neural tube defect

This is a slight variation of a neural tube defect known as iniencephaly in which there is lack of proper formation of occipital bones with a short neck and defect of the upper cord. The head is tilted back. The most common outcome of this condition is a stillbirth, although rarely live births do occur. In these rare cases the infants invariably die after a short period of time (typically only a couple of hours). 

Empty

I decided to try my hand at Grey’s fanfic. Here’s something I wrote for the following anonymous prompt on @omeliafics:

“Set after 14x08, the little boy dies from the heparin, Amelia feels responsible cuz she told Alexa to chance it. She relates it to feeling responsible about her baby’s death. Owen is there to comfort her and finally gets why she’s so scared of having more children”

I think I strayed just a tiny bit from the prompt, so I apologize to whoever wrote this prompt. As the fic started to take shape, it went in a slightly different direction, and I just sort of went with it. Please be patient with me as I’m new to Tumblr, I’ve never written any Grey’s fanfiction before, and I’ve never really been much of a writer.

Empty

Empty. Everything was empty right now. The darkened on-call room Amelia was sitting in was empty. The coffee cup she had been staring at for the past hour was empty. The room that just this morning had been filled with the chatter of Frankie and his mother as they watched Doc McStuffins together was now empty, the sheets stripped from the bed and the name and vital signs erased from the whiteboard by the door. And Amelia herself felt so empty as she stared at that coffee cup, unable to do anything productive, but unable to go to sleep on one of the old bunks in the on-call room.

If she laid down and closed her eyes, she would see that little boy’s sweet face. She would see his smile and hear his voice talking to his mother about how obvious it was that she wanted to date Dr. Alex. She couldn’t bear to see that face and hear that voice. The guilt that was consuming her, leaving her empty and hollow, was enough to deal with by itself without the image of his face burned onto the backs of her eyelids, assaulting her mind as she tried to sleep.

So here she sat, staring at the empty coffee cup in front of her and willing something, anything to take her mind off of the death of sweet little Frankie. The death that she had caused.

Amelia looked toward the door as she heard it open. She could tell that Owen must not have heard about Frankie because he just shot her a passing glance as he strode across the room to one of the bunks, asking over his shoulder, “Are you about ready to take a nap too?” Amelia opened her mouth to respond, but the words caught in her throat, and she was left staring at his back, willing herself to say something. Or do something. Willing anything to happen that would break the painful emptiness of the last hour.

“What happened?” Owen asked, his head tilting in that way it tended to as he turned back to look at her.

“I, um,” she choked out, “It’s just been a long day.”

“Amelia,” Owen sighed, drawing out the syllables of her name. “You know you can talk to me about anything anytime. That hasn’t changed.”

Amelia stared at him for a few moments, simultaneously trying to decide if she was ready to address this problem out loud and if she was ready to have the most substantive conversation she had had with Owen since their separation. At this point, she figured she might as well. She couldn’t really feel any worse than she was already feeling right now. “Did you hear about Frankie, Alex’s patient with the AVM?” she whispered.

“Oh yeah, he’s having surgery tomorrow, isn’t he?” Owen asked.

“No he’s not because he’s dead,” Amelia bit out. Owen reflexively flinched, but he quickly caught himself and recovered. He shouldn’t have been surprised. This was Amelia. She never minced words. Her next words, though, truly did catch him off guard. “I killed him,” she whispered.

Owen’s mouth fell open a little bit, and then his legs were moving before he even realized it, carrying him over to the bed where Amelia sat. Amelia didn’t move as Owen sat down beside her. “Amelia, I’m sure you didn’t…” he began, but he was quickly cut off.

“No Owen,” she said forcefully, speaking louder than she had in hours. “He had Factor V Leiden, so he was on anticoagulation. He came to the hospital for vitamin K to reverse the anticoagulation before the surgery. He started vomiting and complaining of a severe headache, but we didn’t have his records, so we couldn’t see if he’d gotten the vitamin K. Alex came to talk to me, and I told him to give Frankie heparin. He hadn’t gotten any vitamin K, and he had a massive brain hemorrhage. I killed that boy, Owen.”

Owen’s heart clenched as he tried to think of something to say. He thought of the times a patient had died because of a decision he had made, and he knew there was nothing that was going to take her pain away, but he struggled to come up with something to say to help her through this. “Amelia,” he began, “you are the most brilliant neurosurgeon I know. This kid had the best possible care out there. You made a decision based on what you knew, using your knowledge to do the best you could to give him a chance at life. Sometimes we do everything we can and it still falls apart on us. It hurts like hell, but it doesn’t make you less of a surgeon. You didn’t kill him.”

“But what if I didn’t think like a neurosurgeon?” she whispered.

“Excuse me?” Owen asked, struggling to follow her train of thought.

“The choice to give him that heparin without knowing if he had gotten the vitamin K was not the choice of a neurosurgeon, Owen,” she explained. “That dose of heparin was not part of stroke protocol.”

“The system was down, you had no way of knowing,” Owen began to argue, but Amelia cut him off.

“No, Owen,” she said, her voice once again gaining confidence. “Stroke protocol states that you don’t treat a patient for ischemic stroke without confirmation that it’s not hemorrhagic. I knew that the CT was inconclusive. I knew that we were unsure if the anticoagulation had been reversed or not. I knew that giving the heparin was against protocol, but I chose to do it anyway. I could feed you some line about how protocols aren’t foolproof and I used my best medical judgment to do what we could with what we had, but that would be a lie. The truth is that, in that moment, I thought like the woman who spent weeks knowing that she had a baby growing inside her that had no brain. During those weeks, every time I looked in the mirror I wished that there was something we could try. I wouldn’t have cared if it had been a gamble. Having the opportunity to try something would have been far better than weeks of knowing that he was going to die regardless of what I did. So today, when I saw that little boy vomiting and crying, I knew that I was supposed to wait until I could confirm that his anticoagulation had been reversed, but I couldn’t. I couldn’t just let that boy suffer and die. So I chose to gamble, and it cost Frankie his life.”

By this point, tears were rolling freely down Amelia’s cheeks. As Owen reached out to brush the tears from her cheeks, he struggled to make sense of the sea of emotions swirling through him. He was devastated for Amelia. He would do anything to take away the pain of today, the pain of the death of her son, and all of the pain that seemed to find her in every season of her life. He was also shocked to have heard the words that had just come out of her mouth. In all the months of their marriage, he could not recall a single conversation that was as honest and emotionally raw as the one they were having now. Finally, he was grateful to her for trusting him with her pain, doubts, and guilt. He knew Amelia was a professional at hiding all of these things, and he was honored that she had chosen to share all of this with him, even in the place they were currently at in their relationship.

Owen wrapped his arms around Amelia, pulling her head into his chest much like he had the night she had met Penny at the dinner party. “Oh, Amelia,” he whispered, closing his eyes and struggling to come up with anything else to say.

Amelia sniffled into Owen’s chest for a few more minutes before breaking the silence. “Children are so beautiful and innocent and perfect,” she whispered. “The world is too cruel for them. My world is too cruel for them. Every child who comes into my world is broken by this cruelty. I am terrified of bringing another child into my world just so he can have his life shattered by a neural tube defect or a computer virus.”

As Amelia spoke, Owen felt the tears begin to well in his own eyes. For the first time, he thought he was beginning to understand why Amelia hadn’t wanted children after that negative pregnancy test. His heart broke for Amelia and for the tiny little boy who had only gotten to experience the beauty and depth of Amelia’s love for 43 minutes.

Amelia felt one of Owen’s tears run down onto her forehead, and her heart clenched. Here they were, sitting in a dark on-call room with tears streaming down their faces and no rings on their left hands, but finally beginning to pick up the pieces from the mess of their conflict about having children. As Amelia glanced down at the coffee cup that she had dropped onto the ground a while ago, she thought that she still felt pretty empty, but she was oddly at peace with it now. Perhaps one has to be emptied in order to be healed and filled again.

2

Anencephaly is a serious birth defect in which a baby is born without parts of the brain and skull. It is a type of neural tube defect (NTD). These are birth defects that happen during the first month of pregnancy, usually before a woman knows she is pregnant. As the neural tube forms and closes, it helps form the baby’s brain and skull (upper part of the neural tube), spinal cord, and back bones (lower part of the neural tube).

Anencephaly happens if the upper part of the neural tube does not close all the way. This often results in a baby being born without the front part of the brain (forebrain) and the thinking and coordinating part of the brain (cerebrum). The remaining parts of the brain are often not covered by bone or skin.

Almost all babies born with anencephaly will die shortly after birth. CDC estimates that each year, about 1 in every 4,859 babies in the United States will be born with anencephaly

Molecule of the Day: Folic acid

Folic acid (C19H19N7O6), also known as Vitamin B9, is a yellow powder that is insoluble in water under standard conditions. It is essential to metabolism and cell division, and is found in many fruits and vegetables.

Folic acid (in the form of tetrahydrofolate [THF], a metabolite) plays an integral role in methylation and other metabolic reactions by carrying one-carbon groups that react with other substrates. Additionally, it also is a key intermediate in the synthesis of purines and hence DNA via N10-formyl-THF (see diagram below).

It is also essential in the process of cell division, since the methylation and demethylation of DNA, which controls gene expression, and the synthesis of nitrogenous bases, which is required for DNA replication, are absolutely key to this process. 

Folic acid is commonly found as a food additive, as it lowers the probability of neural tube defects occurring in pregnant women. These are characterised by openings in the spinal cord or brain which fail to close during pregnancy, and can result in the death of the foetus. Hence, the fortification of cereal grains and other foods with folic acid is mandated by many governments.

The inhibition of dihydropteroate synthase, an enzyme that synthesises tetrahydrofolate, is one of the key mechanisms that antibacterial agents can target. Sulfonamides, which are similar in structure to 4-aminobenzoic acid, the natural substrate, are reversible inhibitors of the enzyme. As a result, insufficient folic acid is produced in bacteria, and they either stop dividing or die. 

This makes sulfonamides seem dangerous - wouldn’t this affect human cells as well? However, bacterial cells produce their own folic acid, whereas human cells do not; instead, we absorb it from our diet, while bacterial cells lack the ability to do so. As a result, sulfonamides selectively kill bacterial cells, leaving our cells intact and healthy.

anonymous asked:

I say this because I don't want bad advice out in the world, but being strictly vegan while pregnant is a bad idea, especially for your baby. You need to take supplements for vitamin B12, calcium, iron, folic acid, and protein. You can get calcium from kale and protein from nuts and/or soy, but it's likely to not be enough. Also, you just shouldn't consume soy while pregnant. It messes with hormones, especially for males.

When embarking on such a journey as parenthood, mothers and fathers need to ensure they are informed and aware of both baby and mother’s nutritional needs. Research must be done, books read and eating plans formulated. 

A most recommended vegan pregnancy book, written by mothers with successful pregnancies, births and healthy children is ‘Pregnancy, Children, and the Vegan Diet’ by Dr. Klaper. Another recommended by the Vegan Society is ‘Raising Your Vegan Infant - With Confidence’ by dietician Sandra Hood.

Dr. McDougall also published an informative newsletter about vegan pregnancy, including a part on morning sickness. What I found most fascinating in the newsletter was the research on how most morning sickness is related to meat, fish, poultry, and eggs and that morning sickness is effectively the body’s tool to remove food that is harmful to the mother and child. Dr. McDougall notes that societies with less of a focus on eating animal products have less instances of morning sickness. He also talks about prenatal vitamins, omega-3s, and more.

In their 5th Edition (2004) of the Pediatric Nutrition Handbook, the American Academy of Pediatrics says:

Children exhibit good growth and thrive on most lacto-ovo vegetarian and vegan diets when they are well planned and supplemented appropriately. (Chapter 12: Nutrition Aspects of Vegetarian Diets, p. 194)

In their 2009 Position Paper, Vegetarian Diets, the American Dietetic Association and Dietitians of Canada state:

Well-planned vegan, lacto-vegetarian, and lacto-ovo-vegetarian diets are appropriate for all stages of the life cycle, including pregnancy and lactation. Appropriately planned vegan, lacto-vegetarian, and lacto-ovo-vegetarian diets satisfy nutrient needs of infants, children, and adolescents and promote normal growth.

As of 2003 the American Dietetic Association and Dietitians of Canada considered well-planned vegan diets “appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood and adolescence.”[133] 

Nutrients

To make certain that you are getting adequate nutrition, pay particular attention to the following nutrients.

Calcium: The Dietary Reference Intake (DRI) for calcium during pregnancy is the same as before pregnancy, 1000 mg/day for women ages 19-50,2 due in part to increased maternal calcium absorption.

Just as it was before pregnancy, getting enough calcium on a vegetarian diet is easy. In fact, calcium absorption from plant foods is often superior to that of dairy products.3 Good sources of calcium include tofu and soy beans, dark green leafy vegetables, bok choy, broccoli, beans, figs, sunflower seeds, tahini, almond butter, calcium-fortified nondairy milk, and calcium-fortified cereals and juices. If these foods are included in the diet every day, calcium needs are easily met.

Essential fatty acids: Alpha-linolenic acid (ALA) is an essential fatty acid and an important component of the diet. ALA converts in the body into omega-3 fatty acids (DHA and EPA).

The Institute of Medicine has set the adequate intake (AI) for ALA at 1.1 g/day for women ages 19-50 and 1.4 g/day during pregnancy.1 ALA can be found in a number of vegetarian foods. Flaxseeds and flaxseed oil are the most concentrated sources; however, ALA is also found in canola and walnut oils, walnuts, and soybeans.

An important factor in essential fatty acid status for vegetarians is the ratio of omega-6 to omega-3 fatty acids. The World Health Organization recommends a ratio of 5:1 to 10:1 for proper conversion of ALA into DHA and EPA.4 The lower the ratio of omega-6 to omega-3 fatty acids, the better the conversion. Omega-6 fatty acids are found in seeds, nuts, grains, legumes, and green leafy vegetables, as well as in high concentrations in certain vegetable oils (corn, soybean, safflower, cottonseed, sesame, and sunflower).

The fatty acid that is often discussed regarding vegetarian pregnancy is DHA. DHA has been shown to be lower in the plasma and umbilical cord of babies born to vegetarian mothers.5 Since vegetarians don’t consume any preformed DHA in the diet, they must convert it from ALA. It certainly is possible to meet omega-3 fatty acid needs on the vegetarian diet by consuming enough sources of ALA, balanced by not having too many omega-6 fatty acids. However, if a vegetarian woman is concerned about DHA, microalgae-based supplements are available, marketed under the name Neuromins.

Folate: Folate, or folic acid, is necessary to help prevent neural tube defects and serves other functions as well. Folate is especially important in the first weeks of pregnancy, and it is therefore important that all women of childbearing age get adequate amounts daily. As its name (derived from the word “foliage”) implies, its natural source is leafy greens. Legumes are also rich in folate. Because diets can be erratic, it is prudent to take a multiple vitamin or other supplement that provides at least 400 μg/day. Many breakfast cereals and other grain products are now fortified with folate. During pregnancy, 600 μg/day of folate is needed.6

Iron: Iron needs increase during pregnancy to aid in the development of the fetus and placenta and to maintain increased maternal blood volume. The DRI for women ages 19-50 is 18 mg/day, increasing to 27 mg/day during pregnancy.7 Iron needs may be greater for those on a vegetarian diet because of less efficient absorption of iron from nonanimal sources.8 Iron supplements (or prenatal vitamins containing iron) are often prescribed for women on any kind of diet, as it is difficult for any woman to meet increased needs through diet alone.

Vegetarian women should include iron-rich plant foods daily, in addition to taking their prescribed vitamins or supplements. Iron supplements should not be taken at the same time as tea, coffee, or calcium supplements. Dairy products decrease iron absorption and should be avoided. Iron sources include whole and enriched grains, legumes, nuts, seeds, dark green vegetables, dried fruit, and blackstrap molasses. Including vitamin C-rich foods at meals can increase absorption of iron from these sources.

Protein: The DRI for women ages 19-50 is 46 g/day, increasing to 71 g/day during the second and third trimesters of pregnancy (25 grams more than pre-pregnancy needs).1 This is a greater increase than previously recommended; however, it is still easy to meet these protein needs on a vegetarian diet. DRIs are intended to cover the needs for 97.5 percent of the population, so actual needs for most individuals may be slightly lower than this.

Protein sources on a vegetarian diet include whole grains, beans and legumes, soy products, vegetables, and nuts and seeds. A balanced vegetarian diet, providing adequate calories and including these foods, will likely meet protein needs.9 The meal-planning chart above provides plenty of protein for pregnancy.

Vitamin B12: Vitamin B12 needs increase only slightly during pregnancy, increasing from 2.4 μg/day for women ages 19-50 to 2.6 μg/day during pregnancy.6 Vitamin B12 is found in fortified foods, such as fortified cereals, meat substitutes, nondairy milk, and nutritional yeast. Be certain to check the labels to find out which foods are fortified. Seaweed and foods like tempeh are generally not good sources of vitamin B12. To be sure of getting adequate B12, it is prudent to take a prenatal vitamin containing vitamin B12 or to take a vitamin B12 supplement.

Vitamin D: Although vitamin D needs during pregnancy are the same as before pregnancy (5 μg per day),2 it is important to both mother and baby to ensure adequate intake. Vitamin D is made in the body as the result of exposure to sunlight. For many people, 5 to 15 minutes per day of sun between the hours of 10 a.m. and 3 p.m. on the arms and legs or hands, face, and arms during the spring, the summer, and the fall is sufficient to meet vitamin D needs.10

This nutrient is poorly supplied in all diets unless people use foods that are fortified with it. Many brands of ready-to-eat cereals and nondairy milks are fortified with vitamin D. Pregnant women who don’t regularly spend time in the sun, live in northern latitudes, or have darker skin will want to be sure to include fortified foods in their diet. Many prenatal vitamins contain adequate amounts of vitamin D as well.

Zinc: Zinc needs increase during pregnancy. The DRI for women ages 19-50 is 8 mg/day and increases to 11 mg/day during pregnancy.7 Needs for women following a vegetarian diet may be higher, however, because of lower absorption of zinc on a plant-based diet.8

Zinc is often included in prenatal vitamins. In addition, zinc is found in legumes, nuts, whole grains, and cereals. Zinc absorption from plant-based sources can be increased by including sprouted grains, beans, or seeds and yeast-raised breads in the diet, soaking and cooking legumes, and combining zinc sources with acidic ingredients such as lemon juice or tomato sauce.

A note about dietary supplements: Your doctor may recommend a supplement to ensure you are meeting your vitamin/mineral needs. Most prenatal vitamins will be adequate to cover your needs. If you are interested in taking any additional dietary supplements, including herbal or botanical supplements, talk to your doctor. Many herbal supplements may not be safety for pregnancy.

I understand many women are different and I understand that supplements may be taken as well, but there are enough proof that if you eat right and you know what you’re doing you can have a healthy pregnancy. (Birth Stories).

And everybody knows I’m not a doctor, I provide information and advice and people should look for their current doctors and health professionals to double check always how they’re are and if they’re good to go. 

References:

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Anencephaly is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development. It is a cephalic disorder that results from a neural tube defect that occurs when the rostral (head) end of the neural tube fails to close, usually between the 23rd and 26th day following conception. it is accepted that children born with this disorder usually only lack a telencephalon, the largest part of the brain consisting mainly of the cerebral hemispheres, including the neocortex, which is responsible for cognition. The remaining structure is usually covered only by a thin layer of membrane— skin, bone, meninges, etc. are all lacking. With very few exceptions,infants with this disorder do not survive longer than a few hours or possibly days after their birth.

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