The other night, we went to a barbeque with D’s coworkers.  One of his colleagues has two kids, and they were there, too.  One is roughly 13 months and the other is roughly 3.  (I didn’t ask for specific ages but the mom was talking about potty training, and how they would be probably trained at the same time, at 4 and 2…so it isn’t a bad guess for the ages.)

I will say that I *used to* evaluate kids ALL. THE. TIME.  Because for my job, I was evaluating kids ALL. THE. TIME., and giving these kids diagnoses that they would potentially carry with them for the rest of their lives, and *my* role in the evaluation was to ask their parents a bunch of questions and observe the kids in their home environments.  But?  The kids were all pretty much scoped out for me.  This was for a research project, and the kids were referred by their EI (early intervention) providers for some concerning symptoms, and we had done the M-CHAT (Modified Checklist for Autism in Toddlers) on the phone with the mom, and *sometimes* we had even done the ADOS (Autism Diagnostic Observation Schedule) with the child in our lab, so I had a good sense of what the kid was doing EVEN BEFORE I was in the family’s home.

So I spent a lot of my time with “typical” toddlers (or those who did not carry a diagnosis of an ASD) observing them, too.  Because I can describe what “initiating joint attention” is – in layperson’s terms – with the best of them, but to see it?  Is something entirely different.

And I am slightly embarrassed to say that I would sometimes diagnose our friend’s child with an ASD, and those children appear (now, a few years later) to be completely normal.

OK, that happened once.  Just once.  And there were many more kids that we met that I decided were normal and, lo! – they were.

(For the record, I *NEVER* shared my opinions with other parents unless I was specifically and directly asked.)

So ANYhow, I stopped this practice probably 2 years ago, mostly because I got a decent sense of typical toddler behavior all on my own, PLUS I started evaluating teenagers and adults, and the bulk of my clinical experience to that point had been with teenagers…so it became less necessary.

I say all of that because it kind of explains my new post series, called, “My toddler…”

This weekend, we met these two kids, and the three-year old (a boy) was just kind of hanging out by himself, being cute, whatever.  I honestly didn’t pay much attention to him at first.  D and I got some food, put it on plates, and walked out to the balcony where other people were hanging out.  Little Guy came out, plopped himself next to me, and, without LOOKING up at me or saying a word, reached over to my plate, dragged it over in front of himself, and proceeded to eat my grilled corn on the cob.

Which was, frankly, hilarious.  I just got up and got another piece of corn.

Then there was a cordless phone in the middle of the table.  He reached out to the phone and started messing with the buttons.  I decided that was probably not the best idea (his parents were inside, and the rest of the table was totally not paying attention to him), and redirected him by asking him if *I* could see the phone.  I reached out my hands.  Again without making any eye contact, he handed the phone over, and then proceeded to take his (my?) corn, go over to the grill on the balcony, and try to stick his corn in the grill by saying, “Hot.”  “Hot.”

Which we interpreted to mean, “I would like this corn hot”.

(The grill was off by that point, for those of you wondering about child abuse and neglect here…)

So one thing, that I am not going to ask about because I *KNOW* without asking, is that this child’s expressive language is delayed.  VERY delayed.  Two-word phrases, all prompted (some less prompted than others, but the unprompted, spontaneous language was all comprised of single words), and very few of the phrases included a subject, like, “Corn hot”, or “I go in”, etc.  So let’s leave the language alone, because it is clearly an issue.

However, here are the things that I would normally pick up as a concern:

1)  The taking food without looking up at me and making eye contact.  Yes, it was funny.  But do three-year-olds typically make eye contact when taking something?  The food was certainly far enough from him that he PROBABLY did not think it was his, but the way he grabbed it…well, he probably did know it wasn’t his.  In fact, later in the evening, he proceeded to grab food off my plate again (I really don’t care about that), and his mom was sitting next to him, scolded him, and he looked up at me again, as if to ask if he could take the raspberry…which says to me that he knows how to ask permission.

(Nonverbal kids can still “ask permission” to take things, by using joint attention and eye contact.)

So…does your kid make eye contact when grabbing something from someone else?  A stranger?  A familiar face?  A parent?

2)  Eye contact, round two:  if someone asks your child to hand them something, does s/he make eye contact with the individual asking for the object?

3)  Tantrums:  if your child likes an object, and is playing with the object, and a stranger asks him to hand it over (in a happy, fun voice), how would he respond?

4)  Playing with the grill:  this is a two-part question:

a)  Does your three-year old know that something is “hot”, and should not be touched?

b)  Does your three-year old try to mimic you, by putting things in the grill (or on the stove)?

5)  When saying goodbye, does your three-year old:

a)  wave upon mom/dad saying, “Say bye-bye”, or in response to others waving to him/her

b)  Wave on his own, because he knows he’s leaving, and that’s what you do when you’re leaving

c) not wave.

I will post the description of what *I* might be looking for in an evaluation of a toddler (either typical or with suspected ASD) in my next post.  I’m really curious to know whether I am too harsh in my interviews (maybe?  Although I follow the algorithm of the interview VERY tightly) and whether my image of a “typical” toddler is, in fact, “typical”.

So…what does your (2-4 year old) kid do?  (**Don’t worry, these questions comprise only a *TINY* proportion of what I ask about, so even if your answers are, “never looks at anyone, doesn’t wave, and plays with fire”, I will not think any differently of your child.)

Thanks for your responses!

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So…the end of the weekend.  I spent almost every moment of it studying or sleeping.  It wasn’t all that fun.

Tonight there was a review session for the bio exam.  I usually hate it when people say things like this, but I am going to say it – this test is on what seems to be an insane amount of material.  It is covering big topics, in a *lot* of detail, and some of the topics have absolutely NOTHING to do with each other.  See:  immune system, and hormones (ok, those are similar enough), and kidneys and not being cold or hot (ok, those are close enough), and…evolution.  (Huh?) And then back to…embryos.  Specifically, like, fertilization and the first oh, say, 10 cell divisions of an embryo (zygote).  In humans, birds, frogs, and…sea urchins.  Yeah, sea urchins.  So vitally important to know how *they* start out.

But in any case, so we get to learn about sperm and eggs and how they find each other and set up shop.  Great.  Well, one of the (many) things we need to know about is what is called the “fast block” to polyspermy (mulitple sperm going into the egg) (ie, preventing that from happening) and the “slow block” to polyspermy.  The fast block is something that sea urchins have, because their eggs are floating everywhere and surrounded by sperm everywhere and they need to be sure to only have one sperm get in that egg, right?  And the slow block is something that *everyone* – mammals, sea urchins, frogs, you, me…has.  (The fast block happens…faster…than the slow block.  As the name might imply.)

See where I’m going with this?

So I have learned all of the blocking polyspermy stuff.  I feel rather up-to-speed on these things, if only because hey – it is relevant to me (see previous post re: toaster magic, and peeing), and it was interesting.  It came up today in the review.

Volunteer former student running the review session: “So the fast block is… and the slow block is… and they are in all animals”.

Dude in the class:  “Wait, I thought the fast block wasn’t in mammals?”

Volunteer dude running session: “It isn’t? [Fumble.]  Hmm…”

Another dude in the class:  “So few sperm get to the mammal egg that they don’t NEED the fast block…by the time you need to block the sperm, the slow block is in place.”

(Me…thinking about how I WISHED mammals had a fast block and a slow block.)

(Some ensuing discussion about whether mammals had fast blocks or not, and why polyspermy is a Bad Thing.)

Someone in the room: “Because what a MESS it would be if there were more than one sperm in the egg!!”

Everyone…laughs.  All I was thinking was, “It’s not that funny when it actually happens…”  I was just short of breaking down, thinking about what a MESS our kid was.

A mess.

Yes, that’s exactly how I think of him.  A mess.

Anyway, part of me thinks I am being too sensitive.  (A big part.)  But the other part?  Wishes that mammals really DID evolve with both the fast block and slow block, because then I bet we wouldn’t have had the eager-beaver sperm problem.  Damn sperm.

Damn ineffective slow block.

And…back to studying.  Some more.

I am really, really committed to studying, so I have not been online at all recently.  It is amazing how a little lot of fear of failure will inspire such…behavior change.

Yes, I, Rachel, am now studying roughly 10-15 hours a day.  No joke.  No breaks.  Although I have noticed there is a diminishing return around the 10-11 hour mark.

(That should give you some idea of how far behind I am…the fact that that level of studying is necessary.)

Anyway, Jena is running a giveaway on her new blog Cute…Covered.  It is the second post down.  The blog is about being fashionable and modestly dressed, and she has some really great thoughts.  I just tried to characterize those thoughts and I totally failed, so I would encourage anyone who is interested to go check it out!!

As an aside, her blog is pretty much perfect for me, since I am very modest and have absolutely no sense of style.  In any way.  See, exhibit A:  sweatpants and torn alma mater sweatshirt.  See also:  $8 jeans and turtleneck sweaters in every color and for every season.  Yup.  (I only partly jest.)

So I have learned a lot from her already :).  Go enter!

Back to…today, bio, and then tonight, physics.  Mostly because physics is a lost cause.  Mostly because…well, you know how you plug in a toaster?  Into that socket in the wall?  Yeah, so I have been plugging in toasters for most of my life, and not really thinking for more than 2.2 seconds about how it is that the toaster works.  It is JUST MAGIC.  POOF.  And it turns out, it really would have behooved me to actually think about what the hell happens behind the three holes that miraculously give life to my toaster.

Or to the hair dryer.

Or the alarm clock.

Or any other electrical object.  It turns out that the area of my ignorance is vast, and it is unlikely (highly, highly, highly unlikely) that I will come CLOSE to filling in the holes in the next 4 days.  Like, I don’t even KNOW what I don’t know.

So…biology.  I actually *have* paid attention to, you know, PEEING.

So I have been in a studying cave for the last week, and I intend to continue to be in a studying cave for the next week and a half…so blogging is taking a backseat. 

However, despite the studying cave, DB and I have become mildly obsessed with the Somali pirate story…as DB said this morning, “If they had an entire TV station devoted to pirates, I would never leave our house…”

It’s been a while since we’ve *both* been obsessed with the *same* news story.

And…here is a question for you all…we got this new car in December/January, right?  Well, it has the gas mileage prominantly displayed on the dash – both overall, and at any given instant.  When we were test-driving the thing, the salesperson told me that I drove rather…aggressively.  I kind of brushed it off.

Well, the stupid gas mileage summarizer-thingy would apparently agree with him, and DB has pointed it out to me on multiple (MULTIPLE) occasions.  My gas mileage is, like, MANY miles/gallon worse than DB’s.

Apparently I am like the world’s most wasteful driver.

So recently I have decided to embark on a campaign to reform my driving habits.  I know, I know, I tried hypermiling over the summer, too, and I was a dismal failure (too lazy to find those posts now, but suffice it to say, it was a dismal failure for both MY mileage and the presumed safety of everyone else on the road) – but this isn’t hypermiling, this is simply not driving sub-20 mpg when the car is rated at 25 mpg in the city.  (Or something in that ballpark.) 

Any ideas?  I *think* it is tied to my gear-shifting habits (this is a stick-shift car).  Until, um, yesterday? – I started the car – ALWAYS – in second gear.  First was just such a PITA.  But then I started noticing that I burned a lot of gas starting in second, so back to first.

But…contrary to what you might think given the first/second observation, DRIVING in a lower gear seems to blow through gas.  So cruising through the city in 3rd is WAY more wasteful than shifting to 4th or 5th.  (Which makes no sense to me, because on that token, starting in 2nd should be awesome for mileage, no?)

So…any ideas?  And I do not want to google this, so really, these are ideas that can fit into a small comment box… 🙂

I am determined to beat DB somehow.  The gas mileage is going to magically become amazing.  Ha.

Ok, this is more under the category of “things that can save your DOG’S life…” but close enough.

Last night, after I went to bed, Little started retching, like coughing/trying to throw up without producing anything.  I thought he was actually puking, so I woke up to clean it up – but found that he was just gagging.  Over, and over, and over.  And he had drooled all over the couch (and he doesn’t drool).

And he would stand up, retch, lay down, retch, stand up, retch…

So I decided to Google “dog retching”.  Which turned up several websites, all of which told me that retching unproductively was the number one sign of bloat (or gastric torsion) in large, deep-chested dogs.

Awesome.

Now, I will say, by this time, Little had *stopped* retching.  And, in fact, he was acting ABSOLUTELY FINE.

But then I found this site, which described how a dog had the SAME SYMPTOMS, and was happy and “wagging her tail”, who then DIED on the operating table.

If the intention of that website is to scare the living daylights out of its readers, well…it succeeded.

Little and I were off to the emergency vet.

(Thankfully, we live about 10 minutes from one, so this wasn’t nearly the big deal that it could have been at 2:00 am.)

And now…here is my second piece of lifesaving advice (for Fido…)

The vet said that about an hour before we arrived last night, another dog had come in, dead on arrival, because his owners didn’t know that retching unproductively was a sign of bloat.  They thought they’d let him wait it out, and by the time he stomach got the characteristic “bloat”, it was too late.

So if your deep-chested dog is exhibiting retching, drooling, or any of the other symptoms listed on that link – take the dog in.  It is a really easy diagnostic process.  If it is bloat, and it goes untreated, it is fatal.

Our happy ending:  $200 later…Little is absolutely, perfectly, totally fine.  He loved the X-ray machine and apparently loved having sandbags placed on him (to hold him still for the X-ray) and thought it was a great field trip at 2:00 am.  His stomach was totally fine, his other organs were in the right place (I wasn’t really worried about that, but she kindly highlighted it for me anyway 🙂 )…but hey, better safe than sorry, right?

Right.

(Although I do wish it hadn’t cost $200.)

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…today it is going to happen.

Yes.

(for the record, I have two songs that are running through my head like a soundtrack for my life in the last month:

When you’re going through hell, keep on going (Rodney Atkins)

And:

Bring the Rain – Mercy Me

(I did not say they were impressive.)

(If you click on the links, it pulls up a YouTube video – just a warning for those reading in an office cube…)

I will say that last night was a Rodney night, and this morning is a Mercy Me morning.

“Bring me joy, bring me peace, bring the chance to be free
Bring me anything that brings you glory
And I know there will be days when this life brings me pain, but if that’s what it takes to praise You…Jesus bring the rain.”

Or, as Maya Angelou says,

Still I Rise.

(It was a bad night last night emotionally and academically.)

(I had half a beer over physics homework, which made it – the night/homework/life – somewhat better.)

(It was my first beer in 6 months, and I normally have the tolerance of a flea.)

(And now, I am going to study…I need all the encouragement I can get in this arena.)

(thanks.)

(p.s.  also, we have doctor’s appointment this morning.)

(also, a blog I have on my reader published this very sad story about a homeless woman in Kyrgyzstan.  it made the morning more of the mercy me morning vs. a rodney morning.)

(wow, do we live in a broken world.  Lord?)

(that’s all i have to say about that.)

I realized that I really never explained what on Earth this type of pregnancy is.  I don’t even know if anyone *wants* to know, but I figured I’d explain it and provide a few links, just to clarify.  (We have spent hours scouring the web for information about it, and it is, frankly, really hard to come by.  There is no way around this:  this is a fairly rare pregnancy outcome.)

So this pregnancy was a partial molar pregnancy, or a partial hydatidiform molar pregnancy.  There are two types of molar pregnancies:  complete moles, and partial moles.  In the complete mole, there is no genetic information in the egg, and the sperm fertilizes it and makes a copy of its own genetic material, so there are 46 chromosomes, but they are all from Mr. Swimmer.  That type of pregnancy develops into a massive placenta that looks like a snowstorm on an ultrasound, and there is no baby or fetus present.

In a partial molar pregnancy, the egg has genetic material, but for some reason, the egg never signals to the other sperm that it has been fertilized, so two sperm (eagerly?) fertilize the egg.  (This is thought to be an egg dysfunction.  I thought I’d spell it out for you.  Yes, that would be *MY* egg dysfunction.  You cannot find that anywhere in the medical literature.  I had to ask my doctor, who has devoted his life to this issue, to clarify that for me.)  The fetus then has 69 chromosomes (triploidy), rather than the normal 46 (or liveable, but not typical, 47).  Having 69 chromosomes is absolutely fatal.  There are cases where a baby has survived with 69 chromosomes, but s/he typically does not live very long.

In a lot of the literature online, it says that there is no heartbeat present for a PMP.  I don’t know how accurate that is.  We saw a healthy, strong heartbeat twice on ultrasound and made it to the second trimester with what we thought was a healthy, normal-looking baby.  By the time we had found out there was no heartbeat, I do not know if the baby looked abnormal (it looked like a dead baby to me, but then again, I am not really looking at lots of ultrasound pictures of alive or dead babies these days).  I know that the placenta, by THAT time, looked abnormally large.  That was what our doctor told us was suggestive of a molar pregnancy – that the placenta looked strange (I don’t know if she was just sparing us the misery of knowing our baby was odd, too, is what I’m saying.  Does that make sense?).

So the symptoms of a molar pregnancy include abnormally high hCG (pregnancy hormone) levels, which come with more intense nausea/vomiting, early expansion of the uterus (so one looks further along than one actually is), ovarian cysts (there are typical pregnancy ovarian cysts that support a healthy pregnancy, and there are cysts that are not normal from high serum hCG), and some other symptoms that I didn’t experience whatsoever, like bleeding.  If you read through some of my earlier posts about “popping”, and the daily puking update, you will see that early on, I had some of these symptoms – but I had no idea that they meant my baby wasn’t right.  Plus, I have lots of friends who are also very nauseated in pregnancy – I thought that it was normal to throw up multiple times a day.  (And their babies are alive and healthy now!)

The cancer issue:  what on Earth am I talking about?  Well, a molar pregnancy is a form of gestational trophoblastic disease (GTD).  Because the placenta is this strange mix of chromosomes, it really buries itself into the uterus.  Molar pregnancies are almost always evacuated by a D&C (dilation and curettage).  Most of the time that tissue is evacuated entirely, but sometimes it isn’t, and the placenta material left behind can act like a tumor.  It continues to produce hCG, and if it is left unchecked, it can metastasize to the lungs (most common), GI system, or brain.  So although all women who have a D&C generally have a quantitative hCG test to ensure that there is no residual tissue left behind (I hate the term “products of conception”, but in this case, that’s really what it is), for molar pregnancies, women must have weekly hCG tests to ensure that their hormone levels are going down.  If the hCG levels go up or plateau (less than a 10% change from week to week), they either have a second D&C or start chemotherapy to prevent the tissue from metastasizing.

The goal is to have zero hCG, which is defined by a score of <5 or <2, depending on the lab.  (For me, it is less than 5.)  Once I have three weeks where I have zero consecutively, I switch to monthly blood draws, and then after three months of zero hCG on THAT, we can consider trying to conceive.  That decision is on hold and I probably won’t blog about that here.

There are a lot of things that say that a couple cannot TTC until the woman is clear for 6 months, or 12 months.  Those are dated statistics, and better research indicates that three months is a safe amount of time for a woman to wait to conceive.

The reason one NEEDS to wait is because in pregnancy, the hCG levels in a woman’s blood begin to double from the moment of (implantation?) – so all of a sudden, hCG levels rise.  At that point, it is impossible to tell if she is fighting cancer or growing a baby, and the woman’s health is at risk.  Although this is a very treatable (approaching 100%) cancer, it is not so treatable if one is also trying to support a baby.

So essentially, this sucks.  🙂  Can I say that?  This is kind of like a double whammy – we made it through the first trimester, then lost the baby, then lost a lot of blood, then lost a lot of time, and now we’re waiting to be sure that I don’t have uterine cancer.  Talk about getting more than we bargained for.  Last week, I was quite certain that I would have to have chemo, because my hormone levels were so very high.  This week, in the greatest news of the last month, they look to be about where we could expect a normal post-D&C PMP to be.  THAT is a huge blessing for so many reasons – not only the cancer, but also because having high hCG levels means that one also has lots of pregnancy symptoms.  It is such a painful reminder of what once was, to have heartburn, to be throwing up, to be craving something, totally constipated, or waking up totally congested.  You know, the joys of the first trimester…sans baby.  It’s been a month since the D&C, and I can honestly tell you that I have only had about 5 days without a lot of those symptoms.  That is really emotionally painful.

So if you are wondering how to pray, well, we are just praying that God opens a door somewhere, and we are praying to feel at peace with all of this.  I usually don’t pray for THINGS, but these days, I am also praying that the levels go down, and go down quickly.  So far, so good 🙂  but I want to also say that if the levels had gone UP, I wouldn’t be questioning whether God was listening or not.

Sometimes that is a tricky line to walk.

Here are two articles on line that are also good sources of information:

http://emedicine.medscape.com/article/254657-overview

http://www.obgyn.net/women/women.asp?page=/women/articles/molarpreg_dah

And just to clarify – this was a freak thing, although we have a higher chance of having another molar pregnancy given this one (originally it is 1/1000 pregnancies; now we have a 1% chance of having a second).  However, it doesn’t make it any easier.  To us, this was a baby, and it was a loss, and this additional anxiety is like rubbing salt onto a wound.  Although it is true that my antibodies did not kill the baby – and for that I am really, honestly, relieved – we have enough else going on that really, that reality is diminished.  Perhaps I will be more appreciative of the randomness of this…later.

I am intentionally unpasswording this.  I will be changing the PW for this blog after this.  If you’ve never commented before, and still want the PW, now is the time to make yourself known.  (If you are a regular commenter, don’t worry about it – I will email you directly.  You don’t need to come up with something here to get the PW!  :))

For those who might come here because they also have a molar pregnancy, feel free to email me.

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Yes, I am on vacation and blogging about this.  It takes 4 minutes and I just discovered (or rediscovered) that I am *still* competitive, even for things that I am ONLY PERIPHERALLY RELATED TO (!!).

DB’s friend from law school – or at least, that’s where he knows her from; the details are kind of sketchy to me but only because I haven’t paid much attention – OK, the POINT – she is getting married.  In San Francisco.  In October.

Anyway, SF weddings are expensive, and I guess she entered this contest to win a free wedding for April, and she was kicking butt, but NOW she is SLIPPING.

So here is what you need to do:

Click here:

http://www.star1013fm.com/pages/wiawvoting.html?feed=335890&article=5185658

And vote for “”.

I think there was some early fraud in the contest (this has been going on for a WEEK, and people, I have VOTED EVERY DAY for the last WEEK!  Because I am a TOTAL LOSER!) and now you need to put in an email address and then verify your vote.  After voting all week, I can guarantee that you will not receive any junk mail whatsoever from this.

And the background – their wedding is reserved for two weeks after I was due.  It is really hard for me to still think about the “what ifs” – I’ve had some difficult days on this trip watching little kids and whatever.  She is a very close friend of DB’s and we really cannot AVOID this wedding, but if she gets married through this radio thing, the wedding will be in a week (hence the contest – this sounds like hell to me, but she is very excited) and she will hold a party in OUR city in October instead.

So it saves her a ton of money, it saves US a ton of money, and, um, it would make me feel like I sorta won something.  Kinda.

I am a total dork.

So, vote!!  Please?  Vote!

P.S.  Vacation – we have done what we planned to do 🙂  although it was adjusted to account for vertigo.  Oh, vertigo, how you suck.  Thankfully the vertigo is almost gone (as of yesterday) and we drove out to the Grand Canyon (yes, insanity) and managed to actually hike some of it.  A small hike.  There are ledges that seem to be kind of dangerous if you, um, get dizzy, and I can trigger the vertigo just by looking down.

I’ll leave you to imagine the funniness (?) that might ensue on a rocky trail.

We leave to drive back to LA today.

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