30 October 2016

44/52 - Hip Dysplasia, the End of Soccer

This past week, we got some disappointing medical news about Oskar. But let me back up a minute first.

In the hospital, newborns get all sorts of screenings shortly after they are born. One of those screenings checks the joints to make sure that they are formed correctly and functional. When we were in the hospital with Oskar for the better part of week, we saw a number of different pediatricians. About half of those thought that they noticed a "click" or "pop" in Oskar's left hip. The doctors didn't seem to be overly concerned about it but did mention that we could followup with an orthopedist to be sure.

Oskar was breech in utero, and breech babies to have a higher incidence of hip problems due to the way they are positioned. For comparison, here are Oskar (breech) and Anders (vertex, aka normal) and the default position of their legs.


Oskar...


...and Anders

We got a recommendation for a pediatric orthopedist and scheduled an appointment. At the first appointment, Oskar wasn't terribly cooperative; he kept his legs tense, so the doctor couldn't get a good feel of his hip movement. The orthopedist also wasn't terribly concerned but recommended that we schedule an ultrasound just to be on the safe side.

By now, I'm sure that you've guessed the outcome of the ultrasound. Oskar's left hip has dysplasia, a condition where the hip joint is not correctly formed. You can see the difference between the normal right (top) and dysplastic left (bottom).


Hip ultrasound

In Oskar's case, the malformation is relatively mild; the hip socket is shallow, but the ball is still in roughly the correct place. There are much more severe cases where the ball is completely dislocated from the socket. Nevertheless, without treatment it would likely result in serious hip problems later or an early hip replacement.

The recommended treatment: Oskar is to wear a harness that keeps his leg at a slightly acute angle (<90°) from his torso. Since all of his bones are still soft and growing, the hope is that keeping the leg in this position will encourage the socket and ball to grow into the correct shape. Apparently this approach has a very high rate of success. If it doesn't work, then the alternative path involves surgery to correct the joint manually. In either case, the result should be a normal hip with no issues in the future.

At the end of the appointment, the orthopedist put the harness on Oskar and showed us how to do it. Oskar will probably wear this for the next 2-3 months, taking it off only for baths. (In worse cases than ours, the harness is kept on at all times, with only sponge baths allowed!)

We weren't mentally prepared for this scenario when we went to the appointment; we were merely dotting the i's and crossing the t's. The doctor warned us that the next several days probably wouldn't be easy. Babies often have a difficult time adjusting to the harness (justifiably!).

Here is a stock photo of the harness, followed by a photo of Oskar just a few hours after having it fitted. See if you can spot the main difference.


Stock photo...


... and reality

After we got over the initial shock of the situation, we had to try to move on with the rest of our day. We had lots of other things planned that day, including having our "new" car repaired. When the dealership sent us to the local Enterprise rental car for a loaner and all they had was trucks, that didn't add to our enjoyment of the day. And when the one-day repair was now stretching out to a second day, that wasn't so good either. But we made it home and tried to adjust.

New parents are taught about purple crying, but we didn't experience it until the harness. Oskar loved to kick his legs, but with the harness he would go into a crying fit everytime he tried to move. Nursing sessions all started with crying. And naps were pretty poor. He was generally pretty irritable; it felt like we had lost a part of his personality. We had read about newly-harnessed babies only sleeping for 15 minutes at a time during the night. Fortunately for all of us, the harness didn't seem to affect Oskar's nighttime sleep. After about a week, things started to get better; he was crying less and smiling more. We put a onesie on under the harness to help prevent irritation from the harness, and we're learning how to change a diaper efficiently through and around the harness. Fun times.



Since he wears the harness all the time, there are lots of clothes that he can't wear. Pants, for example. Or anything with legs, really. Donna made a couple of sleep sacks from some cool fabrics, to fill part of that wardrobe gap.



The first follow-up is in early December, when we'll see how the hip is progressing. Wish us luck!



In other news, Anders' 1st and 2nd grade soccer team had their last game this past week. Last year, Anders played like a ref: always near the ball but never interacting with it. This year he really engaged and loved playing, and the team was actually pretty decent! At this age, there is no keeper (aka goalie), no corner kicks, and they don't keep official score. But of course the kids kept score themselves anyway.

Anders picked up a few tips from watching all of those Olympic soccer games, primarily how to celebrate a goal (victory lap with arms in the air) and how to block the opponent during throw-ins. Sometimes he is paying more attention to blocking the opponent than receiving his own team's throw-ins, but he's learning.





They had a pretty rainy season, but only one game had to be rescheduled entirely. Mostly, they just got wet and had fun. As parents, we enjoyed the required downtime in the beautiful outdoors.





They celebrated the end of the season with a pizza party in the park.



A few days after the "last" game and end of season celebration, the rained-out game was rescheduled. Between the two teams, there were 4 kids from the same preschool class. Reunion!



Anders is already looking forward to next year.



- Mike, Corinne, Anders, and Oskar

21 August 2016

34/52 - Olympic Baby

One of the benefits of Oskar arriving when he did is that we had an excuse to just sit and watch the Olympics! Starting about 5 years ago, we became "cord cutters" when we dropped all TV service in favor of Netflix on a Roku. So it took a little investigation to figure out how we could even watch the Olympics online. We subscribed to a streaming service (SlingTV) for the sole purpose of watching the Olympics, but none of the online-only options include the main NBC network. So we could only watch the "off brand" events that didn't make the cut for primetime NBC viewing: team handball, water polo, badminton, table tennis, soccer, etc. Nevertheless, it was pretty engaging and impressive to watch athletes at the top of their sport.

Anders was enraptured by the Olympics in general, regardless of the sport. For each event he watched, he had to choose which "side" he would root for, then he would act as if he had been rooting for that person/team all of his life. One day he looked at the event schedule and saw kayaking and canoeing for 5am the following day. He immediately decided that he would get up to watch it! And to our great surprise, he actually did. (This is the kid who has slept until 11am on Christmas morning and who struggles to get up by 7am to catch the school bus.) On that day, he watched the Olympics for 13 hours straight. Hey - it's the Olympics!



Anders and Grandma Donna made cheese crackers, since everyone knows that watching sports on TV is better with salty snacks.



I think this was the first time that Anders was exposed to television commercials. Since most of what he has watched previously was educational programming of some sort, he interpreted them all as public service announcements. "We should get a Pizza Hut Big Flavor Dipper pizza. It comes with 4 sauces!" "Did you know that ExxonMobil makes cars go further with less?"



We had another full week of doctor appointments, including the 2 week checkups for both Oskar and Corinne. Both passed with flying colors. Oskar made it back up to his birth weight at just about the two week mark.


Oskar and his "life-size" sock monkey, courtesy of Aunt 'Nita

While in Portland, we couldn't pass up another stop at Salt & Straw. I guess it's not every day that a newborn waits in the S&S line, so Oskar garnered quite a bit of attention. One boy asked if he was real. (We sometimes wondered that ourselves.)





After a week of Anders being able to spend time with Oskar, he is more excited about his little brother than he was before he was born.



Anytime he is around, he tries to give his brother kisses and tells him how cute he is. If we had any doubts about how Anders would handle no longer being the only child, they have now been thoroughly dispelled.





Since Oskar was born early, we had a bonus 0th birthday party for him on his official due date! Anders insisted. And since Anders also had a 0th birthday party, it seemed only fair. Plus, cake.





Anders made the decorations. Unfortunately for Oskar, he can only appreciate the cake second-hand.









Happy 0th Birthday, Oskar!

- Mike, Corinne, Anders, and Oskar

14 August 2016

33/52 - First Week Home

With excitement and a bit of trepidation, we left the hospital with Oskar and headed home on our own.



Our first task was introducing him to his brother, who had waited all week back in Trout Lake with Grandma Donna. Anders has been really excited to have a brother. He has always loved little babies and has a nurturing personality. After the initial introduction - which didn't take long, given how little Oskar has to contribute to the interaction at this point - Anders immediately went into helper mode. He helped setup Oskar's bed (the pack-n-play we had for Anders), retrieved burp cloths, and anything else we asked. "Mom, can I get you anything?" "Mom, what do you need?" "I can do that." This was a good start!

Corinne summed up the first overnight at home pretty accurately: "That was challenging." Oskar didn't sleep for more than about an hour at a time that first night. It turns out that he had day/night reversal, which is just what it sounds like. He slept great during the day but restlessly and intermittently at night. This seemed to correlate with his activity in the womb; some of his most active times were just as we were getting into bed at night. The experts indicate that this usually resolves itself "in 2-3 weeks", but thankfully he seemed to settle in to an average of 2-2.5 hour blocks by about the third night. We won't be fooled this time around, though; we know that there will be many sleeping regressions in our future.


Daytime (of course)

On the morning after that first challenging night, we all went to a parade! Another one of the differences between having the first and second child is that when you have your first, you can just drop everything and focus on the newborn. But the second time, you have another child that still has things he wants to do! That weekend was the Trout Lake Fair, and Anders wanted to ride his bike in the parade. So we hauled all of us out for a hometown parade.



Anders decorated his bike and brought some candy to toss along the route. But he didn't have a chance to practice his tossing technique: on his first toss attempt (which happened to be to us), the candy only landed about one foot from his bike and he almost crashed. Anders reports that his tossing improved by the end of the parade.



When it came time for the emergency vehicles, I covered Oskar's ears to mute the loud noises. He didn't seem to care one way or the other.



The Trout Lake Fair is a local fair, put on by and for the locals. For such a small community, there sure is a lot of creativity. This "float" was our favorite this year.


After the parade, Anders and I stayed for the rest of the fair while the rest of the crew went home to relax since Corinne is on restricted duty for 6-weeks, to recover from the surgery. Just getting everyone to the parade was a major accomplishment!


Anders climbing up to run the zipline

For the entire first week home, Grandma Donna stayed with us, helping with whatever needed to be done (lots of laundry and dishes). Thanks!


Babies make so much laundry

About halfway through that first week, Grandma Lee (my mom) arrived on a short visit before her National Parks tour. She made the plans a year ago but added on a short visit at the beginning of the trip "just in case" there was a new baby to see. She got lucky. We'll see her again for a few more days at the end of her trip.





At this point, newborns spend 95% of their time eating and sleeping. They are most expressive while sleeping (and dreaming) as they move the muscles that will be used to create their voluntary facial expressions in the near future.


Practicing his smile

Here are a few things we have learned in our first week home as a family of four:

  • Changing a diaper and getting a bath are tantamount to torture, but peeing on your own face isn't worth even noticing.

  • Saving those bins-and-bins of baby clothes, toys, and gadgets was useful after all. It is much easier to pull out something you already have than to spend an hour researching which one to buy.

  • Anders really does enjoy being a big brother. Sometime in the first few days home, he gave Corinne a spontaneous hug and said "Thanks for giving us Oskar."

  • We really can do this. No matter how many times we thought "yes, we really do want another child", there's always another voice saying "You're too old and set in your ways!" "Two kids is much harder than one!" "It'll ruin everything!" So far, so good. :)



All in all, a successful first week!

- Mike, Corinne, Anders, and Oskar

07 August 2016

32/52 - Start of a New Eon

Now that we've had a few days to recover from the big change in our lives, here is the story of Eon's arrival.

The baby had been breech since early May, with no signs of moving on his own. When the ultrasound at what would be our last weekly prenatal visit showed that he was, indeed, still in the same position, we decided that we would schedule an External Cephalic Version (ECV) (aka version, aka turning the baby) for as soon as possible. Waiting longer only increased the chance that Corinne would go into labor and we would have little choice but to do an emergency C-section. Medical protocol required that we wait until 37 weeks into the pregnancy, so we scheduled for the first available day just 3 days later, on Monday.

Over the weekend, Corinne made a point to take it easy, avoiding exerting herself as much as possible. The last thing we wanted was for her to go into labor before we had a chance to attempt the turn! Meanwhile, Anders and I took a break from baby prep to visit the Hood River County Fair.



Thankfully, Monday arrived and the baby hadn't. Since there is always a chance that the version could either induce labor or stress the baby, preparations are made for a C-section, just in case. Therefore Corinne couldn't eat or drink anything starting that morning. After an acupuncture appointment in the morning - also intended to help the baby turn - we departed for the hospital with our overnight bags and infant car seat, just in case.

Corinne was hooked up to an IV for a few hours before the version to rehydrate her, then the doc arrived around 4pm to start the ECV. I'd never seen one before, but it looks like what it is: trying to push the baby around with your hands.



Our doctor tried turning him one direction, then the other. After about 30 minutes, she declared the version unsuccessful. Both Corinne and the baby were monitored during the whole procedure, and the nurses continuously commented that "the baby was happy". Corinne's monitors, however, showed that she had some mild contractions even before the ECV had started. She couldn't feel them beforehand, but after the version attempt she started to feel them. Our doc wanted to monitor her for a couple hours before deciding what to do, though we both started to get the sense that we probably wouldn't be going home that day.


Waiting, waiting through mild contractions...


Working while waiting in what would turn out to be our home for the next 4 days

Two hours later, Corinne was still having mild contractions and was slightly dilated. A few more hours later at 11pm, with contractions still present and dilation progressing, the path was clear: we were having a C-section that night. Just 45 minutes later while on the operating table waiting for the start of the surgery, her water broke, thereby confirming the wisdom of that decision. No turning back now!

Once the procedure had started, it took only about 10 minutes for Oskar to emerge at 12:24am on Tuesday morning. For the sake of the squeamish readers out there - not to mention Corinne - I will leave out the details of the C-section procedure itself. I will say that it was very cool to be able to watch. I guess all of those medical dramas and graphic horror movies finally came in handy; I was fine.



During the operation, they did discover the most probable reason for why he wouldn't turn: the umbilical cord was fairly short, somewhere less than 18 inches long. Between that and his breech position, we are pretty thankful that it all happened the way it did. We are pretty sure that Corinne had started labor before the version. By already being at the hospital that day, everything was calm and procedural. We didn't have the stress of deciding when to leave home or whether to make the 1.5 hour drive to our preferred doctor; given how she presented in the hospital, the labor would likely have progressed pretty quickly.

C-sections are a mixed blessing. They are sometimes the only option (like in our situation) and involve less pain during the delivery, but the trade-off is a much longer recovery time. It is a fairly invasive surgery, after all. We would be in the hospital until at least Thursday so that the hospital staff could monitor both patients. Oskar did have an orange pall, indicative of possible jaundice. But unlike with Anders, Oskar's bilirubin (the substance that makes him orange) never reached the level requiring any light therapy. On his 2nd day, Oskar's temperature and blood sugar were low but those were resolved over the next day.





The hospital is certified as Baby-Friendly, which among other things meant that Oskar stayed with us in our room for the whole visit.


Enjoying a double-nap

We were in the hospital through Friday, staying an extra day to allow for additional Oskar monitoring and to fix his ankyloglossia, aka tongue-tie. His tongue ended up being fixed with a simple scissor snip that made Corinne cry even though Oskar barely noticed.



We had wonderful nurses and became pretty friendly with them. As it happened, during our stay the hospital was doing a promotional video about one of the nurses and the educational program through which she became a nurse. We got to be part of the shoot! The hospital makes souvenir (aka not a legal document) birth certificates with the baby's footprint; we received an extra one signed by the film crew.





The final video and still photos should be available sometime in the next couple months; we'll post them when they are. It was great fun!

Finally, on Friday we were cleared to go home. Now the real journey begins.





- Mike, Corinne, Anders, and Oskar