It Hurts.

Merriam Webster defines pain as, “physical suffering or discomfort caused by illness or injury.” It is as subtle as the burning sensation in tired eyes felt with every blink and as agonizing post-operative healing without medication. It is also everything in between; gut-wrenching stomach pangs, dry sore throats, pounding headaches, throbbing sinuses, and internal distresses felt from your ears to your toes.

Maker:S,Date:2017-10-12,Ver:6,Lens:Kan03,Act:Lar02,E-ve

But a parent and a caregiver knows it as so much more. We know it as the sting in our hearts when we see a child or loved one helpless, the anguish in our bellies because “we are sick again,” the shock and awe that that frail, emaciated young body is your poor daughter after months of recovering from virus after virus. It is the frustration when you just want to see your child giggle, run and play versus curled up in the fetal position with tear-stained cheeks.  It is the pain felt in the darkness when there has been no break in day.

The last six months in our household have been trying. The physical strain that has come with this last season is one for the books. After monthly trips to urgent care, two late night E.R. visits, two surgeries and two more on the calendar, countless ear infections, too many hours waiting for prescriptions to be filled and almost 10 weeks straight of being sick, we are tired of being sick. At times, I think my children have forgotten what it feels like to be well.

There’s no doubt that I’m a “glass half-full” kind of gal, but I’m starting to strain to see the rose color in my glasses. I know this too shall pass but I pray it will pass sooner rather than later. We are not interested in any Guinness Book of World Records for the number of viruses we can mutate and redistribute in one season.

I will end on a positive note. I still stand by the need to take one moment at a time and in each moment seek the joy. For each crack of a smile, unannounced giggle, bout of childish energy or sneaky hug around the legs is a ray of sunlight through the clouds, and they all must be cherished.

Maker:S,Date:2017-10-12,Ver:6,Lens:Kan03,Act:Lar02,E-ve

 

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Zero to Quints

quintuplets31n-3-web

I believe further explanation of how we went from “status quo” to “the babies will be delivered within the next 45 minutes” is warranted.  I was settling in for a day’s work on the morning of July 31st, when I felt like I wet my pants. Now to be honest, I just assumed little Theo was going to be controlling my bladder for the day. But, upon further investigation, I realized he had popped his little sac and I had “broken my water.” I called my doctor’s office, but since they were closed it directed my call to the physician on-call, which just so happened to be Dr. Elliott’s “bat phone.” I felt awful for bothering him on vacation, but he didn’t mind one bit. He encouraged me to pack a bag and head to Ob triage (the moms’ ER).

We arrived at the hospital and were quickly shuffled in for an assessment. They tested the fluid and confirmed that indeed it was amniotic fluid. Then, they discontinued my nifedipine (calcium-channel blocker), gave me a steroid shot (Betamethasone) to enhance fetal lung development, and started me on 3g of Magnesium sulfate. I was then whisked away to ultrasound to confirm the culprit. It was indeed little Theo (baby A) whose deepest vertical pocket went from around 5cm to about 1.6 cm, which indicated that he only had about 1.6 cm of fluid surrounding his little body in his sac. His head was now so low in my pelvis he appeared as though his little body stopped at his neck.

The nurses assured me that once my contractions stopped, it was entirely possible I could remain pregnant for several weeks. This amazed me but they said it happens all of the time. Unfortunately, this scenario is only true if 1) your contractions do stop, 2) you tolerate the medicinal anti-contraction regimen and 3) you do not develop an infection. My contractions did stop, thanks to the “mag.” But, it was clear after 24h on the magnesium sulfate that I was not tolerating it, and my lungs began to fill with fluid.

Magnesium sulfate is used for contraction management. It is thought to affect calcium channels to slow uterine contractions. Typical side-effects include water retention, muscle weakness, sweating/flushing, nausea, vomiting, constipation, and blurry vision. For most, these symptoms are tolerable and some mom’s of multiples can again remain on magnesium sulfate for several weeks, in order to prolong their gestation. Unfortunately, I hit the jackpot and experienced all of the symptoms noted above.

My body was only able to combat these side effects for about 3 days. I was placed on b-pap to increase my oxygen saturation and Lasix to try and rid my body and lungs of the extra fluid.  On the morning of August 3, I was moved back to labor and delivery due to my pending diagnosis of pneumonia. When I spiked a fever and my white blood cell count shot up, we knew today was the day. It was then that we got the news that we would get to meet the quints within the next few hours.

They informed us that Dr. Elliott was speeding to the hospital, on his way back from vacation, and we were going to try and wait for him to arrive around 4pm. But, when he heard that I had a fever, he gave the go ahead to deliver in his absence.

A moment to smile before delivery.

A moment to smile before delivery.

Thus, they unraveled the most well-orchestrated delivery I have every heard of. With over 20 people in the delivery room (6 teams: one for me and one for each baby), they delivered the quints in about 3 minutes. The entire “operation” took about 45 minutes. I vaguely remember these moments, but Frank was right by my side to catalog it all.

Following delivery, Frank headed to the quints’ recovery room. By the time I arrived, all were gone and up to the NICU. My mom awaited me in the recovery room, and was over-joyed to see me safe and sound. I, unfortunately, could not see our little angels until my fever subsided and my breathing had stabilized.

Frank is ready to be a Daddy!

Frank is ready to be a Daddy!

Dr. Elliott arrived and it was clear he was upset that he could not deliver our babies, but we truly respected his decision. He shared with Frank that sometimes as a physician you have to make a decision with your head and not your heart. If we had waited even a moment longer my infection may have complicated the babies course.

Those 48 hours preceding the birth of our babies, were some of the worst of my life. But, I know that without that treatment regimen, our 5 little miracles would not have passed the “steroid efficacy window” and may have been at an even greater risk for serious complications.

Our heartfelt thanks goes out to Dr. Elliott and the teams at Banner Desert for their superb, patient-centered care, compassion and wisdom. For I know that if we were anywhere else, the circumstances and outcome may have been very different.

We have much more to share with everyone and are working on getting some fantastic pics of the quints, so look forward to some more baby updates in the near future!

Eating for…Six

“Let food be thy medicine and medicine be thy food.”  -Hippocrates

Food-Is-Medicine

This is a statement I passionately believe in. Medicine is defined as “the science or practice of the diagnosis, treatment and prevention of disease,” and thus nutrition is also the science of the diagnosis, treatment and prevention of disease.

This is especially true when educating and counseling persons with chronic diseases, such as diabetes, high cholesterol, high blood pressure, kidney disease and the list goes on and on. Tweaks in what these persons eat on a daily basis can dramatically improve their disease state.

Many of you are probably waiting for the link to pregnancy, well here it comes. While I continue to believe in the power of nutrition, my view of food has shifted during pregnancy. I believe food during pregnancy is very similar to food for the elite athlete; it is its most basic form- fuel.

While dietary quality is of the utmost importance during both pregnancy and athletics, but quantity often is slightly more important. I have been intrigued by the amount of energy (Calories) required to grow and sustain life, let alone 2, 3, or 6 at one time.  The average adult woman needs approximately 1600 Calories per day and the average adult male needs nearly 2000 Calories per day. These amounts of course vary depending on an individual’s metabolism, body composition and daily physical activity. But, the average woman pregnant with one child needs approximately 300 additional Calories per day beginning in their 2nd trimester. However, this is not the case with multiples. This additional energy requirement starts in the 1st trimester and quickly escalates with each fetus:

  • Twins: 3,500 Calories
  • Triplets: 4,000 Calories
  • Quads: 4,500 Calories
  • Quintuplets: 5,000 Calories

One may be jumping for joy at this amount, because it’s like Thanksgiving everyday! Unfortunately, when you add in morning sickness, indigestion and limited belly capacity, this feat requires a bit of creativity.  Again, it is important to remember that quality is a close second to quantity and thus the type of Calories consumed is also very important.

The average dietary composition is 50-55% Carbohydrate, 25-30% Fat and 15-20% Protein. During pregnancy, this also shifts to approximately 40% Carbohydrate, 40% Fat and 20% Protein. Fat, primarily from unsaturated sources high in omega 3’s, like DHA, is critical for neurological development. Protein is known as the building block for life and food sources that maintain a complete amino acid profile, animal-based proteins, are ideal. The percentage of carbohydrates decreases during pregnancy, and my assumption for this decrease is two-fold: 1) To account for the increases in necessary fat and protein and 2) To limit edema, or swelling and bloating. Carbohydrates tend to pack on water has they are stored and extra L.B.’s from fluid tend to be unappreciated, especially later in pregnancy.

Overall, we know that nutrition is an individualized science and all of the energy goals have to be adapted to the individual. I believe the best outcome for measuring a person’s nutrition during pregnancy is maternal weight gain. Future mom’s of multiples are to gain an average of 2-2.5lbs per week beginning with week one, so that by 30 weeks mama has gained nearly 80lbs. Maternal weight gain is highly associated with fetal growth and gestational age, which we know are the two variables that often influence fetal complications.

So, for you “bump” lovers out there I will be sure to post a pic or two in the coming weeks along with some updated ultrasounds. Until then, hang tight…patience is a virtue (lol). And, for you nutrition geeks and foodies out there, much like myself, there will certainly be future posts on nutrition tips and meal planning for mom’s of multiples.

Five Buns in my oven

Written by: Cassie Vanderwall, MS RD CD CDE CPT

Woes and Wishes of the First Trimester

The first trimester poses something new with each week. The two-week wait presents great anticipation of finding out whether you have been part of the miracle of conception, as well as, the opportunity to strengthen your patience. In week three and four you begin to realize that your body is certainly not your own. As your blood volume begins to increase your heart rate, blood pressure and respiratory rate all tend to also increase, which left me exhausted and out of breath. It is amazing how nature has a way of slowing down even the busiest of all the bees. Then, come the GI (gastrointestinal or belly) woes. Bloating, indigestion and the beloved “morning” sickness all of which can be attributed to the hormones that are bouncing around like Flubber. My biggest woe has certainly been “morning” sickness, which for me has been 24/7 nausea.  I am very grateful that everything has stayed down, because we know every nutrient counts. I’d love to take a moment to share my tried and true tips for nausea.

The Do’s and Do Not’s of Morning Sickness

  • Do take 60-100mg of extra vitamin B6 everyday.
  • Do get your hands on ginger chews and ginger tea.
  • Do have your own stash of seltzer water and salty snacks on your person at all times…in your purse, car, desk, bag and table next to your bed.
  • Do get fresh air. For me, there was nothing like taking a walk around the block.
  • Do try a cold cloth on your forehead and back of neck.
  • Do stay hydrated with ice cold water.
  • Do purchase Seabands…they rock.
  • Don’t eat really fatty or smelly foods. The high fat foods take a long time to digest which delay transit time. Smelly foods (spicy foods, fish, etc) can trigger the nausea center in your brain, which usually doesn’t end well.
  • Don’t become constipated. If you can help to keep that train running you will prevent the intestinal traffic jam that can cause a nasty back-up. Focus on whole grains and fruits and vegetables that you can tolerate.
  • Don’t eat foods that don’t sound good. Food aversions are odd to me. Foods you love can quickly become foods that you cannot even think twice about. Don’t force it, save them for later because this too shall pass.
  • Don’t wait until you are hungry to eat. Establish a meal pattern, such as every 2-3 hours. An empty stomach is not your friend.

Alright, thank you for entertaining my list. Hopefully, some of you find it helpful. Onto a few more woes and wishes. During week 8, my nausea began to subside, which was scary for me because up until that point that’s how I knew I was not alone. My greatest fear at this point remains miscarriage. So, I am highly cognoscente of my signs and symptoms. This fear only escalated during week 9, this is a warning that if you’re grossed out by lady talk skip on to the next paragraph.  During week 9, I started spotting. It is really frightening to bleed during pregnancy, because I immediately think Aunt Flow has come for a visit and she doesn’t visit pregnant folks. I called my docs and they assured me that as long as it is not accompanied by cramping or back pain and does not increase in flow that everything is alright. I’ve heard a variety of reasons for bleeding during pregnancy, including:

  • Implantation
  • Placenta Formation and Attachment
  • Blood clots created during placenta formation
  • Bursting of blood vessels
  • Uterine growth and contractions

My plan is to keep a close eye on things and make a follow-up to ensure that everything is alright, so please be praying for this.

My greatest wish at this point is to make it to 32-34 weeks miscarriage free because I know at that point my babies have the best chance of a handicap free life.  I also hope and pray that I can create the ideal environment in my belly for their growth and development.

All of these woes and wishes, hit me pretty hard on the way to work yesterday. Then, I was blessed by a song on the radio; “I need you now, how many times” by Plumb. Amazing song and exactly what I needed to hear.  I hope it inspires you, too!

Written by: Cassie Vanderwall