Beginning a path of uncertainty...

We went in for our 20 week ultrasound on Monday afternoon with the full expectation that everything was going to be normal. Everything about the pregnancy had so far seemed on track. Monday night we got a call that the baby appeared to have a marginal cord insertion a the placenta (often not a big deal if that's all they see), was small enough that they feared intrauterine growth restriction (IUGR, big problem), had short femurs (potential Down's syndrome marker), and, biggest problem, appeared to have a congenital diaphragmatic hernia (CDH).

CDH is a condition where the diaphragm doesn't close during the early portion of gestation (9 or 10 weeks) and contents of the abdomen (like the liver, stomach, and intestines) find their way up into the chest. In a left sided hernia, the heart gets pushed way over to the right and the growth of the left lung is impaired due to the abdominal organs filling its space.

First thing Tuesday morning, we called the recommended perinatologist and they fit us in that afternoon. A more high-resolution ultrasound confirmed the CDH but they couldn't find anything else structurally wrong with the baby. We found out that we're having another girl. She was still measuring in the 5th percentile for growth but I mentioned that my uncle, an obstetrician, had done an 8 week ultrasound for fun when I was visiting them and that the baby was measuring much younger at that point. The perinatologist beamed and remarked that a first trimester ultrasound that was more than a week off from expected due date was enough to change to due date. After the appointment, we rushed home to get the pictures and, sure enough, they ended up changing the due date to 6/29 from 6/20 - meaning we now have a baby growing just above the 75th percentile - almost chubby really. :) Taking IUGR out of the mixture for the time being is really important for her chances at survival.

They also did an amniocentesis to rule out genetic defects. We had two days of worry regarding the potential of a trisomy (nonsurvivable) before the chromosome count came back normal.

We got referred to the Colorado Institute of Maternal and Fetal Health, which is located in Children's Hospital and associated with the University of Colorado School of Medicine as well. Due to our move to Denver just over a year ago, we happen to be at one of the best facilities in the country for this type of thing. In another example of how exemplary our care has been so far, they got us an appointment for Friday (only 4 days after the original ultrasound!). We spent all of yesterday at the hospital getting a fetal echocardiogram (everything came back normal for the heart), a fetal MRI, and yet another ultrasound.

We went into the family meeting at 5:30p to hear our girl's prognosis after the doctors had had a chance to talk about all their findings and put them through a complex equation that gives a likelihood of survival. Because it seemed like our case was leaning toward being "isolated" (having no other complications/malformations besides the hernia), I was hoping for something in the 60% range. The two big indicators we were still waiting on were whether the liver was herniated (bad) and the LHR (lung head ratio). The LHR compares the volume of lung tissue they can see on the MRI to the head circumference to determine how much lung has managed to develop compared to normal for that gestational age.

We were delighted when he didn't keep us in suspense and started the meeting by saying that, based on all of the factors, they currently believe her chances of survival are 90%! There is very little liver involvement, her right lung is fairly well developed, and her left lung is doing fairly well, considering how little space it really has. The LHR is currently .7 but they're going to have to do another test at 25 weeks, which is really the time they can get a more meaningful reading. He's hoping it could get as high as 1. (For reference, above 1.4 is a very mild case, below .7 - when measured between 23 and 28 weeks - is quite underdeveloped.)

If she survives birth (we'll either induce or have a Cesarean at Children's on about June 15), there will be a critical 2 weeks or so where they will be supporting her transition to living outside the womb and doing everything they can to relax her and allow her to stabilize. If she survives to that point and stabilizes enough they will be able to do the repair surgery. If all goes well, she could be a fairly normal little girl after overcoming a few developmental delays and other challenges in her first couple of years. If given the space and time, lung tissue can actually grow and fill the space so she wouldn't have respiratory problems.

Not exactly how we were planning on bringing our second girl into the world but we have hope now, which I did not think we were likely to have early in the week. We'll see what the next few months bring.

Howe First Cousins Reunion

Here are a few pictures, courtesy of cousin Joe, from the 

1st Cousins Reunion (plus Liz and Willow)

in Sister Bay, WI, September 14-17

Willow's First Birthday

I finally got my brother's pictures from the girl's first birthday looked at and ready for posting. Only a month late, not bad. :)

Removing stains (aka I'm a Clutz)

This is the second day in a row that has been a two shirt day for me since I keep spilling on myself as soon as I get dressed. First, there was the butter spatter while making cherry almond muffins. (OMG, 1/2 t. almond extract and a drained pint of home canned cherries added to any basic muffin recipe - excellent. Don't forget to drink the leftover juice too!) Today, coffee.

So, tips I've been dredging up from my memory or finding on the internet

Coffee - rub with ice. Keep rubbing with ice until it disappears. It's so much fun watching this happen that I'm sometimes almost tempted to spill coffee on something just so I can perform this magic trick.

Grease - scrub with dish soap, rinse with white vinegar, repeat as needed (still waiting for it to dry to see how well this one worked, so far it looks good.)

Berries and Grapes - pour boiling water over it until it disappears - another magic trick.

Please add any of your favorite cleaning tricks in the comments below because who knows what I'll manage to spill tomorrow?!

New Spring Menus

Since we moved, Q and I have fallen into bad eating habits so for the last two weeks, we've gone back to eating pretty much following Whole30 rules during the week. We've been eating whatever we want on the weekends but that's going to have to stop. We really do feel better overall when we're not doing grain and sugar (the other stuff doesn't seem to affect us as much). Last time we were eating this way was during winter and we relied on a lot of braised/roasted sorts of winter foods with lots of root veggies. That felt very wrong for this time of year so I dug up some new recipes to throw into the mix. These first four have been excellent successes - and they're all relatively fast and easy.

Curried Coconut Chicken - oh my goodness, so delicious. We served this with artichokes and used the sauce for dipping the leaves which meant we didn't miss the rice for the curry or the butter for the artichoke. I threw some scrambled eggs into the leftover sauce the next day for a phenomenal breakfast.

Sweet Potato Chicken Salad - This was a wonderful hot weather meal because it's served cold. I prepared it a few hours before dinner and then fridged it to let the flavors meld a little. The leftovers had gotten a little overpowered by the onion flavor the next day. I wondered about storing them separately and then mixing them in just before serving if I knew I was making it in advance or using milder or sweeter or just plain less onion.

Tuna Noodleless Casserole - It's best to think of this as a "Casserole featuring Tuna" so it doesn't get unfairly compared to something loaded with noodles and cheese and cream. It's super delicious though but it does take a fair amount of preparatory chopping. We used all yam and no white potatoes.

Pork Chops with Mushrooms - Okay, I totally cheated on the Whole30 thing here because I knew my tweaks would make it better and who can't resist making more tasty food? I added a little butter to the cooking onions along with the olive oil and deglazed the pan with some red wine after the mushrooms/onions cooked. Still paleo, but tweaks just the same, I used beef stock instead of chicken and half fresh and half mixed dried mushrooms (soaked) because that's what I had. Nom nom nom. All in all, still a pretty healthy dish for the amount of rich flavor it carries.

Let me know if anyone else tries any of these and what you think (especially if you come up with ways to make them even more delicious). Also, give me links if you have any other favorite recipes that fit the paleo/primal diet.

Breastfeeding in America

Okay, so until recently I was living in Eugene, OR; which I think many will agree is not "America" per se. In Eugene, if I'd happened to pump and was feeding a bottle in public I wanted to wear a sign assuring everybody that it wasn't formula in the bottle. :)

Once again public breastfeeding is getting some publicity because Beyonce was breastfeeding in a restaurant, which is really the first thing she's ever done that made me have any respect for her. The comments on the facebook post where I first saw the article had a lot of discussion about covering up. Personally, I seriously begin wondering about people. There's a huge baby head covering the "not for magazine covers" bit and it seems like doing something like I did in the photo above is much more subtle than the "hooter hiders" and other such nonsense, which, to me, seem to be around simply to announce "there is a naked boob just under this cloth". I'm all for every woman doing whatever it takes to make her comfortable feeding her baby wherever she may be but I wish every woman could feel confident and comfortable enough to not feel she has to go to such lengths. I also can't imagine Willow's ever increasing volume as I got a contraption like that in place.

One of the other comments in the post linked to this site, which reminded me of some information I'd forgotten since I first read it when Willow was a newborn. Even though the American Academy of Pediatricians (about as mainstream as you can get) recommends breastfeeding through the first year and breastfeeding exclusively for the first 6 months, only about 44% of American infants are still being breastfed at all at 6 months and about 15% are being breastfed exclusively at that age. I can only imagine how difficult pumping is for working moms and I think this probably accounts for some of the statistic; I'm extremely grateful for my situation. Even for me the past six months have not been a fairy tale nursing story. I have had mastitis twice, many sore nipples and plugged ducts and spent the first six weeks of Willow's life dealing with an SNS (supplemental nursing system) and a nipple shield as she learned to nurse. That said, I believe it's one of the greatest gifts I can give her in these early months to set the stage for a healthy life and I've never once even thought of stopping in the last six months.

We starting playing with giving her a few bites of pureed banana and peaches over the last week (she was 6 months old on February 24) but after some initial enthusiasm she hasn't really shown a great deal of interest in more than a couple of bites now and then. Rereading the recommendations, I've been reassured that I shouldn't be feeling this push from some invisible force to try too hard to get her "eating". She's a healthy, chubby baby and we'll just keep playing with food here and there until she's ready to lead the way to more regular forays into solids. I feel like this is really the new frontier of the breastfeeding revolution - continuing past the first few weeks or first couple of months and letting babies get the full benefits that more extended breastfeeding can offer. Who knows, maybe Americans will someday even get to the point where the WHO's recommendation of breastfeeding up to 2 years won't seem unusual and "weird".

So ends the latest rant, which is good because I've got to get an hour or so of sleep before my baby wakes up for one of her nighttime feedings. ;)

(Pretty much a viral image at this point but I copied this one from here.)

Nanners are Yummy (First Foray into Solids)

http://vimeo.com/37779510

Oh my darling girl. I can't believe she's already ready to start exploring food. She's certainly taking to it as enthusiastically as she does everything else.