Baby Face?

Went for an ultrasound today to check on the status of my low lying placenta. Tomorrow I will be 28 weeks and officially in the final trimester of this pregnancy, so I guess right now is the last day of the second trimester. 

According to the various charts and sites on the internet, the baby is the size of a plate of pancakes, eggplant, head of lettuce, butternut squash, Kraft Dinner Mac and Cheese box, and the list goes on, all being slightly different shapes and sizes, making it really hard to understand how big she is. However, the tech asked if I wanted to know the baby's approximate weight - which is exciting data! So apparently she is currently 2.4 lbs (or 1.08 kg).

While showing Jason over the phone at the end of the scan the tech was able to get the front of her face - Jason let out a little squeal! I asked if we could get print outs and the tech was very excited about how 'cute' the face was, with its 'chubby cheeks.' I have included the images but made them small since I think they are super creepy and look ghost-like, click the picture to see larger. Jason claims that when it showed up over the phone it looked a lot better (it depends what 'slice' the images are as to what they really look like.) It was the first time he had seen something that "maps directly to a real face, a real human thing."

A Depressing Flowchart

So, in an effort to feel more control, or something, I have been mentally going through a flowchart of events for the next few weeks of this pregnancy.
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Heartbeat - Is there still a heartbeat? - I say 'still' because there was one at the last ultrasound at Week 7, but we know from last time, where we saw the heartbeat twice before the eventual fetal demise, and that while seeing it early lowers the chance of miscarriage, it doesn't eliminate it. After days (weeks?) of worry, we will get this answer tomorrow (Thursday) at an early early hospital ultrasound arranged by my doctor.

-- Heartbeat - No - I should know right away during the ultrasound if there has been another 'silent miscarriage' the behaviour of the technician is quite different when things are fine vs. not. Though they sometimes stick really hard to the "technician can't say anything" and I will need to wait for the doctor at the hospital or my own doctor later in the day to give me the sad news. If this is the case then all further steps stop and I will get a reference to the Early Pregnancy Loss clinic to deal with another miscarriage that will be devastatingly similar to the last one. The following weeks going through that process will be awful and annoying and I am trying not to build out that branch of the flowchart except to know that this time I would like to go through the processes at the hospital so that I can be put under general anesthetic and that the tissue can be tested afterwards.

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-- Heartbeat - Yes - As mentioned above, I should (hopefully) find this out during the actual ultrasound. If everything is still developing properly, not only with a heartbeat but proper size for 12 weeks then I move onto the next step.

Prenatal Testing - When will I get my Enhanced First Trimester Screen (eFTS) done? - My original hope was to not have to do the eFTS because the results are much later than the NIPT (Non-invasive Prenatal Testing, or the blood only paid-for DNA test that I needed to get a redraw for that started this whole emotionally challenging spiral.) The eFTS is also not as accurate so having to rely on those results instead of the NIPT means that we aren't out of the dark tunnel of worrying that we are sitting at the end of this pregnancy. More on this below.

-- Prenatal Testing - Tomorrow - Because my doctor's office was sending out urgent ultrasound requests to multiple clinics and hospitals, they were unsure if the one I have tomorrow will be just a 'viability scan' to basically check for the heartbeat and that is it, or if they will have time at the hospital to do the full eFTS. If there is time, than the ultrasound will just continue on for 45 minutes or so with a ton of measurements being made and I will be sent for blood-work tomorrow as well. This is preferred because we will get the results sooner and everything will be done at the same time.

-- Prenatal Testing - Next week - If they only have time for the quick scan tomorrow then I will be keeping the clinic appointment I have for the eFTS on Wednesday June 29. This will delay results by a week, and as my own doctor is away next week, possibly delay us learning the results even longer. (Obviously if there is no heartbeat, or if there is and the hospital ends up doing the eFTS, I will cancel this clinic appointment.)

NIPT - Did it work from the blood redraw? - I gave blood again this past Friday to try to get results through the DNA system, after my first blood draw the week before came back without results. Based on my weight and the low FF (Fetal Fraction is a measurement of the amount of the DNA found in the blood that isn't mine) from the last blood draw the chance that I can get results from the second blood draw is only 41%. This is why we are moving forward with the eFTS in the likely case that the NIPT comes back inconclusive again. I should know by early next week what happened with the blood redraw.

-- NIPT - Yes and Low Risk - This would be the best outcome of this flowchart, if I was drawing it out the box it sits in would be a starburst or something. The NIPT low risk result is very very accurate, it would mean that we could move into the second trimester of this pregnancy with a huge feeling of relief that the baby is currently healthy and doesn't have the three most common chromosome differences. (We would ignore the chromosome speculation in the eFTS in this case.)

-- NIPT - Yes and High Risk - This would be a very very worrisome outcome. Since NIPT is more accurate than eFTS, heading into the Diagnostic Testing it would be highly (greater than 90%)  likely that there are chromosomal abnormalities which would mean a termination of the pregnancy. The next step would be Diagnostic Testing, see below.

-- NIPT - No - This is fairly likely and would mean we have to wait for the eFTS results. The 'no result' as a result in itself actually signifies a slightly higher chance of chromosomal abnormalities which isn't good. The next step would be to wait for the eFTS results which depending on when I got the testing done (see above) will be ready between Aug 3 - 12.

eFTS Results - What is my risk factor? - It will be a long wait for these, but if the NIPT is inconclusive for a second time it is our only option for screening on chromosomal abnormalities.

-- eFTS Results - Low Risk - Definitely a good outcome, this would give us about the same level of relief that a NIPT Low Risk result would, that the baby is currently healthy and doesn't have the three most common chromosome differences. It would just come almost three weeks later.

-- eFTS Results - High Risk - Strangely not as bad as you would think. Because eFTS uses fetal anatomy measurements along with my hormone and protein levels to determine the risk factor it has a really high rate of false positives. It would still be cause for worry but a lot of room for hope when moving onto the Diagnostic Testing, see below. In fact there would be only around a 10% chance that there are chromosomal abnormalities which would mean a termination of the pregnancy.

Diagnostic Testing - Another whole flowchart - If we ended up in this box, either from a High Risk result coming from the NIPT or eFTS then there are a bunch of considerations that I am not dwelling on at the moment. Firstly there are two types of testing depending on how far into pregnancy you are. Depending when I get a High Risk result I made not be afforded a choice between them but if I get it early enough then I can choose between the two, one of which would involve waiting a few weeks. In both cases this type of testing is considered invasive and carries a risk of miscarriage from just undergoing the procedures. There are other health risks for both me, the baby and the pregnancy depending on which test taken. The results take between two and three weeks, so again more waiting and the potential of terminating well into the second trimester, a horrible outcome. The results from either test are considered diagnostic (stronger than screening). But let's cross that path, make that flowchart when we get there.

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Hard to make a flowchart vertically using only blog-word-processing. I can definitely see this making better sense in the more traditional visual form with boxes and arrows. However, this let me get the thoughts and timelines and steps/stages floating around in my head down onto 'paper' to some extent and hopefully help me sleep better tonight ahead of the first step coming my way really early tomorrow morning.

Cramps With Less Meds

Since getting pregnant I haven't paid a lot of attention to 'the rules' because I pretty quickly discovered them to be based on bad studies, no science, disproved theories, etc. I would totally recommend reading Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong--and What You Really Need to Know by Emily Oster, it was great to have someone go through the studies and provide the facts and statistics around them instead of just getting an absurd lists of dos and don'ts.

However, for the past couple of weeks I have had really bad cramps in my lower stomach. I don't know if it is gas, or constipation, or my uterus expanding or implantation pain, or what have you, but it hurts! To the point of crying some evenings after dealing with multiple periods of sharp and constant pain throughout the day. Luckily I can keep it in perspective with my gallstone pain, which was way worse. Those gallstone attacks are still the most painful thing I have ever experienced!

One of 'the rules' that I have been paying attention to is medications while pregnant. (In fact I have decided with my doctor that, while I will continue to take my two anti-depressants, I am going to go off of the Adderall I take for my ADHD for at least the first trimester.) Anyway, while I would normally just take Tylenol or Advil, which ever I found first for pain, like cramps, soreness, or headaches, it is advised that Advil (or ibuprofen) should be avoided. However, Tylenol (or acetaminophen) is fine to treat pain and/or fevers. It sucks a bit that I am a bit more limited now on my pain killer choice and I really need to stock up on the one that is okay, because I am frequently very uncomfortable!!

Really? That Many?

Decided to check out the statistics for Always Standing since I haven't done so in a while and I was blown away by what I found.

Firstly, I just used the little Stats tab on the Blogger homepage instead of going through the full on Google Analytics route so I don't get as much information as usual.

Secondly, as has been true for the past few years, Puns For Anna consistently gets tons of visits. I don't know how or why people find it but they do.

Alright, onto the shocking thing, in the past week my post about the municipal election got 45 page views! I did post about it on Facebook and in the past that has meant a decent uptake in views, maybe double the normal amount but nothing close to that number.

I have about 244 Facebook Friends (I think I need to cull that down) so does that mean that one fifth of them clicked the status update? I hope they decided to become (or return to being) regular Always Standing readers.

A Tiny Advantage

I won't get into how horrible it is that Premier Doug Ford, in the Provincial Government, has cut the size of Toronto city council. Basically it is a terrible idea, but on top of that doing it in the middle of an election is unethical. However, because The City is now 25 ridings instead of the previous 47, Vote Compass has been expanded to include city councillor races as well (maybe it was always going to do so for this election but I really like thinking there is some tiny silver lining in the disgraceful city council meddling.) In 2014 they had information for the mayor stuff, but the ward details are a great addition.

Vote Compass is an amazing tool, I love it so much and use it every election. So glad that I used it because the incumbent councillor (from my section of the ward, since there have been mergings) visited the house and I enjoyed talking to her. However, she isn't at all progressive and I didn't fully know her voting record. She voted to cut transit routes! So, good to get an idea of a more appropriate candidate for our neighbourhood. Here are my results:

This didn't tell me anything new for the mayoral race, I knew that I aligned more with Jennifer Keesmaat, she is an urban planner and I thought she was awesome in the role of Toronto Chief City Planner when she did it a few years back. I will be voting for her. However, I think John Tory is doing a good job and I will not be disappointed if (when) he is elected.

Doctor Numbers

Flying home today and I still keep thinking about the intercom call for a doctor that happened on our flight down. It seems like such a strange policy. And for sure it is some type of policy because airlines have procedures for everything. I decided I wanted to look at the numbers:

Cooling My Feminist Jets
So, I had been very happy/surprised that it was a female doctor answering the call. Turns out, not that rare. There is probably still a wage gap, and possibly still a 'senior position' gap, but the gender gap for Canadian doctors has shrunk considerably. 41% are female; 59% are male. Two thirds (64%) of family physicians under age 35 are female.

What About Specialists
Almost half of the over 83,000 Canadian doctors are specialists of other disciples, instead of Family Medicine. Students in medical school in Canada will experience many fields of medicine and decide on their specialty during 3rd or 4th year. After that choice, residency training can be anywhere from 2 years (Family Medicine) to 6 years (Neurosurgery). Most specialties are a 5 year program. So they have the medical base, but a specialist can really be pretty specialized, and there are 37 specialties available in Canada. Would a urologist be that much help to someone who fainted in a plane?

Seems Like A Long Shot
Based on the total population of Canada there is only about 1 doctor for every 500 people. The plane we were in seats 100. That is a 0.2% chance there would be a doctor on board. When looking at people who fly, mainly those who can afford to fly, than doctors would be more likely to be on board a plane while the general population less so - this increases the chance. Often planes would be larger than the jet we were one, increasing the passengers to maybe 200. Huge planes can have more than 600 seats (in a two-tiered class configuration. Actually 800 in single-class, but I have never seen that.) I still don't like the odds, or many I don't like the fact that they are relying on odds.

Improve Your Odds
If they had asked "Is there a doctor or nurse on board" that would really improve the chances of a generally trained health care professional. There are lots of different types of nurses, including those in advance nursing practice, like nurse practitioners and clinical nurse specialists. There are 4 times as many nurses as doctors in Canada.

Source information:
Look at me citing things like a good girl who went to university and grad school!
- Canadian Institute For Health Information
- The Canadian Medical Association
- University of British Columbia Medical School
- AirBus Corporate Site, Aviation Blogs

Further Reading:
I am like my own Wikipedia article here. If you found this as fascinating as me, the likelihood of that might be small, then these are some interesting international articles on the same topic:
- July 2017 - ABC News (Australia) - Is there a doctor on board? What happens during a mid-air medical emergency
- March 2017 - The Telegraph (UK) - What really happens during a medical emergency at 35,000 feet
- January 2017 - Singapore Medical Journal - What to do during inflight medical emergencies? Practice pointers from a medical ethicist and an aviation medicine specialist
- April 2013 - Quartz (USA) - What it’s like to be the “doctor on board”, and why airlines shouldn’t be relying on them

Quiz - Distance Dispute

I don't know if you noticed from the previous posts but Jason and I had different answers for the question about the furthest we have traveled together. He said Peru and I said Paris. He was pretty confident that Peru was further, I didn't really know but felt like going over an ocean seemed like a bigger deal. But we both love facts and statistics and numbers, so Jason looked it up.

So, as the crow flies, in a straight line from one city to the other, using a Distance Calculator, we got the following answers:
- Toronto to Cusco: 6,410 km
- Toronto to Paris: 6,007 km
Jason was right but the difference is pretty close!

Fall Wedding Handicap

Steph has reported on her blog the TOP 5 POSTSs for the year, Jason and My Wedding did make it. (Though we did get a nice little shoot out at the bottom, and included one of my favorite pictures of us hugging.)

I am a bit competitive and like to achieve really high digital and social media stats, so I was careful to link to Jason and my wedding post on her blog as often as I could. I also love the pictures and want to share them with everyone.

I think that we had a small disadvantage since the wedding was at the end of September and the main post went up at the start of November, so only two months of traffic! However, there was a wedding listed that only had a month up on the blog, very impressive, they must have a large network of friends and family.

Steph uses Wordpress, I think, for her blog so I won't be able to ask her how she figured out the top posts because Always Standing is on Blogger. I want to look into it though and maybe post mine later.

Ramp Up In January

Looking to 2017, I am again hoping to post more on Always Standing. I realize that December has the trend of being a slow month for me writing over the last few years, historically this is how many posts I have done each December:

2016 - 4
2015 - 3
2014 - 7
2013 - 16
2012 - 15
2011 - 14
2010 - 30
2009 - 16
2008 - 15
2007 - 24
2006 - 22

However, I am going to ramp up for January and plan to get a lot of posts lined up. So, no backdating posts, I actually am going to try to write in advance and schedule them. Stay tuned.

Can You Believe The Gall Of That?

As I detailed the pain and diagnoses in my last post, I thought I would write a quick description of my issue with Gallstones.

Over the weekend, and on Monday morning, it turns out that I experienced some gallstone attacks, also known as flare-ups. Gallstones form in the gallbladder, in fact many people (20%) have them. Sometimes (about 1% of the time) these gallstones move to block a duct in the gallbladder causing extreme pain, this is then considered a medical emergency - which makes me feel better about ending up at the hospital when it happened to me.

Sometimes this blockage can lead to infection and inflammation of the gallbladder, which requires emergency surgery to remove the organ imminently. This is not the case for me. However, I will need to have my gallbladder removed since I am now considered to have gallbladder disease. The attacks will continue and if the stones pass through the ducts in the gallbladder into other areas than more serious complications can occur. I have been given an appointment with a general surgeon next week.

In the meantime, I was prescribed some strong pain killer medication to take if another attack occurs and given some suggestions as to how to eat to possibly avoid the attacks, though a lot of what I have read is contradictory. What I am trying while I wait to have the pesky thing removed is multiple (6-8) very small meals each day of low fat foods, mainly fruit and vegetables. I am not eating anything that is high in fat, and am not having caffeine, or anything carbonated, deep fried, or overly processed.

Good Morning

Me: I slept in..
Jason: Umm, yeah, a little bit.
Time: 2:54pm

On a side note, Jason woke up at 6:30am this morning to meet a friend down at the waterfront for an early morning bike ride. By the time he got back to the house, around 10:30, he had cycled for almost 3 hours and gone a total 85km.

Go Jason Go

Jason and Meg were awesome Saturday morning doing Max's Big Climb in Dundas. Jason made it up the hill in 3 minutes and 39 seconds the first time and 3 minutes 52 on the second time (yes, they had to do it twice.) I am definitely going to try it next year.

Most of the participants were very serious racers so Jason and Meg didn't place but they did get prizes for raising the most money. I would like to thank you my friends and family for donating, including:
- Mom
- Aunty Nicky
- Rob
- Kristen
- Laura
- Teri (who pledged Meg)

We got to meet Max, and his family, at the event. His father spoke and handed out the ribbons. They made the decision a few years ago to use biking to raise money and donate it to an already well established charity fighting to defeat Duchennes - Jesse's Journey.

Damn You Bob Barker

The house next door sold this week. We saw the SOLD sign go up and immediately started guessing what it had gone for. We knew that it had been listed sometime in May at $599,900. Jason was pretty sure that it been sold for around $575,000 since it was priced quite high and hadn't sold right away.

I didn't think our neighbours were in a rush to sell so would wait to get something close to what they had listed as asking. We made a bet with "Price Is Right Rules" and I decided that the buyers would need to have offered at least $585,000 to get the house, any lower than that would be too big of a discount off of the list price.

We get a daily email that provides all the GTA real estate sold data. It is interesting to keep on top of the market and also the houses have all sold so there is not hoping and falling in love with options, just research. When the listing update came through on the house next door it confirmed that it had sat on the market for a long time (by Toronto standards.) They didn't put a sign in their yard right away but it was officially for sale for 29 days. It sold for $584,000.

So Jason won, even though I feel like I was right, the annoying Bob Barker technicality that helps eliminate closest-to comparison math - screwed me.

Diet Gamechanger

I started back on The Curves Diet today. I was still pretty much following it, except for over the holidays and in Peru, but I wasn't writing things down. With tracking/planning my meals and snacks I am better at sticking to small portions and healthy food.

The main breakfast on this diet has always been cottage cheese for me. Because I was feeling lazy, I decided I would bring some 'on-the-go' style cups to work so I can just eat one of those each morning. Normally I would portion out a big tub myself daily, or prep my own small tupperware, but as I mentioned - lazy.

When I went to pick up the normal 1% cottage cheese four-pack of small portions, I noticed a different type was available as well. Nordica Smooth, Lemon flavoured cottage cheese. I picked up a 4-pack of that too since it sounded interesting.

I tried the smooth lemon cottage cheese thing this morning and WOW! It is thicker than yogurt and tastes amazing. It is like a little lemon cheesecake treat. They have caramel and vanilla versions as well, according to the website, though I didn't see them at my grocery store. I don't even want to eat the 4 normal ones that I got, this smooth stuff is so delicious.

In comparison, the normal plain 1% on-the-go cottage cheese is 90 calories, 5g of sugar, and 14g of protein (the high protein is why it is an important part of The Curves Diet.) For a much more enjoyable little tub of the lemon stuff (and I really like normal cottage cheese on its own, it isn't a problem to eat for me at all), I feel like the nutritional difference is fairly minor; 110 calories, 12g of sugar, and 10g of protein.

Serious gamechanger!

Failed Again

So, it seems like every year I make a goal to post every day on Always Standing; then the year finishes and the numbers don't add up to that magical 365. Of course, 2015 was no exception - I only did 242 posts, less than the year before. However, that still means that I was writing on about two thirds of the days last year and it is a fairly high number when you review my history (check out the Blog Archive on the left.) Of course I have the goal again for 2016, let's see if this time I can do it.

Feminist Friday - Wage Gap

It seems unbelievable that that the Gender Wage Gap exists. As in, I actually have a hard time believing the science. I don't understand how it can happen. I expect women to trend lower pay from choosing careers that pay less or due to maternity leave absences. However, even when statistics are adjusted for these variables it still shows up.

Article from Forbes

The Awful Truth Behind The Gender Pay Gap

It makes me wonder if it has been some unseen force in my life. I have occasionally felt underpaid, but never because I was a girl - usually due to the company I was working for, the stage I was at in my career, that not-for-profits involve some sacrifice in pay, my skill-set and industries of preference are undervalued, etc. Never because of my gender.

However, maybe I wouldn't see it, I have never been somewhere that had lots of people doing the same job as me, the statistics have never represented a male that is physically sitting beside me and getting paid more. It feels like an issue that exists only on paper and it infuriates me that these numbers keep showing up in black and white - reflecting quiet biases back to us. It so unfair that it is unfathomable. But it also seems so abstract that it is hard to believe.

Seriously, how does it even happen? I just want this issue to go away, I know it won't fix itself but I don't really know what can be done to change it. (Besides making it illegal, but isn't it already under discrimination laws?) Someone needs to fix this.

Quote Of The Day

"There may be said to be two classes of people in the world; those who constantly divide the people of the world into two classes, and those who do not." 

-- Robert Benchley

I am the former, for sure! For an interesting history of the saying above, check out the Quote Investigator.

Travel Diary - Saturday August 8, 2015

Date: Saturday August 8, 2015
Theme/Title: It's All Over
Overview: The San Diego Airport is right near downtown. It took no time at all to drive over there in the morning. We returned the rental car only to find out that the company charged us to add extra drivers (Jason and Greg) when they had previously said that they wouldn't. Teri went to get it corrected and was successful. We hung out in the airport waiting for our flight, I found a Starbucks to have a smoothie for breakfast. Had a direct flight back from San Diego to Toronto with no issues. Went through customs with  60 pashminas bought in San Francisco Chinatown for Jason and my wedding without a problem. Jason picked us up at the airport and drove us downtown for dinner at Greg's pop-up restaurant.
Meals: Amazing food at the August weekend pop-up for the restaurant concept Greg and his friend are working on - Satay Street is going to be a hit!
Highlight of the Day: Finding out we put 2,144 miles (3,500 km) on the rental car!

A Solid Score

I did a GMAT prep test this weekend. I would like to get an MBA at some point but am not in any rush because of the time, work, and cost involved. However, both Maria and Natasha are planning on writing the GMAT this summer to apply for their Business Masters. I figured it would be nice to have some company when studying and the scores last for 5 years. The fake test helps give a sense of my starting point - I went in pretty much blind. I knew what type of questions to expect but hadn't studied at all.

My score was 620, which is pretty decent. This is in the 69th percentile. With just that score I would have no issue getting into most of the Canadian schools. However, it isn't quite high enough for the elite programs and it isn't good enough for scholarship options, which I will need because an MBA is expensive. Here is what the test is like and how my score broke down:

Analytical Writing Assessment (AWA) - 30 Minutes - 1 Topic
Scored out of 6, not scored on the practice test.
This is an essay.

Integrated Reasoning (IR) - 30 Minutes - 12 Questions
Scored: 4/8
Percentile: 37
Types of questions: Multi-Source Reasoning, Graphics Interpretation, Two-Part Analysis, Table Analysis

Quantitative - 75 Minutes - 37 Questions
Scored: 36/60
Percentile: 40
Types of questions: Data Sufficiency, Problem Solving

Verbal - 75 Minutes - 41 Questions
Scored: 40/60
Percentile: 90
Types of questions: Reading Comprehension, Critical Reasoning, Sentence Correction

I know that I can do much better on the Quantitative (or Math) section. I knew how to figure out pretty much all of the problems but without studying, I didn't have the tools needed (like the formula for the area of a circle, or different shortcuts you can make with exponent equations). I am glad that I will be able to improve this because the main score is out of 800 and is calculated only from the last two sections. The IR is really really hard. I don't know if they send that score separately and if they do how much it matters to admissions.

Soon!

Teri and I have started to book things again for our trip this summer. (We booked our flights a while
ago.) It is going to be an amazing two weeks, mid-summer, for a road trip down the west coast of the USA. We will spend time with Monica in Seattle, visit Portland, meet up with Jason and Greg in San Francisco for the long weekend, and hang out on beaches down near San Diego. I put a countdown on my phone this morning. However, right after the took the screenshot (see Right) I double checked and we actually don't fly out until Sunday morning, June 26 so the counter has been updated to reflect that. 47 DAYS! We are doing most of our planning on a Google Docs spreadsheet, Greg made it for us and I love it! Travel planning is almost as fun as the travel itself.