Worrisome birth mark on spine? - Mothering Forums

Forum Jump: 
 
Thread Tools
Old 07-19-2008, 01:30 AM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Ok, so when my dd was born, we all ooh'd and awe'd at her heart shaped dark red birthmark on the base of her spine. Nothing more was ever said of it, just 'how cute!' by the midwives (CNM's).

Until recently when I found out that I have spinal issues, I never thought anything of her birthmark. Now I'm a bit worried about it.

If it was an issue, would we know by now?

I do have an appt with her pedi to look at it in a couple weeks, but I wanted to get the thoughts of the moms on here with experience on this subject.
If her pedi isn't worried by it, should we push further on it? Get xrays/mri/etc?

She's 4, btw.

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Sponsored Links
Advertisement
 
Old 07-19-2008, 06:03 AM
 
feebeeglee's Avatar
 
Join Date: Nov 2002
Location: Oklahoma
Posts: 2,689
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I'm a mite worried for my 2.5yo.

Hers is shaped like Argentina.
feebeeglee is offline  
Old 07-19-2008, 11:04 AM
 
KatWrangler's Avatar
 
Join Date: Mar 2005
Location: Affton, MO
Posts: 10,794
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My daughter has Lipomyelomeningocele and Tethered Spinal Cord (also Neurogenic Bladder and Neurogenic Bowel which is result of nerve damage from tethering of the spinal cord). She was born with a Hemangioma at the base of her spine. Unfortunately, the Ped we were using told us it was fine and would get bigger and darker and go away by the time she was 5 or 6 WRONG. A birthmark, patch of hair or dimple can be a marker for tethered spinal cord and should be seen by a Neurosurgeon for evaluation.

This is from Primary Children's Hospital in Salt Lake City. Dr. Walker there did my daughters 2nd De-Tethering back in February.

http://www.neurosurgery4kids.net/tetheredspinalcord.htm

Quote:
Cutaneous Markers. Most patients with a tethered cord have a mark or discoloration of sometype on the skin of their lower back, usually in the midline. This is referred to as a "cutaneous marker". This may be a tuft of dark hair, a red coloration of the skin, a dimple that appears to go deep into the back, a localized subcutaneous collection of fat, or other similar abnormalities. The image below shows two different cutaneous markers in the same patient in the lumbar region of the back: a small area of very thin skin surrounded by a red discoloration and a separate area of red discoloration below. Other than the presence of a cutaneous marker, many children with a tethered cord are neurologically normal in their early years
I will be back.....My 9 week old is crying for boobie. I have more to tell you. Also, there are some others on here with kids with tethered spinal cord.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

KatWrangler is offline  
Old 07-19-2008, 11:25 AM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
So regardless of what her pedi says, we should take her to see a NS?

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 07-19-2008, 01:03 PM
 
chann96's Avatar
 
Join Date: May 2004
Location: West Vrginia
Posts: 1,177
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My daughter has spina bifida. She was born with a full-on hole in her back so there was no doubt about her case.

Yes, I do think that even if the ped isn't concerned that meeting a n/s to ask about it would be a good idea. If there is no problem then fabulous, but if it is a problem you(and she) are so much better off knowing sooner. Peds(
most anyway) are very good docs at overall childhood stuff, but they aren't specialists and don't see 100 kids a week with neurological issues.
chann96 is offline  
Old 07-19-2008, 02:14 PM
 
bandgeek's Avatar
 
Join Date: Sep 2006
Posts: 2,356
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
It never hurts to get it checked out by an expert. I love our pedi, but I'd never expect him to be an expert on all things, and if he wasn't concerned, but I wasn't so sure, I'd err on the side of caution. Nothing against him, but pedis are human too.
bandgeek is offline  
Old 07-19-2008, 02:35 PM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My only worry taking her to a NS is that pretty much automatically means an MRI, right? Thus, IV and sedation and so much unfun stuff. lol. I'll do it if needed, I just don't know if it is needed? Should all birth marks on the base of the spine be given mri's? I'll take a pic of it and show in a sec.

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 07-19-2008, 02:41 PM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Ok, here it is. I showed a tiny bit of her butt crack to help show where the birth mark is.
http://i274.photobucket.com/albums/j..._07_20_999.jpg

Btw, she was cracking up that I was taking a photo of her butt.

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 07-19-2008, 03:58 PM
 
Ceinwen's Avatar
 
Join Date: Jul 2004
Location: The cold, crazy north
Posts: 2,599
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I had a tethered cord as a child, but it wasn't diagnosed until I was fifteen.

I lost feeling in my rear left leg, foot, and left buttock.

The doctor's in town kept telling my parents it was a pinched nerve. They pushed harder, we went to Sick Kids in Toronto for an MRI and they ended up operating three days later (because I was older and having problems already).

They said the tell tale sign was the birthmark I have on my lower spine. I have to go for an MRI yearly to monitor the lipoma tumor that was there because they weren't able to remove all of it (it's tangled in the nerves).

Full time working mom to two bright and busy little girls! treehugger.gif
Ceinwen is offline  
Old 07-19-2008, 04:03 PM
 
Bookmama's Avatar
 
Join Date: Jan 2002
Location: Pacific Northwest
Posts: 76
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Wow. That looks EXACTLY like the birthmark on my 20 mo DD. Uncanny. Same shape, same shade, same place. Our pediatrician referred us to a nuerossurgeon, who is sending her for an MRI (still waiting for a call on the scheduling . . .gggrrrrr. . . .). I've made a couple posts in the last weeks about this and the moms here have been super helpful. I think it's worth getting checked out for piece of mind. Let me know what you learn!
Bookmama is offline  
Old 07-19-2008, 04:25 PM
 
KatWrangler's Avatar
 
Join Date: Mar 2005
Location: Affton, MO
Posts: 10,794
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Yes, they will probably want to do an MRI. Being your child is 4 would require sedation. But I think thats a small price to pay. If in fact your child has something, you want to address NOW. Once the damage is done, you can not reverse it.

Here are some pictures of the Hemangioma on my daughter, Gabrielle. These were taken the night before her emergency surgery. She was 4 1/2 months old at the time. Under the Hemangioma is the lipoma.

http://img.photobucket.com/albums/v2...une2006012.jpg
http://img.photobucket.com/albums/v2...une2006011.jpg

Here are some pictures of her I took the other day.

http://img.photobucket.com/albums/v2...uly2008050.jpg
http://img.photobucket.com/albums/v2...uly2008052.jpg

Now, we may have a problem with my 9 week old daughter. We discovered a Hemangioma on her back and a shadow of something at the base of her spine a couple of weeks ago. I am taking both girls to see the Neurosurgeon (we just moved in May) on July 30th. We were taking Gabrielle to see him anyway and they said they would take a look at Delaney. I would imagine the new Neurosurgeon will want us to do an MRI on Delaney.

http://img.photobucket.com/albums/v2...e2008003-1.jpg
http://img.photobucket.com/albums/v2...e2008004-1.jpg
http://img.photobucket.com/albums/v2...e2008005-1.jpg

So there may or may not be anything wrong with your daughter. But its better to be safe about it.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

KatWrangler is offline  
Old 07-19-2008, 04:39 PM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Ok, thank you for all your thoughts. I'll definitely push for an MRI on her.

Anne, are spinal issues hereditary? I am going to be having an MRI soon to look for a TC and I have other spinal issues as well. If I have one, does that raise the chances the rest of my kiddos could have one?

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 07-19-2008, 06:40 PM
 
Ceinwen's Avatar
 
Join Date: Jul 2004
Location: The cold, crazy north
Posts: 2,599
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I wonder if hemangiomas and lipomas are connected somehow?

If you look at the link in my sig (my dd Zoe) she has a hemangioma on her face. She fell into the approx. 2% we were told where it *didn't* stop growing at around 18 months, and she had to have prednisone injections directly into it. She'd also been on systemic prednisone since she was 6 weeks old.

Kathryn and KatWrangler, I hope your little ones are okay.

Full time working mom to two bright and busy little girls! treehugger.gif
Ceinwen is offline  
Old 07-19-2008, 09:58 PM
 
jewelsJZ's Avatar
 
Join Date: Jan 2008
Posts: 503
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hmmmm....now I'm a bit worried about ds. He has a light brown mark on his lower back by his spine. He was not born with it. It showed up around age 3, then around when he turned 4, it got bigger and a little darker. His back has not been exposed to the sun. He always wears a swim shirt. I asked our ped. to take a look, she said it was a birth mark. I said it was not, it was not there until 3 years after birth. She said the reason it likely got bigger was because he grew bigger and as long as it stays in proportion to his body, it's nothing to worry about.
It isn't red in any way, just looks like an odd shaped tan mark. Should I be worried about this? Get another opinion?
jewelsJZ is offline  
Old 07-21-2008, 12:48 PM
 
AllieFaye's Avatar
 
Join Date: Mar 2007
Posts: 688
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I think it's worth getting a second opinion. Most peds don't see enough serious spinal issues in a career to distinguish between a harmless birthmark and a hallmark for serious conditions. Most birthmarks ARE harmless, but it's better safe than sorry.

Regarding some of the other questions in the thread. Hemangiomas and lipomas are often connected; they are both signs of similiar internal conditions. Some spinal issues are hereditary; some are not.
AllieFaye is offline  
Old 07-21-2008, 01:01 PM
 
Jillybean's Avatar
 
Join Date: Dec 2003
Location: NC
Posts: 604
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Gosh thank you so much for this thread. My dd has both a tuft of dark hair and a dimple on the base of her spine. My pedi said he'd "keep an eye on it" whatever that means. I like him a lot, but I think now I'll take her to a specialist just to be sure.

Mama to Boy (10) Other Boy (7) and Girl (4)   mdcblog5.gif in my profile!

Jillybean is offline  
Old 07-21-2008, 06:32 PM
 
Karry's Avatar
 
Join Date: Apr 2002
Location: Arizona
Posts: 820
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Does anyone know if the birthmark is higher up on the back if it could still be related to a tethered cord? My dd who is 9 has had a fairly large red birthmark on her back since birth, and as she has gotten older the birthmark has gotten larger. It's also not midline, it's off to the right side of her back. She has had chronic constipation issues for years, and this would possibly expain why she says she can't feel the urge to go.
Karry is offline  
Old 07-22-2008, 11:54 AM
 
MotherWhimsey's Avatar
 
Join Date: Mar 2005
Posts: 3,387
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
aniyah has one almost exactly like that, except hers is shaped like a pair of lips. We were told that it's not a hemangioma since it's not raised. I've never been concerned about it.
MotherWhimsey is offline  
Old 07-22-2008, 12:04 PM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
So if it's not raised, it should be fine?

Anne, have you found (in all your experience/research) that to be true? Dakota's isn't raised at all, it's just coloured skin.

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 07-22-2008, 12:47 PM
 
KatWrangler's Avatar
 
Join Date: Mar 2005
Location: Affton, MO
Posts: 10,794
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by Kathryn View Post
So if it's not raised, it should be fine?

Anne, have you found (in all your experience/research) that to be true? Dakota's isn't raised at all, it's just coloured skin.
I am not sure. I have always heard Hemangiomas are associated with Spina Bifida/Tethered Cord.

I would have to say if its just a colored birthmark and not raised it is probably nothing to worry about. But for peace of mind you might want to have someone look at it. Now if it was raised and was a Hemangioma I would be more worried.

I will ask on my groups what they think and let you know.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

KatWrangler is offline  
Old 07-22-2008, 01:02 PM
 
MotherWhimsey's Avatar
 
Join Date: Mar 2005
Posts: 3,387
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
it's not a hemangioma. I forget what it's called, but there was another name for it. a hemangioma is always raised I think.
MotherWhimsey is offline  
Old 07-22-2008, 01:11 PM
 
Contrariety's Avatar
 
Join Date: Jul 2007
Location: The UC
Posts: 2,226
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by MotherWhimsey View Post
it's not a hemangioma. I forget what it's called, but there was another name for it. a hemangioma is always raised I think.
Not true. DS got a hemangioma on his belly a few weeks after birth. It started out like a bruise but and then it got flecks of red... but it has stayed under the skin. I did a bit of research, and while it's not common for a hemangioma to stay under the skin, they definitely can. His is going away now, but you can still see it. If I can wrangle him, I'll take a pic to post...
Contrariety is offline  
Old 07-22-2008, 04:29 PM
 
KatWrangler's Avatar
 
Join Date: Mar 2005
Location: Affton, MO
Posts: 10,794
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
This is why it needs to be looked at by a specialist to make sure what exactly it is.

Here is some info on Hemangiomas.

http://www.birthmark.org/hemangiomas.php

Quote:
Approximately eighty three percent occur on the head and neck area. The remaining seventeen percent appear throughout the the rest of the body (both externally and internally). In the early stages some appear either as bluish or reddish spots or flat patches. Rarely is a hemangioma fully grown at birth.


Hemangiomas that are flat and appear reddish in color are called "superficial" and those that are deep beneath the skin and appear bluish in color are called "deep" hemangiomas. When a hemangioma is both deep and superficial it is called a "compound" hemangioma. The correct diagnosis is critical for proper treatment.
http://dermnetnz.org/vascular/haemangioma.html

Quote:
Haemangiomas arising over the lower part of the spine are sometimes a marker for occult spinal dysraphism (spina bifida), when spinal imaging may be appropriate.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

KatWrangler is offline  
Old 07-22-2008, 04:34 PM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Ok, so the pic I posted of hers, does it look like a hemangioma or is there even a way to tell by looking at it like that?

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 07-22-2008, 04:51 PM
 
KatWrangler's Avatar
 
Join Date: Mar 2005
Location: Affton, MO
Posts: 10,794
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
No way to tell from the pic.

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

KatWrangler is offline  
Old 07-22-2008, 06:33 PM
 
mamaverdi's Avatar
 
Join Date: Apr 2005
Location: Texas
Posts: 12,572
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Did you see anyone yet?
mamaverdi is offline  
Old 07-22-2008, 08:20 PM - Thread Starter
 
Kathryn's Avatar
 
Join Date: Oct 2004
Location: Colorado
Posts: 5,859
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
No, her pedi appt is the first week of August.

Mom to Dakota (6), Coy, (4), Max, (4), Lily (4), and Auri (June 19th 2010)!
Visit Lily's site at www.caringbridge.org/visit/lilymathis1
Kathryn is offline  
Old 08-02-2008, 01:24 AM
 
M&MsMom's Avatar
 
Join Date: Apr 2008
Posts: 8
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My 14 month old DD has a redish-purple flat birthmark at the midline of her lumbar spine as well. It's about an inch wide, half inch high, it blanches when you press on it, and it seems to be growing with her, but I'm not sure. It has not faded since birth, even though the pedi thought it would. She also has a "stork bite" at the back of her neck under the hairline. I've read these two birthmarks combined greatly increase the chance of spinal abnormality. We have a check-up on August 15 and I hope I can convince them of the risk and need for MRI imaging.

I saw a couple of posts here from moms with similar conditions, and now I'm wondering if heredity plays a part. I had a kidney infection at age 3, have recurrent UTIs, had mild scoliosis as an adolescent, and suffer from low back pain, leg length discrepancies, pelvic alignment issues, etc. I see a chiropractor every few years, but the problems never really go away.

Here are a few links I found helpful:

http://dermatlas.med.jhmi.edu/derm/I...geID=133161659

http://archderm.ama-assn.org/cgi/con...act/140/9/1109

http://dermatology.jwatch.org/cgi/co...ull/2001/130/1

There is also a clinical trail recruiting children with hemangiomas of the face and lumbar spine to test for these associated conditions. I emailed them offering my daughter for science, even sent a picture, but no reply yet.: Might be becuase dermatologists are supposed to refer, or because my daughter's mark does not look like a hemangioma. More like a port wine stain. Or because university researchers take long summer vacations!

http://clinicaltrials.gov/ct2/show/N...yndrome&rank=1

http://www.ninds.nih.gov/disorders/t...hered_cord.htm

Anyway, good luck and keep us posted.

-Mom to Mateo (9/04) and Malena (5/07)
M&MsMom is offline  
Old 08-02-2008, 09:31 AM
 
KatWrangler's Avatar
 
Join Date: Mar 2005
Location: Affton, MO
Posts: 10,794
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I would demand an MRI. First you may have to request with a Pediatric Neurosurgeon. The Neurosurgeon will/can order the MRI. You are absolutely correct these can be markers.

I don't know if you saw my post...

http://www.mothering.com/discussions...d.php?t=940615

http://www.mothering.com/discussions...ght=hemangioma

An MRI is being ordered for my youngest. Still waiting for answer of a date and time.

ETA - Duke University is also doing a study on Neural Tube Defects.

http://www.chg.duke.edu/diseases/ntd.html

Anne, Mama to Conner 2/27/04 blahblah.gif  Gabrielle 2/6/06 W/LMC-TCS, Neurogenic Bladder, AFO & KAFO wearer, Neurogenic Bowel energy.gif & Delaney 5/12/08 mischievous.gif &  Beethoven cat.gif& Gizmo cat.gif

KatWrangler is offline  
Old 08-02-2008, 09:47 AM
 
*Robin*'s Avatar
 
Join Date: Aug 2007
Location: Michigan
Posts: 386
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
s for your worries. While I do not discount any of the above advice, and would definitely get my own child checked out thoroughly, by a specialist, I just thought I'd post and say that I have a birth mark very similar to your daughter's, Kathryn. It's not raised at all; it's at the base of my spine. And it's just that: a birth mark. But as I said, I'd get anything on my child checked out thoroughly as you are. I just wanted to put it out there that it could just be a birthmark.

wife to treehugger.gif, mama to carrot.gif(7/06) and joy.gif(4/09), plusdog2.gif

*Robin* is offline  
 
User Tag List

Thread Tools


Forum Jump: 

Posting Rules  
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off