A work in progress

Tomorrow is Emmeline's surgery.  I'll be updating this post throughout the day as the procedure happens so that friends and family can get an update.  We're supposed to be at the hospital at 7:30am with the procedure set for 9:30am (and no nursing after 4:30am -- oh no!).

6:59AM -- Not a great night of sleep for anyone.  Emmeline is waking up on the couch, where we slept for an hour or two this morning.  I'm pumping, hoping to empty my body of the thing she can't have until after surgery.  It's cold and gray and wet outside.  Heading to the hospital in about 15 minutes.

9:13AM -- Just handed Emme off to one of the anesthesiologists to go back for surgery and am now camped out in the waiting room until I get an update.  We got to the hospital around 7:30, checked in, did a few laps of the waiting area, and went back after not too long for vitals and such.  I've told about twenty people now that she doesn't have allergies, asthma, or a runny nose.  She even got enrolled in a pneumonia study (as a control, of course) that Wes is a part of (the CTA had to call and make sure it was okay!).  I was fine handing her off but had a moment of pause watching her walk down the hall with the team.  I'm sure she'll be fine, but it's always weird watching somebody cart your kid off.  She did manage to keep it together sans milk though she got pretty worked up for about 10 minutes near the end.  She for sure won over all the nurses and techs and doctors who saw her with her grins and spit bubbles.

Dr. Chester said probably 1-2 hours for the surgery, and the anesthesiologist said at least 1-2 hours after surgery before we can go home, so we'll be here for a little while.  She also said she's probably going to put her in a plaster cast afterwards just to speed healing.

11:00AM -- Nurse from the operating room called to say everything was going well.  Nothing specific to update, and no timetable for when they'd be done, but so far, so good.

1:56PM -- And home.  Right around noon, I was taken to a consult room and told that surgery was wrapping up.  Probably ten minutes later, Dr. Chester came in to tell me how things went.  She had pictures on her iPhone of before and after.  Emme is in a plaster cast clear to her hip, so we won't see the finished product for two weeks.  She took 2 1/2 cm off of the nevus, plus one larger one on her knee.  The anesthesiologist had a little trouble getting an IV in, but ultimately it was fine.  As soon as I left the consult room they were ready to take me to the PACU.  She was already waking up and had demanded something to eat, evidently, so they'd given her some Pedialyte.  Wes showed up shortly thereafter (is it just me, or is he always there right at the end of the excitement?) to see how she was doing.  She's been hungry and fussy.  She'll be okay for a minute, relax in my arms, and then get kind of upset -- a mixture, I think, of pain her leg, the anesthesia drugs and tube down her throat, and even maybe the IV site.  Because she woke up so well and ate so quickly thereafter, they let us leave pretty quickly.  She fell asleep on the way home, so I left her in her car seat, but we'll see how long that lasts.  My guess is that the afternoon (and next few days) will involve a lot of baby holding, Tylenol, and general soothing until she gets used to the cast and initial pain wears off.  Many thanks to those who sent prayers and good thoughts our way!

Like old times

The last few nights, Emmeline has been going down earlier in the evening.  She'll rub her eyes, fuss, and I put her in the swing.  Sometimes she's down for the night, sometimes just for a few hours before she eats again, but it does give me an hour or more before Oliver's bedtime to be with him. And on nights when Wes is working a shift, that's something extra special.  We play with Oliver's toys or he helps me with the dishes, and when it's time for bed, I can let him play in the bath for awhile and we read books before I tuck him in.  The first night I got to do this it reminded me of what life was like before Emmeline came, before I was pregnant even, trying to shield my abdomen from his exuberance and fighting nausea and exhaustion.  I love having Emmeline.  I wouldn't wish her away for a single second.  And there is nothing more special about my first child than my second.  But in those moments, when I'm blowing bubbles for him in the bathtub or letting him read me Blue Hat, Green Hat, it feels like old times.  

My little boy

So grown up!

This is what tired looks like

Like mother, like daughter

The one where I look like my kids

Here's Oliver, and below is one of Emme.

Mardi gras man

Oliver's daycare teacher, Miss Tanga, sent home a string of beads a week or so ago for Mardi Gras.  Wes picked up Oliver that day and said he was very excited about his "bracelet."  He's been wearing his beads everywhere since then.  He puts them on in the morning until I make him take them off to go to daycare.  He puts them on in the afternoon and even wears them with his pajamas (metallics go with everything, I tell you).

I told Tanga that I didn't want to know what he'd done to get his beads.

What did you see at the zoo, Oliver?

Animals...

and a tractor (note the elephants behind it).

Told you so

Yesterday afternoon, Emmeline and I returned home after a few days in Savannah, where I was doing research in my sister's school.  I asked Wes if he was well rested after a few day with no shifts, only one kid at home in the evening, and no crying baby at night (which, in fairness, only interrupts his sleep a little).  He nodded rather half-heartedly, so I probed.

The night before, Wes had decided to make tuna melts for dinner.  But Oliver wouldn't eat his.  Wes tried adding some cheese, offering it with chips, all kinds of things.  But Ollie wouldn't touch it -- something that's really unusual.  He told Wes that he would not eat the tuna because it would make him sick.

So either Oliver is a soothsayer or has some kind of supersensitive nose, but turns out he was right.  Wes spent all Friday night with food poisoning, vomiting and feeling generally awful.  He spent all day yesterday in bed and is just now eating somewhat normally again, though he says he's still feeling sapped of energy.

Oh, and Wes tossed the other can of tuna.  

Beetlejuice

Emmeline had her 2 month checkup with her pediatrician yesterday.  She is doing great, of course, but it's always nice to get her official measurements.  She's grown almost 2 inches since her 4-week appointment, but she's only gained about a pound a half (from 8 lbs. 13 oz. to 10 lbs. 8 oz.), despite her excellent eating. She is around the 80th percentile for length (a highly interpretative measurement with a baby), 40th percentile for weight, and continues to be around the 20th percentile for head circumference.  Her pediatrician was very impressed with her neck and shoulder strength.  When she saw Emme push her arms and head up when lying on her belly, she commented that was a four-month milestone.  Perhaps it's because of her small head or because she can see that she'll have to be strong to survive in house with Oliver, but it's fun to see such a little person trying to be so big.  She even likes to stand and push up on her legs when held.

Emme's doctor assured us that the fussy evening period usually peaks between 6 and 9 weeks, but I'm not sure anyone's told Emme that.  I did get a swing today (though I'm leaving it in the box and keeping the receipt), so if the troublesome evening period continues, we might try that.  She is stretching out her nights more.  I've seen a few 5-hour and even one 7-hour sleep stretch.  Of course, I'm not always in bed when that happens, but it's a move in the right direction.  I also read somewhere and had another mom mention to me that we should try to put her down earlier, like 6 or 7 o'clock, to help her sleep better (though, as Wes pointed out, it's not like we're keeping her up).  She sleeps fine once she's down, but helping her settle for that first stretch of sleep has been a real challenge the last few nights.  But as they say, this too shall pass -- and all too soon, I dare say.

Emme got her vaccinations yesterday, too.  I knew what to expect, having watched Oliver bump her head often enough to evoke her greatest rage.  She was pretty easily consoled, though.  We did end up giving her some acetaminophen last night, when her crying got even louder than the normal fussing.  She's been down for a big long nap today, too, but hasn't been especially cranky.  Next appointment with the pediatrician in two months -- and hopefully not before!

*To understand Wes's reference in the title, view this video clip. 

Just lovely

Two months old

60 seconds of smiles

FAQs

What's Emme like? There's only so much one can say about a person who has only been around for about 7 weeks and is changing all the time, but here's my best effort at what she's like of late.  Emme loves to be held.  She sleeps happily when snuggled against me or on her tummy, but she often fights sleep, even when she's clearly really tired.  She likes to look around and move when really awake.  She's started to have happy waking periods when she moves her arms and kicks her legs all around.  I keep expecting her to roll over.  She has great head control and has since birth.  She can really get her arms and head up in off the ground when she's on her tummy.  She has big blue eyes that get wide open, and sad little pout, and a truly pitiful cry.  She likes to move -- whether on her own or in someone's arms.  And she's finally started to smile.  My mom got a great picture of her today with a big grin on her face.

How is she different than Ollie? To the best of my memory (which may not be great), she's a lot needier and fussier than Ollie was.  He was content to lay down on his own, went to sleep nursing and stayed that way when moved in to the crib or co-sleeper, and except for being kind of gassy, wasn't too much trouble.  Of course, I may have blocked out the harder stuff -- and I do know that naps were really hard for much of his infancy.  As she gets older, she starts to look more like him, though a tone darker.

How's Ollie doing? He is doing great.  He hasn't had any regression with potty training, and there haven't been any big temper tantrums.  A few things we've noticed -- he's been drinking more milk recently, which I think might have to do with all the milk Emme drinks.  He wants to be picked up more often.  And he tries to give himself the hiccups because she gets them all the time.  Otherwise, his behavior is pretty much normal two-year-old behavior, both good and bad.  He likes to go check on Emme, put in her pacifier when she cries, and gets excited to see her when we show up at daycare.  He rarely hurts her intentionally -- though sometimes he acts out by pretending to hit her -- but he has on several occasions sent her into hysterics because he bumped her in his enthusiastic play.  All in all, I think he's enjoying being a big brother.  His life hasn't been too disrupted by her arrival, and all the visitors that have come are just as excited to see him as her, which he likes.

What's it like having two? Hard in the usual ways, but not too bad.  It helps that I have an easy toddler who is actually somewhat helpful at times.  The challenging moments are when he starts acting out and I need to discipline him, especially when Emme is crying -- all of this usually happening in the evening around bedtime.  Wes is sometimes gone -- working, at a dinner, or whatever, so I'm dealing with them both and trying to stay patient.  Time outs sometimes work in disrupting the behavior but don't always, and I don't feel like I have much of a next step when that happens.  I occasionally get a glimpse of sibling love, which is wonderful, and I'm so glad to have her here.

How are you feeling? Great. Sleepy.  My body is completely healed.  My milk supply is fantastic.  I only have a few pounds and some tummy pooch to lose to be back in all of my pre-pregnancy clothes.  My brain doesn't work as well as it might given the sleep deprivation, but aside from needing a nap, I'm doing pretty well.

Do you want more kids? No doubt.  I really think Wes and I will have one or two more kids if we're able.  We have so much fun with our kids, even when they're a little needy or test our patience, and I think we both envision more.  We won't think seriously about it, though, until Emme is a year old, so for now, it's just something for the future.

A leg up

It's not every little girl who has her first plastic surgery at around 2+ months, but that's exactly what Emmeline's going to do.  After preliminary consultations with two plastic surgeons in Nashville, it seems clear that she's going to need a series of surgeries to remove the larger nevus, and both suggested that we start soon, so as to take advantage of the great skin elasticity she has right now.

Our first consultation was with a surgeon at Vanderbilt.  He was a surgery resident at UVA when Wes was in medical school there, and they actually recognized each other.  He seemed nice, very knowledgeable, and pretty confident in his recommendation that we should remove the large nevus.  He disagreed with the dermatologist, though, in how to go about it.  He recommended a series of 10-15 surgeries, starting at the end of February, to excise the nevus in stages, possibly with a graft at the end.  He didn't think the location of the nevus would support the tissue expander without running a high risk of erupting, which requires emergency surgery.  Wes and I left the surgery a little overwhelmed by the prospect of so many surgeries and such an early start date and decided that, though we trusted this surgeon's opinion, we wanted a second opinion before making a decision.

A few weeks ago, Wes took Emme to meet with the other plastic surgeon the dermatologist had recommended.  She is based out of Centennial but does her surgeries at Vanderbilt (the only hospital in Nashville with a pediatric anesthesiologist).  Whereas the doctor at Vanderbilt is only a few years older than Wes, this surgeon, Dr. Chester, is much later in her career and has spent much of her career dealing with nevi removal.  She agreed with the other physician that a tissue expander was not a good idea, but she thinks she can do the excision in four surgeries, the final being a graft with the skin coming from Emme's tummy.  Wes felt more comfortable with this surgeon, a little more confident in her experience, and we both prefer the idea of four surgeries versus ten or more.  Emme will still have surgery soon -- the first one is set for March 30, with plans to do the subsequent spaced six months apart.  She has another appointment on March 21, when I will get to meet the surgeon and hear about the first procedure, the hospital stay, recuperation, and follow-up care.  The excision will leave her ankle pretty scarred, but her young age should minimize the scarring from removal of the various other smaller nevi and the graft site.

I should mention that Wes's position at the hospital has really helped us get these appointments.  Both surgeons were booked for months out (much like the dermatologist), but the fact that he's on faculty got us in almost immediately.  We're not people to play our connections -- frankly, we just don't have any -- but the doctor's offices who make the appointments for us don't seem to mind, and well, we let them.  There's not the same kind of "professional courtesy" among doctors these days that there used to be -- people don't just treat each other for free -- but if we can get in to see specialists sooner because of it, we'll take it gratefully.

I'm still not thrilled with the prospect of having to do all this, but everyone seems to agree that it's medically necessary and that it can be done safely.  I have to think the later surgeries will be a little harder when she's crawling and walking and more likely to be affected by the recuperation, but the first one will hopefully give me a sense of what this will be like.  And hopefully, by the time she's two, we'll be all done with this -- a little girl with a scarred ankle who wears lots of sunscreen, but one with a much better prognosis.