THE PEDIATRICIAN AND THE PINTO

The time has come for the hallmark rant about the pediatrician. Don't get me wrong, I like Leila's doc. I think this is a reflection of the larger issue that is U.S. healthcare. I'd also like to preface this with the fact that I work with a lot of physicians and understand that their position is crammed right between the rock and the hard place. The rock: patient well-being and leaving no stone left unturned (wow, what's with all my geological references?). The hard place: making money and satisfying insurance companies.

At our last visit, I had what felt like a proverbial finger waving in my face about Leila's growth stats. For those who are interested, Leila has dropped from the 90th+ percentile to the 5th in a matter of a few months. Hubby and I were prepared by the docs at Children's for the steroid-induced stunting and have since embraced the notion of raising a wild, little smurf until the treatment is completed (at which point her growth will rebound to where it should be). Back to our 8-month checkup. I felt a reaction of disbelief and quiet judgment coming from the pediatrician that we haven't been feeding Leila solids at least twice a day, if not three. I'm immediately feeling embarrassed and a whole lot guilty. Is that something everyone knows? How could I NOT know that? Shit. (I know, I know, you're sitting there thinking, "duh." Whatever, smarty pants.) Anyway, I then got internally defensive. At our last visit, it was recommended that we introduce solids at one meal a day to see how she does. If we wanted to, we could go ahead and give her more, but the message I heard was that the goal is to get her interested and to get her practicing. Ok, now I take some responsibility for not scouring the internet for a feeding schedule for my baby. But, I also expected that the pediatrician would help us out with this one - and, no, not a sheet printed from the internet with general milestones. I'm talking about one that is specific to Leila, who has been on a steroid regimen (which affects her appetite) for the past 5 months and who consistently deals with reflux and bouts of constipation. Did I mention the milk protein allergy? With all that is going on in life, that pinto brain of mine has been sputtering along just trying to stay within the lines - it doesn't have time to be proactive, much less common sensical about something. Plus, if you've read my earlier blogs, you know that I've tossed the kooky baby books. There's such a thing as an oblivious first time parent! ::hand raised high in the air:: How was I to know? Communication gets faulty. Misunderstandings happen. I get that. But I think this touched a nerve and is a sign of what things have come to with managed care. I would prefer to receive guidance and support throughout this daunting process, not a boatload of judgment followed by a request for a copay. Appointments have to be shorter, patient questions need to be succint, and responses are rapid-fire. You would be scratching your head feeling as though you've missed something, but you can't because you have an appointment card in one hand and a heavy, cumbersome car seat drooping in the other as you're quickly shuffled out the door. Again, I can't fully blame the pediatrician - I'm perfectly capable of researching things and, bottom line, I dropped the ball. But, given that I have the memory of a 90-year-old Alzheimer's patient, remind me of what I'm paying the pediatrician for? All snarkiness aside, I guess we learn from our mistakes. I just wish I didn't have to feel so inept in the process. We'll chalk this up to Mommy of the Year Moment #37.

THEY COULD'VE MENTIONED THAT - PART DEUX

Well, I'm back from another hiatus from Blogtown. No good excuses really - just no time and no creativity. I went back and read my previous blogs and, let me tell you, things have drastically changed. Well, except that I'm still dog tired. And, I feel like I have no time to myself. Oh, and I have no clue what today's date is...erm, so maybe things haven't changed that much. As I had suspected, over the past number of months, I've come to realize more things that I wish They would've told me. Again, feel free to add to my list, whether I'm at that stage or not, because that false sense of preparedness really does wonders! So, without further ado...

They could've mentioned that....

1. Poop can wreak havoc on a family. Constipation, I'm talking to you.

2. The pediatrician will always find SOMETHING for you to follow up on, no matter how big or small. I'm convinced there's commission involved somewhere.

3. Even when you've got things covered, time is still spent on wondering how things might not be covered, or how they can be better covered. Let it go, mediocrity is the new perfection.

4. Babies do quirky things and look weird sometimes. It doesn't necessarily mean there's a developmental issue.

5. Even though you very much know that most people are not as invested in your baby as you are, you still have that desperate urge to post a zillion pictures with hopes of acquiring a few converts who appreciate the awesomeness that is your baby (deep down, though, you realize that this is likely not the case).

6. Babies claw like rabid animals.

7. Even though they're tiny, babies are resilient little creatures.

8. Babies are little weebles with very round bottoms. Weeble + soft bed + nimble movements = Hello, Floor. Good thing for #7.

9. While you are clapping and making a fool out of yourself that your baby is now crawling, pulling to stand, what-have-you...you will also be thinking in the back of your mind "please, no."

10. Even though you survived childhood with cardboard boxes, keys, and balls, you will feel the urge to buy that fancy $40 plastic toy with all the bells and whistles because the experts say how great it is for bringing out your child's inner savant. Too bad you know that your savant is just going to drool on it and smack herself in the head with it, but alas, you buy the damn thing anyway.

11. "Pregnancy brain" is a misnomer. That mental fog and memory deficit you feel while pregnant and then on maternity leave is actually your new brain taking over. That's right, you just traded that sharp lamborghini brain of yours in for a pinto.

CALL ME CYNICAL

It's no secret that I'm cynical. It's part of my charm, I say. Not only is it my way of viewing the world, it's my way of coping with it. So, it's not surprising that my blog today is written with the cynic in mind. But bear with me because beneath my cynicism is a real issue. I was talking with a good friend tonight about some of the tribulations of motherhood. It became clear in our conversation that too often we experience women who romanticize motherhood. Now, that's not to say that motherhood is torturous, so how could anyone NOT complain. But, I AM saying that many women seem to feel the need to minimize or dismiss the frustrations of motherhood in order to appear like they've got their sh*t together when, in reality, they struggle to maintain their sanity at times, too. In general, my personality is to call BS when I hear someone talk all positive or all negative - it just isn't real. And, most importantly, it's annoying. When I really think hard about why the all-or-nothing attitude bothers me, it comes down to the fact that it totally minimizes and invalidates other people's feelings. It's isolating and it makes people doubt themselves. So, let's keep it real. The women who paint a rose-colored picture of parenting (and, ironically, I have found my cynical self guilty of this at times) don't realize that in the process of convincing themselves and others that they can handle anything, they make those of us who struggle with the stresses feel bad about ourselves. In my opinion, women shouldn't feel guilty for acknowledging when things are tough or overwhelming. We get too focused on not wanting to look like the complainer, wanting to look like we can do it all, or, worst of all, potentially being perceived as not loving our children. Of course we love our children. Acknowledging the poo doesn't mean we love them less, and maintaining that everything is perfect doesn't mean we love them more. Bottom line, I have learned that there are aspects of parenting that are just unpleasant, unfortunate, and unfair. That's not to say that everyday should be a bitchfest, but I am a believer that if we can talk more openly about those hair-pulling moments with each other, a lot of guilt and the incidence of postpartum depression would decrease. [Did anyone else hear those violins in the background?]

As I step off my soapbox, I will preface my List below with the fact that I love Leila more than I can put into words (which, now that I think about it, is probably why my blogs focus on the cynical stuff), and I happen to think that, overall, I'm a pretty good mom so far. I just need to get a few things off my chest. So, here we go. It is totally UNFAIR that...

1. I can describe, in detail, the pattern of shadows the moonlight creates on the nursery wall at 3AM.

2. Only a mere 12 months after celebrating my doctoral degree, do I feel like I can only have coherent conversations about baby spit up.

3. My "friends" blatantly lied to me about this "4-month hurdle," after which things magically fall into place and parenting an infant becomes an easy, blissful experience. Well, Leila's 5 months old - is it me, or is it just as damn hard as it was a month ago?

4. Getting ready to take Leila to the babysitter's looks like I'm packing for a week-long trip to Paris. Well, minus the passport. And Paris.

5. After only spurts of sleep here and there, the next morning I have black circles under my eyes while Leila is a perky, happy, rosy-cheeked cherub of a bebe.

6. My social life has dwindled down to ".com"

I really could go on, but it's 4:42AM (I'm sure I could work that into the list somewhere). Feel free to share your own "UNFAIR!" moments. When all else fails, they at least provide mommies everywhere with a good laugh!

STEROIDS: THEY AREN'T JUST FOR BASEBALL PLAYERS

Leila's treatment for her hemangioma is officially underway. We decided to go with treatment via a research study at Children's Hospital because, well frankly, it just made sense. Here's why: Hemangiomas have historically been treated with prednisolone with great success. However, the corticosteroid has lots of unpleasant and scary side effects (vomiting, chubby cheeks, temporarily stunted growth, irritability, insomnia - to name a few). And let me tell ya, when you've had a chubby-cheeked baby with reflux and colic due to milk protein allergy, the idea of having a crankier and pukier baby who sleeps even less and has chipmunkier cheeks is really frightening. There's another medication, propranolol, that has accidently shown some efficacy in treating hemangiomas, but it doesn't have a well-known treatment history like prednisolone does. The benefit of the propanolol is that it has relatively few side effects, so that's comforting. Bottom line, Josh and I couldn't make up our minds about treatment because for every pro there seemed to be a con. Aside from Leila's situation, participating in the study seemed like the right thing to do given that my career is centered around doing clinical research to help children get better. I felt like it would be kind of hypocritical to not consider helping other kids in the process of treating Leila's hemangioma. So here we are, participating in a single-blind clinical trial of both medications. We were randomized to the prednisolone arm of the study and we're now one dose in. We had to take her in to the hospital for an ultrasound, blood sugar check, and to get the medication. Josh and I hated every minute of it. I actually cried during the ultrasound. To see such a little peanut pinned down with a wand over her face and goop running into her eye just seemed cruel. The fact that she was wailing so hard she was purple didn't help. Fast forward to today - so far, we've had a good day. Leila has been smiling, resting, cat napping, and occasionally crying (well, I hear babies do that from time to time...). If we don't see any progress in the next 2 weeks (aka the hemangioma doesn't shrink), we'll be taken out of the study and switched to propranolol. We're keeping our fingers crossed that the medication is effective and she (and we!) doesn't have to suffer many side effects.

On a lighter note, Murphy is now bonded with our little Roger Clemens. From here on out, they'll be known as "The Steroid Siblings." Or should it be "The Prednisone Pair" ?? :)

See my feet! My blood sugar was normal - 82.

Mommy is beyond tired. I mean, look at her! By the way, this fist tastes great...nom, nom, nom...

Daddy walked me around to make me feel better. It worked!

"CHEEEEEESE!"

A HEMA-WHAT?

Well, I've returned to the blogosphere after a short hiatus. A lot has been going on with ironing out a schedule and, most recently, arranging doctors appointments. The latest news is that little Miss Leila had developed what looked like a bruise and burst blood vessel on the side of her nose by her left eye. It was a little worrisome then, but after it started to grow, my worry catapulted to a whole new level. I tried to keep calm by telling myself "it's a burst blood vessel and those things resolve on their own within a few weeks," but I had a gut feeling that this was not something that normal. The nurse and pediatrician upon first glance immediately diagnosed it as a hemangioma. A hema-what? Well, I've heard the term before but couldn't recall in what context. The "oma" kept swarming around in my mind because I know all too well that that suffix means tumor. My baby cannot have a tumor. So, a hemangioma is a benign tumor of the cells that line the blood vessels. It's often referred to as a category of birth marks because a child is born with it (even though you might not see it right away). Hemangiomas typically look like bright red strawberries on the surface of the skin, but can look like a purplish bruise if it's beneath the skin. These things go through proliferation (a growth phase) until the child is about 12 months old, rest, and then go through involution where they start to diminish. Most will diminish by the time the child is 5 years old, but for some children it doesn't diminish until they're 10. TEN?!?! Psychologist Mom steps in. That has too many social implications, as far as I'm concerned. This is what I do for a living - help children with acute and chronic illness adjust to their differences and come to terms with their illness, and help them feel like a normal kid. I also provide support to the parents. Oh, man, this is irony at its finest. Am I going to have to do this with my own daughter? Is this a "full circle" moment? Am I going to have to provide support to myself? Ha! Then I kick into "let's get rid of this thing" mode. Well, according to my pediatrician and online resources, oftentimes doctors advocate for no treatment because it's benign and cosmetic, so they let it run its course. Psychologist Mom hears that and immediately shakes her head 'no.' Definitely not. Well, in Leila's case, they might not have an option to let it be given its location at her eye. I'm taking her to see a couple of specialists this week to have the hemangioma evaluated, specifically to determine the risk of vascular damage around her eye. As I understand it, if there's any inkling that it will affect her vision, they will want to treat it while it's in the proliferation stage. How the hell do you treat this thing? Somebody better say something other than the word 'surgery.' Well, often treatment involves corticosteriods and beta blockers. We'll see what other options we have once we talk to the ophthalmologist and cosmetic surgeon. Why am I having to say 'cosmetic surgeon' when my little baby is only 9 weeks old?? I also think to myself that this could be worse. I really hate that phrase, but after working in pediatric hospitals for the past 10 years, I have seen countless heartbreaking and completely unfair situations. So, I'm working on keeping this whole thing in perspective. We're on top of it and doing everything we can do at the moment. And, truth be told, even that's not comforting. Anyone have a magic wand??

BUT THE BOOK SAYS...

Once you learn that you are pregnant, all the talk about pregnancy, delivery, and parenting begins in full force - with family, friends, and, much to my chagrin, strangers. Nothing like a baby (or puppy) to bring out the extrovert and "experts" in people. During these discussions, it becomes clear that there is a great divide between generations when it comes to raising children. Nowadays, things seem pretty hard core compared to the 70's [insert favorite illegal substance joke here]. I was actually shocked with all the gentle advice (read: firm recommendations delivered with a ruler to the hand) I've received. One of my faves: No baby powder. "I'm sorry, what?" Apparently, it's now considered a hazard because the baby can ingest it, creating serious lung damage. Um, I'm not planning on unscrewing the cap and dumping it all over her face, leaving her engulfed in a haze of white powdery goodness. And, last I checked, we don't breath through our butt cracks. What's wrong with a dry, rash-free, fresh smelling bum? It didn't kill me or anyone else over the past 120 years, so in Josh's words, the pediatricians can pound sand on that one. The American Academy of Pediatrics and all these Don't Kill Your Baby 101 books really lay down the law with what is considered "good" parenting. I actually feel judged when I read them. My God, all the expectations involved in raising your child flawlessly can drive you to the nut house (erm, maybe a poor choice of words considering my profession) before the kid's 1 week old. I've found that these books can be reassuring in terms of general expectations of babies' behavior and developmental milestones, etc., but I think they also create a pretty rigid view of good parenting and, as you read through all the no-no's, create this drive for [unattainable] parenting perfection. Just with anything in life, isn't it all about balance and common sense? I think, for now, I'm done with the advice books. I'm to the point where I feel like I'm raising a mogwai, who I will turn into a gremlin with one benign, good-intentioned parenting misstep. So, perfect parent or not, I'm going to sit back comfortably with a paper umbrella in my bottle of baby powder, toasting the old school attitude and enjoying my baby girl. Cheers!