Tuesday, February 16, 2010

Home From The Doctor

We're home from Peeper's appointment and, other than a missed exit on the way there, which made us about thirty minutes late (pretty standard for us) the trip was more or less uneventful.

Peeper was quite a trooper with all the car time, and was very brave getting her blood drawn.

The doctor says that he's certain her tests will come back perfectly normal, but we will still be glad to hear it officially, in about 10 days.

In other news, of the we-needed-a-doctor-to-tell-us-that? variety, Peeper is small for her age, and adorable. And has beautiful eyes and hair.

Well, duh.

Actually, both the doctor and his (hmm, nurse? assistant? resident?) seemed to be rather hung up on her size.

The first thing the (lets call her an assistant, because she was assisting him, whatever her actual title might be) said when she walked in the room was, "Oh, she's so little. I was expecting like (gestures quite a bit taller than Peeper). She's like the size of a six month old!"

Um, no.

She may be more like the size of your average twelve month old than fifteen month old, but definitely not a typical six month old!

(And I know that, because I looked it up. Because I am me. Her height and weight would be "greater than 95th percentile" for a six month old. So there.)

The assistant asked if she's small because of her heart defect and we explained that, while her growth did speed up after her surgery, and although she had some placental/umbilical issues in utero, she's most likely just petite, like Shrike.

I also pointed out that, other than bulking up around a year, just prior to a height spurt, she's tracked right along that same 5th percentile line since well before birth.

Sidebar
Speaking of the surgery, when we told the assistant about it, she asked, "How did they do the surgery, because I don't see a scar. . . ."

As she was saying it, she was approaching her, to do the exam, and pointed it out, to which she replied, "Wow - that's a great looking scar!"

During this whole conversation, Peeper had been running around the room, just a few feet away from her, wearing nothing but a diaper, and she'd not even noticed it!

When the doctor was commenting on her size and asking her about growth, he asked what she's eating and how her appetite is.

I said that she's mostly still breastfeeding, but that she eats lots of solids as well.

To that, he said (and this is where Shrike tells me that she was amazed at the restraint that I showed), "Well, you've got to be careful with breastmilk. It's not doing anything for her now (Or maybe it was "It doesn't have anything for her now" - I don't remember the exact wording.) and it fills her up; she needs to eat more solids."

I just nodded and assured him that, "Oh yes, she eats lots and lots of solids, as well."

I did not point out that breastmilk is more calorific than most of the solid foods she eats, or that in the second year, breastmilk actually gets more concentrated, both in nutritional and immunological factors, or that it certainly didn't magically turn into water on her first birthday.

Given that she's growing and thriving, I think it's pretty obvious that the breastmilk is providing the nutrition to do so.

Either that, or she's photosynthesizing, because even in her recent hollow-leg mode, she's still not really eating all that much in the way of solid food.

(Certainly not of the nutritious, healthy-body-building variety. She really likes her carbs. That's my girl.)

I just bit my tongue and told myself that we (knock wood) never have to see this guy again.

Although, later, I thought about the fact that the next mom he says that to might not know better, and maybe I should've said something along the lines of, "Well, you know, there's a recent study. . . ." (The thing about it becoming more concentrated.)

When we finished up with the exam, as soon as we got out of earshot, I said to Shrike, "That's a load of bullshit! What about . . . ( see above study, etc). . . "

As I sputtered, she said, soothingly, "I know. I know, honey. I know everything."

I stopped. "You know everything?"

"Well, no," she said. "I know what you tell me. And you know everything."

"Oh, okay."

Ironically, right across the hallway, there was a big sign on a door indicating that there was a training going on inside - for lactation nurses.

I was thinking that I ought to go tell the trainer that when she's done there, she should go set this guy straight. Later, I found out Shrike was thinking the same thing!

The only other "concern" that the doctor and his assistant seemed to have was with Peeper's speech. I described how she's been hitting all her verbal milestones at the very late end of the normal range, and told them that she's got 30 - 40 signs, and maybe 5 words.

Oh, yeah, did I mention that?

That she's picked up some words? (It's on the sidebar. Pay attention!)

Since her check up two weeks ago, when she was pretty much saying, "Mama" and that's it, she's started saying "baby" (baaaah-buh), maybe "doggy" (duhgeeduhgeedugee), and definitely "eye" (aaahh! - over and over, while pointing to the eyes of various people and animals in a book).

She can also tell you that the monkey says "ahah" and sometimes will tell you that a doggy says either "ah-ah" or (pant-pant).

She's also started mimicking us on occassion, and the other night, when we were reading a book about polar animals, she repeated both "Humph Humph!" (the walrus) and - I swear! - "Waddle, Waddle!" (the penguin).

In the past few days, we're also thinking she's hitting that stage where it sounds like she's speaking a foreign language sometimes, rather than just baby babbles.

So, once again, she's made a big leap right after I've talked to the doctor about my concerns - but she is still behind where she really "ought" to be.

This doctor, or maybe it was his assistant, said that they like to see (I think it was) ten words at fifteen months, and she definitely does not have that.

He agreed that there's nothing to worry about cognitively or with receptive language or language processing, but did encourage us to consider getting her checked out to see if she might qualify for some early intervention for her speech, on the basis that it's free and it can't hurt and if it can help, why not do it.

If we don't see big leaps and bounds in the next couple of months, I will definitely mention to her pediatrician that this doctor thought it was worth checking out.

(Yes, I know he was an idiot a few minutes ago, when we were discussing breastfeeding. Shut up.)

On the other hand, I wonder if this metabolic specialist is quick to jump on things like that and to push for early intervention because many of his actual patients (rather than "rule-outs" like Peeper) do have developmental delays, as compared to our regular pediatrician, who deals primarily with typically-developing kids, and sees the occassional one who needs some sort of intervention.

When we finished up with the doctor, we went to the lab to turn in her pee sample (collected yesterday, with really no drama at all) and have her blood drawn.

They called her back while I was in the bathroom, so Shrike got to hold her hand - well, her whole body, actually - during the stick.

From the waiting room, I could hear her crying, but Shrike said that she actually did quite well.

When we were all done with the medical portion of the trip, we let her run off some energy in the hospital's atrium.

She pushed buttons on all the "learn about your body" exhibits, and got almost as big a kick out of the amazing Rube Goldbergesque kinetic sculptures as we did.

Then, off to the cafeteria for some dinner, and more energy-off-running, and then we headed back home.

It was a big pain in the ass, but all day long I just kept thinking about how much easier it was than our first couple of trips there - especially the first trip, when we were still shell-shocked from her birth, and then her heart diagnosis, and we didn't know what we might find out about the metabolic stuff.

That, and just being there and seeing so many other kids who are so much sicker than Peeper has ever been, really reminded us - once again - just how very, very lucky we are.

4 comments:

  1. I think you have AMAZING restraint in not telling the doctor a few facts about breastfeeding. I probably would have been imploded, but then I'm not always the best at doctors appointments ...

    Sometimes doctors just don't know anything outside their speciality. I asked our developmental pediatrician about weaning on Monday, and she said "Oh, you know, just stop feeding her when you're done." Right.

    I'd love to hear what your other doctor said about language. My fusspot (who is just about the same age as Peeper) doesn't have a single word. Not even Mama. And no signs. But over here in Lalaland nobody is in the least bit concerned. Their guidelines read 3 words by 18 months and then you get a second hearing screen and another couple of months to see what happens (and yes, I am in a very civilized Western European country). So I at least want to be prepared when I head back to the U.S. for what our American pediatrician will say.

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  2. Rachel -
    Our regular pediatrician said that he would be worried if she didn't seem to understand what we say to her, but since she does well with that (and since she signs) he said to just wait and see, and if she doesn't have a few words by 18 months, then look into an evaluation.

    This doc seemed more interested in getting her evaluated.

    I think, from what I hear. most docs tend to take a "wait and see" approach, but I guess that varies.

    If a kid qualifies for Early Intervention (for speech or anything else), that's a free service provided by the county.

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  3. After I read your post, I went and did some reading on breastfeeding after one year, and apparently the fat content of the milk becomes greater, to make up for the fact that toddlers nurse less often than newborns. Also the toddler continues to benefit from the immune factors in the milk, which is really important when the baby gets to the stage of walking around putting all kinds of gross stuff into their mouth. Toddlers continue to get all kinds of calories from mother's milk. The milk never loses it's nutritional value. Plus there are many benefits of continued breastfeeding for the mother as well. So there, that doctor didn't know what he was talking about. Well, obviously he's not a lactation specialist, but perhaps he should know more about the subject, seeing as how he is working with children.

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  4. Anonymous - Yeppity, yep, yep.

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