Sunday, February 12, 2017

Anonymous PBSC (Peripheral Blood Stem Cell) Bone Marrow Donation via Be The Match

If we are IG and/or Snapchat buds, you've likely been inundated with my copious after-school-special PSA stories / snaps about my experience as an anonymous bone marrow donor through the Be The Match Registry. If you're at all interested in the anonymous marrow donation process and are hankering for an honest donor testimony, you've come to the right place! {And, if you found my updates highly obnoxious or smug, hold onto your butts, because I'm not done yet.}

Every3min

Registering with Be The Match

I first registered with Be The Match in 2004.  On September 11, 2001, I was a college freshman, just 3 weeks into my first year at Wake Forest. Surrounded by strangers and feeling helpless, I started donating blood monthly at the American Red Cross.  I soon discovered whole blood donation made me feel like complete ass {I have low iron}, but I could donate platelets through apheresis {whole blood is taken out from a needle in one arm, spun through a centrifuge to separate platelets from the rest of your blood, platelets are collected, and the rest of your blood is returned through a needle in your other arm} with no issues.  Needles don't bother me so being hooked up to the machine for an hour was no big deal and I could donate more often. Through my involvement with the American Red Cross, I helped with a bone marrow registry drive on campus my junior year.

how marrow donation works_960x540px_v2.jpg

Back then, registering required a blood sample.  Now, anyone who is interested can order an at-home cheek swab through BeTheMatch.org. For registrants ages 18-44, the process is free of charge.  Interested persons between 44 and 60 years of age are welcome to register but will be asked to make a $100 donation.

Once you've registered, you wait! Just remember to update the registry whenever your contact information changes so you can be reached quickly if you are preliminarily matched!

The Preliminary Match

I sat on the registry for 10 years before I heard anything from Be The Match.  In June of 2014, I was contacted as a potential match for a woman in her 60s living in the United States who was battling Acute Myeloid Leukemia {the patient's age, sex, specific blood cancer and whether s/he is domestic or international are the only pieces of information a donor receives about the recipient at the outset}. After confirming I was still interested in being a marrow donor, I was sent for a blood screen to determine if I was the best match for the patient {the registry often pulls up multiple potential matches for a particular patient; the transplant surgeon will ultimately determine who is the very best bet for donation after reviewing the blood screens}.  The blood screen occurred very quickly after the first call -- within the week. I also completed a super, super thorough phone interview regarding my health {get ready to answer A LOT of questions about your sexual history}. My coordinator also reviewed the two processes by which donation occurs {more on that later} and asked if I would be okay with either the PBSC donation or the traditional hip aspiration. While most people think of the hip aspiration when they think about marrow donation, the PBSC is actually more common by far nowadays {the aspiration is normally only requested for recipients under the age of 19 because the cells collected are more immature and align more perfectly with a child's biology}.  PBSC requires 5 days worth of filgrastim injections {again, more on that later} to mass produce white blood cells.  This is not a medication that can be taken when you are nursing, which I was at the time.  I was honest and told my coordinator I wasn't entirely sure I'd be willing to give up nursing {B was only 3 months old} at that point, but we decided to wait and see what the results of the screen were before crossing me out as a potential donor.

I was told the timeframe for the recipient's doctor to make a decision on the bloodwork would be anywhere between 30 and 60 days.  A month after my blood test, I was informed that I actually was the best match for the patient, but that the patient had decided not to go forward with the treatment. Potential donors are not given a concrete reason for why a patient makes this decision.  I still think about this woman and hope against hope she made a miraculous recovery thus negating the need for a transfer.

So, I went back on the registry and waited.  Two years to practically the day in June 2016, I received another call -- this time asking if I'd be willing to donate to a 59 year old man living in the States, also suffering from AML. I went through the exact same process again -- the long health interview {now with Zika and Ebola inquiries!} + the bloodwork.  About a month later, same result -- I was the best match for the patient, but he had decided not to pursue treatment.  I have no clue how this scenario stands in the odds game {but here's a general registry numbers breakdown for you, if you're interested}, but I definitely had a ton of mixed emotions after that second "rejection" call -- mostly, I just felt deeply for the patient, knowing what a horrible disease AML is and understanding that declining treatment usually doesn't happen for happy, healthy reasons.

Surprise! The Next Steps in Donation

To my dismay, my coordinator {coordinators are regional -- mine is located in Dallas} called me right before Christmas and said the patient I'd been matched with in June had a change in situation and was ready to attempt transfer!  At the time, I was 100% excited -- so happy this man still had a chance at treatment and so humbled to be able to be a part of that process for him.  During that same call, my coordinator told me the transplant surgeon was asking for PBSC donation.  {If you'd like to read about the alternative: hip aspiration, here's some info.}

Time Out: Peripheral Blood Stem Cell (PBSC) Donation:

The exact same cells found in bone marrow are also floating around in your blood like an immuno-charged lazy river.  PBSCs are collected through apheresis just like platelets -- whole blood comes out of one arm, PBSCs are separated in a centrifuge, the rest of your blood is injected back into the other arm... except this is platelet donation on crack.  Donors take a medication called filgrastim 4 days prior to the procedure as well as one last done the morning of; filgrastim stimulates your bones to mass produce white blood cells. The procedure itself can take up to 8 hours.  It might completed in one day or require an additional day of collection. Any bumps in the road can require a central line {yep, more on that later, too} or changing course to the hip aspiration.  Any procedure for the donor has to be perfectly timed with the recipient, who is taking massive doses of chemo in order to completely wipe out the entirety of his/her immune system.

Time In: My coordinator informed me the transplant team was aiming for a transfer date of February 6th or 13th.  Since my birthday is the 13th, we signed on for the 6th.  She FedExed me a massive stack of information and consent forms and gave me 3 weeks to look everything over before our big phone interview walking through all of the worst-case scenarios. Up to this point, I'd watched a bunch of donor testimonies and knew generally what to expect, but I hadn't done a ton of research on filgrastim. I knew most donors experienced bone aches, headaches, and very mild flu-like symptoms that disappeared very soon after donation. I wasn't aware that the most common {but still very uncommon} side effect is spleen enlargement / rupture... so I definitely asked a bunch of questions about that {my coordinator said they've never had a donor with a spleen rupture} and had a doctor friend assure me my spleen isn't actually terribly important.  Dosing healthy PBSC donors with filgrastim is an off-market use of the drug which was not all that concerning to me at this point in the process, but really bothered E. He was very much in the pragmatic "what if you take this drug while trying to do something good for someone else but end up with cancer yourself in 5 years because of it?" camp. I'll be completely honest -- I totally {and unfairly} dismissed his concerns.  I really never considered not donating, despite any risk, real or imagined.  I do wish we'd done more independent research together, because I definitely signed all those scary consent forms {and the very-worst-case-scenario life insurance policy} unilaterally without giving any pause to my loved ones' uncertainties.

Time Out: Long-Term Side Effects of Filgrastim:

Had we really delved deeply into research on filgrastim at this juncture, we wouldn't have found a ton of information on long-term side effects of taking the drug as a young, healthy PBSC donor. Filgrastim has been used for this purpose since 1999, and there is an ongoing study {that I am participating in}, but it won't be complete until 2022.  Currently, experts seem to agree a one-time use by an otherwise healthy individual *probably* doesn't increase or decrease that individual's likelihood of developing a related, life-threatening illness in the future.  But again, it hasn't been widely studied.  Here are three articles I found {after I started taking filgrastim and the side effects were more than I was anticipating and I had a minor-yet-intense internal panic attack} that were somewhat informative:

Risks for Healthy PBSC Donors? One Family's Powerful Experience

Long-Term Safety of Filgrastim Administration

A Response to the Article Above

I really do wish Be The Match would include articles such as these in their literature; obviously donors should do their own research, but I do feel like filgrastim was downplayed {once again... more on this later!}.  But, spoiler alert, if I had a do-over, I'd still go through the donor process again.

Time In: My other concern after reading the materials was the likelihood of central line placement. Be The Match stated 1 in 5 female donors necessitate a central line due to arm vein finickiness.  I read that a central line is a catheter placed in your jugular under local anesthesia.  Again, I feel like this description was downplayed.  I would have done a ton more research on this as a needle in my neck did not sound like a fun time to me, but my coordinator assured me we'd talk more about the central line if the doctor at my upcoming physical felt my veins might pose a problem. So, I pretty much tabled any further consideration of the central line, signed a million consent forms, and FedExed all my paperwork back.

Donor Physical & Follow-Ups

Next on my donor to-do list was a complete physical. {Note: Be The Match coordinators set all these appointments up for donors and everything is free of cost to the donor (your insurance won't even know these appointments are occurring).  I found all the scheduling to be very smooth, and my coordinator was very cognizant of my schedule.}  The physical included all the usual suspects {weight, height, blood pressure, medical history, etc} as well as a pregnancy test, a very thorough inspection of my veins, and 14 vials of blood drawn. The doctor seemed to think my veins would handle the procedure with no issues -- not shocking since I've never had problems before but still a relief {FORESHADOWING}.  This is the point where I officially put the central line out of my mind.

After the physical, it's mostly a waiting game until it's time to administer the filgrastim and actually donate {unless, I suppose, bloodwork comes back with some surprise communicable disease that disqualifies you as a donor... it was nice to get a full blood panel for free!}.  There was a mixup with my bloodwork -- apparently there were 3 additional vials that didn't get drawn so I popped over to a lab to get that squared away.  Also, they REALLY do not want their donors to be pregnant, so I took 2 more pregnancy tests {also blood draws}.  There is a lab super close to work, so I just did these 3 draws on my lunch break in about 20 minutes. When all was said and done, the donation process involved over 25 vials of blood drawn in addition to the actual donation.

Filgrastim Injections

2 weeks prior to donation, a styrofoam ice chest was couriered to my home.  I was told to confirm its receipt, take everything out of the ice chest, and put everything in the fridge -- which I did.  Now, here comes my big critique of Be The Match... I was never given an itemized list of what SHOULD be in the cooler or what was ACTUALLY in the cooler.  Everything was packed in multiple zip locks {some opaque} and it was super hard for me to determine what they'd actually sent me, but I wasn't concerned; I assumed everything was ticking along as it was supposed to. This became a massive, massive issue when my home health care nurse {also scheduled by my coordinator} showed up at 6 am on Thursday, February 6 to give me my first injection and discovered we didn't have the actual vials of medication {they are TINY}. We are not sure what happened {and I was asked several times if I could have thrown them away... NOPE}, but it was a Drama Llama Situation.  This is the point where I realized just how nuts filgrastim is -- it is classified as a chemotherapy drug {the courier who brought me the meds on Day 2 reminded me to "call my hospice coordinator" if I had any questions -- this is a drug normally given to very, very sick people}, is not something one can just pop on down to the pharmacy to replace, and costs over a thousand dollars per vial {and I was supposed to have been sent 12 vials}.  We did get it all worked out, but my experience with the administration of filgrastim was much more "lively" than most donors {my coordinator said she's never heard of this happening before, so, thankfully, my experience is extremely rare}. I am just so glad we discovered the issue so early in the morning, because a new single dose {3 vials} for Day 1 didn't arrive via courier until 3 pm.  Timing is everything with these donations so we were all so thankful I was able to receive the injections according to schedule.

The actual injections themselves are given in fat deposits.  I did two in the back of my arms {I knew those sausage arms would come in handy someday} but vastly preferred my love handles and FUPA -- more bruising but way less pinch. 2-3 injections per day for 4 days prior to the donation and then an additional 2 injections the morning of.  My kids found Shot Time enthralling -- I think they're bummed not to see their nurse friends this week.

Day 1 - I felt 100% normal.  This was E's birthday, and, despite all the drama, we enjoyed a really nice day together and then a super fabulous dinner out.  You are allowed to drink alcohol while taking filgrastim {although you won't feel like it after Day 1} but it can increase the intensity of the side effects the next day.

Day 2 - I felt "off" but not terrible, although I did get a bad headache that evening after receiving my second round of injections are 6 pm.  Donors may take Advil or Tylenol {no aspirin} and are encouraged to take Claritin {which decreases side effects for some magical, unknown reason}. E left before the rest of us woke up for a partnership retreat this day {Friday} so the kiddos and I flew solo.

Day 3 - This was the worst day for me by far. I had my injections in the morning so I think the side effects just compounded with two rounds being administered so closely together.  My spine, hips, neck, and ribs generally ached {this I was expecting} and I had a dull, unending headache... but the killer was the sudden, "bone-crunch-contractions."  These would come in waves and my ribs and spine would feel as if they were shattering.  I felt like a laboring mother -- each time they would hit, I'd have to stop and try to breathe through them; they definitely took my breath away. I was not expecting this reaction -- none of the donor testimonies had described these waves of pain. They weren't constant, so I wasn't incapacitated, but they were pretty shitty when they occurred. I took the kids to the trampoline park that morning since it was wet and cold outside, and we were all going to go crazy in our house, and this was the moment I started frantically Googling long-term side effects of filgrastim and began to have some crappy thoughts {the most prevalent being "I really hope this dude isn't a xenophobic, racist, sexist, MAGA fanatic}.  I'd say the morning of Day 3 was my lowest point.  I actually did feel better after a ton of Motrin, Claritin, and a nap -- good enough to celebrate E's birthday with my parents at dinner time.

Day 4 - I received my last at-home dose of filgrastim in the morning. I did not wait to take Motrin and Claritin this time -- I took it right when I got up and kept up with the Motrin every 6 hours. The waves of intense pain were still prevalent but I felt well when they weren't rolling through. We ran a few errands as a family, hit up the park, and did our grocery shopping.  I took another nap when the kids rested, and we watched the Super Bowl pre-game {#SISTERHOOD} before my ride to San Antonio arrived at 6 pm.


Donation Day

The apheresis center where I was to donate is located in San Antonio. I was a little surprised Be The Match doesn't have medical centers they contract with in Austin, but I'm always down for a trip to the Alamo City. Since I had to be hooked up to the machines at 7:30 am, BTM hired a driver to take me to San An the night before and booked me a room at the Embassy Suites.   My driver was the best -- he owns a company in Austin called The Cheap Ride {recommend!}.  Both of his parents died from blood cancers, and he does a ton of work with BTM in their honor.  He is also a 6th generation Austinite and a life-long democrat, so we had a ton to chat about.  I arrived at the hotel around 7:30 and settled in with the 2nd half of the Super Bowl and a cheesy movie on HBO.

The morning of donation, I passed on the hotel breakfast buffet and hitched a ride with Andres, the Embassy Suites shuttle driver, over to GenCure.  Andres' grandmother's AML was cured by an anonymous marrow donor 6 years prior -- I cannot tell you how serendipitous it felt to randomly get him as a driver and hear her story when he realized where he was taking me.

When I arrived at GenCure, I met Dot and Elloy -- the two nurses who would be taking care of me all day.  Elloy gave me my last 2 filgrastim injections and Dot got me all settled in my recliner.  No one else was in the apheresis center so we had a lot of fun chatting {Dot donated 12 years ago to a then-19 year old girl in London who is now living a completely healthy, normal life! She and Dot still exchange letters.} while the poking began. Elloy was an expert with veins and I was on the machine before I even knew it.  The first cannula - the "sucker outter" - is inserted into the crook of your elbow which you have to keep ram-rod straight for the entirety of the donation.  The second cannula - the "putter back inner" - is inserted into the side of your wrist so that you have movement in one arm. The movement capability is nice but that insertion is a bit of a bitch - lots of nerve endings!  The center had just received brand new apheresis machines, and the staff was super jazzed about them!  I was actually the very first donor to use them -- a virgin voyage!  As such, the center's PR staff came to take photos of me and the machine {I was not aware this would be happening; hopefully their intended audience appreciates my One Bad Mother t-shirt}.  BTM's PR guy also came to interview me on camera about my experience.  And my padre drove up to sit with me which was much, much, much appreciated -- especially later on.

The average apheresis PBSC donation takes 4-6 hours.  During this time, the entirety of your blood volume cycles through the machine FIVE TIME!  Insanity!  After 3.5 hours, I asked about using the restroom and was unhooked from the machine {I was told I might have to use a bed pan, so this was a fabulous turn of events... for the moment}.  Dot came in with me to make sure I kept my arm super straight {the cannulas remain in your arms}.  Once I got hooked back up, things started getting a little nutty.  The "sucker outter" canula was not sucking as much blood volume as the machine wanted, and Elloy fiddled around with the needled for a good 45 minutes {super unpleasant, but I am so thankful for his calm persistence} before trying to place it two more times.   My vein just wasn't cooperating.  We don't know if the vein was just irritated from 4 hours of stress or if the movement from the bathroom trip messed up with the super sensitive needle.  Regardless, my biggest piece of advice for donors is DON'T PEE.  Or, at the very least, wait until you absolutely can't stand it... and then make yourself wait 30 minutes longer.  This is the worst advice ever for bladder health, but a UTI would have been worth avoiding the ensuing dramatics.

At this point, we tried switching arms.  Elloy then spent another 30 minutes trying to get my blood pressure {which had dropped} high enough to pull from the new cannula.  It became clear it wasn't going to work and my care team started talking about other options... I was asked if I could come back the next day {of course, the answer was "yes, I could work that out if it's needed}, but also told the transplant surgeon might request a central line or the hip aspiration.  Having not thought about a central line in weeks and since hip aspiration had NEVER been on the table for me, this was pretty shocking.  I asked each care member which they'd prefer, if given the choice, and they each emphatically said the aspiration, which surprised me since the recovery time is pretty intense and it's a general anesthetic surgery.  Then they explained that the central line isn't just a needle in your neck {as I'd assumed} but a catheter that snakes all the way down into your heart, and that the chances of big-time bleeding are higher than most people are comfortable with {especially an otherwise healthy person}.  T-Pop was like HOLD THE PHONE, WHAT?!  And, I am slightly ashamed to admit I stopped feeling so giving at this particular moment.  At what point do the personal risks override the benefits to a stranger? But at the same time, how can you go this far and then say "nope! never mind!" to someone who is putting all their trust in you to follow-through?  NOT A FUN MOMENT.

The care team decided the best thing to do would be to sample the cells I'd already donated and see if there were enough to stop.  Elloy had told me I'd be donating about half of this big ol' collection bag and, eyeballing it, it looked somewhere between 1/3 and 1/2 full to me.  Everyone kept saying "well, it does look like it's probably enough"... but they'd also been a bit noncommittal about whether my white cell count from the labs that morning was as high as they'd like it to be so I was very nervous. We asked a lot of questions about the central line.  I tried to remember if either of the surgeries I had prior to my c-sections were completed under general anesthesia {pretty sure they were both "twilight sleep"}. I suggested perhaps we could give my leg veins a shot.  It was a really long 40 minutes.

Thankfully, the lab results came back and the transplant surgeon phoned in to say the cell count was sufficient for the patient.  This was a huge relief {especially looking back and knowing what my arms looked like the day after -- I am not sure trying the apheresis on Tuesday would have been a success} -- mostly because I was really concerned about upsetting the trajectory of the recipient's transplant, but, yes, #SelfishSallyAlert, I really did not want to make a quick decision about the central line vs. hip aspiration.

Since I'd already been unhooked, I was able to leave pretty much immediately -- after big hugs for Dot and Elloy and Vanessa {who was overseeing the procedure and brought me a delicious breakfast taco at the outset of the apheresis and was kind enough to pretend not to notice that I spilled salsa all over myself attempting to eat one handed}.  Dad and I hit the road before traffic and were home in time for a nap before supper -- it ended up being a much shorter day than anticipated.

Recovery

I felt pretty crappy immediately after the procedure -- I still had the sudden, bad bone "spasms" and I just felt really worn down and mildly nauseous.  I felt better after a nap, but hit the hay early that evening.  The next day {Tuesday}, I was operating at about 80% -- I felt generally well but still experienced the bone spasms when I'd get up out of a chair or change position suddenly.  I was fine working a full day at the office, but I bowed out of a neighborhood wine tasting that evening and went to bed early again.  Wednesday I was back at 90%, and Thursday I went to my 6:15 am Orangetheory class with no issues. One week out, my arms look like I belong in a battered women's shelter, but nothing hurts. Overall, recovery has been super smooth.

The Recipient

Updates on and contact with the recipient depend on the rules of his or her transplant center.  My recipient's center will provide 3 updates on his health throughout this first year, and then we are allowed to contact one another {if we both consent} one year after the date of donation.  I do know he received the transplant, and I am so hopeful it turns out to be a success and I get to hear from him one day.  I haven't been very prayerful this last decade and I'm not entirely sure who exactly is listening, but I think of and pray for this man every day. By receiving my cells, he is essentially receiving my entire immune system -- he will inherit my vaccinations, immunities {don't need to worry about that swine flu ever again!}, and even my allergies {watch out for bees!}.  He and I will be as genetically linked as siblings for the rest of our lives.  Science really is miraculous.

Ruminations on Anonymous Donation

I'm going to start with logistics and work my way down into the deep stuff.

1. There are a lot of needles involved. Kind of a "duh," but its something to keep in mind if needles make you squeamish. I've done a ton of platelet donation and acupuncture and I've had two babies via cesarean and needles don't phase me at all and it still felt like a lot of pokes.

2. I wish I'd taken more photos on the day of donation. It was one of those "I feel weird asking at the time; this isn't really about me" moments, but now I am really sad I don't have a photo of me with Dot and Elloy. And I wish I'd taken a video of the machine putting my blood through it's paces.

3. Be The Match generally works as a well-oiled machine but there is room for improvement. Specifically, I think it's absolutely nuts I wasn't given an itemized list of what was supposed to arrive in my first cooler of meds and then required to confirm the actual contents item by item.  The filgrastim drama could have been completely avoided this way.  I am just not sure why this isn't protocol considering what's at stake for the recipient and how expensive and hard to get a hold of the medication is.

4. Outside Research, Outside Research, OUTSIDE RESEARCH. Be The Match's website is very informative but it really only scratches the surface.  I know no one {including me!} wants to scare off potential donors, and I don't want to accuse anyone of downplaying certain things, but I think there could be more material given to donors about filgrastim, central lines, etc. No where in any of the materials I was given did it mention these crazy intense bone spasm pains {everything was all "mild flu-like aching"}, but when I mentioned it to my coordinator and the home health care nurses, they were all like "oh yes, that's normal - take an Advil." And if 1 in 5 women really do end up with a central line {or even end up seriously discussing a central line}, the fucking central line needs to be explained way better.  I should have taken more responsibility in doing my own research {I did some, but not a ton, and, as I mentioned, I was super defensive when E brought up legitimate concerns}.

5. This experience taught me so much about giving without reservation. The doctor who did my physical did not have my very favorite bedside manner.  She kept joking about donating anonymously, starting by saying she always assumed donors hoped they were donating to children. I told her I knew my recipient was a 59 year old man, and she responded "well, you just hope he's a nice grandfather and not some creep."  Then she asked me if I knew whether or not he was in jail.  {Please note: this doctor was NOT affiliated with BTM in any way and was actually not the doctor who was supposed to do my physical. I'm assuming the physician who normally performs the physicals has a much more thoughtful outlook on the process.}  Her callous comments really metaphorically smacked me on the back of the head -- and I stopped mentally assigning "positive" attributes to my recipient {"maybe he's similar to my dad -- with a spouse and kids and grandkids who love him!" "maybe we share a similar belief system!" "maybe he loves to travel!" "maybe he does important work!"} and started putting my proverbial money where my liberal-elite mouth is.  I do sincerely hope he is surrounded by a special people who love him and that he gets more time to do whatever it may be that he enjoys doing. But this man deserves more life to live simply because he is my fellow human -- not because of some litmus test of worthiness.  I keep describing this experience as humbling -- yes it feels good to put some good out there in the world {especially this particular world we're living in at the present}, but it also makes you aware of just how tenuous and interconnected our lives really are. If I teach my children anything about giving {or really about living life in general}, let it be: if a need arises and you are able, fill it without the expectation of gratitude, strings attached or reservations assigned.

Phew.  That feels like a good place to end.  Please feel free to leave any questions in the comment section or shoot me an email.  I would be a first-time donor again in a heartbeat. And I hope you'll consider registering to do the same!

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Thursday, January 19, 2017

Day in the Life: Winter 2017

Nothing like a DitL to get back into the blogging routine {is something I've likely said for the past 3 DitLs...}. As always, big kudos to Julia for steering this link-up ship!

DitL Winter 2017: Tuesday, January 17

I am less than one month out from 34.
E has 2 weeks until 35.
L will be 5 in 34 days.
B is 2.5.
Boom is 10.5.

6 am - Alarm goes off.  I tap Snooze. I usually take the 6:15 3G Orange Theory class on Tuesdays, but E had a super early flight this morning so I'm holding down the fort.  Semi-recall him getting out of bed about an hour ago.  Mentally fist-bump L's immune system for No Night Terrors last night -- She has horrible seasonal allergies and any medicine we've tried triggers them.  Even without meds, she sometimes gets them as a side effect of her body battling allergens.  Damn you, cedar!  I check my email in bed and respond to a friend whose dinnertime playdate we will attend this evening. Press Play on a MFM episode I started yesterday. I check the weather and it appears as though there might be some scattered showers but the high will be close to 60 degrees.  Mentally prepare myself for a clothing battle with B, who is sure to leave us for Southern California at the first opportunity so that he may wear shorts and t-shirts year-round. I get up, shower, brush teeth, slap on some clothes {I'm really pushing the Leggings as Acceptable Business-Cas Pants envelope lately} and makeup.

 I head downstairs to let Boom out and take the recycle and trash to the curb.  There is a pile of recycling from earlier in the week that accidentally got left out during the past 3 days of rain and it disintegrating behind our fence... I conveniently ignore that since I'm already in work clothes. Maybe it will compost itself by magic. I prep the cold brew coffee, pack lunches for the kids (crackers, turkey pepperoni, cheese cubes, berries, carrots + yogurt) and myself (quinoa, tomatoes, avocado + Tessamae's spicy ranch dressing), and "organize" the dirty dishes in the sink to make myself feel better for neglecting the not-yet-unloaded dishwasher.  I head back upstairs for a quick blow-dry.

7:11 am - B is singing "I've been working on the railroad."  I go in to get him and he immediately asks if he can wear shorts and is none too happy with my insistence on pants.  Negotiations ensue and we settle on pants (which he promptly rolls up to his knee for make-shift shorts) with a tee shirt --> Condition Precedent: No arguments about wearing his hoodie when we leave. L comes out of her room and immediately starts asking questions about Moana (which we saw yesterday). 
L gets dressed and brushes her teeth while B reads us Rudolph that I've failed to put away with the rest of our Christmas books.  We head downstairs; kiddos put their own PJs in the hamper by the washer.  There is drama over B's breakfast (I want waffle! No - can-cakes! No - waffle! NO - CAN-CAKES!) -- He throws a Lego tower in protest of my executive decision to warm up pancakes for him.  Gummy vitamin bribes and threats to put him in a long sleeved shirt result in Lego clean-up and enjoyment of breakfast carbs.
In total, 3 waffles and 8 mini pancakes are consumed by my offspring; I eat coconut yogurt with blackberries and pecans. We listen to Moana and the plot questions continue -- my favorite being "mama, do our hearts look like the Earth goddess' heart?" L shows off her "rainbow pose" from the yoga her class does in Creative Movement (heart eye emoji cue).

8:10 am - The kids do early drop-off on Mondays, and I am hoping there is space for them this morning even though I haven't received a reply from the director of their school.  I get my work bag, purse, and their school bag packed, and everyone finds their own socks and shoes and hoodies.  L wants to take her horse backpack with a bunch of random stuff in it and B wants his yaya in the car. I make an iced coffee for the road in my super trendy ginormous Honey Ham Styrofoam cup that I keep reusing to ease my yuppy-crunchy guilt, crate Boom, and we head out.  The temperature has dropped at least 10 degrees in the last hour, and it's now raining.  The kids climb into the car while I run back in to grab rain jackets. I hear my email ping, and it is the director telling me there is no early drop off this morning.  Fabulous. No way am I unloading everyone again so we drive to school and listen to some more Moana and talk about school buses and the rain and why didn't Mommy know it was going to be so cold today? At 8:50, we hustle in and drop B off at his classroom first.  I make a lame joke about toddler stubbornness while frantically motioning to B's teachers that there is both a hoodie and a rain jacket in his cubby and HA HA HA I SWEAR I TRIED TO GET HIM TO WEAR APPROPRIATE CLOTHING. The registration form for next year is in his cubby and I note that he is only pre-registered for 3 days, so we'll have to get that sorted out today.  I drop L off at her classroom and remind her that I will pick her up after Extended Day this afternoon.  I make it to my car just as the rain really gets going, and listen to a MFM mini-sode as I commute.

9:30 am -- Even in the rain, it only takes me about 25 minutes to get to work.  3 of my 4 colleagues are already in the office; there are 4 of us who work part time on different schedules so some days it's really quiet and some days we're all around at the same time. I put my lunch away, reorganize some notebooks, statutes, and handouts into my new magazine files from IKEA, and log into my computer.  I read the WaPo headlines and get last week's time entered in 2 of the 3 places required (saving the big-daddy for later). I email the school's director abut B's days for next year and reply to E's good morning email.  I check the callback list on our case management system and we are at 37 today with 25 new clients up for grabs.  I actually have some drafting to do before tackling the call backs.  I review an order for one client and call him back with a few questions; leave him a VM to call me back before I can start his demand kit. I review another client's order and pull up her child's ISD schedule to create a custody calendar for her demand kit.  Per usual, it's about 62 degrees in my office and I whip out the micro-puffer jacket over the vest with the scarf. ITPitB that, baby.
Break for lunch at noon.  I read today's Lenny Letter; get pumped up about the Women's March being just around the corner. Call my case manager at Be The Match back; the blood work I did last week was missing a component and I have to go back to get more blood drawn.  Slightly annoyed since they drew 14 vials last week, but at least I can go to a lab nearby instead of the one in Round Rock. Plus, it's pretty hard to be miffed with a minor inconvenience in the grand scheme of this entire, incredible process -- I continue to feel humbled to be a part of it all. Start back in on my demand kit at 12:17 pm.  I finish the calendar, draft demand letters, and put it all together for the client with instructions on how he needs to proceed in order to build a potential Enforcement case. I finish his packet and take it downstairs to our main offices to the mail room. I pick up my mail and the physical mail for our team and check for custody orders; none today. I spend the rest of my work hours entering my incremental time; I am way behind on this and getting caught up feels good! I head out to pick up the kiddos at 2:40.
I pull into the school parking lot right at 3:00 pm. I gather lunch boxes and art from the kids' cubbies and collect them from the gym.  Usually they are outside on the playground, but it's still raining.  B is a little manic -- Extended Day on Tuesdays is always a little rough for him since he doesn't get a nap.  He is pretty adamant about changing his clothes when we get home; this is a new phenomenon that I usually discourage, but since the temperature never climbed above 50 and his leggings are wet from climbing into my car, I throw him a bone.  It is B's turn to pick the TV show and he selects Chuggington.  The tidbits settle in for some traintastic fun + fruit snacks and popcorn.  I add today's art to the playroom display {interestingly, all of L's contributions are tropical in nature and all of B's are snowy} and pull together the components of a New Baby Meal I prepped on Sunday evening {oven baked chicken fajitas + Trader Joe's Way More Chocolate Chips cookies + 14 Hands Hot to Trot vino} as well as a salad for the playdate we are headed to. 
4:00 pm - Chuggington is over and we are headed out once again to drop off the meal and go play. The new mama {twin girls!} is a neighbor I've actually haven't met yet, and she is so sweet. Her son and L share a birthday but he is B's year in school.  Turns out she was actually on the invite list to the playdate we're headed to and she's decided to come along so I am excited to see her in a few minutes and get to know her better.  We drive the 5 minutes to my friend M's house and some buddies are already running amok. M invited B's entire playgroup + siblings and likely didn't anticipate that pretty much every single person would enthusiastically respond in the affirmative... Over the course of two hours, there are 25+ crazy meatloaves commandeering chaos and eating pizza while the moms chatted, wine-d, and attempted to avoid bodily injury. It was essentially the best, loudest playdate of all time, and I'm pretty sure we all owe M a spa gift certificate with a Xanax chaser. Our neighborhood really is my favorite.


6:00 pm - E texts me that he's home from the airport and pre-heating the oven for our veggie fajita supper just about the same time B begins to turn into a pumpkin {a very emo, screechy pumpkin} so we say our goodbyes. It is pouring outside and I have no umbrella and B is quite literally stripping down to his diaper in FOMO protest of leaving the rager so that was a super fun departure.  We are home again, home again lickety-split and all very happy to see E.  I am even happier that he has unloaded that pesky dishwasher and poured two glasses of wine.  The minis tell him all about their big day, and I cut up some more fruit to counter-balance the pounds of pizza they've consumed. E lets me know he has early morning conference calls and can't take the chicklets to school tomorrow.  This doesn't bode well for my schedule as I'd planned to exercise at 5 am and head straight to work from OrangeTheory to knock out some hours.  Jay to the rescue!  I call my mom, and she is on board for school drop off; we are so so so hashtag-blessed to have her and my dad so close by. E herds them upstairs for a bath while I pop the fajitas in the oven and make lunches for tomorrow.  Soundtrack: Rent.

6:45 pm - Early bedtime for B since he's a bit of a skipped-nap mess. He picks out his PJs {"Frankenstein!"} and makes it through two Richard Scarry nursery rhymes before he starts body slamming L, and I take him to his room for books {The Little Engine That Could; I Want My Hat Back} and songs {"the car song" - which I have to freestyle; "the monster song" - more freestyling; and "You Are My Sunshine"}.  I remember to put some lavender in his diffuser hoping it will help him settle down a bit more.  Our new "goodnights" are my favorite as he shouts "no, I love YOU!" and "no, YOU'RE the best" as I leave his room.  He jumps up and down in his crib as if it is a trampoline for about 3 minutes and then conks the heck out. 
E and L have already picked out her clothes for tomorrow and read a bunch of nursery rhymes.  I show her the invitations I have bookmarked on my phone for her super hero party next month, and she selects one {which happens to be my favorite as well!}.  We read a chapter of Charlotte's Web, sing 4 songs {Mary Had a Little Lamb, Itsy-Bitsy Spider, Twinkle Twinkle, and Miss Mary Mack}, rub some diluted peppermint oil on her chest and feet, and switch on her diffuser {peppermint + lemon + lavender for allergies} before loads of goodnight kisses.  It's an early lights-out for sister, too.
7:20 pm - Our veggies are ready so we test out some new almond flour tortillas for fajita assembly.  Verdict: Pretty good, especially considering the nutritional content, but definitely not for any dish you don't plan to eat immediately. After dining together {standing up huddled over the island like true romantics}, we switch on the first episode of The New Pope. It's fine; I keep expecting Jude Law to suddenly stab someone in the jugular -- he's a shifty character. Thoroughly enjoy this article about the mail Obama received these past 8 years and the shifting roll of the White House mailroom. In a super rare weekday move, E and I actually head upstairs to bed together since he didn't bring any work home. 





















I perform my vanity-worshipping nighttime ritual and pack my gym bag to take to OTF tomorrow.  That 4:30 am alarm comes earrrrrrrrrrly.  I read a little bit of Catastrophic Happiness {which is way less cheesy than it appears... the author is the advice columnist for Real Simple and I love love love her} before falling asleep around 9:45.

10:27 pm: NIGHT TERROR.

11:40 pm: NIGHT TERROR.

11:47 pm: Adjust thermostat after realizing we turned off the Heat.

12:14 am: NIGHT TERROR.

4:30 am: ALARM. No one should willingly be awake at this hour.


Wednesday, December 14, 2016

Gift Ideas for Adult Humans

We're down to the wire here, folks.  I haven't done a gift guide for peeps over 4 feet tall in a while, but I had a few requests for one, plus I had a handy dandy "Favorite Purchases of the Year" iPhone note burning a proverbial hole in my pocket.  All of these items {save for one} are things we own and love, love, LOVE. A few are old friends, but the vast majority were new finds from 2016. 

If you're working that last-minute holiday shopping hustle, I hope you find something here that tickles your pickle... or perhaps just a January happy prize for yourself!

1. Benefit Soft & Natural Brow Kit: I've never done a thing to my brows aside from plucking and waxing, but I'm now somewhat addicted to the products in this kit!  I don't bother with the stencils, but the filler/liner glides on and fills in smoothly, the gel keeps everything in place all day without flaking, and the highlighter really adds some pop -- all without looking like you've tattooed your damn forehead. If I only have 1 minute to slap on some makeup, I do my brows + mascara and lip gloss, and I still feel polished.

2. Bauble Bar Earrings: The only item(s) on the list I don't already own, I want about 8373 pairs of Bauble Bar earrings... but especially the Crispin Drops and Pinata Tassels!

3. Hurraw Lip Balm:  This balm was a local Whitefish, MT discovery, but it's likely available at a boutique or spa near you or via Amazon {although there is a price hike}. The ingredients are organic, vegan, and raw {HIGH CRUNCH}, but most importantly, it smells delicious {the ALMOND!!!}, isn't tacky or greasy, and won't melt -- not even in your hot ass car in August. I cannot tell you how happy this makes my Texas heart. 


4.  Lysse Leggings: Are you stumbling through life wearing leggings not made by Lysse?  Then I'll be blunt: you're doing it wrong. My friend Erin turned me onto these about this time last year, and it is one of the 8373 reasons why I love her face off so hard. I tried to let my mom in on the secret, and she admitted she'd already been wearing Lysses for months.  So. We know who really loves me now. ANYHOO.  Get you some.  I wear the Seamed Ponte and the Jeggings each and every week. Super comfortable, super thick, perfect for travel.

5. Antonini Olivewood Cheese Knives: We've had these for 8 years, and it would be impossible to count the number of times we've used them.  I pull them out anytime we have guests, and they still look brand-spankin' new.  Automatic purchase if I spy these on a wedding registry.

6. Lifefactory Silicone-Sleeved Glasses:  These come in all sorts of colors, sizes, and styles {the 20 oz variety would make an excellent "super pint" for the beer drinker in your life!}, and I've pretty much ditched my regular wine glasses since purchasing these. The silicone sleeve is cute and cushy and is perfect for patio-sippin' and/or Distracted Disaster Insurance.


7. Hamilton: The Revolution: Hey, did y'all know I kinda like Hamilton? This is the most gorgeous coffee table tome that is sure to delight fans of the show, general Broadway enthusiasts,and history buffs alike.

8. CoffeeSock Cold Brew Kit: Still loving my CoffeeSock, and still slamming that cold brew in December!
9. Wide-Mouth Klean Kanteen w/ 2 Tops: Klean Kanteen makes my very favorite adult insulated beverage receptacle. Cheaper and less obnoxious than a Yeti, but your coffee will stay hot through the work day / your ice will remain icy throughout a beach marathon.

10. Le Creuset Stoneware Mugs: Much more fun than your boring white coffee mug but classier than your "Let That Shit Go" cup {just me?}, these mugs make me so happy! I received the turquoise color in a This Is My Fave IG gift swap, and it truly is my fave now!

11. The Smitten Kitchen Cookbook: Deb can do no wrong. Everything she cooks is gold.  As is this cookbook.

12. Rifle Paper Co. Slim Wall Calendars: My 2016 Folk Art version looks so cheery in our kitchen. And the prints make pretty frame-fillers when the new year arrives!

13. Deneve Riverock Diffuser: I know I've waxed poetic about these before; we have three now, and I'm purchasing another for my office.

14. Parabo Photo Desk Calendar: This product is only available via their app {which is super use friendly}, but I'm gaga for these desk calendars. The quality is excellent {nothing I like better than a luscious, thick paper product!}, and it adds just the right amount of personality to your workspace. 2 photos featured for every month: a new photo for the calendar side and last month's photo on the flip side {so your office guests can ooh and aah over your kiddos or your pups or your latest culinary endeavor}.



15. Folding Wayfarers: Classic style now folds up to fit in your tiniest clutch. These are the only sunglasses I wear now.

16. Elizabeth Volk Suede Tassel Earrings: Elizabeth is an extremely talented personal friend {who I happen to be having beverages with manana - what, what!}.  I have 3 of her pieces and am constantly eyeing more! I'm particularly fond of these suede tassels.

17. Mi Golondrina Mexican Peasant Dress: If you grew up in a Southern border state, chances are you sported a zillion polyester Mexican peasant dresses as a kid. Mi Golondrina's offerings are your childhood favorites all spiffed up -- the embroidery is all done by hand and knock-your-socks-off pretty.  I get more compliments on this dress than any other item of clothing I own, and it's the easiest and coolest thing to throw on. The price tag feels decadent considering mass-produced styles are available for 15 bucks a pop, but the craftsmanship truly is worth your dinero.


16. Humble Hilo Bag: Finally, speaking of most-complimented, I've been carrying a Humble Hilo medium-sized bag since last Christmas, and I get stopped constantly with inquiries. HH products are made from gorgeous recycled Guatemalan hupils, and each item is one-of-a-kind.  A portion of every purchase supports your choice of three humanitarian projects in Guatemala: Child Nutrition/Clean Water; Education for Women, and Small Business Opportunities for Women.

*Please note: Amazon links are affiliate.  All other links are "squeaky clean." No freebies or sponsored items on this list -- just a bunch of shit I adore.