Christmas Day - 2008
Thursday, December 25, 2008
Kenneth F. Trofatter, Jr., MD, PhD
Above all, I have missed the regular research and writing and the interactions we have shared through your many thoughtful questions. However, I am also looking forward to getting back into the routine again soon because a new Chair has accepted the position and is scheduled to start some time in February! I was going to begin a new series today on Multiple Gestations and could not believe after reviewing my work here that I had not addressed this more thoroughly in the past. But it is Christmas and I just realized that today’s post will be the 300th I have contributed to this site! So the twins will just have to wait! Please indulge me while I wax reflective for a few moments…
Yesterday, I mentioned to several of my close friends how much I love this holiday. But, more than Christmas day itself, Christmas EVE has always had a special place in my heart as the most magical day of the year. I am not exactly sure why that is, but it seems that many of the cherished childhood memories which have stayed with me until now were born on Christmas Eve. It was so much more than the anticipation associated with “visions of sugar plums” dancing in our heads although I am sure those have contributed to the aura of the holiday. On Christmas Eve, we would always go to pick up my grandmother so that she could spend a few days with us. My grandmother was a remarkable woman who not only made sure my parents could put a special present under the tree each year, but also could complete the New York Times crossword puzzle faster than anyone else I knew. She was a bundle of energy who remained active until the day she died at age 96. Shortly before she died, she took me aside one day with a glint in her eye and said, “Kenneth, I want to tell you the secret to a long and healthy life – it’s GARLIC.” She was a gem!
Christmas Eve was also the night of the special ‘Candlelight Service’ at church. We moved to New Jersey from Brooklyn, New York with the mass migration to the suburbs in the 1950’s just before I started first grade. We joined a small Methodist church in Bound Brook, New Jersey shortly after our arrival and the small group of other children I met there became my closest friends. On Christmas Eve, all of us would sit together in the balcony of the church, dressed for the cold, sharing the limited space, enjoying the comfort and warmth of the physical closeness, and singing carols. As the midnight hour approached, the lights were turned off and then the church slowly brightened as the candles were lit, person by person, throughout the church while we sang Silent Night. To this day, I can picture the glistening in my best friend Deb’s eyes and the wetness on my own cheeks by the time the benediction was spoken. It was something I looked forward to every year. It was a time of sharing and anticipation, but even more so, of hope.
I have come to understand over time that regardless of your religious beliefs, the child whose birth we celebrate on Christmas day did walk the earth and did provide us with an algorithm for surviving our own short-comings as human beings. The message that he provided was not that which was expected by his disciples during a very tumultuous time in history when many of them yearned for a strong military leader. But, as they soon discovered, the impact it had was contagious and the message is as powerful and relevant today as it was at the time it was delivered. ‘Doing unto others as we would have others do unto us’ is ingenious in its simplicity, still eludes most of us in its implementation, but it is the key to achieving a lasting ‘Peace on Earth’ and good will, common respect, and understanding among all its inhabitants. I for one so pray that I live to see the day that is realized.
Happy holidays to all and blessings for the year to come!
Dr T
6 Comments:
At Fri Dec 26, 10:13:00 PM 2008,
Anonymous said…
Dr. T.,
And a merry belated Christmas to you from all your readers. Thank you for your answers to readers' questions and your blog, they were very helpful in my decision in September '08 to get an amnio due to maternal age (42) and low-PappA (.23 MoM) with normal HcG. Just to reassure other readers, my odds were raised to 1/25 for DS and the result came back genetically normal. Based on your information, I have still been very proactive in this pregnancy (I'm 29 weeks today) concerning fetal growth and possible future placental issues. Based on multiple U/S, including one last week, baby girl is a little small for gestational age but otherwise normal and we are carefully monitoring her growth.
I don't really have a question for you, more just a sincere "thank you" for giving us the information to enable us to not only make informed decisions about prenatal testing but also, if the testing shows a normal result, to continue to be aware of other possible issues that might arise during the pregnancy. I hope you have a wonderful new year and get a break from work once the new head is on staff.
At Mon Dec 29, 05:03:00 PM 2008,
JGK said…
Hi Dr. T,
I think it's really wonderful that you took the time to reflect on Christmas and what your family traditions mean to you. I have been reading your archived blogs for pregnancy information and can see that you are a very knowledgeable and highly respected medical professional, but this post also made me admire you as a human being. Thank you for sharing.
I do have a question if you have a moment to answer. I am 14 weeks pregnant with my first child (following one miscarriage in April 2008) and will be 38 years old when I deliver. I just completed the first trimester screening and am having some anxiety over the results.
Nuchal Translucency: 1.24
HCG: 1.68 MoM
Papp-a: .88 MoM
Down Syndrome Risk: 1:380
Trisomy 18 Risk: 1:10,000
The test was taken when I was 11 weeks based on LMP, but the baby measured exactly 12 weeks with a CRL of 5.42 cm. The heart rate was 165 bpm. While there was no discussion about a nasal bone, my husband and I both commented during the ultrasound that the baby had a big nose. The sonographer didn't say anything except that it had a nice profile, so I have to assume the nose looked okay to her or she would have said something.
I was very encouraged by the initial NT result, but then a bit deflated by the elevated HCG score and the low papp-a score. Though I am technically "screen negative," I find myself worrying about my DS risk and wondering how significantly high/low my HCG and Papp-a scores are?
In addition to my miscarriage, I also had surgery in June for a uterine fibroid. The fibroid has returned but doesn't appear to be interfering with the pregnancy. Could the fibroid affect my HCG or papp-a levels?
I'm also trying to decide whether to go ahead with an amnio at 16 weeks or wait until my 18 week ultrasound to see those results and then decide about the amnio.
I know you can't make the decision for me, but I would appreciate your professional insight on my risk for DS and how my specific HCG and Papp-a levels are affecting that risk. I feel like I should focus on the likelihood that my baby will be perfectly healthy, but sometimes I'm just overcome with worry that I'll be the "1" in "380".
Any words of wisdom for me?
A very Happy New Year to You!
Janet
At Mon Dec 29, 07:39:00 PM 2008,
Anonymous said…
Great to have you back! I have a couple of questions and would love to get your advice. My wife is 15 weeks and we are debating whether or not to have an amnio. Do the following circumstances increase risks of miscarriage from an amnio: 1) A prior miscarriage and D&C? 2) An Anterior Placenta?
Also, does having an anterior placenta when pregnant with our first child increase the likelihood of having it again now?
At Thu Jan 01, 10:53:00 AM 2009,
Thad said…
Dr. T-
Thank you so much for your blog. My question does not apply to your wonderful "Christmas Day-2008" post, but to your cystic hygroma post. I apologize for posting here, but I was unable to post under the cystic hygroma post.
Quick synopsis. My wife is 21
weeks pregnant with our second child. We have a diagnosis of cystic hygroma, pleural effusions with a FISH diagnosis of Turners in our daughter, Caitlyn Grace.
My question is, do you know of any doctors who are performing fetal interventions to eleviate the hygroma and/or pleural effusions?
Thank you for your help and insights.
At Tue Jan 13, 04:22:00 AM 2009,
Lauren Golding said…
Dear Dr T,
I realise that this is not the appropriate place to post but I have been desperately scouring the internet for days now and, as you seem a wonderful person to provide advice, this seemed the only way of contacting you.
I am a 32 year old mother of one, currently 32 weeks pregnant with my second daughter and living in the UK. I have suffered very badly with severe perinatal and postnatal depression during this and my last pregnancy and have recently been urged to begin medication in the form of Sertaline (Zoloft or Lustral). I am desperately worried about the consequences for my unborn baby. Having carried out as much independent research as I can I have discovered that risk of Persistent Pulmonary Hypertension in the newborn is well documented and so I am in turmoil as to whether taking the medication to improve my current state is a large enough benefit to outweigh the risk to my baby. Apparently the risk is increased if medication is begun during the last trimester, but as I am only 7 or 8 weeks away from delivery I wonder if the risk is lessened. I would also only be taking 25 or 50 mg daily.
I would be so so grateful for your opinions regarding the use of Sertraline in pregnancy. I am well aware that I most definitely need medication but feel that the health of my baby is the paramount concern. Unfortunely the support and expertise available in the UK is severely lacking and neither my GP nor midwife (who are the only 2 people available to assist me) can provide much information.
Thank you so much for your time. I am clinging to the hope that you will reply.
Kindest regards,
Lauren
At Wed Jan 14, 08:15:00 PM 2009,
Alli said…
Dr T,
I posted a comment to one of your older posts on PAI-1 awhile ago about my concerns about having a VBAC, did you receive it? I have been checking back to it, but have not seen anything.
If neccessary you can contact me at flstfi@roadrunner.com
Thanks,
Alli
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