Emergency cerclage & bedrest

I went for my weekly cervix check with my peri, DrGav, on Tuesday.  I was a pretty happy and healthy little chick as I bebopped into the office. Things were great, I could feel the babies move here and there, a little tap, a slight jiggle when I didn’t expect it.  I had a walk in the sun the day before.  Life felt normal and good.  Got results back from karyotyping amnio test, but am still awaiting the final CGH microarray results.  So far no problems, but I want to save that post until all results are in.

As you may or may not recall, during my 16 week ultrasound, they noticed a blood clot right behind the top my cervix.  DrGav was concerned about this as it could cause irritation to the cervix and wanted me to see him for a cervical check every week until things looked fine.  A week later, I had a tiny bit of spotting and while the cervical check measured 3.5cm and closed, I was asked to come again in one week for another check.  On week later, two days ago, Tuesday came and I went in for my cervical check, which involves our good friend, dildocam, aka “Wanda”.  The babies were checked briefly, their heartbeats were fine and they seemed active.  Then the ultrasound tech started checking my cervix.  She looked both with the abdominal and vaginal transducer.  She had me move a bit and push to see how it was reacting.  She was very nice and didn’t give away too much, but at the end of the exam, told me to stay put and wait for DrGav as he may want to double check things himself.

He checked me out with Wanda and then started talking to me and the ultrasound tech.  He pointed out that the internal cervical os was completely open, that there was significant funneling (even I could see it with my untrained eye) and while my external os was currently closed, I had the beginnings of effacement.  The diagnosis:  Incompetent Cervix.  My cervix had gone in one week from 3.5cm and closed to .6cm with funneling.  I felt absolutely no cramping, no pain, no contractions and there was no spotting.  It’s very scary to know that it all could have been lost so easily.  The only thing keeping my babies from harm was my placenta previa.  The edge of the placenta of baby A was still stretched over the top of the cervix and acting as a bridge, keeping it from splitting wide open.  The previa was moving and getting near the edge of when it was going to break free.  A manual check of my cervix was also found to be very soft, which could allow for dilation starting at any time. 

DrGav and I discussed the situation.  We decided that this was all looking very dire.  His recommendation was to place a cervical cerclage.  He did an excellent job of answering all of my questions and describing the procedure, why he was choosing to do it, what type of stitch, etc.  He explained that he preferred the Shirodkar stitch technique. He also wanted to make sure the stitch was placed very high, closer to the internal os as he felt this has worked better for patients in the past.  I was actually very worried about having an incompetent cervix due to my prior uterine surgeries, so I had done many hours of reading on this subject.  I had no problem agreeing to the procedure.  Anything to keep them in here and safe was best.  Even with strict bedrest at 18 weeks, it was very unlikely that they would make it to viability, much less term.  DrGav checked his schedule and the OR at the hospital and we decided to do a cervical cerclage that same day in a few hours.  I went to the hospital, was put on intraveneous antibiotics and had the procedure with a general anesthetic four hours later.  MrBeep came to be with me after work and arrived a few minutes before I went to the OR.  He met with DrGav and discussed the procedure and asked questions.

According to DrGav (he talked to MrBeep after the surgery was complete) it went very smoothly.  I had no bleeding from the placenta, everything seemed to go very well and with no complications.  They checked the babies whose heartbeats were both doing fine. I awoke in recovery with little pain, was dispatched to a maternity ward room and rested for a couple of hours.  The contractions monitor they put on me showed no contractions after the procedure.  I had a tad bit of crampiness, like the day before AF arrives with a vengeance, but it was managed with medicine. I went home that night around 9pm.  I didn’t want to stay in the hospital and DrGav said I could go home if I felt fine.  I had a little bleeding just after the surgery and it’s fading to a smaller amount and today it is just a little bit of pink on the TP.

I am on modified bedrest until my next appointment with DrGav on Tuesday 2/2.  I have a friend who is unemployed right now over as my “official babysitter” for the next few days.  We are giving him a little $ to help him out.  He cooks my food, keeps me company and we needed to do some movie production work this week, so it really turned out well for us both.

Even though this all seems scary and nerve wracking, I am glad and so relieved that we caught it in time.  Many women who have an Incompetent Cervix don’t find out until they have had a pregnancy loss.  It is more common with twins and is most likely to happen between 18-22 weeks.  DrGav is hoping if the cerclage is holding well that I won’t have to be on bedrest for too long, but we’ll see.  I have my little countdown calendar on my browser.  I have 36 days to go until viability (24 weeks), my first goal.  Hoping that in the end it all works out and my monsters are with me for as long as possible. 

18w2d – Little things that bring sunshine

Well, what can I say. Ummmmmm. I’m still here. I’m at 18w2d. Monsters are still here.  Cervix measured well on Monday, still closed and long. I had a little brown spotting for the week, but we suspect this may be the old blood clot from the big bleed finally moving through the cervical os and on its way outta here. (Good riddance.) It was very strange to be far enough along that while I spotted, I didn’t have a lot of anxiety or fear attached to it.

Still waiting on the final results for the amnio.  Not terribly stressed, but it will be nice to have closure on that too.  I want to tell my grandparents and SIL and nephews and niece, but am waiting the extra week to know if it is all OK.  I mean, I can wait a freaking week, right?

It’s funny how at this stage in pregnancy I am glad, but I don’t allow myself to get overly confident or excited.  I am beginning to dream of nursery and baby item shopping, but it is too early.  I want to shout HOORAY but am waiting for 24 weeks, or 28 weeks before I feel I can really take that a breath deep enough in order to shout.  My “miscarriage signs” Google searches are now changing to “pre-term labor signs” or “incompetent cervix,” but every now and then it all swings 180°and I am suddenly looking and watching videos on double strollers and thinking things like “How in the hell can I carry two infant car seats at the same time?  I will need arms like She Hulk.” And then I stop and really think, “actually I wouldn’t mind looking like She Hulk.”

I feel little twinges and flutters every now and then, but it is very subtle.  90% of the time I don’t feel anything at all. I generally have to lay down on my side and get very calm and still.  When I focus my mind, I can feel if they move.  Other times I just lay there like a lump and eventually fall asleep because I can’t feel a thing and horizontal = naptime. Every now and then I get distinct movement and it’s like sunshine streamed on my heart.  I was sitting in the park this week, near the waterfront.  I had bought a gyro sandwich and was munching down on a bench with a fabulous view of the water and the boats and Seattle across the lake.  All of a sudden I felt Wiggles and Pips (our not-so official names for the monsters) squirming around.  I sent MrBeep a text message saying “The monsters really like love gyro sandwich with onions.”  He was happy all day and gave me lots of kisses and belly pats when he came home.  He lurves gyro sandwiches.

Sending you a little of my sunshine for your hearts too, whether they be filled with sorrow, or filled with joy or filled with hope.  We all need that sunshine some days.

Chillaxing

Not much to report over here in the dark and soggy Pacific Northwest.  As Sunny mentioned, it has been pretty gray and rainy for a while.  I don’t mind it a bit, but a break for an outdoor walk would have been nice.  I’ve been mostly chillaxing since last Tuesday when I had my full anatomy ultrasound and amniocentesis.  After the amnio I went home and did as DrGav instructed.

“You are to be a couch princess for the rest of the day, take it easy the next few days.”

I am happy to report that I was very successful in my assigned task.  I endeavored to be a regal and gracious princess, ruling my dominion with dignity and benevolence.  MrBeep was a most attentive royal servant, I may have to knight him.  I puttered around on my computer. I read some magazines and books. I watched the Dakar 2010 rally updates with MrBeep each night. 

On Saturday I went out to a local coffee shop and played many hours with a gaming group.  I was able to get in on two games.  First I played a really fun game called “Jamaica.”  I think that I will buy this one to take down the next time I see my niece and nephews.  You are a pirate, sailing around an island trying to get treasure, food and gunpowder.  You are in a race with the other players and can also get into battles against them. The rules aren’t too complex, there is some randomness via dice rolls but there is an element to thinking ahead and strategy too.  The second game I played, called “Agricola” – currently ranked #1 on boardgamegeek.com - was much more complex and required a lot of strategy.  It was the first time I tried the game and came in last place, but it was very fun and I would love to play it again.  You have a plot of land and are trying to improve your house, build a farm, plow fields, harvest grains and add members to your family (more people = more turns).  Guess who took the longest to add members to their family?  Yeah, me.  Not by a little, but by several turns.  Really?  I have to be the infertile in a danged board game too?  Had to shake my head with the irony on that one.

The weekend was good.  I am doing fine.  I had very little cramping following my procedure, maybe a twinge or two.  I’ve had no pain, spotting or fever.  Now I just get to wait it out a bit for the results in a couple more weeks.  And now for a couple of questions:

Question 1 from Anonymous: “There was a result called "FISH" or something for the CVS that came after 2 days with the bigger results coming at 2 weeks. Does amnio have that?” 

Yes.  Amnio has the option for doing FISH.  We considered it.  I asked about the cost.  It costs about $500 and you get the answers for a couple of conditions, down syndrome, tri 13/18 in about 2-3 days.  We decided that even though insurance pays for the test that we would just wait it out to save money.  I was not considered a significant risk and we would want the full results no matter what.  If we had received a worrisome screening test, then I would have absolutely insisted on FISH.  This is an excellent article that includes some useful and detailed information: http://www.enotes.com/nursing-encyclopedia/amniocentesis

Question/comment 2 from mekate: Hope EVERYTHING is perfect and that no difficult choices need to be made. YOu are so brave doing the amnio! (I am scared of the big needles, never mind the rest of it).

Thank you dear sweet mekate. I’ll be honest.  DrGav recommended that I watch the ultrasound monitor and I took his advice.  I didn’t want to flinch or move at the exact wrong moment so I just kept my eyes glued to the screen.  He described what he was doing, what I was seeing.  The truth is, after all of the really painful and nasty stuff from IVF, like a pinchy speculums or being punched in the ovary, an amnio needle was a cake walk.

The comments I received were so heart-warming.  I am delighted at the wonderful support of the ALI community.  Thank you all for your kindness and good wishes.  I appreciate it so much.  The votes on the poll are very interesting.  I am, like you, very excited to find out the results very soon.

16w4d ultrasound – so far so good

I’m glad to report that we came back from an ultrasound yesterday afternoon at the MFM clinic and the quick report is that everything looks good.  DrGav wanted to do a full anatomy ultrasound early and then do subsequent ones every 4 weeks to make sure that the growth of the monsters is on track.  If growth does not seem to be progressing normally, then I may get put on lovenox or heparin.  I weighed in and am up about 7 lbs since the start of things, so that is looking fine. 

MrBeep sat at my side, touched my shoulder and kissed my forehead.  A full anatomy ultrasound takes a while as each thing is scrutinized and measured.  For over an hour I got to lay back and watch the monsters jiggle and wiggle. I saw happy squishy brains, thumping hearts and kidneys and stomachs and bladders.  I got to see the profile of each face, accompanied by waving arms and legs, twitchy hands and feet. I counted 5 fingers on a wee hand held out and easy to see.  I got to see eentsy little toes.  I watched so hard my eyes started to water and by the end my vision was blurred.  I couldn’t help it!  I guess I forgot to blink but the perma-grin was wide on my face.  

It’s amazing how reduced the room is in there compared to 5 weeks ago at the NT ultrasound.  No easy turns doing back flips at will.  They’ll just have to practice to be in Cirque du Soleil once they are in normal gravity like the rest of us.  The ultrasound technician got a couple of shots from under each baby’s legs, she asked me to guess, but I had no idea – remember it’s only 16 weeks along.  She is pretty sure the sex on one and the other is an educated guess, it’s legs were held tight together.  The internal ultrasound showed my cervix was long and closed, that is another very good thing.  DrGav warned that with twins, they want internal cervical checks every two weeks as things can change very quickly and a month span is too long between checks.

DrGav also said that the measurements on both babies looked good.  He needs more time to review all of the pictures to look closely at the placentas, etc.  We expressed our interest in amnio before the appointment and he said that it was really up to us, but that the measurements again put the risks for DS and Trisomy 13/18 as really low (1 in 650).  In the end, we still wanted to do the amnio.  The procedure went well.  DrGav explained each step and all the precautions he took for good results.  My belly was swabbed with iodine.  The ultrasound was on and referenced the entire time.  One quick poke for each twin’s sac/fluid. I watched on the ultrasound and all seemed to go fine.  The babies heartbeats were measured right on track after the procedure.  I have had an easy time afterwards so far.  No spotting, no leaking, no high temperature.  I have felt the babies flutter happily all night and day.  I have added a poll to the right column so you can guess what flavor the monsters are.  I get the results in about two weeks.

Why decide to do the amnio?  Folks, I’m 41, MrBeep is 46.  These are my own old eggs, his own sperm.  I’m going to be very honest, if one of these babies has a condition that is incompatible with life and puts the other baby at great risk, I need to know. I have to think of more than myself.  Screening tests are highly educated guesses, they are not diagnostic and they do not have the real genetic answers.  Also, D/S and Tri 13/18 are only 3 things.  Amniocentesis karyotyping tests for over 40 and we are also getting a prenatal CGH microarray that looks at over 100.  The real risks for continuous scan amnio with a highly qualified specialist like DrGav are significantly lower than 1:200.  They are actually more like 1:1,600.  Please believe that I don’t think that my preferences and decisions are right for everyone, but they are right for us.  In two weeks I’ll either have the hardest decision of my life or I’ll get to finally breathe a little easier for the first time in years.  I am happy to answer any questions for those of you who need to know more, just post in the comments or email ifoptimist.at gmail.com.  I would appreciate understanding and not judgment.  If you have strict religious beliefs and ideals, I respect them.  Please my friends, I’m scared and I’m crying. I will meditate.  I will try to instill calm in my heart.  Now again with a wholly new kind of 2 week wait, I will embrace Hope in all its bright sunshine, glowing at the end of a dark cave. 

Ups & downs & everythings in between

It has been a bit of a crazy week.  First an update from my Ob/Gyn visit.  I saw my ObDoc on Wednesday and had a routine exam.  My labs for cultures and thyroid tests came back negative/normal (wooo!) I tested negative for being a carrier of cystic fibrosis (wooo!).  My blood pressure was 126/80 (only slightly elevated) and we heard two heartbeats with the doppler at 146 and 153 bpm.  I’ve gained 4.8 lbs since the beginning of my pregnancy, which doesn’t seem like a lot, but I was easily 35lbs overweight when I started.  I go back to the ObDoc at the beginning of February but I was doing fine as of Wednesday and was given the green light to do light exercise (walking, swimming, pre-natal yoga).

I am becoming a little more active, getting out for walks with MrBeep, shopping, running errands, working, etc.  I like it much better than taking it too easy.  I have been editing and working on some videography stuff.  I finished my friend’s wedding DVD before she headed off to Australia to visit her husband’s friends and relatives who couldn’t make the wedding.  In addition to the video editing work, I did a really fun photo slideshow set to the song “Lucky Day” by Judy Garland.  It turned out great and I was glad to get the creative workout. 

I also dragged my lazy ass to the computer and put on my photography hat.  I went through a photo shoot session I had with my friend Tiff and her then 9 month old baby.  I chose the best photos, did some retouching and sweetening, then took the top 3 and made a framed picture with a tri-cut mat and some additional art supplies.  I glued his name down a vertical and then added stickers with the words “adorable, laughing, marvelous, baby boy” in between the photo cut outs.  They had a dual birthday party (kids from 6p-9p and adults from 9p-12a) on Saturday.  I gave the framed picture and the other good prints to Tiff for her birthday.  For her son’s 1st birthday, we got him a 4-in-1 ride in car.  She says he digs it big time.

I think I may have overdone things a bit on Friday and Saturday.  I knew I was thirsty and should have stopped to get something to drink, but I thought that I’d be done soon and home.  I guzzled a good quantity of water before bed.  On Sunday morning at 6am, I woke up really needing to urinate and afterwards had a lot of cramps, but after an hour or so of resting, it calmed down.  I went back to sleep and woke up at 11am with more cramps that got worse (TMI-had a bowel movement – FINALLY).  Afterwards I had a lot of gas pain and an upset stomach and mild backache.  I called my ObDoc who was on call, she recommended I sip some baking soda and water (a bi-carb) and if that didn’t work after an hour, to go to the emergency room.  After another hour I still had a lot of gas pain and then severe cramps and then I became nauseated.  I vomited the water and baking soda (YUCK!!), then I became even more nauseous, and dizzy, and my hands started to shake.  MrBeep took me to the emergency room. I got a full work up – blood pressure normal, temp normal, urine sample normal, blood normal, and the nurse found two healthy heartbeats for the monsters with her doppler.  At no time did I have any spotting or bleeding.  After about 20 minutes, it all increased.  I had tons of pain in my sides, back and cramps in my belly, then I started to shake all over.  They started an IV drip.  After about 3-4 minutes I could feel my whole body relax and calm down, the effect was almost instantaneous.  A couple minutes after that, the nurse gave me an anti-nausea drug and a little pain killer into the IV.  Those things took the rest of the edge off and we stayed in the ER for a couple more hours so they could keep an eye one me.  Since I had so much pain in my sides (left side especially) and back, they did an ultrasound to check my internal organs -  kidneys, liver, pancreas, gall bladder - these all checked out OK.  The ultrasound tech also did a quick heart rate check on the kiddos, they were having a grand old time, doing fine, their heart rates normal.  I was less concerned about them because I could feel them moving and squirming all day.  The feeling was subtle, but unmistakable.  Thank goodness.  In the end, my release papers called it “Abdominal Pain, Uncertain Cause [Female].” I think it was the perfect storm of dehydration, indigestion, and constipation.  All of which got everything including my uterus to start aching and cramping. No fun.

Why am I telling you all of this disgusting stuff, 100% TMI with too many details?  It’s because I recognized my symptoms may be from dehydration as described by other bloggidy friends when they had trouble.  Had I not known this, I would have tried to suck it up at home and risked big problems.  After I came back from the ER, I noticed my sunken eyes with dark circles beneath them  I remembered how dark my urine had been in the last couple of days, etc.  I’m mad at myself for not keeping up and recognizing my lack of liquid intake.  The multiples book and other sources recommend 8 16 oz glasses of water/day.  Yes 128 oz.  That’s over 3 liters or a gallon per day.  Folks, that is a fuckton of liquid.  I didn’t drink a thimble’s worth, I didn’t drink a gallon.  I think I drank around a liter/day in the last few days leading to Sunday (BTW-why can’t the US just go metric?  I mean, c’mon really?)

I am being very good and monitoring my water intake and will do so from now on.  I feel fine and have felt great since about 5 minutes after the IV kicked in.  I will go tomorrow afternoon to the MFM specialist for my 16 week ultrasound.  I’m good.  The monsters are OK.  I thought about keeping this all to myself, lest I seem the drama queen, but then I remembered how much other posts help me, so…there it is.  Sending lots of love out on the wires of the internet to you all.

Talking to the Big Guns

Last week I went to the Maternal Fetal Medicine specialist office and I met DrGav.  He seems like a very intelligent and thoughtful man.  My ObDoc loves him, says he’s a sweetheart.  I started off the appointment by answering a ton of personal and family medical history questions with the MFM nurse who stayed during our appointment the whole time.  MrBeep was with me, sitting opposite in a chair, his serious face set and ready.

DrGav arrived and looked over my medical and family history.  We discussed my heterozygous MTHFR issue with the added knowledge about my brother’s thrombosis a couple months ago.  He said that he was glad to know my homocystine level was normal, that was a very good thing.  He was also glad ObDoc kicked the folic acid dosage up and that I was taking a baby aspirin per ObDoc’s instructions.  He said that he didn’t want to put me on any heparin for now because he thinks the baby aspirin and folgard will do fine.  He does want me to take 2 baby aspirin per day instead of 1 because I am carrying twins.  So one in the morning and one in the evening.  Taking two baby aspirin is means the kiddos will get a daily dose of aspirin. They’re so small.  This makes MrBeep nervous which therefore makes me nervous, but we will go with his expert advice.  He said that in order to monitor the babies, we’ll get an ultrasound at 16 weeks and then compare it to future ones to make sure their growth seems on track.  If it is not, then we will assume the MTHFR is causing placental problems and I will go on heparin or lovenox.

They took more blood to check my thyroid.  The results showed all is fine and normal.  DrGav did notice that I had a slightly elevated pulse.  He seems convinced that I will get high blood pressure during this pregnancy because my mom had high blood pressure before her kidneys finally gave out.  I don’t know.  I guess it may be likely.  I have, on his recommendation, bought a home blood pressure monitor (so we can see if it is slowly elevating over time) and I am also cutting out excess sodium.  The blood pressure pre-judgment frustrates me because I have always had normal or low pressure. My mom had it from the time she was in her early twenties, she smoked a pack a day, etc.  I know it can still happen but c’mon.  Honestly it is really hard to take someone’s advice you have just barely met, but I have done my research on this practice and the specialists and they are top notch.  I must admit I agree with him it is important to monitor and try to prevent a serious condition before it happens.  A proactive approach is wise. 

I talked to my mom and my brother and jokingly whined at them that their health problems are causing me grief from my doctors and would they please take better care of themselves.  They promised to do their best.  I see my ObDoc on Wednesday afternoon for a routine check-up.  It’s been three weeks since I heard the little monster’s heartbeats.  Every time I get close to a doctor’s visit I get extra nervous.  Anyone else crazy like that?

It’s interesting how many nice comments say things akin to “Wow. 15 weeks sure did fly by.”  I want your time machine folks because my weeks seem like they are really dragging.  I alternate between nervous terror and excitement.  A small part of me wants to go to sleep and wake up 15 weeks from now, but most wants to savor every minute.  I lay awake in the quiet of the night and try to feel them move.  Sometimes I think I can sense a fluttering and other times I’d swear it’s just my pulse.  C’mon my monsters, Mommy is looking forward to Squirmfest 2010.

2010 A New Year of Possibility

Wow.  2010.  Here I am in the year 2010.  The 2000s were years of great change in my life.  In the last decade I have moved to a new state, married my true love and best friend, shifted my career, found and bought my first home, made many new and wonderful friends.

In my mind I stand now on the road of my life with a marker reading Friday, January 1, 2010. 

It is so strange to be mentally at this place.  It is not a crossroad.  There is only one path I see before me.  Turning around is never an option.  Yet lifting my head to take the first step is daunting and proving harder than I had anticipated.  My mind swirls with possibilities of the future both good and bad.  Joyous and devastating.

I am not always an optimist.  Doubt and worry and fear creep over me.  It is the reason why I chose to write as IF Optimist, then…  I wanted a reason to focus on why my life is good, why I need to choose a place of hope in my heart.  I wanted a reason to believe in the power to keep my mind unclouded with negative things.  I hoped that power would allow me to see what is truly before me, clearly, so I can make the best decision, do the right thing, choose the best path to follow.

I suspect this will be the decade I say goodbye to my wonderful grandparents, now at 88 and 85. I know that they worry and pray for me, I will finally tell them my news in a few weeks after my next ultrasound.  I hope they will get to meet my children some day.  My children?

Will this be the the decade, I will finally go from living as part of a happy couple to a happy family?  Will I get to go from having “monsters” to babies (who will hopefully grow up to earn their name as monster)?  Will I get to the other side of this year with two babies or one or none?  Will there be cause for celebration or sorrow?  Will I be sitting on the floor in a three years, spaghettios in my hair, cleaning crayon off the wall, wondering where my professional career went and why won’t these two just take a freaking nap?  Will I walk into their room 20 minutes later, watch them dozing lazy and warm, and suddenly remember just how lucky I truly am?  Will I get to watch MrBeep grow from a hesitant first time father to a warm and loving daddy?

In my mind I stand now on the road of my life with a marker reading Friday, January 1, 2010…

…taking a deep breath, calming my mind, with sunshine in my heart and a smile brightening my cheeks, I step forward onto the path.