Smidge

Under the heading of "Coincidence", in light of our recent discussion re. the halcyon days of summers past, comes the fact that Steve is now on antibiotics for Lyme's disease. I removed a deer tick from the back of his knee two days ago that was nestled into the center of the most obvious bull's-eye rash one could ever hope to see. I think we got it quite early, though, so I am optimistic that he will not be succumbing to anything beastly any time soon. It is much easier to find ticks on Patrick (I removed another deer tick from the child the same day. no rash) since Patrick is not covered with thick black hair and dotted with small black moles (hmmm, doesn't Steve sound appetizing). As for me I don't go outside when it gets all buggy so I have only had one burrow in this summer. 

Nature is one big death-trap, I'm telling you.

However, as you rightly noted, the Patrick Y camp dilemma is not really about disease-carrying insects or even sunburn. Wait. Let me get cranky about sunscreen for a minute. It is my only cranky thing (well one of the few) but we do not fuck around with sunburn here. We held the wake for Steve's cousin's husband when died at thirty from melanoma developed after childhood burns on the lakes of Minnesota. I have had squamous cells removed twice from a spot on my abdomen that got terribly burned the first (and last) time I ever wore a bikini. Patrick got a sunburned scalp (through a tent no less) at three months and has subsequently developed an irregular, rough, mole-like, skin patch there upon which we keep a very close eye. My grandmother was missing most of her nose by the time she died, due to skin damage acquired during an Alabama adolescence spent on the tennis court. For every few kids that produce a healthy golden glow you will get one with sun sensitivity and then... trouble.  Skin cancer can develop from ONE bad childhood sunburn, so you must always be vigilant. VIGILANT! Ahem. Thank you.

Where was I? Oh right, I was acknowledging that that was not the point. The point is my fear of letting Patrick grow up and your gentle (mostly) prodding that I need to do so. You are right of course, and it is always nice to hear it thoughtfully and sympathetically expressed.

AM I certain that Patrick cannot put on his own sunscreen? Not in the slightest. It has never once occurred to me to ask him to try. He (although I know this will shock your lights out based upon how I describe him) actually has excellent small motor skills, so there is no reason, really, to believe that he is not perfectly competent in this area. Just yesterday he sat in his booster seat with a pen and a Mad*Libs and neatly completed several pages in perfect tiny legible print (although he used "plastic" as an adjective about 12 times for some reason). While the car was moving. So he could probably smear himself with cream, given the cream and the inclination.

I do question the inclination, although (good lord, could I be any more wishy-washy in this post) his teacher assured me he was very good about getting himself dressed to play in the snow at school despite the fact that neither Steve nor I have ever seen this reputed talent. Patrick is the kid who would a million times over rather go sit in his room than put on his boots because we told him to do it in order to go sledding. Cute kid, that. As I think I have mentioned in the past Patrick has never once in life said, "I want to do it!" OK, once, but we were talking about driving the car so it was not bloody likely. The rest of the time he is perfectly content to wander around forever, wet and naked, until someone appears to dry him off and help him into some pants.

One of the things that appealed to me so much about the Montessori camp is that they are such bad-asses when it comes to fostering independence. I was hoping that they would be able to help Patrick build on many of the skills he has developed through preschool over the past two years. For whatever reason I expect that the Montessori instructors are better equipped at gently but firmly nurturing self-reliance in a recalcitrant four year old than I can expect the college counselors to be at the Y. Still, as long as he isn't actually injured, your insistence that he will probably have a great time was well taken.

In conclusion: I recognize that I have hindered Patrick's necessary development either through well-intentioned smothering or deeply-rooted subconscious resentment that my role as a stay-at-home mother is predicated upon essential planned obsolescence. I further recognize it is a big world out there and Patrick is eager to paint it. So my only remaining concern is how to best make up for letting my beloved child develop his valet addiction and whether dropping him head-first into a potentially chaotic camp situation is the way to begin to remedy this. Most of you said yes. Some said no. I think the best thing to do is start with one day and work from there. All in favor?

Motion carried.

Meanwhile, hey! I am pregnant with twins! 7 weeks 3 days today. Go figure. I cannot decide if I am now immune to the realities of pregnancy unpleasantness so this doesn't seem so bad, or if it really isn't that bad this time. I throw up about three or four times a day, but... I don't know, who doesn't? I go to bed early and my lower back has this THING going on that makes it agonizing to sneeze. Apart from that, not too bad so far.

But enough of that. I am facing a massive dilemma and I need your thoughts, please.

Despite the PGD we are still going to do CVS. At least one of my two previous PGD'd pregnancies carried the unbalanced arrangement so we are not confident enough in the embryo screening process to avoid secondary genetic testing altogether. It is possible that CVS cannot be done with this pregnancy (google assures me it is harder with twins) in which case we will do amnio later but either way we will do something.

Now this is what is keeping me up at night. There are two perinatology practices here. The first one is the place I had such problems with last spring. Was it last spring? Remember the perinatologist who did not tell us that the fetus had obvious abnormalities and the genetics counselor who wrote a bogus letter when I sought a hospital termination and the week of pointless run-around followed by the ultimately inevitable in-uterine fetal death that could have been predicted if just one person had had the integrity to be honest with us just once in the process? Yeah. I hate them. But that doctor was really, really good at CVS. The best, I think. Extremely careful and methodical.

The other place continues to provide care whether the genetic results are good or bad, no matter what the patient chooses to do. That perinatologist told us immediately when she saw that the fetus had defects and candidly gave her opinion that she did not believe it would live. They were kind and forthright and I loved dealing with them. But I thought she rushed the procedure itself and I had a massive bleed afterwards for the first time following CVS. I do not trust her skills as much as I do those of the other doctor. However, I am terrified that something will be wrong with one or both of the embryos and I will be left alone to figure out what to do.

See my problem? Do I assume everything is fine and go with the place where I feel there is the least risk or do I assume we might have problems again and go with the place that has a much more compassionate approach?

It's a hard one.                   

PS New post up at REDBOOK.          

Comments

[LisaR]

I would be very concerned about doing CVS with twins. Aren't there docs that sub-specialize in this? This is such a delicate situation I would seek out an ulta-pro who specializes in CVS with twins, even if that meant flying to NY or Chicago or whoknowswhere. Seriously.

Ask dr heartless how he feels about CVS with twins. I think you'd be surprised. It's an unusual and delicate situation.

[Ollie]

All I can do is say what I WOULD DO. First, if CVS is an option in twin pg, I would go to the Peri who does the good CVS. Especially with the slightly higher risk a twin pregnancy poses, it's a good idea to get a doctor who knows what he's doing. After you get the results, you can always get a second opinion on the findings if necessary (hopefully it will not be).

[Amy in NJ]

Since you asked for an opinion, I would go with the more skilled doctor given that the CVS is for twins. My good friend had CVS with twins and it all went fine but she too was warned that it was a bit riskier than with a singleton. I know that this could leave you in a lurch if there is bad news but for me, the tradeoff of the most competent CVS possible would be worth it.

[mary]

Do either of the practices or a local hospital provide nuchal translucency scans? It was offered to me this time around (at age 44, three pregnancies, two miscarriages) as an alternative to amnio and I have to say I was mightily impressed. Results are as good or better than amnio, can be done early in the pregnancy (11 weeks), immediate results, no sharp instruments and some pretty nifty 3D video to look at. More about it here: http://www.mtsinai.on.ca/pdmg/Tests/nuchal.htm

[Carla Hinkle]

The best. BEST doc for the CVS. Even if it means flying elsewhere. With your history you should not fuck around.

As said previously I believe you know enough to be your own counselor now.

[Jb]

I've had CVS twice by same (highly skilled doing it longer than anyone else in a large metropolitan area blah blah) and say skill over compassion, period. There is a very good chance you won't be able to have it done. I think I would be very, VERY frank about wanting to know how things look. Do a nuchal screen - just the measurment (blood would not mean much due to twins) - that gives you alot of information even if you can't do the CVS. But, that too needs to be done by folks that have been doing lots of them. I hope you can have the cvs, period. Best of luck.

[Jb]

For Mary re: Nuchal results as good or "better than" amnio: Having been around the testing block, I just want to clarify for readers: Amnio is a definative test with a result. Nuchal is a "screening test" that gives you odds of something happening. It cannot compare to amnio in terms of accuracy (over 99.9% with amnio) to a screening test - comparing apples to oranges. But, in the USA, the nuchal blood/measurment screen is much better than the AFP blood test in terms of accuracy.

[colicmommy]

Oh man, Julia, I know why you want to do CVS, but that's so risky with twins. To be honest with you, my advice is to not do CVS. Even last time, you did the CVS and then, well, a week later the fetus died from the translocation. (I'm still so sorry). So, if you hadn't done the CVS last time, you would have only had to wait a week for your "answer".

Even with a super pro in Philly or Boston...oh sheesh...what if the results turned up normal and one or both of the babies were lost because of the CVS itself? What would that do to you? I know what it would do to me.

My vote: wait it out until amnio time, then go with Dr. Mean for the amnio, after which you promptly transfer yourself and your records to Dr. Nice.

[grumpygirl]

i won't talk about camp because i'm in therapy the rest of my life because of bad camp experiences.

as for doctors, i say this both as a frequent patient and child of one: we hire them, they work for us. use the brilliant one and TELL HIM HOW TO BEHAVE. no, he won't be warm and fuzzy. but you can stop him from being completely heartless if you're open. shockingly, doctors are human. and they boil things down to bland science when they're hard to talk about emotionally.

the guy will be shoving things up your cooter; you have a right to tell him how to treat you.

[~Lucy~]

I too am exceedingly nervous about CVS near the twins - but of course I would be guided by my doctors on this one, as you will be.

But equally I would go for the arsehole with a steady hand over the avuncular butcher.

Lastly - my son is 5 in August and there's no way I'd let him go. To a CAMP? Where he may fall into large bodies of water and drown, or be eaten by a bear, or sunburnt, or, god forbid, he may not like the food? No thanks. I realise that camps are something you Americans do, but us Australians are not familiar with the concept, and it fills me with portentious doom.

[Kylie]

If it were me, I'd definitely go with the most technically competent practitioner, irrespective of their (even really significant) personality flaws. Bottom line is I'd be seeking the option with the lowest risk to my babies and me. Good luck!

[PamR]

I say go with the most skilled doctor. Congrats on the twins...so happy for you!

[Anon]

You know, I couldn't help but keep thinking as I read your post that guiding Patrick toward independence *before* the babies come would be a great move on your part. With two babies he's liable to feel left in the cold if you've done lots of things for him to this point. Also, the more he can do on his own with just verbal direction, the better. You're going to have your hands full! He's a very bright kid. Teach him how to apply that sunscreen while you can watch him. Trust me, I was in my son's back pocket for a long time-you can't be there forever and while I know Patrick is still young, let him do for himself as much as possible. Be his guide! Please don't see this as an attack. It's definitely not! Just threw it out as something to think about since I now consider myself an experienced parent. When did *that* happen ;-)

As for the CVS, wow, tough decision. I've read your blog for eons-first time commenting. I have been pregnant six times, have three children, 16 (boy), 14 (girl) and 10 (girl). I had CVS while pregnant with my son after two losses. One of my losses was found to have Down Syndrome and I wasn't sure after two losses whether I had a genetic issue or not (no family history) so I went with CVS. I didn't have CVS with the other two even though I lost my third between my girls but went with the AFP testing. Yes, I was nervous throughout my pregnancies but I probably would have been no matter what I did. I see that others are concerned about CVS with twins. This is something to discuss with the doctor for sure.

I wish you all the best with this pregnancy. I'm encouraged and hopeful along with all your other readers and it has been such heartache to read of your struggles.

[Deborah VA]

Hi. I read but don't say much in comments. One of "those" people. Nonetheless I would vote for the heartless pro, because I feel technical know-how beats compassion in this particular situation.

I am SO optimistic and excited for you. I have boy-girl 1.5 year old twins and, well, let's say they have turned my world upside down in a joyous and challenging way.

Best wishes!

[Mellie]

Heartless pro, all the way.

[Rebekah]

I don't know, I think I would assume that everything is fine but go with someone who is compassionate. I have a strong preference for this kind of thing, but you know what YOU need at this time, so go with your heart or gut or whatever you need to listen to at this time. (Because I think you're going to get conflicting opinions here!)

And I have to tell you how incredibly excited I am for you. I know it's so, so early but NBHHY and I am keeping every digit crossed for you and wishing for the very, very best. Blessings ...

[Sally]

My vote - screenside manner doesn't amount to anything, really. It's about getting this part over with safely and quickly. Nothing will change the results and what ever nonsense happens between the belly gel and the phone call is just noise, despite how much it ticks you off. And come on, plucky one, like you're NOT going to let them know that what they did last time was awful? You will and that will probably prevent a recurrance right there. Be safe and GOD, I AM SOOO FUCKING THRILLED FOR YOU!!

[amy]

Holy crap you now have me terrified of the sun! As a kid (and young adult) I had numerous bad burns from said sun. Never really thought about it and the fact I must start slathering children in sunscreen daily. Scary.

Congratulations on the twin pregnancy :) My son and his little twin sisters are the about the same age difference yours will be. Be good to yourself.

[legalmama]

I had no problem having a CVS with my twins. We had also done PGD, and I didn't think that I would do any testing. But we started out with triplets, one of my twins had an identical twin. But one of the identical twins' heart stopped beating at 9 weeks. So we were concerned that it could have been caused by something genetic, which the identical twin would also have had. We did our CVS through the abdomen, and had no problem at all with it.

When I had an amnio with my son, we went to my OB instead of to a peri. I had a big leak, and almost lost him. For my twins, we went to the peri that is known specifically for doing a lot of CVS procedures. Get the CVS at the doctor that you feel comfortable with, and go back to the other doctor to manage your pregnancy, where compassion is more important.

[corky]

Hello

I've just recently been through this dilemma with my post ivf twin pregnancy. We ended up going for a NT scan with a calculation of risks based on the measurement and I was slated for a cvs later that day if the test was abnormal. The NT results were good so we deferred on the cvs and went back to big city practice in toronto to do the anatomy scan at 18 weeks with the possibility of amnnio the next day if there were any soft markers found. I don't have the loaded history of a b/t and multiple losses so I understand your need to know definitively. As I understand, twin pregnancies are riskier wrt to testing but it would also be nice to know early enough so that you can make decisions. I had a long discussion with a genticist and a perinatologist and there certainly wasn't alot of concensus about what was more reliable aside from cvs/amnio. They also mentioned that reduction, although ideally done before 14 weeks can be deferred until much later so that the healthy fetus is not endangered.

I don't know, I think I would prefer the most skilled doc you can find and tell them emphatically how you felt about how you were treated last time so that they will hopefully toe the line. I am shocked at what you had to go through last time and I think those offences would be reportable to the respective licensing bodies. The other option I like is to travel to the best person possible..I've heard alot about Wapner and Stone (NYC).

Best wished in your decision.

I also have a 4.5 year old and I am debating about the day camp thing. He did ok in full day junior kindergarten but I'm not sure I am ready for him to be away all week/day yet. I'll read with interest what you decide.

corky

[Flicka]

I have no idea if this is possible or even if anyone else suggested it, since I just rolled right on past everything. But if I could choose, I'd have the CVS done with the rude but skilled doctor and have them send the results to the caring place. That way two people read them, so you've got two opinions and if there is something wrong (and we pray there isn't) you'll have the caring support you need.

I'm wishing all the best for you!

[Cherith]

I want to say something helpful and intelligent but I cannot stop twitching from your discussion of ticks. We don't, thank God almighty, have to deal with those in my neck of the woods.

twitch twitch twitch

OK, on the subject of Patrick. I have both a 4 and a 5 year old boy. They are both VERY independent in many ways, but there is absolutely NO WAY I would put them in an all day camp situation at this age. Perhaps I am over proctective, I don't know. But I take serious issue with people who insist that kids have to learn independence and how to deal with the world, etc. That may be true for a 13 year old, but we are talking about a 4 year old for pete's sake! Yes there are SOME parts of the world that he has to learn how to deal with, but there is nothing at all wrong with easing him slowly into the rest of life.

In my not so humble opinion, I am a middle school teacher, BTW, I think that society asks kids to grow up WAY too fast. We thrust kids into situations before they have the foundation to process and make good choices about what they encounter. I am a firm believer in taking it slow, keeping them young and letting them make the decision as to when they are ready to jump the parent ship, within reason, of course.

[Hetty_Fauxvert]

You can go to both places, you know, and it sounds like it is advisable. We paid (THOUSANDS of $$) out of pocket to have our fetal reduction done by the best doctor in town, instead of letting our humongous HMO take a crack at it for free. I knew it was hellishly unlikely I'd ever get pregnant again at my age, and I wanted to make as sure as possible that reducing our pregnancy from four to two did not result in losing the entire pregnancy. Best dollars we ever spent. And to my surprise, nobody at our HMO gave us grief about going out of the system. I really recommend going to the best doc for whatever that particular procedure is.

[KarenT]

(1) Go with the doctor with the better technical skills. In the long run, that's what is most important. But I would definitely communicate with them up-front about your prior dissatisfaction and explain that you expect immediate full disclosure of all results this time. Often the physician is unaware that the patient wanted the communication handled differently.
(2)Banana Boat Kids Tear Free (really!) spf 50 kept my 21 month old free of sunburn after waterbabies failed miserably. It is Zinc oxide based, but it will blend in.
(3) I was rather stunned to discover that my older daughter had independent skills exhibited at preschool (also Montessori) which far exceeded those she has shown at home.
(4) Congratulations!

[Jodi]

Personally, I would go with less risk and be thick skinned about the lack of compassion and demand an appropriate standard of care from them. But them again, I don't like to routinely be known as the nasty patient. Sometimes it just happens that way :).

When I got the scan for my pregnancy and the foetus was anencephalic, the practise took a grand total of $20 off their fee. I guess they thought that was being 'nice'. It was insulting.

[Meredith]

I personally wouldn't take the chance of a m/c or a significant bleed by going with the not as impressive dr..I say, those babies are fine & you should make sure the CVS procedure has as little risk as possible to the babies. You won't need the touchy feely clinic! And you can be very upfront with the experienced clinic & express your dissatisfaction with how your situation was handled last time..and ask them to be honest to save you the pain you had to endure. That's my opinion..for what it's worth! I couldn't imagine risking the health of the babies with a less than perfect procedure b/c you will suffer interminable guilt if it goes badly & you could've chosen the better clinic. At least that's how my brain works!! Good luck with this difficult decision!!

[emma]

hello.. congratulations. If I were in this situation, I'd go with the most skilled doctor but would be very blunt about how I felt in the dark last time and stress that I would like to know if he has any suspicions of abnormality. All the best x

[Slim]

Because I am always very free with your money, I vote for travelling to the best doctor in the country and not even checking out whether s/he is a total jerk, just the CVS stats.

And I have a kid who wants to do lots of things by himself, just not things it would be actually helpful for me to have him do.

[Pam L]

I agree with most of the population who say go to the capable guy and get your support elsewhere. Can you tell him you want honest results which you didn't get last time? Also,
I agree that sunscreen is very important and I have no doubt your son is totally capable, in theory, of applying it, I mostly meant that in MY experience boys will not think of it, it will not enter their busy minds, so I would ask a counselor to make sure they have him reapply as necessary. And sure, a new thing like camp, if it doesn't suit him, he doesn't have to go back. My only rule was for things they knew about, like baseball, if they wanted to sign up for it they had to finish the season, unless there was something seriously wrong with the program, or the coach or something, but this was mostly because my younger son was always so indecisive about things, one day he wanted to do something , then next day no.

My husband also has a translocation, and I, like you, was 100% sure I was going to have CVS or amnio.

Then the peri convinced me to go with the gazillion blood screenings, all of which my daughter passed with such flying colors, that the peri convinced me I didn't need CVS or amnio. She said these blood screenings are getting more and more sophisticated everyday.

That said... A friend went to Wapner. I think CVS, amnio and S/R is all he does, all day, every day. Because his practice is such a well-oiled machine, she got some sort of result the day she had the CVS -- all okay. It was confirmed a couple of days later.

So an added bonus might be a quicker turnaround time.

[maggie]

Heartless pro. And what Victoria said - write letters.

I've heard great things about Wapner. Joanne Stone in NYC is also terrific. But that's if you want to or are able to travel for the CVS.

[Candy]

Adding absolutely no help to your dilemma at all, I can only say it is rather daunting to leave the 82nd post. Who the hell has time to read 82 comments to a post?

[silene]

Skill, skill, skill. As someone above said, all the rest is just noise - Compassion is nice but it won't change an inevitable bad outcome. Lack of skill can create a bad outcome. So whichever test you end up with, go with Dr. Skill. Or travel - Mt. Sinai (Stone and Eddelman) do CVS and amnio exclusively, probably 8-10 per day, and Stone is a DOLL (I have friends who were patients of Stone and who to this day get weepy that she can't be their OB anymore. She actually showed up in the delivery room for two of their births even though she wasn't the Dr, just because she could and that's just who she is.) Eddelman is no slouch either... Stone did my CVS (twice, actually, since the first one didn't get enough cells for the FSH we wanted, so we got two for the price of one, in the span of an hour. Fun, I tell you.) Good luck whatever you decide.

I can relate to the sunscreen addiction. My most vivid memories are of sunburn in the part of my hair (and my darker skinned mother COMBING IT without realizing - OW!!) and of one on the backs of my knees - couldn't sit down for a day because I couldn't bend my legs...

[Celeste]

Commenting on your Redbook post regarding Steve's knee dilema:

Steve sounds like my husband. He would never get excited until the later ultrasounds sexing the baby, and never vary the routine or plans until I was in labor. Both times our cribs were put up after returning home from the hospital.

My husband's in Orthopedics and they usually recommend elective surgeries to be done in December. That way the patient is fully recovered by spring when they are generally more active. He could opt to take care of it sooner, but could still be having issues for a while. (Though probably not as bad as shape he's in now I suspect.)

Could you hire a baby nurse or nanny for a few months while you recover?

[the cat]

I think this comment should have gone on the last post...oops, sorry.

I too have that skin that burns just thinking about going outside, and have passed it on to my son. Due to the new ozone etc., I worry so much about the amount of exposure he gets. I just found this great company that do sun clothes, and we both got great sun hats from them. But, they also make a "wash", that ups the protection that clothing provides from 5UPF, to 30UPF. When you said Patrick burned even in a tent, I thought you might be interested. The stuff is called SunGuard Laundry treatment, by Rit, and we bought it from www.sundayafternoons.com .

Kids should get to play outside, but we can still remove as much risk as possible. :)

[Cindee]

I had a CVS and was terrified something would go wrong. I had a choice of practitioners and went with the cold fish lady I could not stand - simply because the office staff told me she was the best at CVS and had done the most (I found comfort her seasonedness. Indeed, she was true to her cold fish form, but also executed the procedure flawlessly. I was glad I went with her.

[Giillian]

As an old woman, I have to say that there are way too many mothers-in-law in the world today. There used to be one woman who thought that nothing you did was right, that she knew more about your kid than you did and was sure to play the devil's advocate about any decision you made regarding your home, marriage and children. Today they are heavy on the ground.

There are some people who can be quite cavalier about sunscreen because it is simply not a big issue in their genetic make up. Clearly your family history gives you cause to be vigilant about the issue. So, for one person to be telling you to stop being over-protective while another becomes faint at the thought you would consider leaving this responsiblility in your child's hands is so amazing to me.

There are a slew of bad parents out there, and even the best parent can make a bad call however, you are not a bad or thoughtless parent. I would say trust your instincts and lets have a glass of wine.

As to the two perinatology clinics, I would get an ultrasound evaluation from the clinic where the people treat you like an adult first and then get the CVS done by the paternalistic clinic. Once you have the values you could decide with which clinic you choose to go forward.

[Mrs X]

Neither here nor there but they do make spray on sunscreen now. Won't work for his face, but it certainly makes it easier for little hands to reapply to the rest of the body. Then perhaps someone can help him with his face?

[SarcastiCarrie]

Put sunscreen on Patrick before he goes (maybe like SPF 90), dress him with a hat and clothes, and then the reapplying and voila. Hopefully no problems. If any hesitation after the first day, consider it money spent on some kind of lesson.

And I agree to go to Dr. Nice first for a Level II & BUN screening (I think this is what they call it now with the nuchal to get an idea, as you mentioned your specific bt does tend to have high nuchal measurements). Then, go to Dr. Mean Lady who uses her speculum as a way of putting your uterus *just* where it needs to be. If, heaven forbid, the results of the CVS are less-than-desirable, you can go back to Dr. Nice for a "second opinion" and follow-up care. I like Dr. Nice, really I do, and I'd love to send more business her way - (what with having a plan for how to handle undesirable outcomes!), but Dr. Mean Lady, she's got the skillz.

[SheilaC]

Congratulations once again on this twin pregnancy - hooray! So far, so good.

Interesting comments about the testing dilemma. I'm sure you realize that if your twins are in separate amniotic sacs with separate placentas, then you have to have 2 CVS or 2 amnio tests done. So some of the risks are doubled, and it's essential to have the most skilled doctors to do this invasive testing. I'm not sure how you determine which doctor is the most skilled and experienced at doing this, besides asking each of them very frankly for their statistics and level of confidence, and maybe even whether they would recommend each other for this procedure. (We had triplets in 2000, and we refused amnio tests because of the possible risks of the procedure. Fortunately the babies were healthy, but it was a very anxious time.)

By the way, I am smiling at your Redbook post about Steve and his apparent emotional detachment. My husband is also a Steve, a Brit with an undemonstrative, stiff upper lip, problem-solving approach to life, and while he has many excellent qualities, emotional support is not his best thing. At least you only threw the celery, not the knife!

Re: Patrick at camp, it's hard to tell in advance when so much depends on the staff. You could have him practice sunscreen at home, and let him try the Y to see how it goes. He'll either have a great time the first day or he won't, and he'll let you know if he wants to continue.

Good luck with whatever you decide to do; I'm sure it will be the right thing.

[jennyg]

I'm sorry I don't have time to read the comments, but something important: Patrick needs to be treated for lyme as well, RIGHT AWAY. My entire family was devistated by Lyme disease, and only ONE of us EVER had a rash. We had the full spectrum of problems including my mother getting rather severe psycological problems from it. Even our DOG had it. You can take just a relatively short (2wk doxycycline) course of antibiotics right when you have the tick bite and that takes care of it... or you can go into the awful, terrible, months and months of IV antibiotics like my mother. I'm sorry, but I just couldn't read your story and not comment with my experience here with this. Sorry for the assvice!

[jennyg]

Oh and since you actually asked about this part:

First, have you considered not getting CVS? I honestly would not in your situation. Honestly.

Second: If you do, go with the talented jerk, and then transfer. Often the most skilled or smart doctors are NOT the ones with the best bedside manner!

[Stacie]

I have nothing useful to say other than congratulations on your twin pregnancy.

You'll get huge, swell up like a balloon and start to loathe all non-pregnant people. Having been there, I can't wait to read your comic take on the misery of the third trimester with twins.

[jenebene]

Delurking to say that when I was pg at 43, before the NT scan became available, I took a huge leap of faith and opted out of invasive testing b/c I was certain this was my one and only chance given my age and I was more afraid of losing a healthy baby than any other outcome I could (only, admittedly) imagine. A perfect level 2 at 18 weeks allayed some of my fears, but truthfully I worried so much during that pg that I still wonder if I'd make the same choice again. My boy is perfect. If I'd gotten pg again, I'd have gone to the best in the country if I'd the nerve to do the testing. If.

Whatever you choose, I'll be holding you and the little ones in the Light,,, jen

[Leslie]

Oh yay oh yay oh yay!!! I've been gone for awhile and just checked in for the first time in a looooooong while tonight to learn, (oh yay!) that you are preggers!!! With twins no less!!! Hallelujah - it's about time it went your way. No doubt these sentiments are echos of many posted much much earlier - but I had to say "yay!"

Can you get the cvs from the good cvs'r and the rest of your care from the other?

[Becky]

Skill, skill, a thousand times skill.
I'd find the best in the U.S. and book a flight.
Good luck with whatever you decide. It's a sucky decision.

[Crystal]

I'll preface this with a huge "if it were me"...

If the little ones are destined not to make it, it matters not how quickly the pregnancy is ended (okay, not entirely true, but stick with me here).

However if CVS is already harder with twins, or not, I'd go for more safety over honesty and earlier termination. Birds in the hand and all that.

Besides, you (or Steve) could call the good doc on the BS of last time, and ask for absolute forthrightness. Remind them you've lost how many now? And all you're looking for is healthy and living, same as he, so the sooner you know where these little ones fall, the better.

Had I been through that many losses, I just couldn't handle any more risk, real or perceived. The CVS would be a necessity in my mind, but I'd want to minimalize the risk as much as possible.

May fruitful hail Mary's be the order of the day. Or something like that...

[Tertia]

yay twins!!!!!

[Kate]

Accuracy over compassion. Definitely.

Sunburn and cancer. There is a direct correlation. Ask any Australian over the age of 40, before the days of "no hat no play" and rashies (swim vests) and we all have memories of childhoods filled with sunburn and peeling. And we all know now to watch those spots. Too late of course. We can only but wait. So good on you for being so vigilant.

Fingers crossed with the twins. Its gotta happen soon for you. There is no way that amount of persistance won't pay off.

[BG]

Julia,

Haven't read all the comments but I've just recently started as an apprentice midwife (direct entry midwife, not nurse midwife) and I JUST took a class on genetics testing.

We talked about the risks associated with doing it at all (obviously not an reasonable consideration in this case), and the CNM who I'm working under (who knows pretty much everything) points out the risk of miscarriage rates vary wildly based on skills. Here in SF, she recommends everyone go to UCSF for genetics testing where the risk of miscarriage is a quarter of what the average is nationally.

I say GO FOR THE BEST. You have the money, and if there was ever a time to use it, now is the time. Look for the best of the best, and go there. I have a super good feeling about this, and I'm pretty sure that you are going to end up with two healthy twin babies at the end of this, but I think you should treat this with super-duper kid gloves. Go to the best hospital you can find with the best geneticist you can find. I think your case in particular would interest plenty of excellent MDs who would be eager to help.

Course I know timing is a huge necessary factor but you still have a few weeks right?

Good luck.