Paul & Sarah

Where has the time gone? I can’t believe Kieran is already two months old. And yet, it seems like so long ago that I was pregnant…. WAY more than 2 months.

Today we went to the pediatrician for Kieran’s Well-Baby visit and his first vaccinations.

Length: 22″ (10-25%) [up from 20" at his 1mo appt]
Weight: 10lb 3oz (10-25%) [up from 9lb8oz 13 days ago: a better, slower rate of gain]
Head Circumference: 40cm (50%) [up from 37.5cm at his 1mo appt]
Vaccines: Hep B, Polio, DTaP (Diphtheria, Tetanus, & Pertussis/Whooping Cough), Hib (Meningitis), PVC13 (Pneumococcal disease), and Rotovirus

We discussed a couple of things with Dr. Hodapp –

• Constipation: We were thinking about this as an acute condition, when we need to be thinking about it (and treating it) as a chronic condition. So it’s diluted prune juice twice a day for the foreseeable future. Dr. Hodapp assures us that it’s not hurting Kieran to have the juice, even though he understands our concern about him having that much sugar at this young age. Juice is what fixes normal baby constipation, so that’s what we’ll stick with. Dr. Hodapp says that it’s more than likely not any of Keiran’s formulas that are causing the constipation, as we’ve continued to have a stopped-up baby across three difference formulas now. (And HALLELUJAH, we don’t need to be sticking with a formula for 2 weeks to see if it helps. Dr. Hodapp said if we don’t see a big change within 2-3 days, we’re not gonna see one.) Apparently like gassiness, constipation just happens, and as long as the usual remedies work there’s nothing to be concerned about. So this means we can dump the soy formula and it’s horrible toots, poots, and possible hormonal side effects. Hooray!
• Gas: Nothing we can do. DANGIT. All the home remedies we want to try are fine. But all infants are gassy for the first three months at least, and ours just seems to be particularly so. Again, formula doesn’t really make that big of a difference according to Dr. Hodapp. So we’re welcome to try whatever we want in that regard.
• Reflux: Got a new prescription for the Zantac which has worked wonders for our little guy. Dr. Hodapp confirmed that we were correct to up his dose on our own 10 days ago because Kieran had put on so much weight. Our new prescription is written at a better dosage, and Dr. Hodapp predicted that Kieran would outgrow the reflux before the prescription needed to be re-written again.

Dr. Hodapp assures us that we’re doing fine, and Kieran is thriving like crazy – so whatever we’re doing at home is working and to keep it up. He was pleased to hear that Kieran is smiling, following objects with his eyes and reaching for things in front of his face. Developmentally, he’s right on target for his actual age, and physically he’s doing just great. He’s surprisingly strong and able to hold his head up to look around for longer than expected at this age.

Kieran is sleeping longer at night, but certainly not through the night yet. We usually get a 4-hour stretch starting around 7:00pm, and a couple of 3-hour stretches after that if we’re lucky. Unfortunately, he’s taken to waking up for the day around 5:00am and cannot be persuaded to take a nap much before 10:00am. Paul is suffering greatly with this, because he gets stuck with this early-morning shift. It doesn’t help that Kieran’s natural fussy time seems to be first thing in the morning (as opposed to around dinner time for most babies.) We’re hoping that as we get a better handle on the constipation that Kieran won’t wake up so fussy.

Kieran is learning to love the swing and bouncer. He just this week noticed the mobile above the swing for the first time. His slack-jawed amazement was too cute for words. Having somewhere we can put him where he can be entertained and soothed by the motion is very nice when we just can’t pace and bounce him anymore. This week we’ll set up his IKEA baby gym with it’s plushy play mat and overhead crossbeams with dangling toys. We’re transitioning into more of an ‘entertain the baby’ household as Kieran’s attention span has grown and he’s now able to engage with us for longer periods of time.

I’ll be returning to work full time on September 13th. I’ll be in the office from 8:30-2:00 four days a week, working from home the balance of the day and all day on Wednesdays. I’m grateful to my supervisors for having such an open mind to a flexible schedule. Of course, this arrangement will be reviewed regularly to make sure it’s working for everybody, but if nothing else it will help us transition into a different schedule. Currently I’m working part-time from home with occasional office days. It’s been a good way to ease into Paul having charge of Kieran for longer periods of time while I’m working. I’m not looking forward to leaving my boys, but this is what’s necessary for our family. I have 1000% confidence in Paul though, which makes it a little easier. And it sure beats daycare, that’s for sure.

But for now, we are enjoying our little boy every moment. He is the light of our lives. Our little miracle.



2 Comments | Tags: development, Doctor Appts, formula, work

There have been lots of returns recently. Mostly in the form of various types of formula as we struggle to find something that works for Kieran. We’ve tried regular formulas from Similac, Enfamil, Costco and Target. We’ve tried the “gentle” versions of formula from Similac, Enfamil and Target. Now we’re back on Soy, using the last of our sample from Similac. (I’m about to go out to Target to get a container of their Soy formula.)

I am SO thankful for easy return policies on formula, although I do feel bad returning an open container, knowing it can’t be used by anyone.

Initially we were looking for something to help settle the incredible amount of (apparently) painful gas Kieran has. He’s been gassy literally since he was born, so we’re trying to find a formula that won’t exacerbate the situation. It’s so hard to see him so uncomfortable. (The clothes we’re sending to Paul’s sister for her shortly-due baby all have worn spots from rubbing Kieran’s tummy so much.) But it seems that the “gentle” formulas actually made the situation worse by constipating Kieran. (I felt horrible when it dawned on me that 4 days of easy-clean poops were actually constipation getting worse and worse.) We’ve pretty much got him regular again with judicious use of prune juice (good lord, that stuff is powerful and unaffected in any way by digestion!) But we don’t want to have to constantly spike his bottle with juice, ya know? So we’re trying Soy formula again to see if possibly he’s lactose intolerant. It’s seeming to help the constipation, but not the gas.

And yeah, we’ve got (Little Tummies brand) Gas drops and Gripe Water… neither of which seem to help all that much. Suggestions on other remedies are greatly appreciated.

The other return this week was a hard one: the Breast Pump. I took it back 6 weeks early. (We’d done a pre-paid 3-month rental through early October for the lower fees.) It just wasn’t working. I was drinking my lactation tea, and taking my supplements (none of which were cheap, btw) and it just wasn’t seeming to help. Was it really worth it to spend the money on supplements and rentals, to spend nearly an hour each time hooked up to the thing to get less than an ounce of milk? (And the milk looked more and more like just foremilk anyway.) Seeing that pump on it’s little table next to the couch all the time was just a constant reminder to me of my failure. The guilt I had every time I sat down to do anything and wasn’t hooked up to the pump was really wearing me down.

So Paul and I talked about it (I cried about it, again) and we decided that it wasn’t worth the emotional pain to me to keep trying for such diminishing returns. I could barely get 2 ounces a day (most days it was 1oz or less total) for all my trying – and Kieran is currently sucking down 25-30oz a day. The little I could eek out was barely a drop in the bucket.

He got the colustrum at the beginning. He got as much milk as he and I could coerce out of me for the first 2-3 weeks. I have to believe that was enough, that he got the benefits from that little amount. I have to believe that, because I have to forgive myself, because I have to move on. I told Paul I needed his permission to stop trying, and after a long pause, he gave it.

End of an era, or something. I’m off to Target now to buy a full-size container of Soy formula so we can really see if Soy is the answer for us right now. Kieran seems to be over his constipation, but is still gassy as all get out. But he is thriving and growing like a weed. And in the end, that is all that matters.

Today we all went to breakfast and then went to a park a couple blocks from the house for a family picture session. Tom and Paul scoped out the best location they could in the noonday sun with shade for the Grandmas to sit in while shots were set up.

The pictures came out great, although we all were a little wilted towards the end. Mama and Kieran both got a little sun… oops. We never take Kieran out in the daytime like this, but next time we do, he’ll certainly have his hat on and sunscreen on any exposed skin – that’s for sure!

Click on the pictures to see the whole album of Kieran’s parents, grandparents and great grandparents together for the first time!

Kieran’s had a busy couple of weeks, with lots of folks coming to meet him!

Kieran has had visits from our friend Lisa (with her boyfriend and daughter in tow), our friend Sibyana, my co-worker Caroline and her daughter Hannah, and just last week: our long-time friends Eric and Jenn. (I took Kieran out to a work luncheon when he was 1 month old, so he’s met my local co-workers and two Board members already as well.)

But this weekend is a biggie: Grampa John and Grandma Cat are coming to meet Kieran for the first time! They’re coming out Saturday through Monday, and we can’t wait. They’ve kept up with Kieran’s adventures through this blog and through Skype video calls, but we’ve all been looking forward to their first visit now that we’re more settled into a routine here at home. I am immensely looking forward to introducing my Dad to his grandson. There will be pictures and video for sure.

Speaking of pictures, we’re gonna have a little informal photo shoot on Sunday after breakfast with Paul’s parents. I want to get pictures of Kieran with his grandfathers together. (Hrm, I wonder if we could get Nonny and Grandma Cat together too – pics of Kieran with his great-grandmothers… well, 2 out of 3 of them.) But family pictures will happen on Sunday, which will be great.

Kieran has quite the full weekend though, because on Friday he gets to meet more of Mama & Daddy’s friends: Joe and Rachel will be in town for Rachel’s birthday. So we’re meeting them for lunch!

Then in September (hopefully) we’ll have two more first-time visits: Uncle Oin + Auntie Cynthia in early September and Kelly (Gnoam) and her daughter Kara (and HOPEFULLY husband Peter too) late in the month. Neither of those have been confirmed yet though.

That’s all I know of for visits right now. We’d love to see more friends though – Kieran’s a very outgoing guy and likes making friends!

OMG, it’s not our imagination! In the last 15 days, Kieran has gained 28 ounces – 1.75lb!!! He’s been eating like crazy, and it shows! In the last couple of days, we’re finding that the footie sleepers that fit fine last week are too short now, Kieran is filling them out so well. He’s fine in his newborn-sized onesies, pants and rompers – but he can’t fully stretch out his legs in his footie sleepers anymore! (We can barely strap the newborn sized disposable diapers on him anymore. Same goes with his preemie-sized cloth diapers!)

I weighed him today at the lactation consultant’s office, using their very precise scale. Paul and I are going to try to get his length tonight – I think he’s grown taller too. I can’t believe how BIG he looks now, especially compared to the pics we took in the hospital.

I’m boxing up the stuff that Kieran is outgrowing to give to Paul’s sister, who is due at the end of September. It’s harder than I expected to box up Kieran’s clothes like this. We’re happy that Cassie will get to use them, but folding up our favorite outfits from our son’s first weeks of life… it’s hard to do so immediately after he’s outgrowing them. I’m saving the striped preemie-sized onesie that Kieran wore in the hospital. I don’t know that we’ll save something from each other size… but it’s tempting.

Tonight, I’m continuing to re-do Kieran’s dressers. I was a little over eager with their organization when I filled them up a week before going into the hospital. Makes it kinda hard to know what sizes are what, and makes putting away laundry a PITA. Now that I’m removing nearly all the newborn clothes, it will be easier to get at his various types of clothing in his current size of 0-3 or 3. Stuff that he won’t be wearing for another 4-6 months doesn’t have to be in the dresser yet, methinks.

My little boy is a little brute!! But man, he’s so cute! Paul and I are struck several times a day with just how precious this little guy is. He’s becoming more alert and aware of his surroundings every day – so interacting with him is getting more and more enjoyable. We haven’t had a smile yet, but we’ve had cute grimaces. (A silver lining to the gas that plagues our little man no matter what formula we have him on.)

Kieran is starting to hit some development milestones too – like reaching out for things, grasping and not letting go. He frequently holds on to my shirt or finger while he’s eating. He reaches out for, grasps and pulls off my glasses at least once a day now while we’re playing. (I don’t mind cleaning my glasses when the fingerprints are SO TINY!) He’s able to hold his head up really well – which I think comes directly from his dislike of being burped. I put him on my shoulder so he can rear back his little head and tell me off directly into my face & ear. Good exercise for my little man.

It’s still very much an adventure, but I think Paul and I are doing a pretty good job. Paul is fantastic with Kieran, which makes it a little easier to contemplate going back into the office in three weeks or so.

The struggle continues…

My supply continues to dwindle. The herbal supplements don’t seem to help (neither the Mother’s Milk Plus nor the Fenugreek seeds) although I don’t know that I’m taking enough of the Fenugreek seeds because I don’t think I smell like maple syrup.

I’m averaging less and less with the pumping every day. Sometimes I’ll get over an ounce (30ml) combined, but like this morning, I got just over 10ml combined. That is SO frustrating, let me tell you. That’s a lot of time being tied to that pump for so little return. I’m working to increase the number of times I’m pumping though, in the hopes that I can bounce back.

Kieran is basically refusing the breast all the time now. Having to give him thickened feedings because of his acid reflux has necessitated using an even more open bottle nipple, which requires even less effort than a regular bottle nipple for Mr. Lazy Nurser. We give him the occasional un-thickened bottle with the tightest nipple we have just to remind Kieran what it should be like. We can tell that frustrates him. So when he’s offered the breast (even when I’m nearly engorged, so I know he could get a fair feeding outta me) he just fusses and squirms and cries and won’t nurse. We’ve tried giving him a half feeding with a bottle and then offering the breast when he’s not ‘starving’ – but Kieran is convinced that he’s starving until he’s full.

It’s disappointing on several levels.

• I was SO INCREDIBLY looking forward to nursing Kieran. The bonding, the special time, the perfect nutrition that only I could provide, the easy-clean-up diapers.
• The Cost. Even using some of the most inexpensive formula we can find (currently Target’s house brand “up & up” Partially Broken Down version) is gonna add around $60-75 a month to our budget that already doesn’t quite cover everything. And as he grows, that figure will only increase. (I can’t imagine if we had to stay on one of the name brands. The Target stuff runs ~$.46/oz whereas the cheapest you’ll find Simalac is ~$.89/oz at Costco or Amazon.)
• Formula diapers are not as pleasant as BF diapers were. Just sayin’.

On the bright side though, Kieran is gaining weight like a champ. He’s still right at the very bottom of the growth percentage charts – but that mostly has to do with the fact that he was 3 weeks early and such a tiny peanut to start with. ~8lb is teeny for a nearly 6 week old baby. But then again, ~8lb for a nearly three week old baby is still small too. He’s gaining ~1oz a day, which is a very healthy growth rate – so his pediatrician is happy with that.

Truth be told, we’re a little concerned about him gaining weight too fast with the thickened formula – but we’re carefully watching Kieran’s signals and feeding him when he actually tells us he’s hungry, feeding him a set amount (currently 3oz + 1T of oatmeal cereal) and waiting to see if he asks for more 10 minutes later. Sometimes he does (and gets another 1-1.5oz + cereal) and sometimes he doesn’t. The oatmeal cereal added to his formula adds the nutrition/calories equivalent to another ounce of formula. So he’s getting what he needs to grow at the rate that works for him.

I’m bummed that Exclusive breast feeding hasn’t worked out. (Not devastated though, which is a VAST improvement over my mental status for the first 2-3 weeks of this adventure.) But I’ll keep trying with the pump, which we have rented through September and see how it goes. I’m comforted by knowing that any breastmilk Kieran gets is better than none, but that regardless he’s growing well and thriving.

As we settle into the daily routine of having a baby, it’s amazing the things we start to take for granted. The tools and gadgets that make life so much easier right now – things that we never would have given a thought to before.

We are so blessed to have friends and family who take an active interest in Kieran’s life – even before he was born! We were (and still are) blessed with gifts from family and friends throughout the pregnancy, not just at the shower – which was overwhelming in a very good way. The little gifts keep coming now, and are hugely appreciated as we discover new things that are required to keep Mr. Kieran happy and healthy.

A huge example of that right now: Kieran is getting slightly thickened feedings now due to his acid reflux – 1t of oat cereal per ounce of formula or EBM. The bottles we have for him (Born Free) don’t really support thickened feedings – which require a different type of nipple. Fortunately, Kelly (Gnoam in the comments) had just sent us yet another care package of hand-me-downs from her 9 month old daughter Kara – which included four 5oz Avent bottles. The Avent system has a FANTASTIC variable flow nipple for thickened feedings. So Kelly’s hand-me-downs saved us from having to go purchase other bottles for these next few months of feedings for Kieran. So HUGE thanks to Kelly (and hubby Peter and Ms. Kara) for the great hand-me-downs.

But even more than that – when I look around Kieran’s room I see what he cannot. That every minute he is surrounded with reminders of how much he was loved before he even arrived. That he is (literally) cradled with and wrapped in love from people who have never met him. Aunt Nita provided his crib; Auntie Lisa & Uncle Mikey provided the mattress and sheets he sleeps on; Donna, Lisa, Kym, Becky, Lisa & Tia, Aunt Cassie & Uncle Kurt, and Grammy Jeanne provided the stuffed friends who keep watch over him as he naps. Every time we change Kieran, we’re grateful to Great Grandma Cat and Grampa John for the wipes warmer which makes all the difference in the world to Mr. Sensitive Tushy. Bathtime is made possible by Uncle Oin & Aunt Cynthia who completely stocked our cabinets with baby necessities, and by Caroline who passed on her baby bath now that her little Hannah has outgrown it.

And that doesn’t even start with the clothes!! Admittedly, nearly everything he’s worn at this point was provided by Mama & Daddy (or Kelly again with the hand-me-downs in newborn sizes) but Paul and I look ahead with a bittersweet glance to the future when Kieran can wear outfits provided by everyone – from adorable onesies, to rompers and safari outfits and teeny tiny smoking jackets. (I don’t think any of us expected me to have such a tiny little peanut!) But the flannel blankets that we received from so many people have been put into daily use – as well as the burp cloths! (Admittedly, I wish the burp cloths weren’t so needed now – the reflux really made those a necessity.) Once he’s able to wear the outfits that fill his dresser and closet – we’ll think of the friends and family who gifted him with such cute togs every time we change his clothes!

The books we’ve been gifted with right before I gave birth are being put to use already – not that Kieran has much of an attention span… but it’s nice to have something to read to him.

So thank you, again, to everyone. The love and support that you have shown Paul and I since we announced our news last Thanksgiving to our family and to the world at Christmas; the care and concern and interest shown during the roller coaster ride of my pregnancy; the generosity shown as we transformed our house into a haven for our son; and the fact that you’re even reading this now… it means more to us that we can say. Kieran has no idea how lucky he is.

I really need to find the time to write out the whole birth story and our experience in the hospital… Paul kept good notes for me of what went on so I can construct it from memory and notes, but there just doesn’t seem to be time to sit down and write it out! (I’m writing this while pumping, thanks to my hands-free bustier thingie.)

As some of you may know, I was born with a birth defect in my heart. (A Ventricular Septal Defect, or VSD to be precise.) Because of this, and the fact that I was on an ACE inhibitor when I got pregnant, Dr. Schwartz ordered that a fetal echocardiogram be done while I was pregnant (remember? I talked about it.) which necessitated a follow up echo before we left the hospital.

The echo was done on day 2, I think. A tech came to the room with the machines and did the tests on Kieran there in the room. She didn’t tell us anything, but said that the cardiologist would come talk to us the next day after he reviewed the results. The cardiologist did come chat with us and explained that while Kieran definitely doesn’t have the birth defect that I was born with (WHEW!) that there was a murmur and a thing or two that wasn’t 100% on the echo. Basically it’s nothing to be worried about, just little flaps inside his heart that hadn’t closed all the way when his heart and lungs kicked into gear, and a “bypass” that hadn’t closed itself off as expected.

So today was the 1 month follow-up to the hospital echo to see if things had healed up like they should. The answer is a qualified “yes” on all accounts. Things are healing, but they’re not *healed* yet. The murmur is still there. The holes and latent byways are still there, but smaller. The cardiologist says there’s nothing to worry about at this point, that this is all very common and that things *are* healing up, so there’s no reason to think that they won’t continue to heal. The Pulmonary Artery is a little narrower than he’d like to see, but he says that he sees it all the time and usually they strengthen and widen out on their own. (I don’t have my notes at hand while I’m pumping here… otherwise I’d give the technical terms.)

We have an appointment to return in three months (Nov 16) to make sure everything has healed up the way it should. Until then, we’re not worrying about anything. Kieran isn’t showing any signs that these little issues are bothering him, he’s gaining weight like a champ and is cute as hell: so life is good.

On a side note: it was nifty to see ultrasounds of Kieran from the OUTSIDE. :)

[setting: a dimly lit living room, with the TV on in the background]

Mama: (to sleeping baby in her arms) [Tearful mushiness about how much he's loved and what a life-changing miracle he is. Blathering continues about how beautiful he is, and how Daddy is going to be his best friend]

Kieran: [faaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaart]

Oh the joys of having a boy. I’ve tried to explain to him that the time wherein farting and burping are encouraged is finite, so he better enjoy it while he can.

This week has been kinda rough for us all. Kieran’s sleep patterns changed to naps of an hour or less. His usual little bit of fussing after feeding increased to nearly an hour or more of arched-back screaming. He started spitting up, not just directly after feedings, but an hour or more later, and while he was asleep.

Kieran has always been gassy – literally from birth, but this was more than his usual gassiness. (I’m starting to notice that the tummy part of his sleep & play outfits is slightly more worn and pilled than the rest of the outfit from where I rub in firm circles for 20 minutes or so after every feeding.) I was really starting suspect Acid Reflux, which is really quite common in infants. (More and more pediatricians are thinking that what was diagnosed as “colic” in years past really was acid reflux.)

On the advice of the lactation consultant on Thursday, I made an appointment with the pediatrician to check Kieran out for reflux. I was able to snag a cancellation appointment at 3:45 yesterday afternoon, thank goodness. I didn’t want to go through the weekend with Kieran crying in pain after every feeding. (Talk about feeling helpless!) Dr. Alazard was pretty open to the idea of reflux when we presented all Kieran’s symptoms. He made a couple of suggestions for isolating the problem:

• To confirm reflux vs. a food sensitivity (either to the type of formula he’s getting, or something I’m eating that’s coming through my breastmilk) he suggested giving Kieran two feedings of Pedialyte, which is basically neutral for allergens. If Kieran still did his back-arching, screaming routine with Pedialyte, that would confirm that it’s acid reflux causing his pain, versus a sensitivity to the formula.
• He also suggested that we try a Soy formula, just to see if that makes any difference in how much Kieran spits up or how long he cries.
• Lastly, he suggested we thicken Kieran’s formula with some Oat cereal – since there tends to be less allergies to oats than rice.
• He also gave us a prescription for liquid Zantac once we confirmed reflux. Meds are supposed to be a last resort.

We came home after a long afternoon of the doctor’s appointment and then a trip to Walmart to actually purchase the Pedialyte and oat cereal and whatnot. Kieran got his bottle of unflavored Pedialyte and acted the same as he had been, but worse. I’d never heard him scream like that before. He was bordering on frantic, which is just heartbreaking to hear. Knowing that he’s in such pain and there’s nothing we can do to take the pain away.

I decided to break the rules and give him the medicine then. I’m more interested right now in preventing my child from being in pain than figuring out what kind of formula to give him. The meds are supposed to be administered three times a day, 15 minutes before a feeding. It took until a third feeding for them to kick in, but when they did it was blissful. The 2:30am feeding was peaceful, with Kieran calm and relaxed, with nary a back-arch or squawk.

We are also making sure we keep him vertical for at least 15 minutes after a feeding. Paul put bricks under the far side of the crib, so Kieran sleeps on an incline now too.

So while we’re thrilled to have the meds in our arsenal, we’re kinda stuck now for checking out other kinds of formula or possibly altering my diet. We don’t want to stop giving him the meds, because we KNOW we’re dealing with reflux – so regardless of what he eats after we stop the meds, he’s gonna have pain and spitting up. We’d prefer not to have to change his formula, and REALLY prefer not to have to change my diet – especially cutting out dairy. We’re HUGE milk drinkers in this house, so cutting out dairy would be akin to cutting out water.

I’m pumping as much as I can right now (a proper-fitting hands-free bustier thing is helping SO much with that) to build a several-feeding supply of breastmilk so that we can try to ‘reset’ Kieran from one formula to another in another day or two.

We’ve started another tactic this evening with thickening Kieran’s bottle with some oatmeal cereal. OMG, if it’s possible for a baby to be drunk, we think we achieved it this evening. The nipple had to be enlarged so that the thickened formula could come out, and Kieran (Mr. LAZY nurser) loved just having this amazing elixir thrown down his throat! Here’s hoping the combination of Zantac and thickened formula will keep everything down – cuz Kieran has been urping formula all afternoon. (Maybe soy isn’t the best for him, huh? We’ll be switching back to the regular Similac formula on Monday or Tuesday.)

So we’ve joined the ranks of parents of reflux babies. Here’s hoping the solution stays simple. We just don’t want our baby to be in pain.

3 Comments | Tags: reflux