As the title suggests, since I last posted here my wife Amanda and I have become parents to two twin boys! They’re just over eight months old now and it’s been an exhilarating and exhausting experience.
I have a number of posts in the hopper about weight gain during pregnancy, pregnancy nutrition, how I managed to fight off (and then succumb to) some sympathy pounds myself, New Year’s resolutions, and some other posts unrelated to being pregnant or being a new parent. I haven’t posted any of them (yet) because we had a rough pregnancy, and then because being a new parent is much, much more time-consuming and enervating than I ever would have possibly imagined.
Losing weight is simple but it isn’t easy. It requires a certain amount of dedication, but getting fit mostly requires a good routine, and it’s hard to keep to any kind of routine when you have two babies to feed, change, play with, and otherwise look after. There are two of us and yet sometimes Amanda and I still feel outnumbered. Before they were born I was walking on our treadmill just about every morning before work, recording everything I ate, weighing-in every day, and losing a nice steady 8–10 pounds every month until last Fall when I stagnated.
After the boys were born I started to put on weight at almost the same rate, gaining about a pound a week through the holidays. Some of it was a change in routine, or because we ordered-in a lot more, but I’m sure some of it was due to stress, too, since high-calorie foods are very comforting.
I said above that our pregnancy was “rough” but I should probably elaborate a little.
Our Terrible Pregnancy
We’d been trying to get pregnant for nearly two years before we finally did, with a couple of half-starts and false-positives. When we bought our house in May 2011 we kept the second bedroom mostly empty and referred to it as “the nursery” before we moved in. So even before we were actively trying we were at least planning to have children.
Amanda and I had both seen a number of fertility doctors after the first year, and nothing was really wrong with either of us. We both lost some weight and exercised more. I started taking supplements to increase the count and motility of my sperm, and there was talk of my having surgery to remove a varicose vein that could be heating things up too much “down there,” but I never got the surgery. Amanda was (and still is) young enough that age wasn’t a major consideration, and everything just appeared to be working normally. Still, we weren’t getting pregnant.
When I was younger I assumed that you have unprotected sex once and BAM – you get pregnant. The real world doesn’t work that way, though. There are only a few days per menstrual cycle where a woman can actually get pregnant (although sperm can live for over a week inside) and not every woman actually releases an egg every single month. So right away the odds are against us. How did the human race ever proliferate before ovulation calendars and timed abstinence?
Nonetheless, sometime in October 2012 we finally got pregnant. We tested with two different brands of pregnancy test, and then Amanda got a blood test that confirmed it. I just happened to be working from home (for some other reason) the day the doctors called and we both heard the good news together while standing in our bathroom.
We found out a few more weeks in that we’d be having twins. When it rains, it pours.
We got each other a lot of baby-related gifts for the holidays last year. Amanda got me a “World’s Greatest Dad” mug and a Minnesota Twins t-shirt (that says “Dad 1” on the back – I brought it to the hospital and changed into it on the day they were born). I got her a bunch of kitchy pregnant t-shirts that said things like “Baby Bump’s First Christmas” and “Two For the Price of One”. We bought cute onesies and books for “the babies” (we wouldn’t know their genders until mid-February or so). I had two onesies made. One said “Buy One” and the other one said “Get One Free.”
There were complications almost immediately, but thankfully most of them were painful for Amanda but not harmful for the babies. All of the books, pamphlets, and doctor’s warnings will say things like “Some pregnant women may experience…” and then some symptom. Amanda is “some pregnant woman” – she experienced almost every pregnancy complication a woman can. Terrible morning sickness? Check. Swelling in the belly because of extra fluid that needed to be removed with a needle once a week for the first five weeks? You bet! We spent the better part of Christmas 2012 in the ER because of some bleeding that turned out to be cervical polyps, caused by hormones and only tangentially related to being pregnant. Still, you’re pregnant and you start bleeding, you get your ass to the hospital, major holiday or not.
Because of our history and because Amanda is by her nature private and a bit of a worrywart, we only announced the pregnancy to our families after the customary twelve weeks, on Christmas day when everyone on my side of the family was gathered together back in Philly, but waited another month to make the big public announcement to our friends, coworkers, and social media sites at sixteen weeks. So on Monday, 21 January 2013, we announced this to the world:
We’re pregnant! With TWINS! Due on the 4th of July. http://t.co/1DIigapo
— Jough Dempsey (@jough) January 21, 2013
Thanks for the kind words, everyone. Amanda announced the pregnancy by changing her Facebook status pic to this: http://t.co/sybl2CKv
— Jough Dempsey (@jough) January 21, 2013
Two days later I posted the last article I wrote for this blog before this one.
This is the first time I’ve written about the worst day of my life. Before I delve into this personal horror story I’ll:
a) warn that you may not want to read this if you’re pregnant or planning to ever become pregnant, and
b) remind you that this story has a happy ending (although we didn’t know that it would at the time).
I was standing on the El platform at my station on the way to work when I got a call from Amanda who just got to work herself. She said that she thinks her water broke as she was stepping out of the car. She felt a gush and her pants were soaked. She said she called the OB first and they told her to come in. I told her I’d meet her there, left the station and started walking to the OB, emailing my office on the way to say that there was an emergency and I’d be late. We just announced that Amanda was pregnant a few days before, so I didn’t have to elaborate.
I got there first (since the OB office was near home) and waited while Amanda drove in from the suburbs. I called her and we talked on the phone for a minute, trying to reassure her that it could just be urine from her bladder being pushed out by the babies, which I’d read about online as something that happens pretty frequently.
At this point a sense of dread was already emerging, but we’d already seen other complications that affected Amanda but not the babies, so I remained optimistic that this was just another hurdle that we’d have to suffer, some minor indignation that Amanda would experience and then we’d move forward. As I waited for her I started to doubt this more and more.
She got there a little while later and we waited, not knowing how serious it was. They finally saw us and examined Amanda, swabbing the remnants of fluid to look for “ferning” which is a sign that there’s a leak. Our regular doctor wasn’t in, but the doctor on duty smiled, looked up at us, and said “it is amniotic fluid.” The discrepancy between the news (bad) and her demeanor (cheerful) was confusing for a second, but after a moment it sunk in and Amanda started to hold back tears and asked it it was bad, and if there was a chance we could lose the baby. The doctor said yes and we both broke down crying.
They did an ultrasound and found that the fluid around Twin A (the one closest to the cervix) was low. Ultrasounds are too low-resolution to see the tear or spot where the fluid is leaking.
Fluid levels in the amniotic sac being low is dangerous not only because the fluid acts as a cushion to protect the baby, but also because the baby breathes the fluid in and pees it out (gross but true) and this stimulates lung and kidney development. Having a rupture is more dangerous, because it means that infections and things that the baby would be otherwise protected from in their little isolated chamber can now reach them.
They sent us to the labor and delivery ER at a major downtown Chicago hospital. I drove us there in the snow, praying they were wrong, and hoping there was still a chance to save Twin B.
I dropped Amanda off so I could park the car and got stuck in the hospital driveway. Aerosmith’s “Dream On” was playing and it felt like the universe was taunting me.
I left the car with the valet and met Amanda in the lobby. They took us up to the labor and delivery department and the sinking feeling in my chest started to lower to my guts as I realized they were walking us to a nearly-abandoned wing. They put us in a huge corner room away from everyone else (probably in case we started to cry loudly) and then we waited.
While we were waiting we talked about being strong for Baby B, already resigning ourselves to maybe losing another baby but pressing on to do the best we could for both of them. We cried a lot. Mostly we just waited, praying please, please, please let them be okay.
A resident finally came to see us. He said that once the amniotic sac breaks there’s very little that they can do, and that they can’t save Twin B if Twin A’s bag broke because everything’s connected. The bag around Twin A had a “pre-term premature rupture of membranes” (PPROM) which is to say it sprung a leak prior to thirty-seven weeks of gestation. We were only at week seventeen, and their chances of survival outside the womb at that point are virtually none. Even if they did survive, they’d likely have all sorts of developmental complications and wouldn’t live a good life.
The rupture, he said, was likely caused by an infection that weakened the amniotic sac, and thus waiting meant that Amanda was at risk for getting an infection that could potentially get septic and cause her to lose her uterus, which would mean we’d never be able to have children at best, and could cause Amanda to die at worst.
He explained our options would be to wait to deliver the babies, or to perform a “dilation and extraction” or “D&E” procedure which is tantamount to an abortion. Basically they’d open up Amanda’s cervix and pull the babies out in pieces.
Since we were intent on keeping these babies, and the options presented both sounded horrible in different ways, we waited to talk to the attending specialist and to see our OB. He said if we waited and did nothing that Amanda would go into labor within 24–48 hours and maybe we could hold them briefly before they died.
Think about these options. Either they’d induce labor, in which case Amanda would have given birth to both babies who wouldn’t have survived for more than a few minutes to a few hours, or she’d willingly abort them and have to live with that. Amanda was terrified of giving birth to babies that were doomed to die, of having the happy moment she’s been dreaming of turned into a twisted nightmare. At the same time, we couldn’t willfully abort them if there was anything, anything at all we could do to save them.
We waited for another hour and our regular OB came to see us. She confirmed the resident’s grim outlook and gently pressured us to make a decision because time was running out. She said that one of the best prenatal doctors in the world, who has been on boards appointed by the president and who has won all sorts of awards would be in to see us along with her team.
She left us alone to think about and discuss our options and we waited for a few hours holding out hope that the world-renowned specialist would have better news for us. I searched the internet for answers, hoping to find news of how our babies could get out of this alive.
In the meantime, neither of us had anything to eat or drink. They didn’t want Amanda to have anything in her stomach in case she had to go to surgery.
We finally saw the specialist, Dr. G, who arrived with her resident and the first resident we saw, plus another doctor plus a counselor and at least another nurse or two. They sat around us and reiterated what we’d heard before. We asked every desperate question we could think of – is it possible the bag could reseal? Are there any other options? Can we save Twin B by removing Twin A? Is there any chance at all for us having a positive outcome?
Their answers were dire. No, the bag can never heal or reseal. D&E or inducing labor are your only options (and if you don’t induce, labor will happen naturally within 24–72 hours, so you may as well induce or abort). They said the chance of keeping the babies was around two percent, but based on what they’ve seen they didn’t think it was even that good.
They stared at us and waited for us to make a decision. What would you like to do? We didn’t know. Are you absolutely sure it was amniotic fluid? Are you sure there’s a rupture? Dr. G asked if we’d like to do another ultrasound to confirm. We did.
Amanda couldn’t even look at the screen. She burst into tears upon hearing their heartbeats on the monitor. The fluid was indeed low.
They left us alone again to confer and decide, with the implied pressure of making a decision, and the doctors were getting more annoyed as the day went on.
We called our parents. We cried some more. We tried to decide what to do.
Finally, after it was too late to go to surgery that day, they brought us some water and a couple of turkey sandwiches, which we didn’t really eat much of.
Eventually we decided to leave and take the night to think about it (with the instructions to rush back should Amanda go into spontaneous labor).
I searched frantically for information online. I found some success but mostly sad stories at the pPROM support site. We were physically and emotionally exhausted. Amanda was still pregnant, and stress on her is stress on the babies.
The owner of my company texted me to see how we were, and put me in touch with his doctor who’s a bigwig at the hospital. He called and suggested I talk to Dr. G. Things were looking hopeless. We went to bed really early and in the middle of the night Amanda asked me to hold her. We cried some more. We prayed. We cried.
On Friday morning I called every high-risk pregnancy doctor in the Chicagoland area. I explained our situation over and over trying to get an appointment for a second opinion, trying to find someone that could help save our babies.
While I was calling other doctors Amanda’s OB called to suggest that we schedule the D&E for Monday, just in case we decide to go that route so that it’ll be on the schedule and we’ll be able to do it. Amanda said she’d do that and then got off the phone. It felt like getting a phone call from the Devil. I called the hospital where my urologist was based. They said they could see us in two weeks. I explained that it was an emergency, that we were told we only had 48–72 hours. They said they’d call back within the hour. They called back a week later saying that they could see us the following week. Gee.
I called another practice affiliated with a different major Chicago hospital. They told me they didn’t have any appointments available and I broke down crying, begging them to please see if they could fit us in. I was placed on hold and a few minutes later was told that if we could be there within the hour Dr. H would see us. We jumped in the car and went to see the doctor.
Dr. H did an ultrasound and found that the fluid level was low but not dangerously so. He said that while Dr. G was technically right in that the bag won’t heal like a skin wound it does sometimes close up and reseal. He agreed with the assessment that we only had a two percent chance of success, but thought we could afford to wait as long as Amanda didn’t show signs of going into labor or having an infection. We told him what Dr. G said about sepsis. Dr. H was incredulous, and said that would only happen if we were in a third-world country without access to medicine. He said they’d monitor Amanda and if we wanted, he’d like to follow-up on Monday. We said we would and so we switched doctors to the new practice.
All of the other doctors at our old practice (and at the hospital) were entirely focused on managing the negative and not at all interested in helping us save our babies’ lives. Dr. H, and other doctors we met in the new practice, seemed to be all about what we could do to mitigate the risks (keeping in mind that a lot of it was out of our hands) and doing everything possible to give our pregnancy the best chance that it had.
The day after The Incident was the first and last time we saw Dr. H. He moved away shortly after we started going there, but we’ll always be grateful to him giving us hope, which gave us strength to persevere. We asked him what he would do, and he was the only doctor we’ve ever asked that of who actually told us. “If it were my wife? I would definitely wait and see.”
We weren’t out of the woods yet, and were still scared about what could happen, but we left Dr. H’s office with some hope that we could save our babies. Amanda was prescribed bed rest and for both of us to avoid other people as much as possible.
We Became Shut-Ins
The first couple of days and weeks after The Incident were terrifying. At first we were just waiting for something bad to happen, looking for signs of infection. Amanda went on sick leave. I was in the middle of a big project at work but thankfully they let me work from home and use some of my vacation days as FMLA time so I could take care of Amanda who wasn’t supposed to go up and down the stairs or really get out of bed any more than she absolutely had to.
An infection would mean that Amanda would likely go into labor and we’d lose both babies. There is very little chance of stopping labor once it happens to save Twin B. At 25 weeks their survivability would go up to the 80th percentile, and after 30–32 weeks (depending on which statistics you follow) well into the 90s. So we had to just hang in there, one week at a time.
I can’t even begin to describe the horror of just waiting for something bad to happen for seven weeks. We never left the house except to go the doctor’s for a weekly checkup and ultrasound. We had groceries delivered. I’m sure the Peapod guy had a good story to tell about the customer who always greeted him wearing a face mask and gloves. Sometimes I’d go to the supermarket (also wearing a mask) extremely early in the morning when I was less likely to run into anyone else. I washed everything well, including myself, whenever I had to interact with Amanda.
To keep hydrated and keep fluid levels up Amanda was pounding down watered-down cranberry juice, which also helps ward off urinary tract infections. We took her temperature several times a day to make sure she didn’t have a fever.
It worked, or at least seemed to. The fluid levels increased. Every week we’d find out the measurement of the largest measurable pocket of fluid in each amniotic sac. As the weeks went on we’d even see one of the boys sucking his thumb or them touching each other through the membrane between the bags.
There wasn’t much else I could do other than take care of Amanda, make sure she had pregnancy-safe food to eat, plenty of fluids to drink, and to keep her spirits up as much as possible. As the weeks went on we grew more cautiously optimistic, but never any less vigilant. For the first few weeks Amanda wouldn’t look at the ultrasound screen because she couldn’t bear to see them in case things went bad. She’d start crying when hearing their heartbeats. Those first few moments before they found each heartbeat every week was especially anxious. After the first week the doctor came in to discuss the ultrasound results along with a “coordinator” from the hospital who was just there to assess Amanda’s well-being and to try to talk us down from the ledge.
I read that watching funny movies and comedy TV shows sometimes helped a pregnancy’s outcome, so Amanda tore through various seasons of comedies on Netflix.
It was impossible to enjoy the pregnancy, however, and because something terrible could happen at any time, we avoided buying things for the babies or decorating the nursery for a long time.
Around twenty weeks we found out that we were having two boys. We didn’t tell anyone until after they were born.
A week before The Incident we went to a furniture store to order two cribs, a chest of drawers, and a book cubby for the nursery. We were ordering pretty early, but one of the items was on backorder, so they said it could be 6–8 weeks before we got everything delivered, which was actually perfect for us as it would give us time to do some decorating in the nursery.
Naturally the day of The Incident I got a call saying that the furniture came earlier than expected and when would we like it delivered. At that point we couldn’t take having two cribs in the house in case things took a turn for the worse, so we put off delivery until after 30 weeks when they would be more likely to survive even if Amanda did go into early labor.
At week 25 Amanda was admitted to the hospital as a matter of routine to administer a series of steroids and intravenous antibiotics, just in case. The antibiotics would help prevent infection, but were also known to delay premature labor, and scientists don’t know why, but it does. Maybe it only works due to how the numbers are crunched, but we were willing to try anything that could be thought to help as long as it didn’t do any harm.
The steroids are for the babies. They speed up lung development in case they’re born early. Most of the benefit occurs within the first 24 to 48 hours, but studies show that there may be longer-lasting benefits for weeks after. There are two rounds spaced apart by 24 hours, in two courses – one at 25 weeks and then another 24 to 48 hours before Amanda would go into labor. How good are doctors at predicting when a woman will go into labor? Not very. But we’ll get to that.
While she was there they’d monitor the babies a few times a day with a doppler ultrasound machine, which were these plastic circles attached to straps that went around her back and had to be placed as specific angles to read the babies’ heartbeats. Sometimes the two rates would synchronize and it meant that both monitors were reading the same baby, same heartbeat. Some nurses were especially bad at setting it up for two heartbeats. I got to be pretty good at it. Of course as soon as you’d lock onto one the other baby would shift and it would stop reading. It was somewhat comical, our little rascals wiggling around in there.
So Amanda was in the hospital for the better part of a week, and after seeing her in there for a day I went back to the office (at first secluded in a room and wearing a mask whenever going to and from, and then once Amanda got the green light to matriculate back into society we both were able to go out into the world again, which we did cautiously). After testing to see if there was any fluid leaking, and a swab didn’t show any ferning, Amanda was discharged and the OB appointments continued like any other pregnancy.
Those weeks after week 25 were still scary because we still didn’t know what would happen, but at least after passing that milestone we knew they had a much better chance even if Amanda’s water did break again and they were born prematurely. The entire pregnancy was like walking out onto a frozen lake, knowing that the ice was thin, and just not being sure if the next step would be the one where you broke through the ice. We just hoped when (not if) we did, we’d be closer to shore.
Around 4am on Wednesday, May 8, 2013 Amanda called me from the bathroom. She was leaking again, at 32 weeks. We called the doctor, rushed down to the labor & delivery triage, and they saw us right away. The trip to the hospital wasn’t anything like I pictured it would be. Mostly we were quiet. It was so early that the roads were empty.
They took Amanda back and made me wait in the waiting room so they could ask her questions about whether she feels safe at home. She later told me that she kept asking for me, but they had a checklist of things they first had to ask her. When they finally called me there were at least half a dozen people around her. Amanda was crying and there was blood on the gurney, Amanda’s gown, and even on the floor. The fluid was indeed amniotic and the blood was from her cervix dilating. They brought us down to a labor & delivery room in case the babies were coming soon.
While we waited they gave Amanda the second course of steroids in case the babies were born within 24–48 hours.
They put a doppler ultrasound around her belly again and didn’t see any signs of contractions. They planned to move us into an antepartum room to wait until Amanda started to go into active labor, so I went home later in the afternoon to grab some things for her since we still should’ve been two months out from having the babies so we never got around to packing a bag and leaving it in the car.
We waited around for two more days in antepartum with the baby heart rate monitors strapped to Amanda’s belly the whole time. Sometimes an alarm would sound because the babies’ would “decel” meaning that their heart rates decelerated, which is usually a sign of contractions (the uterine muscles contract, the babies slow their breathing for a bit in anticipation of being born). They’d move Amanda around and they’d come back up again.
A decel would mean every nurse on duty would rush into the room and flip on the lights shouting and moving Amanda, and usually happened when we were both sleeping (I certainly don’t miss sleeping in hospital recliners), startling us both awake. It was more preparation for having babies than we realized at the time.
In any case, by Friday afternoon they didn’t think Amanda was going to go into labor anytime soon, but her OB wanted to keep her in the hospital now for the duration of the pregnancy. I planned to go back to work on Monday and just come to visit her at work every night.
The hospital had a special “date night” meal for patients and their guests on Friday nights, and we enjoyed a romantic hospital dinner together while wondering how long we’d be able to keep our two little buns in the oven. Every week meant more development, a better chance of their ability to thrive in the inhospitable world outside the womb.
Sometime after midnight the babies decelled again but this time instead of watching the monitor return to normal and then leaving, the nurses had me pack up everything and moved us to a little room full of equipment in labor & delivery a few twisty corridors away.
No one said anything about Amanda going into labor, but two hours after we got there Amanda started to have excruciating pain, mostly in her back. A doctor or a nurse would check-in once an hour, but we mostly just waited together in that little room. Amanda moved to a chair so she’d be more comfortable, and eventually fell asleep a little.
We kept asking if she was going into labor and they said they didn’t know. Meanwhile the pain in her back was getting worse and worse. She was experiencing something I’d never heard of before: back labor. She didn’t feel contractions exactly but felt an increasing pain in her lower back that would surge and then fall off (but still hurt between surges) so we started timing those. They started to grow more frequent and it was clear that those were labor contractions.
After another shift change one of the doctor’s from our OB practice, the only doctor we’d seen only once previously, arrived to deliver the babies. It was time.
She asked if we wanted to do a natural birth or Cesarean section, with plusses and minuses for each. We wanted to do a natural birth, although because we had twins there was a possibility of a hybrid birth as well, with one being born naturally and the other requiring a C-section, depending on position, etc.
Just in case, they brought us into a large operating room with the brightest lights possible. There were at least fifty people present – including a full team of doctors, nurses, and assistants for mother and each baby. The NICU teams usually don’t come down until later, but they hung around waiting since the babies were so premature and they expected a very fast delivery.
Amanda was in labor for two and a half hours before the doctor called it and said we’d have to switch to a C-section. They kicked me out to do prep and I made smalltalk with the nurses and staff in the hallway while trying not to break down crying for fear of Amanda and the babies’ health while they gave her a spinal anesthetic to keep her immobile from the torso down.
They finally let me back in, and I sat behind a big curtain holding her hand while the doctor performed the surgery. Eleven minutes later our son Atlas was born, and a minute later Ezra came out screaming. As the babies were pulled out the doctor called to me so I could stand up and see them.
The day my sons were born was probably the second scariest and also happiest day of my life. Both boys were born eight weeks early and weighed around four pounds at birth. They were dark red and had tons of hair matted to their heads. Atlas had to be on an assisted respirator for about six hours, wearing a mask like Bane in The Dark Knight Rises. Ezra was in the NICU for four weeks and Atlas for five (which is a story for another time).
We were terrified for them before they were born, scared about their progress and survival while they were in the NICU, and frightened of breaking them when we first brought them home. I still have anxiety about them being okay, and sometimes wake up abruptly in the middle of the night and go check on them.
I still feel a little shell-shocked by the whole experience. Can you get Post-Traumatic Stress Disorder from a horrible pregnancy? I should probably talk to a professional about it. Sometimes I think I hear them crying when I’m at the office.
Seeing their adorable little smiling faces or hearing them baby-talk or laugh does alleviate a lot of my anxiety but that doesn’t stop me from checking-in several times a night to make sure they’re still breathing while they sleep, especially now that they can turn over and sleep on their stomachs.
So Many Babies
Having two babies sometimes feels like having ten. When they’re both crying it’s just total bedlam, and a baby’s cry has the tendency to feel as though it’s piercing through the center of your skull.
They’ve gone through phases over the past eight months of sleeping really well, and then not sleeping well. Or one would sleep well while the other didn’t, and then vice-versa. I don’t think we’ve slept well since Amanda got pregnant.
We had them both in the same crib for their first four months at home, as having them in your bedroom is said to reduce the risk of Sudden Infant Death Syndrome (SIDS) which is yet another thing to worry about. Basically I’m just never going to stop worrying.
Having babies is great, though, despite all of the horror and anxiety. They’re little people with preferences, personalities, and feelings, probably far more fully-realized than we usually give babies credit for having.
Against the odds, we made it through. We are the 2%. I don’t know if the prayers worked or we just got lucky, but either way we are truly blessed, and grateful for these boys each and every day. I hope I’m not doing irrevocable harm to their psyches when I tear-up sometimes while holding them.
We’re just now settling into a bit of routine with them, although I’m sure as soon as we get used to their current behavior they’ll hit another developmental milestone and everything will change again. Despite my body craving carbs and fat during one of the harshest Chicago winters in many years I’ve been slowly losing weight just by counting calories and recording everything I eat again. I’m sure the pace will pick up once I’m able to get more exercise.
At the very least, once the boys start to crawl and then walk I’ll be burning calories chasing after them.
Apologies if I offend anyone referring to “our” pregnancy and writing that “we” were pregnant – I fully acknowledge Amanda did most of the work – but we were in this together and while I couldn’t actually physically gestate our babies I was very much a part of this pregnancy in every other way. ↩
There’s a word that starts with an “M” and doesn’t end with a baby that we never utter in our house. ↩
I still have them both, although since the one had a little battery and LCD display it’s gone dark, but the chemical one that shows the blue stripes is still just as blue. ↩
Most complications in pregnancy that cause a major problem happen within the first trimester, or the first 12 weeks or so of pregnancy. ↩
Let’s not digress into a debate about any moral issues regarding abortion. We wanted to keep our babies, so abortion wasn’t an option. ↩
Fever, foul-smelling odor, and localized bloating. ↩
The ultrasound was hilarious – they drew little arrows for each baby pointing at their penis with the label “BOY” on it. ↩
The steroids definitely helped with their lung development – the doctor and nurses were actually surprised that Ezra was screaming at birth because usually a newborn’s lungs get cleared by the contractions squeezing the baby’s torso during birth, and they have to clear the lungs manually after a c-section. ↩
They’re already starting to crawl somewhat, with Ezra using his face to caterpillar himself across his crib, the floor, whatever. ↩
I don’t know why I can eat right and exercise throughout the Winter, Spring, and Summer, but Autumn always makes me crave more calories. Is it the increasingly colder temperatures? The lure of holiday baked goods and other unhealthy fare?
This particular Fall a number of various events have made it harder to eat right or get exercise. It’s the busy season at work so I’ve been spending more hours working. The shift to Standard Time means that it gets dark earlier. The weather has gotten cold very quickly, so I don’t take walks as much outside. My wife started a new job so I don’t have a couple of uninterrupted hours in the morning to walk on the treadmill while she’s sleeping anymore. Plus, there are a few other personal issues that have come up that take my time and attention away from Clean Livin’, or require me to eat & run more often.
I can come up with any number of reasons, but what it boils down to is that I’ve slipped. Luckily I have so many healthy habits that they haven’t all fallen by the wayside. I still weigh-in every day. I still record everything I eat (even the unhealthy, high-calorie foods).
How I Start To Slip
At first maybe I’ll grab some food on the run, or not calculate my caloric intake for dinner until the next day. Then maybe I miss recording a meal. Then miss recording a day. Then I get busy with other things and don’t do any research or writing for this site.
So far no matter when I’ve slipped a little (or a lot) I’ve still weighed-in. I think of all of my Clean Livin’ habits, weighing myself and then recording it are the easiest things to do. After four and a half years weigh-ins have become ingrained in my daily routine. Sometimes I forget to weigh in when my routine changes, but barring a day or so every few months where I don’t weigh-in, I have a solid record, and can at least see when I gain weight rather than lose or stay the same.
It’s hard to gauge gaining or losing weight when you weigh in every day, though, because you do go up and down even when you do everything right and are on a trend of losing weight. I think my threshold for thinking “Shit, I’ve got to do better” is going over a five pound mark. For instance, I was down as low as 254.4 a couple of weeks ago (so close to 250!) and then a few days ago weighed-in at 260.0, after going up and down a pound or so here or there for the past three weeks.
So that was a wake-up call. The hard truth is that losing weight takes conscious effort and attention. You have to think about it a lot more than you may want to, and stick to your daily budget most of the time. Sometimes it’s okay to go over budget, but not most of the time. When those indulgences become more frequent than eating right, you’re going to gain weight again. I don’t know about you, but I’ve worked too hard and come too far to backtrack now. Fuck that noise.
Back On Track
It’s not like I haven’t written about derailment or plateaus before. When it happens, no matter how many reasons I have no one to blame but myself. A slip can be just the kick in the pants you need to refocus your weight loss efforts, no matter how cold it is outside.
I’m not sure how long it’ll take me to lose the next ten pounds (some of those pounds… again) but I know it’s doable. I’ve done it for weeks, months, years now.
Losing weight may be harder as the weather grows colder, life gets busier, and habits slip by the wayside. Plan for weight loss to be slower then, but as long as you’re aware of the difficulty and consciously plan means and exercise, you can hunker-down and do it.
Update: Slipped on Posting Here, Too
Speaking of slipping, I originally had this post set to publish in late November and haven’t finished it until just now. Everything else still stands, and now that the holidays are over and I’m back to focusing on weight loss, updates should be more regular once again.
After trying numerous cioppino in San Francisco my wife and I decided to try our hand at making it at home.
You can prep the seafood while the vegetables are softening or the broth is cooking, so it comes together very easily.
- Prep Time: 10 minutes
- Cooking Time: 40 minutes
- Serves: 4–6, generously
- 1 large onion
- 1 red bell pepper
- 1–2 fresh diced tomatoes, or 3–4 roma plum tomatoes
- 1 clove garlic
- 1–2 jalapeños (optional, if you want it spicier, which you do)
Broth and Spices
- 2 cans crushed tomatoes
- 2 cups dry white wine
- 1–2 tsp crushed red pepper
- 2 tbsp salt
- 2 tsp smoked Spanish paprika
- 1 tsp turmeric
- 1 tsp cayenne pepper
- ground black pepper
- fresh basil leaves for garnish
- 1 pound jumbo shrimp, peeled and deveined
- 1 pound live mussels
- 1 pound small clams
- 1 pound sturdy white fish (cod is excellent)
- 1 can crab meat
- calamari rings
From what we gathered during our cioppino scouting trip, everyone who makes cioppino makes it a little differently. You can mix up various kinds of seafood, try other vegetables, change up the spices. It’s a very forgiving dish. Ours is an amalgam of the best cioppinos we’ve tried.
- Chop the onion, red bell pepper, and jalapeño if you like it spicy, and sautée on high in a tablespoon or two of olive oil in a large pot or dutch oven until the onions are translucent and the peppers have softened a bit.
While the vegetables are cooking, mince a lot of garlic and add it to the pot just long enough to brown it a little and give it that nice nutty flavor. Be careful not to burn the garlic. Stir often with a nice sturdy wooden spoon.
- Chop up the tomatoes and add them, along with two cans of crushed tomatoes to the pot or dutch oven. Add the dried and ground spices, saving the basil for the end.
- Simmer the broth for a while to cook the tomato sauce a bit. Once it’s nice and hot, and the color turns a little deeper red, add two cups (eh, about half a bottle) of a dry white wine. Don’t use cooking wine – use something you’d actually drink. You don’t have to go high-end, but the wine will contribute a lot of flavor to the finished product. I used a chardonnay from Napa, figuring I’d keep it local to the region.
The seafood will water-down the broth a little as it releases some liquid during cooking, so don’t worry about it thickening up as it cooks.
- While the broth is cooking, prepare your seafood. The market we bought our shellfish and seafood at didn’t have calamari, but they did have baby octopus, which I grilled before cutting up into the cioppino. It was the only misstep in this recipe, and I wouldn’t recommend adding it to the dish unless you really like rubbery baby octopus. It could be that I just didn’t cook it properly. I cut off the heads and discarded them (Amanda took a photo of the pile of heads).
- Cut up the white fish (the cod held up really well, and was the best thing in our cioppino), peel and devein the shrimp, and otherwise get the seafood ready to go. Add it to the pot, stirring it gently just to get it covered by the broth. Let it simmer on medium-low (so it’s not splashing or bubbling) for 15–20 minutes or until the mussels and clams have opened.
After simmering the seafood, dish into large bowls and garnish with fresh basil. Serve with some crusty garlic bread and a glass of wine (red or white, both go very well with cioppino).
My wife Amanda and I love to travel and walk around new places, eat new foods, and experience a bit of different culture (even if that culture is just a another region of the U.S.). This Fall we spent a week in San Francisco and its surrounds. One of our favorite regional dishes is a seafood stew called “cioppino.” It’s a spicy, tomato-based sauce that’s loaded with seafood (mostly shellfish), sometimes a few vegetables, but mostly fish. It’s delicious, there are a lot of variations, and it’s fairly low-calorie, especially if you split an entree portion of it with someone, as my wife and I tend to do.
Did I mention variations? All of the cioppinos we’ve had have had mussels and some kind of white fish (although one replaced the white fish with salmon which was also excellent). Most have clams and shrimp. A couple of them had calamari rings and crab. Most are served with garlic bread.
We had cioppino twice during our first time in the Bay Area together back in the Summer of 2009, at Tadich Grill (which claims to be the oldest restaurant in California), which was our first cioppino, and at the Fisherman’s Wharf Boudin restaurant, which was better. While it’s hard to compare our recently sampled dishes with those we tried three years ago, our second time around in San Francisco we wanted to plan better. This time we did some research to find out some of the best places in SFO to try cioppino, and we were not disappointed (although some were clearly better than others).
All in all, we tried five different cioppinos during our seven day stay. We ate the shit out of cioppino.
1199 Valencia Street
San Francisco, CA 94110
Cioppino price: $19
This unassuming bistro in the heart of The Mission featured the best cioppino of our trip. Beretta features great craft cocktails, Italian small plates, salads, bruschetta, and pizza. They only offer one entree per day. On Tuesday (at least when we went) their offering is cioppino. Because of that, and based on reviews that claimed it the best cioppino in San Francisco (which thus means best anywhere), we made a special trip.
Where Beretta excelled was in their broth, which was spicier (not spicy hot, just nicely spiced) and more delicious than any of the others we had. They added some fresh basil at the end which was unique to Beretta’s cioppino. Sure, they had mussels like every other cioppino, but they also added calamari which was a great addition. The portion size was average (i.e. a large two quart bowl) and Amanda and I split it, along with a panzanella salad.
552 Green Street
San Francisco, CA 94133
Cioppino price: $38 (enough for two)
Sotto Mare is a charming little neighborhood Italian restaurant in the North Beach section of San Francisco. We went on a Thursday night and it was packed with locals and tourists alike. While we waited for a table the hostess offered us a glass of house white or red wine, which we accepted and enjoyed while waiting for our table, which turned out to be at the counter.
We ate our last cioppino this trip at Sotto Mare and it was either first or second best, depending on what you mean by “best.” While Beretta had the tastiest broth, Sotto Mare wins by just the sheer volume of seafood. Their “enough for two” crab cioppino arrived in a massive silver soup cauldron and must’ve contained a couple pounds of shellfish.
They call theirs “The ‘Best Damn Crab Cioppino’ with seafood” and they’re not just boasting. Our cioppino did indeed contain an entire crab, chopped up, and pre-cracked so we shouldn’t have to use a cracker to pop the shell.
We sat at the counter by the kitchen where we enjoyed dinner and a show, although it was very very hot there. Still, the festive atmosphere, watching the waitstaff abuse the happy-go-lucky cooks who laughed as they were being yelled at, and the happy slurps of our fellow diners, most of whom were also eating cioppino, was worth the trip.
Follow up cioppino with a cappuccino and a cannoli at one of the classic cafes in North Beach afterwards (if you can eat another bite after stuffing two pounds of shellfish down your gullet) and browse through the stacks at the City Lights bookstore. It’s all very romantic.
1 Al Scoma Way
San Francisco, CA 94133
Cioppino price: $39
Scoma’s at Fisherman’s Wharf offers what they call the “Lazy Man’s Cioppino” because most of the fish has already been shelled for you. They offer the recipe on their web site (although you may want to make my cioppino recipe, coming soon, instead, as it was better). Scoma’s was the most touristy of places we tried, but what do you expect, they’re located at Fisherman’s Wharf, the most touristy of San Francisco locations.
Scoma’s cioppino is very good (as it should be, they’ve been serving it for years) but at $20 more expensive than Beretta for a similar portion, it feels like you’re paying for the location (and we didn’t even get to sit at a table overlooking the bay).
Sam’s Anchor Cafe
27 Main Street
Belvedere Tiburon, CA 94920
Cioppino price: $26
Sam’s was the worst cioppino of our trip, and it was still really good, so we did pretty well. It wasn’t on our list of the best cioppinos in San Francisco – we just happened to be visiting Tiburon via the ferry and it looked like a nice place to stop and have lunch (although our waitress said that their cioppino has been featured on the Food Network – twice). The price for the lunch portion of cioppino was the same as their dinner menu, so maybe it’s the same exact dish. It was an ample amount for one person.
Their menu claims it includes “dungeness crab, clams, prawns, mussels, fresh fish, in a spicy tomato broth” but there wasn’t much crab (although it does tend to disintegrate in the broth).
Of all of the restaurants we visited to try cioppino, Sam’s had the best view.
It’s nice to take a ferry somewhere – Tiburon, Sausalito, Larkspur, Angel Island – and just get out on the bay. Tiburon was a cute, relaxed place to visit and walk around. It’s not as crassly commercial as Sausalito, but then there’s not as much to see either, unless you’re into natural beauty.
2362 Market Street (between 16th St & 17th St)
San Francisco, CA 94114
Cioppino price: $22
Catch in the Castro is a lively upscale seafood place that technically doesn’t offer cioppino, but instead has a “seafood stew” that just so happens to resemble cioppino in most ways.
We ate our first cioppino this trip at Catch (after seeing Vertigo in the historic Castro Theater, which was awesome). Catch’s version is very good, although by the end of the trip I think this one ranked second to last.
Their cioppino includes – aside from the usual tomato broth – mussels, clams, shrimp, scallops, crab, and some sort of white fish. It was very tasty, and the broth was a little more interesting than all but Beretta’s (although the chorizo broth that accompanied the mussels appetizer was so good we couldn’t stop drinking it).
Cioppino is such a simple dish, inspired by the Italian fisherman that settled in San Francisco, lived in North Beach, and shaped the local cuisine.
It’s easy enough to make at home, and I foresee cioppino being a regular staple of our weekend dinners.
I like to listen to podcasts and audiobooks from Audible.com while commuting to and from work. I can catch up on tech punditry, learn more about a subject in which I’m interested, or just listen to funny people being funny. Sometimes it’s just nice to hear an author reading their own words (although there are a lot of great audiobooks read by voice actors).
Beginning with this very post, I’ll be publishing an audio version of each blog post on Clean Livin’. Rather than putting out a supplemental podcast, these audio blog entries will be like the audio book version of this blog, for those on the go, or the blind or sight impaired. You’ll get to hear me stammer through what I’ve written. Maybe from time to time I’ll sneak some extra content or commentary into the audio version, especially for older posts.
Over the next few months I’ll fill-in previously published posts with their audio versions, working backwards until I reach the beginning. If you want to listen to them as they’re published, you can subscribe to the podcast feed, stream or download each episode right here on Clean Livin’, or subscribe via iTunes.