Thursday, January 29, 2009

Still Pregnant: Reporting on my 12 week Scan

I'm 12 weeks and two days pregnant. Unbelievable. Yesterday, I had my regular 12 week OB check-up, along with the nuchal translucency test, and all was well. The baby was measuring right on track, had a healthy heartbeat, and passed the NT test with flying colors.

I wish I had a better sonogram picture to share. The ultrasound machine at my OB's office is old school. It gets the job done, but that's about it. The machine at the MFM's office is so advanced, it not only takes clear, gorgeous pictures, it might have a setting to read the baby's mind. Instead of having a beautiful picture to share of a sweet baby face, I have instead a grainy picture of an alien trying to consume me from the inside out. What a special memory. Oh well. It could certainly be worse.

Back to the sonogram: it took a while to get a good read on the NT test, which concerned me. I'd come in concerned since my last scan was at the hospital -- I was concerned we'd come in and see no heartbeat. After all, I was 12 weeks along, and I just don't get that far. Instead, we saw a heartbeat right away, and a baby who was as vigorous and active as before. So vigorous, in fact, that it kept turning spine up, thus preventing the sonographer from getting a good read on the nuchal fold. The sonographer tried and tried to get a good image, then she left the room to have me get up and move around. She tried different probes, had me roll onto my hips, even suggested a hand stand. Finally, at the very end of a very long appointment, the baby turned and the sonographer was able to get three good measurements.

For those who don't know, the nuchal translucency test is a fairly standard test for women at 12 weeks gestation that helps to determine the odds of having a baby with Down's Syndrome. The sonographer measures a little pocket of fluid in the baby's cervical spine, as well as the length of the nasal bone. Babies with Down's Syndrome generally have a shorter (or missing) nasal bone and that pocket of fluid at the nuchal fold is wide and easy to spot. Along with the sonogram, a panel of blood work is run.

These tests don't guarantee anything either way. Everything could look normal when there is a chromosomal abnormality, or the results could look daunting when everything is really fine. This test just helps to determine the odds of a problem, and since (based on age) I was already at a low risk of having a baby with Down's Syndrome, the positive outcome of this test just makes my chances that much more favorable. For that, I am grateful. It's nice -- really, really nice -- to have these instances of great news.

During yesterday's scan, the sonographer even took the time to determine the sex of the baby. The sex organs, while tiny, are generally visible by 12 weeks. Many sonographers won't bother looking this early because mistakes are easily made, but our sonographer was probably more agreeable because she had to have me do so much to take care of her end of the appointment! She showed us two little lines parallel to one another and said, in general, when they're in this formation, it indicates a girl. (A little boy has lines perpendicular to each other.) It's far too soon to buy anything in pink, but it's exciting to have an idea! I have repeat sonograms scheduled at 14 weeks, 18 weeks, and 20 weeks, so hopefully after a little more looking around, we'll feel good to make the call official.

In the meantime, I'm in this very surreal state. The doctor made the comment yesterday about the first trimester being over (though I don't think it officially is until week 13-14), and I'm just astounded to be at this stage. Because of my history, and particularly because of the scares early on in this pregnancy, I honestly did not anticipate making it this far. Could it be that my chances of bringing home a living, breathing baby have increased exponentially? I really do know to much for my own good and know that there's never a time in pregnancy (or in life, really) to take anything for granted, but I also know that statistically, my chances look really good now. Again, unbelievable.

At this point, my prenatal care becomes more routine -- well, routine for me anyway. I'll rotate biweekly between my OB/GYN and my MFM for check-ups and sonograms. Even with the transabdominal cerclage in place, my cervix will still be visually monitored and measured. (However, with that cerclage in place, the pressure of the pregnancy should be dispersed in the uterus among the tendons and above my cervix. As a result, my cervix should hold up just fine.) I'll likely begin the 17P hydroxyprogesterone injections at 16 weeks to stave off any pre-term labor. Other than that, no bedrest is anticipated, and there's a really good chance this could be a normal-ish pregnancy. God has been truly gracious towards me.

"Yet the LORD longs to be gracious to you;
He rises to show you compassion."

Isaiah 30:18

"The LORD, the LORD, the compassionate and gracious God,
slow to anger, abounding in love and faithfulness..."

Genesis 34:6b

"The LORD is gracious and righteous;
our God is full of compassion."

Psalm 116:5

"...You are a gracious and merciful God."

Nehemiah 9:31b

Then Esau looked up and saw the women and children.
"Who are these with you?" he asked.
Jacob answered, "They are the children
God has graciously given your servant."

Genesis 33:5

Cross-posted on Mandigirl Muses

Tuesday, January 20, 2009

I'm Feeling Much Better Now...

By Sunday morning, I wasn't bleeding anymore. I was back to spotting in the same way I had been for two weeks prior. There were no more clots and no new symptoms. I only felt completely confused about Saturday's experience. I spent the morning laying in bed with James, recalling the experience and making fun of him for running around the parking lot as he did. I already know how terrible I am for making fun of a man who loves me so and who was doing his best to take care of me, but in retrospect, he looked hilarious. Plus, it was nice to look back and laugh when we really felt like crying.

Mid morning, James began to ready himself to pick up the kids from Mom's house, and I decided to ride along. We made plans to stop at IHOP for omelets on the way. As we sat in the restaurant lobby waiting for our table, my OB/GYN came through the door. He was working at the hospital across the street, and while waiting for a birth, he decided to come have some breakfast. Since I'd paged him on the way to the hospital on Saturday, he was already familiar with the day's events. Then, the hospital called him again before my discharge to update him further. As we waited for our tables, we talked about the rest of Saturday and about how I was feeling right then. Even as we talked and he could see our faces and hear the emotion in our voices, what completely rocked our world left him totally unmoved. "I think everything's going to be fine," he said.

Sunday was indeed fine -- the spotting slowed as the day went on. I spent all day Monday on my feet helping out at an outreach event at our church, and the spotting slowed to nothing. When I called the OB's office on Monday to follow-up, Dr. K said he felt secure to not see me until my scheduled appointment on the 28th. Today, everything is fine still.

I've been back on the progesterone supplement since Saturday, but tonight is the night I skip a dose. I'm a little concerned about what tomorrow will be like, but hopefully, whatever was there lingering has already been completely resolved. The sonogram indicated nothing to be concerned about -- the pregnancy looked fine and the environment looked fine, so I'm hanging onto that. Still, prayers (lots of prayers) are greatly appreciated.

By the way, I'm 11 weeks pregnant today. This is the longest and the most eventful first trimester known to man. At least to any man we know.

Sunday, January 18, 2009

Random Thoughts (by James)

  • Are all pregnancies as crazy as all of ours have been?
  • I witnessed Amanda at her finest last night. She is no doubt the strongest person I know. In the midst of what we thought would be a tragedy, she remained calm, collected, hopeful, and thankful to be a child of God.
  • I think our baby was break dancing last night.
  • I witness my wife drink a half gallon of Orange Juice this morning in less than 15 minutes.
  • Where did this "plum-sized" clot come from?
  • Bub last night, "I really thought this one was going to work out since it was going so well."
  • When do we officially start the 2nd trimester? I say 13 weeks 3 days.
  • Bub is sick today. Puked all over the bedding aisle at Babies R Us this afternoon, followed by a vomit session in the car."
  • Amanda thinks we should schedule a baby shower at Gatti Town. Funny wife that I have.
  • I spoke to 3 RNs, an Ultrasound tech, and 1 ER doc last night. None of them had heard of a heterotopic pregnancy.
  • I think the same medical personal I spoke to last night were quietly impressed by both Amanda and my knowledge of "pregnancy speak".
  • Waiting in the ER makes me feel like I am the same setting as buying a car.
  • Why is it so hard to think of names for the baby that we can agree upon?
  • I almost had 3 wrecks trying to drive Amanda to the hospital last night.
  • Amanda wanted a chicken drumstick from Popeye's last night. I would have driven to get her one if they had been open.

Saturday, January 17, 2009

And Now We Can't Go Back to Gattitown...

On and off for the last couple of weeks, I've struggled with pretty constant spotting. It's primarily been the brownish-colored spotting that's often attributed to residual implantation bleeding, so there wasn't a great deal of concern on the part of my care team. Additionally, I'd had ultrasounds while the spotting was ongoing, and since the baby was always growing well and seemed stable, and since there were often signs of blood around the deteriorating ectopic twin, my doctors felt that the spotting was normal and not worrisome.

When the spotting began, my OB/GYN suggested doubling my progesterone supplement as a precaution, and my MFM prescribed an antibiotic to ward off bacterial infection. Despite these additions, the spotting continued and I became used to it. We just decided I was a "spotter," as some women are.

On Tuesday, when I hit ten weeks gestation, my OB's nurse instructed me on the plan to begin weaning me off of the progesterone supplements. Hormone supplements have to be reduced slowly, so I was told, beginning Tuesday, to move from two tablets per day to one tablet per day for three days. On Friday, I wasn't to take anything. Saturday, take one a day for three more days, skip, take it for two days, skip, and so on. I began following the instructions with minimal stress and noticed as my supplements decreased, so did my spotting.

On Thursday, I went to the lab for my last blood draw to monitor my progesterone levels. I stopped at a bakery on the way to bring cookies to the women who've taken such good care of me. They celebrated the milestone of my last test with me and seemed excited that I'd made it as far as I had. One woman even shouted, "Thank you, Jesus!" there in the lab with other clients waiting to be drawn. On Thursday evening and all day on Friday, I experienced no spotting at all. It felt like things were continuing to come together for me -- that I was "normal" after all!

I still had no spotting this morning, and this afternoon at Bub's basketball game, I jokingly mentioned to James that because of the lack of the spotting, something must certainly be wrong. Again, I was absolutely kidding, but I'd grown so accustomed to what would be abnormal in another woman's pregnancy being acceptable in my own.

After the game, we spent some time running a few errands and went to dinner at Gattitown. We thought it'd be fun to take the kids to a pizza buffet and let them go willy-nilly on the video games. We ate our crummy, overpriced pizza and watched a little Kung Fu Panda in the Theatre Room. After we finished our dinner, we stood to head to the arcade and a really good day suddenly went bad.

When I stood, I knew I was passing a large clot. Everything felt very similar to my experience losing Ainsley -- when I passed clot after clot and pools of blood until I lost consciousness and was told I was close to not making it through. There we were in a child wonderland far from my doctor and chosen hospital and I knew my uterus was about to explode.

As I was rushing to the bathroom, and I thought I made it clear to James that something was very wrong. I guess I didn't. By the time I made it 40 feet from the Theatre Room into the bathroom, I'd passed two large clots and was absolutely covered in blood.

I stood there shaking in the bathroom stall, wondering if I should scream for James to call an ambulance, or if I was okay to make it to the hospital in our car. I decided against an ambulance. The clots weren't coming as quickly as they had with Ainsley, so I thought I could make it in the car a few miles. I stepped out of the bathroom, obviously in distress, clothes covered in blood, to find James lounging on a bench with the kids nowhere to be found.

James immediately recognized my distress, jumped up, and began rounding up the the children. I was afraid to move, afraid to leave a pool of blood where I stood, afraid to be noticed, afraid to get worse. Gracie accidentally locked herself in a bathroom stall, Bub was full of questions, the manager noticed me and thought all the blood meant a certain lawsuit, and James ran to the parking lot to get the car, leaving us all behind. I huddled the children out the door to find James actually running through the lot, having forgotten that we'd parked right in the front.

Because we were east of my Mom's Home Depot heading west to the hospital, we called her to keep the kids. At the hospital, they took me into Triage right away, and when my pulse rate went from 100 resting to 140 standing, they rushed me back to a room to push IV fluids. They drew a large vial of blood and had me wait two hours for the sonographer. I noticed as I waited that the bleeding didn't continue, but I dismissed it, sure the plum-sized clots meant I'd already miscarried.

When the sonographer arrived, I updated her on the whole heterotopic thing and asked her to not only check my uterus, but also that crazy left ovary. She began her exam, and right away, we noticed my uterus wasn't as empty as we convinced ourselves it would be. Still, all we saw at that moment was a shadow and a spine, so though there was a body, there surely couldn't be a heartbeat... could there?

She rolled around, checking out the environment, and returned to my uterus. Not only was there a baby there in my uterus, there was a baby with a heartbeat. There was a baby with a heartbeat dancing around so vigorously it was nearly doing the Cabbage Patch. A baby who at 10 weeks 4 days measured in at 11 weeks. My uterus looked fine with no evidence of fluid. My cervix was long and closed with no fluid inside.

The clotting is officially unexplainable, but there is no evidence of it coming from my uterus. I have theories about the release of the blood from the ectopic being delayed by my high levels of supplementation, but really, it could have come from any old thing. My pulse rate regulated after the IV fluids, and I was sent home to follow-up with the doctor on Monday. Since arriving home, the bleeding has begun again, but it's lighter and likely related to the aggressive exam today. I've not passed any more clots, and I have no pain or cramping or any other sign often associated with miscarriage. On this side of today, I really feel very little concern.

I'm taking it easy tomorrow, planning a day at home on my left side. Unless my symptoms change significantly, I'll connect with my OB/GYN on Monday for a repeat ultrasound. Fortunately, mercifully, miraculously, our big, exciting day was all for naught -- I'm still pregnant and my baby is still growing. Though we may never be able to go back to Gattitown again, I can't thank God enough.

Friday, January 16, 2009

There Must Be a Mistake

I'm at 10 1/2 weeks gestation today. 10 1/2 weeks. I keep looking at the calendar thinking there must have been some sort of mistake. Part of me thinks when I go to the doctor for my next appointment, the nurse will look at my chart and tell me it's all been a big misunderstanding.

Now, I know that's not possible. I've had too many of that sort of exam to know none of this is imaginary, but still, I am in awe to be this far along with minimal complications. Were it not for the whole heterotopic pregnancy issue, this would be a normal pregnancy. That never happens to me!

My progesterone level has remained stable throughout this first trimester. James and I can't help but analyze everything, and we're really wondering if my successful levels are related to the blood thinner I've been taking all this time. Normally, my natural progesterone level is around 10-11 because of my short luteal phase. I then take 300 mg of Prometrium every day, plus 50 mg of a compounded progesterone supplement. Normally, I'm dosed three times every day. Throughout this pregnancy, I've taken one 200 mg tablet of progesterone (except for the time span between 8-10 weeks where I took two per day as a precaution), and my levels have ranged between 21-46. I've never been above 15-16, even with triple supplementation!

When I last miscarried, my MFM suggested I may have some sort of blood clotting issue. While two panels of blood work for common clotting issues have come back normal, he's had me taking a low-dose baby aspirin since my positive pregnancy test -- just to be safe. Since taking the baby aspirin, my hormone levels and fetal growth levels have been better than ever, and I can't help but think there's a connection -- particularly when I commonly miscarry at 8 1/2 weeks when the placenta begins to grow and tap into my blood supply. At that point, a healthy blood flow matters.

Regardless of the medical reason this pregnancy is progressing well, I am so grateful. I know every day is God's miracle, a gift to me. I don't take anything for granted. I still feel overwhelmed by peace. Thank you, Abba Father.

Sometimes, I Really Can't Stand People...

Article: Judge To Decide Whether Tortured Baby is Allowed to Die

Wednesday, January 14, 2009

Cravings, and Other Ramblings on Food

All Things Citrus Make Me Happy

I'm fortunate in that I don't generally experience morning sickness when pregnant. What I do struggle with is a serious aversion to food, and if this pregnancy ends up being like my pregnancies with Gracie and Zachary, that won't end after the first trimester.

So far, I've struggled to eat meat or nearly any sort. I'm affected by the smell, the taste, and the texture, so it's a no-win situation on all accounts. I can eat sandwiches with small portions of meat in them, like a chicken salad sandwich or a deli sandwich from Potbelly's. I can sometimes eat meat overcome by some kind of carbohydrate, like fajitas or a meat-in-rice casserole. Right now, though, I would totally throw up if I tried to choke down a chunk of pot roast. I have other random aversions generally related to smell or texture, but meat is the only predictable thing.

Cravings have been minor, really, and rare. I've really been enjoying all things citrus lately. I've been drinking more milk than I normally would. James had to make a cheesecake run this week. The best thing ever is when I find a food I've been craving on mark-down. For example, on Wednesday I ate nearly an entire carton of strawberries on my own. On Thursday, I went back to the store for more and found that several of the cartons had just been marked down to $1.00 each. I bought six pounds (six pounds!) of strawberries and now on Friday, we have a little less than three pounds left.

Monday, January 12, 2009

Back From the Past

Today, as I sat having my blood drawn for the millionth time, the phlebotomist asked me why my doctor sends me in for lab work every three days. I explained my doctor's caution by telling her of my normally short luteal phase and the resulting low progesterone levels that have ended three of the six pregnancies I've had. Before I finished speaking, familiarity shadowed her face.

"I lost a baby once -- at sixteen weeks," she said. "I was in maternity clothes and everything."

There she stood in her middle age, in her workplace, drawing blood from my arm, and she couldn't find her way back from the past.

Sunday, January 11, 2009

Because I'm Not Immune to Melting Down

Last night, I had a major meltdown. I'm sure a good bit of my emotional outburst was induced by my currently raging hormones, but I had a moment of being completely overwhelmed.

With lots of crying.
Along with some snot.

First, I should say that I have an incredible sense of peace about this pregnancy. I don't necessarily know what to predict as far as an outcome goes. I'm hopeful that we'll come home with a baby in July or August, but I know whichever way the tide turns, God is faithful and He will sustain me. To clarify, I don't feel an imminent sense of doom, and I don't necessarily feel like I'm going to have another miscarriage. I really just feel sort of ambivalent about this pregnancy, disconnected -- like it's something that's happening to me instead of really being a part of me, a part of who I am, a part of my core makeup. I find that I'm excited with reservation, hopeful with a healthy dose of reality, and most of all, confident that my strength lies outside of my own abilities -- regardless of what outcome befalls me.

But last night, this whole pregnancy "situation" just sort of overtook me.

I'm a very self-reliant person, but because of lifting restrictions, I now have to wait for James to unload the groceries, move bins of Christmas decorations into the garage, and do various other sorts of suburbany feats of strength. I suddenly felt overwhelmed by my new found "disability," as well as the dishes, the laundry, the decluttering, and the newly-spayed dog pinned in her crate. I felt overwhelmed by kids making messes and needing snacks and being sick. I felt overwhelmed by appointments and practices and play dates and lesson plans and wondering how it would all work if tragedy should strike.

And then I felt overwhelmed by how it would all work if tragedy didn't strike -- if, say in 6 months or so, I brought home a squirmy little person who would need lots of me in the midst of kids making messes and needing snacks and lesson plans and having play dates and practices and appointments. How would all that work then? Could I hold it together? Could I keep all the plates spinning? And if not, which plates would fall? Could I or could I not do it all?

Then I felt guilty. I felt overwhelmed by guilt because I felt so overwhelmed in the first place. I felt guilty because my emotions absolutely seemed like a lack of trust in what God can and will do in my life, and in this situation, however it goes. I felt guilty because I knew how extraordinarily terrible I would feel if I did indeed miscarry -- like I'd wished the whole thing on myself.

Rationally, I know this is a season, but emotionally, I was momentarily consumed. I know as far as my new "disability" goes, I'm sacrificing so little for the potential of such reward. It's just that I'm in those weird weeks of waiting -- those weeks where I feel okay physically, but I don't really feel anything else. Since I'm not yet far enough along to feel the baby moving, it's all still so abstract, and that makes me feel like I'm not pulling my weight around the house or in life in general. May this be a time that I look to the Lord for the simplest of needs, and may God meet me at even my basest place.

"But may all who seek you
rejoice and be glad in you;
may those who love your salvation
say continually, "Great is the LORD!"
As for me, I am poor and needy,
but the Lord takes thought for me.
You are my help and my deliverer;
do not delay, O my God!"
Psalm 40:16-17

"And this same God who takes care of me
will supply all your needs..."
Philippians 4:19a NLT

Cross-posted on Mandigirl Muses

Wednesday, January 7, 2009

Monday's Numbers, Again

The nurse called this morning with the results of Monday's lab work. My progesterone level was at 46.5!! I have NEVER had results like that, ever! It makes me feel good about weaning off of the progesterone supplements next week. I can't believe it's that time already.

Tuesday, January 6, 2009

And now I'm stressed out...

I've been handling medical crises with ease, but I just announced my pregnancy on Twitter and Facebook, and now I'm sick with worry. I've had no morning sickness to speak of, but now I feel like I could easily throw up. What's wrong with me?

Monday, January 5, 2009

The Roughest Week Wasn't So Bad

Week 8 of pregnancy is always our worst. Two of our four losses have happened at this particular gestational stage -- at 8 1/2 weeks to be precise. But I'll be 9 weeks pregnant tomorrow, and all is well. My progesterone levels are holding steady (with a result of 23.6 from Friday's draw), a baby still growing 2 days ahead of schedule (by today's scan), and a heartbeat of 184. I'm really so surprised. It's nearly like I'm a normal human being.

Emotionally, things were a bit harder this week. During week 7, I was miserable physically -- so miserable, I was sure I was miscarrying -- yet my ultrasound showed everything to be well. During week 8, I felt great physically and was certain that meant the baby's heart had stopped and I'd had a missed miscarriage. Fortunately, I couldn't have been more wrong and the baby is just fine. I suppose my physical well-being is a bonus, not a bad omen. I really should just embrace how I feel physically and take advantage of my need for a good long nap.

I'm still dealing with intermittent brown spotting, but at my appointment today, Dr. T (my MFM) was unconcerned. The spotting could be related to the ectopic pregnancy still being reabsorbed (it's smaller now and the yolk sac is flattening). It could be implantation bleeding just slow to release. It could be anything really, but nothing to be concerned about at this stage. He did prescribe a Grade B antibiotic to ward off any bacterial infections that may result from the spotting, but it's more of a precaution than a need. Dr. T just doesn't want there to be any irritation around my cervix, and an infection would be an irritant.

Not one person on my care team is willing to take any risks with this pregnancy, and I'm really so glad -- no, grateful -- for such conscientiousness.

I really am so surprised to be at 9 weeks. I've only ever been this far along with Gracie and Zachary. Being at this stage nearly makes me feel ready to make the public announcement. Nearly.

Thursday, January 1, 2009

Even Strangers Concede...

James is working on a search for an MFM/Perinatologist in Wisconsin. When following up with his client yesterday, an OB who serves as president of the group, he shared our recent obstetrical experiences by e-mail. (They'd talked about the fact I was expecting when they met recently, so James caught him up on the heterotopic pregnancy and its progress.) James thought his response was hilarious, but I'm not sure I agree:
WOW !!

You could get an entire high risk OB education with your wife. I have seen alot, including abdominal cerclage, etc. I can truly say I have never seen or known anybody with heterotopic pregnancy. Thank goodness it has resolved without surgery.

Have a peaceful New Year,