Thursday, August 3, 2017

Fetal Surgery Saga Conclusion

I know you thought the saga was over right? CHOP told us no end of story no fetal surgery...well not quite. After we returned home to Mississippi we were referred to Oschners in New Orleans because it was the closest hospital that could really care for little K. Close being a relative term, we had to drive 90 miles each way to get there.
My first visit I was going to meet with my new MFM doctor and the neurosurgeon who was supposed to close up little K's back after he was born. Everything went well, I clicked with my new MFM and felt really comfortable with the plan to wait until as close to my due date as possible to have a C-section. This would allow for little K to grow as big and strong as he could so when it came time for surgery he would have the best chances of minimal complications. We discussed fetal surgery and the evaluation CHOP gave me and all seemed normal, then the ideal of fetal surgery was brought up again as an option.
Say what? Going to be honest I didn't really even know they did fetal surgery because there really are only a handful of places that are well known for it (and they weren't one of them yet). I was stunned and overwhelmed because I had just been told a very definitive no by one of the leading centers so I had written that chapter of my life and closed that book. To reopen that book was confusing. After talking with their neurosurgeon I had about 2 days to consider the option because of how late in the pregnancy I was at this point. I left the appointment in a haze so many thoughts running through my head I couldn't wrap my brain around it all and to make it worse I had to endure that 90 mile drive home alone because the hubs couldn't get off work. It was a long drive to say the least.
So to not drag this story on any longer (because it's long enough already) we ultimately decided not to have fetal surgery done. There were so many factors we had to weigh in this decision and when it was all said and done the risks did not seem to outweigh the benefits in my situation. This is NOTHING against Oschners fetal surgery program or the doctors there because I think they are all great. But I had a then 1.5 year old child at home that needed his mom and fetal surgery would have me laid up in bed for 3 months. Fetal surgery is MAJOR surgery and the risks are great to both myself and the baby and I just didn't feel right about so much risk. The benefits to fetal surgery are great for a lot of babies but in our case they weren't as profound as in some other cases due to things we saw on the ultrasound. We went round and round for a day or so with the yes lets do it and just try to give little K even the smallest benefit and the No it's just too risky. In the end we decided it just wasn't right for us. I would be lying to tell you that I don't think about it from time to time, what if I had done it? Would things be different? How would things have changed? But I don't regret my decision, I honestly think it was the right decision for us and wouldn't change it for the world.
There it is the Fetal Surgery Saga! And a Saga that was for us. And to think this was just the beginning of our Spina Bifida journey? Little K was even born yet!

Saturday, June 10, 2017

Our Fetal Surgery Saga (Part 2)

So last time I left off with that we decided we wanted to get evaluated for fetal surgery. When I made that decision things seemed to happen at warp speed. I mean there was a lot I had to get done in a short period of time to even make the evaluation happen. When your in the military there is a whole army of people that need to help you get there (pun intended).

I had to:
Get an amniocenteses done and sent away for screening, get a referral up to CHOP (Children's Hospital of Philadelphia), get approval from insurance, get all records transferred, get approval from the military and our commands (since my husband is in the military he needed all the approval from his side as well...hello double the paperwork!), and once that was all accomplished don't even get me started on the actual military process to get flights and hotels and approval and government charge cards and the list goes on.

For those of you who aren't as familiar with the military lets just say getting this done takes a lot of help and relying on others to get you there. Did I mention we had all of like 1 week to get these tasks accomplished? Remember that short window I mentioned before, time was crucial. I forgot to mention I also had to fly my mom out so there would be someone to take care little R. And yes there was more paperwork involved with that process as  she needed to have access to the military base in case of emergencies while we were gone (ah military life). The logistics to even get us to Philadelphia were overwhelming and the whole time I was still trying to wrap my head around the idea of Spina Bifida.

When we finally had everything taken care of it came time to actually leave. This was the first time I had EVER left little R for more than 12 hours. You guys when I put him to bed the night before we left I bawled my eyes out. Oh and there was the whole flight debacle causing us to almost not make it at all, but I won't go in to that. Lets just say if my husband wasn't there I wouldn't have made it.

Now it was time for the actual evaluation. If you are going to be evaluated be prepared it is a LONG day. I mean like 10 hours of meeting all the departments, scans, MRI's and the works. When your like 24 weeks pregnant it really takes a toll on you. I was exhausted. The day was going along great. I had completed the MRI (which honestly was the most nerve racking part for me), an ultrasound to look at babies heart, meeting with social workers, and meeting a genetic counselor. Then came the "big" ultra sound, the one that looks at all the anatomy especially the defect. It was over 2 hrs I think. I mean they looked at every little thing possible. As fun as it was to see little baby K up close and personal for so long I was just ready to be done with it all. We had arrived just before 7am and it was getting close to 4pm by this point. So when we were finally done we got to meet with one of the doctors to go over all the results from the day.

I remember they pulled us into a room and started talking about everything. Just throwing information at us. Then he began explaining specifics with our little K and what we could expect. I mean we talked nerves and the level of involvement, complications, risks and benefits. If I didn't have some medical knowledge I would have been so lost! Then it happened the world stopped for a moment. After all the talk, everything we had been through that day the doctor said "due to the fact we found some slight agenesis of the corpus colosum you are NOT eligible for fetal surgery." Wait say what? I don't understand all day they had been telling me how great everything was looking and how good of a candidate I was because I was so healthy. It was like a room of glass shattering all over again. We talked some more but eventually there was nothing left to say it was over. The doctor left the room but said we could stay there as long as we needed to collect ourselves. I just cried, I sat in the empty room with my husband and cried. I didn't know what to think in anymore. We had held on this little bit of hope we could "fix" some of the problems. I know fetal surgery isn't a magic cure all, I am not that naïve, but when you have something you think can help reduce possible complications you hold on to it and you hold on to that hope tight. Yes I still believe in fetal surgery, but it wasn't meant for us. The next few days were tough. There was a lot of crying and just quiet moments. But returning home to little R was honestly the best feeling. I mean if I had gotten fetal surgery I would have been on bed rest in Philadelphia for almost 3 months! So if there was a bright side to it all that was it.

So we returned home and just tried to figure out what was next. I still couldn't deliver at our military hospital as they didn't have the pediatric specialists needed to care for little K. I had to drive all the way to New Orleans to meet new doctors and specialists. I had to figure out our new plan of attack and prepare for it all. Then just when I (and you) thought my fetal surgery saga was done there was one more little twist!

Until next be continued!!

Thursday, May 11, 2017

Our Fetal Surgery Saga (Part 1)

I am going to start by saying if your a mom looking for a story of someone who actually had fetal surgery this is not it. This however a story about how we got to that decision.

Now that I have gotten that out of the way lets get to the story. I realize some of you have no idea what I am even referring to and that is ok; if you bear with me I promise I will explain it all. I left off last time with that agonizing 5 day wait of waiting for some clarity. Finally the day came when we got to meet with our MFM (maternal fetal medicine) doctor, or high risk pregnancy doctor. My wheels had been spinning the last five days trying to figure out all the possible things I would hear today. Honestly I still had that hope that they would tell me it was a mistake the tech took the images wrong and everything was just fine, I mean who wouldn't hold on to that dream?

The doctor took us back and began scanning. It didn't take but about 2 minutes for her to stop and say, "see that? There it is." She was referencing the "bubble" along his spine. This "bubble" is really the area on his back where the spine didn't close up all the way and where the contents of his spinal column stick out and they call it his "bubble" because it looks just like a bubble on his back on ultrasound. There it was you guys, it was confirmed little K did indeed have spina bifida. My heart sank, that last little bit of hope I held onto was gone. I was crushed because now my mind went from maybe it's nothing severe to what does this really mean now? Will he be ok? What complications can I expect? What was his lesion level? Will he be able to walk? The questions were endless and honestly I didn't know what to think or where to start.

One of the first questions our MFM asked was what we thought about fetal surgery. Fetal what? I had no clue what she was talking about. In it's most basic explanation it is a surgery where they open me up to get access to the fetus and close the opening in the babies back then sew me back up and continue with the pregnancy. It is a very risky procedure with the biggest risk being preterm birth. My gut reaction was NO are you kidding me? cut me open and perform high risk surgery on my baby? Oh and did I mention after surgery you are basically on permanent bed rest? Oh and the surgery has to be done by like 26 weeks so you have 3 MONTHS of bed rest? Yeah, there was no way I could do it. I had a 1.5 year old at home to worry about. I had made my decision no fetal surgery just no.

So your thinking that story is pretty boring right? Well it would be if that was the end, but like most stories there is always a twist.

After the initial appointment my husband and I went home and began (like any good student would) reading up on fetal surgery. We read peoples blogs, we read journal articles, we read case studies I mean come on we are both dentists we know how to do our research of medical studies. Yes I read the numbers you know those fancy statistic type (sample sizes, standard deviations, confidence intervals and all). The more we read the more the research pointed to fetal surgery as being a great thing. All the studies and results were so promising! I mean if we really wanted to do everything for our child to give him the best quality of life we decided we had to at least look into the option of fetal surgery. But by this time I was almost 23 weeks pregnant and the range for fetal surgery is very small it has to be done before 26 weeks. So we called the MFM and told her we wanted to investigate Fetal surgery. I needed to get an amniocentesis done to be even considered so that was our first step in our journey. I got the amnio done and then the real journey began...yup I am just getting started.

Because we were stationed in Biloxi, MS at the time there were no hospitals in our area that routinely performed fetal surgery. There was one hospital that had done a handful of cases in New Orleans, but I didn't feel comfortable with those numbers. I wanted to go to a hospital that has a proven track record. There are 4 hospitals that have been doing this surgery since the very inception of the idea, these 4 hospitals where the ones that have been doing these surgeries since the MOMS trial began.

*In case your really interested in the MOMS trial study here is a little more information MOMS*

I mean have a medical background I knew the odds were going to be better if I went to a place with a proven track record. I will note that many more hospitals now are doing fetal surgery and in much greater volumes so I do believe the options will only continue to grow, which is amazing! But anyway at the time this is how I felt and that is what my gut was telling me was right. Being active duty military at the time I was so fortunate enough that they were willing to basically give me free pick of where I wanted to be evaluated at since there wasn't really an option close by. In the end I decided on Children's Hospital of Philadelphia because after reading all the research they seemed to really be one of the pioneers of this surgery and I wanted the best of the best so that is where I wanted to be.

Now the real adventure begins!
To Be Continued...

Tuesday, May 2, 2017

Stir Fry

So this post has been sitting unfinished in my draft section for like 2 weeks now. I really had the best intentions of finishing it many times. Anyway that is life with kids right? When I first started posting pictures of my meals on social media this was probably the recipe that got the most interest. I don't know what it is but people just really went crazy of my beef stir fry pictures.
I never was able to give people the recipe (until now) though because honestly there was no recipe. I have been making stir fry for as long as I can remember. It was one of the first things I had my dad really teach me how to make. My dad makes the best stir fry, and I request it pretty much every time I come home. So when I started tinkering with actually creating a recipe for the stir fry I had a hard time getting it right because honestly after making something by eyeballing measurements for so long it was hard to get it right. I won't say this is picture perfect ideal, but it is a really good base recipe. The reason I say that is because everyone has their preference on how they like their sauce (spicy, more garlic, more ginger, no garlic, less ginger, no spice, thin/thick, sweet, etc) So try it and then adjust to your liking.

This is how I do a beef stir fry, but it works with pretty much any meat you choose. The key is to slice the meat really thinly. If you have frozen meat it actually is easier to cut it super thin when the meat hasn't completely defrosted/slightly frozen still.
 Then you will marinate the beef. Heat a skillet/wok up super hot with a little oil. You want it hot to cook it fast and get a good sear on the meat. If your like me you may need to cook the meat in batches, as I have a tendency to use a large cut so we can have leftovers for lunch the next few days. Do not over crowd the pan!
 See that nice browned color?
 Remove the meat and cook the vegetables. Cook to desired tenderness.
 Add meat and the sauce in and let cook a few more minutes until thickened. Serve!

I love to make stir fry because it's really quick and simple. It's also a great way to pack in a lot of vegetables in one meal. I mean look at all that color!


While the meat is marinating prepare the Sauce

Assemble the Stir Fry
*Note I don't say what vegetables to add because there are just too many great combinations and the basic way to make it is pretty much the same.
1. Heat up a skillet/wok with a little oil. You need to get the pan really hot.
2. Add meat and let cook until brown
3. Remove meat from pan (repeat if doing in batches)
4. Heat a little more oil and cook vegetables (I used a frozen stir fry mix here so it took about 10 minutes to cook vegetables through) If you use fresh vegetables it will not take as long.
*note I like my vegetables more tender so I often add a little water and cover the pan to steam the vegetables, but if you like very crisp vegetables you can skip that step
5. Add meat back in and all the sauce
6. Turn the heat down and let sit on the heat for just a couple minutes to let the sauce thicken.
7. Serve and enjoy

Thursday, April 27, 2017

The Next 5 Days

If you remember from my last post I said we had a 5 day wait to get any "definitive" diagnosis. I was told "there is evidence of" "it appears as" "there are signs of" but no "Your baby has XYZ". Those 5 days were quite possibly the longest most agonizing days I have ever experienced. It was like boarding that plane [read the poem Welcome to Holland if you don't get the reference] and waiting to take off not knowing if the engine would hold up. So what does one do when they have 5 days to wait?
The answer I am going to tell is the answer that almost every parent with a child of Spina Bifida will tell you NOT to do...Google. I googled like a mad woman. Honestly when I heard Spina bifida I really didn't even know what that meant. Sure I had heard of it on maybe a slide on neural tube defects back in dental school, but lets be honest I didn't really know anything about it other than that. When I said I googled, I mean I googled the poop out of that "possible" diagnosis. (If any of my SB moms are reading this I hope you appreciate this little pun) Again being honest I am not sure if it helped or hindered my thoughts on the diagnosis. Yes I got educated about what SB was and the possible complications and possible problems we were going to face, but I also got a lot more scared by reading all these worst case scenarios and grim prognosis. Knowing what I know now about SB is that it's near IMPOSSIBLE to say anything definitively about what aspects of your child's life will be affected. It truly is a "snowflake" condition and no two cases are a like. What I will also say is that I know no matter what I write here or say to an expecting mom they will hit the internet hard after hearing this diagnosis; I mean it's human nature to want to know and that's just the day in age we live in that the internet will be the go to for that information.
Honestly looking back now (almost 1.5 years later) I can barely remember those 5 days. I was so consumed with fear, emotion and sadness that it was almost like an out of body experience. You want to know what was even harder than coming to terms with that my baby was going to have some sort of birth defect (no matter how small or severe) the thing that was the hardest for me was trying to come to terms with the fact of having to say it out loud not just with my husband but to my family and eventually friends. I just remember crying or tearing up every time I spoke the words out loud. It had turned this thing [pregnancy] that was so fun and exciting into something that I just cried over...a lot. I felt guilty that I wasn't enjoying this pregnancy like I had my first. Don't worry this would eventually change and I would learn to accept the fact, but that's jumping ahead many, many weeks. Those 5 days were hard, but what I can say looking back is that I survived. I learned, I grew and I survived. For any mom that may read this just know you will survive it too! It may not seem like it because honestly I didn't know how I would survive it all, but you will and you will be much stronger because you did.