1/12/2010You know how sometimes “life” just hits you, and you need to take a few minutes to let it all sink in? Well, that is what has been going on with me…only in this case, I apparently needed to take about six weeks.LOL. I haven’t been writing because I’ve been busy processing (and planning) what is going to happen during a new chapter of my family’s life. That chapter begins soon with a visit to Boston to start looking for a new home. That’s right…we are officially moving to Massachusetts! What a scary and exciting thought.
We’re moving out of necessity, due to my husband’s job being relocated. Believe me, we certainly didn’t just decide, “Let’s pick up and move across the country to a place where everything costs twice as much as it does here.” Plus, we have never even been to Boston! But from all we have read and heard, it is an amazing city full of history and natural beauty (as well as more than 50 colleges and universities). For a Missouri girl, it sounds really cool to live somewhere that you can go whale watching one day and go skiing the next. I’ve never lived near the ocean or the mountains…and now I’m getting both in one place! It’s hard to complain about that.
The hard part about this move is leaving our family and friends, and in my case, a job and workplace that I really love. Right now, both sets of our parents and all of our siblings live within 20 minutes of our house, so our kids get to see their grandparents all the time. We have lots of friends nearby that we love dearly, a great in-home daycare that is right next-door, and a house that is perfect for our family. And as I have said before, I really love my job and the people that I work with. It is really hard to let go of all of that, and leap into the big “unknown” of a new life in a new city. Will we find friends there? Will we find a school and daycare that we love and trust? Will I find another job that I can be equally passionate about? All we can do is trust that God has our family in His hands, and the answer to all of those questions will be YES. Hopefully, this move will be one of those defining life moments that we will look back on with a smile in years to come, and know that it was the best thing that could have ever happened to us.
Of course…since I will no longer be working for SSM Health Care after the move, there will be no more Balancing Act blog, as Dr. Barton already indicated in his final post. That too is sad, as this has been a big part of my life for the past two years. I was actually in my first trimester of pregnancy with Kellen when I started writing, and now he is a ridiculously active and very verbal 20 month old. And Anna, who was two when I started detailing her funnylife moments, is now about to turn five. Gosh, life goes by fast!
Being the writer that I am, I couldn’t stand the thought of not continuing to chronicle the adventures of my growing family…so I am starting my own blog. Besides writing much more frequently than I currently do on The Balancing Act, I also plan to talk about other things that I am interested in, like children’s books and music, and chronicle our New England travel adventures (maybe you’ll get some ideas for the next family vacation). The new blog will be called www.AdventuresinParenting.me. It is still being put together, but should “go live” within a couple of weeks. And, if you ever want to look back, it will also include archives of all of my old posts from The Balancing Act and Kate’s Having a Baby. Not that I think anyone should care that much about my life…but because every now and then, you just might need a good laugh, and a reminder that you’re not alone in this crazy adventure called “parenting.”
Thank you for sharing the last two years with me. I’ll see you at www.AdventuresinParenting.me!
12/30/2009
Well, the end of a year and the beginning of a new year…an opportunity to set the past behind us and look forward to new challenges and opportunities. This ‘blog has been an important part of my last two years and it has been a pleasure to communicate with you during that time. With Kate leaving, there will be a change in the structuring of this column that will affect all of us. This ‘blog was originally Kate’s “baby” (every pun intended). Now her and her baby are off to yet another community. Rather than continuing on in her absence, I will be continuing my ‘blog in another location. Look for me at http://peddocdoug.blogspot.com. I hope to reinvigorate my efforts there. It may take me a little time to get started as I have some mechanical/technical issues to learn in order to make that site the best it can be. In the meantime, please direct any bookmarks over to that site.
What would a year end ‘blog from your doctor be if it didn’t include some comments about moving forward? As I mentioned above, this is definitely an opportunity to set the past behind and look forward to new opportunities, challenges, and goals. As with every year, there will be the usual roadblocks and hurdles to overcome. However, every time you set a goal, you improve some, even if it’s only a very small amount.
As your physician, obviously I would recommend that you set health-related goals. Simple, lifestyle goals will be the easiest to maintain. Consider adding at least one serving of vegetables a day (ideally, you would have 5-9 servings of fruits and vegetables each day). Consider adding antioxidant-rich foods to your diet. Blueberries and almonds are easy to eat by the handful. Fish and broccoli are very high in the type of nutrition we could all use more of. Consider dropping a serving or two of alcohol if you generally have more than two servings a day.
Probably the biggest impact you could have on your health and the health of your children is to quit smoking if you currently do. Smoking directly impacts your longevity, the cost of your medical care over the long haul, and your quality of life over the long haul. It increases the incidence of illness in your children. Finally, it sets an example to the kids that it is ok to smoke.
Exercise is both under and overrated. It is very important to get your heart rate up for a half to a full hour a day, five or six days a week. This is important for your metabolic rate and your heart health. It doesn’t matter what you do, as long as the heart rate is sustained in the 110-140 range (for children, these numbers are even higher). If you enjoy the activity, you’ll do it more often and for longer periods. It is overrated as a weight loss technique. While it is critical to workout in order to lose weight, your weight is really made in the kitchen, as mentioned above. Cut out refined foods. Get rid of “white” foods (potatoes, white bread, white rice, and white pasta). Drink non-fat milk. Increase the proportion of your diet that is protein. Each of these changes will help some.
Every time you set a goal and try to achieve it, you move one step closer to achieving your ultimate goals. Even if you fail, you join the ranks of those who are striving to accomplish something you’ve never done before. Each new attempt, successful or not, moves you closer to your ultimate goal of better health and a better quality of life.
I’ll talk to you on my new blog. Have a very safe new year and may your resolutions come to fruition! 12/7/2009
Usually, when I hear these words, it is with a sense of indignation that a doctor would accuse a child of faking symptoms. Usually, the child has a confusing set of symptoms that the parents are very frustrated about and don’t have answers to…and the last thing they want to hear is that their child’s symptoms are all in his or her head.
The truth of the matter usually is far more complex. Most parents are very familiar with the stomach ache every night before bedtime or every morning before school (except, of course, on weekends when the stomach ache magically disappears and the children are up a half hour earlier than normal watching TV). But, even though the parents are pretty sure they know “what’s really going on,” sometimes these children even make it into the doctor’s office because the pain seems so “real,” that parents start to wonder if it is.
What most parents do not know is that the pain IS real! For most of these children, they are having what are called psychosomatic symptoms. These symptoms can be anything from stomach aches to muscle aches to headaches to weakness. The common thread in all these symptoms is that there is no way to reliably measure how real they are, so many of us get very frustrated when we hear about the same symptom over and over and wonder if the child is crying “wolf.”
Psychosomatic symptoms are very real to the children (or, in many cases, adults). They do actually feel the complained-about pain or weakness. The problem is that these pains have no medical basis. That is, no test can reveal the source of the pain. The pain is a construction of the brain in response to some trigger. The brain truly does perceive the symptom, even though there is no medical reason for the symptom to be there. Therefore, while the child is having that muscle ache, stomach ache or weakness, for that child, at that time, the symptom is very real.
Triggers for these kinds of pain are very complex, incompletely understood and vary quite a bit from patient to patient. For most patients, the primary trigger is some kind of stress. “My kids don’t have stress!” you might say. But you must remember that stress for children is very different from stress for adults. The straight-A student at school who seems well adjusted may feel compelled to get straight A’s, and stay up late worrying about getting a B. Parents having frequent disagreements at home can cause stress. Being part of an excelling sports team, while very rewarding, can be very stressful. Often it takes several sessions with a counselor to break down what exactly is triggering the patient’s symptoms.
So the next time your doctor says it’s all in your child’s head, listen carefully to what comes next. Ask questions. Make sure he or she has thought through the possibility that it is not psychosomatic. If the reasoning seems sound, then realize that your child’s symptoms, while very real to them, really may be all in their head. And then you can take steps to try to get to the root of the problem…and the pain. 12/1/2009I think that I have just discovered another HUGE parenting mistake that I have been making for the past 18 months (and one of many more to come, no doubt).
So, my four-year-old daughter LOVES her lullaby music. She listens to a lullaby CD of her choosing every single night. She can’t fall asleep without her music. In fact, if her CD player malfunctions in the middle of the night or we forget to put it on “repeat,” she will usually wake up due to the QUIET, and beg for her music to be turned back on. I know, I know…some of you are already shaking your heads, as you think about this awful noise dependency that we have created in our child. Well, yes, that’s probably true. But it is what it is. And that wasn’t the mistake I was referring to. I’m getting to that part.
Our son Kellen came along 18 months ago, and we tried to encourage good sleeping habits with him from the beginning. We created consistent routines for bathtime and bedtime, and of course, I went to great lengths to find the best lullaby CDS that a baby could ask for. The whole iTunes revolution made that process so much easier this time around. I customized some really great compilation soundtracks – with not just the “sappy” traditional lullabies done by children’s artists, but also really great soothing music from artists like Paul Simon, James Taylor, The Grateful Dead, The Dixie Chicks, Steve Tyrell…the list goes on and on. Basically, the kid has the best lullaby music ever. You would love it.
The problem is, for the last few months, he has also been the worst sleeper ever. He seemed to wake up constantly throughout the night, whining, moaning, tossing, and turning. My husband and I couldn’t figure out what was wrong with him. Two nights ago, out of desperation, I decided to try a little experiment. I took his lullaby CD off of “repeat” mode. I thought, what could it hurt? He wakes up all night long anyway…so if he wakes up screaming when it turns off, like his sister would, no big deal. And guess what happened. Our baby finally slept…like a baby. He didn’t make a peep. It was the most peaceful night of sleep that I can remember him having. And last night was a repeat performance.
I can’t believe that for 18 months, we have been torturing this kid by playing music all night long, when all he really wanted was QUIET! Can you imagine trying to sleep through music that you didn’t want to hear repeating over and over and over? Poor boy. No wonder he’s always so crabby. Shame on me for assuming that just because his sister likes music at night, that he would too. Lesson learned. And if Kellen could talk (with real words), I’m sure he would add, “And not a moment too soon!”
11/23/2009
It’s impossible to fully plan our lives. We can try our hardest…but just when we think we have everything all figured out, the unexpected happens. And really, those “unexpecteds” are the little moments that always end up having the biggest impact on our lives.
For instance, one afternoon three years ago, I went to lunch with my girlfriends to talk about my recent divorce. One of them decided to set me up with her brother. Three months later, we booked our wedding venue. A year after that, I surprised my new husband with an early morning call at work when I saw a little pink line that I wasn’t expecting. Our 18-month-old son has been making us smile ever since.
Last week, we found out (along with hundreds of other St. Louis families) that my husband’s place of employment is shutting down a large component of its operation within a few months. I read the news on the Post-Dispatch website on the day of the announcement before I officially heard anything from my husband. And in an instant, I realized that our lives had just experienced another one of those defining “unexpected” moments.
Fortunately for my husband, there is a strong chance that he will be one of the few who will still be able to keep his position in the company. Only it will be in Boston. Neither of us have ever been there, but we’ve heard it’s lovely…as long as you don’t mind the snow (actually, I hate snow, but I’m willing to adjust). In fact, in an attempt to get “on board” with this probable change in climate, I went online tonight and ordered a lovely snowman-making kit for our family to enjoy for years to come. It comes with all the supplies needed to make a perfect family of four snowpeople (except the snow). My four-year-old daughter will be in heaven. And hopefully, when the time comes to roll snowpeople out of the fabled “feet” of New England snow, I will be loving every frigid handful.
What else do you do in a situation like this? Complaining certainly wouldn’t do any good. And there’s no point in living in denial. I’ve made it very clear to everyone I work with (in a job that I love), that a cross-country move in the near future is a very real possibility for me. And while no one is happy to hear it, they certainly understand that this is one of those situations in life that is beyond our control.
My husband and I love St. Louis. It is our hometown. Our families and friends are here. The Cardinals are here (we’ve already been threatened not to let our kids grow up to be Red Sox fans). But sadly, St. Louis is not really a scientific hub. And as my husband is a scientist, we must go where the science jobs are. I, on the other hand, do public relations and marketing. I talk. I write. I am easily transplantable.
So even though my four-year-old daughter has now lived in this, her sixth home, for nearly two years…and we weren’t planning on moving for at least five more (evidenced by the $4-thousand investment we just made in our swing set!)…my husband and I are getting out the touch-up paint and checking out the Boston real estate websites (yikes…can I just say sticker shock?). And we wait for official word of what the next phase of our lives is going to entail.
We rest in our faith that God is in control, and knows what is best for our family. We’re also grateful that even in times of uncertainty, we can look back at the anecdotal evidence in our lives and remember that sometimes the best experiences stem from the “unexpecteds.” 11/17/2009
Some medical topics are just not much fun to talk about at all. Nonetheless, they come up on a regular basis in conversations with patients. (Before we go any further, I feel like I should warn you that if you are eating right now…stop!) Probably one of the most frustrating issues for parents is their children’s bowel habits. It seems that no matter where a young parent turns, there is someone telling them that their child’s habits are not right. They are either too frequent or not frequent enough, they are too watery or they are too hard. So what’s a parent to do?
In the newborn period, bowel habits are extremely variable. Formula-fed babies tend to be a little more regular, usually stooling anywhere from three times a day to every other day. Their stools tend to be a little firm and can vary in color from dark brown to light tan with occasional green shades thrown in. Breast fed babies tend to be far more unpredictable, with periods of up to seven days between bowel movements being normal. As long as your infant is not spending an hour or more straining to have bowel movements and is generally happy, there is no reason to try to alter things.
For toddlers and young children, a bowel movement every day or two is fairly normal with some days having two or three stools. It can be much more difficult to tell with this age group as they are starting to toilet train and don’t want someone checking on their every trip to the bathroom. Unlike other age groups, constipation at this age can sometimes result from control issues, when parents try to force toilet training and the child is resisting. Generally speaking, when I see control issues, I recommend backing off of toilet training and allowing the child to enjoy their sense of control.
For most children and teens, trouble with bowel movements is due to trouble with the diet. The American diet tends to be relatively low in the vegetables and whole grains that provide us with the majority of the fiber we need for adequate bowel health. Most experts recommend that children receive five-plus-their-age in grams of fiber a day. Thus, an eight year old should receive 13 grams of fiber a day. Normal adult intake should be around 30 grams a day. For most individuals, adequate fiber means adequate stool patterns. For some children, we will recommend alternatives that may be dietary and may involve supplements. If your child loves vegetables and whole grains, but still can’t stool regularly, check with your pediatrician for some alternatives.
Finally, severe abdominal pain, abdominal pain that wakes your child at night, black stools or blood in the stools are all abnormal and should prompt you to discuss your child with his or her pediatrician. 11/5/2009
Every now and then, I think it’s fun to share some of the memorable “sayings” of my four-year-old daughter, who makes life interesting for me and my husband on a daily basis. Kids are so honest…and literal. It always makes me smile when I think about it.
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Who’s your da-da?
Not long ago, my husband was giving the kids a bath, when our one-year-old son kept referring to the rubber duckie faucet cover as “da-da.” Finally, Anna, our four-year-old, asked in exasperation, “Is Kellen crazy? How can he think that duckie is his da-da? The duckie doesn’t talk, he never helps Kellen, and he never leaves the bathtub!” I mean, besides the obvious…he’s a rubber duckie faucet cover, and not an actual person…but that would be stating the obvious, right?
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A conversation while lying in bed one night:
Anna: Does being a toddler mean that you are always making a mess and getting into your sister's stuff and driving her crazy?
Me: Yes.
Anna: Then Kellen must be a toddler now.
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Me: Where do you think we should go for our next vacation?
Anna: I think we should go East.
Me: East? Why East?
Anna: Because I’m pretty sure that’s where the Easter Bunny is from, and I really want to meet him.
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While driving down the road:
Anna: Ooh! Ooh! Can we go get one of those yummy milkshakes at Shake-n-Bake?
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Random thought out of nowhere:
Anna: Do you think that we call it a rainbow because it has to rain before you can see one?
???!!! All I could think at that moment was, “I was an English major in college and have often contemplated the origin of words, but have never once thought of that before!” So, I looked it up…and she’s right…the word ‘rainbow’ does stem from the word ‘rain.’ So smart.
http://dictionary.reference.com/features/spring.html
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One more bathtub story:
Anna and Kellen were taking a bath in the jet tub in our bathroom. We almost never use that tub, because the pipes for the jets are flaking on the inside, and always get little pieces of crud all over the tub. But Anna insisted that she wanted to take a bath in there, so I let them. When the water level was just below the jets, without thinking, I hit the jet button. Water instantly shot out of all of them, pelting the kids with the force of fire hoses, which freaked Kellen out so much that he practically fell over the side of the tub in a dash to get out. Anna was left sitting in the tub alone, and when the water settled, she looked down at the brown flakes that were everywhere and immediately started sobbing, “Oh no! I did that! I’m sorry! I did that!” I couldn’t figure out what she was freaking out about, as I was the one who had pushed the button, so I asked her what she did. And in utter anguish she cried, “I went to the bathroom and I didn’t wipe good enough! That’s all from me!” I laughed so hard I almost cried. Poor baby. I had a hard time convincing her that the tub full of brown flakes wasn’t “stuff” that had been stuck to her bottom.
Kids…gotta love ‘em.
11/2/2009 As a pediatrician, I am often asked when patients are able to return to “full activity” after an injury. In my practice, I often see ankle sprains, knee sprains, wrist sprains and fractures of all kinds that take a week to six weeks to heal completely. This question has also been highlighted in my personal life recently, as I try to return to some kind of physical activity after a knee surgery. So how does a family decide when a child is able to return to “normal” sports and activities?
My first reaction to that question is always, “If it hurts, don’t do it!” I have to laugh as I say that because my sister, the high school and college soccer goalie, was once told by her doctor, “Then don’t do that!” when she told him that she landed on her hip quite often when trying to stop the ball. My mother was in the room at the time and was quite offended. Needless to say, as irreverent as it may sound to some serious young athletes, it is good advice. When coming back from an injury…if it hurts, don’t do it.
Always think baby steps. If you or your child has had a four to six week layoff from vigorous activity, never assume you can get right back into it. Your muscles, ligaments and tendons have gotten used to inactivity and are not primed for full intensity work. Pretend you’re a beginner again. Start with very basic, low-impact, low-intensity practices. If you’re a runner, start with slow, short distances. A gymnast might start with gentle stretching exercises and a slow, low-impact floor or beam routine. A weight lifter/body builder might start with very light weight, slow movements and high repetitions.
As these gentle activities start to feel better and the muscles start to react the way they did before the injury, then the athlete can start to increase duration of the activity. It may still be best to keep the intensity low, but the athlete can work out for longer periods of time. As the muscles and joints start to adapt, then the intensity can gradually be increased back towards full activity.
This entire process is extremely variable in duration, depending on the age and fitness level of the athlete and the performance level demanded. A relatively lumbering old man like me might be able to get to full activity very quickly. A spry, young, high-impact gymnast might take four to six weeks to return to full activity. An older fitness runner who does long distances is likely to return from an ankle sprain more quickly than a college soccer player who puts a heavier load on the ankle.
Regardless of the injury, let pain be your guide. A gentle feeling of being stretched and a “comfortable” soreness after physical activity is normal. Pain during the activity or lingering long after an activity is a sign that things have not healed back to full strength. Back off some and remember that long-term, injury-free health is far more important than short-term sports successes.
10/27/2009October 26, 2009
Isn’t it amazing how a haircut can make or break you? Those beauticians are not just waving around scissors and combs; they are wielding some serious power in their skilled hands!
For example, my husband went for a haircut last week, and it didn’t turn out so well. In fact, he was so embarassed of his new ‘do…which was somewhat of a cross between an Army recruit special and a mohawk…that he came home and completely shaved his head. Ugh. Not my favorite look (although you still look gorgeous, sweetie!)
My son, on the other hand, also got a haircut last week. (Different place, by the way.) And it did him a WORLD of good! He looks amazing…not to mention about two years older, which is a lot when you’re only 17 months old! I love it. Yet, as I saw Kellen’s new “look” slowly taking shape in the salon, and watched those last long blonde strands floating down the floor, I truly had a moment when I thought, “This is it. These hairs are like the last remnants of his babyhood. He’s really becoming a big boy now.” And I had to blink back a few tears, quickly, so my husband wouldn’t notice. How sappy am I? I’m telling all of you because I’m hoping that there are some other mothers out there who can relate. Surely I’m not the only mommy who has nearly cried over a simple haircut!
Here are a couple of pictures to prove what I am talking about. They were taken one week apart! In picture one…me and my baby. In picture two…a little boy! Unbelievable. Where does the time go?
10/22/2009
A recent experience with a patient reminded me just how important it is to stay “clean.” His case was striking for how severe it was, but similar problems could occur with anyone. He is a football player who got his hand stepped on during a game. The other guy’s cleats ripped a gash in the back side of my patient’s hand. Of course, out on the turf of a football field, there were plenty of germs to go around. He went to an emergency room where they attempted to clean up the cut. The family’s impression was that they spent a lot of time cleaning and clearing out debris. The gash was stitched up appropriately, but over the next twenty-four hours, it became clear that there was an infection brewing. It took us a couple of days of IV antibiotics and another ten days of oral antibiotics to get him cleaned up. He’ll also have quite a scar to impress the girls with. He says it will make him look tough.
While a large cut that has been ground into the dirt is rather dramatic, there really are myriad ways that your children can pick up serious skin infections. The most common that I see in the office is a terribly itchy bug bite that the kids can’t resist scratching until it bleeds. Other skin infections can come from small cuts that aren’t adequately cared for. Another common source is the minor cold. With all that nasal drainage, kids can’t resist drawing their forearm across the nose many times a day creating skin breakdown just under the nose which is a portal to allow bacteria into the skin.
What almost all skin infections have in common is a break in the skin and some contact with an infected surface. So how do you prevent these from developing? Probably the single most important thing you can do is to teach your kids to wash their hands often. The more often they clean their hands well (vigorous scrubbing for at least 20 seconds), the fewer bacteria will reside on the hands. It is especially important to clean under the fingernails. Fingernails are used for everything! Prying rocks out of the dirt, untying a knot, picking scabs and noses and scratching at itchy bug bites.
Secondly, keep any break in the skin absolutely as clean as possible. With any wound, soap and water should be the first line of treatment. Soap and water can be used on any injury for as long as it takes that injury to heal. Flush with as much water as possible. If it is a dirty cut, an abundant amount of peroxide or Betadine can be used with the first cleaning, but should not be used after that (these two compounds injure healthy skin cells almost as much as they do bacterial cells). If there is ground-in dirt, take the time to scrub out the dirt as much as you can. These small particles of dirt harbor lots of bacteria. Finally, keep an antibiotic ointment on the wound no matter how small or where it is on the body. Neosporin is adequate for most purposes. We will sometimes use prescription strength creams when over-the-counter creams fail.
Sometimes, in spite of your best efforts, breaks in the skin become infected. Signs that you need to take your child to the doctor include pain, swelling, and redness outside of the immediate injury or pus coming from the wound. Pus is usually thick, white, yellow or green, and often smells bad. Often wounds will drain a clear thin yellow fluid. This fluid is not pus, is actually aiding in the healing, and can be washed off with soap and water. If any drainage persists past a few days, it may indicate a need for further therapy. | Edit in Browser | /_layouts/images/icxddoc.gif | /Maternity/thebalancingact/_layouts/formserver.aspx?XsnLocation={ItemUrl}&OpenIn=Browser | 0x0 | 0x1 | FileType | xsn | 255 | | Edit in Browser | /_layouts/images/icxddoc.gif | /Maternity/thebalancingact/_layouts/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser | 0x0 | 0x1 | ProgId | InfoPath.Document | 255 | | Edit in Browser | /_layouts/images/icxddoc.gif | /Maternity/thebalancingact/_layouts/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser | 0x0 | 0x1 | ProgId | InfoPath.Document.2 | 255 | | Edit in Browser | /_layouts/images/icxddoc.gif | /Maternity/thebalancingact/_layouts/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser | 0x0 | 0x1 | ProgId | InfoPath.Document.3 | 255 | | Edit in Browser | /_layouts/images/icxddoc.gif | /Maternity/thebalancingact/_layouts/formserver.aspx?XmlLocation={ItemUrl}&OpenIn=Browser | 0x0 | 0x1 | ProgId | InfoPath.Document.4 | 255 | | View in Web Browser | /_layouts/images/ichtmxls.gif | /Maternity/thebalancingact/_layouts/xlviewer.aspx?listguid={ListId}&itemid={ItemId}&DefaultItemOpen=1 | 0x0 | 0x1 | FileType | xlsx | 255 | | View in Web Browser | /_layouts/images/ichtmxls.gif | /Maternity/thebalancingact/_layouts/xlviewer.aspx?listguid={ListId}&itemid={ItemId}&DefaultItemOpen=1 | 0x0 | 0x1 | FileType | xlsb | 255 | | Snapshot in Excel | /_layouts/images/ewr134.gif | /Maternity/thebalancingact/_layouts/xlviewer.aspx?listguid={ListId}&itemid={ItemId}&Snapshot=1 | 0x0 | 0x1 | FileType | xlsx | 256 | | Snapshot in Excel | /_layouts/images/ewr134.gif | /Maternity/thebalancingact/_layouts/xlviewer.aspx?listguid={ListId}&itemid={ItemId}&Snapshot=1 | 0x0 | 0x1 | FileType | xlsb | 256 |
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