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...

Scary Stories from the Interwebz: What is a GMO?

The Internet is a big, scary place. It contains a plethora of information on just about any available topic. That's the big. Unfortunately, there is very little regulation of the quality and accuracy of that information. That's the scary.

Like just about any other form of media, people have an overwhelming tendency to believe that everything they read on the Internet is true. Especially blog articles that use words like "studies," "research," and "scientists," and definitely when they discuss things like cancer and obesity and all of those other pervasive medical problems that are plaguing our generation.

I'd therefore like to start a new series affectionately titled Scary Stories from the Interwebz. I'll use this series to discuss hot topics that I come across at work and in my personal life that are largely misrepresented, and sometimes blatantly false. And I'll do my best to support my claims with evidence. Like, actual evidence. That I read. And understand (<-- that part is important!).

For our first Scary Story, let's talk about GMOs.

OMP and I were getting lunch today, and a nearby diner was telling his college-age sons about the dangers of GMOs.

"Yeah, it stands for 'Genetically Modified Orgasms.' I mean, ha-ha, 'ORGANISMS.' Yeah it's like, they take fruits and vegetables and animals and stuff and inject them with all sorts of chemicals and antibiotics. Montasanto is the name of the company that does a lot of it, and basically these chemicals are toxic and can cause all sorts of problems like cancer."



*FACE PALM*

I understand that the idea of dudes in labcoats injecting "TOXIC CHEMICALS" into fruits and veggies can be rather terrifying, but why don't we take a few minutes to discuss what a "Genetically Modified Orgasm Organism" actually is.

Genetic Modification (formerly known as selective breeding), goes back to the early days of farming. Selective breeding is the process by which farmers (or scientists, or people who are bored or whatever)

[breed] organisms with desirable traits in an attempt to produce offspring with similar desirable characteristics or with improved traits. 

Most of the animal and plant products that we consume today are the result of selective breeding. In fact, many of the products available today wouldn't even exist if it wasn't for selective breeding. Corn is a great example. Michael Polland's The Omnivore's Dilemma tells an amazing story about the history of corn (and also why the Corn industry is a little terrifying). You can also read all about the history of corn here. 

Image from http://learn.genetics.utah.edu/content/selection/corn/

As time goes on and technology improves, we're getting a little better at this this whole selective breeding thing. Now instead of providing a candlelight dinner and mood music to our various livestock, we can perform artificial insemination and DNA modification.

A 2011 literature review published in Genetics discusses how the genetic engineering of crops differs from traditional selective breeding

Genetic engineering differs from conventional methods of genetic modification in two major ways: (1) genetic engineering introduces one or a few well-characterized genes into a plant species and (2) genetic engineering can introduce genes from any species into a plant. In contrast, most conventional methods of genetic modification used to create new varieties (e.g., artificial selection, forced interspecific transfer, random mutagenesis, marker-assisted selection, and grafting of two species, etc.) introduce many uncharacterized genes into the same species. Conventional modification can in some cases transfer genes between species, such as wheat and rye or barley and rye (Ronald, P., 2011)

Basically, we can do it in a lab. Oh, and we're much, much better at it.

So what's the big deal? Well, it could be nothing.

According to the American Association for the Advancement of Science, 

The World Health Organization, the American Medical Association, the U.S. National Acad-
emy of Sciences, the British Royal Society, and every other respected organization that has examined the evidence has come to the same conclusion: consuming foods containing ingredients derived from GM crops is no riskier than consuming the same foods containing ingredients from crop plants modified by conventional plant improvement techniques (Statement by the AAAS Board of Directors on Labeling of Genetically Modified Foods, 2012).

Like any new technology, GMO's have been subjected to absurd amounts of safety monitoring and scrutiny. If you have a few weeks of free time, you might want to read A Decade of EU-Funded GMO Research put forth by the European Commission. I'll be honest, I just skimmed it. But suffice it to say that there's been a fair amount of investigation, and the general consensus is that GMOs are filling an important need without introducing any significant risks.

Then why did my favorite soccer-mom blog tell me that GMOs are scary?

Despite the fact that the process of genetic engineering is not all that scary, the purpose of all this modification is worthy of some reflection. Genetic engineering can accomplish some amazing things. It can increase the protein and iron content of rice so that poor communities can afford nutritionally- and calorically-dense foods. It can create stalks of corn that stand up straighter, increasing the yield and the health of the plant. Actually, for the most part genetic engineering is pretty amazing, and has the potential to solve a lot of the world's hunger problems.

But, like any technology, it can be dangerous when taken into the wrong hands. For example, genetic modification can also make it so that plants can survive an offensive onslaught of herbicides and pesticides, and somehow manage to not die. 

ZOMG CHEMICALS.

Image from http://sci-ence.org/red-flags2/

I'll have to save my rant on how much I hate the word "chemicals" for another day. In short, "chemicals," aka man-made substances, are not inherently bad. That being said, if there's a substance potent enough to kill unwanted plants and animals, it's probably worth a second look. 

In addition to the bazillions of soccer-mom blogs, there's plenty of actual research that indicates a statistically significant correlation between certain herbicides/pesticides and adverse health outcomes. An herbicide known as Roundup (manufactured by the evil Montasanto company) has drawn considerable criticism (Richard, S., et al., 2005).

Does this mean that your salad is coming with a side of Roundup? Maybe. Unfortunately, that's only the tip of the iceberg when it comes to the true dangers of herbicides and pesticides. A short list of other concerns:

1. Herbicide resistance
2. Endangerment of species that are not "Roundup Ready"
3. Seed contamination
4. Endangerment of "non-targeted" species of insects and mammals (think: honeybees, deer, etc.)
5. Contamination of groundwater and endangerment of aquatic flora/fauna
6. Possible endangerment of the local human community

 There are too many sources to list, but you can start with the following:

http://web.mit.edu/demoscience/Monsanto/impact.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984095/

http://pubs.acs.org/doi/abs/10.1021/ac991359c

Or just try wikipedia

In short, you shouldn't be worried THAT genes are being modified. You should be worried about WHICH genes are being modified. And unfortunately, grocery stores have yet to advertise that above their produce bins.

So what's a concerned consumer to do?

Honestly, don't worry about the whole GMO thing. It's over your head. Frankly, it's over my head. All you need to worry about is supporting sustainable agriculture. When possible, buy organic. Better yet, buy local AND organic. Sure those organically- and locally-grown apples might have been genetically modified at some point, maybe to make the trees grow taller or to make the apples a prettier color. But you can rest assured that you're not getting a healthy dose of Roundup in your fruit salad. More importantly, you're supporting an organization that, at least in some way, has examined how its growing practices impact both the environment and the people who consume its products. Win-win.

That concludes this week's Scary Story from the Interwebz. Stay tuned for an actual update on Babykirk. I promise I'll get to it eventually.

Proof that you've been in the game.

Hello dear neglected blog.

I'm way overdue for a Babykirk update, I know. There's a lot going on right now and I want to be able to record it all, but still waiting on a few things to fall into place so to say. Here is a more recent shot of the little nugget, a little more detailed than my MS paint drawings, but obviously lacking a certain aesthetic.

gawww.

For now, let's talk about stretch marks.

Aka striae gravidarum, these puppies are a common concern among pregnant women. Let's do a little myth-busting here.

...

1. Cocobutter prevents them.

Nope (Osman, H., et al., 2008).

2. Lol, there's no such thing as a cream that prevents them. They are 100% genetic so you're basically screwed.

Not exactly. Yes, there is shown to be a strong genetic link to the presence and severity of stretch marks. They're also more common in women of certain ethnicities, or women with a personal history of stretch marks (due to pregnancy or other reasons). But there are two products that have demonstrated some hope:

A product called Trofolastin, a cream that contains Centella asiatica extract, vitamin E, and collagen-elastin hydrolysates, has demonstrated some clinical effectiveness in the prevention of striae (Osman, H., et al., 2008). Also there is some evidence that early use of Tretonoin (aka Retin-A) might have some effect (Rangel, O., et al., 2001). 

I know it's not super encouraging, but for women who have a strong genetic risk, at least there's a glimmer of hope on the horizon.

3. If you gain less weight during pregnancy, you're less likely to get them.

This one actually has some merit to it. There are numerous reasons to gain a healthy amount of weight during pregnancy. But if that evidence isn't enough for you, a 2007 study did show a statistically significant correlation between the presence of striae and excessive weight gain in pregnancy (Rubeiz, N., et al., 2007).

4. You're less likely to get stretch marks when you're young.

Once again, false. First of all, I see plenty of teen mothers in my office who have just as many stretch marks as the next person. Anecdotal evidence aside, there is actually some scientific evidence that younger mothers (average age 26 versus average age 30) are actually more likely to develop striae than their older counterparts (Rubeiz, N., et al., 2007).

5. Drinking plenty of water is the best way to prevent them because it keeps your skin hydrated.

Ehh. Yes and no. Hydration is really important in general during pregnancy because you're effectively doubling your blood volume. Drinking plenty of water does also help to keep your skin hydrated, and there's some evidence that good skin hydration helps with the itchies that are common with stretching skin. But no clear evidence that it does anything to prevent stretch marks.

...

The take away here? Know your genetics, ask mom and grandma and see what your chances are. If you're really concerned, talk to your OB about some of the treatments listed above.

Or...don't? Stretch marks are like any scars. As my Dad used to say, it's proof that you've been in the game. Own them, ladies. You earned your stripes.

To snip, or not to snip

In 2012, the American Academy of Pediatrics published a statement regarding newborn male circumcision. The statement made more than a few waves - both in the medical community and beyond. The statement has been published, re-published, agonized over and interpreted down to the letter.

The statement is more or less summarized by the following sentence, taken directly from the AAP website:

Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. 

Since then, researchers have been cranking out piles of literature. A very large cohort of European scientists were quick to publish this review after the statement had been published, calling attention to some of the weaker statistics and pointing out what they identified as cultural bias. The debate rages on two years later, with the New York Times publishing this blog post recently, in response to a recent paper in the Mayo Clinic Proceedings.

And so the question remains; to snip, or not to snip?

When I first came across the AAP Statement, my interpretation was (I believe) similar to that of the masses; that this was the AAP's way of subtly recommending newborn male circumcision. But the more I thought about it, I realized that this was not necessarily the case.

The AAP had been decidedly neutral on newborn male circumcision prior to 2012, and America saw a steady decline in newborn circumcision rates. Health insurance companies took note of this. As important as health insurance is, companies will not waste a second to cease coverage if a procedure is not deemed to be medically necessary.

The above statement may or may not provide sufficient evidence in favor of newborn male circumcision. But it undoubtedly provides evidence for the continuation of health insurance coverage of the procedure. In publishing their statement, the AAP is not so much saying that individuals should circumcise their children as they are protecting the individual's ability to do so without breaking the bank.

What do I think? Well, I've done quite a bit of research, and have given it a lot of thought. I haven't been practicing long, and as a Pediatric Nurse Practitioner I don't know much about the long-term sexual effects of the procedure. But in terms of medical complications, I have seen far more in individuals with in-tact foreskins than I have in individuals without foreskins. I have not noticed any significant difference in breastfeeding or maternal bonding, and the literature seems to agree with me. So as for now, my vote is for the snip.

Ovia Pregnancy: App Review.

Two posts, one day, ftw.

After scheduling my first appointment with my OB, I decided to download some pregnancy-related apps. I was looking for an app that would let me keep track of symptoms, check in on Babykirk's progress, and allow me to look up foods/medicines that might be unsafe.

I started out with "The Bump," because I had used its sister site "The Knot" for wedding-planning and really liked it. The best thing about The Bump - something that I was not initially looking for - is it gives you access to something called a Birth Club - a forum with all the other Moms-to-be who are due in the same month as you. Since I'm still in the "don't tell anyone!" stage of pregnancy, I've found it to be surprisingly comforting. Also, the "Your baby is the size of a..." section is pretty cute.

That being said, the app is otherwise pretty useless. Even their checklists are kind of stupid. Some are useful, like "Schedule your first ultrasound," but "Give yourself some 'Me' time?" Gross.

I tried a couple other "Can I eat this?" apps, but I didn't find anything worth keeping.

But today, a fellow Bump member recommended the Ovia Pregnancy App. If you find yourself looking for a pregnancy app that is comprehensive, cleanly designed, and easy-to-use, then look no further.

The front page presents a quick overview of your pregnancy to-date; complete with trimester, week counter, illustration of size of baby, and illustration of size of baby's handprint (awww).

Below that, it gives you a live feed of your "data." By clicking the "Add Data" button you can include updates on your weight, exercise, sleep, nutrition, symptoms, medications, and even blood pressure. Further along, you can also utilize a kick counter and a contraction timer (so cool). It allows you to set goals in all of these categories and gives you little updates (and recognition!) as you accomplish them

Also included in your feed are relevant articles and information about pregnancy and parenting. And...drumroll please...

Ya. It's basically like the holy grail of pregnancy info. The Food Safety Lookup has just about every food you can image, and allows you to search, rather than browse (good for very hungry pregnant women rummaging through the fridge at midnight). Pregnancy week-by-week provides enough information without being "too much." And Symptoms Lookup explains what the symptom is, whether or not it's expected, why it occurs, and what you can do about it.

Overall, I give the App 5 stars...or thumbs up...I don't know, I don't exactly have a functional rating system. I like it. You should use it.

** I also looked into "I'm Expecting," by Medline, "What to Expect," and "Sprout," by American Baby. They were pretty good, but not as comprehensive as Ovia.

The Drink

I'm a coffee person. I have often said that my blood type is Venti Bold. If you want a break down on why coffee is the greatest thing in the world, check out ilovecoffee or talk to my husband for more than five minutes.

Now that BabyKirk™ has come along, I've been doing some research into the effects of coffee on fetal development. Coffee is one of the few million things that you are not allowed to consume during pregnancy, because of course you and the baby will spontaneously combust and THE ENTIRE WORLD WILL END.

Coffee is an especially tough one for me because it has become so much more than a drink. It's actually a pretty significant part of my life. My morning routine legit doesn't exist unless I get a cup of coffee. At work, I perk up at just the though of my mid-morning joe. If I work nights, a quick stop at Starbucks is what gets me through the second half of my shift. So if this was something that had to go, I wanted to be sure that it really had to go.

I started out by browsing UpToDate. If you're not familiar with it, it's basically like medical Wikipedia. Really awesome, well-written, and well-researched medical Wikipedia. Subscribers only (sorry guys), it presents the lastest data on a variety of medical conditions, diagnostics, and treatments.

I expected to troll around for a while and maybe come across a link or two to some interesting studies on the topic, but to my surprise and delight, I stumbled upon a very comprehensive literature review titled "The Effects of Caffeine on Reproductive Outcomes in Women." Jackpot.

Turns off that coffee turns so many heads in the scientific world because of how accessible it is to the developing fetus:

Maternal caffeine metabolism declines significantly during pregnancy; the half life increases three-fold in the third trimester, reaching a t_1/2 of 11.5 to 18 hours. The fetus metabolizes caffeine very slowly, mainly due to immaturity of caffeine-metabolizing hepatic microsome enzymes and lack of CYP 1A2 activity in the placenta. Therefore, even low maternal caffeine consumption can be expected to lead to prolonged fetal caffeine exposure, particularly when the mother is a genetically slow caffeine metabolizer.  (Nisenblat, V, Norman, R, 2013).

This sounds exceptionally terrifying at first read, but the review goes on to explain that, despite the ready absorption, the effect of caffeine on the developing fetus is largely unknown. There is precious little literature on the effects of caffeine on human subjects, and the literature that does exist is of poor quality. Furthermore, there are a large amount of cofounders that have made studying the effects of caffeine difficult, most notably that the only women who consume large amounts of caffeine during pregnancy nowadays are typically doing other not-so-great things - like smoking, drinking, not accessing prenatal care - at the same time.

Poor evidence aside, the review did examine the effects of caffeine on a variety of reproductive outcomes. Here's the rundown:

1. Probability of conception (fecundability): Inconclusive, caution advised
2. Spontaneous abortion: More likely with >300 mg per day
3. Congenital anomalies: More likely with >300mg per day
4. Fetal Growth Restriction: Some good evidence that caffeine intake is associated with fetal growth restriction, but the range of concern varies between 200mg and 600mg
5. Preterm delivery: No significant association
6. Gestational Diabetes: Unclear (actually some studies showed that it was beneficial!)
7. Gestational Hypertension: Slightly increased risk, but no increased risk of preeclampsia
8. Post-partum depression and long-term effects on infant psychology: No significant association

Upon review, I feel that there is good reason to be cautious with caffeine intake during pregnancy. Given the outcomes, the most sensitive period (like everything in pregnancy) appears to be in the first trimester. After some consideration, my plan is to avoid caffeine entirely for the first twelve weeks. And then after, limit myself to <300mg daily. Although given the amount of caffeine typically found at your average Starbucks, that might be pretty difficult.

source: Huffington Post

Who knows? Maybe I'll start to like this whole decaffeinated tea thing.

Probably not.

**

Nisenblat, V., Norman, R. "The Effects of Caffeine on Reproductive Outcomes in Women." UpToDate. September 11, 2013. Published by UpToDate Inc. [0503-50.169.70.108-4E541A501A-6.14-178603391]

The test

The thing about knowing stuff is that occasionally, it takes the romance out of things. The surprise. The spontaneity.

For some time, I've dreamed about the moment in which I would discover my first pregnancy: the pregnancy test illuminating a brilliant blue, the Hallmark embrace with my loving husband, the single tear I would shed in the most elegant possible way.

I did not picture myself at 5 AM, bathrobe and slippers, shoving a stick (upon which I had just urinated) into my husband's face shouting "look, you can almost see it if you hold it up to the light." And him smiling through bleary eyes, saying "that's great, sweetie," and promptly falling back asleep.

I certainly did not picture myself buying an economy-pack of pregnancy tests so that I could start testing myself at nine days post ovulation and then daily until I achieved a shade of blue with which I was satisfied.

The other thing about knowing stuff is that occasionally, it makes you an absolute stud.

Basal body temperatures charted. Ovulation predictor kits utilized. Ovum fertilized. We knew we wanted a baby and we were not. joking. around.

The other thing about knowing stuff is that occasionally, you're wrong.

And this is where where we wait patiently to see if the other shoe drops...

My name is Erica and I'm a Pediatric Nurse Practitioner. Children are my business. I listen to heart beats, clean runny noses, pat babies on the head and hold mommys' hands. I debate feeding schedules, wax eloquent about limit-setting, and check upwards of forty ears a day. I can coax an 18-year-old to tell me about her drug use, and I can examine an 18-month-old without a single teardrop.

And - holy crap - I just found out that I'm pregnant.