second-time mommy

Dear Eli,

When Sophia was about a year old, your Daddy asked me for my thoughts on when we'd have another baby.  To his surprise and dismay, it spurred on a rush of tears from me and I had trouble verbalizing why.  It wasn't that I didn't want to give your sister a sibling, because I absolutely wanted to; we had always talked about wanting more kids.  It was that I loved every second of motherhood and couldn't imagine losing out on experiencing all of those firsts with her and only her.  I didn't want to miss out on any more time while it was just the three of us.  I guess the simplest way to explain what I was feeling is that... I was unsure how I could possibly learn to share my heart.

Today you are three weeks old, which means we've arrived at your original due date.  I remember when we had scheduled my induction, time seemed to suddenly speed up -- the weeks were flying by and there didn't seem to be enough weekends to get your nursery reorganized and all your little clothes washed and folded away, and the car seat in or the pack and play set up.  And while I had wished for more time then, now that you've been with us I couldn't imagine it any other way.

Today at 3 weeks old!

Even a bit early, you came in to this world at 7 lbs, 0.35 oz, and 20.25 inches long.  We wonder how much bigger you would be today!  You had a full head of thick, dark hair, the feel of it much like your dad's now.  (My OB was trying to describe it while I was pushing you out and encouraged me to 'reach down there and touch his head,' so I actually did and freaked myself out a bit).  The resemblance to your big sister as a baby was uncanny.  There are numerous similarities, but slight differences too.  You have long fingers and "Jana finger toes," which one day you'll understand once you meet your aunt.

Your sister vs. you... twinning!

"Hi, I'm new here. Are you my Mommy?"

Aunt Jana finger toes

You were born during an extremely interesting time.  We are in the midst of a pandemic, where the safest thing for us to do is to socially distance ourselves to stay healthy.  Timing-wise, we had planned to be home-bound anyway, but the most difficult part is that our families are still unable to meet you.  Fortunately for technology, you made your debut via FaceTime and Zoom to extended family on your Yeh-Yeh's birthday, and even through our kitchen window with your daddy's parents, but we're hoping that one day soon that your grandparents and great-Nan and aunts and uncles and many others that love you will be able to see and feel you in person.

Zoom with extended family

Happy 69th birthday, Yeh-Yeh! (on 3/31/20)

Your sister, though, who is around... She is absolutely in awe of you.  The hospital wasn't allowing visitors, so to our disappointment we had to wait until after discharge to introduce her to you and she was crazy excited to catch her first glimpse of your face.  Every day she diligently washes her hands (singing "Happy Birthday" twice) as soon as she comes home so that she can hold you, and some days she refuses to let you go.  We've included you in her bedtime routine so that she can feed you or have you at her side during storytime.  Last night, she stayed up until 9:30 because she was waiting for me to read to her, so I convinced her to join me in the nursery where I fed you and read to her as she flipped the pages for me.  Learning to multitask!

Singing "Rock-A-Bye Baby" (and other songs she makes up)

Right now you are napping (sort of) in between meals, so I thought I'd use this precious little time I have to tell you about yourself and these first few weeks.  You are by no means a quiet baby, which is why I said you were "sort of" napping.  Most times you are making some kind of noise -- a creak (to which Sophia has affectionately nicknamed you "the creaky door"), a grunt, a gurgle, a sneeze, a cough, a short cry -- so I check in on you and your eyes are closed or fluttering.  When I burp you, you're humming along, so with each pat there's an alternate sound and it makes me laugh.  You're active in your sleep too.  Sometimes you've wiggled almost perpendicular from where I had laid you down, your legs up in the air and your tiny fists at your side.  You seem to be able to nearly roll to one side already.  Like your sister, you manage to always kick off a sock or flail away a mitten or wiggle off your hat.  We seem to always flop your ears back whenever we put your hats on, and have determined that the shape of your ears are a mixture of both your dad's and mine.  Diaper changes usually involve a small foot right into your own mess and subsequent crying, which at times can escalate until it appears that your lips and cheeks are vibrating, while I try to minimize the poo splattering and potential fountain of pee on other things.  (Yes, I've been reduced to using those words).

"When my mom thinks everything is cute... including my hiccups."

Yet in your quiet moments, you are the sweetest boy.  You can lie down awake and look at the world around you, sometimes with your noisy commentary.  Your hiccups come on as frequently as they did while you were in my belly, and somehow even those are adorable.  I love how you fit perfectly in that small space on my shoulder, cuddled up in a ball with me rubbing your back.  That was one of my favorite memories with Sophia, and time had passed too quickly before she had grown too big for that spot.  But for now, I don't even mind that it's right where my port is, because I know to cherish this moment that I can snuggle with you there.  Sometimes when I touch your cheek, you do this smirky thing in your sleep.  Other times you open your eyes and look at me, and I tell you I'm your momma.  The first time you did that, it was almost as if you recognized me and were asking, "Are you my mommy, the one who was talking to me all that time?  The one telling me to stay with you, through it all?"  Yes, it was me, and I'm so glad you did.  Yesterday I told you I loved you and you smiled in response, and when I repeated it and you smiled again, my heart melted.  I love every baby smell, and sneak whiffs of your hair, whether freshly washed or matted under your cap, and don't even mind your milk breath when we're doing tummy time, or even more still when I know you need a diaper change.

Nighttime is your party time.  Your sister would hardly nap during the day but you're the opposite.  Usually around 10-11 pm, you're wide awake and ready for a feast.  And boy, can you eat!  We were able to obtain generously donated breastmilk from a couple of friends, and you are mowing through it.  Whenever you're really hungry and becoming impatient, your mouth flaps open like a baby bird and you start sucking on your hands, so we do this funny bit where I'm trying to get the nipple in your mouth before you snap it shut again while prying your hands away.  Today you actually grabbed on to the bottle and could essentially feed yourself.  Do you even need me anymore?

"Hey ladies!"

"I'm so hungry I will feed on my hands. Tasty."

"I got this."

I'm enjoying this time with you.  With Soph, I was constantly vacillating somewhere between joy and terror... the goal was to keep her alive, of course, and I obviously didn't want to fail at that.  This second time around, I'm a bit more confident since I've decided I kind of know what I'm doing.  Beyond that and my treatments, fighting through the fatigue (of having a newborn or chemo, who knows which), late night/early morning feedings, napping when you nap or prepping for your next feeding... the blur and humdrum routine of it, the peace and simple joys of motherhood again, of you needing me for a little while longer... I'm happy, I'm content, and I'm savoring it all.

And I realize now, after all those years since that night when I thought I couldn't share my heart -- I was wrong and silly to believe that.  My heart is wide open again, and you, my sweet, darling, amazing, miracle son, have a huge place in it.

Love,
Mommy

the final countdown

It's a very odd time to be this pregnant during a pandemic.  On the one hand, I'm trying to stay grounded... I work for a health system after all, and have always practiced hand hygiene and been a germaphobe with our four-year-old.  On the other, I'm being induced in 5 days (yes, 5!) and restarting chemo 5 days after that (yes, 5).  So feeling a bit vulnerable?  Definitely.

But if there's anything I've learned over the years, and especially over the last few months, fear will get you nowhere.  I could have been paralyzed by it -- when I first found the lump in my breast, when I had the biopsy, when I was given a cancer diagnosis, when I underwent surgery.  I could have been overcome with it -- when I started treatments, when my hair started falling out, when I knew I had to be strong for my baby.  I could have let it slow me down, but instead, I let it drive me as it normally does -- to do the same things I've always done, to continue moving, to keep our little girl happy and unaware and maintain a semblance of a routine.

So tonight we did what we'd normally do and braved the store for some last-minute items before baby.  I'll have to admit, it was the weirdest Target run ever (and at the same time a bit fascinating, when you're trying to figure out why certain items are being stockpiled more than others).

I legitimately needed baby wipes. This is what was left.

Just being there and seeing those empty shelves felt a bit like panic, and I didn't want to be there longer than I needed to.  But I'm happy to report there was plenty of ice cream for this momma and Paw Patrol sneakers in the right size (score!) for a delighted soon-to-be big sister, so at least we managed to pick up some of the items we actually intended to get.  I'm convinced it's those little things that will keep us sane...

Last MFM visit at 36w2d! (and last MFM visit ever).
The final countdown begins!

chemo #2

Chemo #2 today!  And last one while pregnant (thank goodness).  I'm 33 weeks and counting, and hard to believe that I originally was going to be induced in less than 2 weeks from now.

A sweet note/pick-me-up from a
friend on the way to treatment.

Today I was in a room/bed instead of a bay (a rarity, I'm told), but here's a picture for the full effect.  You'd think it would be more comfortable than the chair, but it was harder getting in and out (probably because of my big belly).  I can't fully lie down due to the cold cap, so preferred sitting up.  Speaking of the cold cap... I was in that t-shirt for the majority of the time, not even needing my cardigan or the blanket.  The nurses were in disbelief but I truly run hot while pregnant.  Maybe a weird blessing in disguise?

To pass the time, I had a list of things to do including kindergarten registration along with ALL of the required forms for our big girl... so hard to believe she will be taking that next step so soon.  And I feel like I haven't filled out that many forms in a long time.  Apparently her elementary school is offering both a part-time and full-time option, but we won't find out if she "passes" into the full-time option until August.  Her daycare also offers a full-day kindergarten so we looked into that as well.  As parents, we feel a bit lost... We've had our daycare routine since she was 3 months old, so this is uncharted territory.  Big changes in the near future!

Anthony brought this book along that we've been reading to Sophia.
It is well-written and highly recommended for introducing a child to
what cancer is and what happens with treatment, etc.

Partway through treatment, my husband ran out for a bathroom break and I heard him talking to someone on his way back.  At first I thought he was talking to another patient, because at times he can be friendly like that, but then realized it must be someone he knew.  After awhile, he came in to tell me it was one of his work colleagues (who I've met before) and his wife, who was undergoing treatment and asked if it would be okay to introduce us.  Of course!  So he brought both of them in our little room and we chatted awhile.  She was undergoing Taxol treatments, which I start next, so I asked her some questions.  Apparently they had both seen us at my last treatment but weren't quite sure if it was us.  It really is a small world.

After treatment today, we are packing up the car and driving to Hershey for the weekend.  I've always thought that it's important to make time for family, no matter how busy our lives are or how hard things get.  I had booked a mini-trip for the 3 of us as a Valentine's Day gift prior to baby's arrival and opted not to change our plans once chemo was scheduled.  My mom was really concerned about us going, but I assured her that I'd rest in the short car ride over and to take it easy.  I'm actually really looking forward to spending time away together as a family.  More to come on our trip later!

Post-treatment meal! Takeout from the Mexican restaurant
down the street is becoming a thing.

hair and there

My hair is falling out.

I knew it would, but knowing it didn't make it any easier when it started happening.  It was two weeks to the day of treatment when I noticed the shedding, right on schedule.  I had decided to try the scalp cooling despite the extended chair time, despite the ridiculous cost... because it was important to me not to be "marked" as a sick person.  Not to look and feel sick.  Not to have strangers know about a fight I was intimately experiencing or being the subject of sympathy.  And even though I knew thinning was likely to happen, when it actually did I was almost terrified by how much.

Today was one of those days that I was feeling particularly sensitive about it.  My husband cracked a harmless joke and I found myself crying during dinner.  Our daughter came over to comfort me and said, "It's okay, Mommy.  Some people don't have hair.  Some people have hair, and those that don't are really cool."

Sometimes you just need a four-year-old's perspective.

chemo day 1

First day of chemo.  My husband asked me last night if I was ready, and I told him I wasn't sure if I'd truly feel ready.  I mean, my chemo bag was packed, I read through all the literature on my meds, picked out my outfit, checked off my lists.  So I was prepared, yes.  But feeling ready?  I just really wished I didn't have to be ready for something like this.

Soph had a bit of a meltdown at bedtime since we know she could feel the stress we've been managing.  She understands that I'm sick and that I'll be given medicine.  In her world, that's kind of like having a cold or the ever-present daycare cough, maybe a visit to the doctor for medicine, and gradually getting over it.  It's hard explaining 16 rounds of chemo to a 4-year-old for her to comprehend... so I use terms she understands and then put on my brave face to try to keep our home life as unaffected and routine as possible.

This morning we were up a bit earlier so my MIL could bring Soph to school and we could be on our way to the hospital by 7:30.  The scheduler had told me the infusion center had allotted 7 hours so I was prepared for a long day.  My nurse was ready for me and talked me through every step, which helped to ease my anxiety.

My weight/height and vitals were taken and recorded.  Next came the cold cap/scalp cooling prep.  Even though I watched the educational videos on how to prep and fit, it was more of a two-person job to make sure the cap was as snug as it could be to my head.  Once it was plugged in, then my port was accessed and pre-meds were started.

First one, 15 more to go!

The nurses were amazing.  They hooked me up with my favorite treat. And the cup that Anthony got me for Christmas was perfect for treatment.

Time to get comfy!

And then it was time to start A/C therapy.  I was most nervous about Adriamycin (I mean, look at the color of it!) and the fact that the nurses suit up to administer it, but besides the metallic taste in my mouth, I seemed to tolerate it fine.  The infused Cytoxan hit my sinuses though, enough for me to say something.  A bit of ice on my nose and it relieved the pressure.

The "A" part of chemotherapy.

Effect of "C" on me.

Then it was time to wait.  Time seemed to pass fairly quickly... IR visited to check on my port, and the dietitian I had requested for a nutrition counseling went over how I could feed my body to help manage potential symptoms.  After treatment, I had to sit with the cold cap for 90 minutes.  After the first 10 minutes or so getting used to the cold, it wasn't so bad.  The nurses couldn't believe I wasn't even using a blanket, but I think that's partly because I run hot naturally and even hotter with pregnancy.  So in a weird way, that may have kind of worked in my favor?  As the countdown was nearing an end though, I definitely was eager to have it thaw and off my head.  Vitals were checked again, and soon after, we packed up and headed out.  One down!  And onward...

Post-chemo meal.  So glad I could eat.

P.S. The fatigue hit me later... and I've been pushing through like my nurse had recommended at my chemo teaching.  It came on like she had described it would, like that feeling you get when your body is readying itself to fight off an illness -- a bit flushed, working on overdrive.  The way I see it, I've been growing a little human inside me for 7 months now with an active preschooler at home, so I kind of understand managing fatigue and moving forward.  And that's all I can really do for now.

a welcome surprise

My teams surprised me with a cake today and it was such a wonderful treat to celebrate baby mango.  Less than 2 weeks ago, I found out that I need chemo after all, and am already scheduled for my first infusion this Friday.  Needless to say, there’s been a lot on my mind... and it often can overshadow the joy of carrying the life inside me.  So thank you to my awesome coworkers for reminding me to pause and simply be grateful.

insurance policy

Here I am on my husband's birthday, sitting in the lab for 3+ hours for my dreaded 3-hour GTT (which luckily for me I've done numerous times due to PCOS and insulin resistance).  At the same time, I was scheduled for a full CBC panel so thought, why not?  Five vials of blood so far, 1.5 hours down, baby is kicking like crazy, and I could really go for a hamburger.

We met with hematology/oncology on Thursday afternoon, and so much has changed in a matter of days.  My Oncotype DX (https://www.oncotypeiq.com/en-US) recurrence score came back on my tumor, and to my surprise and dismay, it indicated a high risk of recurrence.  While my surgeon and I both thought and hoped I could be spared chemotherapy and move straight to radiation after delivery, that is no longer the case.  With the new information, the statistics show that with both a combination of chemo and endocrine therapy, the risk of recurrence in my individual case will decrease by half.  In my oncologist's words, he said I would benefit from chemotherapy and the treatment would be like "an insurance policy."

Even though I don't always feel it, I know I'm young to be diagnosed with breast cancer.  At my age, I wouldn't have been scheduled for my first mammogram for a couple years yet and my oncologist said it was good that I had found the lump on my own.  It's because of my age that I understand the recommendation for chemotherapy, as difficult as it was to hear and process.  My logical mind could understand those facts, but the mother in me immediately thought of the child I'm carrying and what it would mean for the both of us moving forward.

We discussed timing.  I had a few options.  The standard is to treat pregnant patients like non-pregnant ones.  A few adjustments would be made, yes, but overall chemotherapy is "safe" when it is administered in the second and third trimesters since all the baby's organs are fully formed.  Does that just blow your mind or what?  I had been told this by my nurse navigator the same day I was diagnosed, but hadn't been ready to process it then since I was hoping for a miracle.  So option #1 is to start treatments right away.  I would go through 2 phases, the first being 4 cycles of Adriamycin/Cyclophosphamide every 3 weeks since I wouldn't get the booster shot being pregnant and it would take that long for my blood counts to recover.  The second phase would be Taxol every week for 12 weeks, which means when all is said and done, that is roughly 6 months of chemo.  So timing is crucial.  My oncologist felt I shouldn't delay, otherwise I would not see the benefit in the long run.  We talked at length about chemo during pregnancy.  Since I'm currently 28 weeks, he recommended that I start as soon as possible so that we could undergo 2 cycles prior to stopping at 35 weeks, before resuming treatment a week after delivery.  Since my pregnancy is being followed by MFM, we agreed consultation was necessary with all providers involved to give their blessing.

I had an appointment with my OB that same evening where we discussed the risks and benefits, and she promised to reach out to MFM before my appointment the next morning.  MFM consulted with my husband and me on Friday morning, covering the research on chemotherapy drugs during pregnancy and any reported incidents of issues affecting babies.  We talked about coordinating therapy with a delivery date, as inducted at 35 weeks was no longer necessary but at 36-37 weeks a distinct possibility.  We agreed to a referral to the NICU to prepare for a pre-term baby and what to expect.  Meanwhile, baby, at 28w2d is measuring at 30 weeks, already 3 lbs 3 oz, and as my OB says, happy and snug and pretty much oblivious to everything going on outside of the womb.

By Friday afternoon, I was already scheduled for my bloodwork, 2D echo, nurse education, port placement, first 2 cycles of chemo, and follow-up nadir visits.  My first chemo will be in less than 2 weeks.

Besides our families and a few select friends, we haven't updated anyone else on this new development.  My initial feeling?  A bit of fear.  Baby and I have made it this far, through surgery and recovery, and I'm scared of going through anything else that could put him at risk.  It's a bit hard to align my head with my heart, so I've been relying on my logic to move forward.  My parents are currently overseas and can sense them freaking out a bit.  Obviously, this wouldn't have been my choice.  Who wants to go through chemotherapy?  Especially while pregnant?  But my oncologist assured me he's seen it done with successful outcomes and I think my MFM provider said it best when he said I need to get healthy to be around for my kids' weddings.  So here I go... investing in our future.