weight while pregnant game even with a singleton metabolic issues.

Sense of impending doom, lifted!

May sound a bit overdramatic, but the feeling was also very dramatic.  My sense of impending doom has lifted.  Feel calm and at peace and amazingly free from an expectation of being struck down.  Crazy, huh?

So yesterday went to the OB and they both looked good.  A who is on the right and a smidge lower measured 12 even and B, on the left, measured 11 and 5.  My OB described them as putting on a cirque de soleil show in there as they were waving in sync.  Nice fact about this is they were so active that I was able to feel confident they were both alive at the same time rather than waiting for the second heart flicker. 

Big improvement from last time is the fact that the OB and the perinatologist are calling the same baby A as each other.  Last time, the OB's A was the perinatologist's B and vice versa.  This was even more obvious after we knew genders since they were boy/girl.

Speaking of genders, the perinatologist said that he'll likely be able to tell their genders at my 16 week anatomy scan there.

Today, A measured 12 weeks and 1 day and B measured 11 weeks and 6 days, so both exactly one day bigger than yesterday!

They're up to 5.54 cm and 5.04 cm measured from crown to rump.  He also did a cervical length check, because the tech at my OB's office had gotten a short measurement at 8 weeks.  Both my OB and I thought the tech was just in error, but to be safe, we had them check today.  It was 4.5 cm though, so all is good on that front for now!

The peri did blow my confidence that they were fraternal out of the water.  My theory was that between my previously producing a set of fraternal twins and 8 out of 9 di-di twins being fraternal, seemed pretty likely.  Apparently those stats on 8 out of 9 include IVF and other ART procedures and the percentage of di-di twins that are identical among spontaneous twins is higher.  I still feel they are likely fraternal though.

He seemed much less concerned about any of the causes for concern (multiples pregnancy, short gestational interval, history of preterm delivery, history of fetal demise, conception occurring with an IUD in place) that I'd gotten from the OB.  Seemed pretty laid back even.  Said we would do a little more monitoring and he might be slightly more inclined to pull them early with good biophysical profiles, but that was about it.

Their nuchal translucencies looked good, I think.  They were bigger than I remember the previous three times being, but at 1.8 and 2.3, they are still not in the abnormal range and are just a bit above the 50th percentile.  The blood part adds more info as well. 

And, I forced myself to work through my weird psychological hangup over a place called The Coffee Bean.  On my way to the catastrophic appointment, I had stopped there to get a rooibos latte.  I left it in the car to cool off when I went up for my OB appointment because I was used to them being so quick.  I never saw that drink again.  And somehow I just got a hangup that I couldn't go there.  I figure it's much better than the OB or the perinatologist or the hospital, but I'm not a fan of myself having irrational hangups.  So I decided this morning that I could do it.  And I did!  And it was good. 

It really is odd the degree to which the sense of impending doom has lifted.  Here's to hoping that it doesn't return.  Next OB appointment is in two weeks and then next perinatologist is in four.  Maybe not back to naivete, but cloud of doom definitely dispersed.

And must gain more weight.  Must.  It shall be done, rawr!

Chunky Monkey and I'm still a genius!

Chiron had a followup with his gastroenterologist and his rock star status was cemented.  He is at 8.33 kg!  That's 18lb, 6oz for you imperial unit users.  His doctor was really impressed with his growth and that his development was catching up from his failure-to-thrive days.  He actually downgraded his malnutrition status to mild!  And perhaps the most impressive thing is he scheduled him for a FOUR MONTH followup.  Yes, this is the kid who was seeing the gastroenterologist every week to two weeks for months.
And why do I say I'm a genius?  Well, Chiron was supposed to have a recheck at his primary for his ear infection on Friday and I got her gastro to look at them and since he said they looked great I was able to cancel that appointment and save me from a fifth doctors appointment this week.

We did stuff him full of food this weekend to help get that weight up including his first hamburger and his first turkey sandwich.  Kid was a FAN of bread:

In related news, I've had a medical appointment with someone every single week since at least the first week of September 2010 (I need to go check the months before that to see exactly when).  Literally every single week for at least 17 months now.  Next week as of right now has ZERO appointments on it.  I considered not even writing this to not tempt fate, but decided I'm not that superstitious.  So, if all goes well, I will not see a single medical professional next week professionally!

I didn't get any shots of Chiron today, but here's his doughboy impression from this weekend:

You can also see my mysterious facial rash breakout thing.  I've been going with ignoring it besides doing a good job of cleaning and moisturizing it, but it seems to be spreading and so considering consulting with a dermatologist since it is a bit disturbing.

Also, evidence that Chiron really does seem to love his brother's affection regardless of the degree of energy that it comes with:

And I like his response to grocery shopping:

He just hit 28 inches, so we're going to have to move him out of the infant car seat within the next month or so!

(Oh, and had OB appointment this morning and all is well, but going to wait until after the perinatologist tomorrow to write anything to cut down on the redundancy)

I may be a genius

So, the logistics of childcare has been on my mind a lot.  Here's the situation we will have next fall: a kindergartner (we are most likely going to take the plunge and move him to the public school for next year), an 18-month-old and hopefully two newborns.

We adore Chiron's daycare.  It is so good that relative to the two places we had Trajan before preschool, I feel almost negligent.  They love and enjoy the kids.  The notes from the director to Chiron's developmental pediatrician plus how they work with him had her declare at his 9-month appointment that we didn't need to add PT or OT.  Their food has been written up by the restaurant critic of the local newspaper.  They have great events and the families really interact and it feels like a community.  Not only that, but so far they have always had a slot for Trajan to go on his school holidays and he enjoys getting dropped off with his brother and also seems to really like the kids and activities for the big guys.  A school with enough outdoor time!

I feel pretty confident that the director would be willing to work with us to negotiate down the price of two newborns and a toddler to under a nanny.  They should be a bit over a thousand each, but I really think she'd make us a package rate.  I started fantasizing about this idea and it seemed great!

Then reality hit.

One, how do you get two newborns and an 18-month old in and out of the school?  I'm guessing a carrier plus a double stroller would work, and probably would work pretty well, but that seems like a lot to do every day just for daycare.  Still, other parents are very helpful and in the morning there is often a second teacher around and this could work.  Ok, maybe we can do this.

Then Chiron got his first fever.  Minor thing, an ear infection, but enough to keep him out of school for two days.  Then it hit me what a cold could mean.  Kid one has it Monday and Tuesday, kid two on Wednesday and Thursday and then kid three on Friday.  An entire week worth of missed work for a cold.

We can't do daycare.

So, a nanny seems like the answer.  There are a lot of logistic to be figured out related to a nanny ranging from finding and hiring one to withholding and social security/unemployment taxes to arranging food in the house for all of them to eat and all the minor details, but I really think it will work for us. I've been convinced by those who have used nannies that as long as we select carefully and hire someone with appropriate experience (pay rate appropriate to that experience) that a nanny should be able to watch Chiron as well as two newborns. 

Here's the part where I think I may be a genius.  Was thinking that we would look for starting sometime around August or September.  Both Paul and I really ate through vacation and sick time with Chiron staying home five months after getting discharged from the NICU, so we frankly just don't have the amount of time that we would like.  So, having someone in place early will better allow us to get some work in and nurse projects along as well as children. 

But hiring someone during that time frame seems stressful for several reasons.  One, having hopefully two additional little people.  Two, knowing that we HAVE to have someone soon.

Thus, the genius.

We should go ahead and try to hire someone to start at the beginning of June! Trajan's school year ends the first couple days of June and we were trying to decide between some camps and putting him at Chiron's daycare, so instead we can just leave him and Chiron at the house with the nanny.  This would allow us to get to the nanny and the nanny to know us, and in particular the big boys, ahead of time.  It also would put another support person in place in case something bad happens again necessitating restrictions and/or the fun of the hospital.

A nanny for these months will be slightly more expensive than leaving the boys both in daycare, but I think the advantages to us will be well worth it.

So, experienced friends of the internet, what do you think?  And if we are looking for June, when should I start contacting people?  The nanny agencies seem insanely expensive.  Was thinking with a mix of telling every person we know that we are looking, advertising with Craigslist and maybe care.com or similar and creating a basic starting application with Google Docs to do some weaning, we could do it ourselves?

Any other nanny logistics, experience or recommendations you can share with us?

Trajan stopped my heart for a beat...

"I hope my next sister doesn't die."

Pause

"I never got to see Aurelia, so I don't even know what she looked like."

Questions about what she looked like and whether we got to meet her.  Answers and telling him about the time we spent with her and our description of what she looked like.

"Even if she was dead, she's still my sister and I wish I'd gotten to see her."

<end scene>


Trajan doesn't actually know that I am pregnant yet.  We haven't really discussed it with him and I think it will make sense to wait until we know genders just to make it an easier conversation.  The above conversation arose from him discussing his desire for one more brother, PLUS another sister.


This was at dinner time and you can imagine my apprehension when he turned to me last night after we finished reading in bed and said, "let's talk about stuff."

What did he proceed to talk about?

"Like why we only have doughnuts on the weekend and only sometimes then?"

I love this kid's mind.  The discussions with him that we have every day just make my world a better place.  And you know what, bubba?  I hope no more of your siblings die too (well, I'm an actuary so I know mortality will occur, but lets say none die prematurely).

And I've said it before, but I really think discussing Aurelia's life and death with Trajan has likely helped me more than anyone else.  He's not plagued by taboos or trying to say the right thing, he's just trying to understand the world and so am I.  I'm very lucky.

Innocent and wise.  Sleeps with a fish and prefers the floor.

First Sick Day and Skin Testing

Chiron had his first fever last week and ended up staying home Thursday and Friday.  Considering he's over one, I think this is pretty impressive.  He started out with a 101.6 or so fever Wednesday night which continued into Thursday.  We were just watching it and going to go in for a quick check with the pediatrician Friday before the weekend, but it had jumped to 103.8 by afternoon before a Motrin dose and so they had us come in.  The pediatrician was saying that given the high level and his relative lack of reserves (code for underweight), they were going to do a urinalysis and we should probably do chest x-rays.  Then she looked in his ear and grinned.  Why?  He had his first ear infection and thus a clear cause for the fever!  So he's on amoxycillin and looking better!

His head really is huge!

Then yesterday he had skin testing for food allergies.  As expected, he did not react to any of them!  Coupled with his 0's on the blood RAST tests and the conclusion was that he can now eat everything but dairy and soy.  And since we are worrying about protein intolerance and digestion issues with them, we don't even have to be concerned about trace amounts of them!

We will likely try soy at two years.  She also decided that she will do his environmental skin testing early at 18 months.  And she wrote us a prescription for Pulmicort to try using to cut down on his Xopenex needs if he gets junky again.

His back wasn't allowed to touch anything once it was done, so he and I got creative to keep amused and even get a bottle eaten!

This adventure at the doctor did prove something to me: my normal workday is very easy on the body.  By the end of yesterday, I was feeling the heavy cervix/crampy abdomen feeling of a irritable uterus.  Not like contractions or preterm labor, just a bit of a protest of the body.  Could tell it was, because even grabbing and Chiron made it more intense.  But some water and some rest and all is back to good.  Glad my job is so easy on the body!

I was also starving after completing his appointment and so got two slices at a pizza place that has slices at lunch.  Each slice is huge, so I ate half of an 18 inch diameter pizza.  That's 127.2 square inches of pizza. 

And yes, I ate it all.

And yes, in calling last Thursday his first sick day I am completely glossing over the 59 days spent in the hospital. That's totally my perogative!

I smell like cabbage...

My body is apparently constitutionally incapable of being typical.  Conceiving twins, who are likely fraternal, with a Mirena IUD in place is a good example of this, but the current issue is actually perhaps even a bit weirder. 

Two nights ago when I went to change out of work clothes before dinner I noticed that my right breast hurt and doing things with that arm was a bit off.  I explored a bit and came to the conclusion that I somehow had a blocked duct.  Now, I haven't pumped AT ALL in over three months and it has been a bit over four since I was exclusively breastfeeding, so this struck me as a bit odd.  The OB had mentioned leaving my breasts entirely alone and being careful to avoid any sort of nipple stimulation, so I found myself in a bit of a quandary.  I had a visibly hard area on my breast that was full of milk.  Those of you who have breastfed probably know the big risk of this, mastitis.  The normal treatment?  Getting the milk worked out.  But I wasn't supposed to interact with my nipples at all!

So, I called the on-call nurse who said to go ahead and hand express it as the risk of mastitis was worse than the stimulation.  She also said to call my nurse in the morning and they might want to see me. I did and they did.

My OB remarked how weird it was, but her best theory was that my body had decided it was time to start producing milk.  She said to NOT hand express any more as that was likely to encourage the production of more milk and instead to wear a very tight sports bra with cabbage on the breasts and replace the cabbage every three hours.  Her goal is to get me to stop producing and dry up.  As I'm just past ten weeks, this sounds like a wise idea.  The only other aspect of the plan is that we will add Bactrim DS if I show any signs of mastitis.

Thus, I smell like cabbage. So far it doesn't seem to be working at getting my breast to stop producing the milk [TMI warning: I'm slow to completely stop lactating, so both breasts were capable of producing a couple drops, but the right one is currently capable of producing an across the room stream -- not what you are looking for in a non-breastfeeding mother with a history of a preterm delivery], but the cool of the cabbage does make the painful area feel a lot better.

That's the end of my ramble on my breasts, aren't you glad you now know more than you ever wanted?  But I learned some other interesting information at this appointment.

I was taken to a room without an ultrasound and the medical assistant took my blood pressure.  It was 120/65, more or less normal.  Then, my OB came in and said that based on my blood pressure she was guessing that I didn't want her to look at the babies, but she was planning on it and only wouldn't if I asked her not to.  I agreed that my blood pressure was lower because I had no expectation of seeing them and thus no need to prep myself for information on their possible demise, but said that I was fine with getting an ultrasound.  They brought in the quickie machine then and while they didn't check it, I'm thinking my blood pressure went up.

I'm glad my OB did this experiment as it helped give her more evidence that I don't have hypertension and also because it helps me to know that the reaction should be within my control.  It's physiological and fight or flight, but if I can get myself to not be as worried about protecting myself, perhaps I can keep it down.  Going to try to play with that.



Both babies were beating their hearts like pros and while I didn't expect there to be much change from the ultrasound I'd had three days earlier, there was.  They are now moving their limbs and bodies obviously!  Was great to see.

It's a bit wacky that I've now had five ultrasounds of them at 10 weeks and change and have two more scheduled for a week and a half from now.  I find it reassuring, in perhaps a morbid way, that if something bad does happen, I won't have to live on for a long period of time not knowing.


And I really do smell a bit like cabbage.

Logistics

I'm not to the point of tackling them yet, but thinking I should consider an intentional series of blog posts (I know, goes completely against everything I've done to date) considering logistics as we move towards potentially adding these additional two kids.  There's a whole range of topics, and I think writing them out would make me think about them and consider things so we are better able to take action when we reach a point that action should be taken.

Possible topics include:

• Car - logistics and safety
• Housing - where is everyone going, can we preserve guest bedroom for a while, is it possible to start out with just rock 'n plays and then move, etc.
• School for Trajan
• Childcare - HUGE area to consider
• Breastfeeding
• Names (oh my)
• Sleep
• My necessary work travel
• Work - I MUST clean my office, and get the technical issues that are preventing VPN fixed, and set up the printer and work station at the house with the hospital table and all that...
• Hospital run logistics
• Handling transportation other than just car (i.e. stroller?)
• Money
• Spousal relationship survival

Then there are some that I feel like worrying too much about in advance wouldn't really do us much good and would definitely have some negative, so why not just ignore for now?  These are such things as restrictions and/or bedrest and how we would manage that (one that the OB has already mentioned is it's possible the perinatologist will ban me from lifting Chiron at all at some point.  Um, how does one do that?).  Fetal death and/or prematurity.

There definitely is a balance between being prepared and getting ahead of yourself.  For example, I really don't think working on four names now is in our best interest.  We are better off holding off until we know genders and they are further along.  There are some things that I figure it is perfectly fine to work on at any time.  These are the things that are beneficial to our family whether we end up with two babies, one baby or none, such as decluttering, organizing and getting more efficient household systems in order.

What other logistics should I be putting on my list to potentially consider if I get my butt in gear?

And to finish my thoughts, here's the most intense baby ever:

We went to a kids show Sunday morning with friends and he stayed in this transfixed state the entire time.

Big brother?  Well he really liked getting ON the stage after:

Oh yeah, that reminds me of another logistic: preserving these two boys' awesome relationship. 

Google, Blogspot, Friend Connect Help!

Wise, sophisticated bloggers of the internet, how do I drop a google friend connect?  I have one that is for some reason pushing through all their posts every time they publish a new one.  Would be just a little bit annoying, but Reader doesn't give me a "mark all as read" option since I'm not "subscribed" to it.

I got smart after a bit and subscribed to blogs in google instead of clicking friends with them.  I tried going in through the google friend connect page, but it just gives me options to manage my blogs.

I'm guessing this is obvious, but I'm overlooking it....

I really am more and more feeling the compulsion to move to whatever platform it is that makes the nice need comment form with name/email/website (i'm thinking this is wordpress) and the ability to reply to a comment, but just seems like so much work and blogspot is so easy.  Except when it's not.  And then it's evil and totally unmanageable.

Is there a hire it done open for basic rather than fancy blogs to get set up as wordpress?

They're Alive!

One with a heartbeat in the 150s and one with a heartbeat in the 160s.  One measures 9w5d and one measures 9w4d.  There being so similar in size in all four ultrasounds and staying so is a really good thing.

The shot of the ultrasound might be odd to you, but this is my friend the quickie ultrasound.  Since you can't distinguish between the heartbeats of two babies, my practice does a quick ultrasound each appointment to confirm cardiac activity. 

Next appointment is in 2 weeks and also going in for first appointment with the perinatologist around that time.  My OB actually offered me either 2 or 4 weeks.  I said 2 and then said that perhaps 4 would work since I was seeing the perinatologist, but she said I might as well just do the 2. Blood pressure is improving in their office as well, was only 135/78 this time!

Now for a real leap of faith, I think I need to tell my boss.

I actually do not have an impessive bump at this time, contrary to popular belief regarding back to back twin pregnancies.  But, I still think it likely will look comical at some point with Chiron's diminuitive size.

Here's baseline:

Some pudge, but not bump per se.  Oh, and this is about 8 weeks pregnant on the last set of twins.  I do NOT have any pre-pregnancy shots at all this time, since this is a bit of a surprise. 

Here's almost 22 weeks pregnant with twins last time:

And here I was this time at 8 and a half (this was December 30):

The nurse noted this morning that I'm out of the pelvic girdle as a uterus already, so I think my uterus is on a rubber band.

I'll try to remember to take a shot in the next day or two just for giggles.  I'm guessing it'll be at least another month before will qualify as a bump.

Also, aren't we all proud of myself for being willing to consider a month from now?  And I was flatout assuming they'd be alive, I really think I've made great mental progress.  I know I've been mainly mocking it, but I think I really am coming more to terms with things.  The only bad side of that is once I really get my mind wrapped around the pregnancy, I'll have to start thinking much more about logistics.

One last OB note: she also told me today that 37 weeks is the farthest out that we are willing to consider.  In my head, I already knew this, but was thinking 38 or even 38 and change where she said 37 is the farthest.  She did follow it up with "even if a bit earlier than that, we will still be a lot past 29!"  It's such a hard balance between the safety of removing them and the risks of gestating outside of the uterus.  But twin pregnancies have a bad rap for cords and placentas anyway, so I think I'm ok with this idea of early even if it ends up meaning some NICU time for babies who appeared to be doing find in-utero.  Also, she hasn't said it (in fact she said she'd call it 50/50), but I feel pretty certain I'm earning myself another c-section.

A $30 Leap of Faith

Just before we went out of town for Christmas, I logged onto the group for our local mothers of multiples group to search old forums for thoughts on car seats.  While I was on the site I happened to see a classified in the corner for 16 Dr. Brown’s bottles.  As these were the ones that have worked well for our boys, I clicked through.  It happened to be a mom that I knew from before either of us were pregnant with twins as our older sons would play together when we happened to be at the local elementary school at the same time on the weekends.  And I took a leap of faith.  I emailed her and set up buying them from her.

This may seem like a very small thing, but it was taking concrete action based on an underlying belief that two living, breathing children will join our family this summer.  This might be the normal assumption, but it hasn’t been my general mindset.  But taking that $30 leap of faith has really helped me in transitioning to a world in which I consider the logistics of a successful pregnancy and not just how to handle their possible demise.

On a related note, last week I saw the grief counselor that we had seen after Aurelia and Chiron’s birth.  I found it was really useful to talk through what I was feeling and thinking in general and I had two big realizations from the appointment that perhaps make it one of the best hundred dollars I’ve ever spent (the boys’ clothes still wins though). 

First, my anxiety/craziness is rational.  Yes, I am a bit crazy.  Yes, my body responds physiologically to my obstetrician’s office with a fight or flight reaction that is reflected in my elevated blood pressures.  This is all true, but it’s okay.  It is reasonable that I feel this way and I do not need to be upset or worried about the fact that I’m a bit crazy.  I do not need to apologize to anyone for that craziness.  I do however appreciate that those around me who know the anxiety acknowledge it and support me in reaching a positive place with it.  And as always, I’m blessed with an obstetrician who completely gets this insanity and not only doesn’t judge me for it, but goes out of her way to support me in it.  And hallelujah, she isn’t pregnant this time and so won’t be out for a maternity leave! (Not sure I should be celebrating that someone else is done, but I am ;-) ).

The second one is the one that I really think is critical and has made all the difference in the world as to my mentality and general attitude.  I didn’t write anything last week after we got back in town after Christmas and before New Years and this was primarily because I was uncomfortable acknowledging the degree of distress I was feeling and I was also uncomfortable trying to hide it.  I’m pretty much what you see is what you get.  And prior to my appointment on the 29^th, I had honestly been in a place for the previous couple days where it wasn’t just that I feared they had died, I felt sure they had.  Note, I had no reason to feel or suspect this, but I still did.  I was convinced on some non-rational level that they had both somehow died, my body hadn’t noticed and I had a missed miscarriage.

What do I think today?  Well, it’s been a week since my last ultrasound, yet I still feel confident that they are both with me, growing and with beating hearts.  I feel comfortable in the lack of negative evidence, such as cramps or bleeding, and no longer am driving myself to search for positive evidence that can’t exist, i.e. a massively expanding midsection or a development of morning sickness that I’ve never known.

So what was the realization that has resulted in this huge change?

It is impossible to distance myself from those in my own body and while trying to do so will not protect me or make me feel less pain if something bad does happen, it can prevent me from bonding and attaching as I’d like to and thus I am better off to freely give my heart to them as they already have it whether I intended them to or not.

The bottles were the first leap of faith towards that realization.  Then I added in a very helpful conversation with my obstetrician that made it absurdly obvious that she is willing to do whatever will make me feel the most comfortable and an hour of just being able to talk through what I’m feeling and thinking and I got there.  I know this will be a work in progress in terms of ups and downs and that there are still many hurdles and dark spaces out there that we may come to see.  But I know myself and I know my strength and I know I can face them when they come and so I do not need to live in fear of the unknown or produce anxiety in myself about what may be.  For whatever may be, I can manage it.

It kind of comes down to the same attitude that has caused me to feel certain about my relationship with Aurelia.  There is nothing that I can do to undo her death.  And I wouldn’t choose to undo her life, even if I could evening knowing how it would end.

I have my next ultrasound and obstetrician appointment on Monday and will be a day shy of 10 weeks then.  As always, I've produced a pretty good set of questions.  Even if they didn't want to do the extra monitoring, it might be a good idea to keep having appointments every week to two weeks just to keep the question log from getting too long.

And as a final bonus, the ultrasound shot from last week as well as the cardiac activity confirmation on each.  The tech announced when we walked in that she was just supposed to check my cervix length and not look at the babies.  I said that I was almost certain the doctor had wanted their growth checked (since we are trying to age this pregnancy as there is no LMP and this is harder with a twin pregnancy) as well as confirm cardiac activity.  She looked at a sheet of paper and said that wasn't the case.  Rather than flipping out, I calmly asked if she would just quickly confirm cardiac activity for my sake (aren't we all proud?).  She agreed and also gave us one quick shot of them.  When we got upstairs, my obstetrician was more than a bit annoyed and questioned if she had to absolutely spell everything out and questioned why we would not have want them looked at thus affirming that I was right.  As a result, she's just going to do the ultrasound herself Monday instead of sending me down to the tech.

I didn't take a shot of the cervix measurement, but it did alarm me a bit (see, I'm not completely recovered from my alarmist nature).  At first she measured 2.2 cm, which would be a PROBLEM for eight weeks.  She then said something to the effect of, "oops, didn't see the curve" and so came in at 3.7 cm.  My cervical length at 24 weeks last time was 4.37 and then at 28 weeks after preterm labor and dilation was 3.7.  My doctor wasn't concerned about the relative difference and anything over 3 is fine, so I'm not very concerned, just mainly bothered that I don't feel much confidence in the accuracy of the measurement that was taken.

I really don't think I have an incompetent cervix, so I actually don't have much anxiety on this issue, but I would like a nice clear value and so will be happy whenever the perinatologist takes over the cervical length measurement. 

Slowly killing my children with breastmilk

While this may sound like an exaggeration, I think this title is a fair medical description.  My obstetrician, who is very pro-breastfeeding, actually said at the first appointment where we found out that I was pregnant something to the effect of “you’re not even going to try this time”. 

My mentality from the time of Trajan's birth was that while there might be some debates over how strong the merits of breastmilk are, there’s pretty much universal agreement that there are benefits and that’s what I was going to do, dadgumit.  I had a great supply and with a nipple shield to help with inverted nipples, we were gangbusters. 

Then, the day he turned two weeks old (two days after we were finally able to get him off of the biliblanket for jaundice), I became convinced that stooling more than once an hour with mucus was not right.  The doctor agreed and sent us to the hospital where we stayed for the next six days.  They found blood in his stool and the conclusion was that he had protein intolerance issues.  I immediately went on a diet elimination and pumped for three days while he got formula and then they put him back on breastmilk.  The blood and mucus improved, but he still had some of the telltale signs of protein intolerance: skin issues, sinus/ear infections, and stools that were just a little off. 

By four months, I was eating brown rice, lentils, sweet potatoes, spinach and water.  He was still dropping on the weight chart having gone from 50-60% to under 10%.  I was underweight.  His pediatrician looked at me and said, “we are done.  Both of you are starving.  We are moving him to an amino acid formula.”  The change was amazing both in his health and my sanity.

Then Chiron came along.  I was concerned about protein intolerance and talked about it to the doctors and neonatal nurse practitioners in the NICU.  They all said that there’s not a high incidence of recurrence and that actually being premature makes it less likely as the immune system isn’t fully developed.  And he had no issues the entire time he was in the NICU.

About two weeks after his discharge, right around his due date, he started having reflux issues.  Was checked for pyloric stenosis just like big brother and came up clean.  We immediately went to the pediatric gastroenterologist we had used with Trajan and the conclusion was no protein intolerance, but severe reflux.

Fastforward to September, when Chiron was almost nine months old.  He had always been low on the chart, but at this point had literally not gained in over a month and a half.  And just didn’t look great.  His gastroenterologist still thought reflux and we had done all the imaging possible and so decided to adjust his meds and see what would happen at an appointment the next week.  It was literally the next day that he finally completely tanked.  He became lethargic to the point of being non-responsive.  He had extreme pallor.  Again, we returned to the same hospital big brother had gone to.

They drew blood and he was extremely anemic with some other liver and vitamin levels off consistent with malnutrition or malabsorption or something like that.  His gastroenterologist decided to try an experiment and put him on Neocate since it had worked well for his big brother.  His one condition was that I had to keep pumping through it as he anticipated returning him to breastmilk after the three days.  Chiron went from throwing up over 30 times a day as recorded in the hospital on breastmilk to barely 14 on Neocate.

Chiron had literally no symptoms of protein intolerance, but he did so well on the Neocate that it was obvious that he should be left on it.  At the same time, his doctors decided that we should remove all other food sources from his diet to start fresh.  He had deteriorated so badly on the breastmilk that it was still necessary to give him a blood transfusion before discharge despite the improvement with Neocate.

While the reflux/vomiting improved, his weight didn’t.  So, he was again scheduled for a scope called an EGD.  The results from that was the surprising diagnosis of congenital lactase deficiency.  Good news was the same Neocate formula worked great for it.

So, breastmilk caused both of my living children to deteriorate in nutritional status, develop system-wide symptoms and become failure to thrive. 

At the same time, I have a very rare condition called lactation-induced hypoparathyroidism.  Basically, something about the process of lactating causes my body to attack the parathyroid and shut it down like an autoimmune disorder.  This in turn impacts my ability to regulate calcium in my bloodstream.  We didn’t figure out what was going on with Trajan, who stopped breastfeeding at 4 months, but we did figure it out this last time.  It’s treatable with monitoring and medication and knowing about it makes it less of an issue.

Add to it by over 105 degree fever with antibiotic mastitis while Chiron was in the NICU and the 6-day readmit that I earned and you can see why several people have questioned whether I’d even consider breastfeeding these two.

[Note: be proud of me, I just didn’t write a statement such as if they make it to that state.  Great progress!  No really!  And I should write about it.  The appointment with the grief counselor that my OB recommended that I do was really a good idea.]

So, what is my plan?  I’m only at 9 weeks, so have time to work it out, but my plan right now is to first consult with the pediatric gastroenterologist that both of the boys have seen and who is wonderful and ask his opinion about what the best thing I can do will be.  My gut is leaning towards breastfeeding them for a period of time, perhaps six weeks (?) in an attempt to get some of the immune benefits but not risk the longer term issues?  I have promised Paul that I will not be as gung ho crazy and insistent about it this time.  Our general pedi and I discussed it briefly yesterday and she said that I should definitely talk to the gastroenterologist at Chiron’s next appointment in case he wants me to consider diet elimination during pregnancy.

This is obviously predicated on the idea of them being reasonably full-term.  If they aren’t, I imagine the risks of not giving them breast milk will be greater in that period and I will provide them breastmilk.

So, yes, I slowly killed my children with breastmilk, but do I regret it?  No.  It was an attempt to provide the best for them and I am glad I did it.  I’d do it again and if I’m being completely honest really hope I am able to try.

One last fact.  Despite the difficulties we had with our boys, I donated excess expressed milk with both pregnancies to the milk bank and I am happy to say that it was thrived on by recipients and I know from my time in the NICU may have literally meant the difference between life and death for some preemies.

And I own a Medela Symphony folks, it would seem a shame to not utilize it!

Badass and a bag of chips

I might be setting my expectations too high, but that's the description I'm expecting the developmental pediatrician to use for Chiron on Friday.

In the last month and a half, he's gone from not sitting on his own to sitting, crawling, cruising, pulling up and standing in his crib. Really talking up a lot with at least a dozen consonant sounds and all the vowels.

Found this on my dad's phone from a week or two ago and I think it does a good job of summing up how good he looks.

He had his one-year with his normal pediatrician today and she was so impressed with him that literally every nurse came in to say hi and look at him! And in more good news, he is on the chart for length now at 28.25 inches!

He's at 17.5 pounds or 8 kilo, so not on the chart yet there, but he is at least gaining. He even seems to be getting a bit closer to the bottom curve. And his head is even more ginormous at over 49 centimeters or 19.5 inches. But as the doc and I talked about today, we really have looked at his brain all possible ways and it really does seem the case that baby's just got a big old head!

He has his skin testing on the 17th and I'm hopeful we will get to start adding some of the banned foods into his diet after that since his blood food allergy tests (RASTs) all came back great. He has a gastroenterology appointment on the 23rd, so really hoping between those two we will get a plan in action.

The boy's primary who Chiron saw today says that I do need to talk to their gastroenterologist to see if he wants me to adjust my diet at all at this time now that both boys have had protein intolerance issues to try to give these two a better chance.

I need to write about obstetrical progress, my sanity, my $30 leap of faith, my murderous breast milk and more, but that's for another day. For now, my focus is that Chiron is badass and a bag of chips!

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