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!

Toddlerhood in Full Swing: 16 Months

I can’t believe my little guy is headed toward a year and a half now.  Time sure flies!  This month has been full of firsts for our baby boy so I wanted to share some of the excitement.

My baby started walking this month!  I took him to his first physical therapy appointment (for not walking) and the PT freaked me out that his feet were pointed out too much, his ankles were too weak, and that everything was just all wrong.  She said he'd need braces up to his knees and lots of PT....Eek! (I feel anxious even now thinking about what she said despite knowing that he's fine!)  At any rate, she must have scared Liam too because he started walking that same day!   He took 3 steps from me to a chair.  I was beyond thrilled!  From there, within a week he was toddling everywhere.  It’s so cute!  I love watching him toddle around the house.  It’s definitely made him even more mobile.  Lately, it’s not an uncommon sight for me to be chasing after him as I attempt to brush his hair, put his shirt on, etc.  (And he’s fast!)  He also refuses to sit still now.  He wanders restaurants and squirms to get down as soon as we step outside in the morning.  He's a real toddler now with places to go and things to discover!

My baby had his first haircut.  He looks like such a handsome little BOY now!  We went to a local barbershop that my husband uses for his haircuts.  They don’t have a kids haircut place where we live unfortunately.  I was a little worried but they and he both did great!  I had to hold him in my lap since he wouldn’t sit on the padded plank they set up for him and he moved a lot but the barber was great.  We got the whole thing on video, down to Mike (the barber) talking about how lucky we were that Liam is a boy because we only have one penis to worry about (I know...WHAT??!).  I’m sure it’ll be hilarious when we watch it in years to come.

I weaned my baby. This one was a tough one.   Originally, I was going to let him self-wean.  But we made the decision to start weaning months ago.  (There were a lot of personal/family decisions that played into this.)  I went very slowly, cutting back one feed each month.  Each time the transition was smooth, but this month I cut out that final feed, the one before bedtime.  This was harder than I thought it would be!  On ME not him! (more on this sometime) I was dreading how he’d take it, but he did really well.  We gave him some toddler formula before bed (which he loves!) instead of nursing but kept everything else the same.  I rocked him, sang to him, brushed his teeth and read to him like I do every night then put him to bed.  He had no trouble sleeping!  He has taken to pulling my shirt down at times as if he's checking to see if my breasts are still there.  But that's really the only change in behavior he's had. 

 

Coloring for the first time.  I’ve been trying forever to get Liam to color.  I see people posting pictures of their kids coloring at his age, but until now, the concept was lost on him.  He loves to eat crayons (which I think is partly because he always gets them at restaurants...I can see how this can be confusing) and he loves to beat them against hard surfaces (AKA: break them).  I finally got him to scribble using the big baby crayons my mom got him for Christmas.  Once again, I was through the roof.  (I'm sure you can see a trend here in my reactions.  Thankfully, he's too young to say "Mooooommm, please!")

20 Life Lessons I Discovered in the Dark

So, for those of you who may have missed it, Georgia has had two snow and ice storms this winter (that groundhog knew his stuff this year!). Atlanta seemed to have the worst time of it during the first go-around but Augusta was hit pretty badly with the second storm. The second storm was mostly ice and was much worse than the first for us in the eastern part of the state because of the damage it caused.  There were tens of thousands of people without power for days. Trees littered the streets (and still are piled high in yards waiting for the county's promised free disposal). Ice and snow pretty much never happen down here in Augusta, especially not to the extent it did this time.  In fact, the closest thing we get to something resembling a natural disaster are bad thunderstorms (not impressed? you shouldn't be...).  As a result, our trees are never pruned by Mother Nature. So the ice surprised them as much as it did us humans. Here's some images of the chaos that ensued.

Down Town Augusta even had trees uprooted

Walton Way in Augusta, GA

My little family was without power for 48 hours before we decided to give up the pioneer life of chopping firewood and boiling water in the fireplace and turn tail and run (to my parents of course and just in time to miss the next thing thrown at Augusta...an earthquake!). But not before I learned some great life lessons.  I thought I'd share them here with you:

1. Your hand goes instinctively to the light switch when you enter a dark room, even on your second day into knowing that nothing is going to happen when you flip the switch.
2.  You think that it's hard to find the random things your toddler hides from you when you have power?  I'm here to tell you, it is impossible to find something like a bath tub stopper that your child crawled away with when all you have is a flashlight (even if it is an industrial one).  You might as well get creative and use something else to plug the tub!
3. My husband can actually get tired of splitting wood and starting fires! (I never thought this would happen! Not until pigs fly and the moon turns blue.)
4.  You still have hot water if your boiler runs on natural gas.  This seems like an obvious fact, but it felt like an amazing gift when I was soaking in a tub of hot water after shivering all day!
5.  Mens' socks work as DIY babylegs.  Just cut the end off for little feet to slide through and voila! another layer to keep your baby from freezing. (You may want consent before you cut....oops!)
6.  People always talk about disposables having the drawback that you can run out and have to run to the store...well, with no power, the cloth diaper stash started running low.  Forget the milk and bread and buy some disposable diapers when a storm is headed your way!
7. When there is no power, the warmest place in the house is by the fire.  So, this naturally becomes your living room, kitchen, baby room, etc.  And the changing pad belongs on the coffee table right in front of the fire, of course.  Coziest changing table on earth!
8.  My son refuses lukewarm formula (he spews it from his mouth! Well, that may be a little dramatic but he wouldn't drink much).  Even boiler warm water is not adequate.  He likes his milk hot!
9.  On that vein, you can actually boil water by placing a pot near the fire in the fireplace.  We have a metal ledge around the edge so this may have helped by heating the pot from below too. (And the plastic lid handle never melted, thankfully!)
10. Chinese restaurants are always open.  Always.  They will find a way to have power and open even when nothing else is open.
11.  Nothing tastes better when you are cold and it is dark, than hot anything.  Hot chocolate, Chinese take-out, soup, s'mores... we tried it all and loved it all.  Every single bite and sip. (See #9 and 10 for how to obtain these wonderful things.)
12.  USPS actually does deliver in rain, snow, sleet, and ice.  These four situations are ones I have personally witnessed.  Liam's Valentines Day diaper's arrival was even more exciting in the midst of nothing else to be too excited about.
13. Duck down blankets are a must for survival planning for a home.  It actually feels like you have the heater on full blast when you're under that thing and you fall asleep so easily after shivering all day because you just feel warmth hugging you all over.
14.  My cats fear my son more than cold.  They chose to spend the majority of his waking hours in the coldest room in the house (safely on the other side of the baby gate) to avoid him, far away from the warmth of the fire.
15.  Back-up power supplies are not meant to run space heaters, even for a minute. They make a horrific noise because the circuit is instantaneously overloaded.  Honestly, they are useless in a power outage that lasts more than a few seconds.
16.  More of your neighbors have generators than you may think.  (Really.  Mine do and this is hardly a rich neighborhood.)
17. When all else fails, run home to your parents.  (This is a great life lesson in general!)
18.  Georgia weather is like a pregnant woman's mood swings...it can actually be in the 80s the week after a crazy ice storm. (It really was.)
19. Sago palms do not like ice storms.
20. Baby gear for really cold weather is adorable!

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.