Monday, March 30, 2009

Six months

So, Andrew's six months old. I love this stage of babyhood, because he's old enough to have personality, but he's still easy to keep up with. That will be short-lived, because he is rolling/squirming himself all over the place, and I think we are no more than a month or so away from actual crawling. He still tends to fall over when sitting up, but he's figuring it out day by day. He's a very happy baby as long as he is being played with, held, talked to, and otherwise interacted with, full of smiles and giggles. Until this weekend, he'd been doing very well about sleeping through the night, and even the 45-minute naps are slowly stretching out to an hour, sometimes an hour and a half. In most respects, things are going well.

The not-so-good respects is our old bugbear milk supply. At his six-month checkup last week, he weighed 15 lb 14 oz. That's 25th percentile, not terrible of itself, but it's only a six-ounce gain in five weeks. The doctor pronounced herself unconcerned, because babies do often slow down at this point, but now he's started acting hungry again. He's nursing every two hours again, biting and acting mad at me after feedings, and waking up at night again. He feels lighter to me than he did a couple weeks ago, and my mom also noticed a difference. When the wet diaper count started to drop off, I was pretty sure we had a problem again.

I had weaned myself mostly off the Reglan, mainly because I was tired of taking pills, so the first thing I did was to go back on it three times a day. I've taken Reglan for months now, and took it for months during my pregnancy with no problem, but apparently I've crossed some side-effect threshold. After just two days of increased dosage, I've been jumping out of my skin, restless and anxious and weepy and sad and obsessive, in a way that is very much not like me. My LC's nurse thinks this is probably due to the Reglan, and told me to get off it posthaste. Low milk supply is better than emotional instability, to be sure, but I'm not happy about losing the Reglan just when I need it more.

I had started Andrew on solids on his birthday, beginning with mashed banana and pureed pears and applesauce. He's been showing signs of readiness for a while -- watching our food like a hawk, stealing off our plates, gumming anything you hold up for him to taste -- so I was surprised when he wasn't enthusiastic at all about the fruits I offered. After some experimentation, though, I think perhaps he just doesn't like fruit much, because he likes oatmeal just fine, and any bits of our food that are soft enough for him to eat. Rice with vindaloo sauce was a huge hit, and I thought the kid was going to take my hand off over mashed-up new potatoes -- I couldn't get them in his mouth fast enough.

So solid supplementation will take some of the pressure off the milk-supply thing, I hope. I'm giving him a bottle at bedtime again, too, which he attacks with enough vigor to reassure me that he needs it. I don't intend to wean him yet if I can help it, and would really like to keep nursing to the one-year mark, but it looks like I just can't keep up with breastfeeding alone.

Low milk supply is a real thing and does happen, even to women who do everything "right". I've never doubted that, but I just didn't think it would happen to me. I had hoped the first episode was a temporary hurdle, but it looks like something I'll have to fight for the rest of my time as a nursing mother. It's not just the Reglan talking when I say I'm sad today.

Thursday, March 19, 2009

To everyone who ever asked me

"Why don't you just adopt?"

I come down on the pro-life side of the abortion continuum, if mildly so. Obviously, I am less than hardcore, as I was prepared to proceed to IVF, and got up-close-and-personal with the possiblity of high-order multiples and of serious genetic defects. I would not, I think, have chosen termination under either circumstance, and I am sure that I would have gone down the embryo-adoption path had it come to that; but I've at least thought it through enough to know that I am somewhat mushier on the subject than, say, the Catholic Church. However, I have much greater reservations about ending pregnancies which are merely unwanted due to age or circumstance, which don't fall into those exceptional categories or involve rape, incest, or maternal health.

That doesn't mean I can wave my hands and talk about how adoption is always such a wonderful alternative. It can be, under some circumstances, and under others, it can be hideously damaging. We most likely would not have considered adoption, although you never know until you get there, and this article illuminates one of my major reservations. I have deep misgivings about taking another woman's baby just because I happen to be wealthier and have a broken reproductive system. It's one thing if we're talking about babies who are already in a foreign orphanage or the foster-care system, and another thing entirely when the baby's mother isn't out of the picture before the subject of adoption arises.

There are no easy answers, and I think it's important for pro-lifers to understand that adoption is not a panacea. It's possible to believe that an unborn baby's right to life is important, while acknowledging the real consequences of that belief. Rights are about more than just the least-unpleasant alternative, but that doesn't mean you get to pretend the collateral damage doesn't exist.

Sunday, March 01, 2009

I am contractually obligated

If you have a parenting blog, it's mandatory to do a sleep post at some point. (I'm sure it's in that terms-of-service legalese SOMEWHERE.)

We started out with Andrew in the co-sleeper, swaddled and pacifiered, and initially it was lovely to roll over, feed, and put him back to bed. As newborns do, he napped wherever he happened to be, in the swing or in the crib or especially in the bed for naptime with Mama. We've fought the 45-minute nap monster his whole life, but he seemed happy enough, and went to bed at 8 PM or thereabouts without complaint. In November, he started sleeping until 7 AM, and I thought we had the sleep thing more or less licked.

In retrospect, the return of the night wakings should have been a clue that my milk production was on the wane. Once I got clued in to the great milk supply debacle, I started making sure he got a supplemental bottle at bedtime, and resigned myself to night feedings for a while. There was no question he was getting hungry in the middle of the night, and straightening out his weight gain was the top priority. Eventually he dropped the 2 AM feed, but was still waking up at 5 AM and then getting up for the day somewhere in the 7-8 AM range.

The milk supply seems to be pretty well fixed now. I gradually weaned him down to one 4-oz bottle a day, and when he gained a whole pound in a week on that single bottle, the doctor gave me the okay to discontinue it. (He even had RSV and needed a nebulizer during that week, and still he gained a pound!) I'm still on the Reglan, mainly because I'm scared to mess with non-brokenness. He's obviously gaining weight, and during the day seems very content. He's spacing his feeds out to be more like every three hours, instead of wanting to eat every hour and a half or two hours, which is a really nice break.

Now that he's knocking on the door of six months old, I'm getting really ready to get him out of our bedroom. He is a light sleeper, easily disturbed by the TV on the other side of the wall, or the barking dogs, or toddler wails. I miss not being able to read before falling asleep, and fold and put the laundry away in the evening, and have conversations with my husband in bed at night. To that end, I spent last week painting his room and setting up his nursery (total case of third-child syndrome, that).

More importantly to Andrew, I took his pacifier away and stopped nursing him down. He got to where I couldn't put him down unless he was so deeply asleep that he didn't care if it fell out of his mouth, and couldn't get back to sleep without it if he started to wake up. I'm still rocking him to sleep, and he fusses for a minute or so about wanting something to suck on, but then he goes down and stays that way until he wakes up for a feed. I'll be dropping the swaddle tonight, since he is outgrowing the blanket and also keeps winding up on his tummy, despite the sleep-positioner foam blocks I bought to prevent that. No plans to drop the rocking -- that was a major production with the girls and involved some crying-it-out, which I'm just not big on at his age. (I don't consider the pacifier removal fussing to be CIO, given that he's crying while being held, rocked, and sung to.) He's still waking up to eat in the middle of the night at least once, but at this point I'd rather go upstairs and either nurse him there or bring him back downstairs.

I'm pondering night-weaning, but I'm not ready for it yet, especially given that I am probably about to disturb the milk-supply equilibrium with endometriosis treatment stuff. After almost three weeks of good days, I've had some pain trouble again for the last several days; and I can't explain without going into TMI territory, but the endo has clearly been growing. I'm going to see the RE for another scan this week, and depending on what the ultrasound shows, it's probably time to start treating it, before it gets too invasive. I am half leaning toward asking for another lap excision, but I expect he will want to at least try BCP first. We'll see.

The sleep thing could certainly be worse, and it makes me realize just how fantastic the girls were at this age. They slept from 8 PM to 8 AM with three 1.5 hour daytime naps, which is as close to textbook sleep habits as you can get. I could wish Andrew napped better and didn't still wake up in the night, but I know the status quo really isn't too bad.

Wednesday, February 11, 2009

I am full of random

I have more random than time to blog, so here, have some bullety goodness:

  • The Percocet-free days count is now up to six. My last post started a string of bad days, but I have been feeling almost normal since last Friday, with only NSAIDs

  • I am not sure if this is a natural good streak, or if it's due to the new NSAID (Ponstel) I started taking on Thursday. My RE has had other endo patients do quite well with Ponstel, so it may be working for me too. Regardless, it's a good thing.

  • Andrew learned to roll over back-to-front, but cannot push over again onto his back. He expresses much TINY BABY RAGE whenever this happens, but promptly goes and does it over and over again.

  • He can even do it when swaddled, which produced a couple nights of acute misery. However, the purchase of a sleep positioner seems to have solved the problem for now.

  • I am still going to try to wean him out of the swaddling blanket, because he's outgrowing the thing.

  • He weighs 14 lb 8 oz as of Monday, so I've dropped another bottle, and he is now getting just one 4-oz bottle a day.

  • The improvement in my milk supply has brought me within 2.5 lbs of pre-pregnancy weight, if not quite so close to pre-pregnancy shape.

  • I have zero enthusiasm for doing anything else about that, and am thankful that "low milk supply" gives me an excuse not to diet.

  • As if I needed an excuse, being a grownup and solely responsible for my own weight and food behavior. Insert Shapely Prose rantage here.

  • Or I could try eating like a toddler. Claire in particular is getting rather thin, having better things to do than eat.

  • Having had a bout with eating disorders as a teenager, I'm acutely aware of the many pitfalls of raising girls, and modeling healthy behavior, and walking that fine line.

  • I am watching this story play out with my seven-year-old niece right now, who is just slightly overweight enough to have triggered my mother and sister into making comments about her weight and suggesting that she change her eating behaviors.

  • This probably deserves a post of its own, or a series of them. I'm pretty upset about the thing with my niece, and pondering how I'll handle the issue when it comes up (as I strongly suspect it will, especially with Katherine).

  • After months and months of bedtime/naptime chaos, I have finally instituted Project I-Said-Stay-In-Your-Beds. Bedtime is going supremely well, naptime less so. This too deserves a full post.

I think that's enough random, don't you?

Monday, February 02, 2009

Like an industrial accident

Pain-free days: 0

So much for that bright idea.


Sunday, February 01, 2009

This is not my beautiful life

I'm still trying to wrap my head around the whole endometriosis thing. Out of nowhere, I have a chronic disease that's going to have daily effects for the next ten or fifteen years, and all I can do is blink and say, "the hell? How did I get here?"

I have now had three relatively pain-free days in a row. Even the good days haven't been entirely good, I've still had some pain at here and there, but they've at least been good enough that I haven't had to take anything other than my usual handful of prescription-strength naproxen. It should illustrate the whole state of affairs, that three days of relative normalcy is noteworthy. Prior to that, the last week has included two days where I had to resort to narcotics, two other days where I made do with soaking in hot water, and daily cuddles with my rice bag heating pad.

(Some people make lemonade when life hands you lemons. Me, I sew up rice bag heating pads. If you can sew a straight seam, or have a friend who can, I highly recommend them. Take a 17 x 21 piece of 100% cotton fabric, fold it in half, sew it up on two sides, turn inside out, fill with 2 lbs of rice, and stitch up the remaining seam. Microwave for 2 minutes and it's a warm slice of heaven. Mine has a pretty cover with a zipper, but that's not essential for functionality.)

Anyway, so I've had a couple not-terrible days where I've almost felt like my old self, and it has really made a sharp contrast with the "new normal". I am hoping the feeling-good days are related to where I am in my cycle, because if that's so, at least I can expect a good week, maybe even two. If it's not, well, that's going to pretty much suck.

The reason I am trying to still make jokes about it is because I don't really have a choice. This isn't going to go away, at least not until menopause, although I have some hope that some treatments might help. I've decided against Lupron and Danazol, due to high failure rates and unpleasant side effects, but I'm going to try BCP. I want to make it to the six-month mark first, since I may well wind up having to wean Andrew. I'm going to ask for another ultrasound first -- I am deeply suspicious my left ovary's got some nastiness going on, which would push me toward surgery first. If not, I'll try BCP, and then another lap if things don't improve quickly.

I kept hoping we'd get this thing figured out, treat it, and be done, and I'm now having to come to grips with the fact that it won't happen that way. There's been a shift in the status quo, but it's taking me some time to make my peace with it.

Wednesday, January 21, 2009


The whatever was still present on today's ultrasound, and it's now obvious that it is contiguous with my endometrium. Instead of being all tucked inside my uterus like it should be, my endometrium appears to literally keep going right through my scar and to expand on the outside of my uterus. Dr. Boss says it's probably either more endometriosis or adenomyosis, and that there's really no good way to distinguish short of laparoscopy or hysterectomy. I'm a long way from ready to discuss the latter, and he doesn't recommend the former at this time.

This is logical enough, I suppose. Adenomyosis requires hysterectomy (or at least removal of a substantial chunk of uterus), but it's less clear-cut for endo. It's in a tricky spot, on the front of my uterus directly behind my bladder, and he is reluctant to go poking in there if it can be managed medically by cutting off the estrogen supply. Reading between the lines, it will probably happen sooner or later, but he wants to try drug approaches first.

Medical options are somewhat limited at the moment because I'm breastfeeding, so BCPs and Lupron and Danazol are all off the menu. I don't have much enthusiasm for them anyway, given the side effects and the limited effectiveness. We know I was hypoestrogenic for at least some of the time the endo was growing anyway, so it's questionable whether artificially-induced hypoestrogenism would help. On the other hand, I had bad periods as a teenager but was fine for all those years of BCP, so the BCP may have held it in check. BCP is easily reversible and has relatively mild side effects, so I'm more okay with that than the other two, after weaning.

The current plan is to do a pain-management approach. The pain has backed off some since I quit bleeding last week, and is mostly manageable at the moment with daily NSAIDs and the odd Percocet right now. We're going to keep doing that until I'm ready to wean or until I am dysfunctional enough to decide to do something about it. After that, we'll see. The simple fact is that we don't know what my natural progression is, and what my "normal" cycle will look like. I had four periods between the girls and Andrew, none of which were really terrible. Since Andrew's birth, things have been so muddled, with the infection and the endo and the lap, that it's just really not clear how things will settle down.

Another lap and/or a hysterectomy is probably in the cards eventually, because this stuff seems to be pretty aggressive. Four months ago, I didn't have endometriosis at all. Six weeks ago, the endometriosis was removed. In the four weeks after that, it appears to have regrown enough to flip my uterus around and escape its boundaries. At this rate, Tokyo better watch out.