Friday, April 12, 2013

No, I won't.

Newest Big Yam phrase: "Will you pay me the dollars, please?" - said at random moments (e.g. last night during the tail end of dinner or during play).  I find it so funny when I'm elsewhere in the house and I can hear the Dotytron say, "No! I will not pay you the dollars!!!"  I don't really know where he got it from, but it's pretty funny, and at least he asks nicely.

The whole asking nicely thing is a bit of an issue right now.  We've stressed the asking nicely (repeating the request sans whining, saying please and thank you) thing a lot, but now he thinks that when we say no, it's because he didn't ask nicely enough.  So he'll say stuff like, "I want to ask nicely now!" and get all sad and cryface about it.  Now we have to explain that even though we really appreciate that he asked nicely, sometimes, he still doesn't get the thing he wanted.  It's a bitter pill for him to swallow.

This Tumblr called Reasons My Son is Crying (which has gone viral, justifiably) encapsulates some of the madness that is parenting.

Another Big Yam thing: for the last month or so, he'll randomly want us all to hold hands in a circle, and then pump our arms up and down while we say, "Gracias, thank you, gracias, thank you" again and again.  On Sunday morning, I was thanking him and his Baba for making a delicious waffles and sausage breakfast and I got all "teachable moment" and was like, "We should also thank the farmers who harvested the grain, and the pigs who gave us their meat for sausage, and the non-unionized slaughterhouse workers for processing the pork into sausage..." and the Big Yam looked at me for one long, grave moment and then stretched out his hands to me and the Dotytron for a round of "Gracias, thank you."  It was so funny!  It might be our new family way of saying grace.

I've been dealing with mad twerps-related dramas lately.  Basically, I was supposed to have been referred to the multiples clinic at Sunnybrook at about the 20 week mark so they could monitor me.  Then, assuming everything was fine, they would release me back to the shared care of my midwife and OB once I reached the 32 week mark.  Through a series of giant clusters, mostly related to the OBs at Sunnybrook balking that a midwife is in any way involved in my care, I still haven't been to see them yet.

When I last saw my regular OB, she was all like, "So have you been to Sunnybrook yet?" and I'm like, "Uhhh, noooooo...I thought your office was handling this," and she's all like, "You NEED to see the multiples clinic, [insert comment about how the twerps are as high risk as they come]"  Here's the thing: getting in at Sunnybrook is COMPLETELY out of my control!  At first, my midwife sent in the referral, which got rejected.  Then my OB sent in the referral, and it also got rejected (because they didn't like her sharing care with the midwife).  There's weird midwifery politics going on.

There are a few factors at work here.  1) Say I went into labour tomorrow *knocks wood a billion times*, I would just have the Dotytron take me to Sunnybrook immediately, so that's a moot point.  2) Assuming I go to term and everything is all as normal as possible with the twerps, as soon as I step foot into my regular hospital, it's a transfer of care to the OB anyway.  My midwife is just around to like, catch the baby (if the OB gives the go ahead) and provide labour support and then help me with the post-natal care (home visits and the like), so that's a moot point.  OBs don't do labour support OR post-natal care.  My type of twins means that I HAVE to be under the clinical care of an OB during delivery.  I mean, I can do what I want technically.  Like, if I wanted to be all guerilla crazy-cray about things and do a homebirth, I could do that, solo, but there's no way my midwife would touch that legal firestorm-waiting-to-happen with a 10 foot pole.

Anyway, while I've been waiting in limbo, I've decided to do what I can do, which is research the f**k out of my type of twin pregnancy.  I went on PubMed and downloaded a million articles on ultrasounds and twin pregnancies and I've been reading about twin-to-twin transfusion syndrome.  It's pretty grim, guys.  Level 5 TTTS is death (I know I'm no doctor or anything, but I feel like if level 5 is fetal death, then you don't really need a level 5, do you?  Shouldn't it only go up to 4?)  Levels 3 and 4 are pretty grim, with a high rate of fetal death of one of the twins and neurological and cardiac defects in the surviving twin.  Level 1 is okay, and just requires a tonne of monitoring.  There are two kinds of TTTS, chronic, and acute.  Chronic can pop up at any time and either hold steady or progress.  Acute happens like, all of a sudden (during labour or whatever).  Statistics on TTTS occurrence for monochorionic diamniotic pregnancies (which is what I have) range anywhere from 10-15% up to 20-30%.  Again, there's nothing I can do about it.  It either happens or it doesn't.

The only way to stay on top of it is through ultrasound monitoring followed by some kind of doppler if level 1 presents itself.  Suffice to say: all this reading made me feel like a s**t person and a s**t parent.  Like, way to NOT KNOW ANYTHING, LAGERFELD.  Here I've been more concerned about my Land of Nod order coming in on time and getting the Big Yam's room set up and there's a risk of brain damage and heart problems?  I'M THE WORST.  More importantly, the lack of information has meant that I haven't been able to adequately advocate for myself during this whole process of trying to get to Sunnybrook.  I should be getting ultrasounds every 2 weeks if level 1 TTTS presents itself, otherwise, I should be managed conservatively.  My last ultrasound was at 20 weeks.  I'm getting one this week, which is week 25.  I've consoled myself that I've only technically missed one ultrasound, then.  Also, my last ultrasound was perfectly normal ("grossly normal," even).  So there wasn't a risk of TTTS at the last one.

The latest update is that based on my ultrasound this week, we'll decide what to do from there.  My OB apparently tried to refer me AGAIN to the multiples clinic this week (Sunnybrook rejected me again).  Basically my OB is at the point where she's like, "Uhhh, do we even have to bother with the multiples clinic?"
Stage 1 TTTS is determined through the presence of oligo-polyhydramnios (where the amniotic fluid index in one sac is 5cm or less [donor twin] and greater than 24cm in the other sac [recipient twin]).  If this ultrasound shows that I'm developing stage 1 or am at stage 1, then I think I'll end up at Sunnybrook.    BLARGH.  So much to think about.  If this ultrasound comes back normal, then I'll get ultrasounds every 3 weeks to monitor for the development of TTTS, until such time as I hit twins term, which is around 32 weeks (and I'll probably be getting weekly ultrasounds at that point, to watch for intrauterine growth restriction).

The OTHER complicating factor is that there's a chance that my twins aren't identical at all.  The easiest way to determine chorionicity of twins is with an ultrasound before 8 weeks.  I had my first ultrasound at 12 weeks, when it is possible that two eggs implanted and their placentas just fused together, giving the appearance of one.  There's also this thing called the twin peak sign, which indicates dichorionicity, but that also has to be picked up at a certain time.  Otherwise, we wait to until the twerps come out and inspect the placenta, or, if we REALLY cared about whether they were identical or fraternal, we could send away for genetic testing, at a cost.  Frankly, I don't care.  I just want healthy me, healthy twerps.  The thing is though, all this fretting about the potential for TTTS could all be for naught (fraternal twins can't develop TTTS).

Well, all this reading has served to simultaneously make me more freaked out AND feel better because I am now armed with knowledge and a vocabulary.  Despite what a mess this all is, I am feeling better knowing that I know more.

Tuesday night we had patty melts for dinner.  Ummmm...patty melts are LIFE.  It's basically a hamburger/grilled cheese mash-up.  The most traditional form of a patty melt is a hamburger, with caramelized onions, rye bread, and Swiss cheese.  Our rendition was a 6oz all ground-beef patty (that the Dotytron cooked PERFECTLY - look at how rosy and juicy it is inside!) that we pan-fried in butter, between slices of challah (also buttered and griddled) and aged cheddar cheese.  We instantly regretted not making 2lbs of ground beef's worth.  It is everything you want it to be - gooey, juicy, crispy, buttery.

Broiled kalbi with jap chae (with spinach, mushrooms, and carrot) on Wednesday.

Last night's dinner was spinach & artichoke melts (basically, a souped-up spinach artichoke dip sandwiched between thick-cut bread and grilled), with more dilled cucumber salad.  

I've also been working hard on this orange poppyseed cake I made with Cara Cara oranges which are THE BEST ORANGES IN THE FREE WORLD.  They're like a super-sweet cross between blood oranges and pedestrian navels.  Check it.


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