Thursday, July 31, 2008

Week 9!

I had my first appointment yesterday with the group that delivered Little Miss. It ran two hours in length and most of my questions were answered and most of my concerns were addressed.
Dr. C is not at all for the antibiotic treatment Dr. Davis is suggesting. Since Dr. C is my primary doc, I suppose I should listen to him. He is fairly confident I was a classic case of IC and believes infection played no role. He did mention bed rest. And I think he was taken aback by my response of "no". I explained that I felt extremely confident in the TAC. Yes, I will be nervous and sensitive to every pain, but I would be a candidate for the mental institution if I didn't do the TAC at all; even with a TVC (which Dr. C pushed for initially). I told Dr. C that maybe my mind is playing tricks on me, that perhaps the TAC won't work, but the mental state I am in is a positive frame of mind that will help me get through this pregnancy with reduced anxiety. Again, by no means will it be anxiety-free. I will do bed rest in the presence of cervical change, PTL or any other complication related to IC or not. My hope is that I can get by with reduced activity - no heaving lifting, being on my feet all day, etc.
So in my local practice of 4, only 2 are actively delivering and taking patient calls. That means I have a 50/50 chance of Dr. C delivering this baby. He did an excellent job on my c-section with Little Miss Miracle. In fact, for a 24 week delivery, he was able to pull off a low-transverse cut and closed me up properly with the double suture. Having gone any other way would have left me open for more issues. I am still nervous about uterine rupture but according to ALL the medical professionals I've talked to about it, my chances are no more increased. Anyway, Dr. C was even impressed with the size of the incision when he saw my scar. He couldn't believe that he didn't make a larger cut. The main point of this is something I didn't mention yet, and that is that Dr. C delivered Little Bit safely. I could have ten holes in my stomach, as long as she is here as safely as possible, that's all I care about. But I can't ignore the perks of having a small incision that looks good and healed great.
I have been exhausted this week and nauseous day and night. These past six weeks have flown by and I am in no rush to push this pregnancy along. The baby is perfect right where it is. However, I would like a little break from feeling so sick. It is hard to keep up with a two year old when I don't want to pick my head up from the pillow. Here's hoping things get better soon.
Finally, I had my OB panel drawn today. Just standard blood work. I have an ultrasound at 12 weeks for the sequential screen (we did it with PM) and then I go back to the office at 15 weeks. I start my P17 injections at 16 weeks. Then it's the anatomy scan and then I will be monitored weekly from about 20 weeks on. I was told they will be much more responsive this time, also being aware that I will be hypersensitive. And, Dr. C announced that they will not hesitate to admit me. I just need to make sure I have someone on call round the clock to take Little Miss for me.
It's back to Dr. Davis on Monday!

Sunday, July 27, 2008

A Busy Weekend...

Precious Miracle celebrated her second birthday on Friday. I spent Thursday night with my husband, mother and mother-in-law transforming my living room and dining room into "Elmo's World". I think I overdid it. Friday was a long day of visiting the NICUs (we dedicated the lactation room in honor of my little peanut), had lunch out, came home to let the dogs out and then headed back out for dinner at Hibachi. Saturday was crazy as we hosted the "kiddie" party. Running around, lifting and being on my feet all day was not the best decision. I crashed last night once everyone left and my poor husband had the duty of bath, bed and cleaning the house. I was in bed before 9:00. My body ached. I had no idea my thighs would hurt so bad. This morning was no better as I threw up inspite of taking my Zofran. Lovely. As I was heaving (not visible to my little girl but within earshot) she kept saying, "Bless you". If she only knew.

I am totally exhausted and luckily she has been napping since 11:00. She is overtired too and we are hopeful to catch up on much needed rest and relaxation.

My next appointment is on Wednesday! Can't wait!

Thursday, July 24, 2008

A Nervous 8th Week

I was a little nervous that I might be reporting different news today. I have had some abdominal discomfort in the evenings (probably from over-doing things with Precious Miracle's birthday tomorrow) all week. It's been a pulling/burning sensation straight down from a few inches below my naval. As I would relax in bed at like 8:30-9:00 relief would not come as quickly as I thought it should have and nights have been a terrible bout of tossing and turning.

Speaking of nights, last night, my stomach turned into one big tight mass and I was so scared I was in the process of a miscarriage. The Prometrium can postpone or prolong a miscarriage and even though there was no bleeding, I was still worried.

I called my local group and Dr. Gerson (the doc who told me my membranes were bulging with my peanut) refused to see me. He insisted I see Dr. Davis because, "If you miscarry, he's the one who needs to deal with it." Great, huh? Perfect choice of words for someone dealing with an anxiety-ridden, high-risk pregnancy. I do see the group on Wednesday and I pleaded asking what difference less than one week makes. I mean, what changes between Thursday and Wednesday that I miraculously can become their patient?

So, I called Dr. Davis who knew it was me by caller-ID. He is wonderful! He said to come on over, that he will always see me, anytime. So, luckily my MIL was able to take PM and I made the long drive to South Jersey alone.

The wonderful nurse, Patty, the woman we had last time, called me right back for a transvaginal ultrasound. Thankfully, the baby was going strong with a heartbeat of 163. The sack was the proper shape and the baby was measuring 8w 1d - exactly one week ahead of where we were last week. Thank God!

Dr. Davis then came in and told me my pain (severe pain) was caused by a retroflexed uterus. Basically, my uterus was tipped backward and due to the growth of the uterus during the past week, has now started to cause some significant pain. I presented my ideas - dehydration, constipation but it turns out the retroflection was the culprit and he offered to manually manipulate my uterus back into position. It hurt so bad and I think I broke the fingers in the hand of the intern shadowing him this week.

There is a 50/50 chance it will hold. If not, I need to go back for another manipulation and have a pessary placed (a vaginal support to hold things in the proper spot until the uterus is big enough to become an abdominal organ). I am totally against the pessary as it is a foreign body that could introduce infection and inflamation and I want to avoid ascending infection at all costs. If a pessary was placed prophalactic antibiotics would be a must. Oh, and the reason for my terrible constipation (sorry if TMI) is because my uterus is blocking things. Great.

So, I am ordered to bedrest for the next 24 hours. So much for decorating the house. Then I have to take it easy, no lifting or abdominal exertion (lifting my nut, laundry baskets and closing the hatch on my station wagon, for example).

The good news is, the baby is doing just fine. The bad news is, I might have to deal with this again, perhaps tomorrow or Saturday. Tomorrow is our NICU dedication and Saturday is the birthday party.

So, here I am, in bed, trying to fiqure out how I am going to turn my house into Elmo's World so when my two year old daughter wakes up for her birthday tomorrow, she is in awe.

Thursday, July 17, 2008

A Single Heartbeat!

Today I am exactly seven weeks and we saw and heard the heartbeat for the first time! The baby, yes, just one baby!, is measuring on target for the gestational age. Dr. Davis answered all my questions and the game plan is this:

1. During my next visit (9 1/2 weeks) I will have preliminary labs drawn to look at fetal proteins. (I am concerned about my higher levels of HCG with this pregnancy.)

2. At 12 weeks, I will begin a prophylactic antibiotic/anti-fungal treatment to reduce the risk of ascending infection.

3. Due to crazy morning sickness, it's ok to skip my prenatal vitamins for the first trimester as long as I get 1000 mcg of folic acid.

4. Once the second trimester hits, I need to take two of each prenatal vitamin. (My vitamin comes as set of two pills: one vitamin and one fatty acid pill.) I also need to take 500 mg of vitamin C to help the iron better absorb.

5. My chance of miscarriage at this point is 16%. When I see Dr. Davis again on August 4th, assuming all is well, my rate will drop to 4%.

6. I will continue with the Prometrium until week 16 when I will begin my P17 injections.

7. Dr. Davis said there is an 80% chance I will make it to 35 weeks.

8. If I have PTL with cervical changes, I will get steroid shots to develop the baby's lungs and all attempts will be made to stop the labor.

In addition to seeing Dr. Davis, I will also be followed by my local group. I see them at the end of July.

As my little peanut would say, "Hip, hip, hooray!"

Wednesday, July 9, 2008

Morning Sickness

I know it's a good thing for a pregnancy to experience morning sickness. But in comparison to my first pregnancy, this morning sickness is really kicking me in the pants. I am not even six weeks. I skip breakfast and feel queasy until well past noon. It started on Saturday and has been getting progressively worse. Today I haven't been able to eat much at all and it's 5:30. With Miss, my morning sickness held off until week 10.

On another note, Little Miss has some form of viral pneumonia. The doctors think I may have given it to her, although I feel fine at the moment. I did have shortness of breath a few weeks ago. Perhaps that was it. Who knows. No one can seem to tell me the impact it will have on the baby. I hope it is growing and developing healthy.

Wednesday, July 2, 2008

First Ultrasound

This morning at 11 was my first ultrasound. Grammy and Little Miss came with. The tech I had was a crazy woman, who questioned why I was getting an ultrasound. I almost told her if she didn't want to do it, I'd gladly accept another tech. She then proceeded to ask my little one if she was "growling". No, actually, she's whimpering because when she sees Mommy as a "medical subject" she likes to hold my hand and make sure I'm okay.

Among other things, I wasn't 100% confident in the tech's skill with ultrasoundography. She had a difficult time navigating around my cerclage and made more of it than there really was.

The good news is, we saw a gestational sac and she was even able to see a yolk sac. It was too early of course to see a heartbeat or fetal pole. I knew this would be the case and was not the least bit disappointed. When I see Dr. Davis on the 17th of July, I will expect to see the flutter then.

Once Little Miss knew that I was going to be okay, she "beeped" whenever the machine "beeped". She thought it was the funniest thing.

Turning to a much heavier subject, I just learned that a good friend's son and daughter-in-law lost their baby at 4 1/2 months. My heart aches for them and I pray that they come to terms with their grief and that they can move forward as a united couple in their own time.

Tuesday, July 1, 2008

Increasing HCG

This past weekend, I had some chest pain and shortness of breath. The on-call (internist) was not very helpful so I made an appointment to see the nurse practitioner on Monday. I feel so lost right now. My regular doc left my practice to head a new PENN practice downtown. I could have followed her (PENN makes you choose a location and stick with it) but couldn't commit to driving that far. I agreed to see the new doc but she doesn't start until July. My Perinatal group won't see me until 8-9 weeks, Dr. Davis is just pain far and my GYN is on vacation. I can't win. So I took the 1:00 NP appointment yesterday afternoon. She is sending for an echo thinking I have some "regurgitation" from the increased blood volume. My EKG looked normal. She also drew labs that were originally ordered by my old doc but canceled by the lab. That was another issue altogether but I had the labs redrawn and asked her to throw in another HCG for the heck of it. Oh, and I also got her to order an ultrasound - I go tomorrow at 11:00!!!

Anyway, my HCG was 2336 at 4 weeks 4 days. With Missy Madame, my HCG was 388 at the same gestation. My levels are doubling at about the same rate this time as last time, every 1.3 to 1.5 days.

I have had a terrible upset stomach which the NP says is part of the whole "morning sickness". I have nausea but still have an appetite for very specific things. My craving this time around is angel hair with olive oil, tomato and shrimp. I had this for breakfast yesterday. With Missy's pregnancy, it was eggplant parm and sometimes it was just breaded eggplant. Interesting.

It is going to be easy to push myself too hard during this pregnancy. For example, this morning, my little monkey climbed out of her bed. So after therapy, she and I took her crib apart and reassembled the "toddler bed" portion. I moved a heavy rail, tipped the crib on its side and shimmied it back against the wall.

One more thing I want to mention for the purpose of "personal record keeping/journaling" - I took my last Dollar Store pregnancy test yesterday morning. It is amazing just how fast that thing turned positive. As the wave of color was moving across indicating the test was working, the test part turned red before the control part. It was a dark red. Forget the pink. And wiating one to three minutes, it was more like 1 to 3 seconds.

Just about 18.5 hours until my ultrasound!!! Is there one baby? Or are there two??