One Million Point Error

We’ve been manoeuvring down the highway of life playing Preemie Pinball now for the last fourteen months. Once out of the NICU we thanked our lucky stars and praised God for the Terrific Trio’s incredible progress and our very good Preemie Pinball score. We steered clear of several potential disasters, such as the NEC epidemic that swept through our NICU just a few weeks after the last baby, Carys, came home. A few months out of the NICU, after Carys had a month of physio under her belt, the score kept rolling higher. We know we are not out of the woods with numerous issues that lurk any corner. Overall, though, the Terrific Trio has done extraordinarily well. However, the last few days something has worried us with Jasper. After hours of research last night on the Internet it dawned on me that last June we may have made a million point error that has yet to tabulate itself in the Great Score of Preemie Pinball.

The problem with pinball is my inability to keep up. A quick glance during the game lulls is about all my reflexes can afford. Triplets and preemies are about the same way with stuff transpiring so quickly. There is always something that didn’t get done, or could have been done differently. I guess it’s like that with lots of parents – constantly second-guessing if the right choice was made in the best interests of your child. Like everyone says, “There’s no instruction manual.”

To end the suspense, here is the deal: Jasper has an upper tooth coming in. But this is no ordinary tooth… this tooth looks like it belongs in the mouth of a retired racing horse put out to pasture. First, this tooth is huge. Second, this tooth is erupting at a tremendous speed. Third, from what we can tell there is no enamel on the bottom… it’s as if you can look right up the centre to the exposed, pinkish red dentine.

Yes, that’s correct, looking at this tooth will make your average person cringe. Think of Dr. Evil’s Executive Assistant in the latest Austin Powers movie that had the gigantic mole on his face – no one could stand to look at him. Every time I examine Jasper’s tooth, I have visions of a mad dentist rushing at me with a screaming, high-speed dental drill. Each time Tess and I discuss Jasper’s pink iceberg we imagine ourselves avoiding the poor lad’s face for the rest of our lives.

Diagnosing Jasper’s Heterodontosaurus gums may be a little early until this ten-inch tusk completes its adventure out of Jasper’s jowls. After a lot of reading my first guess says that Jasper has Enamel Hypoplasia.

“Enamel hypoplasia means there is a lack of enamel (white coating) on the outside of the teeth. Premature infants have enamel hypoplasia four times more often than term children. The left upper front primary teeth are twice as likely to have enamel hypoplasia than the right. It can be found on the permanent teeth, however the problems are generally less severe. Causes are intubation and mechanical ventilation, as well as a lack of certain nutrients in the NICU. Children with enamel hypoplasia are more likely to develop cavities in these teeth and will need careful, routine brushing and close monitoring by the dentist.” (Courtesy of www.prematurity.org.)

Any number of serious illnesses and circumstances can cause enamel hypoplasia that clearly don’t apply to the Terrific Trio. But there is one controversy that causes enamel hypoplasia and could apply to the triplets: water fluoridation. As most readers would be aware, in the 1960’s developed nations around the world began fluoridating water. Why? The belief was that the fluoride would reduce the incidence of cavities in children and make for stronger teeth. This assumption is now greatly challenged by a large part of the global medical community. As one doctor writes on the Fluoride Action Network web site "I am quite convinced that water fluoridation, in a not-too-distant future, will be consigned to medical history." – Dr. Arvid Carlsson, Winner, Nobel Prize for Medicine (2000).”

Research continued in parallel with more and more nations introducing water fluoridation in the latter half of the 20^th century. As a result many countries, Hong Kong being one of them, started reducing levels of fluoride in community water supplies. Interesting results emerged: cavities in children dropped. “In 1988, Hong Kong reduced water fluoride levels from 0.7 parts per million (ppm) to 0.5 ppm. By 1995, 31% fewer 11-year-olds had cavities with a 42% reduction in average cavity rates, according to the Hong Kong Public Health Bulletin (1). Similar reductions occurred in 1978 when Hong Kong’s fluoridation rates were first cut from 1 ppm to 0.7 ppm (2)” Read more here… Meanwhile, a growing body of research indicates that water fluoridation leads to enamel hypoplasia.

Hong Kong authorities never eliminated fluoride altogether. My point in all this? Last June we made a decision to use filtered, and then boiled, tap water when making the Terrific Trio’s eight daily bottles (each) of formula. The filter we use (similar to Brita) removes nasty germs, bacteria and bad tastes, but not fluoride. Boiling the water does not eliminate the fluoride either. In fact, boiling the water actually increases the concentration of fluoride in the water. This whole thing came together last night like the past piece of a giant sabre toothed jigsaw and I thought to myself, “Well THAT’S a one million point error.”

Being premature, the Terrific Trio are already at risk of enamel hypoplasia. Adding in fluoride increases the risk and boiling fluoridated water increases the risk even further. Sela and Carys have yet to sprout little pearly whites upstairs but we’re watching their gums closely. We cannot beat ourselves up too much, either. Irrespective of fluoride the Terrific Trio could have nurtured terrible teeth due to their prematurity alone.

Is there anything we can do about this? If damage has been done it is too late and also irreparable. It is too soon to say if this will affect adult teeth – also extremely common. In either case, cosmetic enhancements is the only answer to insure glistening smiles or strong self esteems. We can prevent further damage by immediately switching to distilled water. That happened today – a month’s supply of distilled water will be delivered shortly. The rest is a waiting game to see if the Preemie Pinball machine deducts one million points from our score. As it happens the game paused after flashing up a flag that reads, “Game will resume after receiving gold coins to pay for YOUR son’s dental work.”

Jasper Update

I thought everyone would like to know that Jasper’s rash in the last few days has taken another major turn for the better. Tess notes Jasper’s demeanor is much better and he seems like a much happier baby. Quirky thing, too… each morning when Jasper sees me appear he makes a beeline for my legs and wants to be picked up. Do you think he is trying to tell me something?

Crazy week at work and have been unable to write as much as I’d like. We bought two companies this week and are integrating a third… so I guess integrating three companies!  We are in what I call the "Ambiguous Zone." This is where everything has to be done immediately but people have lots of patience if things get done "immediately give or take a few seconds" while the correct decisions get sorted out. We’re a great team and it’s a very exciting time to work for my company! Go go go!

The Jasper Experiment

His Royal Highness, Jasper Amadeus, has a nasty eczema-type rash on his face. The rash has been around for several months. It comes out in full strength on hot sweaty days, on cold damp days and on cold dry days. Hot dry days it goes away. As Tess headed off to Vancouver, Jasper’s rash reached news heights of intensity. (Yes, I hear… he is allergic to his mother being away… aren’t we all!) The rash can also be found on Jasper’s wrists. Other symptoms include: colicky behaviour (much less lately but still has the occasional bad night with gas); crankiness or restlessness, especially when eating; and wheezing that up until now we’ve labelled as asthma. (Those who’ve popped over from Tess’ blog will recall the stories of nebulisers for Jasper.) The only remedy that alleviates the rash is Vaseline. The only remedy that alleviates the crankiness and gas is patting his tummy. I’ve long suspected this had something to do with what Jasper eats. 

After Tess left for Vancouver we started an experiment. Operating on the assumption that Jasper had a dairy allergy, we switched him from dairy-based formula to soy-based formula. We also switched yoghurts to a soy-based yoghurt. We poured the first bottle and load of soy-yoghurt down his gullet on Saturday night. Remarkably, after Jasper swallowed the first mouthfuls of soy formula he pulled the bottle out of his mouth, studied the liquid, then popped the bottle back in his mouth and resumed sucking.

Sunday morning the results of The Jasper Experiment revealed themselves… Jasper’s rash on his face decreased by about 50%. For the next few days there was mild improvement each morning. Then, maybe Thursday or Friday there was another marked improvement. Lita reports that Jasper is easier to feed (read: less grumpy) and seems happier overall. I didn’t think he could get much sillier but after his flu shot on Friday I am convinced. We have had few problems with his breathing the last month but part of me even thinks his lungs sound clearer. Finally, in the last week there have been almost NO middle of the night growls… it used to be quite common for Jasper to cry in the middle of the night for 20 – 30 seconds and then drift back to sleep. (At left: Carys, Sela and Jasper enjoy their mid-morning bottles.)

The discouraging thing is the rash… I’d prefer if it had disappeared altogether and his wrists appear no better. I kept asking Lita if she really felt there was a marked improvement. According to Lita, the improvements in rash and Jasper’s spirits are significant enough to continue the soy-based diet.

Yesterday I asked Dr T about our experiment. Upon hearing our results he supported the hypothesis that Jasper may have a dairy allergy. I asked if we needed to supplement Jasper’s diet with anything. Dr T said, “No, all soy based formula’s these days are fully loaded with vitamins to mirror the same nutritional value of regular formula.”

The Internet tells a different story. After doing a quick search on soy formulas, I discovered doctors have mixed soy opinions. For starters, babies allergic to milk protein may also have problems with soy protein. A very small percentage of babies are lactose intolerant, which reportedly develops further into the toddler years. Allergic reactions to milk protein are more common in babies than lactose intolerance. Both conditions have similar symptoms. We might want to try a hydrolysed dairy formula instead of a soy formula. I think we’ll also have to consult with an allergist to determine exactly what is provoking Jasper’s symptoms. At the end of the day His Royal Highness Jasper is a happier kid with less of a rash. Who can argue with that? Anyone have comments?

End Note: as I wrote this blog Sebastian watched his favourite video, “Talking Letters” prior to his bedtime. I noted when “30 minutes” was up (the length of the video) and wondered how long until he showed up next to me. Suspicious that he was playing in the Play Room to avoid going to bed I just checked on him… the picture tells the whole story.  Tess (who we are delighted to have back) and I can now easily escape for dinner.

Morning Glory

The triplets are growing up…

Last night I had a conference call at 1 AM. It was one of those three continent deals, which meant APAC had the midnight shift. Fortunately, the call leader knocked off the APAC HR agenda first so we could get to bed. My Japan colleague had it worse… it was 2 AM for him.

I forgot about this call when I committed to run with a friend, Ross, at 6:30 AM. Ross trains regularly – he’s an accomplished triathlete for starters. For a while Ross and his running buddy have wanted to find an elusive trail near where we live in Pokfulam. With a renewed commitment to fitness I made the commitment to run with Ross and show him the trail. (Renewed commitment to fitness includes being suckered into buying “The Abscissor – Body By Jake” from an infomercial during a US business trip back in January. After a jet-lagged sleepless night, and watching the 30-minute show four times I was brainwashed into a purchase! I sent the apparatus to my father’s in Toronto and brought it back to Hong Kong on the way back from Antigua.)

Recently my sleep patterns have been all mixed up. (Another reason for renewed fitness, but to be honest the fitness is to insure I maximise my chances at a long and happy life.) Therefore, I was awake at 6:05 partly from my skewed body clock but also because of the chattering coming from the kid’s room.

The last few weeks when the babies awaken, they chatter for 10 – 15 minutes before demanding (read: scream or cry) to be removed from their cribs. This morning the chatter was very sweet. At first it sounded like Sebastian. Prior to talking, Sebastian had his own language that would softly fill the flat as he lay in bed contemplating life. Haven’t heard that language for a while, therefore, I was surprised to hear it this morning. “Has he digressed more?” I thought. (I have a theory that Sebastian’s recent wave of whining and uncommitted crying/whinging, when not really upset at all, is a form of him mimicking the babies.)

No, this was not Sebastian… this was Jasper. Jasper was sitting upright in his crib chattering to the world while Carys and Sela, contorted in their cribs – legs in the air, kneeling on knees – listened, and contributed every minute or so. (“Alright brother… amen…” – that sort of thing – in Seb’s former language.) The chorus, thrown in for good measure and probably to tease yours truly was “Da- da- da- da…” to which they’d all chime in like a staggered start to “Row, row, row your boat.”

Seems like only yesterday Sebastian chattered like this. (With Seb’s speech issues, Terrific Tess – who we miss dearly, by the way – would probably argue, "It was yesterday.")  Suddenly it struck me… “Oh my gosh… these kids are growing up.” Another thing emanating from their room was a smell… the very familiar soiled (NOT just wet) morning nappy, stewing for an hour or two. Suddenly and conveniently it struck me… “Oh my gosh… I am going to be late.” I launched myself out of bed, threw on my running clothes and waltzed out the door. I stopped quickly to check the results from “The Jasper Experiment.” (I’ll be doing a full report on that experiment later this week.) The Team had already extricated the babies from their cribs so the nasty nappies were in control.(Offenders were Sela and Carys.) Sebastian was still asleep. I grabbed my shoes and was off.

Being a few minutes early (intentionally of course, not because of soiled nappies) I was able to stretch before Ross the Racing Machine pulled up alongside me. Ross had already run 45 minutes to hook up with me so I was pretty certain this would give me the edge to at least keep up with him. Not the case. Our 45-minute circuit around the reservoir required stopping on the hills. I was spent by the end of our run. Ross had another 45-minutes ahead of him to return home in Mid Levels. Now you should be getting a picture of Ross’ level of fitness… I think he has less than 3% body fat. (Thank you, Ross, if you read this, for tolerating me!)

But what a glorious morning… this is a wonderful time to be in Hong Kong. Today the sun is out; the mornings are cool but not too cold. They are also not stifling as will be the case in another two months. In Hong Kong, the transition from Winter to Spring is a wonderful time. And that’s why, after cooling down, drinking some water and pouring myself a fresh cup of coffee the whole gang headed down to load Sebastian onto the school bus… Seb carried his backpack and book bag, I held Carys, Lita held Jasper and De held Sela.

Down at the entrance where the bus picks-up Sebastian, we experienced the full community of our building and wonder of the triplets. It’s a cosy little guest parking area with a massive mountain, coated in a quiet, sub tropical rain forest, rising immediately behind the complex.

For starters, everyone who walked by waved and smiled because that’s just what everyone does in our building. As we stood their with Sebastian and the Terrific Trio though, we seemed to be just a little happier to see everyone… they all know where the trips have come from in the last 14 months and the tenuous milestones they’ve each surpassed. Everyone also knows we’ve followed a Protectionist Policy to shelter the Terrific Trio from potential infections. Those days are drifting further behind us and waiting for Sebastian’s bus with the triplets on such a gorgeous, crisp morning seemed almost like it’s own milestone. In no time we will be down there waiting for The Terrific Trio to be bussed off to school. Yes, the triplets are growing up. The past faded just a little bit more and the joy fought hard to trickle in.

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