Quinn's Birth

    Throughout my pregnancy, I always got comments about how small my belly was but I was measuring ~2 cm smaller than expected which is within the normal range. I attributed it to genetics, because my mom said she was small during pregnancy. However, my when I went in for my 39 week appointment on a Tuesday, I was still measuring around 35 (I think), so they decided to get an US to check on things. Being at the the big academic center of UAB, there were no US appointments until Thursday since it wasn't an emergency, so over the next few days I continued to tell myself everything would be fine. George and I went in on Thursday for my US. The US tech was obviously measuring things smaller than expected and due to our knowledge of the procedure, etc, was unable to hide it, so we immediately knew things were not within normal limits. Because it was apparent that we knew things weren't as expected, she finally told us that the cardiac activity and everything looked fine, but the baby was measuring in the 6th percentile.
      My OB had already told me that if he measured under the 10th percentile, I would be induced. A few weeks previously, he had measured in the 50th percentile, so she did not foresee him measuring that small.
      We went back out to the waiting room to wait to see Dr. Gleason - the only doctor who was still in clinic. We knew we would be having a baby within 24 hours- I was super excited; George was super nervous. I had not been dilated more than 1-2 cm previously, so we figured I would need to be admitted that evening for cervidil, but when we met with Dr. Gleason, I was already dilated to 3-4 cm so he sent us home for the night and told us to come back in the morning for induction.
    We called our families, went home to pack, and got dinner at Saigon Noodle, my latest pregnancy craving. I could tell George was nervous, but he wouldn't say why. I finally got it out of him that he had researched all the complications of IUGR (intrauterine growth restriction) and was concerned about the complications with our baby. Of course, this then made me nervous, but I refused to look it up myself, because I kept telling myself everything would be fine. Throughout the night,  I was having some mild cramping but didn't thing anything of it. I had not had any braxton-hicks contractions or the like, so I didn't know what to expect.

    The next morning we went in at 7am to be induced. Once I was hooked up to all the monitors, etc. They said I was already having contractions every 5 minutes and asked if I could feel them. I guess I could once it was pointed out, but they weren't bad. They decided to just let me labor an hour or two to see what happened.
    Nothing happened, so Dr. Stewart (my OB) broke my water.  The contractions began increasing after that. I went ahead and asked for my epidural.
   My first epidural only took on my left side. They kept saying to give it some time and then had me positioned to try to get it to take on the right but it never did. It felt like I had intermittent appendicitis, because the pain was sharp and only on my lower right abdomen. They had turned the pit on to the minimum setting of 2. I ended up getting a second epidural that took on both sides and was glorious - I was then pain-free. However, the sensation of dead weight in your legs is very bizarre and unsettling, but worth not feeling the pain of labor and birth. It took a few hours for me to dilate to 6-7, but I quickly dilated thereafter.
   My parents were in town at my house waiting to come to the hospital until closer to time. They barely made it!! As soon as they walked in, I felt the urge to "use the bathroom" which is the sign the baby is crowning. We said our hellos, took a few pics, and kicked them back out of the room. I pushed through 3 contractions, and Quinn had arrived. I can only hope my subsequent deliveries go just as smoothly.
   Quinn came out screaming at the top of his lungs and was 6 lbs 12 oz - 25th percentile, instead of 6th, so George was relieved to say the least. We were so happy to finally have our healthy baby boy in our arms.

George Augustus Nelson, V

6 lbs 12 oz

20.5 inches

born on Friday, June 14, 2013 at 2:34pm

Growing a baby

9 weeks

Somewhere around 9 weeks

12 weeks

Confirmed it was a boy on the ultrasound in the CICU!

20 weeks

22 weeks

AAD in Miami

26 weeks

Hannah's Wedding

38.5 weeks

We're having a baby! Can you believe it? I'm not sure I can....

Recap of first half of pregnancy:

-Found out I was pregnant October 5th on a Friday afternoon. I was hopeful, but really did not expect to be. Kori was coming in town and we tend to hit the town, so I thought I should just be sure, and I couldn't believe it when I thought I saw 2 lines about an hour before she got in town and while George was on the way home from work, completely unaware of what was going on. I then took another one that said "yes" or "no" which confirmed it. I put them both in a gift bag on the counter and told George I got him a surprise. He was confused and I'm sure he thought it was going to be something random, like when I buy him bookends at the flea market. He was shocked when he put saw the tests and took a few minutes to put it together. We obviously had to tell Kori later that night after dinner, though I was almost busted at dinner because the waiter did not get the concept of "give me a non-alcoholic drink in the same cup as the alcoholic ones".

-We told George's parents the next night. We went over to their house to pick up Hudson. George's mom just so happened to pull out all her old baby clothes that she had recently found and washed. After 15 minutes of just talking and me about to loose it because George hadn't told them, he finally asked if his mom was ready for another little one, or something to that effect. She said, "Oh, are Chase and Rebecca having another baby?!". When we corrected her and said "No, we are having a baby," she was speechless for a good 5 minutes and super excited.

-The next day my parents had already planned to be at my brother and sis-in-law's house in Montgomery, so I suggested that we come down and all have a big family lunch, since we hadn't seen my nephew Charlie is a while. On Saturday, Kori's' friend was kind enough to monogram a onsie for Charlie that said "big cousin". When we got to Montgomery, we gave the gift to Erin to open for Charlie. She had her hands full in the kitchen, so my mom took the gift and opened it. She and Erin were the first to read it. Mom and Erin were definitely confused for a minute, but when they put it together, they too were super excited. Then, we had to take a minute to explain it to my dad who was then in shock. :)

-From 7-14 weeks, I was so tired I was convinced I was anemic or had hypothyroidism, but niehter was the case. Just pregnant. Also, I managed to evade the flu despite George getting it pretty bad.  I've already managed to forget when I felt particularly sick and yucky. I did have pretty bad post-shower nausea in the first trimester. At first I thought I was imagining it, but apparently its a recognized side effect of increasing estrogen/progesterone. The heat from the shower causes vasodilation and the higher levels of hormones exacerbate the vasodilation and can drop your blood pressure causing nausea and lightheadedness. It was pretty miserable, but not as miserable a true morning sickness I'm sure.

-Found out it's a BOY when we went for my 12 week screening ultrasound at 11.5 weeks. We had a senior faculty doctor, Dr. Davis, who asked us if we were planning to find out the sex of the baby as soon as they put the ultrasound on my belly. We casually said yes and next thing we knew, he was showing us that it's a boy. We were not expecting that news, but were glad to have it. He was 99% confident and told me I could start buying blue. I was still slightly skeptical, because it just seemed so early to know. The rest of the screening went fine too.  We then reconfirmed on our own on an ultrasound at work a month later that it still looked like a boy to us.

-Had my 20 week anatomy scan ultrasound at 19 weeks. My mom and George's mom both went to the appointment with us. Fortunately, this baby was all balled up and we couldn't see much of anything other than a balled up fetus. George and I went back the next week, since they couldn't get all the needed measurements and views. That ultrasound was great! We could see so much and they put it on 3D so we could see his alienish little face.

-Thought I felt kicks during my 21st week, but couldn't convince myself with all the other rumbles in my tummy. On Feb 10th, 21.5 weeks, I defintely felt him kicking and George could feel it too. Since then, he's been kicking a few times a day. Sometimes I poke back :)

Overall assessment of pregnancy so far: not my cup of tea, but the endpoint will be great. 
Next up, ultrasound pics and belly pics. 

I'll try not to be so scarce. 
I'm hoping to make this more of picture blog in the future.

Chef U Dinner Party

So its been quite a while.... I keep meaning to post things, but since I started dermatology residency in July, I've been a lot busier than expected. Whenever I have downtime, I should be reading, but I'll elaborate on that in another post. I promised that I would do a post about our dinner party last Friday, so here I am :)

I bought a SuperDeal for a Chef U dinner party for 6 almost a year ago with intentions of using it for a birthday dinner for George - his birthday is in March- but that didn't happen, but I wanted to make sure to use before it expired, so we finally found a good time to do it. We had it our friends Chase & Rebecca's house, because they have 2 little ones and a bigger kitchen. The basis of Chef U is that she comes into your house and cooks a 4 course meal in an interactive fashion. Check out her website here. She let us pick the menu items ahead of time.  Our menu was...

Spiced Shrimp Rice Paper Rolls
Mango Cranberry Chutney, Vietnamese Dipping Sauce

Mexican Crab Cakes
Corn Relish, Chipotle Tartar

Espresso & Brown Sugar Lamb Chops
Sweet Potato Hash
Malta reduction

Blackberry Cobbler
Vanilla Ice Cream

AND she had the wine guy from the Western send us wine pairing for each course! We each got a shot at making shrimp rolls and the guys learned how to make the crab cakes and lamb chops while  Rebecca, Caroline, and I enjoyed catching up and drinking wine. It was so funny how the guys were all waaay more into the cooking than any of us girls were.  Below are a few pics from the evening...

Prepping the delicious dinner.

Learning how to make shrimp rolls.

Beautiful table setting.

Chase & Rebecca

Caroline & Grant

All the pics of us were blurry. We all enjoyed the wine :)

I just wanted to share this great experience and recommend it to anyone interested. I know we'll definitely be doing it again!

xoxo,


(btw, I've been watching too much gossip girl....and that's another post...)

Skin cancer and surgery combine...

Currently, I'm on my general surgery rotation. We had a great skin cancer case come into the resident surgery clinic last week. This lady has been very unfortunate and had multiple skin cancers on her face which have pretty much eaten her nose away. Now, she had a new one similar to the picture below. Her skin cancers, including her new one, were clinically keratoacanthomas. This new one above her lip grew to this size in about 2 weeks. The natural course of these lesions is controversial. Basically, they can be cancerous (squamous cell carcinoma) or they can be benign and go away on their own, only time will tell. Well, most people don't want to wait to figure it out since they continue to grow, etc. (I wouldn't!) So our lady already has a disfigured nose, and now has this new skin cancer which is almost identical to the one pictured below only located directly above the lip, not on it.

Lesion similar to my patient's. (Picture from here)

We decided to proceed with surgery to remove the lesion and hoped we could find a plastic surgeon to help us with this case. I am by no means even remotely familiar with the administrative/reimbursement side of things, but from my vague understanding, patients come to our resident clinic with little or no fee and are able to have surgery for a much reduced price or free or something of that nature. Therefore, if we need a specialist, we must find someone who will participate in this charity care. Luckily, we found a plastic surgeon who agreed to supervise the chief resident and me on the case!

The next week, we went to the operating room. We cut out the visible tumor and sent it to pathology.  While we waited for the results, we determined that that we could very easily close the defect (hole) we had created. Unfortunately, the margins were positive, meaning there was still tumor around what we cut out. Then we had to cut out more, send it to pathology, and wait again. The margins were positive again! The pathologist confirmed that it was squamous cell carcinoma (skin cancer) and said that it was a pretty aggressive tumor because it invaded around the nerves (perineural invasion) in the skin we had cut out. We cut more out and sent it to pathology again. No longer would this be a simple closure. We had created a pretty large defect, similar to the one in the picture below (ignore the grey & black, that was already in the picture). At this point, we were extremely glad to have asked a plastic surgeon to supervise us. He was essential to helping guide us in repairing this hole we had created in our patient's face. The 3rd time we sent tissue to the pathologists, the margins were clear = no more tumor, whew.

This is about the size and location of the defect we created. (Picture from here)

Typically, you can do a rotational flap by taking skin from up near the nose and rotating it down above the lip. So take a look at the picture below with my attempt (the gray & black figures) to demonstrate the technique. Sorry, its blurry. We would cut along the lines, as they did in the picture, then take that flap and swing it over to above the lip to fill the hole we had created by cutting out the skin cancer.

An example of the rotational flap. (Picture from here)

However, remember I told you our patient had had multiple prior surgeries on her nose, so we were unable to use the skin near the nose because it was already scarred. We elected to perform this same rotational flap, but in reverse. We cut the flap from down the side of her face by her mouth, rotated it up into the defect, sutured it in place, and sutured the area we had cut the flap from together in a line. When we finished, it looked similar to the picture below. (The black lines show how we cut our flap, although ours were curved).

Similar to our finished product. (Picture from here)

In the end, I think it looked great! 

I have actual pictures from all stages of our case, but due to HIPAA, I'm not 100% sure I'm allowed to post them even though she allowed us to take them, so we'll just make do with these pics from all over the internet. I couldn't find any that showed exactly what we did, but I hope I adequately explained the technique.


I love this case, because its relevant to my career and interests. My attending has asked me to do a presentation to all the surgery residents about keratoacanthomas and squamous cell carcinomas at morning conference. (Eek!) I'll be sure to report how it goes...

Disclaimer: I am an intern. I am not a trained dermatologist or surgeon, so this information represents my opinion and not necessarily medical fact.