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On Funny Math - Karen's Musings
Random Rambling
estherchaya
estherchaya
On Funny Math
You know, I thought the math on Dr. C.'s 28 calorie recipe was a little weird, but math has never been my strong suit, so I just figured I was just a dumb blonde and she was the smart doctor, so I should just do what I was told. Um, I'm not actually blonde, but go with me on this one, okay? I mean, the thought had occurred to me to run the math by my pharmacist husband, but see... I never have a lot of faith in that either... I always think this sort of thing is some secret, highly complex code that even my super-smart husband can't possibly crack and I don't want to burden him with the embarrassment of straining his intellect. I mean, it would be a horrible blow to his ego, right? And I wouldn't want to be the cause of his mid-life crisis at such a young age (he and I just had birthdays, so I'm a bit sensitive about his age since I'm catching up to him). And so, I simply followed the doctor's directions, knowing that I could never possibly understand the highly complex calculus involved in mixing 28-calorie food for my under-fed daughter. After all, I am a mere mortal, and Dr. C... well, SHE went to medical school.

Ahem.

And then Lea Bea... Dear, sweet Lea Bea, was avoiding schoolwork, so she tried out the math for me. Because, really, apparently, schoolwork avoidance=too much damn time on your hands (see, some math isn't too difficult for me!). And apparently, this math is pretty damn simple. The piece I was missing was that I didn't know how many calories were in a scoop of formula, because I'm a total moron. See, I know that formula contains 20 calories per ounce. And I know that you mix one scoop of formula with 2 ounces of water when you're just making regular formula for a baby. So it would make SENSE that one scoop of formula has... YOU GUESSED IT... 40 calories! But I am tres stupid, so it never occurred to me that it was that simple.

Dr. C's directions were VERY clear. "1 scoop formula + add breastmilk until total volume = 5 oz" Now this is the exact opposite of how you make formula. When you're mixing formula for a baby, you pour water in a bottle to the desired volume, THEN add the powder (or so I'm told... I've never actually made formula). If you put the powder in first, and THEN add the liquid to 5 oz total volume, you only need to add about 4-4.5 ounces of liquid before you get to that 5oz mark. If you add liquid first to the 5oz mark and then add powder and then shake it all up, you end up with 5.25 oz of final volume. Go figure (I'm not really sure why this works this way, and I really don't WANT to know). I remember very specifically clarifying Dr. C's instructions, because it was the exact opposite of how I'd been taught to make formula, and she was very specific that she meant to put the powder in the bottle first and THEN add the liquid. So if you do it her way, here's the math, courtesy of Lea Bea:

1 scoop formula = 40cal
4 oz breast milk = 80cal
Total = 120 cal in 5oz bottle
divided by 5 oz = 24cal/oz.


Gah! So all this time*, I've allowed Dr. C. to make me feel guilty for hanging on to breastfeeding my daughter, despite the fact that it's making her fall short of her calories because she's only getting 4, 3-oz 28-calorie-per-ounce bottles per day, plus 2 breastfeeding sessions per day (approximately 3 oz of intake per session at 20 calories per ounce)... for an estimated total of... 456 calories per day (if I've done my math correctly, but remember I've already admitted math isn't my strong suit). Ellie's supposed to be getting a MINIMUM of 480 calories per day. However, if these are really 24-calories-per-ounce bottles, she's ACTUALLY been getting an estimated 408 calories per day, which is an even greater shortfall than I thought. And that's because of Dr. C's lousy math.

According to dear, sweet Lea Bea, however, if I added the powder to 5oz of milk, I'd get closer to 27 calories per ounce, which is a lot closer to what I wanted in the first place. And I trust Lea Bea's math more than Dr. C's at this point (plus, um, my husband concurred, because apparently it's insulting that I didn't trust him to be able to do the math in the first place). But honestly, I'm not making any changes until we see our regular pediatrician tomorrow. She's barely tolerating the fortified bottles as it is. But she IS definitely gaining some weight. Her cheeks have filled out a little bit and she's more alert than she was. And she's definitely getting more calories than she had been before, so anything's an improvement.

It's just... so frustrating! There's this doctor who already frustrated me with her recommendation to stop breastfeeding all together, but I could at least understand her logic. But then I thought there was a reasonable compromised reached which I assumed wouldn't pose any serious problems for Ellie since she'd still be getting pretty darned close to her calorie requirements, when it turned out that a problem in Dr. C's math was going to cause a pretty significant shortfall! Gah!

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*Okay, to be fair, "all this time" is really only a week, but still! This is a tiny baby we're messing with!

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Current Mood: aggravated aggravated

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Comments
(Deleted comment)
estherchaya From: estherchaya Date: February 6th, 2008 02:16 pm (UTC) (Link)
when we did it last night, it added 7mls, which is approximately .25 ounces, which is how we came up with the math that adding a scoop of powder to 5 ounces of milk would yield 27 calorie per ounce milk.
From: have_inner_lady Date: February 6th, 2008 02:39 pm (UTC) (Link)
My first pediatrician had problems with 0.8 + 0.4 -- and also with ml versus tsp. In horror, I watched her strain for 45 seconds over the above equation before grudingly coming to 1.2 (for a dose of medicine).

"One point two what?" I asked.

"One point two!"

"Right. But of what?"

"Just one point two."

Apparently not all people who make it through medical school understand units of measurement or basic math. And this was the woman who measured and administered my newborn's first vaccinations!

I never saw her again.
estherchaya From: estherchaya Date: February 6th, 2008 03:37 pm (UTC) (Link)
argh.
marag From: marag Date: February 6th, 2008 03:04 pm (UTC) (Link)
Argl. That is very very very sad. But more alert is good, so it sounds like once you start getting the right around of fortification, Ellie will do great!

From personal experience, once they get the hang of taking in more calories, they catch up amazingly fast. (That's why Yael was in the hospital so long: because they just couldn't get enough calories into her, even with fortifying the breast milk.)
estherchaya From: estherchaya Date: February 6th, 2008 03:36 pm (UTC) (Link)
Ellie was growing just fine in the NICU without fortified milk (Ellie and Sam stopped getting fortified breastmilk after about 2 weeks...they got it straight after that point) But hey, she had an NG tube back then, to help make up for when she was too tired to eat.

She was my biggest baby when she was discharged from the NICU!
kalki From: kalki Date: February 6th, 2008 05:06 pm (UTC) (Link)
I am so sorry that you're having to go through this hon.

But I trust in you and your awesome momma skills. *hugs*
estherchaya From: estherchaya Date: February 6th, 2008 08:12 pm (UTC) (Link)
It's all good. Ellie's definitely improving. I just suspect that she'd be improving MORE if she was actually getting to the caloric goal we'd THOUGHT she was getting to.
fheyd From: fheyd Date: February 6th, 2008 05:58 pm (UTC) (Link)
If it's only been a week, can you ditch Dr. C and see Dr. D as you'd originally hoped? Dr. C has gone from sounding less than empathetic and flat out rude to being in such a hurry she can't do math, which in turn is failing to accomplish the goals of her patients. The twit.

In other news i'm discovering that the passionate loyalty i have for my friends apparently extends toward their children. Dr. C should be glad i no longer live in Richmond *grr*
estherchaya From: estherchaya Date: February 6th, 2008 08:11 pm (UTC) (Link)
I'm going to talk to my pediatrician tomorrow and see how he recommends I proceed re: followups with the GI doc. I think it will depend on whether Ellie needs the NG. If she needs the NG tube, the way to expedite that will probably be to stick with Dr. C. If not, I will change my one-month-followup to an appointment with Dr. D.

I miss you, chiquita banana. I think of a cow every time I sneeze. :)
mrn613 From: mrn613 Date: February 6th, 2008 07:32 pm (UTC) (Link)
I might also be a dumb blonde, but I thought a scoop of formula had 45 calories (pretty sure it does, actually). Because if you add 2 scoops to four ounces of water, you get 4.5 ounces of formula, which is 90 calories, or 20 calories per ounce.

Out of curiousity, why does she have you adding hideous elemental formula powder to breastmilk? Any infant formula powder will add 45 calories per scoop. Goodstart supposed tastes the most like breastmilk. They also sell premixed liquids that are 50 calories per ounce that you add to breastmilk.
estherchaya From: estherchaya Date: February 6th, 2008 07:56 pm (UTC) (Link)
a scoop of formula adds 7mls, which is only a quarter of an ounce. So I'm not really sure how the math works out on that. I'll double check with the pediatrician tomorrow. Him I trust. Dr. C, not so much. Even if a scoop had 45 calories in it, which I'm not totally convinced it does, that would still yield only 25 calories per ounce, rather than the promised 28 calories per ounce.

She has us using Alimentum. As for why, I haven't the foggiest clue, but it is nasty, revolting stuff. She was pretty specific about using it versus other options. (she, in fact, specifically told me not to use the Enfacare which is 22 calories per ounce) As for the premixed liquids...hrm... I'll investigate. Seth will have to do the math for me, now that I've come to terms with the fact that he does a little more than just play a pharmacist on TV.
mrn613 From: mrn613 Date: February 6th, 2008 11:59 pm (UTC) (Link)
If it adds 0.25 fluid ounce, then formula has 45 calories per scoop.

4 ounces water plus 2 x 0.25 ounces formula = 4.5 fluid ounces
2 scoops formula = 90 calories
90 calories/ 4.5 fluid ounces = 20 calories per ounce

estherchaya From: estherchaya Date: February 7th, 2008 02:10 am (UTC) (Link)
right, I misread your original statement which I thought said one scoop added half an ounce. Told you I'm a dumb blonde. Hrm.
From: (Anonymous) Date: February 7th, 2008 02:55 am (UTC) (Link)
i think this post makes a good point. but even so, it still doesn't help me get dr c's math to work out.
--laura
estherchaya From: estherchaya Date: February 11th, 2008 02:29 pm (UTC) (Link)
Sorry, that was me, but LJ keeps logging me out.

I checked with my pediatrician and he says that they generally calculate regular formula at 20 calories per scoop because not all formulas add the same amount of volume. (It's true... the Alimentum adds more volume than the Enfamil Lipil... the Enfamil seems to dissolve more completely. Go figure!)
glenbarnett From: glenbarnett Date: February 7th, 2008 07:59 am (UTC) (Link)
Doctors are notoriously bad at basic arithmetic, which is why I think so many published papers use nomograms instead of formulas - they're harder to screw up.

Fortunately, some doctors are clueful, and there's always pharmacists. They at least can generally be relied on for basic cypherin' as such. Fortunately for the res of us.

Scary, innit?
From: (Anonymous) Date: February 7th, 2008 01:35 pm (UTC) (Link)
It just pisses me off. The lack of precision in her method is what really bothers me. Her insistence on putting in the formula first and then filling the rest of the way with breast milk is so stupid. The dry formula not only settles but also reduces in volume by almost half once dissolved.

So, for instance, a scoop of formula plus 4 3/4 oz. of breast milk would provide exactly 5 oz. at exactly 27 (not 28!) cal./oz., but if you have this data, why add the dry formula first? It's like instructing someone to fill a one-cup measuring cup 1/3 of the way and refusing to allow the perfectly good 1/3 cup measuring cup to be used!

And this is the woman who so easily dismissed my sweet, precious daughter as a simple equation. Gah!
estherchaya From: estherchaya Date: February 7th, 2008 01:36 pm (UTC) (Link)
sorry, that was me.
hannahsarah From: hannahsarah Date: February 7th, 2008 08:23 am (UTC) (Link)
I second the comment to ditch Dr. C. Call me silly, but I have a bad *feeling* about her. Intuition or some such, but I just don't feel like she's right for you and your babies.
From: (Anonymous) Date: February 7th, 2008 01:33 pm (UTC) (Link)
It's not that simple. If my pediatrician (Dr. Wonderful) says today that Ellie needs the NG tube, ditching Dr. C. is not the way to expedite getting the NG tube in place, because we'd be starting over with a new doctor then, and it could take a week or two to get in with a new doctor.

If my pediatrician is satisfied with Ellie's weight gain today and thinks she does NOT need an NG tube right away, I will be switching specialists, because there will be no urgency involved in seeing the specialist.

This is one of the issues I intend to speak to the pediatrician about this morning.
estherchaya From: estherchaya Date: February 7th, 2008 01:35 pm (UTC) (Link)
sorry, that was me.
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