The Anti-Walnut Campaign

Food allergies- when food is the enemy. Allergic reactions range from the mild rash to the very scary anaphylaxis. We have known for some time that little Ellie Rose is allergic to walnuts but thought it was prudent to pursue testing to rule out any other allergies.

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What happens in the body to make your child puff up like a puffer fish?

The spectrum of allergic responses to food trigger is modulated by the immune system. It is important to note that not all allergens result in “Food anaphylaxis” or are IgE-mediated.  The difference in how the immune system responds results in the array of visual symptoms. The role of specific cells and mediators remains a hot topic for debate. Most people believe that more mild food allergy and intolerance symptoms are the result of increases in histamine without a change in basophils, however some have found that eosinophils increase. Basophils and eosinophils are both granulocytes, and white blood cells active in immune responses. The basophils are called to the front lines to interact with foreign bodies and are involved in inflammation by releasing histamine and heparin; histamine dilates blood vessels leading to warmth and swelling while the heparin prevents blood clotting. Eosinophils are phagocytes and consume, or “Eat” foreign bodies and can help to calm inflammation.

IgE, or immunoglobulin E, is an antibody that leads to a systemic inflammatory cascade which utilizes mast cells. Mast cells are another white blood cell rich in histamine and heparin. The IgE response causes reactions in the nose, lungs, throat or on the skin. Epinephrine is the antidote for anaphylaxis; at recommended doses epi can constrict the blood vessels and alleviate symptoms of swelling and itching via α-adrenergic pathways and can restore airways by β-adrenergic properties. In low concentrations, epinephrine can also block the antigen, or allergenic protein.

At Ellie’s first encounter with walnuts, she simply didn’t like them and told me they hurt her mouth. I, originally, thought it was a new texture that she needed to get used to. At second try a few weeks later, her face quickly swelled causing her eyes to swell shut and her breathing became labored. I quickly rushed to get Benadryl (anti-histamine) which calmed her body down and she recovered in a little less than an hour. Since that day, we have carried out a strong educational campaign among the quints and her caretakers to strongly reduce the risk of another exposure. The campaign has worked but knowing that she will be starting school in a few short months, we thought an epi pen may be a great tool in our tool box. This warranted a visit to Allergy Clinic.

Big Eight

Food allergens are water-soluble glycoproteins that are typically stable to heat and acid. The most common food allergens are called the big eight and include:

  1. Cow’s milk
  2. Chicken Eggs
  3. Peanuts and Legumes (almond, pecan, coconut, cashew)
  4. Tree Nuts (Brazil nut, chestnut, hazelnut, pine nut, walnut)
  5. Cereals (Wheat)
  6. Soy
  7. Fish
  8. Shellfish

In clinic, the team tested Elliott using the skin-prick test. Since Elliott consumes peanuts, almonds and coconut safely, they chose to only test those nuts, legumes and tree nuts that are unknown and most similar to walnuts: Black walnuts, English walnuts, Hazelnuts, Pine Nuts and Pecans.

The skin prick test is completed by scratching the surface of the back while applying a diluted allergen solution. Then, a labeled grid is drawn around the test area. The control is always included to demonstrate a sample “wheal,” or raised, red and itchy bump. After 15-20 minutes, the team can see which allergens cause a response. It is important to note that the size of the wheal does not necessarily correlate with the allergic response. So, as one can see in Ellie’s photo the A column demonstrates her response to the control solution and the two types of walnuts, as well as, pecans in column B. Despite, pecans larger than walnuts it may not produce anaphylactic reactions. Of course, we have added pecans to Ellie’s list and have restarted our walnut and pecan allergy campaign. We also left the office with school plans and a prescription for epinephrine.

Now, while Elliott won’t be eating any walnuts or pecans in the near future, the doctor said it is unlike wheat allergies/gluten allergies and we can keep them in the house. They shared that despite popular knowledge, nuts do not commonly produce allergic responses via airborne contact. Therefore, Theo can still enjoy his walnuts at snack time despite sitting right across from Ellie.

To lighten up this post, I’ve also provided some fun Snapchat photos which were taken while waiting for the Doc.

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Trick, Treat, or Teaching Opportunity

Halloween can be a scary time for more reasons than the goblins and spooky ghosts. Halloween seems to kick-off the season of treats beginning with the tempting sweets that line the grocery store aisles. Many parents dread Halloween due to the amount of candy that their child drags home after a long night of trick-or-treating.  However, I am looking forward to this teaching opportunity.

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Many of you know that food, nutrition and overall wellness are near and dear to my heart. I love equipping and empowering people in their health pursuits… especially my children. Trick-or-treating is a great time to teach moderation. There is a growing body of research that encourages families to mark no food as forbidden. Ellyn Satter encourages parents to help their children to, “Learn to manage sweets and to keep sweets in proportion to the other food [they] eat.” Moderation can be a difficult concept to grasp, but it is a lesson worth learning. According to research, treat-deprived children often end up weighing more later in life due to hoarding forbidden foods. I appreciate these findings but also recognize that these lessons need to be age-appropriate.

At three years young, my kiddos still are led by their frontal lobes (aka Impulsivity) therefore, we have tailored the moderation conversation to one of “wants” versus “needs” and “wants” have a time and a place. Since candy and sweets are unnecessary “wants,” my children have never had any. We don’t have any in the home so, if they encountered a candy bar on the street they wouldn’t know what it is. This is intentional because I know the power of sugar and I also know the consequences. Sugar is a sweet and silent killer that is a great contributor of morbidity and mortality around the world. Because of this I often associate excess sugar with excess alcohol or even smoking. As parents, we are guides and guardians for our children. We are blessed with the opportunity to guard their hearts, minds, bodies and souls until they are able to “digest” the media and message and then tasked with helping to guide them through this muddy world.

This does not mean my children will never have the pleasure of candy; recall those that are deprived often become the secret hoarders. Instead, we will continue to be intentional about when, where, why and how we introduce these types of foods and experiences. I also feel led to set others up for success that is why we will continue to be the weirdo house on the street that does not handout candy, but rather an allergen free snack. There are also a host of other food and non-food alternatives including…

Non-Food Alternatives:

  • Stickers
  • Glow sticks
  • Play dough
  • Rings
  • Toothpaste/Floss/Toothbrush
  • Pencil/Erasers
  • Seasonal Post-it’s
  • Bubbles

Food Alternatives:

  • Gum
  • Granola Bars
  • Pretzels/Crackers
  • Popcorn or Puffed Corn

So, with moderation in mind may the force be with you as we forge into the season of sweets and continue to guard and guide our children in the days to come!

Declaration of Independence

What better way to declare your independence then by eating all by yourself?! On Monday morning Mom was preparing breakfast for her five beautiful children and decided that their traditional oatmeal and yogurt needed a splash of color. While apples and bananas are favorites they weren’t bright enough, but berries certainly would do the trick! Strawberries, blueberries and raspberries turned the dreary oats into a bright purple surprise! Little did Mom know that today was the day that her children were going to exercise their right to feed themselves! DSC02414 Kali was the first to say, “No thanks, Mom, I got this.” Of course, she chose not to use her words, but rather to swat the spoon from Mama’s hand sending it flying onto Bella’s lap. She then proceeded to raspberry her raspberries all over the table and her brother, Theo, sitting 2 seats over. Theo thought this was hilarious and joined the raspberry spray fest. Of course once the spoon hit Bella, she, too, caught on, and soon Mom had a mutiny on her hands. While I would have appreciated a subtler request to learn how to feed themselves; the message was nevertheless received. DSC02407 I am eager to celebrate this milestone with my children. I won’t be packing away the Baby Bullet just yet, but now that four out of the five have at least 2 choppers we will be discovering the quints’ finger food faves! DSC02412 Their new meal plan that embraces their new found independence and celebrates their 11-month milestones is as follows: Breakfast:

  • 5-6 ounces Milk (Breast Milk with Goats Milk)
  • Banana OR Cooked Pears, Peaches, Fig, Plum or Apple
  • Cheerios OR Oatmeal OR Oat-based Teething Biscuit

Lunch:

  • 5-6 ounces Milk
  • Cooked Carrots, Peas, Summer squash
  • Ground Meat (Beef, Chicken, Turkey) OR Flaked Fish
  • Cooked Potato OR Spiral Whole Grain Pasta

PM Snack:

  • 5-6 ounces Milk OR Water (Will switch to water after 1 year)
  • Avocado OR Chopped Hard Boiled Egg
  • Cheerios OR Oat-based Teething Biscuit

Dinner:

  • 5-6 ounces Milk
  • Cooked Carrots, Peas, Summer squash
  • Cooked Beans (Chick peas or Kidney beans) OR Soft Cubed Tofu

Evening Snack:

  • 6-8 ounces Milk

The V-5 “Enjoy the Taste of Eating Right”

The V-5 definitely “Enjoy the Taste of Eating Right.” As a registered dietitian nutritionist (RDN) I couldn’t miss the opportunity of featuring my beautiful children during National Nutrition Month®!

Lily enjoying some pre-meal tummy time.

Lily enjoying some pre-meal tummy time.

Eating well is a pillar in the pursuit of overall wellness, especially if you are/were a premature infant. I attribute my children’s well-being to their healthcare team’s (which includes Mommy & Daddy) dedication to feeding them well from day one.

I have bragged on and on about breast milk in past posts, including Mommy Nutrition and 2 Simple Acts, so the following will feature the best solid foods for infants, or Baby’s Super Foods. These also happen to be super foods for the oldest of children- aka adults. I selected the following foods based on their nutrient density, ease of digestion and preparation and friendliness to the young palate.

Tummy time-out for Kali

Tummy time-out for Kali

Grass-fed Beef & Organic Poultry

Meat and poultry are great first foods due to their iron content.  Baby’s stores of iron begin to fade around 6 months so, a food rich in iron is important. Additionally, iron from animal sources (heme-iron) is much easier to absorb and use by the body. Meat also is loaded with B-vitamins and zinc. If you opt for grass-fed over grain-fed cattle, you will also get meat with more healthy omega-3 fats, vitamins A and E, and less of the unhealthy saturated fats, hormones and antibiotics. Organic poultry is ideal for the same reasons; basically more time and attention are directed towards the birds living quarters and nutrition creating a better quality end product.

Lentils

Lentils may be small but they are mighty. They are loaded with protein, fiber, iron, zinc and a host of B-vitamins. They are also a good source of copper, potassium and molybdenum. These legumes are quick and easy to prepare and generally more tender than other types of dried beans.

Bone Broth

This nutritional powerhouse can be made by boiling chicken or beef bones in water and a touch of vinegar. It is a significant source of GAGs, or glycosaminoglycans, chondroitin sulfate, keratan sulfate and hyaluronic acid, which are all “ingredients” for cartilage. Additionally, the red marrow has myeloid stem cells, which supports red blood cell development and the immune system. This broth also is a great source of glycine and proline, which are the building blocks for other amino acids (protein). Glycine and proline are also used by the body to aid digestion, promote healing, and create healthy plasma. Logically, bone broth also provides a good source of minerals found in bone: calcium, phosphorus and magnesium to aid in bone development and maintenance.

Theo chowing down on avocado

Theo chowing down on avocado

Avocado

This fatty fruit is a good source of fiber, vitamins K, E and C, a few B-vitamins, as well as, potassium, and copper. Avocadoes provide a host of anti-inflammatory phytochemicals (antioxidants from plants) and can help with absorption of other nutrients, like carotenoids (orange, yellow and red phytochemicals). Besides aiding in blood sugar regulation and heart health, they also make a great beauty product.

Butternut Squash

This orange, winter squash may require some extra prep work but the sweet flavor and benefits are well worth it. Although squash are a starchy vegetable, their carbohydrate is much different than a potato; it has anti-oxidant and anti-inflammatory properties. The orange color gives away that it is a great source of vitamin A, but it is also loaded with vitamins C, B6 and several minerals.

Gluten-free Oatmeal

This hardy cereal is a great first food for infants. My vote goes to oats over rice for an infant cereal because it is rich in iron, zinc, phosphorus, fiber and protein, as well as, several other vitamins and minerals. It also comes without the worry of arsenic toxicity.

Why gluten-free? Well, gluten is a very inflammatory agent that is found in wheat, rye, barley and some oats and can be difficult to digest. Often times, traditional oats can also be “contaminated” with wheat due to shared processing equipment. I feel it is best for babies to be wheat-free until their first birthdays when they dive into that cake! Overall, I opt for gluten-free because it is much nicer to the kiddos’ digestive tract.

Bella loves to help feed herself

Bella loves to help feed herself

Banana

I had to include at least one common fruit. Bananas are a great first fruit because they are a good source of vitamins C, B6, B2 and of course, potassium. They also provide bone-building minerals, including magnesium, calcium and phosphorus. Besides the benefit of being very convenient to prepare, they are also known as nature’s antacid because they contain a substance that can help the stomach and intestines produce the mucus lining.

Another bonus of the foods mentioned above is that when they are pureed they contain at least 20 calories per Tablespoon, which is equivalent to the average amount of calories in one-ounce of breast milk. When you have picky bottle-feeders who love solids this can be a huge lifesaver!

Ellie loves to help feed herself, too.

Ellie loves to help feed herself, too.

Whether these foods are old favorites or perhaps news ones to try, I encourage children of all ages to serve up these super foods and “Enjoy the Taste of Eating Right!”

The sign of good food (Kali)

The sign of good food (Kali)

Let the Games Begin!

At 5 ½ months the quints are starting solids!spoons

How do you know when to start solids?

There are several signs that a child is ready to start solids:

  • At least 4 months old (Check!)
  •  Significant weight gain.

The quints have definitely doubled their birth weights)

    • Theo is now 14½ lbs.,
    • Bella is 11lbs,
    • Lily is our little one at 10½ lbs.,
    • Kali is 12 lbs., and
    • Ellie is just shy of 12 lbs.
  • Able to make chewing motions and loss of “extrusion reflex.”

The extrusion reflex is when an infant uses their tongue to push solids from their mouth. An infant’s mouth develops in sync with their digestive tract. Therefore, if the little one is able to push food to the back of their mouth with their tongue and simultaneously swallow their gut is ready to accept the food.

  • Able to support their own heads with good neck strength. bumbo

In preparation for solid food we began feeding the kids in their bumbo seats. At first this was a disaster! The bumbo is designed to teach little ones to use their core to sit up, so you can imagine what happens when they are all tensing their abs during mealtime. Spit ups and blowouts galore! But, thank goodness this did not last long. A week’s worth of feedings and they got the hang of it.

I attribute the great gains in their neck and head strength to their time in the bumbo seats. Even big brother, Theo, with his 95th percentile noggin can hold that coconut up proudly!

  • Good appetite and often still hungry after their feeding.

This is definitely the case for Theo, Kali and Lily who often are quite upset to be sucking air at the end of their bottles.

  • Curious with what Mom and Dad are munching on.

So, needless to say after reviewing the list above, I was confident that the quints were physically ready for solids.

Which foods do you start with?

There is a bit of a debate on which food is best to start with. Currently, there is no strong evidence to support a specific sequence of introduction. Nutritionally, the best foods to start with are those that are highest in iron. This is because around 4-6 months of age a child’s iron stores are becoming depleted. This is especially true for premature infants because their time to accrue these stores was cut-short. Additionally, foods high in zinc and vitamin D are especially important because these nutrients are traditionally low in breast milk.

Traditionally, people start with iron fortified rice cereal. However, from my research this appears to be merely a generational tradition and in fact meat is a much better first food. This article from Dr. Greer, one of the quints’ physicians at the Madison NICU, offers a great explanation! Rice cereal is very easy to digest and has a very low allergy risk, but the iron from the food is not as easily absorbed and this food is high calories and low in nutrition. Plant-based iron (non-heme iron) is not used by the body as easily as that from an animal source (heme iron). Additionally, meat is a great source of zinc.  I believe that chicken is a fantastic first food, followed by beef.

The quint’s sequence will be as follows, with a new food every three days: Baby-Bullet-Batchbowl

I chose butternut squash and sweet potatoes because they are fairly high in vitamin C. The body uses vitamin C to help the absorption and use of iron. Zucchini was next as their first dark green vegetable because it is easy to digest and a low allergy risk. Their first grain will be gluten-free oatmeal because it is naturally high in iron and B-vitamins.

This delicious faire will be homemade with an awesome Baby Bullet, courtesy of a fellow quint mom. I puree the vegetables using breast milk and the meats using bone broth. Both are fantastic sources of vitamins and minerals and freeze very well! In just one hour, I had a month’s worth of food for the kiddos.

Let the games begin!

Frank and I thought we would catch this monumental meal on film. This video illustrates why it is important to feed your little one their bottle before trying solids. Can you guess which quints had eaten first?

If you guessed Theo and Lily you were right! They were cool and calm during their trial. Ellie and Bella were quite the opposite and approached meltdown mode. Kali, well, Kali enjoys mealtime in whatever order it is presented.

The other very important reason to offer solids after their milk is because breast milk should remain the primary source of nutrition for infants until at least 1 year of age, and thus you don’t want to ruin a feeding with an unfortunate food trial. I do promise you that Theo, Ellie and Bella all recovered from this feeding experience.

So, at the conclusion of food trial #1, all of the quints tolerated chicken. I would say that Lily, Ellie and Kali even liked it. I believe Bella will come around to liking it, too. As for Mr. Theo…I’m pretty sure he just wants a butter burger and some crinkle cut fries.

Baby Central: The V-5’s Domain

The Vanderwall home has quickly transformed into baby central with pack and plays, bouncy seats, burp cloths and pacifiers abounding. Everywhere you look you see signs of our little ones. We are also trying hard to create an environment at home that is conducive to growth and development.

Theo is home!

Theo staking out in the Pack N Play

We hope that the V-5’s domain will:

  • Help them differentiate between night and day.

During the day the kiddos stay on the main level in well-lit areas. Here they are exposed to the sounds and hustle and bustle of day time. At night we keep them upstairs in their nursery where it is dark and quiet. We also are intentional about not talking or playing with them during their night-time care times. We are down to business at 12am and 3 am. This has proven to be very helpful in getting them on their care schedule.

  • Practice good nutrition.

All of the quints enjoy breastmilk for all their meals. However, since they were premature it is common practice to fortify their milk for additional calories, protein, vitamins and minerals (sodium, calcium, phosphorus to name a few).  Their calorie goals vary quite a bit and like adults are based on their weight, ranging from 108-120 Calories per kilogram body weight. On average breastmilk has 20 calories per ounce, whereas the quints require 24 to 26 calories per ounce to grow at the desired rate. Therefore, we are adding Similac Neosure to their milk. We also are sure that they get their multivitamin (poly-vi-sol) daily.

Rare Occurrence- Ellie is quiet and alert, awaiting lunch.

Rare Occurrence- Ellie is quiet and alert, awaiting lunch.

Mommy & Lily

Mommy & Lily

  • Exercise their Mind.

Lots of time and attention is poured into identifying strategies to develop baby’s brains. There are an assortment of toys, books, apps, programs, etc. that promise to make your baby a genius. However, I’m a firm believer in simplicity and believes that attention, bonding and communication, or ABC’s, develop the brain just as efficiently as any of these other tools. I have actually learned that some toys touted for brain development can actually over-stimulate the child and increase the risk of ADHD/ADD.

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Currently, the V-5 enjoy tracking exercises where we use a black and white images or toys and move the image from left to right. This activity strengthens communication between the left and right hemispheres of the brain, or communication across the corpus callosum. We also love to chat and sing with our little ones. An ideal time to chat is when we are changing them, because we are 12-14 inches away from their little faces and are able to maintain their attention.

  • Massage for Emotional Well-being. 

There are many benefits of baby massage, including stress management. Massage can help to foster emotional health and promote self-soothing.  Touch via gentle strokes stimulates the central nervous system to produce more serotonin, the happy hormone, and create less cortisol, a stress hormone. Typically, as a result the infants breathing and heart rate will slow and they become more relaxed. Often times, this relaxed state does not result in sleep but rather a quiet, alert state perfect for play-time, snuggle-time, or positive feeding interactions.

  • Massage for their Tummies.

Our quints are a gassy bunch. It is no joke that post-feeding sounds much like a barnyard. Therefore, anything we can do to ease their gas pains and help their digestion is a must. Frank loves to take them on bicycle rides all over “town,” moving their little legs in a circular fashion. They have also come to enjoy this and almost do it on their own when you lay them on their backs. Frank tends to take them to the Candy Shoppe, where Mom prefers a trip to the Puzzle Place. We also practice the “I Love You” strokes on their bellies, which can help to stimulate movement throughout the digestive tract. A fool-proof method for gas relief is to place them on their tummies with rounded shoulders and knees tucked up and to glide your hands down their back while supporting their bottoms.

  • Stretch their Bodies.

Since sleep is one of their favorite past times, these little ones can get awful stiff. We continue to try to prevent flattening of their heads and promote good neck mobility. Moving their limbs up and down and inward and outward can help to preven

t these little hedgehogs from staying all bound up. We also like “windshield wipers” with their bent knees to help open up their hips.

Tummy time is also a great way foster good motor development and upper body strength.  It is best done when the infant is alert. Some of the quints love tummy time and others are still learning to like it. It can be quite a frustrating position for them, so we are sure to keep the sessions short and sweet.

Ellie Lays

Elliott is prepping for her calisthenics

  • Encourage Good Coordination.

Newborns are able to open and close their hands, but often times these movements are reflexive. During the first three months of life grasping becomes more intentional and an ideal time for developing foundational skills for hand-eye coordination. The quints are already starting to show signs of good coordination as they reach and grab items from their mobiles, as well as, objects near their face…including mommy’s hair.

Quints circled up for Yoshi Calisthenics

Quints circled up for Yoshi Calisthenics on Halloween

Yoshi egg line-up

Now it’s time for Follow-the-Lily.

All of these activities certainly add up for a full day, but there’s nowhere else we’d rather be!

The Race Home

Stork-with-Blue-BlanketThe quints are one week from being full-term babies and the race is on! Bets have been placed by many on their healthcare team as to who will make it home first.

This past week has provided some challenges on their road home, including getting their 2-month vaccinations, which included:

The doctors warned us that the kids may not be themselves for about 24 hours after the vaccinations and they were right. The most common symptoms include:

  • Fever
  • Pain at the injection site
  • Poor appetite
  • Fatigue/Sleepiness
  • Increased Spells
  • Periodic breathing

Everyone spiked a fever and ended up sweating through their clothes. Their appetites were not the best the following day either due to them being a bit sleepier. Honestly, the best way to describe it is that all of their “issues” from a few weeks back, reared their ugly heads.

Silly Kali Mae who may be one part screecher monkey and another part parakeet.

Silly Kali Mae who may be one part screecher monkey and another part parakeet.

For example, Kali who tends to “bear down,” meaning to grunt to either pass gas, poop, or protect her airway from reflux, was doing so much more often. When she bears down she often forgets to breathe… she isn’t the best multi-tasker, yet. The frequent bearing down led to poor respiration and thus desaturation (decreased oxygen in her blood) where she had to be put back on her nasal cannula to receive extra air flow. Luckily, she only had to remain on it for 24 hours. The unfortunate news is that because she had this “Spell” she got 5 days tacked on to her stay before she can be discharged. So, Ms. Kali’s discharge is now projected for October 15th.

Lillian Grace playing peek-a-boo when she is supposed to be snoozing.

Lillian Grace playing peek-a-boo when she is supposed to be snoozing.

Lily and Bella are now focusing primarily on waking up and staying alert enough to eat by mouth. These two are the last with their feeding tubes. They are currently meeting 50% of their nutritional needs by mouth and need to get to 80% before they can consider sending them home.

Bella who somehow has a striking resemblance to Dwight Schrute from the Office in this photo.

Bella who somehow has a striking resemblance to Dwight Schrute from the Office in this photo.

So, that leaves Mr. Theo and Ms. Elliott who have been favored by Frank and I to win the race home for some time. These two, despite their bowel surgeries, will most likely be the first ones home and arriving via stork, or Honda Odyssey, this weekend!

Mr. Theo snug as a bug in his sleep sack.

Mr. Theo snug as a bug in his sleep sack.

Our little doll face, Elliott Rose.

Our little doll face, Elliott Rose.

In other news, Frank and I are doing well. We are so excited that our NICU journey is coming to an end, and are more than ready to start the next chapter at home! Frank is coming out of his busy season at work and is planning on taking some time off as the kids trickle home.

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I am excited to have him home, so we can establish what life will look- aka a routine- as a family. I am also excited to share that I have returned to my pre-pregnancy weight. I share this for three reasons:

  • One, I believe it is a testament to good nutrition and regular exercise (just practicing what I preach),
  • Two, it is clear to me that weight truly is just a number because my body is definitely not what it was before in terms of composition therefore, operation “rebuild your temple, based on I Corinthians 6:19-20), remains in full swing, and
  • Three, because it has opened my eyes to a whole new population of people I want to empower for better health- Moms!

We also wanted to share with those who were praying for our insurance appeal that we had our grievance hearing. Unfortunately, the committee decided to uphold their decision to deny payment of our perinatal care in Arizona. We would appreciate continued prayer for this journey as we trudge on to the next level. It has become a moral battle of proving the value of life. We are now fighting for more than just our five miracles, and feel as though we have the opportunity to speak for parents who were encouraged to consider multi-fetal reduction and may have moved ahead with those decisions, and thus had to grieve those losses. We also will not back down because we believe in the importance of having a choice in healthcare, and speak for those who may have thought at one point they had no other choice but to give in, or to give up. Most importantly, we also speak for all of the children who did not get a chance at life. We are fired up and ready, so please pray that the committee in this next round would be more open to our appeal.

As always, we thank you for your well wishes, prayers and support. Please know you are a valued citizen of the village that is helping to raise the V-5!