The echocardiogram

Yesterday was Little Sister's fetal echocardiogram. I'll admit that this whole time, I've been more worried about getting lost on the way than I was about finding anything wrong. After all, from everything I'd heard, it was all going to be just fine. There was no sense in worrying about something I couldn't change, anyway. Getting lost was much more likely.

However, getting lost (which happened, as anticipated) does not preclude heart problems, and as it turns out, you can not only have to pull over and consult a map on the way to a fetal echocardiogram, but you might also hear bad news once you're there.

I'll tell the rest of the story, but in the interest of not driving all of you crazy, I'll start with the end: the baby's heart has a small hole in it that will cause a heart murmur when she's born. It'll very likely heal on its own within a few months. It's a relatively common problem, and if you're going to have a heart defect, this is probably the one you'd want to have. Should really be no big deal and, on the plus side, it didn't look like anything else was wrong, and it's unrelated to the arrhythmia we heard last time, which had disappeared. So it's kind of good news and bad news, right?

And please don't freak out on me. If you freak out, I will too, and that's the last thing any of us need right now. I want you all to remain level-headed. We wouldn't have even known about this for another month and a half if it hadn't been for the completely unrelated arrhythmia, so no one's allowed to worry, openly, around me, anyway at least until 2-3 days after the baby's birth, which is when it would've showed up. And it's not a tragedy, just a little thing we have to face. In the meantime, you are allowed (and encouraged) to pray--that's the best thing for all of us right now, anyway.

Onto the story.

I got lost on the way to the appointment, and I blame it on the fact that the area I was driving to was cut off on the map and continued on a completely different page, as are most of the unknown places I drive to. I had looked up directions in advance, but that made no difference. I can get lost in a tent.

Fortunately, I had allowed plenty of time and made it to the gorgeous lobby of the Duke Children's Health Center with minutes to spare. I opened the book I'd brought, and kind of hoped the wait would be longer rather than shorter.

It wasn't: within 15 minutes or so they'd come to get me. The ultrasonographer was a far cry from the brisk, businesslike professional I'd convinced myself to expect. We chatted like old friends as she began the ultrasound.

"Wow, your little girl takes great pictures!" she enthusiastically commented.
"My girl at home does, too!" I enthusiastically responded.

This became a common theme through the ultrasound--apparently, Little Sister was cooperating so well that the images we got were pretty much textbook quality.

"I could look at these all day," the ultrasonographer often said. I had my answer for why this was taking so long (not that I minded).

I, myself, enjoyed watching the baby's heart pump away--it was very rhythmic and calming. We could see the blood flowing around, and hear how each section of the heart had its own unique sound. Amazing. I think in another life I would become an ultrasonographer.

She also noticed at one time that Little Sister seemed to be exercising her lungs. The baby of course doesn't have any air in there yet, but she was kind of moving her abdomen where they are. Keep up the good work, Sweetie! You'll need those! Cute.

And then it was time for the doctor to come in, to take another look and answer all my questions. I tried to doze as I waited, relieved that the ultrasonographer was still upbeat and happy. Nothing could be too wrong, right?

I again expected a brisk, businesslike doctor and was instead met with a nice, friendly guy who had a great rapport with the ultrasonographer. We discussed our Norwegian spouses (the name is always a dead giveaway) and nuances of the Norwegian culture. I was impressed by his ability to make interesting smalltalk while potentially diagnosing heart issues in my unborn child.

And diagnose he did. After the scanning was over, he sat down for a chat with me:
"The arrhythmia has entirely disappeared," he said, just as I expected. But he wasn't smiling as he continued, "However, there is something we need to talk about."

Sometimes sentences take entirely too long to say. And the pause between sentences can be even longer, and then the sentences that follow, until you get to the part that states, "but the hole in the baby's heart will most likely heal on its own and cause no problems," can be excruciating.

But fortunately we did, eventually, get to this final sentence fragment (or something like it--I wasn't thinking clearly at the time), and then the doctor used as many words as it took to reassure me that everything really, truly, for real should be just fine.

Little Sister has a birth defect called Ventricular Septum Defect. It's a small hole between the two ventricular chambers that is allowing blood to flow back and forth between them (more or less). The septum is a muscle, with lots of muscle fibers, and what happened is that some didn't seal up completely as the heart was being formed. As the heart grows, the hole should naturally seal. The only thing that's a tiny bit worrisome is that the hole is close to the very bottom of the heart, where there's less muscle that can join together. Still, the doctor wasn't worried.

This shouldn't become a problem, but if it does, it'll manifest itself in difficulty feeding and gaining weight. However, the baby will be monitored with extra appointments and such, so we'll make sure she's okay. And even then, there are "things we can do." I didn't ask what those were.

He added that the only way he could even determine there's a hole was because the pictures were so clear that he could see the blood flow rushing back into the ventricle it'd come from. This is what produces the murmur, which should be audible by 2-3 days after birth. He said that it's nice we'd caught it before birth (even though normally we wouldn't have), because once anyone hears it on a stethoscope, they'll start freaking out--but we'll already know it's just a small hole, and we'll already be planning follow-up care.

The follow-up care will include an echocardiogram before Little Sister leaves the hospital, as well as a visit with him probably 2-4 weeks after birth, and another probably 3 months after birth. It's nice to live so close to a respected health system, and to already be under the care of an expert.

And even though I didn't ask, the doctor also made sure that I understood (and practically had me repeat it back) that there's nothing I did to cause this--not even a genetic factor. It happens. It's fairly common--one of the top 2 conditions they see. It's really no big deal.

He also stressed that we're not allowed to Google this--VSD can be associated with lots of scary things that he's confirmed Little Sister does not have. I will take his advice and I'd strongly encourage you to do the same.

Finally, the doctor said that this won't affect the rest of my pregnancy or my delivery. I think I have his leave to continue to celebrate a mostly healthy baby, or one that should be completely fine by the time she's solidly into 6-month onesies. That's my plan, anyway.

And the arrythmia? It's completely gone, and was probably caused either by my stress at the time or the fact that I'd overdosed on M&Ms in the week or so before my last doctor appointment. But the M&Ms have been out of the picture for a while now, and I've been working to keep my stress levels low (is that an oxymoron?), so we likely won't have to worry about that again.

It was a strange evening last night as the news sunk in for all of us, but there was a toddler to care for and supper to make and my sister's dog to walk as happy distraction. For some reason, we decided we'd all feel better if we had hot fudge sundaes at McDonald's, even at the expense of Kalina's timely bedtime. It worked, at least in the short term, and now the only things left to do are wait and pray that this doesn't turn into a bigger deal than the doctor promised it would.

Preparing a toddler for a baby

There are several options for telling your toddler that there's going to be a newborn in the house. They are:

1. Include the toddler in every detail of welcoming the new baby, for the full 9 months.
2. Wait until she asks why Mommy's bigger than Daddy nowadays.
3. Let the newborn do it.

We've leaned most closely toward #1. We waffle between making a big deal of expecting a baby, so that Kalina is prepared for the huge change, and trying not to make a big deal out of it, so that Kalina's not freaked. But is there really anything we can do to prepare her?

I've read the following tips for easing the transition:
1. Have the toddler and the newborn exchange gifts.
2. Spend plenty of quality one-on-one time with the toddler after the baby is born.
3. Let the toddler "help" with the baby as much as possible.

We will be doing all of these. What we still need advice on is:
1. How do you get one child to sleep while the other is screaming?
2. How will I open doors, use the bathroom, or cook dinner, assuming Little Sister is as needy as Big Sister was/still is at times?
3. If Big Sister is riding in the basket of the grocery cart, and Little Sister is on the seat, what's the point of even going grocery shopping? Do we have to go twice a day to stock enough food?

Despite my misgivings, I don't think the transition will be 100% painful, after labor and delivery, anyway. Here's why there's hope:

1. It doesn't seem to bother Kalina when I hold other babies, as long as I still pay attention to her.
2. Kalina seems to think babies are cute, mostly because they're little (or "teeny tiny," as she says in her cutest little voice). She likes to wave at them, and she would potentially even let one hold her hand (however, anyone between the ages of 6 months and Mommy is not to be trusted).
3. Kalina is generally content as long as she's within 3 feet of me and I can half-focus on her. I think that fits most of the parameters of caring for a newborn.
4. Kalina is a caretaker. She makes sure Lamby gets to enjoy the same privileges she gets, and also that Lamby naps, is hugged, eats, drinks, potties and helps pick up. She also is a rule-follower, and an orderly little soul. If anyone tries to feed the newborn Cheerios, for instance, I'm sure to hear about it.
5. Kalina is a big help. She enjoys contributing. I take advantage of this whenever and wherever I can, and am hoping to pass diaper duty off on her entirely by her 3rd birthday (hah!).

And so, while preparing Kalina for a newborn is still probably like preparing a sea squid for the Sahara, I'm usually able to convince myself to remain optimistic. For Kalina's part, she probably thinks a baby is something we'll keep in the closet and bring out for exercise and to eat from a bowl on the floor, but I'm satisfied that she seems to think it's okay for her little sister to live under the same roof.

And really, maybe the less we all know, the better off we'll be?

Photo: Eat the red part, Sweetie, red. (In a friend's backyard a few months ago, enjoying some summer fun, including the fruit Kalina has affectionately named "la-la," before this horrid humidity set in.)

Baby Update: I have a fetal echocardiogram scheduled for Friday at 2:30. I'm not really worried about it, at this point, but I'm sure I will be by then. Please pray!

A tough doctor visit

Yesterday morning as Matt and I were both getting ready for the day, I mentioned I had a doctor appointment later. He wondered how far along I was, and I proudly told him I'm 32 1/2 weeks, and that a baby born now would likely do very well. We both discussed this fact and our relief.

And then I wandered off to my appointment, leaving Kalina with her Grandpa this time (yay!) and happily read pregnancy magazines until becoming mildly irritated about how long the appointment was taking, and wondering if Kalina would be getting hungry for her lunch.

The doctor finally came in and asked if everything was going well, and I said yes, just measuring a little small (I'm at a group practice so I don't see the same doctor every time). He agreed I was measuring small and said I'd be having another ultrasound just to make sure the baby was continuing to grow. I replied that I'd look forward to it.

He decided that approximately 4 weeks from now would be a good time for an ultrasound, although he almost upped the date due to the fact that I hadn't gained any weight these past two weeks. "Are you eating well?" he wondered. "I'm pigging out!" I informed him, mentally making plans to add more ice cream into my diet.

And then we listened to the heartbeat.
"Did you hear that?" the doctor asked. "It sounded like it skipped a beat."
I'd heard it, as had the new doctor who was shadowing the one with the heartbeat-listener-gadget.
And a dozen or so beats later, "there it is again."
By this time, my heart was making up for any and all missed beats as I tried to figure out what to think. Wasn't listening to the heartbeat something we did just for fun, to make my 45-minute wait worth it? Could it instead show me something may actually be wrong?

The doctor kindly informed me that the heart wasn't actually skipping a beat, it was adding one in just before--which made it sound like it'd skipped a beat. I took his word for it. He also said that this isn't common, but it's also not rare. We'll have to do an ultrasound to look more closely, but the baby is fine, he told me.

Really? Fine? A little internet research later on confirmed for Matt and I that the baby is most likely just fine. Most likely.

In fact, she's fine as long as she's growing fine, according to one website. But what if she's not? Does that make me the world's worst mommy for not eating enough ice cream prior to this? Should I lay off my daily green salad and replace it with cheap pizza?

I am encouraged by the fact that her first two ultrasounds by our favorite experienced ultrasonographer showed absolutely no problems. And this is the first time we've heard anything strange in the heartbeat. Everything should really be just fine.

The doctor said that I'll need to get a Level 2 ultrasound at Duke Hospital so they can take a closer look at the baby's heart, and that they'll call me with a time. They haven't yet.

As if I could be sleeping any worse.

Please pray for the health of Little Sister!

Doctor visit!

I'm sure you'd all marked your calendars with the date of my latest ultrasound (today), and you'll all be thrilled to know that all is well inside Mommy's tummy! Here's how the visit went:

I was nervous about this appointment, but this time more from the fact that I'd be bringing my 2-year-old than actual concern about the baby. Call it mother's intuition, but I was pretty sure the little one would be fine.

Things were much more up in the air with the 2-year-old. Last week I gave her the choice of coming with Mommy to the doctor and waiting patiently with me, or staying with one of her little friends and his/her mommy (I named a few so she go the idea). Kalina's response was to cower close to me and gently stroke my arm. Point taken.

So this morning, we role-played being in a dark ultrasound room, discussed her options for either playing on a chair or holding Mommy's hand and the fact that I still might be able to line up babysitting for her. No takers--Kalina happily role-played along as we talked about the baby in Mommy's tummy.

Fortunately, I knew that if anyone could handle this, she could. During naptime, I packed up some favorite books and toys she hadn't played with in a while, and put together three surefire snacks (I figured we could share). I was prepared as I was ever going to be.

The ultrasound began right on time. The ultrasonographer, who we love, kindly pulled a chair up right next to the exam table so that Kalina could sit on it and hold my hand. And then we got started! Here's what we learned:

Little Sister is head-down (yay!), with her face smashed up against me a little so we couldn't really get a good picture. Her heart looked and sounded perfect. She was sitting cross-legged (except I guess she wasn't so much sitting as she was balancing on her head, but you get the idea), and we could see a little foot and a little hand. And she's still a girl!

The ultrasound was scheduled to check her size, and we learned that she's approximately 3 lbs. right now, and in the 30th percentile. Looking back at Kalina's late ultrasound, the calculations were definitely off (at 37 weeks she was estimated at being about 6 1/2 lbs., whereas 15 days later, when she was born, she was 6 lbs. 1 oz.), so I think all we really know is that Little Sister is, in fact, little. No big surprise.

What's more, I have plenty of amniotic fluid: good. Not only is this healthy for the baby, but it will cushion her well against her older sister who is still occasionally known to climb on Mommy despite Mommy's best efforts.

We all came out of the ultrasound in good spirits, as I was grateful for another look at my healthy baby, and Kalina, who did remarkably well, was just glad to be out of there. The baby, having been awoken briefly by the ultrasonographer's poking and prodding, settled back to sleep. Role-playing worked like a charm, by the way--as soon as I was on the table, Kalina looked for my hand to hold and played her part marvelously well.

And then we waited for the next doctor for my regular appointment. For about an hour. In a very small, not enclosed, waiting room. You'd think that after an hour of waiting, a toddler would be at her wit's end--but not Kalina! Granted, we had some pretty cool books and toys to look at, but I couldn't help but shine with pride at how contentedly she sat in her chair, and how she knew almost every single animal in our zoo book. I think the nurse who was working in the area was pretty impressed, too.

Once we were actually in the exam room, Kalina developed enough of a comfort level that she was ready to explore, but fortunately we still had enough toys that I could keep her sequestered in the one safe corner. We also pulled out a special snack: cheese cubes. What a treat!

The doctor finally came in, and said that everything looks fine. It was a short appointment, for all that waiting. I don't have gestational diabetes, my weight gain is still on track (4 lbs. this time, but I think part of it was because I was there in the late afternoon, plus I've actually been trying to eat a bit more, just in case).

I did have one question: I wake up achy in the middle of the night and it keeps me awake. Not cool. Can I please, please take Tylenol often-ish? To get an occasional decent night of sleep?

No dice. However, the alternative is equally appealing--I should be getting more backrubs from my hubby, and taking hot baths. I asked if he could write that out as a prescription. He chose not to take me seriously (I'll request a female doctor next time).

And then, we were out the door, with Kalina chanting "All done, doctor!" on the way out. We scheduled my next appointment, and Kalina was given a cupcake sticker by the nice receptionist. It took her a good long minute to choose the pink cupcake over green or brown, and by the time we were in the car, she'd stuck it to me (as she does with most stickers). She certainly earned that sticker, having held up her end of the bargain to "wait patiently" amazingly well.

I doubt I'll get another ultrasound, and this one didn't produce a good picture (Matt compared the image to a dinosaur), so we'll likely have to wait to meet her in person before we can figure out just how cute her little smashed button nose is. No problem--Little Sister is healthy, so I'm happy!

Little Sister, second to none.

One of the things I'd thought of since early on in my pregnancy was that if I have another girl, I'll have lots of the equipment already ready to go. Not only would she justify our frivolous decisions to buy the pink toys instead of the gender-neutral ones on a few too many occasions (and Matt's just as much to blame as I am, by the way!), but she would also curl up under the same blankets as Kalina, wearing her same clothes. Easy as pie.

Always one to root for the underdog, not to mention the second child, though, I felt a little bit sad for Little Sister. Doesn't she deserve to be as celebrated as Kalina was? Dread of sleep problems aside, she's certainly every bit as welcome.

And then I recognized that, really, Little Sister will be born in a completely different season than Kalina was. She may need a few long-sleeved and long-pant articles of clothing to put over the summery onesies characteristic of Kalina's earliest days. And, what the heck, they make teensy clothes pretty cheap nowadays so we might as well get her some new sleepers--Kalina's will definitely be too big for the first few months. And she must have at least 1 or 2 dressup outfits for pictures and such--she certainly can't come home from the hospital in the same outfit Kalina wore, now can she? And maybe some socks? And how do you keep a 3-month-old warm in January? Kalina and I will be doing some serious clothes shopping in September to get ready for this new sweet little baby.

And then I looked at Lamby. Lamby is just perfect--almost pose-able, a wonderful size for hugging and a lovely little thing. We like everything about Lamby, except, possibly, that she wasn't a darker color to begin with. Little Sister will need an equivalent. And she'll actually need two, so that one can be "taking a bath" while the other fills in. We've added that to our shopping list.

But what about the nursery? We have all of Kalina's bedding--perfect. But. Wouldn't it be a little bit sad for the baby not to get anything new? She now has a white crib that Kalina helped Matt set it up this afternoon (Kalina will keep hers, as it turns into a toddler bed that's a much better size for our house than a twin, not to mention the fact that she's happily sleeping and we don't think anything is worth changing that). And of course she'll need a mattress. So there are two new things right there.

But then, I thought, she should at least have a new blanket, to be her own. Right? And maybe I can create a little theme around it, that would blend well enough with Kalina's old stuff. The theme became butterflies (have you ever noticed that baby boys can choose anything from "under the sea" to trains, while little girls can choose princesses, ladybugs or butterflies, and that's it?). And then Babies R Us was having a sale, so Little Sister now has a super-soft blanket (after all, it will be winter and she'll need to keep warm) and a sheet, all her own. And Target had a crib bumper on clearance that would match just perfectly, so even though I was definitely planning to use Kalina's, this one adds a lot of cuteness for not much money. And Little Sister will definitely need her own lamp, as we use Kalina's all the time still, and I love cute lamps and Babies R Us had just the best one on clearance that's goes absolutely perfectly, so we got it, too. And if I could just find the perfect valance, and maybe a pink or blue butterfly picture for the wall, then we'd really be set. However, Little Sister will be using Kalina's play blanket for the floor--no question about it. And her flannel receiving blankets.

Surely diapers will be reusable, too, right? After all, that's why we went for cloth. Yes, absolutely. Why wouldn't they? Sheesh. But if I do come across a really cute diaper cover, I just might have to snap it up. After all, some of Kalina's are a little bit worn, especially the mediums, which she was in for more than a year. And we re-sold a few of Kalina's newborn diapers that weren't our favorites, so those are being replenished as well. But that's it.

And it's not like Little Sister won't still be using all of Kalina's hand-me-downs. She'll just have a few new things of her own now. So we'll be able to tell them apart in photos 20 years from now.

And so, it turns out Little Sister will be welcomed in style after all. She's worth it, right? :)

Daddy's Adventure

So, Mary is sitting out for this blog and I get to write one, chronicling the adventures of the past weekend (written by Matt).

First, a metaphor:

When it snows in Minnesota, everything gets more or less covered in an evenly-distributed layer, including the roads. Then the snow plows are sent out to clear the streets, which results in no snow on the streets, but several feet of snow piled up along the roadsides. Makes sense, right?

Ok, now replace “Minnesota” with “North Carolina”, replace “roads” with “hiking trail”, “snow plows” with “hikers”, and “snow” with “venomous snakes”. And onto the story…

This past Sunday we went hiking at a local state park. This park has very well-maintained trails that get a lot of foot traffic, so it was a great place to take Kalina. She was an absolute sweetheart, and had a great time walking BETWEEN Mary and I, never more than a half-step ahead of us. We managed to find a toad, a smashed millipede, and a few other things. Kalina spotted the millipede all by herself, which was really impressive! Even the simple things (like smashed ant-covered invertebrates) are more fun with a toddler.

We were all having a great time, but even so, I was keeping a careful watch out for animals, especially dogs… and snakes.

We hiked about a half-mile out before Kalina started to get tired and anxious for Lamby and Mountain Lion (both in the car) and we turned around. Mary and I then took turns carrying her back to the parking lot. About 200 yards from the car, we spotted a big lizard scurrying around the side of a tree, about 15 feet off the trail. Leaving Kalina on the trail with Mary, I made a quick check of the ground and then stealthily crept over to the tree, hoping to either grab the lizard outright or at least scare it back to the front of the tree so the girls could get a better look at it.

I got about four feet from the tree, and started to lean around it, without moving my feet further. Sure enough, clinging to the back about chest-level was the lizard. I don’t exactly remember why I looked down at this point, but I think it was to check my footing before I took that final step to grab the thing.

Now, in 7 years of living down here, I’d never seen a copperhead, the red-and-cream colored snakes all the locals talk about. But there it was, Agkistrodon contortrix, a yard long, exactly how it looks in all the books and websites…EXCEPT THAT IT WAS THREE INCHES FROM MY SANDAL-CLAD FOOT!!!!

Does the snow metaphor make sense now? Idiot! This in NOT Minnesota…STAY ON THE TRAILS!!!

I got out of there in one piece, but was very frazzled. It was a miracle I didn’t step on it, and other miracle it didn’t just bite me anyway. Just how dangerous are these snakes? Well, here are a few fun facts about copperheads, courtesy of the fine folks at the NC cooperative extension (http://www.ces.ncsu.edu/gaston/Pests/reptiles/copperhead.htm):

-North Carolina has the dubious distinction of the most venomous snake bites of any state in the U.S.

-Copperheads produce hemolytic venom. The bite needs medical attention, is extremely painful, and may cause extensive scarring and loss of limb. Recovery can take upwards of several months.

-Copperhead bites are typically not fatal (hurray!)

-Closely-related cottonmouths and canebrake rattlesnakes often make threat displays without actually striking. However, the copperhead is different. The copperhead's initial threat display is to strike; most copperheads tested have struck out immediately when they felt threatened. This behavior explains why more people receive legitimate snakebites from copperheads than from any other species of venomous snake in North America.

Yikes. I’d still rather be lucky than good, but needless to say, we are going to be approaching these short weekend hikes in a whole new light after this incident. For that matter, we’ll now be walking around the yard at home with more care! While it was really stupid to step off the trail, we all learned a really good lesson about North Carolina fauna. And better to have it happen to me than the girls.

Fishing with Daddy

Every time Kalina reaches a 6-month marker (and ever since she turned 6 months old), we've upped our standards for her.

"No more mollycoddling!" we firmly tell each other after she's gone to bed. And in the past few months, "When she's 2, she'll go hungry if she doesn't eat the food on her plate! We can't drop everything and play with her every time she whines! She can choose two stuffed animals to bring with her anytime we leave the house, and that's IT!"

Fortunately for Kalina, she's so cute and relatively well-mannered that the actual changes are rather minor and inconsistent. (However, we have managed to limit her to one group of stuffed animals wherever we go: she can choose either her 4 cats, her 5 farm animals, or the Lamby and Mountain Lion pair. This is an improvement.)

And also, there are the happy changes: no more diapers for naps, a few more "treats" than we used to allow Kalina and baby gates that are collecting dust in corners rather than blocking her way as she runs laps around the downstairs of our house, as Kalina can easily navigate steps on her own and knows that the litter boxes are yucky.

But one of the biggest new developments is the privilege of being able to fish with Daddy. After feeding the brim (small fish that hang out in the shallows) with bread and noticing how fast they gobble it up, much to the entertainment of our toddler, Daddy couldn't help but toss a line in. On our first trip, he took the top part of a collapsible rod (so it'd be small enough for Kalina to hold), baited it with thawed frozen corn, and was pulling up a small fish not 10 seconds after lowering the hook into the water.

A few minutes later, Kalina had caught her first fish, and then caught several more without any help. I'm not sure I've ever seen her so proud.

Bedtime was approaching so we couldn't stay long, but Daddy and Kalina headed out again the following Saturday morning to catch their fill (figuratively, not literally). And here's what that looked like: