The Mommy Side of "Routine" Surgery

My son got ear tubes today--bilateral myringotomy with tympanostomy tubes in medical jargon.

I watched dozens of these surgeries when I was a third year medical student rotating through Pediatric ENT, which was actually a surgical subspecialty I enjoyed.  I'm really not a surgeon type, in case you couldn't tell. Wearing hot scrub gowns and masks while holding retractors all day is not my image of paradise.  But ear tubes and tonsillectomies were pretty cool.  First off, you didn't have to gown up so no sweating and having to avoid scratching your face the entire day.  Second, the kids were pretty healthy and super cute before you put them to sleep.  And, last, the procedures lasted 30-45 minutes tops (and this was rare).  Ear tubes were the most minimal of the surgeries.  They take about 15 minutes.  They are very quick and purely routine.  In other words, not a big deal.

Until you're the mom.

From my understanding and experience, ear tubes were usually placed after struggling with many, many ear infections.  Liam had had one that we knew of.  But he had fluid in his ears that may have been there since the fall and he had since started developing a speech delay that was becoming concerning by his 15 month check up.  His pediatrician sent us to an ENT who recommended ear tubes.  To explain why, the ENT told us to stick both fingers into our ears.  That is how my baby was hearing.  His tympanogram backed this up, showing that the ear drum on one side was not moving at all and barely so on the other.  But the ENT also reassured me that I had time to think and decide.  A few weeks would not change anything.

I agonized over the decision of whether or not to have my son undergo this surgery.  No surgery is without risk.  The dangers of anesthesia (though it's really more like sedation in this case and is about as low risk as it gets) are not a joke.  I know about those rare cases where a patient can start breaking down their own muscle in reaction to the anesthesia, get acidotic, overheat, and die.  Of course that's the extreme but some studies are blaming general anesthesia for lost IQ points, increased ADHD and other behavior problems.  And there's the more common and well-known risks of breathing disturbances, aspiration, nausea, vomiting, and headaches.  Then there's the possible complications of the surgery itself: needing more ear tubes, scarring of the ear drum, a permanent hole in the ear drum, hearing loss... the possibilities go on and on.   I knew too much and couldn't help worrying about it.

Different doctors advised us to do different things.  The fluid could clear.  It was almost spring; fluid clears in the spring.  Or he could get retractions and scarring.  But that's rare and the surgery could cause it too...  It was confusing to say the least, but the overwhelming message seemed to be "get the tubes...they will help him hear and feel better.  You won't regret it."

I did some research and found a great article from the AAP that I thought I would share with others who are in the processing phase after being told by a physician that their child needs ear tubes.  Here's the link: AAP Practice Guidelines: Otitis Media with Effusion The article restated what I already knew: that tubes are overused and that the surgery is not without risk.  But there are instances when it is the best choice.  It shared some criteria that have been identified in children to predict better outcomes when tubes are placed.  Liam fit the criteria because he has a speech delay.

 During the period of time (a few weeks) that we were thinking about whether to go ahead with the surgery or not, we started noticing more and more that he didn't seem to hear very well.  My mom tried the blink test by snapping near his ears--no response.  One of my friends tried to get his attention by clapping loudly--not even a flinch.  His speech delay seemed to worsen instead of improve.  He stopped saying "Bubbo" (for our cat Bubbles) and even went through a period where he stopped saying "Mama."

So, we decided. We needed to give him the best chance for building his vocabulary as soon as possible.  I went to his ENT the next day and scheduled the surgery feeling that we were making the right decision.

From my rotation through Peds ENT, the thing I remember the most is actually the part that I dreaded the most.  The part where the kids are wheeled away from their parents, sometimes screaming at the top of their lungs.  Back then, my son was about 5 months old.  With my new-found maternal love, I felt the heartbreak of the parents each time, and I teared up frequently. (The hormones were still flowing strongly...but perhaps they never stop for us moms because I never was a crier but I still am today).  I was thinking how terrible it would be if that were me...

Fast forward a year to today and it was me.

 Liam is a typical toddler and did not wait quietly in the pre-op room.  We roamed the hallway with him.  He was hardly anxious. But I teared up as I saw other kids being wheeled away. I was surprisingly dry eyed when it was our turn.  We had refused the Versed they wanted to use to ease the separation anxiety because I felt it unnecessary to add to the many medications he was already going to receive (much to the disappointment of the anesthesiologist who I could not assure that he would go back to the OR without shedding tears).  But I tucked him in on the gurney with his security blanket and paci.  The nurse pretended the bed was a choo choo train and I advised them not to force him to lay down so they let him ride sitting up.  I clapped for him as they wheeled him off and thankfully he didn't shed a single tear while I could still see and hear him.


Those 15-20 minutes we waited felt like an eternity.  I was just beginning to worry when they called our names.  My husband says I ran to my baby.  He couldn't even keep up (that's saying a lot if you know my runner).

Liam was a champ.  He was the happiest of all the babies that were in recovery (the nurse told us that the distraught baby next to us had received Versed and in his opinion with short procedures like this, it irritates them much more upon awakening due to leaving them with a drunken feeling that they can't shake as the anesthesia wears off).  My baby was pretty happy as he snoozed once I was holding him and he had his paci firmly back in place.  Then, in about 15 minutes, the anesthesia mostly wore off and he woke up. We dressed him and we were off.  He even downed a Mango squeezy snack and some crackers in the car on the way home.

Now, 12 hours later, I feel even more confident in our decision (thank goodness!).  Besides sorely needing a nap when we got home and being a little dizzy and somewhat grumpy intermittently, he has acted pretty happy today.  (Though he despises those ear drops we have to give twice a day!)  He loves his prize from the OR, a pretend sword and shield.

But the biggest thing that we are overjoyed about: our baby boy can hear so much better!  We can already tell.  He's started making new vocalizations (of course no new words yet since it hasn't even been a day).  But there is change.  Even the way he says "uh-oh" is different. My husband described it sounding as if Liam can finally hear himself and can self correct the sounds.  He's also more sensitive to noises. He jumped and covered his ears when I dropped one of his books onto the carpeted floor in our living room (never has he done this!).  He also announced proudly "Uh-ooohhhh!" when the Keurig hissed out my hot chocolate after lunch.  I'm excited just thinking of all the new sounds he can hear now!  I can't wait to hear his precious voice talking to us soon!

Cloth Diapering? Insane! (Or So I Once Thought)

This literally summed up what I once thought about cloth diapers: "Those moms are insane.  Cloth diapers are definitely not for me.  This is the 21st century, after all!"

Where did this strong fervor come from?  Probably my mother's stories of cloth diapering my brother back in Hungary in the early 80s.  The basic story goes something like this.  Cloth diapers were not pockets or all-in-ones.  They were squares of cloth that were folded into a triangle shape (with each use), one corner pulled up between the baby's legs and the other two at the hips.  A rubber outer cover was then pulled over the previous layer and tied at each hip.  This obviously would not be an easy process with a squirming baby.

 But worse was the washing.  There was an order to the whole ordeal.  And lots of buckets.  First was the soaking bucket.  After the soiled diaper had all of the solids knocked off of it into the toilet (or dunked if needed), a bucket filled with bleach and water was used for soaking. Each day, the diapers from the previous day were removed from the soaking bucket and placed into the washer.  The washer had no centrifuge so after the wash, the dripping diapers were moved to the bathroom for further rinsing.  A wooden plank was set up across the tub on which a series of buckets of water were arranged.  The diapers had to be dunked and kneaded in clean water 4-5 times to be considered rinsed from the bleaching process and safe for baby's bottom.  Then these diapers (once again dripping) were placed into a centrifuge to remove excess water.  The centrifuge could only hold about 2-3 diapers so this step took some time (and perseverance).  After each had been centrifuged, the diapers were taken outside and pinned to a line to dry.  Once dry, the inserts had to be ironed.  The rule was to iron both sides until baby was 2 months old and then only one side for the remaining months that diapering was needed.

Then came the worst part. Her mother-in-law (my beloved Nagyi, Katalin who was a wonderful woman but VERY particular) would come over and criticize my mom for the poop stains on the cloth.  This was unacceptable, she said.  She told her she would teach her how to do it right and started washing the already clean diapers all over again, this time by changing the soak bucket to one filled with boiling water and bleach (if you recall, we began with just cold bleach water).

My mother says cloth diapers make her feel sick to this day. (And who can blame her?  Entire days of her life were spent folding and tieing and soaking and rinsing and rinsing and rinsing and carrying and dripping and centrifuging and hanging and pinning and ironing...)

With such stories racing through my head and disposables heralded as a sort of women's lib item, one can hardly blame me for never even considering cloth diapers before my son was born. I even remember a discussion I had with a daycare worker a few years before he was born. It was during a rotation in which we spent some time observing in the hospital's daycare.  I remember  discussing fervently how "crazy" one mom was for sending her baby to daycare in cloth diapers. Why scrape and dunk and wash and stain when you can remove and toss?  Who wants to touch poop over and over if they don't have to?!  They must be insane!

But then, very slowly, after I became a mom, I started to open up to the idea.

I saw friends using cloth diapers (friends who weren't insane, if you were wondering).  And the diapers they used were so cute!  I realized how quickly we burned through those $40 boxes of disposables from Sam's Club.  (The trash was also smelly and enormous in quantity.)  I also realized that I dealt with my son's poop outside of his diaper more than I had imagined prior to becoming a mother.  I rinsed the wonderful yellow breast milk goop off of more onesies than I could possibly begin to count.  The thought of dealing with it inside of a cloth diaper became less horrific over time.

I started researching and I came across a wonderful blog post.  One Lazy Mom's Guide to Cloth Diapering. It spoke to me.  I highly recommend it to anyone on the fence about cloth diapering. This post made me feel ready.  It made me feel like I could do it.  It also made me feel like it was ok to try, even if I ended up deciding it wasn't for me.  I suddenly wanted very badly to try.  After all, if a lazy mom can do it and love it, maybe I could too...and save us some money in the process.

The last obstacle was my hesitance to eat the cost of a stash in case I really did hate cloth diapering. $20-30 a piece is quite an investment for us right now.  And I'd need more than one or two for sure.  Minimum four I figured so...$80-90.  Too much  (I would never hear the end of it from the hubby and I would feel quite guilty as well).  Then my friend introduced me to Alva Baby Cloth Diapers.  Not American economy friendly but wallet friendly.  Cheap Chinese diapers for $5 a piece.  I had my in!  I could afford to try them!

So I bought two. (And, yes, I agonized over choosing the designs.  There were so many adorable ones!)

They arrived in 2 weeks in great shape (despite some scary reviews I had read).  It was love at first sight. So I bought four more.  Then four more.  For a few months, 10 was all I had and all I needed since we only used them when I was home so mostly on weekends.  There was a learning curve, but I was hooked!

I had some difficulties with leaking as my son and his bladder grew (more on this in another post) so I broke down and bought a BumGenius 4.0.  I chose them because they are conveniently available at Buy Buy Baby (for which I get tons of coupons) and I had read great reviews.   $14 I could live with now.  I knew I'd use it enough times to more than make up for the cost. The question was, whether they were worth being almost triple the cost of Alvas?

They definitely are!  I've never had any trouble with leaking and it comes with two microfiber inserts.  I use the newborn insert to double up the Alvas so that I can keep them in service (despite that large bladder). I now have a stash of 7 BumGenius 4.0s, 1 Bumpkin, and my original 10 Alvas.

We cloth diaper day and night, any time we are home. (And the hours of a fourth year medical student are much more lenient than they were in third year.) One of the many reasons I can't wait for my year-long stent as a stay-at-home mommy is so I can cloth diaper full time.

Each disposable we use now feels like a waste. We continue to use them though because I just don't have the heart to force the daycare to use cloth on my son.  Because I really do get where they are coming from.  I've been there...."Cloth diapers?  Insane!"

To Moms Whose Babies Reach Milestones "Late"

I've been reading a lot of these "letters" to mothers, wives, etc.  This letter is to me and all the moms who have struggled with their babies having "late" milestones.  I hope mothers going through a similar experience will find some encouragement.

To the mothers whose baby met every single milestone "late"; to the mom to whom on some days Facebook feels like just another painful reminder of how far "behind" your baby is; to the mom who actually has had a daycare worker ask you if you are holding your child "too much" or somehow preventing him or her from sitting/crawling/walking or whatever the current "late" milestone may be; to the mother who worries every day despite being told not to worry by other mothers who've gone through the same thing; to the mom who cheers her child on even louder and prouder than other moms because instead of dreading the new stage that reaching a developmental milestone brings and mourning the loss of another "baby" feature, you're proud (and relieved) that finally, finally your baby has learned to do something that you've both been working on so hard together.

Let me start by saying: you are not alone.  I am struggling with this and all the emotions that go along with it.  My son turned 15 months yesterday.  He can't walk. In fact, he can't even stand without holding onto something.  He cruises and crawls like a champ but so did all the babies in his daycare class at 10 months old.  

He has been 3+ months "late" on each and every physical milestone (except throwing a ball overhanded, which he did at 8 months :).  He rolled over front to back at 5 months, back to front at 8 months. He sat at 7 months.  He crawled at 10 months.  He (finally) pulled up at 11 months.  

And at each and every milestone I worried.  I'm a mom.  I can't help myself...it's hard not to worry when I see babies more than 3 months younger than mine walking.  

My husband reminds me often that our baby IS "normal" and healthy.  And I know most likely everything is fine and I shouldn't worry because milestones are just averages.  Standards set like lines drawn in the sand.  There is something inherently artificial and generalized about them.  Your baby does not have to necessarily fit these perfectly.  Development ranges widely, naturally.  

My cousin reassured me that it must be genetic because her 3 kids did the same thing.  They were behind, every time.  Her youngest didn't crawl until 12 months!  She's 2 and a half now and running around like all the other kids.  You'd never know any of the 3 had any differences in timing of milestones as babies.

I scoured the internet and (as you would expect) found an incredible number of differing opinions and stories. But one mom's words to another mom who has a 15 month old son (just like me) who isn't walking, really helped me so I thought I'd share them. 

Your son is totally normal. I understand how you feel though. My daughter just started walking at 15.5 months. She was slow with all of her physical milestones. At 12 months, her Dr. sent us to physical therapy, which was incredibly scary to me. The PT told us that she was totally normal and that she would walk when she was ready. So, that was our first and last visit. One night after dinner, she was cruising around the furniture and then just let go and started walking, practically running. It was SOOO exciting. Looking back, I feel like I was lucky to have a late walker. She was more baby-like for longer. Now, she is a full-blown toddler, with things to do and places to go. And remember, it is totally normal for kids to walk from 12-18 months. ~mom who's been there 

                                       

So, I wanted to remind moms like me that, like anything else in life, waiting for something longer makes it that much sweeter. And, people like that daycare worker who, knowingly or not, make you feel as if you've "messed up" in parenting somehow because your baby reaches milestones later than other kids their age, are totally out of line.  (Since when is it ok to make someone feel bad for something they have no control over anyway?!)

Don't let anything (or anyone) take away your joy and your ability to soak up these precious "baby-like" moments. Relish in the fact that you were given the gift of just a few more of these beautiful memories. That's what I've decided to do. After all, my son wouldn't be doing things like holding onto my legs in order to follow me around or playing "hide-and-seek/crawl all over mommy when you find her" anymore if he could walk, would he?

They grow up too fast already. They certainly don't need us rushing them. 

Not So Picture Perfect

This is our family picture for our Christmas card this year.  We look happy, smiley, together, and in my opinion, the cutest little family I have ever seen. I love this picture!  Don't get me wrong, I am blessed with the two best guys out there!  But, believe me, we are in no way as perfect as this picture seems to suggest.  Last night reminds me of the truth that we never know what lies behind the pictures we see on blogs and social media.  People aren't as picture perfect as they seem so there's no use feeling like you don't measure up!

I was thinking about this as my husband and I tried to address and stuff the almost 30 Christmas cards of this picture to our friends and family (and this was the shortened list because I knew this would be no easy task).  My husband, always the letter writer in the family, was meanwhile hand-writing short notes to each of his aunts and uncles.  It sounds like a magical night during the Christmas season.  Mommy, Daddy, baby boy and holiday traditions (and don't forget the beautiful picture on the cards!).

In actuality, the scene was anything but picture perfect.

My son, in between pulling my hair and attempting to prevent me completely from writing, scattered an entire bag of Christmas candy across the living room and threw each and every item (envelopes, cards, paper, stamps, return address labels, my list) from the coffee table to the floor (multiple times).  Every few seconds my husband or I seemed to throw out a half-hearted "don't eat that!" "that's not yours, Liam; put it back" "there's no reason to whine" "play with one of your toys" or "let Mommy write, PLEASE."

We barely managed to address and label 3/4 of them (which became my goal for the night part-way through because one can only handle so much crying!).  There was no drool or serious folds in any of them (who knew that could feel like such an accomplishment?). Liam had multiple tantrums/crying fits and there was snot running down his face by the end of it.

I really wish I had a picture of our living room and his face.  It was in stark contrast to the pictures we sent out today, but, you know what?  I wish I had a picture not only because it would be fun to share it with you, but also because that is a memory I know I will cherish (and laugh about) someday with my husband.  "Remember that time when Liam was one and we tried to get our Christmas cards together just a bit too close to his bedtime?"

That memory isn't quite as pretty as the card we sent out, but isn't real life better anyway?

This hits home for me because I often find myself comparing myself to other moms.  Craftier moms, ones that make pancakes in the shape of snowmen and a sandwich that looks like Rudolf.  But, you know what?  There's more to every story than what we see on blogs, Facebook, and Pinterest.  We don't know what's behind all those pictures.

I want to challenge us mothers to be real with each other. That's how we can best help each other through this crazy beautiful mess called motherhood.

Parenting is messy, stinky, slobbery, urine-soaked, snot-covered, and in general, just not picture perfect.  But it is beautiful, fulfilling, heart-warming, love-filled, kiss-covered, and snuggly.  Now, tell me, what could be better than reality???