I wanted to write about "Detoxing..."

...but this guy did it for me.

The Detox Myth: What your Alternative Health Provider isn't telling you

I won't recreate the wheel here. Cheers.

9 Breastfeeding Essentials

I'd like to say that this is to be my triumphant return to blogging (huzzah!) but I think we all know that I am consistently inconsistent with things like this. So suffice it to say that I hope I'll be back. It's a start at least. 

When I left you, I mentioned that I wanted to write a post about breastfeeding, because in many ways, the experience has surprised me; sometimes pleasantly, sometimes not so pleasantly. Perhaps the biggest surprise is that I learned how very little I knew about breastfeeding despite the fact that I work in Pediatrics. As a general life lesson, I'm trying to come around to the idea that knowing how little you know is actually a good thing, but that's another post for another day.

Over the past seven months (that's right...seven!) I've come across several blogs/articlesthat have provided a list of "breastfeeding essentials." I figure since I'm seven months in, it might be a good idea to come up with one of my own.

So here it is;

1. Knowledge

OMP is a teacher, and frequently finds himself giving a lecture on the difference between Truth and Knowledge. Suffice it to say that there is Truth, and some of us may never find it. Among those of us who do, a large percentage will manage to find the Truth without having knowledge. But to have the Truth and to know WHY it is the Truth, that's the goal.

I find this so applicable to breastfeeding. Not everyone is aware that breastfeeding even has benefits, and among those who do, not many know what those benefits are or why they are important. If you are seriously considering breastfeeding your child then you will need to arm yourself with knowledge. Because there are times where you will struggle, and times where you will ask yourself "why am I doing this again?" And if you want to keep going, you'll need more than just "because my doctor said so" to carry you through the tough parts. 

More importantly, you're bound to run into a snag or two (see essential #2), so you're going to want to at least have some knowledge of potential problems and how to fix them.

2. A realistic perspective

Breastfeeding. Is. Hard. I know what you're thinking. You're thinking that this perfect little baby is going to slide right out of you on sunshine and moonbeams, float right into your arms, latch to your breast with the sound of birds singing in the background, and drink your already ample supply of milk as a unicorn frolicks across the hospital room. 

I'm going to level with you. It's not going to happen.

So rid yourself of any misconceptions of an easy road right off the bat. Expect it will be hard. And then multiply that by five. It's so much easier to be overprepared than underprepared. 

3. A plan

Everyone under the sun will tell you to make a birth plan, but I really wish that I had made a breastfeeding plan too. Because at some point they're going to hand you a baby. And you're going to say "...well what to I do?" (Even if you're a Nurse Practitioner!). And they're going to say "...well what do you want to do?" (Especially if you're a Nurse Practitioner!). So. Know what you're going to do.

I'll avoid specifics, but suffice it to say that the first 48 hours are a blur. And that period is so critical to the success of breastfeeding. I wish I had put a plan in place to maximize not only my time with little V, but also to best utilize the hospital support services. We were successful, but we were lucky, and it required more work (and pain) then probably was necessary. 

4. An International Board Certified Lactation Consultant (IBCLC)

A few Lactation Consultants breezed by after delivery, and I wish I had really taken advantage of them. Luckily, I was armed with knowledge (essential number one), so it didn't take me long after discharge to realize that something was wrong and I needed help. After our first meeting, I cried. I could not believe the amount of relief I felt. In fact, I don't think I truly realized how much I was struggling until I met with the IBCLC and saw how easy it could be. These women are Godsends and are covered by your insurance. Don't ask questions. Just go. Even if you think it's going well. Go.

5. A healthy diet

I use this term very loosely to mean make sure you are eating regularly and drinking plenty of water and are continuing on a multivitamin. No judgies from me if you want that extra slice of cake. The truth is that I still have a hard time remembering to eat when I'm at home with the baby, but it is so important. 

6. A supportive, but knowledgeable pediatrician

It can be a difficult line to walk but you want a pediatrician who is going to do everything she can to support and encourage your efforts until it becomes medically unwise to do so. You don't want your pediatrician to be pouring formula down your baby's throat, but you also want one who can recognize if exclusively breastfeeding is not working and who knows when it might be wise to supplement with formula.

7. A village

Our ancestors didn't have much of a choice when it came to feeding their babies. Babies were breastfed. Young girls watched their mothers and aunts and cousins nurse their little ones. When these girls grew and had their own babies, they could lean on those women for support. Nowadays our experience is quite different. It's not uncommon for a new mom to have never EVER even seen someone breastfeeding. So we need some help.

Luckily there's a lot if you know where to look. La Leche League is a great place to start. You can find real and virtual breastfeeding support groups or reach out to your local LLL leader. Join a local or Church Mom's group. Or look online! It's best to be skeptical, of course, but there's a lot of good information and support out there if you know where to look (start with kellymom.com). We've heard that it takes a village to raise a child and that includes breastfeeding! So reach out to your fellow moms!  

8. Determination

I had a tough time including this one because there are a lot of women who are very determined to breastfeed their babies but who ultimately are unable to. So to be undeniably clear, I am in no way saying that those women were not determined, or not determined enough. Determination alone will not guarantee success, BUT, it is a necessary component. 

9. A supportive spouse 

I can't emphasize this one enough. OMP was so encouraging and supportive, and had my back every step of the way. In the early days he made sure I kept eating and drinking. He basically took all responsibility for our international student. He slept in bed with me when I wanted him to and in the guest room when I wanted him to. Ultimately we all need support in different ways, but for the most part, when I needed him, he was there. In my moments of weakness, it would probably have been easier for him to just step back, but he continued to encourage and reassure me. If your partner is not on-board with breastfeeding then it's worth sitting down for an open and honest conversation. Even if you have items 1-8 per above, if your partner's not behind you, you might find your hard work crumbling from within.

So that concludes the APM Breastfeeding Essentials. It's definitely not a typical "must-haves" list, but I decided to cut the fluff and focus on what really matters. I could have told you all about how much I loved the "My Breast Friend" pillow or how much my "Bebe Au Lait" nursing cover sucked, but those are small personal details, which in all likelihood you will disagree with anyway.

What I can tell you is breastfeeding is tough. It's probably much tougher then you think it will be, but there really are rewards, and the rewards make it so worth it, more than worth it. Looking back from the seven-month mark not only would I do it all over again, I would do it five times over.

Except for pumping. Pumping's the worst.

Images used:

unicorn_pooping_a_rainbow_20px.jpg

http://educationcareerarticles.com/education-articles/higher-education-articles/lactation-consultant-education-job-overview/

http://www.kleankanteen.com/collections/bottles

http://www.quickmedical.com/seca/pediatrics/727.html

http://www.ecobabysteps.com/2009/11/11/how-la-leche-league-can-help-you-with-breastfeeding/

Sweet V is here!

TL;DR Miss V was born Saturday, October 11, 2014 at 3:40 AM. She weight 8 lb 6 oz and was 20 inches long. She was born vaginally without complications.

I was hesitant to share the birth story here because I'm pretty much the only person on Earth who cares. I mean, V doesn't even care and it's her birth story. But I decided to do it anyway because like most people, I had a well-established idea of how birth was supposed to go and, obviously, it did not go that way - close, but not quite. And therefore I'm beginning to think that it's important to share birth stories - real birth stories - to help encourage flexibility and realistic expectations. Birth will probably not go as planned, and that's okay.

Disclaimer: I work in the medical field so I'm not super sensitive to what information might be regarded as too much information. Read at your own risk.

On Thursday, October 9th, at 40 weeks, 2 days pregnant, I had an appointment with my OB. Since I had gone beyond my due date I decided to ask her how she felt about stripping membranes (where the clinician applies gentle pressure to the bag of water to help stimulate uterine contractions). Since the cervix was favorable (2 cm and 80% effaced), she thought it was a good idea, with the condition that if I did go into labor, I didn't tell the OB on call that she did it (apparently, ushering patients into labor when one is not on-call is generally frowned upon). If you're ever considering having this done, there's some scary stuff out there on the interwebs about how painful it is etc. etc. but I did not find this to be the case. Uncomfortable yes, painful no. That part comes later.

Around 11 PM that evening, contractions started. They were irregular at first, but settled into a pattern (about every 6-7 minutes) around 3:00 AM Friday morning. Here's where my sleeping stopped.

Contractions continued to the point where OMP decided to take the day off from work. Unfortunately, they began to slow down. I called my sister-in-law (a labor and delivery nurse), who recommended walking to keep things going. So walk we did. We went on a nice little hike on a nearby nature preserve, stopping every so often so that I could hunch over for a contraction. People totally were not looking at us funny.

Her advice worked, and by 2 PM contractions were regular and getting closer together. Other labor signs happened (I'll spare you), and around 5 PM things were regular and strong enough that I called my OB, and was told to come in.

5 PM on a Friday. In a major metropolitan area. Yeah.

So after 30 minutes of traffic, some aggressive driving, and several obscenities, we arrived in antepartum. They tell you to fill out the paperwork ahead of time, which I did, but I somehow still had a ton of paperwork to fill out when we arrived. Which is super fun at all times but especially when your uterus is doing the equivalent of the strongest man in the world competition.

We adored all but two of the staff members at the hospital. One was the records person (I'll talk about her at some point...), and the other was the antepartum nurse. She wasn't awful, per se, but I got the feeling that she didn't believe that I was in labor. She acted like she was doing me a huge favor. She hooked us up to a NST and monitored for a while before she came in to check my cervix. Except when she went to do so, my water broke. Told you I was in labor. V showed her what's up.

Unfortunately, I now found myself with my water broken, awaiting an epidural on the Friday before a Holiday weekend, which means higher than normal amount of patients are in L&D for scheduled C-sections. The antepartum nurse asked me if I wanted an epidural and mentioned that it might be a bit of a wait because anesthesia was really busy at the moment. Oh yeah, and contractions might be a little bit worse now that the water is broken. Understatement of the century.

Cue horrifyingly bad contractions that were basically constant. OMP stayed with me for a while, but eventually had to run out to the car to get the overnight bags. While he was gone, every important person decided to come into the antepartum room and talk to me. So here I am, basically unable to think, blindly handing my birth plan to the OB on call and trying to figure out what my L&D nurse wanted me to do with the piece of mesh she was handing me (spoiler alert, its underwear). Good news! A room had opened up! She said something about a wheelchair but I was already on my feet, backside exposed to the world (those gowns really are horrible...), walking down the corridor mid-contraction, my nurse chasing after me.

All together it was about 2 hours before I could get the epidural. The anesthesiologist was amazing. My nurse was amazing. Epidurals are amazing. After having one, it is beyond me why someone would refuse it, but if you do, I give you all the credit in the world. Labor sucks.

It was smooth-sailing after that. My new nurse came in and said that she was going to let me labor down as much as possible to hopefully minimize pushing time and risk of tearing. Based on my pain, they were a little concerned that the baby might be occiput-posterior (aka sunny side up, aka bad), so they gave me a special pillow to help encourage her to descend the right way. Basically, my nurse was everything my sister-in-law told me to look for, so I was pumped.

A few things happened here that I was not expecting. First off, I had the shakes like crazy. I guess its common with and without epidurals because your body is under so much stress, even though you can't feel the pain. I slept off and on but the shaking kept waking me up. Eventually, I started to feel nauseated. I mentioned this to the nurse, who immediately ran and grabbed an emesis bag. "Oh I don't think I'll need tha-" aaand vomit. Again, stress. Basically your body is being beat to a pulp but you're unable to feel any pain. It's the weirdest sensation.

Also, my left leg went completely numb, despite the nurse coming to turn me frequently. It stayed that way until sometime the next day. I knew I could move it, but it's so hard to do that without being able to feel it. This provided a good deal of comic relief at various points in the labor process.

Finally, the nurse checked me. Baby was in a good position and it was time to start pushing. OMP was somewhat surprised to be handed my leg, but he made for a great coach. I pushed for about 30 minutes and the nurse went to grab the doctor.

The doctor thought she was just coming for a "pushing check," but when she saw me she immediately gowned up. I pushed once with her in the room and was reassured that we were almost done!

Except...baby started showing some signs of stress (heart deceleration's while I was pushing). I pushed again and I saw a concerned look in the doctor's eyes. Likely cord compression, she thought. She knew that she had agreed to try to avoid an episiotomy (Oh yeah! one of the things I had written on my birth plan! I had forgotten about that...) but she was concerned about the baby and really wanted to get her out ASAP. Was I okay with it? Um...yeah, please do what you need to do to make sure she is safe! At that point I didn't care about anything, just that baby came out and was okay.

I didn't even feel the incision, pushed one more time, and BAM, Sweet V came into the world. The cord was only loosely around her neck, so the doctor was able to easily slide it off. We did skin-to-skin and waited for the cord to stop pulsing (hey! there's something from my birth plan) and basically, I died from love.

My folks had been in the waiting room since midnight, and were happily rewarded by being V's first visitors. My sister-in-law (who lives in a different time zone) got to Skype in and listen to me rave about all the great advice she gave.

And then finally, we all got to go to sleep. The next morning would bring more visitors, and eventually, we were able to bring her home.

As mentioned earlier in this blog, V did have a soft marker for chromosomal abnormalities. All of her testing came back perfect. Even her blood type came back to be A- (mine is also A-, so no Rhogam follow-up). In fact, when we did bring her home I had a full-on ugly cry when I realized how healthy and perfect she was and is. Of course we would have loved her regardless of her number of chromosomes, but in the moment I felt so blessed to have a healthy baby.

My recovery has been pretty good. I had a few complications post-partum. I had really heavy bleeding that required pitocin (the only pitocin I received), Cytotec, and some fluids, and they monitored me pretty closely for a while. I also had the episiotomy, which is still in the process of healing. But generally, I can't complain. I continue to feel like I did in the L&D room: I have a healthy baby, so whatever happens to me happens to me.

I am breastfeeding, but that is an entire post in itself! For now I will say that it was more challenging than expected, but we're starting to get to the payoff now.

...now being a full month later! That's right folks. IOU two follow-up posts, one about the challenges of breastfeeding and one all about V! But another time!

Showering Sweet V

Baby showers are not my strong suit. I have a tendency to be pretty socially awkward, and I have a difficult time in situations that require things like grace and good etiquette. If you're reading this and are thinking "No way, Erica, you're great in situations like that," then chalk that up to some serious acting. If you're reading this and saying "Yup. That is totally you," then ummm...you're right.

So when my parents offered to throw me a baby shower, and asked for my input, my only feedback was that I wanted it to be as comfortable as possible. Like a Barbecue. Everyone loves Barbecues. Even socially awkward people like myself.

Per usual, they absolutely knocked it out of the park. Sweet V's BaByQ was a huge success. OMP and I feel so blessed to be surrounded by such amazing friends and family.

Bocce, Build-a-Babykirk, and Baby Gift Bingo were all big hits. And OMP chipped in by making the favors - Sweet V's BaByQ sauce!

And I was struck by the sheer number of babies that were present. We're so excited to be bringing V into this group!

Any gal would count herself lucky to have such an amazing party thrown in her honor. But I was blessed by not just one, but TWO amazing baby showers, thanks to the sneaky girls at work!

Our Head Nurse sent out a message at the start of the week saying that we were overdue for a staff meeting and would need to stay late Wendesday night. Wednesday came and it was totally stressful. I had a complex patient at the end of the day and was beyond frustrated to have to stay late. Until I walked in the door...

And saw all this...

I was so overwhelmed with emotion. To say that I was surprised is an understatement. I am so lucky to work with such an amazing group of ladies!

Needless to say, V hasn't even arrived yet, and she is already so loved. I can't wait for her to meet all of these amazing people who have already given her so much!

EV68 and Associated Horrors

Remember when I said I was going to update and talk all about my awesome baby shower?

That'll happen. But first, let's rant about EV68.

This post is brought to you by the sign I saw in my OB's office this morning, which stated that siblings would not be able to visit their brand new baby sisters and brothers on the postpartum floor due to concerns over the rapidly-spreading virus. It's also brought to you by the 30 minute segment on NPR this morning. And also the fact that I saw twenty-eight patients yesterday, had at least one nebulizer running at all times, and didn't get home until about 9:00 PM.

I'd like to start by saying what this post is not about. It's not about how EV68 is not a big deal because it is. It's also not about how EV68 is a big deal and how everyone in the country needs to go to their doctors YESTERDAY because that's not exactly the case either. Mostly, its just me venting, but I'm hoping to also present some good info on both the virus and also on how we should be responding to it.

EV68 is an enterovirus. Do you know what else is an enterovirus? EVERYTHING. Polio is an enterovirus. The Common Cold is an enterovirus. Remember that huge outbreak of Hand Foot and Mouth Disease this summer? That's caused by something called coxsackie virus, which - you guessed it - is also an enterovirus. When we say something is an enterovirus, we're basically describing the viral structure (single-stranded RNA), how it reproduces (positive sense), and what types of hosts it tends to infect (mammals).

The media is calling EV68 a "respiratory illness," which is an incredibly vague description almost to the point of not being a real thing. Some people who come in contact with EV68 will have zero symptoms. Some will have a little runny nose and cough. Others will launch into full-blown respiratory distress. Generally speaking, this is no different from any other virus that can cause "respiratory illness." Things like croup, laryngitis, and bronchitis are all respiratory complications that are caused by viral infections. EV68 is just another name on the list of things that can cause these problems. And just like those other viruses, how likely you are to develop complications depends mostly on your age, your current health, and the state of your immune system.

That being said, EV68 is proving to be a particularly nasty virus, most likely because we haven't seen much of it in the past 30-40 years. That means that those of us under 30-40 years of age have little-to-no immunity, and are therefore that much more susceptible to infection. The medical world doesn't often do specific diagnostics for viral infections - exceptions being baddies like RSV and the Flu, which show up every year and consistently reek havok wherever they go - so it's difficult to know for sure that EV68 has been dormant. We're actually not really even testing for it now because the test takes forever to process and is therefore really only for epidemiological purposes. But all evidence seems to point to the fact that it's here and it's legit.

Case in point, my practice recently received word from our local area hospital that we could no longer directly admit patients with respiratory symptoms because there were no beds available. If we had patients who could not be stabilized outpatient, we would need to send them to the hospital vis-a-vis the emergency room. EV68 is a thing. And it's for sure making people sick.

But that doesn't mean that it's making you sick, or that it will make you sick, or that if it does make you sick, you automatically need to go to the hospital and start on supplemental oxygen.

Probably not you.

Our office received this memo from the DPH a few days ago. They summarize the situation brilliantly:

"...EV68 this year is behaving more like a [common cold], even to the extent of causing disease with little or no fever...No antiviral medications are currently available for treating of EV68 infections. Many infections will be mild and self-limited, requiring only treatment of the symptoms. Some people with severe respiratory illness caused by EV68 may need to be hospitalized and receive supportive care. There are no licensed vaccines for protection against...infection." (Bolds are mine)

In so many words, this memo explains that there is absolutely no need to panic, or even to seek medical attention, unless you are having severe respiratory symptoms such as wheezing, chest tightness, and/or shortness of breath.

So what should you do?

MegaHospital (the one that our practice and every other nearby pedi practice bows to), recently sent out the following information to give to our patients:

• At home, wash your hands often, using soap and water, and wash for at least 20 seconds. Carry hand sanitizer when you are out and about.
• Don’t share cups or spoons, knives and forks, and wipe down toys and frequently-touched surfaces like doorknobs often.
• Keep your distance from visibly sick people and don’t let sick people hold or care for your baby. And if you or a family member is feeling sick, stay home.
• Teach your children to cover coughs and sneezes with the inside of the elbow or a tissue, not the hand.
• If your child has asthma or any other lung disease, make sure he or she continues taking any medications as prescribed.
• If someone in your family starts with the sniffles and a cough, don’t panic. Chances are that it is just a common cold. Keep a close eye and, if the cough gets worse or the person looks weak or is having trouble breathing, call your doctor or visit your local emergency room.

So there you have it, folks. EV68 is real. It sucks. But mostly likely, it's not going to affect your life.

My life on the other hand...well...my 38-week-pregnant self gets the privilege of working this weekend. Let's hope I survive.

--
Note: Sources are not cited to protect the anonymity of myself and my practice. As both sources were intended to be public service announcements, I feel that this action is in keeping with the purpose of the documents.

Back to School

"A little back-to-school shopping?" asked the Trader Joes clerk, as she rung up the various snack items I had purchased for our new international student.

"Something like that." I replied, as the enormity of the situation began to register.

The summer is over. It feels like it never even happened.

When I left you in May, the summer was just beginning to take shape. OMP and I were to enjoy a relaxing beach getaway. We would purchase a new car and, with the help of professional movers, move into a fabulous new apartment. OMP would finish his dissertation. I would design the most perfect nursery the world had ever seen. And I would continue to work full-time, never missing a beat professionally. Sure it's a lot to get done, but you know how we roll - always big, better, last minute, and with a flourish.

Instead, the summer began with a call from my Grandmother, asking what I knew about dialysis, as my Papa had recently been diagnosed with chronic kidney disease.

Actually, that's not quite true. The summer began with a call from OMP's father, letting us know that his grandfather had a recent apneic episode with loss of consciousness. He had a short hospital stay and made a quick recovery. Not long after his discharge, the phone rang again. This time, it was OMP's grandmother, who had suffered a heart attack. Her recovery and discharge were not as quick (she is actually still recovering), but the news was generally optimistic.

That's when my grandmother called. Papa had been diagnosed with CKD. OMP and I were filled with a sense of foreboding. Within a few days, he progressed from Stage VI to Stage V Renal Failure. They started dialysis. He died 5 days later. 

A blog entry is a hopelessly underwhelming way to remember such an extraordinary man. I will not attempt to do so, at least not today, but suffice it to say that the world is a better place because of my Papa. I am certainly a better person, and I can't think of a single person who knew him and was not in some way touched by his presence.

I don't know why God chose to call my Papa when he did. I wish I could say I saw the logic to his plan, but I can't, at least not yet. Neither can I say that I'm filled with righteous anger at his passing because I'm not. I am sad, plain and simple. I am sad because I loved him and I miss him.

My Papa's passing cast a shadow across the summer. My family took it hard. I took it hard. Plans unraveled. Our utopian summer was reduced to a series of boxes to check off. And as the summer progressed, it became increasingly difficult to do so.

We bought a car. It was a process and it cost quite a bit more than we expected. 

We moved into a new apartment, no thanks to me. I worked full-time, sure, but by the end of the day I was too exhausted to even think about packing. And fun fact, professional movers are in high demand in big cities the first week of August. We instead relied on the gracious support of my parents. I think my mother packed about 75% of our belongings and she, my father, and OMP moved all 6 rooms of ours into our new 3 stories.

OMP did not finish his dissertation. He was busy packing, unpacking, and putting out various fires along the way.

I laugh at the idea of completed nursery.

Our beach getaway was condensed to one night. We camped. All 31 weeks of my pregnant self slept on an air mattress. All things considered, it was probably the most glorious vacation of my life because it was so necessary.

And my blog? My poor, hopeless, neglected blog has not been updated. I simply haven't had the energy.

God's plan for my Papa may still be a mystery to me, but on the subject of my humility, I have heard Him loud and clear. I am not in charge. I cannot conquer the world single-handedly. My plans are so small and short-sighted compared to His. There are some big changes coming in my life. The summer is over, and things are about to get real.

Of course, the summer was not without its positive notes. Babykirk continues to grow and thrive. I was gifted with not one, but two beautiful baby showers. We are thrilled to welcome our new international student to our new home tomorrow afternoon. All of these things deserve their own updates, and will get them in time.

For now, I will start going to bed earlier. I will try to loosen my grip on my unrealistic ideals. And I will try to take some comfort in the knowledge that God's got this, even when my best laid plans fall apart.

Case Study: Babykirk and her Echogenic Focus

Ok guise. Let's talk about the baby.

Fun stuff first. OMP and I are thrilled to announce that Babykirk is a girl!

The Money Shot

Initially OMP had his fingers crossed for a boy, but now that the results are in, I think he's more excited than I am. When he was 13-years-old, his little sister was born. He's starting to relive the memories he has of her as a baby, and is getting more and more excited for this little one to make her debut.

Now to the nuts and bolts...

At our 12-week visit, OMP and I elected to have the Integrated Screen. This is a multi-part screening tool (blood tests as well as ultrasound measurements) to help to determine the relative risk of trisomy and other fetal problems. Our results were excellent. The genetic counselor estimated our risk of trisomy as being less than 1 in 50,000.

Our 18-week ultrasound, in addition to revealing Babykirk's...um...ladyhood, looked promising as well. All of the fetal measurements came back as normal. Ten fingers, ten toes, one magnificently beating heart.

Or so we thought.

A few days later, I got a call from my OB's office. The radiologist had reviewed the ultrasound images and found something known as an Echogenic Focus on Baby's heart. I wasn't to worry, but they did want me to come in for a Level 2 ultrasound ASAP.

Um. Panic.

Since I work in Pediatrics, I was vaguely familiar with Echogenic Foci and the significance of finding them on a fetal ultrasound. Basically, I knew two things:
1. It's not normal.
2. It's a "soft marker" that is associated with an elevated risk of trisomy, notably Down Syndrome.

Image from http://www.medscape.com/viewarticle/518149_6

I spent the next several hours voraciously researching Echogenic Foci and their exact significance. Luckily, I was somewhat comforted by what I read. Echogenic Foci themselves are harmless (our radiologist would later compare them to a "freckle" on the heart). They usually indicate a slight calcium build-up within the heart muscles. They are not associated with any cardiac problems - short- or longterm. They are only concerning because they seem to be more common in children with chromosomal abnormalities.

How much more common? The literature was vague. The general consensus is that although Echogenic Foci can be a normal finding, they can effectively double an individual's chances of having a chromosomal abnormality. Baby's initial chances? Less than 1 in 50,000. That means, at worst, the Focus increased those odds to less than 25,000, which is still pretty good.

So OMP and I went into the Level 2 ultrasound being cautiously optimistic. We prayed a lot. We asked friends and family to pray.

--- Just to pause for a second ---

If someone happens to stumble upon this blog because they've recently learned that their little one has an Echogenic Focus, first of all let me say that I'm sorry that you're dealing with this. I can honestly say that there is nothing more terrifying than thinking that something might be wrong with your baby.

That being said, I'll remind you that this is just our story. It's ongoing. We still don't know how it will end. But I do hope that our anecdotal journey can be a comfort to you while you're weighing your options. We are still weighing them. We are still praying, trying to trust God, and are still hoping for the best.

--- Let's continue ---

First of all, our radiologist was awesome. She had that "I'm obviously the best doctor in the world and know everything" vibe which is exactly what you want in a situation like ours. The focus was still there, she showed it to us on the monitor. She began by saying that her eldest son had an echogenic focus on his fetal ultrasound. She says that she considers it a relatively normal finding, and that in certain populations it can occur in almost 40% of individuals. She told us that the focus itself was not a problem, and made the comment about it being similar to a freckle.

We were worried that the focus would double our chances. She disagreed. Given that every other screening test and "soft marker" was normal, she felt that it in no way affected our odds. In her words "you don't have a bad option here." She did not feel that further testing was strictly necessary. However, we had her blessing if we did want to pursue further testing like a cfDNA test or an amnio. It was up to us, but if it were her, she wouldn't worry about it. Actually, she kind of gave us the impression that she didn't know why we were there.

As of right now, we've done nothing, except maybe stop worrying. We did briefly consider cfDNA testing, and I might discuss it with my OB at my upcoming visit, but generally we feel very reassured. We've acknowledged that it's a possibility and have emotionally dealt with that. We plan to continue to pray (and would ask you to as well!), but otherwise, we're letting it ride. There's already so much love for this baby and, quite frankly, we're feeling pretty blessed.

Anyway, more to come on Babykirk's Echogenic Focus. As for now, on to more important things, like trying to find some baby-sized hot pink hiking boots...