I am not in a good mood. Wren slept like... nothing. He slept like someone not sleeping. Firstly, he fussed and cried right through the time I wanted to sit down and watch Gray's Anatomy then he carried right on past 10pm. By 10.45 I put him down and slept and he woke at midnight. After that he managed a bit over two hours (the longest stretch) and then we were onto 1 hour or less stints broken by crying that had me walking him up and down on the squeaky floorboards. I didn't get any sleep after 6am and not much before that so I feel I am back to square one.
Lets not talk about it anymore.
Saturday, February 10, 2007
Friday, February 9, 2007
Capillary refill time in extremities
One of the indicators that the cardiac clinic ask about when I am worried about Wren is capillary refill in his feet. That means when you apply a firm pressure to the underside of the foot for a few seconds and then release it, how quickly does the white area go pink again.
Wren had such lovely pink feet after his nap that I pressed his foot for reassurance but the big white spot remained there a while. So I freaked out and squeezed his foot again, tried the left one and so on until I couldn't be sure whether the speed of the refill was normal or not. I squeezed my own foot but that wasn't very diagnostic since my foot is far from my eye and I have no idea whether my refill time is anything like his... I would guess not so I went searching for information online.
The only information I could find was about newborns (who would tend to have slower refill time):
We measured capillary refill time (CRT) in a convenience sample of 137 healthy newborns between 1 and 120 hours of age and 36-42 weeks gestation in the well-baby nursery of a large community hospital. CRT was measured by applying moderate pressure to the dorsum of the right hand and right foot for 5 seconds. Pressure was released and the time for complete refilling of the blanched area noted. Each infant was studied only once. We also measured ambient temperature and the skin temperature of the dorsum of the hand and foot and tested interobserver agreement. Mean CRT was 4.23±1.47 s (SD) (range 1.63-8.78 s) in the hand and 4.64±1.41 s (range 2.15-9.94 s) in the foot (p=0.0001) and did not change significantly in the first 72 hours.
And that "in older pediatric patients it tends to be between 2 and 4 seconds". I have no idea whether Wren is older or not.
Almost 5 seconds seems a super long time - even 4 seconds is okay. I know Wren tends to have slower refill since the hassles with his femoral arteries during the cath so I am reassured. It wasn't that long at all and I will poke him again later to confirm this.
Can I chalk this panic up there with "I can't hear him breathing from across the room"? And can I also ask why the cardiac clinic give me such subjective indicators to watch? I mean, they have never told me what normal perfusion looks like or even shown me what it looks like when there is not a problem 'cos Wren has always had a problem with circulation in the lower extremities. If it was significant where is the stopwatch in my discharge kit? Hrmm? Hrmm? How will I know if it is slower today or is it only serious when it doesn't refill in five minutes? Okay, okay, I am having a moment here.
Wren had such lovely pink feet after his nap that I pressed his foot for reassurance but the big white spot remained there a while. So I freaked out and squeezed his foot again, tried the left one and so on until I couldn't be sure whether the speed of the refill was normal or not. I squeezed my own foot but that wasn't very diagnostic since my foot is far from my eye and I have no idea whether my refill time is anything like his... I would guess not so I went searching for information online.
The only information I could find was about newborns (who would tend to have slower refill time):
We measured capillary refill time (CRT) in a convenience sample of 137 healthy newborns between 1 and 120 hours of age and 36-42 weeks gestation in the well-baby nursery of a large community hospital. CRT was measured by applying moderate pressure to the dorsum of the right hand and right foot for 5 seconds. Pressure was released and the time for complete refilling of the blanched area noted. Each infant was studied only once. We also measured ambient temperature and the skin temperature of the dorsum of the hand and foot and tested interobserver agreement. Mean CRT was 4.23±1.47 s (SD) (range 1.63-8.78 s) in the hand and 4.64±1.41 s (range 2.15-9.94 s) in the foot (p=0.0001) and did not change significantly in the first 72 hours.
And that "in older pediatric patients it tends to be between 2 and 4 seconds". I have no idea whether Wren is older or not.
Almost 5 seconds seems a super long time - even 4 seconds is okay. I know Wren tends to have slower refill since the hassles with his femoral arteries during the cath so I am reassured. It wasn't that long at all and I will poke him again later to confirm this.
Can I chalk this panic up there with "I can't hear him breathing from across the room"? And can I also ask why the cardiac clinic give me such subjective indicators to watch? I mean, they have never told me what normal perfusion looks like or even shown me what it looks like when there is not a problem 'cos Wren has always had a problem with circulation in the lower extremities. If it was significant where is the stopwatch in my discharge kit? Hrmm? Hrmm? How will I know if it is slower today or is it only serious when it doesn't refill in five minutes? Okay, okay, I am having a moment here.
Rock, paper, plastic?
I have been playing a game with myself to see how many cloth diapers I can use in a day. See, its tempting because we are doing that "foot in each camp" of cloth diapering most of the time but Seventh Generation Disposable diapering when its inconvenient.
It is amazing how I can redefine inconvenient.
At night Wren sleeps with a disposable diaper because he pees too much to get good results with the cloth ones from the diaper service plus he gets diaper rash when he's left too long steeping in pee. But when does night begin? I start to put him in disposables about 7pm but last night he only really settled for the night after midnight! (note how I cunningly gave you a clue as to the daily sleep saga without making the whole post about sleep).
Also, he wears disposable diapers when we are going somewhere that it might be difficult to change him and then carry about lots of wet cloth - a doctors appointment for me, the grocery store. However, the pediatrician visit was a cloth-diapering expedition because they have lots of space to change him.
Argh, I am driving myself nuts. I think I should just stand firm and do cloth 100% except nights like we did with Frost. Wren wasn't going to get cloth diapering at all, actually. With Frost we had the cloth diapers lined up in the nursery before he was even born but Wren's diapering was an afterthought - our first impulse was the Pampers product we were given at the hospital in a blantant attempt to win our loyalties. Josh was impressed. As he said "we never had a blowout". By contrast I have regular blow-throughs (legs mainly) in my cloth expeditions so I seem to need to wash the covers daily.
But then I felt sad. You know, Frost being the poster-child for the attentive parent and Wren being all second-hand clothing and expediency. So, I signed up for Loving Diapering 202 and here we go again.
Actually, I also went on a shopping trip fraught with consumer danger - visiting the U-Village Hana Anderson store. Despite the sale discount the new outfit I bought to prove my love cost about half our weekly grocery bill. I know that if I knitted Wren something out of recycled yarn (as was done for Frost) it would mean more but I really enjoyed dressing him up as a pretty green-and-blue Swedish frog.
Anyway, the impulse for this post was putting out a plastic bag chunky with soiled disposable diapers and I must now resume my house cleaning. Next time I do groceries I must remember to ask for plastic.
Thursday, February 8, 2007
New kind of normal
Wren had another reasonable sleep last night. He went to sleep at about 10pm and slept till 1.30am (yippee) and then again till 4.30am and then till 6am and then it was a bit patchy. Still, those are longer stretches than before and I am most pleased with him.
The house is in disarray. I seem to spend all day trying to get him fed or to sleep. The rest of the time is wondering how to carry him and a laundry basket or how to bend over to get the clean dishes out without squashing him. I set out this morning with the goals of cleaning the living room. I have rolled that back to cleaning the couch. I should do it now, I know, but I can't drag myself over there and away from the dregs of morning coffee on the desk. Plus there are all the bills not done and the KapKa book order I ought to do (Frost has selected a whole library of gimmicks I shall have to limit him on).
I am also meaning to look for a crib mobile or Gymini for Wren since the engine in Frost's one has gone kaput and the old Gymini has no toys and is stained with an unknown yellow substance. Even in the 5 years since Frost was small the toys are now all high-tech. The new Gyminis have mirrors, foot pads, noisy things full color mobile objects. I kind of want to lie under one myself. On the way home from Listening Mothers meeting this morning I was going to stop by the consignment store by U-village but when I went there it has gone for construction and Me 'n Moms is way over in Ballard so he will have to wait a few days.
I did get to the meeting this morning. Wren looked a huge fatty among babies in the group. Many of the babies almost a month older are not yet 13+ lbs so he is not lacking in the bulk department. We talked about "Falling in Love with Your Baby". I think it was different for me that for many of the others there because Wren was captured by medical technology for a number of weeks it took me longer to really feel he was my own baby. Plus, after having 3 consecutive losses before him I was always fearing I would have a miscarriage before he was grown, then I wondered whether he would survive his heart defect and when he was finally born it felt as if he belonged to the nurses and doctors for a while. Since he has been home, has started to smile and respond to us we get on famously - its always easier to feel gushing love for someone who is able to acknowledge you're there and he is giving little gummy smiles daily.
Wednesday, February 7, 2007
Family resemblence
My mother emailed this picture of me age 2 (I think I look 3). The other one is Frost age 3. I was wondering who Wren will resemble. The pediatrician said she thinks his blue eyes will turn brown (Frost is blue-eyed like Josh while mine are brown). Its funny - half the people who see Wren say he looks Just Like Frost and the others say Just Like You. I think he looks Just Like Wren.
Another good night / pet sorrows
Wren slept well again last night. He fell asleep on Josh's chest around 8.30pm (nicely timed for me to do Frost's bedtime) and we transferred him to bed about 9.30pm. He woke at 12.30 and nursed and then again at 2.30am and then at 5.30am. From then on it was a bit grunty but still I love the longer stretches. They bode well and I got up at 6.45 without any resentment.
He has also shown no ill effects from the vaccines other than being very sleepy and fussy yesterday afternoon.
I miss the rats. I keep feeling bad when I throw away leftovers that I would have given them. Also, I think I smell them but of course I don't. Josh has started to talk about a lizard, a water-dragon or a ferret. I am thinking of a hermit crab. I want something short-lived and hardy since the rest of the family tend to shirk pet-care duty after the novelty has worn off. Actually, how long do hermit crabs live?
Googling quickly:
Hermit crabs potentially may live 10-30 years with proper care. Success at keeping your pet hermit crab for the length of its lifespan rests solely on your ability and responsibility to provide it with the proper care it needs.
Okay, so we won't have hermit crabs. I recall reading about some insects that have short and interesting lives and never need to eat - rising only to breed and pass on. That may be all we are capable of right now.
Frost says that we should go to church and "talk to the rats as if they are a Newspaper God and a Squeaks God." He added, "only joking". He also said we dont' need a pet because Wren is "so kyoot."
He has also shown no ill effects from the vaccines other than being very sleepy and fussy yesterday afternoon.
I miss the rats. I keep feeling bad when I throw away leftovers that I would have given them. Also, I think I smell them but of course I don't. Josh has started to talk about a lizard, a water-dragon or a ferret. I am thinking of a hermit crab. I want something short-lived and hardy since the rest of the family tend to shirk pet-care duty after the novelty has worn off. Actually, how long do hermit crabs live?
Googling quickly:
Hermit crabs potentially may live 10-30 years with proper care. Success at keeping your pet hermit crab for the length of its lifespan rests solely on your ability and responsibility to provide it with the proper care it needs.
Okay, so we won't have hermit crabs. I recall reading about some insects that have short and interesting lives and never need to eat - rising only to breed and pass on. That may be all we are capable of right now.
Frost says that we should go to church and "talk to the rats as if they are a Newspaper God and a Squeaks God." He added, "only joking". He also said we dont' need a pet because Wren is "so kyoot."
Tuesday, February 6, 2007
Pediatrician appointment and shots
Wren had his 2-month pediatrician appointment (and vaccinations) this morning. I thought I was going in for a general checkup but apparently since he is only a week short of 2 months it is okay to give him his shots.
He had 4 shots and one oral vaccine. I feel very conflicted about vaccinating him so avidly. Frost had only half the recommended vaccinations and we eked them out over a few weeks. Wren has had a BAM BAM series and I hope does okay. Thing is, with all his contact at Children's and with Frost bringing home all the new school bugs and of course the fact I want Wren to be extra protected because of his heart condition I am glad of the vaccines. On the other hand I am of the mind that avoiding some of them is not such a bad thing. I would have been really happy if Frost contracted chicken-pox for instance but now it would not be so delightful.
Aside from the conceptual objections, the shots went well and Wren didn't cry for long. The nurse was like a Duracell Bunny - Zap - bandaid, Zap - bandaid, Zap - Bandaid... and so on.
Anyway, Wren has a slight rash on his face and has been prescribed 1% hydrocortisone cream to reduce it.
His stats are:
Weight: 13 lbs 4 oz - 80th %tile
Length: 23.25" - 75th%tile
Head circ: 15 3/5" - 25th %ile.
Before I started to panic about him becoming a pinhead, Dr Levitt assured me it was tracking that way from birth and he is just long with a fat belly.
I am encouraged to keep him on iron unless there is actual sign of constipation and his Zantac dose has gone up to 1mg.
Now, the big news.. LAST NIGHT WREN SLEPT FOR 3 HOURS, TWICE! He went to sleep at 10.30-1.30am (nursed), woke again at 4.30am (nursed) and then again till 6.30am! It was brilliant. We kind of got up at 6.30am because he was doing the grizzle and grunt awake-sleep. He passed out again in the swing for another hour so he was wanting to sleep more in his noisy way. Still, it was an excellent night. Now, as a result of the shots, he is having another nap so its not a hard morning.
This afternoon the tuberous rats are going to be killed by the small-animal vet. It is very sad and I am trying not to dwell on it but they are having trouble moving and are so alarmingly distorted by the tumors that our guests are alarmed when their small children comment that "the rats are lumpy". It is very disturbing and I can't deal. So, they are to be gone after this afternoon.
I don't like to end on that note but I am going to sit down with the reheated decaf coffee I didn't get to drink this morning. I don't care if it tastes of the kitchen paper I used to filter it. This is the kind of thing one has to cope with when the coffee papers are forgotten in the weekly grocery haul. I can fold a mean funnel out of toilet-paper too and I'm getting pretty nifty with cloth diapers (shaped to Wren, not the coffee percolater).
He had 4 shots and one oral vaccine. I feel very conflicted about vaccinating him so avidly. Frost had only half the recommended vaccinations and we eked them out over a few weeks. Wren has had a BAM BAM series and I hope does okay. Thing is, with all his contact at Children's and with Frost bringing home all the new school bugs and of course the fact I want Wren to be extra protected because of his heart condition I am glad of the vaccines. On the other hand I am of the mind that avoiding some of them is not such a bad thing. I would have been really happy if Frost contracted chicken-pox for instance but now it would not be so delightful.
Aside from the conceptual objections, the shots went well and Wren didn't cry for long. The nurse was like a Duracell Bunny - Zap - bandaid, Zap - bandaid, Zap - Bandaid... and so on.
Anyway, Wren has a slight rash on his face and has been prescribed 1% hydrocortisone cream to reduce it.
His stats are:
Weight: 13 lbs 4 oz - 80th %tile
Length: 23.25" - 75th%tile
Head circ: 15 3/5" - 25th %ile.
Before I started to panic about him becoming a pinhead, Dr Levitt assured me it was tracking that way from birth and he is just long with a fat belly.
I am encouraged to keep him on iron unless there is actual sign of constipation and his Zantac dose has gone up to 1mg.
Now, the big news.. LAST NIGHT WREN SLEPT FOR 3 HOURS, TWICE! He went to sleep at 10.30-1.30am (nursed), woke again at 4.30am (nursed) and then again till 6.30am! It was brilliant. We kind of got up at 6.30am because he was doing the grizzle and grunt awake-sleep. He passed out again in the swing for another hour so he was wanting to sleep more in his noisy way. Still, it was an excellent night. Now, as a result of the shots, he is having another nap so its not a hard morning.
This afternoon the tuberous rats are going to be killed by the small-animal vet. It is very sad and I am trying not to dwell on it but they are having trouble moving and are so alarmingly distorted by the tumors that our guests are alarmed when their small children comment that "the rats are lumpy". It is very disturbing and I can't deal. So, they are to be gone after this afternoon.
I don't like to end on that note but I am going to sit down with the reheated decaf coffee I didn't get to drink this morning. I don't care if it tastes of the kitchen paper I used to filter it. This is the kind of thing one has to cope with when the coffee papers are forgotten in the weekly grocery haul. I can fold a mean funnel out of toilet-paper too and I'm getting pretty nifty with cloth diapers (shaped to Wren, not the coffee percolater).
Monday, February 5, 2007
When I scratch my pants they chirp like birds
Just when you start to wonder why you wanted kids in the first place they redeem themselves by saying something like "Mummy, when I scratch my pants they chirp like birds!". I have been repeating it to myself regularly to counteract the effects of nightly sleep deprivation and 3 hours of co-sleeping (back in spasm, irritability, resentment, tiredness in the bones). Frost has discovered the joy of synthetic material and likes to scratch his clothing and see what noise it makes. To me he sounds like Neruda.
I have also resolved to set up playdates for coming weekends. I think we are up for company when both Josh and I are home and we are clearly failing to meet Frost's needs for social contact. I just sit on the couch nursing Wren or jiggle around the house wearing him to sleep. Josh just sits on the counch watching football or his laptop. Neither of these are conditions that please Frost. Today, he is trying to persuade me to build a look-alikes city with him. Since this involves making a big mess of miniatures, boxes, glue, polystyrene, corks etc to create a city which then decays into a pile of non-recyclable debris - I am not keen. He is begging me. On top of it all I can't find a store that sells pokemon starter sets - an acitivity I would be happy to share with Frost.
I am now off to Children's for the Heart kids support group. Wren is yelling while Josh tries (semi-unsuccessfully) to soothe him and he told me to type fast.
I have also resolved to set up playdates for coming weekends. I think we are up for company when both Josh and I are home and we are clearly failing to meet Frost's needs for social contact. I just sit on the couch nursing Wren or jiggle around the house wearing him to sleep. Josh just sits on the counch watching football or his laptop. Neither of these are conditions that please Frost. Today, he is trying to persuade me to build a look-alikes city with him. Since this involves making a big mess of miniatures, boxes, glue, polystyrene, corks etc to create a city which then decays into a pile of non-recyclable debris - I am not keen. He is begging me. On top of it all I can't find a store that sells pokemon starter sets - an acitivity I would be happy to share with Frost.
I am now off to Children's for the Heart kids support group. Wren is yelling while Josh tries (semi-unsuccessfully) to soothe him and he told me to type fast.
Sunday, February 4, 2007
Synagis done!
The nurse from Swedish Homecare Services came over this morning and gave Wren his Synagis shot. He weighed 13lbs and she said he looked excellent. He screamed and cried for a while after the shot and then had a little nap but seems to have forgotten it already. He gets another one monthly till April. Apparently he is also indicated to receive these for the next 3 years because of having a heart condition and a sibling
Medical non-compliance
A selection of Frost and Wren last night.
For the past two nights Wren has slept one three hour period. Sometimes these begin at 9pm so I miss part of it but its still a bit improvement on the 90 minute sessions he was having a week ago. Last night he slept 10-1am, 1.30-4am and then the bad grunty-snacking period until 7am. I don't think I slept after 6am. He also alarms me at night by dreaming and breathing very fast at times which makes me alert and sleepless.
This morning he seems okay. He nursed well in the night and didn't sweat at all and he woke smiley. I shall wait and see how he does today.
Anyway, the title of this blog relates to the book I am reading The Spirit Catch yous and You Fall Down about a Hmong refugee family with a sick child interacting with the US medical system. One section deals with the way they feel that compliance with medical advice is optional and routinely alter medication and administer the medications they like. While the book addresses the deeper issues of the cross-cultural misunderstandings I was thinking how I am as the patient or parent of a 'sick' child and whether I am totally obedient.
I find that I am not.
If there is an area in which I am not fully educated about the reason for a therapy or subscribe to an alternative I don't comply. An example is the iron supplement Wren is on. I suspect it is causing him constipation (he strains a lot when he is on it) and am also of the view that iron levels in babies are over-rated. However, I am concerned that he not be anemic in case of future surgeries so I have decided to administer his iron every second day. I will discuss this with our pediatrician but meanwhile I am quite happy to do what I think is best. I also didn't use the cortisone my doctor prescribed because I don't like cortisone but I took the prescription "in case" I changed my mind.
I wonder if I am atypical in doing things a bit my own way and how difficult this must be for doctors.
Subscribe to:
Posts (Atom)