Folic Acid 101

Tomorrow is D-Day - The two year anniversary of Diagnosis Day, when I first learned about anencephaly, the fatal neural tube defect (NTD) that effects 1 in 1000 pregnancies in the United States every year - and even more in other parts of the world.

To think, a tiny tablet could have made all of the difference.  Well, several tiny tablets.

A minimum of 1,000 micrograms (mcg) a day, the equivalent of 1 Milligram (mg), is recommended during pregnancy for development of the neural tube, a flat piece of matter that folds to become the tube that forms our spines, skull, and brain.  This all occurs in the earliest stages of pregnancy, between three and four weeks - before many women even know they are pregnant.

Women with a history of neural tube defects anywhere in their family should take a higher daily dose of folic acid during, and prior to pregnancy.  Women who have had a child with a neural tube defect should take between 4 mgs and 5 mgs of folic acid every day, or 4,000 mcgs to 5,000 mcgs.  Women whose husbands have a history of neural tube defects should do the same.  Women whose boyfriends, with whom they are sexually active, have a history of neural tube defects should also take this increased dose.  Although anencephaly and other NTDs such as spina bifida have been determined to be the result of both environmental and genetic factors, the development of your child's brain is not something you want to take a chance on.

I cannot encourage this enough:  Women of child-bearing age who may become pregnant should seriously consider taking the minimal recommended daily dose of folic acid.  Women who are sexually active, women who are not sexually active.  Women who are on the pill, start popping these vitamins right along with them.  Women who are not on the pill, get on this one.  Women who like to get drunk and make bad decisions, take folic acid - In fact, take extra, because when we drink our bodies have more difficulty absorbing the vitamin.  Ladies, take your fucking folic acid.  It is estimated that 70 percent of NTDs could  have been avoided if the baby's mother had had sufficient folic acid intake.  You never, never, NEVER want to to receive the news that I did two years ago and wonder to yourself what you could have done differently, only to learn how simply you could have made a difference in your child's life.

Folic acid can be found in food.  Leafy vegetables, citrus fruit, and legumes and whole grains are a great natural source.  Today many breakfast cereals are enriched with folic acid as well.   But don't rely on food to get your recommended daily allowance.  Your body can more easily absorb folic acid in its tablet form; the table also allows you to know how much folic acid you have ingested.

Not all prenatal vitamins are made equal.  Your average over-the-counter prenatal vitamin has only 800 mcgs; pregnant women, you should really have at least 1,000, remember?  I currently take one of the more popular brands (just in case the Holy Spirit visits me, or something, I guess, or I use a public restroom without a seat liner), One A Day, which has only 800 mcgs.  If I were smarter and more diligent, and if I were sexually active, I would be taking that prenatal and at least four of the 800 mcg folic acid tablets pictured here a day, for at least 4,000 mcgs, or 4 mgs.  I'd also be takig a B-complex supplement, to help my body metabolize the folic acid.  Although there is some evidence that too much folic acid in certain forms can be bad for us, folic acid is water soluble, and much of the "excess" you might intake will be tinkled out throughout the day - one more reason why it's important that we intake sufficient amounts.

You can't really build up a "surplus" of folic acid in your body in anticipation of pregnancy.  As stated above, it's water soluble and is going to leave your body if it's not processed.  Folic acid prior to pregnancy is recommended A) To develop the habit of taking the vitamin daily, and B) Because most pregnancies are still unplanned, and the crucial period for taking folic acid is when many women are unaware that they've conceived.

I'm a bit of a hypocrite.  I vowed to take 4 to 5 mgs of folic acid for the rest of my child-bearing years, but lately it seems I can't be bothered by it.  I also believe that anencephaly was simply God's will for Gabriel; after all, I had added a folic acid supplement to the prenatal vitamins I had already been taking for months leading up to Gabriel's conception - I just added the supplement too late.  Besides, I make no guarantees that taking your vitamins will fix everything.

Maybe Gabriel was just meant to be what Gabriel was, what Gabriel is.  Gabriel has been God's instrument for many messages.  Today, I'm feeling compelled to use the lessons I learned from Gabriel to encourage women to consider this information for the health of their future children. I can promise you that the regret is much more inconvenient than the hassle.

For more information on folic acid, please visit the following websites:

http://www.chg.duke.edu/diseases/ntd.html

 http://www.cdc.gov/ncbddd/folicacid/index.html

http://womenshealth.gov/publications/our-publications/fact-sheet/folic-acid.cfm#f

http://www.metametrixinstitute.org/post/2012/03/27/Folate-Too-Little-Too-Much-or-Just-Right.aspx

The Cherry On Top

At least once a week I go to the Village Grill for lunch.  The cafe is just a block away from my office (although I still drive; walking even just one block in heels can really cut into a one-hour lunch break) and I've never had a bad meal from their large menu.  I think my favorite thing about lunch at the Village Grill, though, is that the waitresses pass out mini-ramekins of cobbler to every customer until they run out.  My favorite is cherry.

I sit at the counter, because it makes me feel like I'm sitting at a bar, and that makes me a feel a little naughty.   I love my job, but it's not exactly what I saw myself doing with a law degree - I saw myself marrying up, and baking cookies as a stay-at-home lawyer mom.  In any case, sitting at the counter makes me feel like I'm doing something subversive, and I guess I need the cheap thrill.

My favorite server is Samantha.  She's friendly, and she's either good at her job or she's figured out that if she gets me in and out swiftly, I'm good for a pretty fair tip.  She's also seemingly learned to recognize when I'm goose-necking for cobbler because she usually brings it to me with my check, complete with a little smiley face.

Last week I found myself wondering about what she must be like outside of the Village Grill.  She wasn't my server last week; another girl who is nice enough but who is no Samantha was.  Samantha seemed to have the day off, because she was no where to be seen.  Somehow, after the years in the service industry myself, it struck me as odd that Samantha should have a day off, that she should have something else to do during the lunch rush.  Maybe it's because on my nights off, I can still frequently be found bellied-up to the bar at the Wright Place.

I found myself wondering how old she might be.  She looks 25 years old, at the most.  I wondered if she is a student, and if she is what she is studying and what she'd like to do with her degree.  I wondered if maybe she's got kids and if she does what the story behind all of that might be.  I found myself surprised at how little I've thought about the stories of the people who serve me.  I wondered if people every wonder when I'm serving them what my story is.

It's easy, so easy, to forget that everyone's got a story.  Or that we don't usually know what's going on in someone else's head.  Every day my colleague in the office directly next to mine calls her two-year old son from her office.  She frequently puts him on speaker phone and through the pre-fab walls I can hear them carry on.  I wonder what it would be like to talk to a two-year old Gabriel.  I wonder what it's like to have a child live longer than ten days.  I wonder if someday I actually will die from the sharp pain that pierces my heart between 11 and noon when these calls generally take place.  I try to acknowledge to myself that her life hasn't been a cake walk, and that there must be days when her son is the only reason she keeps carrying on.  I don't resent her.  I just wish I still had my reason.  I wish I had someone to call at noon.

But I don't.  So I head to the Village Grill, intent on eating my way through the whole menu eventually, and savor the new-found joy I've discovered in dining alone. Sometimes I bring documents or a case to review.  Sometimes I bring a legal pad and draft the opening paragraph of an upcoming blog.  Sometimes I chat with the patron next to me.  Always I hope that dessert today is cherry cobbler.  The apple cobbler's good too.  But with no one to call, and no one to come home to, I find that digging beneath the whipped cream to discover cherry cobbler can make my day.

The Greatest Thing

Two e-mails in one week put me on top of the world for a moment.  The first arrived in my inbox on Monday and came from the Deacon's wife, asking me to consider taking her place on the Board of Directors of the Right to Life of Kern County.  My experience with Gabriel would be invaluable to the organization.

The second e-mail led to a telephone conversation between me and the faculty coach for West High's mock trial team.  I judged their round on Wednesday night and e-mailed the coach for each team the pages of detailed notes that I took, along with some pointers.  West High's coach asked me to be his team's attorney coach next fall.  My experience as a mock trial competitor, also from an "inner-city" high school (the first time I have ever heard either East High or West High so called) would inspire this young team of mostly Hispanic girls.  I would be a good role model.

I'm a role model, or at least a couple of people think so.  I didn't really set out to be, and don't really think I should be, but I suppose we don't really decide these things for ourselves.

People tell me that I'm strong, but I don't feel strong.  When I examine my life I know that I should be happy.  I am happy.  As I type I'm in my parents' living room, watching one of our favorite television shows as a family.  I've got an invitation from friends to join them for a night out, but I've decided instead to go home for a quiet evening with my dogs because I've had a long day at a job that I love because I had the privilege of going to law school.  I have a good life. 

This week I commemorated what would have been my three year wedding anniversay - and I guess, still is - by checking the status of my divorce proceedings online.  I can't help but feel like the very opposite of a role model; I feel like a failure.  And I can't help but feel angry and hurt when others are happy.  It seems everyone around me is in love, and happily breeding away, while longing and resentment fester deep inside of me.  I have so much, but I want more.  I want it all.  I want to be in love again.  I want another child.  I want to feel again like I felt when I did have it all.  That brief, shining moment when I was carrying and caring for Gabriel was the greatest thing I ever did, and the greatest I ever was.  I never mattered more, and I haven't mattered so much since.  Three years ago, all that matters to me was in my foreseeable future.  Two years ago, my family was happily in tact, blissfully unaware of the fatal defect that would claim our growing, unborn baby's life.  One year ago I was still desparately clinging to the last shreds of a quickly fading hope.  Today, though my life is brimming with wonderful things, something - some things - are still missing.  My child is still missing.  My rainbow is still missing.  

I wasn't sure until this evening if I would accept either position.  I wish I could say that my decision tonight to accept both positions was made because I want to help.  If I help anyone it will just be incidental because my true motivation is how nice it feels to be wanted and needed.  I miss being wanted by a man who loves me.  I miss being needed by a child who I loved to serve.  If I am strong it is only because I can admit that I am weak with desire to love and be loved.

Complications

Neither of us looked at the other.  Instead, we stared at the game on the television to the right of us, a re-run of a game that had taken place earlier in the day, and clung to our beers for security.

"I want to be on your list."

We paused for a beer filler. I felt like the conversation should have been more awkward than it was.  Maybe it was the beer.  Maybe it was his uncanny ability to remain unfazed.  In any case, I was relatively at ease and sensed the feeling was mutual.

"What do you mean?"

We stared idly at the game.

"I know you're not dating right now."

"No, I'm not."

"But someday you will be.  And when you are, I want to be on your list.  I want to be on your list of women you consider when you are."

He rocked his bottle back and took a sip.

"It's not that you're complicated, but. . ."

It would be only the first time I would be told I am complicated.  Whatever that means.

"You can't just tell people that you're interested in them," a friend later admonished me.

I crinkled my nose.

"Why not?"

"You just can't.  You just can't come right out and tell someone that.  You'll freak people out."

"That's absurd.  If I didn't say it, how would he ever know?"

The conversation never did result in what I wanted.  But it didn't really ruin anything either.  There had been, up to that point, a looming elephant in the room and the conversation remedied that.  Had I not said anything at all, the result would unlikely have been any different.  In speaking up I assured that I had said what was on my mind, pursued what I wanted, and the rest was out of my hands.  As a woman who seeks control, there's nothing quite like seizing the opportunity to take control by lobbing the ball into someone else's court.  What more can we do, after all?

I don't really think I'm that complicated.  Complicated things have happened to me, it's true, and I have complicated residual feelings about those events.  I doubt the feelings would be any less complicated in a year or even in eight years - not an arbitrary number.  Ultimately, though, I'm a simple girl who knows what she wants and will put up a good, hard fight to get it. Life is short -- too short to pussyfoot around.

My life is full of friends and family and comfort and then some.  Some things are decidedly missing, though.  Perhaps it's selfish to want more on top of what I've already got but my goals are not complicated:  I want loving, romantic companionship and ultimately, a family of my own, and I will charge ahead to find what I want.

Tonight in an interesting, upside-down turn of events someone said it again:  "I like you so much, but you scare me because you're complicated."

I shrugged.  I'm not.  I think, given some of the events in my life, I'm just about the least complex person I know and just about every behavior I engage in can be easily explained away.  From my need for control; to my desire to take charge; to my even more pressing need to take charge now; to my fear of missing something and everything; to my deep longing to find love again - It is all the simple product of my unique circumstances.  The question is only who is up to the task of tolerating me, looking past what's complicated, caring for me, and even loving me in spite of all of that.

It's really not that complicated.

Something Happens. . .

Something happens to us when a doctor tells us our baby has a condition that is incompatible with life:  We learn how to live. 

We learn to cherish every kick, every hiccup, every heartbeat in a way that we didn't before.  It brings out this animal-like zeal in us and turns the remaining weeks or months of our pregnancy into this tragically beautiful experience that imprints itself on our souls. 

Then something happens to us when we lose our children.  We are wounded and we have days where we don't want to get out of bed, or we don't understand why we keep breathing when our child no longer does.  We feel like we could die too sometimes, and it takes everything we have some days to function, but most days we do.

To my knowledge, for the first time in our anencephaly community, one of us was so overcome with our grief that we couldn't get out of bed anymore, we couldn't breathe anymore, we couldn't live anymore.  Emilee Granatowski, mommy to Dallas and most recently an anencephaly baby named Leila Grace, has in her troubled grief taken action that inadvertently ended her own life.  We pray that she is reunited with her precious daughter Leila, but never forget that she leaves behind a husband, son, and other family and friends who will miss her until they see her again.  

I say we, because when we are first told the word "anencephaly" in this age of information, once the shock has begun to fade we begin to search.  And in our search we find support groups, blogs, pages of information encouraging us to give our child the chance to live, not just for him or her but for the strength that we will find through the experience.  And something happens again. Those support groups lead us to women who become our sisters.  We are sisters.  I have never experienced a love like I have for my child, but I have never experienced a closeness with people I have never met like I have through my online support groups.  I didn't know Emilee, never had an exchange with her that I can recall, and only observed her experience from afar through a support group we had both joined, as I have done with many of the mothers new to the anencephaly community.  Yet I am shocked and saddened by her passing and feel the depth of her despair.  We in the anencephaly share experience, joy, and grief.  Any one of us might have been Emilee.  Any one of us would have been dearly missed in our group.  Emilee is already dearly missed. 

Today we are picking apart the signs, wondering what we could have done to change things.  Nichole, one of our youngest yet wisest sisters, says it best when she says there was just nothing.  We want to believe we could, like we want to believe we could have changed things for our babies, because it gives us a sense of control in a situation that is completely out of our control.  We couldn't save oour children - if we could have, we would have.  We couldn't save Emilee - if we could have we would have.  What we can do is pray for her departed soul that she may be reunited with her baby girl Leila.  We can pray for the comfort of those she left behind, especially the mommies who have grown so close to her the last few months. 

We're struck with grief today, but I hope we'll focus on what makes us smile.  In just a few days we'll celebrate the birth of one of our celebrities, Andrew Alvstad, who like my Gabriel lived a miraculous ten days.  We learn in this experience to count our blessings - ten minutes, ten days - we can't take any of it for granted.  Life is precious, and it is short, and we never know when it will be taken from us. 

Something happens when you hold your child in your arms as he takes his last breath:  You learn to live and you learn to love and you learn to hurt and you learn that it's all part of this experience that was nothing like what you expected, and nothing you would ever give up. 

Rest peacefully, Emilee and Leila Granatowski.