Best Practice: Managing Early Breastfeeding Challenges

‘This one-day workshop provides an intensive approach to the basics of breastfeeding promotion and early feeding issues – in the hospital, clinic and community. It is a helpful and effective beginning for education in research-based infant feeding, as well as an excellent update for IBCLCs and others who are interested in applying science to the practice of infant feeding.
This conference is closed.

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Then I have to rush home, where Andy will have the kids all ready to go to the elementary school for Noah’s Kindergarten open house.  We were just there a couple of days ago for his “Kindergarten Countdown” orientation thing, but this is evidently open to all grades at the school.  I’d say we could skip it –we have already gotten acquainted with the teachers and building last week– but apparently in towns that are larger than my hometown, this is standard practice for signing up for teacher conference appointment times for the whole entire rest of the year.  Craziness.  When I was little, parents just kind of showed up on the one appointed date between the hours of noon and 7 PM to the long row of teachers sitting behind big tables in the cafeteria and shuffled down the factory line to hear reviews about their kids’ performance in various teachers’ classrooms.  It was a weird bazaar-like atmosphere.  Now that I think about it, though, I may have fabricated that entire memory.  That seems like a pretty strange way to conduct parent-teacher conferences.
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So anyway, for a mom who usually works from home and is otherwise always there with her kids, tomorrow is going to be a busy day.  I’m looking forward to being part of the “normal” adult population for most of the day tomorrow.  Fun!

I love this video so much.  At age 2.5, Noah had a seriously impressive vocabulary.  Listen carefully and you’ll hear the babies crying in the background.

I do really like hearing the explanations behind them, though. Sometimes I just look at him and marvel at the way his mind works. Love that man.

WWEPD?
(What Would Emily Post Do?!)

So now that that’s out of the way, I have to say that I am really enjoying the “funny” tag I’ve started putting on my pictures when I upload them to iPhoto.  Last night Andy and I stayed up ridiculously late (early?) giggling like school girls at pictures like these:

(They have the power.)

(SNOT!)

(“You Must Have Your Hands Full!” – Every Single Person Who Sees Us In Public)

(NOM NOM NOM)

(Smell it!)

(HOVER KITTY!)

(AKA: Bonzai Kitty)

(Gianna as Raphael)

(TOES.)

(Glowworm Gianna)

(Kung Fu Babies!)

My kids aren’t old enough to hate me for this post yet.  Ha.

(I really do need to know the etiquette for hiring babysitters to watch your children in a hotel room, though.  What would she do for several hours?  Watch TV silently?  Text 900 of her closest friends?  You would almost need to book two adjoining or neighboring rooms and break out the trusty ol’ baby monitor for the sitter to use while she hung out in the empty room.  Am I right?  And if you were the parent of a teenage girl who babysits, would you think this was a strange job?  Am I over thinking this?)

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It all started last month when I took the twins in for their 3-year well child checkup.  While filling out a pages-long questionnaire designed to assess the child’s cognitive, emotional and behavioral development, I could see that Adam was scoring higher than Gianna on the behavioral assessment.  There were “red flags,” like the fact that he often doesn’t look at you when you’re directly talking to him or that he is quick to dissolve into a tantrum when he doesn’t get his way.  None of the ‘flags’ alone was enough for me to think the dreaded “A” word (autism), but Andy has mentioned his fears about it a few times.

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So at this well-child checkup, the kids’ pediatrician took the questionnaires and tallied them up, remarking that Gianna and Adam both scored well above and beyond in milestones such a speech, motor skills, cognitive development, etc.  He did tell us that Adam scored on the threshold of “needs further testing” in the behavioral section, though he was quick to reassure us that this didn’t mean that Adam was autistic or anything; just that he may need further testing as he got older.

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Right before we were ready to leave, I remembered that I had meant to mention Adam’s snoring!  Dr. Joe’s face lit up as he connected Adam’s score on the behavioral assessment to this new information; he began to ask questions about Adam’s sleep.  Does he wake often at night?  Does he snore loudly?  Does he snore every night?  Does he fall asleep in the car or while watching TV?  The answers to all of those questions were “yes!” so he began to explain that the manifestation of sleep deprivation in children is much different than it is in adults; adults who are sleep deprived have difficulties staying awake during the day and feel generally lethargic and without energy, but sleep deprivation in children can manifest itself with hyperactivity, vigorous temper tantrums, clingy behavior, etc.  Sounds like Adam!

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So our options were to schedule an appointment with a pediatric Ear, Nose and Throat specialist, schedule an appointment for a sleep study to see if the snoring was a symptom of a sleep disorder like sleep apnea, or to just ‘wait and see’.  Dr. Joe recommended the sleep study, so that’s what we decided to do.  A couple of weeks later, Adam and I spent the night at New River Medical Center to have a pediatric sleep study conducted.  He did really well and I felt like he slept pretty ‘normally’ even with all the wires attached to his body and sensors on his face to detect mouth and nose breathing.  In the morning before we were discharged the nurse asked me how many times I thought he had awoken; I answered “about three?”

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As we prepared to leave, a nurse told us that the sleep specialist normally took around 7-10 business days to review the findings from the study and make a diagnosis.  She told us it could be up to two weeks before we heard the results.  So I packed Adam back up again and we went home.  The phone rang two hours later and it was the sleep center… wondering if we could come in to review the results in just a few days.  That was alarming; I wondered if it meant that his sleep study results had been so worrisome that they wanted to discuss it as soon as possible.  So three days later I took Adam back to the center to go over the results, and that’s when we were told that Adam has “severe obstructive apnea” and had experienced 73 “apneas in total”.  In bolded text on the interpretation report were the words, “The overall apnea-hypopnea index (AHI) was markedly elevated at 26.2 events per hour.”  A bit further down the page read, “The patient experienced 115 arousals in total, for an arousal index of 13.6 arousals per hour.”  I was shocked.

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So the sleep specialist’s recommendation was obviously that we take Adam to be examined by a pediatric ENT specialist for “probable removal of the tonsils and adenoids.”  She assured us that this type of surgery is better to get ‘over with’ and the recovery faster when the patient is a small child like Adam, and that his quality of sleep would be immediately improved after surgery.  Dr. Joe had told us that if Adam’s behavioral “issues” were due to sleep deprivation, removing the tonsils and adenoids might make all the difference.  I made the appointment with the ENT specialist that same day.

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Last week we brought Adam to the clinic to see a pediatric ENT, who examined him for probably two seconds after reading the sleep study report and concluded he definitely needed to have his tonsils and adenoids removed.  His assistant scheduled the surgery for two weeks later, and we immediately went to the lab to have Adam’s blood drawn to be tested for Von Willebrand’s Disease, a genetic bleeding disorder that Andy suffers from.  (It’s like mild hemophilia; as a kid, Andy used to have severe nosebleeds almost daily and sometimes had to be taken to the ER when he had a cut or scratch that was bleeding profusely and wouldn’t clot.)  The good news is that this blood work came back normal; Adam did not inherit Andy’s bleeding disorder.

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Yesterday I took Adam to the clinic again for his “pre-op physical”.  The blood work had already been completed so he just needed to be looked over to make sure he is healthy and able to have surgery next week.  Surprise, surprise — turns out he has a double ear-infection!  However, since his temperature was only slightly elevated (99.4*F) and he had not complained of his ears hurting either before or during the appointment, Dr. Joe gave me a script for an antibiotic but told me not to fill it unless his fever sparked or he complained of pain.  He thought that Adam’s body was already doing a good job of fighting the infection and probably wouldn’t need the antibiotics’ help.  He also said that the infection wouldn’t prevent Adam from having his surgery next week.

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So anyway, I’m trying to remain calm and rational about this entire ordeal but it is still very hard to prepare your three-year-old child for surgery.  I laid awake in bed last night thinking of all the “what if?”s — “What if he has a reaction to the anesthesia? What if he bleeds too much?  What about the downsides to having one’s tonsils and adenoids removed — like increased infection risk, etc?”  I’m afraid I’ll be a wreck when it’s time for him to actually have the surgery, and I’m afraid I’m not strong enough to be there by myself while Andy is at home with the other two children.  I’m afraid he’ll be in a lot of pain after the surgery; will they give him something stronger than Tylenol or Advil for the pain?  But I have to be strong for him so he isn’t scared.  Ugh, this parenting business is hard work!

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Wish us luck and a speedy recovery!  His surgery is next Wednesday at 11:00 AM and he and I will be spending the night so that he can be monitored (because he is so little; apparently they usually send tonsilectomy patients home the same day) and then released the next morning.

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What a crazy, busy and complicated summer we are having already this year!

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Three kids.  Two boobs.

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Filed under “Future Blackmail”.

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What’s going on here?  Those of you who have followed me here from LiveJournal might remember when I posted this there!  Gianna, my sweet and stubborn Baby A, was in the breech position pretty much from halfway through my pregnancy right until they were delivered.  It wanted so badly to avoid a cesarean but had been warned by my obstetrician that a Baby A in breech position is a deal-breaker.  Being a trained birth doula, I knew I had options and thoroughly exhausted each and every one of them.
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In this picture, I’m doing ‘pelvic inversion’.  This position is good for coaxing a stubborn baby into a head-down position, and the heating pad is extra incentive to move her head right up to that nice warm snuggly spot!  This photo was taken almost exactly three years ago (February 20, 2007–look at little 2-year-old Noah!).  I was doing this inversion technique multiple times a day in addition to musical therapy (headphones placed down by the pubic bone will sometime entice a baby to turn!), herbal therapy, chiropractic therapy, and acupuncture and moxibustion.  For the moxibustion, I’d go twice a week to have an acupuncturist place several needles into my feet and calves and then burn incense at the joint of my pinkie toes!  This is an actual proven method for turning breech babies, but its success is limited in twins due to the confines of a cramped uterus!  Unfortunately, that ended up being the case for Adam and Gianna and my Baby A never did turn head-down.  One month to the day from when this picture was taken, my beautiful and healthy full-term twins were born.
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And life has never been the same… 

The thing is, though, that I really do miss blogging.  And I’m going to regret that I stopped doing it when the kids are grown and I look back and have a year of no recorded first moments and memories.  For example, when Noah was born I recorded every tiny detail of our lives together.  I realize that my circumstances are a lot different these days and my schedule doesn’t allow for as much time to sit around writing flowery statements about my kids’ development.  BUT (there is always a but): if I have time to check Facebook 27 times a day and re-post a dozen political/parenting news stories as I come across them, one should think I’d be able to manage a quick update here or there about the kids.  They are the most important things in my life, after all!
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I tend to keep a lot of this ‘mommy junk’ off of Facebook, and it’s also the reason I have two WordPress blogs (this one and Life Without Apology) just because sometimes I feel kind of weird writing about potty training followed by an opinion piece on sex education in public schools or something.  Still living that ‘double life’, I guess.  But I decided that no matter where I post or what I post, I need to do it more frequently.  These days just pass so quickly and I’ll forget these details before I know it…
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So, without further ado, my first ‘quick’ update:
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I think Gianna will be a singer.  She is always requesting that I turn on the iPod or iTunes so that she can spin circles in the kitchen (always in her princess dress!) while mumbling as many words as she knows.  Her favorite song to dance to is “Three Little Birds” by Bob Marley.  She also loves “Poker Face” by Lady Gaga and “Bulls on Parade” by Rage Against the Machine.  My girl has varied music tastes!
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Adam and Noah are fully absorbed into Nintendo.  Andy even dug out his old SNES system and set it up upstairs; the boys will play the Super Mario Bros game all morning if allowed and sometimes they can even convince me to take a turn!  The music is especially nostalgic for me and takes me back to all those years I’d play these games with my brothers and cousins.  I remember Christmas mornings when I’d rush to the phone to call my cousin Shane and tell him we’d gotten the newest Nintendo system, only for him to report he’d gotten it, too!  (Of course they had, our mothers shopped together!)  It’s still hard to believe that Shane has been gone from this world for over two years now, but I’m really happy to have these memories of him that come back to me when I’m watching my boys play.
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The kids and I made Valentines last week that never got sent to the grandparents, aunts, and friends they were meant to end up with but the experience was the whole point anyway, I suppose.  I’m happy to have the memory.  I just wish I had thought to take some video of them working so hard at their masterpieces.  At least we got a lot of other videos this week and I’m doing a much better job of getting media uploaded, tagged, and organized in iPhoto–it’s a long process, though, and one that tends to end up with me more absorbed at looking at the old pictures than organizing them…
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A reminder to myself this week (and for all the weeks to come):

Enjoy the experiences as they are happening.  Live today.  And write!