Still here... just in my cave. Who started the cave... was it Tertia? Anyway, I've got about 6 posts half-written, and they all degenerate into whininess, so I'll spare you.
26 weeks tomorrow. 15 days to go until our first big milestone. I cannot wait.
Showing posts with label Pregnancy #4. Show all posts
Showing posts with label Pregnancy #4. Show all posts
Saturday, October 13, 2007
Wednesday, October 03, 2007
For Electriclady
Phew! What a relief!
A complete and total false alarm. Dr. Favorite (my first appointment with her this pregnancy! At last, at last!) said I was the third patient this week to be diagnosed with low fluid levels by the ultrasound people, only to check out perfectly fine in the OB office. So, the usual warnings... stay hydrated, try and rest more, she asked what my lecture schedule was like these days and made sure my department was "on alert" that I may just not be able to turn up for class one day (and yes, they know...) and she asked how we were holding up.
Well, and there's that. How are we holding up? It really depends. You can ask, and we can answer, but 5 minutes later the answer may be the complete opposite. It only takes the smallest thing and H and I completely lose our grip. Deep down, I knew from the minute I heard the technician yesterday talking about low fluid levels that it was probably nothing. I'd had an upset stomach the previous day, and maybe I was a little less hydrated than usual. I also knew, deep down, that it was probably all fine again this morning when the OB office called. And yet, I was a basket case the whole day. My body was trembling from the huge volume of adrenaline I dumped into my circulatory system. I checked H's pulse while we were waiting in the exam room, and it was 110. The look of panic on his face when I told him the OBs wanted us to come in today was terrible.
We really need to find a way to get a grip. And yet, tomorrow is the exact gestational age where things collapsed with the pregnancy with D. Maybe that gives us the right to be a little fragile this week? I don't know. I just wish I could keep it together a little bit better. That may have to wait until we get past 28 weeks. But, for today, all is good. Several large pockets of fluid. Cervix long and closed. Growth is right on where it should be. The kid kicks constantly. Even my wieght isn't out of control. Why do I keep waiting for catastrophe? Can't I just enjoy this?
I wish I could have a glass of wine. I guess I'll do the next best thing and go soak in the bathtub with a Dick Francis novel.
A complete and total false alarm. Dr. Favorite (my first appointment with her this pregnancy! At last, at last!) said I was the third patient this week to be diagnosed with low fluid levels by the ultrasound people, only to check out perfectly fine in the OB office. So, the usual warnings... stay hydrated, try and rest more, she asked what my lecture schedule was like these days and made sure my department was "on alert" that I may just not be able to turn up for class one day (and yes, they know...) and she asked how we were holding up.
Well, and there's that. How are we holding up? It really depends. You can ask, and we can answer, but 5 minutes later the answer may be the complete opposite. It only takes the smallest thing and H and I completely lose our grip. Deep down, I knew from the minute I heard the technician yesterday talking about low fluid levels that it was probably nothing. I'd had an upset stomach the previous day, and maybe I was a little less hydrated than usual. I also knew, deep down, that it was probably all fine again this morning when the OB office called. And yet, I was a basket case the whole day. My body was trembling from the huge volume of adrenaline I dumped into my circulatory system. I checked H's pulse while we were waiting in the exam room, and it was 110. The look of panic on his face when I told him the OBs wanted us to come in today was terrible.
We really need to find a way to get a grip. And yet, tomorrow is the exact gestational age where things collapsed with the pregnancy with D. Maybe that gives us the right to be a little fragile this week? I don't know. I just wish I could keep it together a little bit better. That may have to wait until we get past 28 weeks. But, for today, all is good. Several large pockets of fluid. Cervix long and closed. Growth is right on where it should be. The kid kicks constantly. Even my wieght isn't out of control. Why do I keep waiting for catastrophe? Can't I just enjoy this?
I wish I could have a glass of wine. I guess I'll do the next best thing and go soak in the bathtub with a Dick Francis novel.
Tuesday, October 02, 2007
Whew
It's been a bit of a week.
D turned 2. We had a party. It was fabulous, but exhausting.
My mother-in-law came to stay for the weekend and the party. She brought her "gentleman friend" of a little over a year to stay as well. It was hilarious watching this completely creep out my poor husband. I'm delighted that she's seeing someone. She still drives me nuts, but I believe that's the main item in her job description as my mother-in-law. (Note: where can I see a copy of said job description? I'd like to know what to expect next. After reading incoming text messages on my cell phone, of course, which did indeed happen this weekend.)
Monday D had her 2 year checkup at her pediatrician's office. They have confirmed what I already knew: D is huge. She is back on the height chart (after the incident of the 100th percentile), but they confirmed what we already knew, which is that she's an inch shy of being the same size as the average three-year-old. Well, she's always been this way, so no worries. Quite an accomplishment for my little not-quite term child.
Today was the follow-up level 2 ultrasound on little gizmo. Now weighing in at an estimated 1 pound, 9 ounces. They were able to get the cardiac views we didn't get last time, and also checked in on those wacky non-cooperators, the placenta and my cervix. The cervix is maintaining champion status, remaining longer than 4 cm, while the placenta is still marginal, but with time remaining in which it can get the hell out of the way (we hope). The technician thought the fluid volume looked a bit low, so another item to add to my worry list, but all in all a good visit. We'll get the official report in a few days, I hope, or at the very least hear about it at our next OB visit next Tuesday. We're 2 days away from 24 weeks 4 days, which is where everything went crazy with my pregnancy with D, so we were relieved to see absolutely no sign of preterm labor or a funneling cervix. I woke up in at 4 AM this morning with what felt like menstrual cramps (note: this is a sign of preterm labor) but I was able to go back to sleep knowing that I was due for an ultrasound at 10AM anyway. Today: no cramping and only the normal level of contractions, so I am calm(ish).
D turned 2. We had a party. It was fabulous, but exhausting.
My mother-in-law came to stay for the weekend and the party. She brought her "gentleman friend" of a little over a year to stay as well. It was hilarious watching this completely creep out my poor husband. I'm delighted that she's seeing someone. She still drives me nuts, but I believe that's the main item in her job description as my mother-in-law. (Note: where can I see a copy of said job description? I'd like to know what to expect next. After reading incoming text messages on my cell phone, of course, which did indeed happen this weekend.)
Monday D had her 2 year checkup at her pediatrician's office. They have confirmed what I already knew: D is huge. She is back on the height chart (after the incident of the 100th percentile), but they confirmed what we already knew, which is that she's an inch shy of being the same size as the average three-year-old. Well, she's always been this way, so no worries. Quite an accomplishment for my little not-quite term child.
Today was the follow-up level 2 ultrasound on little gizmo. Now weighing in at an estimated 1 pound, 9 ounces. They were able to get the cardiac views we didn't get last time, and also checked in on those wacky non-cooperators, the placenta and my cervix. The cervix is maintaining champion status, remaining longer than 4 cm, while the placenta is still marginal, but with time remaining in which it can get the hell out of the way (we hope). The technician thought the fluid volume looked a bit low, so another item to add to my worry list, but all in all a good visit. We'll get the official report in a few days, I hope, or at the very least hear about it at our next OB visit next Tuesday. We're 2 days away from 24 weeks 4 days, which is where everything went crazy with my pregnancy with D, so we were relieved to see absolutely no sign of preterm labor or a funneling cervix. I woke up in at 4 AM this morning with what felt like menstrual cramps (note: this is a sign of preterm labor) but I was able to go back to sleep knowing that I was due for an ultrasound at 10AM anyway. Today: no cramping and only the normal level of contractions, so I am calm(ish).
Wednesday, September 12, 2007
Hiding in My Hole
I can't blog. I've gone from over the moon ecstatic and optimistic, to terrified of what tomorrow's cervical measurement will bring. We're right in the middle of where things tanked with my pregnancy with D and I am not handling it well. I'm contracting all over the place and H is nervous and his anxiety is rubbing off on me. Which is weird becasue deep down, I really am starting to think that I am just a woman who contracts a lot while pregnant (my mother says she was the same) and the thing that made that matter when I was pregnant with D was the subchorionic bleed, which by all accounts was a fluke and unlikely to recur this time around.
I know that makes no sense. I need to go to bed. Tomorrow we'll know what's up in there. Then I get to go give my lecture students their first exam of the semester. Giving an exam is much easier on me than lecturing for three hours. I really hope everything goes well tomorrow. It feels like a particularly crucial checkup to me. Maybe that's because at 21 and a half weeks, we really are teetering on the brink of viability here.
Long cervix. Long cervix. Breathe. Breathe.
I know that makes no sense. I need to go to bed. Tomorrow we'll know what's up in there. Then I get to go give my lecture students their first exam of the semester. Giving an exam is much easier on me than lecturing for three hours. I really hope everything goes well tomorrow. It feels like a particularly crucial checkup to me. Maybe that's because at 21 and a half weeks, we really are teetering on the brink of viability here.
Long cervix. Long cervix. Breathe. Breathe.
Monday, September 03, 2007
Doh-dee-doh-dee-doh
I don't have anything in particular to say but I feel like I should post. So, perhaps we'll do bullet points today.
--It's hotter than hell here. All of Southern California is having "unseasonably warm weather." Unseasonably warm my ass. It's a friggin' sauna. And I've got this thing squirming around inside my uterus. I don't think crabby and grouchy are strong enough words to describe my mood. I do not handle heat well.
--I'm having a hard time adjusting to the idea of this child, if born safely, being a boy. Which is odd, because I had really thought D was going to be a boy and I had to get used to the idea of her being a girl. Now I'm mourning the loss of her potential sister. Go figure. H has picked up on this and is afraid to express excitement over our potential son because he doesn't want to upset me. That poor man. I don't know how he's going to tolerate me if I keep this up.
--We bought a new car on Friday. A family car. My teeny convertible got me through one kid, but even I could see we needed something bigger. My husband loves it. I'm ambivolent. Friday was an expensive day.
--Yesterday I hit 20 weeks. Halfway to the mythical 40 weeks of a "normal" pregnancy. I'm on the downhill slope of this one. Of course, I have not failed to note that I am now past the last point in my pregnancy with D where my cervix was well-behaved. They measured it on Friday at 41.9 mm so now we wait and see if things are headed down the same path as with D. Oddly enough, now that we're into the preterm labor danger zone, I am calm. 20 weeks is still too soon for viability. I think I'm going to lose my grip when we get into that area where the baby could survive but would likely have major problems. 24 to 28 weeks is going to be hard for me.
--I made my first new baby purchases (besides the car, of course). I carefully read and considered all return policies. I got a pouch (I hated my old sling) and some new and improved bottles. I find it odd that right as we enter my personal pregnancy danger zone, I feel comfortable enough to buy things. I am insane.
--My next appointment isn't until the 13th. I don't know what I am going to do with myself until then. I'm no longer supposed to do anything active in the evenings (this is when I tend to contract). Other than that, I am to use my own judgement.
--Oh, and we checked out double jogging strollers today, too. The one I like is $530. Um, I'm sorry, but that is INSANE. I will now haunt Craig's List in the hopes of finding one used for a sum that I am willing to part with.
I'm sorry this post is so lame. I've been putting off posting all week due to the heat and my associated mood. Maybe I should have kept that up. Oh, well. I'll try and sleep and hopefully things will be better tomorrow.
--It's hotter than hell here. All of Southern California is having "unseasonably warm weather." Unseasonably warm my ass. It's a friggin' sauna. And I've got this thing squirming around inside my uterus. I don't think crabby and grouchy are strong enough words to describe my mood. I do not handle heat well.
--I'm having a hard time adjusting to the idea of this child, if born safely, being a boy. Which is odd, because I had really thought D was going to be a boy and I had to get used to the idea of her being a girl. Now I'm mourning the loss of her potential sister. Go figure. H has picked up on this and is afraid to express excitement over our potential son because he doesn't want to upset me. That poor man. I don't know how he's going to tolerate me if I keep this up.
--We bought a new car on Friday. A family car. My teeny convertible got me through one kid, but even I could see we needed something bigger. My husband loves it. I'm ambivolent. Friday was an expensive day.
--Yesterday I hit 20 weeks. Halfway to the mythical 40 weeks of a "normal" pregnancy. I'm on the downhill slope of this one. Of course, I have not failed to note that I am now past the last point in my pregnancy with D where my cervix was well-behaved. They measured it on Friday at 41.9 mm so now we wait and see if things are headed down the same path as with D. Oddly enough, now that we're into the preterm labor danger zone, I am calm. 20 weeks is still too soon for viability. I think I'm going to lose my grip when we get into that area where the baby could survive but would likely have major problems. 24 to 28 weeks is going to be hard for me.
--I made my first new baby purchases (besides the car, of course). I carefully read and considered all return policies. I got a pouch (I hated my old sling) and some new and improved bottles. I find it odd that right as we enter my personal pregnancy danger zone, I feel comfortable enough to buy things. I am insane.
--My next appointment isn't until the 13th. I don't know what I am going to do with myself until then. I'm no longer supposed to do anything active in the evenings (this is when I tend to contract). Other than that, I am to use my own judgement.
--Oh, and we checked out double jogging strollers today, too. The one I like is $530. Um, I'm sorry, but that is INSANE. I will now haunt Craig's List in the hopes of finding one used for a sum that I am willing to part with.
I'm sorry this post is so lame. I've been putting off posting all week due to the heat and my associated mood. Maybe I should have kept that up. Oh, well. I'll try and sleep and hopefully things will be better tomorrow.
Wednesday, August 22, 2007
Night of Panic
Every night I wake up at around 2:30 AM with a bladder that's simply bursting. I go and pee, get back in bed, have a few contractions as my uterus resumes occupation of the space my bladder was hogging, and after a while spent trying not to dwell on those middle-of-the-night negative thoughts, I eventually go back to sleep.
Last night all went as usual until I got back in bed and took note of the expected contraction. It was crampy. Not a painless tightening like I'm used to, but the ouchy kind that sets off alarm bells. This went on for some time. So, I lay there, engaged in my normal mental debate. Should I wake up H? Should I call the OB answering service and have them page the on-call doctor? Should I go to the hospital and get monitored at triage? Who should we call in the middle of the night to stay with D if H needs to drive me to the hospital?
I'll skip to the end and say that eventually a small rational voice in the back of my head piped up and noted that (1) pregnant women tend to get, erm, well... backed up, shall we say? and (2) previous experiences of this nature have been resolved when nature and my large intestine managed to work things out amongst themselves. I calmed down, eventually relaxed enough to go back to sleep, and this morning step (2) above indicated that indeed, this was what was going on.
The experience has reminded me how much safer I feel in the hospital when having a terrifying pregnancy. You're constantly being watched, monitored, ultrasounded, poked, prodded, blood pressured, etc. One of your doctors checks in on you every single morning and asks if anything new has come up. In the middle of the night, a nurse would be just a few feet away to strap on that contraction monitor in the above situation and either tell me everything's fine or administer an injection to stop the contractions. (Ahh, terbutaline... how I love to hate you...) All of the pressure to keep the pregnancy going is taken out of your hands entirely. And while I cannot emphasize the lousiness of hospital bedrest in strong enough language, there is indeed the advantage of having the responsibility removed for deciding what's a subchorionic hematoma causing preterm labor, and what's, well... constipation.
18 weeks and 3 days. Sigh. How far I have yet to go.
Last night all went as usual until I got back in bed and took note of the expected contraction. It was crampy. Not a painless tightening like I'm used to, but the ouchy kind that sets off alarm bells. This went on for some time. So, I lay there, engaged in my normal mental debate. Should I wake up H? Should I call the OB answering service and have them page the on-call doctor? Should I go to the hospital and get monitored at triage? Who should we call in the middle of the night to stay with D if H needs to drive me to the hospital?
I'll skip to the end and say that eventually a small rational voice in the back of my head piped up and noted that (1) pregnant women tend to get, erm, well... backed up, shall we say? and (2) previous experiences of this nature have been resolved when nature and my large intestine managed to work things out amongst themselves. I calmed down, eventually relaxed enough to go back to sleep, and this morning step (2) above indicated that indeed, this was what was going on.
The experience has reminded me how much safer I feel in the hospital when having a terrifying pregnancy. You're constantly being watched, monitored, ultrasounded, poked, prodded, blood pressured, etc. One of your doctors checks in on you every single morning and asks if anything new has come up. In the middle of the night, a nurse would be just a few feet away to strap on that contraction monitor in the above situation and either tell me everything's fine or administer an injection to stop the contractions. (Ahh, terbutaline... how I love to hate you...) All of the pressure to keep the pregnancy going is taken out of your hands entirely. And while I cannot emphasize the lousiness of hospital bedrest in strong enough language, there is indeed the advantage of having the responsibility removed for deciding what's a subchorionic hematoma causing preterm labor, and what's, well... constipation.
18 weeks and 3 days. Sigh. How far I have yet to go.
Wednesday, August 15, 2007
Vacation is Over!!
I'm back! I must say, two weeks is a very long time for a vacation. And a nearly 2-year-old along for the ride makes the whole thing considerably less relaxing for everyone involved. At any rate, we survived, we're home and I am very relieved to be done with travel. We're all exhausted. One night so far in everyone's own beds has helped, but I think it's going to take a few days to settle in. I put D down for her nap about 20 minutes ago, and so far all I'm hearing on the baby monitor are sounds of her jumping up and down on her mattress, shrieking "Boing boing boing!"
First order of business upon our return was to check back in with our OB group. We'd had an appointment July 30th, which was the day before we left, where I had my first measurement of cervical length, which was 3.5 cm. The placenta was still sitting smack on top of the cervical os. Today's appointment: cervix about 4 cm (!) and some possible migration of the placenta away from the cervical os (!!!). It seems to be moving anteriorly(is that even a word?) as the uterus expands.
Need I even say how pleased we were with this? We were somewhat worried before the appointment, since I have been noticing quite a few contractions over the last few weeks (mostly in the evenings), which is typical for me. Dr. um... let's see... Dr. Likes2Knit switched to the transabdominal ultrasound to get a better look at the placenta, after which we tried to detect some boy parts. None were immediately forthcoming, but the baby was being rather coy, and the resolution of this ultrasound machine wasn't the greatest, so we couldn't be sure. Dr. Likes2Knit said her guess was 80% sure that we have another girl in there. I think my guess is along the same lines. We could catch glimpses of something that might be... well... no, maybe that's umbilical cord... hmmm.... So we gave up. For now.
H confessed he was a little disappointed not to see boy parts. He quickly added he'd get over it and then joked that it gives us a reason to try for a third child. Ha, ha, ha, I say. Ha bloody ha. What a comedian that boy is.
Anyway, originally we were supposed to have our big fetal anatomy ultrasound a week from Friday at the normal imaging center. But, while on vacation, I got a call from the OB office. Remember that mysterious referral to the perinatology group that I specifically asked about and was told not to bother with? Yep, you guessed it. That was for us to go see the perinatologists for the big ultrasound so they can get a good careful look at the placenta. So, I was told to cancel the ultrasound appointment I'd made at the imaging center and make one instead with the perinatologists. I resisted the urge to ask if maybe they couldn't have sorted this out on July 30th when I looked at the instructions they gave me for making an appointment at the imaging center and asked if maybe they didn't really intend for me to make an appointment with the perinatology group instead? Oh, no, they said.
Sigh. The world will be very different when I am in charge.
So, I made the appointment today, but of course they're rather full so I couldn't get in until the following Monday. 12 days of waiting. I need to go buy myself some patience.
First order of business upon our return was to check back in with our OB group. We'd had an appointment July 30th, which was the day before we left, where I had my first measurement of cervical length, which was 3.5 cm. The placenta was still sitting smack on top of the cervical os. Today's appointment: cervix about 4 cm (!) and some possible migration of the placenta away from the cervical os (!!!). It seems to be moving anteriorly(is that even a word?) as the uterus expands.
Need I even say how pleased we were with this? We were somewhat worried before the appointment, since I have been noticing quite a few contractions over the last few weeks (mostly in the evenings), which is typical for me. Dr. um... let's see... Dr. Likes2Knit switched to the transabdominal ultrasound to get a better look at the placenta, after which we tried to detect some boy parts. None were immediately forthcoming, but the baby was being rather coy, and the resolution of this ultrasound machine wasn't the greatest, so we couldn't be sure. Dr. Likes2Knit said her guess was 80% sure that we have another girl in there. I think my guess is along the same lines. We could catch glimpses of something that might be... well... no, maybe that's umbilical cord... hmmm.... So we gave up. For now.
H confessed he was a little disappointed not to see boy parts. He quickly added he'd get over it and then joked that it gives us a reason to try for a third child. Ha, ha, ha, I say. Ha bloody ha. What a comedian that boy is.
Anyway, originally we were supposed to have our big fetal anatomy ultrasound a week from Friday at the normal imaging center. But, while on vacation, I got a call from the OB office. Remember that mysterious referral to the perinatology group that I specifically asked about and was told not to bother with? Yep, you guessed it. That was for us to go see the perinatologists for the big ultrasound so they can get a good careful look at the placenta. So, I was told to cancel the ultrasound appointment I'd made at the imaging center and make one instead with the perinatologists. I resisted the urge to ask if maybe they couldn't have sorted this out on July 30th when I looked at the instructions they gave me for making an appointment at the imaging center and asked if maybe they didn't really intend for me to make an appointment with the perinatology group instead? Oh, no, they said.
Sigh. The world will be very different when I am in charge.
So, I made the appointment today, but of course they're rather full so I couldn't get in until the following Monday. 12 days of waiting. I need to go buy myself some patience.
Thursday, July 26, 2007
Contact!!
Dr. Favorite just called. I feel much better. She's just so calming. She talks me off my ledges without patronizing me, belittling my fears, or smoothing over risks.
Main points:
1. The uterus was about the size of a fist when they saw the previa. There aren't many places for it to sit down that *don't* threaten to or cover the cervical os.
2. The bulk of it is posterior, which means they were looking around/through all sorts of stuff when trying to see it clearly. They're looking for shadows, basically. It's possible that things are better than they thought.
3. She may have hinted that the perinatology group can be a bit, well, alarmist.
4. She thinks there's a reasonable chance it could still migrate.
5. Even if it doesn't, it doesn't really change our plans for managing the risks for this pregnancy, but adds in a c-section at 36 weeks after an amnio to check for lung maturity. Note: 36 weeks falls on December 23rd. Merry Christmas.
Then we discussed the plans for managing my old nemesis, preterm labor with a cervix that doesn't stay shut. She seemed surprised that the perinatologists don't want to put in a cerclage. I explained that they weren't convinced I really have an incompetent cervix and she practically snorted. I get the feeling her money is on a progressively shortening cervix over the next month or two followed by a cerclage. Place your bets now.
In other news, I am done with my grading. Lab reports: graded. Final exams: graded. Raw numbers input into spreadsheet: check. All I need to do now is set my curve, assign letter grades, and submit them to admissions and records. And then, I am DONE with the summer session. Hooray!! We leave on Tuesday for 2 weeks at my parents' house. H and I are hoping to leave D with my mom and sneak off for a couple days at a B&B here. Wonderful.
Main points:
1. The uterus was about the size of a fist when they saw the previa. There aren't many places for it to sit down that *don't* threaten to or cover the cervical os.
2. The bulk of it is posterior, which means they were looking around/through all sorts of stuff when trying to see it clearly. They're looking for shadows, basically. It's possible that things are better than they thought.
3. She may have hinted that the perinatology group can be a bit, well, alarmist.
4. She thinks there's a reasonable chance it could still migrate.
5. Even if it doesn't, it doesn't really change our plans for managing the risks for this pregnancy, but adds in a c-section at 36 weeks after an amnio to check for lung maturity. Note: 36 weeks falls on December 23rd. Merry Christmas.
Then we discussed the plans for managing my old nemesis, preterm labor with a cervix that doesn't stay shut. She seemed surprised that the perinatologists don't want to put in a cerclage. I explained that they weren't convinced I really have an incompetent cervix and she practically snorted. I get the feeling her money is on a progressively shortening cervix over the next month or two followed by a cerclage. Place your bets now.
In other news, I am done with my grading. Lab reports: graded. Final exams: graded. Raw numbers input into spreadsheet: check. All I need to do now is set my curve, assign letter grades, and submit them to admissions and records. And then, I am DONE with the summer session. Hooray!! We leave on Tuesday for 2 weeks at my parents' house. H and I are hoping to leave D with my mom and sneak off for a couple days at a B&B here. Wonderful.
Wednesday, July 18, 2007
Placenta Update
OK, so here's how last Thursday went down.
Nuchal translucency scan: too early to be completely sure, but the word in the ultrasound room seemed to be that the results would probably be fine regarding our risk of a chromosomal trisomy like Down's Syndrome and the like. Full report in 5-10 days after they get the blood work done, etc. And, much to my surprise, it was a transabdominal scan. I got to keep my shorts on. Very civilized.
The fetus is starting to measure rather large for its gestational age. I am concerned that gestational diabetes is looming. This is a minor concern at this point, because of the real "uh oh" moment. The ultrasound technician was very bright and cheerful as she completed her photographs and measurements and said she'd be gone for a few minutes and then the doctor would be coming in.
Doctor? Coming in? My blood pressure shot through the roof. Doctors being fetched during routine ultrasounds has never worked out well for me, and Thursday was no exception. She returned alone, however, and said the doctor wanted her to do a transvaginal ultrasound to see if she could get a better view of the placenta, which looked weird. She still was having issues clearly seeing what she was looking for, so in came another staffer, who then went off to grab the doctor out of a room where he was currently WITH ANOTHER PATIENT. Up went the blood pressure another notch.
Well, to summarize the next few minutes, the placenta looks funky. It's definitely covering the opening to the cervix. This is called placenta previa, and it can be very bad. However, when diagnosed early in pregnancy, it quite often resolves over time as the uterus expands and drags the placenta upwards, away from the baby's potential exit to the world. This would be good. But, this being one of my pregnancies, it isn't that simple. The placenta isn't in one large mass as it should be. A lot of it is on the posterior side (this is good, between my uterus and my backbone) but there appears to be an extra extension crossing the cervical opening and setting up shop for itself on the anterior side. No idea if that will affect the possibility that the placenta may migrate away from the cervix over time. Here's something on wonky placentas.
Interestingly enough, some of the complications during my pregnancy with D were eventually revealed to involve an extra lobe to THAT placenta, which (1) may have been sent out after part of the original placenta peeled away from the inside of the sac after there was a bleed in there (this is called a subchorionic hematoma), and (2) this extra bit of placenta was so deeply dug into the wall of the uterus that it wasn't delivered with the rest of the placenta, and indeed lingered there malevolently until I started hemorrhaging uncontrollably 5 weeks after D was born, and wound up in an ambulance and then had emergency surgery. Placentas that are too deeply attached are called placenta accretia. Also of note: a major risk factor for placenta accretia is placenta previa. Fabulous.
So, best case scenario: this spontaneously resolves itself over the next few months and causes no more trouble than the state of panic that can currently be found in the Problem Uterus Household.
Middling scenario: the placenta previa remains where it is, but my cervix behaves itself until 36 or 37 weeks, thus not causing any vaginal bleeding or loss of blood supply to the baby, which is born via uneventful planned C-section 3 to 4 weeks before my due date. Merry Christmas, everyone.
Other scenarios, of which I am considerably less fond, include:
(a) cervix begins effacing and dilating early, causing attached placenta to pull away in places, causing vaginal bleeding, panic, and likely hospitalization, tocolytic drug therapy, and bed rest. I'm guessing the likelihood of this scenario increases when one considers my history of preterm labor. It this is the case, let's hope it starts as late as possible. They would hold off delivery as long as it seems safe for the baby, and me, but premature delivery seems quite possible.
(b) Part of the placenta is so deeply embedded in uterine wall that upon removal of the placenta, uterine bleeding cannot be controlled, necessitating blood transfusions, and/or a hysterectomy. Possible maternal death.
(c) Cervix misbehavior during pregnancy is rapid and causes unexpected and complete detachment of the placenta (this is placenta abrupta), leading to severe bleeding, loss of blood and oxygen supply to fetus, yadda yadda yadda. Possible maternal and fetal death.
Today I choose to stick my fingers in my ears and loudly sing songs from the new Springsteen release. There's absolutely nothing we can do about this except watch and wait. And, importantly, we have advance knowledge. This is a good thing. We can be as prepared as possible for whatever may be coming.
However, I am mourning the loss of "there's a 70% chance you'll have a completely normal pregnancy." I’m in week 13 and I just used the phrase "maternal and fetal death." I wish we hadn't discovered this so early.
Ignorance is indeed bliss.
Nuchal translucency scan: too early to be completely sure, but the word in the ultrasound room seemed to be that the results would probably be fine regarding our risk of a chromosomal trisomy like Down's Syndrome and the like. Full report in 5-10 days after they get the blood work done, etc. And, much to my surprise, it was a transabdominal scan. I got to keep my shorts on. Very civilized.
The fetus is starting to measure rather large for its gestational age. I am concerned that gestational diabetes is looming. This is a minor concern at this point, because of the real "uh oh" moment. The ultrasound technician was very bright and cheerful as she completed her photographs and measurements and said she'd be gone for a few minutes and then the doctor would be coming in.
Doctor? Coming in? My blood pressure shot through the roof. Doctors being fetched during routine ultrasounds has never worked out well for me, and Thursday was no exception. She returned alone, however, and said the doctor wanted her to do a transvaginal ultrasound to see if she could get a better view of the placenta, which looked weird. She still was having issues clearly seeing what she was looking for, so in came another staffer, who then went off to grab the doctor out of a room where he was currently WITH ANOTHER PATIENT. Up went the blood pressure another notch.
Well, to summarize the next few minutes, the placenta looks funky. It's definitely covering the opening to the cervix. This is called placenta previa, and it can be very bad. However, when diagnosed early in pregnancy, it quite often resolves over time as the uterus expands and drags the placenta upwards, away from the baby's potential exit to the world. This would be good. But, this being one of my pregnancies, it isn't that simple. The placenta isn't in one large mass as it should be. A lot of it is on the posterior side (this is good, between my uterus and my backbone) but there appears to be an extra extension crossing the cervical opening and setting up shop for itself on the anterior side. No idea if that will affect the possibility that the placenta may migrate away from the cervix over time. Here's something on wonky placentas.
Interestingly enough, some of the complications during my pregnancy with D were eventually revealed to involve an extra lobe to THAT placenta, which (1) may have been sent out after part of the original placenta peeled away from the inside of the sac after there was a bleed in there (this is called a subchorionic hematoma), and (2) this extra bit of placenta was so deeply dug into the wall of the uterus that it wasn't delivered with the rest of the placenta, and indeed lingered there malevolently until I started hemorrhaging uncontrollably 5 weeks after D was born, and wound up in an ambulance and then had emergency surgery. Placentas that are too deeply attached are called placenta accretia. Also of note: a major risk factor for placenta accretia is placenta previa. Fabulous.
So, best case scenario: this spontaneously resolves itself over the next few months and causes no more trouble than the state of panic that can currently be found in the Problem Uterus Household.
Middling scenario: the placenta previa remains where it is, but my cervix behaves itself until 36 or 37 weeks, thus not causing any vaginal bleeding or loss of blood supply to the baby, which is born via uneventful planned C-section 3 to 4 weeks before my due date. Merry Christmas, everyone.
Other scenarios, of which I am considerably less fond, include:
(a) cervix begins effacing and dilating early, causing attached placenta to pull away in places, causing vaginal bleeding, panic, and likely hospitalization, tocolytic drug therapy, and bed rest. I'm guessing the likelihood of this scenario increases when one considers my history of preterm labor. It this is the case, let's hope it starts as late as possible. They would hold off delivery as long as it seems safe for the baby, and me, but premature delivery seems quite possible.
(b) Part of the placenta is so deeply embedded in uterine wall that upon removal of the placenta, uterine bleeding cannot be controlled, necessitating blood transfusions, and/or a hysterectomy. Possible maternal death.
(c) Cervix misbehavior during pregnancy is rapid and causes unexpected and complete detachment of the placenta (this is placenta abrupta), leading to severe bleeding, loss of blood and oxygen supply to fetus, yadda yadda yadda. Possible maternal and fetal death.
Today I choose to stick my fingers in my ears and loudly sing songs from the new Springsteen release. There's absolutely nothing we can do about this except watch and wait. And, importantly, we have advance knowledge. This is a good thing. We can be as prepared as possible for whatever may be coming.
However, I am mourning the loss of "there's a 70% chance you'll have a completely normal pregnancy." I’m in week 13 and I just used the phrase "maternal and fetal death." I wish we hadn't discovered this so early.
Ignorance is indeed bliss.
Wednesday, July 11, 2007
Screening Time
Tomorrow I'm going in to my perinatology clinic for a nuchal translucency screen. I got the last possible appointment I could have gotten that both works with my schedule, and is also before I'm too far along to have the test done. Unfortunately, it's at 8:30 AM and it's pretty far away. I am going to be grouchy tomorrow. And I teach that night until 10:15 PM. It's gonna be a long day. We're paying out of pocket for this test since I'm under 35. Insurance companies are so arbitrary about what they will and will not cover. On the other hand, this pregnancy isn't costing me a $15 copay every time I go in for an office visit, and with cervix checks every 2 weeks from 16 weeks onward that would certainly add up if the pregnancy went full term.
Ha! Full term! Ha ha ha ha ha... Whew. That was a good one... [wipes eyes]
So... I didn't have this done with D so I'm not sure what to expect in terms of turnaround time on the results. I'm not even sure which doctor I'll be seeing. I do know they require cash up front. I hope they accept checks too, or it could be a very short appointment.
I am still going to my stroller walk workouts. I'm nervous about it but my doctor assured me the exercise would be good for me. I'm careful not to get my heart rate up too high and that I don't get overheated. Still nerveracking. I'm going to stop the minute anyone sees anything wacky going on, cervix-wise. There are women doing these workouts that are clearly nearing the ends of their pregnancies and they do more than I do-- I skip the big hills, etc. I wish I was so comfortable in my pregnancy that I wasn't worried about walking up and down a few hills.
I guess I don't really have much to say today. I'm still buried under the pile of grading I got last Thursday. Speaking of which, writing blog entries isn't getting me any closer to being done with that. I guess procrastination time is over for today.
Ha! Full term! Ha ha ha ha ha... Whew. That was a good one... [wipes eyes]
So... I didn't have this done with D so I'm not sure what to expect in terms of turnaround time on the results. I'm not even sure which doctor I'll be seeing. I do know they require cash up front. I hope they accept checks too, or it could be a very short appointment.
I am still going to my stroller walk workouts. I'm nervous about it but my doctor assured me the exercise would be good for me. I'm careful not to get my heart rate up too high and that I don't get overheated. Still nerveracking. I'm going to stop the minute anyone sees anything wacky going on, cervix-wise. There are women doing these workouts that are clearly nearing the ends of their pregnancies and they do more than I do-- I skip the big hills, etc. I wish I was so comfortable in my pregnancy that I wasn't worried about walking up and down a few hills.
I guess I don't really have much to say today. I'm still buried under the pile of grading I got last Thursday. Speaking of which, writing blog entries isn't getting me any closer to being done with that. I guess procrastination time is over for today.
Wednesday, July 04, 2007
Happy Fourth!!
I meant to post yesterday after my first OB appointment, but I was just too grouchy. It went fine, in terms of the fetus (it's now a fetus!!!)-- measuring right on, wiggly as a worm, good heartbeat. BUT, what a colossal pain in the ass. I left my house at 11:40 AM and got home at a quarter to six. A little long for a doctor's appointment, don't you think? I'd forgotten how long appointments at my OB's office can take. Ugh. I shall break it down for you:
11:40 AM: depart for day care lady's house.
12:00 PM: drop D off so I can pay $40 for her to nap nearly the whole time I'm gone.
12:01 PM: reflect that I ought to go into the daycare business.
12:02 PM: remember the 6 years I spent getting my PhD and ponder what being in your house all day with 4 small children must be like.
12:03 PM: decide things are just fine the way they are.
12:30 PM: after driving a total of about 30 miles from house, arrive at chinese restaurant where meeting H for lunch before appointment.
12:31: restaurant closed for fourth of July.
1:15 PM: finish lunch at restaurant next door and head to doctor's office up the street. Doubt husband's navigational abilities only to be proven wrong. (I hate that.)
1:30 PM: emerge from depths of parking garage to arrive on time for 1:30 appointment.
1:30-2:00 PM: sit in waiting room.
2:00 PM: escorted back for weight and blood pressure check after having given urine sample (first of the day).
2:01 PM: assistant doesn't know how to use scale properly, or else I magically lost 20 pounds since yesterday. Ponder speaking up and decide to let it go and see how they react next time when they think I've gained 25 pounds in three weeks.
2:05 PM: finish disrobing and sit on exam table in inadequate paper vest and paper square for covering bottom half.
2:05 PM to eternity: remain on exam table as bladder slowly refills.
2:45-ish: nurse practitioner comes in with inch-thick chart, which she has clearly been browsing through. Nurse practitioner immediately disappears to fetch medical records I brought from RE and gave to receptionist.
2:50- 3:00 PM-ish: have lovely conversation with nurse practitioner regarding history of preterm labor. Decide will do what perinatologist recommended, which is transvaginal ultrasounds every 2 weeks starting at 16 weeks to look for a shortening cervix or evidence of funnelling. Discover must go back to perinatologist and pay out-of-pocket for nuchal translucency screen since I'm under 35 and they don't do them in the OB office anyway. Get lab slip for OB blood panel and thyroid hormone levels. Have exam, swabs, etc.
3:00 PM: nurse practitioner departs and says doctor will be right in for ultrasound.
3:05 PM: ponder emptying bladder before ultrasound.
3:05:15 PM: doctor comes in. This is the new one since I had D, who we've never met. Plans of reunion with Dr. Favorite fade.
3:06 PM: doctor fails to get clear ultrasound shot of fetus since fetus is being cruelly squashed by increasingly full bladder. Doctor claims has never had to ask a patient to empty bladder to get good picture. Doctor applies increasing pressure with wand against full bladder. Doctor chides me for allowing bladder to get so full and irritate already well-known-irritable uterus.
3:07 PM: doctor becomes apologetic after I testily remark that bladder was completely empty when I was first escorted into exam room about an hour ago.
3:10 PM: doctor mercifully asks me to go empty bladder.
3:13 PM: doctor gets a quick grainy ultrasound picture and measurement of fetus and immediately vanishes.
3:15 PM: H and I make another appointment for July 30th and gratefully leave the office.
3:15 - 4:00 PM: I fight early rush-hour traffic to do what should have been a 20 minute drive to pick up D.
4:00 PM: take D across street to lab and give 8 or 9 gallons of blood for lab work. Experience first attempt to provide clean catch urine sample (second of day) while juggling a 21-month-old.
4:30 PM: sit in traffic jam due to terrible car accident at intersection on way home.
4:55 PM: emerge from traffic jam and drop off prescription.
5:25 PM: emerge victorious from pharmacy with barely intact sanity.
5:25:15 PM: start car and gas light comes on. Groan and slap forehead.
5:35 PM: arrive at nearest gas station and fill up car.
5:45 PM: arrive home with 45 minutes to spare before need to leave for work and give 2.5 hour review session to lab students.
__________________________________
You can perhaps see why I did not, in the end, post yesterday. Having slept somewhat of a full night (my class doesn't end until 10:15 and it's a fair distance away) I am feeling somewhat more refreshed today. But, I do not want to have to repeat this experience every 2 weeks. What to do? I love the doctors at this practice, and they were great during the chaotic disaster that was my pregnancy with D. Plus, they deliver at the hospital with the best NICU for micropreemies and the special unit for bedresting pregnant ladies. We used to live much closer to their office, but we moved out here to Siberia right after D was born and I don't want to switch to someone local. If I did, and we had more preterm labor fun and this baby was delivered early, the hospital up here would send the baby in an ambulance down to the hospital this practice delivers at anyway, leaving me stranded in the Siberian hospital and far away from my terribly sick child. I think I'm just going to have to deal with the distance and leave things as they are.
Sigh. Off to decorate my flag cake. Firework fun tonight!! I hope D doesn't panic.
11:40 AM: depart for day care lady's house.
12:00 PM: drop D off so I can pay $40 for her to nap nearly the whole time I'm gone.
12:01 PM: reflect that I ought to go into the daycare business.
12:02 PM: remember the 6 years I spent getting my PhD and ponder what being in your house all day with 4 small children must be like.
12:03 PM: decide things are just fine the way they are.
12:30 PM: after driving a total of about 30 miles from house, arrive at chinese restaurant where meeting H for lunch before appointment.
12:31: restaurant closed for fourth of July.
1:15 PM: finish lunch at restaurant next door and head to doctor's office up the street. Doubt husband's navigational abilities only to be proven wrong. (I hate that.)
1:30 PM: emerge from depths of parking garage to arrive on time for 1:30 appointment.
1:30-2:00 PM: sit in waiting room.
2:00 PM: escorted back for weight and blood pressure check after having given urine sample (first of the day).
2:01 PM: assistant doesn't know how to use scale properly, or else I magically lost 20 pounds since yesterday. Ponder speaking up and decide to let it go and see how they react next time when they think I've gained 25 pounds in three weeks.
2:05 PM: finish disrobing and sit on exam table in inadequate paper vest and paper square for covering bottom half.
2:05 PM to eternity: remain on exam table as bladder slowly refills.
2:45-ish: nurse practitioner comes in with inch-thick chart, which she has clearly been browsing through. Nurse practitioner immediately disappears to fetch medical records I brought from RE and gave to receptionist.
2:50- 3:00 PM-ish: have lovely conversation with nurse practitioner regarding history of preterm labor. Decide will do what perinatologist recommended, which is transvaginal ultrasounds every 2 weeks starting at 16 weeks to look for a shortening cervix or evidence of funnelling. Discover must go back to perinatologist and pay out-of-pocket for nuchal translucency screen since I'm under 35 and they don't do them in the OB office anyway. Get lab slip for OB blood panel and thyroid hormone levels. Have exam, swabs, etc.
3:00 PM: nurse practitioner departs and says doctor will be right in for ultrasound.
3:05 PM: ponder emptying bladder before ultrasound.
3:05:15 PM: doctor comes in. This is the new one since I had D, who we've never met. Plans of reunion with Dr. Favorite fade.
3:06 PM: doctor fails to get clear ultrasound shot of fetus since fetus is being cruelly squashed by increasingly full bladder. Doctor claims has never had to ask a patient to empty bladder to get good picture. Doctor applies increasing pressure with wand against full bladder. Doctor chides me for allowing bladder to get so full and irritate already well-known-irritable uterus.
3:07 PM: doctor becomes apologetic after I testily remark that bladder was completely empty when I was first escorted into exam room about an hour ago.
3:10 PM: doctor mercifully asks me to go empty bladder.
3:13 PM: doctor gets a quick grainy ultrasound picture and measurement of fetus and immediately vanishes.
3:15 PM: H and I make another appointment for July 30th and gratefully leave the office.
3:15 - 4:00 PM: I fight early rush-hour traffic to do what should have been a 20 minute drive to pick up D.
4:00 PM: take D across street to lab and give 8 or 9 gallons of blood for lab work. Experience first attempt to provide clean catch urine sample (second of day) while juggling a 21-month-old.
4:30 PM: sit in traffic jam due to terrible car accident at intersection on way home.
4:55 PM: emerge from traffic jam and drop off prescription.
5:25 PM: emerge victorious from pharmacy with barely intact sanity.
5:25:15 PM: start car and gas light comes on. Groan and slap forehead.
5:35 PM: arrive at nearest gas station and fill up car.
5:45 PM: arrive home with 45 minutes to spare before need to leave for work and give 2.5 hour review session to lab students.
__________________________________
You can perhaps see why I did not, in the end, post yesterday. Having slept somewhat of a full night (my class doesn't end until 10:15 and it's a fair distance away) I am feeling somewhat more refreshed today. But, I do not want to have to repeat this experience every 2 weeks. What to do? I love the doctors at this practice, and they were great during the chaotic disaster that was my pregnancy with D. Plus, they deliver at the hospital with the best NICU for micropreemies and the special unit for bedresting pregnant ladies. We used to live much closer to their office, but we moved out here to Siberia right after D was born and I don't want to switch to someone local. If I did, and we had more preterm labor fun and this baby was delivered early, the hospital up here would send the baby in an ambulance down to the hospital this practice delivers at anyway, leaving me stranded in the Siberian hospital and far away from my terribly sick child. I think I'm just going to have to deal with the distance and leave things as they are.
Sigh. Off to decorate my flag cake. Firework fun tonight!! I hope D doesn't panic.
Wednesday, June 20, 2007
Snarkiness
Teresa has a post up over at her blog describing some comments she recently made to people she works with who were being obnoxious. Now, I am an intelligent person with a quick mind. But I rarely manage to make the comments I want to. Dr. Doolittle, for example. Why didn't I demand a rapid strep test when I was in her office last Friday? I thought of it on the way home. Not terribly helpful. My brother always comes up with appropriate remarks in time, either hysterically funny asides, or else cutting remarks when people are being idiots. I never seem to be able to earn my share of this glory.
I was bemoaning this failure to say things at the right time when I remembered something that happened at the scan before last. My RE was observing with my husband as the physician's assistant did the ultrasound. The PA pointed out the embryo's (empty) skull. (This scan was at 7 weeks 4 days and the brain really doesn't start to develop until the following week.) So, we were all looking at the empty skull on the screen while she narrated, "There's the skull. No brains."
I leaned over toward H and remarked, "Well, now we know it's yours."
I guess I do have my moments, after all.
I was bemoaning this failure to say things at the right time when I remembered something that happened at the scan before last. My RE was observing with my husband as the physician's assistant did the ultrasound. The PA pointed out the embryo's (empty) skull. (This scan was at 7 weeks 4 days and the brain really doesn't start to develop until the following week.) So, we were all looking at the empty skull on the screen while she narrated, "There's the skull. No brains."
I leaned over toward H and remarked, "Well, now we know it's yours."
I guess I do have my moments, after all.
Thursday, June 14, 2007
Perfect
Well, today's scan was just about perfect. Our RE clearly didn't have anywhere pressing to be, so we got the full treatment. Heartbeat: nice and fast. Length: measuring 8 weeks 5 days, or 2.1 cm. Yolk sac: still appropriately sized. Arm buds: present and waving. Umbilical cord: nicely visualized. The embryo twitched and wiggled about. We got a bunch of different views.
H took a very deep breath and visibly relaxed. Our RE got H to talk a little about his nervousness and H said he was still feeling especially anxious since a friend of ours recently had a miscarriage at 9 weeks, after seeing a good heartbeat. Our RE calmed H down considerably by telling him that in his experience, you usually have some sign if that's going to happen in a pregnancy as extensively ultrasounded as ours has been. Either the yolk sac is a little too big, or the heart rate is in the normal range but at the low end, or the gestational sac has an odd shape... something is just a tiny bit off. He said with us, everything has been spot on once we got the dates sorted out. He feels very confident that we will safely emerge from the first trimester.
(I know; knocking wood, throwing salt over my shoulder, etc.)
So, our worries have officially been transferred from another first trimester miscarriage, to another second trimester preterm labor fiasco. But that won't be a concern until the baby gets big enough to start putting some pressure on my cervix. Probably 18 or 20 weeks-ish. So, for now, we are starting to unwind a bit. I need to call my OB and get on their schedule. Next Thursday should be our last visit to the RE's office. I can't believe it.
I can also quit the Metformin, cold turkey. I'm frightened of gestational diabetes, but not so much that I'm not grateful to jettison those three pills a day. Progesterone continues for another week and a half or so. And my thyroid still needs to be monitored. The RE office checked it in January-- I had a TSH of 1.2 or something similar. Then they rechecked it after I got my first positive beta for this pregnancy, in May, and it had crept upwards into I believe the low threes. Should have written those numbers down. Anyway, still in the normal range, but climbing. He said to make sure my OB rechecks it fairly early in the second trimester. He'd rather have my TSH at the low end of the normal range because he says it's healthier for the baby. I need to read up on this a bit.
Anyway, it was really great. I have about seventy nine million things I ought to be doing while D takes her nap, so I'd best be off. Time to clean house.
H took a very deep breath and visibly relaxed. Our RE got H to talk a little about his nervousness and H said he was still feeling especially anxious since a friend of ours recently had a miscarriage at 9 weeks, after seeing a good heartbeat. Our RE calmed H down considerably by telling him that in his experience, you usually have some sign if that's going to happen in a pregnancy as extensively ultrasounded as ours has been. Either the yolk sac is a little too big, or the heart rate is in the normal range but at the low end, or the gestational sac has an odd shape... something is just a tiny bit off. He said with us, everything has been spot on once we got the dates sorted out. He feels very confident that we will safely emerge from the first trimester.
(I know; knocking wood, throwing salt over my shoulder, etc.)
So, our worries have officially been transferred from another first trimester miscarriage, to another second trimester preterm labor fiasco. But that won't be a concern until the baby gets big enough to start putting some pressure on my cervix. Probably 18 or 20 weeks-ish. So, for now, we are starting to unwind a bit. I need to call my OB and get on their schedule. Next Thursday should be our last visit to the RE's office. I can't believe it.
I can also quit the Metformin, cold turkey. I'm frightened of gestational diabetes, but not so much that I'm not grateful to jettison those three pills a day. Progesterone continues for another week and a half or so. And my thyroid still needs to be monitored. The RE office checked it in January-- I had a TSH of 1.2 or something similar. Then they rechecked it after I got my first positive beta for this pregnancy, in May, and it had crept upwards into I believe the low threes. Should have written those numbers down. Anyway, still in the normal range, but climbing. He said to make sure my OB rechecks it fairly early in the second trimester. He'd rather have my TSH at the low end of the normal range because he says it's healthier for the baby. I need to read up on this a bit.
Anyway, it was really great. I have about seventy nine million things I ought to be doing while D takes her nap, so I'd best be off. Time to clean house.
Wednesday, June 13, 2007
Ahh, Wednesday.
I feel better today. I'm trying not to freak out about this. Pregnancy symptoms come and go. Who was it that came up with the blue fingernails pregnancy indicator idea? The minute your pregnancy starts going south, your fingernails would turn bright blue. Wouldn't that be nice...
D usually goes to a baby sitter's on Thursdays. This gives me a day to prepare my lectures, do my grading, and more recently, go to the RE for ultrasounds without committing that most serious of faux pas: bringing your toddler into the waiting room of the fertility clinic. I got a call this morning from one of the other moms whose son goes to this baby sitter's. Did you hear about the pinkeye, she said? Yes, pinkeye. Running rampant through the population that goes to this sitter. Now the sitter has it. She was closed today and will be closed again tomorrow. So, now I've got a friend of mine attempting to take her 19 month old and my 20 month old to a local amusement park tomorrow morning while H and I go to the RE for our scan. I have instructions to get out of that office as soon as humanly possible and zoom up the freeway to join them at the park. I REALLY hope nothing goes wrong tomorrow. I hate having anything else planned for later in the day of an ultrasound. I like to protect that time for crippling grief, all the while thinking that if I make the time to sob all afternoon, it won't actually be required. i can't imagine anything worse to do after not seeing a heartbeat than heading out to a Southern California amusement park in June.
Sigh. Pinkeye. Fabulous.
D usually goes to a baby sitter's on Thursdays. This gives me a day to prepare my lectures, do my grading, and more recently, go to the RE for ultrasounds without committing that most serious of faux pas: bringing your toddler into the waiting room of the fertility clinic. I got a call this morning from one of the other moms whose son goes to this baby sitter's. Did you hear about the pinkeye, she said? Yes, pinkeye. Running rampant through the population that goes to this sitter. Now the sitter has it. She was closed today and will be closed again tomorrow. So, now I've got a friend of mine attempting to take her 19 month old and my 20 month old to a local amusement park tomorrow morning while H and I go to the RE for our scan. I have instructions to get out of that office as soon as humanly possible and zoom up the freeway to join them at the park. I REALLY hope nothing goes wrong tomorrow. I hate having anything else planned for later in the day of an ultrasound. I like to protect that time for crippling grief, all the while thinking that if I make the time to sob all afternoon, it won't actually be required. i can't imagine anything worse to do after not seeing a heartbeat than heading out to a Southern California amusement park in June.
Sigh. Pinkeye. Fabulous.
Monday, June 11, 2007
Ugh
I thought I'd dodged this bullet. Constant waves of mild yet thoroughly debilitating nausea. At least it means there's still something going on in the ol' uterus. It's nice to have the reassurance that I am still pregnant.
Why do they call it morning sickness if it lasts all day? And isn't 8 weeks a little late for it to join the party?
Bleh.
Why do they call it morning sickness if it lasts all day? And isn't 8 weeks a little late for it to join the party?
Bleh.
Thursday, June 07, 2007
Starting to Believe
It all went perfectly. Gestational sac, embryo, and yolk sac are all appropriately sized, with a good heart rate. We saw the skull. It's empty (as it should be at this point). Apparently my task for the next 7 days is to grow some brains in there for the embryo. It measures 7 weeks 6 days, plus or minus 3 days. If you go by my last period, I'm 8 weeks tomorrow, if you go by suspected ovulation, then I'm 8 weeks on Sunday. Both within the margin of error.
I'm starting to think this might be okay. At least the first trimester miscarriage thing. I'm not even thinking about second trimester preterm labor stuff. It's just... well, the only other pregnancy I've had that made it this far resulted in my daughter. I guess that was a bigger mental milestone than I thought. My husband, on the other hand, is getting more freaked out the further we get. I think for him, the more real it starts to seem, the more we have to lose. He told me he was really nervous as I sat, pantsless, on the exam table waiting for the PA. The last couple of weeks we have only discussed this pregnancy while at the fertility clinic. The rest of the time it's just not mentioned. This is odd for us; we usually talk about stuff quite a bit. I guess there's just not much to say. It's either going to continue or it's not and there's absolutely nothing we can do either way.
But, for now, all is well.
I'm starting to think this might be okay. At least the first trimester miscarriage thing. I'm not even thinking about second trimester preterm labor stuff. It's just... well, the only other pregnancy I've had that made it this far resulted in my daughter. I guess that was a bigger mental milestone than I thought. My husband, on the other hand, is getting more freaked out the further we get. I think for him, the more real it starts to seem, the more we have to lose. He told me he was really nervous as I sat, pantsless, on the exam table waiting for the PA. The last couple of weeks we have only discussed this pregnancy while at the fertility clinic. The rest of the time it's just not mentioned. This is odd for us; we usually talk about stuff quite a bit. I guess there's just not much to say. It's either going to continue or it's not and there's absolutely nothing we can do either way.
But, for now, all is well.
Wednesday, May 30, 2007
One-Eighties
When I was pregnant with my daughter, despite having had a miscarriage just prior to her conception, H and I were pretty laid back during the first half of the pregnancy. Once we saw her heartbeat, we really relaxed (ha! just relax!) about the whole thing, and we made a lot of plans and remarks that assumed a good final outcome. Looking back, I can't believe how naive we were, but in our defense, I suppose most people are that way unless they've been through hell during their efforts to build a family.
Anyway, we looked forward to the 20-week ultrasound as a chance to discover her gender, rather than dreading it as a chance to discover what horrible thing was going to happen to us next. And for the most part the ultrasound turned out that way. They told us they were pretty certain she was a girl, we got some nice profile pictures, they measured my cervix as long (greater than 3 cm) and closed, and that was that. The only problem was that she went to sleep partway through the ultrasound and wouldn't move, so the technician wasn't able to get a good shot of all four chambers of her heart. Everything else looked perfect, though, so the technician sent us home.
Dr. Favorite duly reviewed the footage and called to tell us it all looked good, but for completeness' sake she wanted us to return in a week or two for a follow-up to get that last image of the four heart chambers. So we returned. The technician got the shot of the heart, and then she said that since we were there, she'd take another look at my cervix. Once she did, her demeanor changed markedly and she said she'd just hop out of the room for a second to ask the radiologist something.
Well, still being quite naive, H and I weren't too concerned. Eventually she returned and said the radiologist saw a lot of funneling in my cervix (note: this is very, very bad) and wanted me to go home immediately and lay down, and he'd have one of the physicians from my OB group call and tell us what to do next. The technician said she thought they'd have me get a cerclage, or a stitch placed into the cervix, to hold it closed and keep the baby in. For some reason we thought this sounded reasonable and manageable and we didn't freak out. After all, the demonic pregnancy book that we owned included a brief discussion of cerclages, so they couldn't be that big a deal, right? (Note: at 24 weeks I was past the latest point at which they like to place cerclages.)
So, we went home and I called into work (I was teaching two courses that semester) and explained the situation. My lab associate drive down from campus to pick up the exams I was due to give each of my classes that evening, and said they'd found people to cover them, no problem. I assured her that I'd be back in a few days at the most.
A comedy of errors ensued with the OB on call that day, and he didn't get a hold of me until nearly 5 PM. He wasn't overly concerned with the radiologist's opinion that there was severe funneling since it was a radiologist speaking and not an OB, and since I already had a checkup scheduled for the next morning, he told me to take it easy overnight, and then they'd look at my cervix the next morning.
The next day I saw Dr. Favorite, who measured my (now incredibly shortened) cervix, told me to get dressed and sit right there in that chair, and was across the hall in her office on the phone with a perinatologist in about fifteen seconds. To summarize a lot of panic in a few sentences, within minutes I was admitted to the hospital, gowned, IV-ed, and being treated with the most drastic tocolytic (anti-labor) drug they have, which is IV magnesium sulfate. They gave me two injections of the steroid beta methasone over the next 24 hours to hasten the baby's lung development in preparation for a possible premature delivery. This last fact was what really brought it home to us that after 24 weeks and 4 days of pregnancy, I was in active labor, and there was a good chance our daughter was about to be delivered as a micropreemie.
That week was the worst that it got. One of the NICU neonatologists came to my room and had a frank conversation with me about the baby's chances, were she to be born. There was a 50% chance she would die immediately. If she survived, there were horrifyingly high chances that she would have lifelong disabilities as a result of her prematurity, including blindness, paralysis, and cerebral palsy. He gently questioned me about whether we would want the neonatal team to take extreme measures to preserve life at all costs, or if there was a point at which my husband and I would prefer to let her go.
(I should note that the IV magnesium sulfate (aka "mag") I was on at that point works by relaxing the uterus that is, after all, simply a large muscle. It has the rather fortunate side effect of relaxing every other muscle in your body as well, and also made me pretty loopy. If you're going to deal with something like this, doing it while on mag is the way to go. My poor husband had to deal with all of this stone cold sober. Poor lad.)
Anyway, I responded well to the mag. Things stabilized. The perinatologist Dr. Lunatic (another favorite of mine- I like a wild sense of humor) did an ultrasound where he identified a small area of bleeding between the placenta and the inside of the amniotic sac, called a subchorionic haematoma. This, he believed, is what kicked my irritable uterus into active labor. A normal uterus would not have reacted in such an extreme fashion. We waited ten days and eventually weaned me off the mag and onto some oral medications with similar uterus-relaxing properties. I was discharged and sent home, there to remain on strict bed rest, and with instructions to call day or night if I had more than 6 contractions in an hour. After we had to return to the hospital for contraction monitoring three times in a week, and despite additional medications at increased dosages, my cervix shortened even more and I was readmitted to the hospital, put back on the mag, and there I remained for all but the last three days of my pregnancy.
I was sprung from my perinatal prison ten days after an amnio done at 34 weeks showed that the baby's lungs were starting to make some surfactant. So one Saturday morning, we had the ceremonial turning off of the mag. They thought I'd deliver within 24 hours. The next day I was still contracting away, but it didn't seem to be going anywhere. So, at last I was sent home, with strict instructions to return with all possible haste if anything changed, so as to avoid giving birth in the car. Thursday at about 4 AM I woke up in the middle of a painful contraction, and we were off. By the time we got to the hospital, got checked in and onto the labor and delivery floor, I was 7 cm dilated. A couple of hours (and just two pushes) later, we were handed our scrawny little troublemaker. After 11 weeks of bedrest, I had my girl just three days shy of 37 weeks and being considered a full term infant.
-------------------
Today: after a week of thinking I was experiencing miscarriage #3, we saw it. Instead of an empty gestational sac, we have a perfectly round, 4 mm by 4 mm yolk sac, and a little blob of a fetal pole with a flickering heartbeat. I can't believe how quickly everything can change.
Anyway, we looked forward to the 20-week ultrasound as a chance to discover her gender, rather than dreading it as a chance to discover what horrible thing was going to happen to us next. And for the most part the ultrasound turned out that way. They told us they were pretty certain she was a girl, we got some nice profile pictures, they measured my cervix as long (greater than 3 cm) and closed, and that was that. The only problem was that she went to sleep partway through the ultrasound and wouldn't move, so the technician wasn't able to get a good shot of all four chambers of her heart. Everything else looked perfect, though, so the technician sent us home.
Dr. Favorite duly reviewed the footage and called to tell us it all looked good, but for completeness' sake she wanted us to return in a week or two for a follow-up to get that last image of the four heart chambers. So we returned. The technician got the shot of the heart, and then she said that since we were there, she'd take another look at my cervix. Once she did, her demeanor changed markedly and she said she'd just hop out of the room for a second to ask the radiologist something.
Well, still being quite naive, H and I weren't too concerned. Eventually she returned and said the radiologist saw a lot of funneling in my cervix (note: this is very, very bad) and wanted me to go home immediately and lay down, and he'd have one of the physicians from my OB group call and tell us what to do next. The technician said she thought they'd have me get a cerclage, or a stitch placed into the cervix, to hold it closed and keep the baby in. For some reason we thought this sounded reasonable and manageable and we didn't freak out. After all, the demonic pregnancy book that we owned included a brief discussion of cerclages, so they couldn't be that big a deal, right? (Note: at 24 weeks I was past the latest point at which they like to place cerclages.)
So, we went home and I called into work (I was teaching two courses that semester) and explained the situation. My lab associate drive down from campus to pick up the exams I was due to give each of my classes that evening, and said they'd found people to cover them, no problem. I assured her that I'd be back in a few days at the most.
A comedy of errors ensued with the OB on call that day, and he didn't get a hold of me until nearly 5 PM. He wasn't overly concerned with the radiologist's opinion that there was severe funneling since it was a radiologist speaking and not an OB, and since I already had a checkup scheduled for the next morning, he told me to take it easy overnight, and then they'd look at my cervix the next morning.
The next day I saw Dr. Favorite, who measured my (now incredibly shortened) cervix, told me to get dressed and sit right there in that chair, and was across the hall in her office on the phone with a perinatologist in about fifteen seconds. To summarize a lot of panic in a few sentences, within minutes I was admitted to the hospital, gowned, IV-ed, and being treated with the most drastic tocolytic (anti-labor) drug they have, which is IV magnesium sulfate. They gave me two injections of the steroid beta methasone over the next 24 hours to hasten the baby's lung development in preparation for a possible premature delivery. This last fact was what really brought it home to us that after 24 weeks and 4 days of pregnancy, I was in active labor, and there was a good chance our daughter was about to be delivered as a micropreemie.
That week was the worst that it got. One of the NICU neonatologists came to my room and had a frank conversation with me about the baby's chances, were she to be born. There was a 50% chance she would die immediately. If she survived, there were horrifyingly high chances that she would have lifelong disabilities as a result of her prematurity, including blindness, paralysis, and cerebral palsy. He gently questioned me about whether we would want the neonatal team to take extreme measures to preserve life at all costs, or if there was a point at which my husband and I would prefer to let her go.
(I should note that the IV magnesium sulfate (aka "mag") I was on at that point works by relaxing the uterus that is, after all, simply a large muscle. It has the rather fortunate side effect of relaxing every other muscle in your body as well, and also made me pretty loopy. If you're going to deal with something like this, doing it while on mag is the way to go. My poor husband had to deal with all of this stone cold sober. Poor lad.)
Anyway, I responded well to the mag. Things stabilized. The perinatologist Dr. Lunatic (another favorite of mine- I like a wild sense of humor) did an ultrasound where he identified a small area of bleeding between the placenta and the inside of the amniotic sac, called a subchorionic haematoma. This, he believed, is what kicked my irritable uterus into active labor. A normal uterus would not have reacted in such an extreme fashion. We waited ten days and eventually weaned me off the mag and onto some oral medications with similar uterus-relaxing properties. I was discharged and sent home, there to remain on strict bed rest, and with instructions to call day or night if I had more than 6 contractions in an hour. After we had to return to the hospital for contraction monitoring three times in a week, and despite additional medications at increased dosages, my cervix shortened even more and I was readmitted to the hospital, put back on the mag, and there I remained for all but the last three days of my pregnancy.
I was sprung from my perinatal prison ten days after an amnio done at 34 weeks showed that the baby's lungs were starting to make some surfactant. So one Saturday morning, we had the ceremonial turning off of the mag. They thought I'd deliver within 24 hours. The next day I was still contracting away, but it didn't seem to be going anywhere. So, at last I was sent home, with strict instructions to return with all possible haste if anything changed, so as to avoid giving birth in the car. Thursday at about 4 AM I woke up in the middle of a painful contraction, and we were off. By the time we got to the hospital, got checked in and onto the labor and delivery floor, I was 7 cm dilated. A couple of hours (and just two pushes) later, we were handed our scrawny little troublemaker. After 11 weeks of bedrest, I had my girl just three days shy of 37 weeks and being considered a full term infant.
-------------------
Today: after a week of thinking I was experiencing miscarriage #3, we saw it. Instead of an empty gestational sac, we have a perfectly round, 4 mm by 4 mm yolk sac, and a little blob of a fetal pole with a flickering heartbeat. I can't believe how quickly everything can change.
Tension, Anyone?
Last night I had a nightmare in which my Dad kept sticking a rattlesnake into my face in spite of my repeated refusals. I eventually punched him. (In my dream.) In real life, I apparently punched my peacefully sleeping husband as he lay alongside me in our bed.
Who knew you could punch people while you sleep? Do you think perhaps I'm a little tense?
Who knew you could punch people while you sleep? Do you think perhaps I'm a little tense?
Tuesday, May 29, 2007
Attempting to Blog, Take 2
I'm going to give this blogging thing another go. I've been spending a lot of time in the last year reading about various infertiles and I think the time has come to get some of the nastiness going on in my life out of me, so maybe typing it out will help. I took a quick look at my previous posts and I see I had just started thinking about trying for child #2 and seen Dr. Favorite to start Metformin. Since then we have:
(1) had a consultation with our perinatologist to see what he thought our risk of preterm labor would be if we tried again (30% or so)
(2) had a consultaion with our RE regarding possible problems related to my not having resumed having periods in the 14 months since having D
(3) discovered the RE was much more concerned over the possibility of scarring to my uterus from the emergency D&C I had after nearly bleeding to death from retained products of conception 5 weeks postpartum (a story for another day)
(4) had saline injected through a catheter into my uterus to look for said scarring (none there- hooray!)
(5) started having periods again after about 9 months of not nursing, 9 months on the Pill, and 6 months on Metformin
(6) stopped taking the Pill
(7) immediately got pregnant
(8) 3 days later became un-pregnant (miscarriage #2 for those keeping track, if we call chemical pregnancies miscarrages, which I think we should)
(9) got pregnant again the next cycle (I realize for someone with PCOS to get pregnant this many times is pretty disgusting)
(10) immediately called the RE for a beta, E2, and progesterone checks. Progesterone was low, started suppositories. Beta was 26. They were not optimistic.
(11) Second beta 2 days later. Doubling time 23 hours. Optimism seeded.
(12) Third beta 4 days later. Doubling time 49 hours. Optimism flourished.
(13) First ultrsaound last Thursday. (6 weeks 0 days since last mentral period) Gestational sac in uterus: check. Yolk sac: absent. Fetal pole: absent. Odds quoted by RE of this pregnancy continuing: 50%.
Since then: pregnancy symptoms are dwindling. Period remains absent. Belief that this will continue is pretty much gone. Memorial Day Weekend desire to drink heavily in order to grieve doomed pregnancy was hindered by the tiny possibility that pregnancy is not really doomed. Who do I think I'm kidding?
Mostly I worry that my chance to conceive without serious intervention by my RE is ticking away. I don't believe I ovulate on my own unless I have recently come off an extended period on birth control pills. So far in my life I have conceived four times, all within 4 months of coming off birth control pills. I'm terribly afraid my body's ability to ovulate without fertility drugs is wearing off while we wait around for another miscarriage.
A note here: I have no problem with fertility treatments. If I need to use them to have another child I will. But, I was in the hospital for nearly three months during my pregnancy with D. I nearly gave birth to her at 24 weeks 4 days. I have been told in the strongest language that I need to avoid conceivng multiples. My RE thinks my best chance of conceiving a singleton (using fertility treatments) is with IVF with a single embryo transferred. My insurance does not cover IVF. So here we are.
The next ultrasound is at 9:30 AM Thursday. Never has time passed so slowly.
(1) had a consultation with our perinatologist to see what he thought our risk of preterm labor would be if we tried again (30% or so)
(2) had a consultaion with our RE regarding possible problems related to my not having resumed having periods in the 14 months since having D
(3) discovered the RE was much more concerned over the possibility of scarring to my uterus from the emergency D&C I had after nearly bleeding to death from retained products of conception 5 weeks postpartum (a story for another day)
(4) had saline injected through a catheter into my uterus to look for said scarring (none there- hooray!)
(5) started having periods again after about 9 months of not nursing, 9 months on the Pill, and 6 months on Metformin
(6) stopped taking the Pill
(7) immediately got pregnant
(8) 3 days later became un-pregnant (miscarriage #2 for those keeping track, if we call chemical pregnancies miscarrages, which I think we should)
(9) got pregnant again the next cycle (I realize for someone with PCOS to get pregnant this many times is pretty disgusting)
(10) immediately called the RE for a beta, E2, and progesterone checks. Progesterone was low, started suppositories. Beta was 26. They were not optimistic.
(11) Second beta 2 days later. Doubling time 23 hours. Optimism seeded.
(12) Third beta 4 days later. Doubling time 49 hours. Optimism flourished.
(13) First ultrsaound last Thursday. (6 weeks 0 days since last mentral period) Gestational sac in uterus: check. Yolk sac: absent. Fetal pole: absent. Odds quoted by RE of this pregnancy continuing: 50%.
Since then: pregnancy symptoms are dwindling. Period remains absent. Belief that this will continue is pretty much gone. Memorial Day Weekend desire to drink heavily in order to grieve doomed pregnancy was hindered by the tiny possibility that pregnancy is not really doomed. Who do I think I'm kidding?
Mostly I worry that my chance to conceive without serious intervention by my RE is ticking away. I don't believe I ovulate on my own unless I have recently come off an extended period on birth control pills. So far in my life I have conceived four times, all within 4 months of coming off birth control pills. I'm terribly afraid my body's ability to ovulate without fertility drugs is wearing off while we wait around for another miscarriage.
A note here: I have no problem with fertility treatments. If I need to use them to have another child I will. But, I was in the hospital for nearly three months during my pregnancy with D. I nearly gave birth to her at 24 weeks 4 days. I have been told in the strongest language that I need to avoid conceivng multiples. My RE thinks my best chance of conceiving a singleton (using fertility treatments) is with IVF with a single embryo transferred. My insurance does not cover IVF. So here we are.
The next ultrasound is at 9:30 AM Thursday. Never has time passed so slowly.
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