Category Archives: pregnancy

Adverse Effects of Pitocin in Newborns

OMG!  “Pitocin Side Effects:  Harm to Newborns Found in Child Labor Drug Study Triggers mommy-Blog Firestorm!

I wasn’t really sure what the problem was from the headline.  Were mommy-bloggers upset over child labor?  Were newborns put to work on a drug study?  What’s going on?!

Apparently the moms at Babble and The Stir have their granny-panties in a knot reporting, sensationally*, on a press release from the American College of Obstetricians and Gynecologists. (*meaning they are sensationalizing the results for clicks, not that they are doing a sensational job reporting on the study)

All the hubbub is over Poster #74 at ACOG’s Annual Meeting.  Title:  “Oxytocin Usage for Labor Augmentation and Adverse Neonatal Outcomes” by Dr. Michael S. Tsimis et al.

What the study looked at?

…a  retrospective analysis of deliveries that were induced or augmented with oxytocin. The study included more than 3,000 women delivering full-term infants from 2009 to 2011. The researchers used the Adverse Outcome Index, one of several tools used to measure unexpected outcomes in the perinatal setting and to track obstetric illness and death rates. (Source)

What the data showed?

Researchers found that induction and augmentation of labor with oxytocin was an independent risk factor for unexpected admission to the NICU lasting more than 24 hours for full-term infants. Augmentation also correlated with Apgar scores of fewer than seven at five minutes. The Apgar is a test that evaluates a newborn’s physical condition at one and five minutes after birth based on appearance (skin coloration), pulse (heart rate), grimace response (medically known as “reflex irritability”), activity and muscle tone, and respiration (breathing rate and effort). A baby who scores eight and above is generally considered to be in good health. (Source)

What the authors concluded?

The analysis suggests that oxytocin use may not be as safe as once thought and that proper indications for its use should be documented for further study. “However, we don’t want to discourage the use of Pitocin, but simply want a more systematic and conscientious approach to the indications for its use.” (Source)

The take home message?  The study (as far as I can ascertain from the ACOG press release) did not establish a causal link between pitocin use and adverse effects in newborns, it showed a correlation.  Like any drug, pitocin isn’t without side effects.  Doctors and patients must exercise their judgement in using it- adverse effects from pitocin may be preferable to outcomes of NOT using it and complications of delayed delivery of a baby.

Keep in mind, since this is a poster and not a published paper, the data hasn’t been peer reviewed, actually, unless you are actually AT that meeting, you can’t see the data, because it’s on a poster. My search for the abstract was fruitless, leading me in circles back to the press release.

So, as always, talk to your doctor, ask questions, make informed choices.  Don’t just listen to some random mommy-blogger (or in this case, #scimom blogger/Evidence Based Parenting blogger) on the internet.

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4 years ago today…

Four years ago today, I found out I was pregnant with Mabel.

Thus, every Tax Day since, I cannot help but remember that day in 2009.

It is so amazing that 4 years ago today, Mabel was this:

visible embryo

Source: The Visible Embryo

And today, she’s this:

041513

Life is amazing.

Four years ago I was living in Arlington, MA and working in Cambridge, MA, just across the Charles from Boston.  To bring Mabel into this world, I labored looking out the window, across the river, at the Boston skyline.  On this April 15th, this Patriot’s Day, I’m in New York, but my heart is grieving for Boston, its people, and all those impacted by the bombing today.

Life is precious.

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Risk-benefit looks different in hindsight

Just saw this article from Reuters:  Insight:  Evidence grows for narcolepsy link to GSK swine flu shot.

The crux of the story- the GSK vaccine (used in Europe, not the US) against the 2009-2010 swine flu may be linked to an increase in narcolepsy in young people.

My first reaction, in all honesty, is a fear that anti-vaccination fanatics will latch onto this story and use it as more evidence that vaccines are bad.

My second, I feel sorry for these kids and their families, but I’d take a narcoleptic kid over a dead kid any day.  I feel much worse for the families that lost loved ones to H1N1.

My third reaction, I hope my virologist colleagues can come up with a universal flu vaccine sooner, rather than later, and safety and efficacy studies can be done thoroughly, without a deadly pandemic looming (more so than it looms currently).

How did this happen?  How did this vaccine get approval?  You have to remember the timeline- it’s extremely tight going from identification of a newly emerged flu strain to creating a vaccine against it, studying safety, and ramping up production in time to protect people from it.  This was made even more difficult because H1N1 was identified AFTER manufacturers had already started making the standard seasonal flu vaccine.  If H1N1 had emerged and been identified earlier, it would have been included in the regular seasonal flu shot and this situation may never have arisen (I say “may” because we don’t really know what is happening with the link between the vaccine and narcolepsy).

David Salisbury, the British government’s director of immunization, says “therein lies the risk, and the difficulty, of working in public health” when a viral emergency hits.

“In the event of a severe pandemic, the risk of death is far higher than the risk of narcolepsy,” he told Reuters. “If we spent longer developing and testing the vaccine on very large numbers of people and waited to see whether any of them developed narcolepsy, much of the population might be dead.”

Pandemrix was authorized by European drug regulators using a so-called “mock-up procedure” that allows a vaccine to be authorized ahead of a possible pandemic using another flu strain. In Pandemrix’s case, the substitute was H5N1 bird flu.

When the WHO declared a pandemic, GSK replaced the mock-up’s strain with the pandemic-causing H1N1 strain to form Pandemrix.

GSK says the final H1N1 version was tested in trials involving around 3,600 patients, including children, adolescents, adults and the elderly, before it was rolled out. Source.

Research is ongoing to figure out what the biology is behind this, but there are a number of possibilities- including the adjuvant (not used in the American flu vaccines) as well as genetics and age of those vaccinated.  However, to give you an idea of the numbers:

In total, the GSK shot was given to more than 30 million people in 47 countries during the 2009-2010 H1N1 swine flu pandemic. Because it contains an adjuvant, or booster, it was not used in the United States because drug regulators there are wary of adjuvanted vaccines.

GSK says 795 people across Europe have reported developing narcolepsy since the vaccine’s use began in 2009.

Independent teams of scientists have published peer-reviewed studies from Sweden, Finland and Ireland showing the risk of developing narcolepsy after the 2009-2010 immunization campaign was between seven and 13 times higher for children who had Pandemrix than for their unvaccinated peers.

Being a wealthy country, Sweden was at the front of the queue for pandemic vaccines. It got Pandemrix from GSK almost as soon as it was available, and a nationwide campaign got uptake of the vaccine to 59 percent, meaning around 5 million people got the shot.

The World Health Organization (WHO) says the 2009-2010 pandemic killed 18,500 people, although a study last year said that total might be up to 15 times higher.

While estimates vary, Stiernstedt says Sweden’s mass vaccination saved between 30 and 60 people from swine flu death. Yet since the pandemic ended, more than 200 cases of narcolepsy have been reported in Sweden. Source.

I was pregnant with Mabel when the swine flu epidemic hit.  That year I got two vaccinations- one standard season flu vaccination, and a second specifically for the H1N1.  As a pregnant woman, I was particularly susceptible to flu, and on the priority list of the H1N1 vaccine that was in short supply.

I think what is crucial for the public to understand about this situation is that decisions were being made in an emergency.  There was limited time for safety studies- and it would have taken a very large and time-consuming study to recognize the increased risk of narcolepsy if only 200 out of 5 million people vaccinated developed it.

They say hindsight is 20/20 for a reason.

PANDEMICS ARE EMERGENCIES- Yet the problem with risk-benefit analyses is that they often look radically different when the world is facing a pandemic with the potential to wipe out millions than they do when it has emerged relatively unscathed from one, like H1N1, which turned out to be much milder than first feared. Source.

If H1N1 had been as deadly as we initially feared it would be, we would be rejoicing that all it cost was a few hundred cases of narcolepsy.  However, because we dodged a bullet and H1N1 did not kill as many people as a ‘worst case scenario’ we feel differently.

My heart breaks for these children whose lives were changed, and their families, just as it breaks for those whose loved ones died from H1N1.

For info on how the flu vaccine works, why you need a flu shot every year, and lots of answers to other questions, see the CDC’s “Key Facts about Seasonal Flu Vaccine.”

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Who drinks the most coffee?

Have you seen this?

Source. Read more about it here or here.

I’m not really surprised that Scientists/Lab Techs are at the very top.

I fought it for a long time.  I’ve been working in labs for about 13 years now.  It wasn’t until I started my current job that I finally succumbed, and now I crave coffee and drink 1 to 3 cups a day.

What changed?  Well, I could say I had kids, but what it really came down to was accessibility.

My current job (probably because scientists are at the top of that list) has Keurig machines in every kitchen, on every floor, of every building in our complex.  Along with the machines, there are 5 to 6 types of coffees (only 1 is decaf) and 3 kinds of tea.  There is powdered creamer on the counter, along with whole, skim, and half and half in the fridge.  You can choose from sugar, Equal, or Sweet n’ Low.  There’s also 3 kinds of hot chocolate (sugar-free, regular, and mini-marshmallow).  Some kitchens have espresso machines and assorted varieties of those as well.

Before certain meetings, there is a line for the machines.  The facilities staff includes people whose job it is just to keep all of that stocked.  On days the K-cup shipment arrives, it looks like we won a lifetime supply of coffee on The Price Is Right.

Now, while it’s nice and generous of my company to provide these, I don’t think they are being entirely altruistic.  By providing all of this- feeding the compulsion of the scientific staff, they are keeping us all on-site.  No need to make a Starbucks run when you have FREE coffee right down the hall.

I have always loved the smell of coffee, but I was never a fan of the taste.  When I started my current job, the constant smell of coffee was irresistible.  So, I started off slow.  A cup of French Vanilla here or there, not everyday.  Then I tried this Vanilla Hazelnut flavor and that was it.  Now I’m hooked. Last year for our anniversary, my parents even got Mac and me a Keurig.  He uses it mostly just to make hot water (either for tea or for warming bottles), I use it for coffee.

Once I was pregnant with Nemo, I kept it to one cup most days, two cups max (see here for why).  That changed once he was born- my consumption picked up considerably.  (I did not worry about caffeine and the breast feeding- see here for info.)  While I was still home on maternity leave, I had at least a cup a day.  After I went back to work and could no longer sleep in or take a nap, that turned into two cups a day, most days.  Somedays I have a third after the kids are in bed and I can sit and savor it.

As for what kind I drink, that’s changed too.  At work I still drink the Vanilla Hazelnut.  At home I’d mostly kept to French Vanilla that people got me as gifts or Hazelnut Cream I could pick up in the store.  Now I surf Amazon looking for sampler packs of delicious sounding varieties.  What I’m currently working on?  This:

You can find it here if you want.

Caramel cappuccino, delish!

Southern Pecan, yum!

Wild Mountain Blueberry, wow!

Apple Caramel Pie, heaven help me!

I think I have a problem.

During Hurricane Sandy, on the day we were without power, I had no coffee.  I really wanted coffee.  I thought, should I hook the Keurig up to the generator?  Then I thought, no you idiot, you should not use the generator to power your coffee machine!  So, I sent Mac to the Dunkin Donuts up the street (oddly, it was only a teeny tiny portion of our neighborhood that lost power.  Our neighbor backlots had power and I seriously considered asking if we could run an extension cord from his window.)  I told him to get a BIG cup and not to put creamer or anything in it (hi, no power=no refrigeration) so I could stretch it out and reheat it on the stove.  Well, I nearly cried when I put the “supposedly no refrigeration needed/Walmart sold me an expired product” little creamer in my coffee and it curdled.  I though, maybe just that one was bad, so I tried again.  Happened again.  Got a new box of the little creamers only to find they were expired (thanks for nothing Walmart), but since I was desperate, and they’d only expired in September (unlike the other box that expired in February, months BEFORE I bought them at Walmart), I used the more recently expired ones and managed to get one little cup of coffee.  When I realized that the treat Mac had brought be was a fluffy donut (which I HATE) instead of a cakey donut (which I LOVE), I nearly cried.

Can you say “First world problems?”

Let me reiterate, I think I have a problem.

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A near miss.

On my 4th wedding anniversary last week I wrote about how Mac and I spent our 3rd anniversary- frightened I may have been losing a much wanted pregnancy.

Well, as I was writing that post, an article was published in the British Medical Journal.  I came across it on Thursday, looking for citations to back up the information I was including in the post.  It shook me, but I didn’t have time to read it until today, and I don’t link to any information that I haven’t read for myself.

Well, I read it today.  It made me realize just how close we came to losing that baby, our Nemo who, as the article would suggest, really beat the odds to be born.  So scary.

The article, “Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding:  meta-analysis of cohort studies” by Verhaegen et al looked at the data compiled by 26 previous studies of women who were less than 14 weeks pregnant and experiencing abdominal pain or bleeding.

This article does a pretty good job of reviewing the data in laymen’s terms if you would like to know.

The finding that made me catch my breath was that in women with progesterone levels below 10ng/ml, the probability of the pregnancy being non-viable was 96.8%.  That meant only 3.2% of pregnancies with that low of a progesterone level were viable.

If you remember what I wrote last week, when my progesterone levels were checked at 7 weeks, it was only 6ng/ml.  (Even after the supplementation with Prometrium, the highest my levels ever got were 12ng/ml.)  At that point I had only a 3.2% chance of a happy ending.

I’m glad this study wasn’t out there for me to find when I was going through that.  As it was, at that time, the worry made me feel so uncertain.

I’m also glad that the ultrasound technician was as stellar as she was.  I’m glad she didn’t give up after the first pass when she saw no heartbeat and an embryo measuring weeks behind where it should have been.  I’m glad that she noticed my tipped uterus, that she persisted, tried something different, and managed to detect a heartbeat and get measurements that reassured us (we even got a picture, see below).  If she hadn’t been as diligent as she was, Mac and I would have left the office with news that I was losing the pregnancy- low progesterone, embryo measuring small, no heartbeat- that would have been the conclusion.

Nemo at 7w3d. Only a few millimeters long on September 27, 2011.

Unlike with Mabel, we didn’t ‘go public’ with news we were expecting Nemo until just before Thanksgiving- at which point I was already 15 weeks pregnant.  I didn’t tell anyone at work until I was over 17 weeks along.  Most parents-to-be can’t wait to shout it from the rooftops that they are expecting.  With Mabel, I felt nervous announcing, like we might jinx ourselves.  With Nemo, knowing that things had been complicated or tenuous or whatever they were, made Mac and I even more reluctant.  Even once we did announce, it was only on Facebook- not the video we sent out via email and posted on Facebook to announce Mabel’s impending arrival.  The picture above- we didn’t share it with anyone (until today).

At one point, once things had settled down and the pregnancy was progressing normally, the midwife actually said to me, “I hope you don’t feel like there’s a cloud over this pregnancy.”

She hit the nail right on the head.  I did feel like there was a pall over me and Nemo, and I think Mac felt it too.  The uncertain start gave me a worry that was hard to shake.

If I had gotten that first phone call from the midwife’s office telling me my progesterone was only 6ng/ml and I’d found the Verhaegen study, I would have been certain things would end badly.  I’m glad it wasn’t out there back then.

I also hope that women who find this post by doing the same Google search I did last September find some answers and some hope.

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Happy Anniversary: Better than last year

Today Mac and I celebrate out 4th wedding anniversary.  We’re going out to dinner at a restaurant near our house that we’ve been wanting to try since it opened a little over a year ago.  I’m hoping it lives up to our expectations!

Last year I posted about our anniversary here.  However, there was something significant that I glanced over.

I mentioned “other craziness/worry that just made me appreciate my husband and our marriage even more.”  Well, I’m happy to say that this year, the cause of the craziness/worry, an embryonic Nemo back then, will be spending the evening with his grandma.

Last year at this time I was about 7 weeks pregnant with Nemo.  Last year, our anniversary was scary and frightening and stressful.

I had had my first prenatal visit on Monday the 26th.  I mentioned to the midwife that I had noticed a few instances of spotting over the previous week or two.  It was very minor, but it was worrying me a little.  She suggested that they run some blood work to see how things looked.  Otherwise, there wasn’t much to do- being only 7 weeks, they didn’t do an ultrasound or anything.

I hadn’t told Mac about the spotting (considering one of the instances happened when we were out for the day, without Mabel, celebrating our anniversary) because I didn’t want him to worry.  Looking back, I think that was a mistake.

The day after that first appointment, our 3rd wedding anniversary, the midwife’s office called me at work.  It was not good news.  My progesterone (the “pregnancy hormone“) levels were extremely low.  For comparison, normal range is 9 to 47 ng/ml, with an average being about 25ng/ml at 7 weeks pregnant (source).  My blood work showed my progesterone level was 6ng/ml.  Very low.

The midwife then said, “Before we begin to supplement your progesterone, we need to make sure it’s a viable pregnancy.”  Right there my heart skipped a beat.  I knew it meant there was a chance I was having a miscarriage or what I thought was a pregnancy was a blighted ovum.

The midwife gave me the contact info for a local radiology center that could conduct the ultrasound, since the midwife in the practice who did them wasn’t in the office that day to do it.

Doing my best to keep myself composed, I took the scrap of paper with the phone number, picked up my cell phone and car keys, and went out to my car.  Nobody at work knew I was pregnant and I couldn’t have that kind of conversation in a shared office.

First, I called the radiology center, told them it was urgent and asked when they could see me that day.  They had a 3:30pm appointment.

Once I hung up with them, I knew I had to call Mac.  I was nearly in tears just thinking about having to make the phone call.  He was totally unaware that anything was going on. I hadn’t told him about the spotting, I hadn’t told him about having the blood drawn.  As far as he knew, everything was fine.

I called him, a tremor in my voice and said, “The midwife’s office called.  They are sending me for an ultrasound.  They think I might be having a miscarriage.  I had some spotting, they did some blood work and they need the ultrasound to confirm that the pregnancy is viable.  My appointment is for 3:30pm.”  It all tumbled out.

His first response was, “What time do I pick you up?”  What else we discussed is hazy in my mind. I know I was crying.  I felt scared at the loss of the pregnancy and I felt guilty for having kept him in the dark.

I then scrambled and called my mom.  She knew I was pregnant, but also unaware of the concerns.  She was great.  She accepted my brief explanation, didn’t ask any questions and then scrambled to get coverage at work so she could come watch Mabel.

I composed myself and went back into my office.  I sat down and started Googling/PubMed searching and reading all that I could about miscarriage, low progesterone, blighted ova, chemical pregnancies, etc.  In my searching I found info on misdiagnosed miscarriages.  Women, particularly those with a ‘tipped uterus’ reported being misdiagnosed as miscarrying.  Transvaginal ultrasounds (the only ones capable of seeing an embryo in the early stages of pregnancy) with a tipped uterus apparently resulted in miscalculated gestational ages- indicating that an embryo wasn’t growing normally, was measuring small, and likely there was a miscarriage in progress.  I tucked that info into my brain.

At 1:30pm Mac with Mabel, my mom, and I all convened in the parking lot at my work. I didn’t even tell anyone I was leaving, I just walked out. My mom took Mabel home, and Mac and I went to the radiology center.

We waited FOREVER- over an hour- to be called back.  It was miserable.  Then they called me back.

The technician began the scan and looked for a long time.  The longer she looked, the more my hope faded.  She said, “Here’s the embryo.  It’s measuring about 5 weeks.  That’s too early to see a heartbeat.  Maybe your dates are wrong?”

I knew my dates weren’t wrong.  I’m a scientist for Christ’s sake.  I was charting.  This was a wanted and planned for pregnancy.  My dates were right.  I had a positive pregnancy test in my hand over 3 weeks ago!  There was no way that I was only 5 weeks along now.  Something was wrong.

Outwardly, I was stoic.  I just laid on the table holding Mac’s hand.  I didn’t look at him.  I couldn’t look at him.  I felt so guilty for keeping him in the dark.  For letting him go along thinking everything was fine.  Then calling him a few hours ago to tell him everything wasn’t fine, that I might be having a miscarriage.

Inwardly, I thought to myself, “Maybe I have a tipped uterus.  Maybe that’s why her measurements are wrong.  It will be hard to wait, not knowing, but I’ll insist on coming back in a week to see if the embryo is still growing.”

Then, the technician, God bless her, said, “You know what, scootch down, make your hands into fists, and put them under your but.  I think your uterus is tipped.  Let me just try to get a better angle.”

I felt a glimmer of how and did as she instructed.  It took several minutes.  I knew she was trying very hard to find us conclusive answers.

After what felt like an eternity she said, “Oh!  I see a heartbeat! Right there.”

I couldn’t even look.  I didn’t even turn my head.  I had too many tears in my eyes to see the screen anyway.  I just reached out and clenched Mac’s hand and said a prayer of thanksgiving.  (I’m getting teary-eyed just thinking about it now.)

She recalculated her measurements.  The embryo was still measuring behind where it should have been, giving my charting, but it was less than a week off, and given the tipped uterus and the trouble she was having getting a good view/good measurements, it was good news.  The heartbeat was definitely good news.

I can’t explain the relief I felt.  I don’t think it’s possible to comprehend just how attached you are to your pregnancy until you are faced with losing it. I knew that the embryo wasn’t a baby, yet, but I wanted it to become one, and I realized I would have been heartbroken if it hadn’t of been viable.

As soon as the appointment was over, I called the midwife’s office and they called a prescription for Prometrium into my local pharmacy for me to start on that very night.  Then I called my mom and let her know that her prayers were answered.

That was how we spent our anniversary last year, Mac and I.  This year promises to be so much better.

________________________

Follow-up:

A few days later (I think it was Thursday or Friday) the midwife’s office gave me another near panic attack when they called with the retest of my progesterone levels after starting on the Prometrium.  They hadn’t gone up at all, and they said I needed an ultrasound to confirm viability.  The fear came flooding back.  This time I went to their office, alone.  When I mentioned the scan I had on Tuesday, and how the tech had said my uterus was tipped, the midwife looked confused.  Apparently they hadn’t gotten around to putting the results from the radiology center into my chart!  That midwife (one of several in the practice) didn’t know the viability had already been confirmed when she saw my blood work and said to bring me in!   So, the midwife did an exam and actually, manually un-tipped it (!) and could see everything just fine.  She measured and said the embryo looked fine and was measuring normal growth compared to Tuesday. I was simultaneously angry at them, and relieved by the results.

I stayed on the Prometrium through my first trimester, even upped the dosage, but my progesterone levels never got above 12.  Thankfully Nemo was fine.  He developed right on track.  By the time of my Nuchal Translucency scan (about 12 weeks) he was measuring right according to my dates.

Thinking back, it was so frightening.  I am so blessed it worked out the way it did.  My heart breaks for the parents whose stories don’t have the happy ending.

___________________________

ETA: A follow-up post with more science, and more emotions regarding this experience is here.

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One year later.

It’s amazing that a year has passed.

Last year, on this Friday before Labor Day Weekend, this baby boy was a twinkle in my eye.

Last year it was just after Hurricane Irene swept through our area.  We were preparing to head up to the Catskills, our little car loaded with supplies and donations for our neighbors.  We had no idea how bad it would be and if the National Guard would even let us in to drop off what we had gathered.

I rushed home from work early.  We wanted to head out early enough that we could travel down the valley in daylight.  We knew parts of the road were barely passable and we didn’t want to navigate the landslides and washouts in the dark.

Mac and I had been trying for a baby for few months.  I knew that it was still pretty early to test for that month, but I would be away at the cabin and unable to test all weekend.  The suspense would be unbearable, so I decided to just chance it and take a pregnancy test before we left.

Mac was downstairs loading the car.  Mabel was running around like a mad woman.  I took the test and waited.

My eyes started tearing up the moment I saw that second purple line appear, faintly, on the test.

I called downstairs for Mac.  He suspected something was up from the tone of my voice.

I had grabbed a T-shirt, this one, and held it up for him saying, “I think we might need this.”

However, in my emotional haste, it was inside out and backwards.  Mac figured it out regardless.

I was crying, he was happy, Mabel was clueless.

We decided we wouldn’t tell anyone just yet.  We’d give it a few days before we shared the good news.  For the next little while it would be our happy secret.

Looking back, it was good timing.  It was hard for me to see my Catskills so devastated by Irene.  Having that joyful secret helped me remember that life goes on, things change, it will get better, we’ll keep going.

It did, they did, it certainly did, and we did.

This weekend we’re headed up again to the Catskills.  The recovery has been amazing, and there is still a ways to go.

Looking at my valley, and my son, one year later, it’s amazing.

 

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