Triple Thumbs Up!

Yay!

Yay!

Yay!

This morning's weekly OB appointment (31 weeks) went really well; in fact, it was the most encouraging one I've had in a while. Have I mentioned that I <3 my doctors? I bumped into all three of them today, and they all said hi and chatted for a minute. My case must be some bit of a topic of conversation because they instantly remembered me, LOL. I seem to be that way with medical staff; I have to go to them frequently enough that I become a household name. Dismaying but comforting at the same time.

So here's the good news:

#1. My cervix measures the same as last time, no further dilation - woo hoo!

#2. I passed the 3-hour glucose test - thank you! thank you!

#3. I can go to my work shower tomorrow - hooray! hooray! hooray!

and an anticlimactic #4. I didn't miss the UPS truck... I'm expecting a t-shirt from Cafe Press that I was hoping to wear to the shower tomorrow, and was worried that it would come during the time I had to leave home for the appointment. But there was no yellow sticky on the door, and online it still says that the package is "out for delivery," so I just have to wait for it to arrive...

Is it nap time yet? All that excitement this morning is making me sleepy...

Operation Keep Baby Cookin' - Part V

All right, I think this post will finally catch me up to the present, as far as updates go...

Friday, March 25: 30-week OB appointment with Dr. Y (though technically I turned 31 weeks the following day; my appointment days got messed up by the trip to L&D on the 8th).

I told the nurse that I was due to have a fetal fibronectin test done, along with a cervical check, per instructions of the perinatologist. She got the fFN test out for the doctor, but turns out Dr. Y didn't do it, because she said it was too soon. My last fFN was done on March 15, and so two weeks wouldn't be until the 29th (this coming Tuesday). Ah well (though I'm wondering if this stricture had more to do with insurance than the test itself).

Anyway, Dr. Y did check my cervix, and found that it's further dilated than last time, at about 2 cm. Oh dear. Doc decided to put me on the fetal monitor again, to check whether I was actively contracting. I wasn't, but my uterus was definitely irritable, showing small peaks and valleys on the graph.

So guess where I went next? Yup, Dr. Y sent me over to L&D for monitoring (I confess I stopped at McDonald's on the way because I knew they wouldn't let me eat once I got there). But here I go, yet again (this is the fourth time now). I'm glad they want to be careful and all, but geez. I mean, this time, one of the nurses and the resident remembered me, and I them. Well, I suppose it can't hurt to build up a rapport for when it really counts.

I spent a couple of hours there, hooked up to the monitors. I'd brought a couple of books, including, this time, The Womanly Art of Breastfeeding, but found it was too heavy to prop up or rest on my belly, so I turned on the TV instead, and watched the first hour or so of Unbreakable (M. Night Shyamalan's 2000 flick starring Bruce Willis and Samuel L. Jackson).

Eventually, the resident came back in and checked the graphs -- nothing of note save a bit more irritability. She also did another manual cervical check -- still holding at between 1-2 cm dilated (whew!). Then she did a biophysical profile on the baby via ultrasound, and it only took her about 10 minutes to see all the signs she was looking for. Yay for baby!

After running her findings by my OB, the resident discharged me back to "house arrest," telling me that my OB wanted to see me in a couple of days. Well, I already had an appointment set for Wednesday, was that soon enough? Yup, that would be fine.

Wednesday will be telling, as I expect to find out (at least) three things:

1. Did I pass the 3-hour glucose tolerance test?

2. Do I have another two-week reprieve from pre-term delivery (will this next fFN come back negative too)?

3. Can I attend the baby shower the folks at work are throwing for me and two others this coming Thursday?

I hope the answer to all three questions is YES! Wish me luck!!!

Cardiologist update #2

I got a voice mail message from my cardiologist's office on Monday (the 21st), telling me that Dr. F wanted to see me as soon as possible, because he had something he wanted to talk to me about in person. And, by the way, he's already talked to my obstetrician about it too. So please call us back so we can schedule an appointment.

Uh oh. What's wrong now?

When I call back, the receptionist says that the earliest Dr. F can see me is Thursday afternoon (the 24th). Three days later? Hmmm. All right, I say to myself. Can't be all that serious then, if they're willing to let me wait that long to hear the news.

Fast forward past the glucose test to Thursday, and finally I get to hear what all the hubbub is about.

It's not my blood pressure. That's been pretty well behaved lately. It's my heart rate, which hasn't been lower than 100 for a little while now. Dr. F is concerned as to why it's so high. I had been complaining that my pulse has been throbbing in my neck and head, especially when lying down, and also experiencing some palpitations, and it seems that it's related to the increased heart rate. Earlier in March, Dr. F had me come in for an echocardiogram, and at this appointment he went over the results with me.

In comparison to the echo that I had a year or so ago, in which all my heart functions appeared normal, this time my heart showed some less than optimal functioning. Apparently my heart is weakening, and compensating by beating faster. All this is likely due to the extra stress on my system from the pregnancy -- especially the increased blood volume. While this is not dangerous in and of itself, it can become a serious problem if it goes on for too long -- the heart can become enlarged and something he called cardiomyopathy can result. At least this is the gist of what I understood from what he said. So we're looking at something that, should it get bad enough, could affect me even after the baby is born.

In the spectrum of "Don't Even Worry About It" to "OMG Emergency STAT!," Dr. F said we're somewhere in the middle; this is something that we need to take seriously and do something about, but there's no need to freak out about it... yet.

The solution (for now): Dr. F put me on another medication (I'm already taking methyldopa for the high blood pressure), Lopressor (generic metoprolol). It's a beta blocker that will help slow my heart rate, the hope being that if we can get my heart to calm down, it will function better, and we can forestall any damage. He's started me on a low dose, 25 mg twice a day, and I'll see him on April 4 to see how I'm doing and whether that's enough.

As he's telling me this, I'm thinking, but wait, aren't beta blockers contraindicated during pregnancy? I asked Dr. F how safe this medication is for baby, and he tells me that yes, there are risks, but we need to weigh the risks against the benefits. He said the main side effect of Lopressor on fetuses is that it can cause intrauterine growth restriction, or IUGR. The caveat is that I'm far enough along in the pregnancy that the majority of growing the baby will be doing from now on is just gaining weight -- most critical development is already complete. It would have been a bigger deal if I had to start taking this drug in my first or second trimesters, but since I'm well into my third, it will have a less deleterious effect than during those earlier crucial weeks.

So, yeah. I'm not keen on taking this medication, but, if I have to weigh the chance of my baby being a little bit smaller at birth than perhaps he or she could have been against my developing a heart problem that could permanently affect my quality of life (and my ability to be there for my child as he or she grows up), well it seems doing nothing is a bigger risk to my health than the drug will be to the baby's.

Not an easy pill to swallow (pun intended). I think I've just gotten my first taste of that parental willingness to suffer so that one's child doesn't have to. I just hate the thought of taking something that might harm my baby. At the same time, I take some comfort in the fact that baby is already measuring ahead size- and weight-wise, so maybe baby has some growth to spare. Plus, the perinatologist is already doing growth ultrasounds to make sure my hypertension isn't causing IUGR, so Dr. F suggested that they may want to do the growth ultrasounds more often than originally planned from here on out, in order to track how the baby is affected by the introduction of this medication.

Of course, this is all provided that the baby stays put...

Stay tuned for Operation Keep Baby Cookin' Part V ---

Intermission: Drinking the Juice

And now, a word for our "sponsor," Glucola*:

YUCK.

*Oh and I'm kidding. Glucola isn't sponsoring anything here, and I'd probably turn them down if they offered.

On Wednesday morning, March 23, I went for my 3-hour glucose tolerance test, having failed my 1-hour. Let me tell ya, that was fun... not!

I find the logic behind this test rather mystifying. First, we're going to make you drink this bottle of liquid, which contains 50 grams of sugar (and you must do so in 5 minutes or less -- chug chug chug), and then take a blood sample after one hour (by the way, please skip breakfast). Sounds like a sugar crash waiting to happen, and I already know I'm susceptible to metabolic nosedives when eating sugary stuff on an empty stomach.

But if you fail, you get to drink a bottle of liquid containing twice as much sugar (100 grams) -- and you must do this after fasting since midnight; we'll draw blood first to prove it -- and then we'll take more blood samples, every hour, on the hour, for three hours. How is anybody supposed to survive that, having failed the easier test?! I know that there are lots of bionic women who do, but it honestly sounds like something ripped out of an edition of Failure for Dummies.

I don't know yet whether I've passed the test, but I did survive it... barely. I felt extremely sleepy for most of the three-hour wait; while I had brought a lengthy book to read (Ken Follett's Pillars of the Earth -- I'm rereading it to get ready to dig into the long-awaited sequel World Without End) along with a Monopoly game on my Palm Pilot (yes, Palm Pilots have existed and still do exist, despite what the blank looks of some Radio Shack and Best Buy employees would have you believe), I found that I spent most of the time with my eyes closed and hoping to nod off. [Sorry for the run-on sentence, but I couldn't help myself; maybe it will read better if you translate this paragraph into German.]

I never managed to sleep. I found that I could only keep my eyes closed for so long before starting to feel slightly nauseous. The worst part was during the last hour. I started feeling super warm and flushed, like I was having a hot flash or something. And I was nauseous again. I knew that if I threw up I'd have to do it again, so I got the attention of the nearest lab tech and told her I wasn't feeling well. She came right over and was going to have me lie down in their "infirmary" but it was already occupied. So instead she gave me a small cup half full of water to drink. I was nervous to drink it, knowing that could spike my nausea too, so I sipped the water for the next 10 minutes or so. That seemed to do the trick, and I made it to my last blood draw. Whew!

If I fail, I fail, but at least I don't have to go through that again... well, until next time.

Operation Keep Baby Cookin' - Part IV

So now we're up to the 30-week OB appointment, which was last Friday, March 18. This time I saw Dr. Y. All the routine stuff was done, along with the manual check of my cervix. Dr. Y said that it didn't look like anything had changed; I was still only dilated about 1 cm. Good!

As she was finishing up the exam, we discussed what I should look out for. One of the things I've been having trouble with is recognizing what is a contraction, and what is not. Sometimes my belly distorts in such a way that it seems as if the baby is doing yoga... particularly Downward Dog. The right side of my belly sticks out strangely and it's really hard, while the rest of my belly slopes up to it. Dr. Y said to check and see if my whole uterus was tight, or just that area. If the rest is soft, then it's most likely the baby, not a contraction. Seems this is baby's attempt at yoga then, as the rest of my uterus seems pretty soft.

But wouldn't you know it, as soon as I start getting up off of the table, I start to feel some tightness and pressure. I mention this to Dr. Y, and she notices that my belly is hard all over. So she says, let's put you on the monitor to see what's going on. I go down the hall to another exam room, get strapped in, and begin to spend some quality time with some trashy gossip magazines, catching up on princess-to-be Kate Middleton's wedding planning, and the meteoric downfall of Mr. Winning himself, psychostar Charlie Sheen.

About 20 minutes into it, Dr. Y comes in and notices that baby is sleeping, so she goes and gets me a lollipop, hoping the sugar will wake him or her up. Bingo, baby is up and running shortly after.

End result: not a single contraction (yay!) and I got to witness baby doing Downward Dog too, and saw that the machine didn't react, so at least I learned that that bit of acrobatics is all baby, all the time.

Finally, time to leave the OB office (it's a good thing I'm already on leave from work, or else I'd be racking up tons of sick time)! But before I am completely free to go, I get some more news.

I failed the 1-hour glucose screening test.

And it's not like I just missed the cutoff. Apparently I epic failed it. Just ducky.

Now I get to take the 3-hour.

What next???

Operation Keep Baby Cookin' - Part III

After one week of modified bed rest...

...I went back to the high risk doctor to see how my cervix was doing. I had a different doctor this time, Dr. W. First though, the ultrasound tech brought me in, and she took a look at the baby to make sure everything was okay with him/her. I'm not really sure what the tech was looking for or measuring; it wasn't a growth ultrasound. Had a very faint hope for another attempt to see the baby's face, but alas, twas not to be.

Then Dr. W. came in and introduced herself (cool, I wasn't expecting a female doctor!) and then proceeded with the exam. She did another fetal fibronectin test, and then a manual check of my cervix. After that, the tech did an internal ultrasound to measure my cervix.

The good news: my cervix was no shorter than last time, still around 1.8 cm.

The bad news: my cervix was now dilated 1 cm.

*blink*

*blink*

Um, yikes?!

Needless to say, Dr. W. said that bed rest should continue, and her big goal was to get me to 32 weeks (April 2). At 32 weeks, a fetus has the same survival rate as a full-term one (though it will need some time to get acclimated in the NICU). Dr. W. said that she would even consider letting me go back to work once I reach 32 weeks (and see what happens).

Really?? I'm sorry, but my goal is to let my baby get as close to full term as possible, thankyouverymuch. Plus, the way I am feeling, and my distractedness over the possibility of going into labor at any time, was likely not going to make me a very effective employee. At this point, I was feeling very glad that my OB had already made the call that I wouldn't be going back to work. And Dr. W. even said that as the high risk doctor, it is up to her to make recommendations to my regular OB, but my regular OB is the one who calls all the shots. So there.

Anyway... my next instruction was to see my OB again on Friday for my weekly check-up (30 weeks) and to have a manual check of my cervix (Dr. W. said that ultrasounds would no longer be as effective). Then the following week, week 31, provided that day's fFN came back negative, I should have another one done along with the manual check. And then I'd see the peri again at my usual growth ultrasound at 32 weeks (4 weeks since the last).

All righty then.

Later that afternoon I got a call from the nurse to say that the fFN had come back negative... YAYAYAYAY! Another reprieve, we have at least until March 29 (or something)! I got another call, this time from Dr. W., the following evening, double checking to make sure I'd gotten the fFN results (she was on her way out of town and wanted to be certain someone had contacted me -- very nice of her).

And so it goes... ONWARD!

Operation Keep Baby Cookin' - Part II

To continue with my blog backlog...

I went to see my OB Friday of that same week, on March 11, for my 28-week appointment. I had thought that, because of all of the drama with the peri that this visit would be more eventful, but really it was the same as always -- with one minor exception. When I reminded Dr. P. of my visit to L&D on Tuesday, and being put on bed rest for a week by the peri, she kind of laughed/snorted and said to me, "You know you're not going back to work, right? With all the issues you're having, it's time to pull you out. We want this baby to keep cooking as long as possible."

I honestly was a bit taken aback. I guess since the peri had been so nonchalant about everything, I hadn't really considered that I was facing something long term. Plus, I still had 12 weeks left before my due date... how could I be out of work this early??? At the same time, there was a part of me that tried to calculate what kind of improvement I would need to make in order to be fine to go back to work, and I wasn't coming up with much. Or rather, based on how I'd been feeling the past three days, I didn't see much progress; I was still having contractions now and then, and my belly seemed to tense up and cramp up whenever I stayed on my feet for too long (read: a few minutes). Sitting in a reclined position, or lying down on my side, were, and continue to be, the most comfortable ways to be.

Still, I felt like I should wait for the week to play itself out, and see what the peri said on Tuesday, before making any grand announcements, i.e., at work.

I have to say though, that, looking back, I was probably overdoing it. Lots on my mind trying to get a handle on things at work, trying to get things organized at home for baby's arrival, plus DH and I were running to childbirth classes two nights a week, back-to-back, among other things. I hadn't been getting enough sleep, and felt like I spent the week struggling to make it to the weekend so I could recuperate.

Well, I got served. And, to be honest, I'm kinda glad. Not to have the threat of preterm delivery hanging over my head -- I don't mean that at all. Just glad to be stepping out of the mix for a while, and spending some time focusing on what really matters... making sure my little bean grows healthy and strong.

Operation Keep Baby Cookin' - Part I

Sorry, I know I am long overdue for an update here, and a lot has been going on. So here goes:

On March 8, I had my 28-week growth ultrasound with the Maternal-Fetal Medicine specialist (or perinatologist; MFM or peri for short). Baby looked great; measured 3 lbs, 6 oz (still 70th percentile), all anatomy seemed to be as it should be, and amniotic fluid level was fine. Unfortunately Little Oatmeal decided to be a stinker and hid his or her face as if s/he was running from the paparazzi, and so we got no good pics (and I was really hoping to see those chubby cheeks again, ah well). However, the tech managed to get this shot (I guess she felt bad for us and wanted us to have some memento):

No surprise this kid will have big feet (seeing as how I wear a size 13N and DH's feet are bigger than mine), but I do hope there was some magnification in that image, or I might have as much trouble getting the feet out as the head, LOL.

When the ultrasound was over, the doctor asked me how things were going. I mentioned that I was feeling some cramps down low, and had been since the evening before. On Monday, March 7, DH and I had gone for our last childbirth education class at the hospital, which included a tour of the maternity ward. While walking around, I'd noticed a lot of pressure and menstrual-like cramps at my bikini line, but hadn't thought much about them, since they were very similar to cramps I'd had a month ago, which had been attributed to round ligament pain (granted I'd ended up going to L&D for them, but they hadn't been contractions). When I got home from the class, it was late enough that I figured I'd just drink a ton of water and go to bed, since those had been the instructions last time. Well, the cramps never really subsided and even woke me up during the night, so I knew I should mention them at the appointment the next morning.

Little did I know, I was not crying "Wolf!" this time (wasn't last time either, as it was the OB on-call who told me to go to L&D to get checked out, but it was still hard to know if I was overreacting or if this was something serious). Since the cramps weren't letting up (and such cramps are a possible sign of preterm labor) my peri decided it was worth taking a look and doing a fetal fibronectin (fFN) test to see if anything was really going on. So he took the fFN swab, did a manual check on my cervix (the first time I'd ever had a male doctor, which was a little weird at first, especially with DH in the room too), and also had the tech measure my cervix with an internal ultrasound.

The verdict: my cervix was high and closed (good), but had shortened to 1.8 cm (not so good; ironically, this was downplayed a bit by the peri, as he only commented that this was "shorter than I like to see"). And off I went to L&D to get monitored for contractions. Oh wait, before I got carted off to perinatal triage (they sent for a wheel chair for me, even), the doc gave me the fFN test tube and told me to hand it directly to the nurse that admits me (we'd get the results faster that way). He also said that, provided the fFN test comes back negative and the monitoring goes well, I should go home, not go back to work for a week, and instead I was to "act like a slug, akin to the morning after partying too hard at college." Then I should come back in and have my cervix measured again.

So off to L&D I went, and they hooked me up to the monitors. DH actually had to leave to go to his hernia surgery follow-up appointment (everything looks great, thank goodness), so I spent some time connecting with work to let them know I was not going to be in this afternoon after all. About an hour into monitoring, the nurse came in carrying some tubes and bags and a syringe and said, "We're going to put an IV in, because you're having contractions." What??? I AM??? Whoa. I couldn't feel them at all; yet, apparently, they were coming every 4 minutes. "But these are Braxton-Hicks, then, right?", I asked. "Nope," the nurse said, "they're the real thing."

So when DH called to check on me, and I told him what was up, we both freaked out a bit (well me more than him, I think). He wondered if he should just get something quick to eat (it was lunch time), or go home, gobble some leftovers, and grab our hospital bag. Thing is, we don't have a hospital bag packed yet! I was only 28 weeks... figured I had at least another 8-9 weeks before needing to get that ready. I started to lose it: "I don't want a March baby... I want a May one!" But DH, ever relaxed under pressure, said, "Why not? We'll manage, whatever happens." I still felt like 28 weeks was way too soon to be going into labor, but knowing that DH was on an even keel helped calm me down quite a bit.

A little later, DH arrived, and we got the fFN test results back: NEGATIVE. Woo hoo hoo and then some; this meant it would be extremely unlikely that I would go into labor within the next two weeks!

Contractions started to settle down too. They were still happening, but had spread out to about 6 minutes apart. I asked why I was having real contractions, but yet they weren't doing anything. The resident OB said, "Some women just have them." Later the nurse said that "for some reason, your uterus is just irritated." Ah, an irritable ute. I've heard of those, but never knew what they were. Now I do. Introducing: Gertrude the Irritable.

They said I could go home, and that I should make an appointment to see my regular OB on Thursday or Friday, and then come back to the peri the following Tuesday.

And so began my week of modified bed rest. Or so I thought.

To be continued...

Hiccups

Weirdest. Sensation. Ever. Woke up in the middle of the night on Saturday, and while lying in bed, felt this thump thump thump thump thump thump thump... in my belly. It went on and on and on. At first I thought maybe I was hearing the baby's heartbeat, but it was slower than that, and faster than mine. Then I remembered that the baby could be hiccuping. Ahhh... so that's what it feels like!

I never got hiccups myself; well, they only lasted a hic or two and then stopped, so it was kind of an alien feeling to me. They say (you know, the all-knowing They) that the baby doesn't feel discomfort from hiccups, and, well, I sure hope not (how do they know???)!

Cardiologist update #1

I had a follow-up appointment with my cardiologist scheduled for yesterday, which was a good thing because I have still been feeling the throbbing in my head and neck (and sometimes my sinuses) at times... usually when I am trying to fall asleep, or driving, or reading at my desk (chin down). What I've noticed, is that while my blood pressure is fine, my heart rate is elevated. The past week or so my heart rate hasn't been below 100 (whenever I've used my home BP monitor), and has sometimes been as high as 120-130 bpm.

I told all this to Dr. F. and he called my OB (Dr. K.) to discuss possibly adding another medication. Luckily he came back from the discussion saying they both agreed that medication wasn't yet the way to go. Instead I will go back on Thursday for an echocardiogram and another stint with the Holter monitor. He also drew blood yesterday to check my thyroid levels, which haven't been checked since just after I got pregnant.

Meanwhile I am experimenting with ways to mitigate the throbbing when going to sleep. Last night I sat in the recliner for a while before going to bed, and although I was a bit uncomfortable and felt some throbbing while sitting there, I didn't feel any throbbing once I got into bed. Seems the throbbing is the strongest when I am lying down because my heart isn't fighting gravity to pump blood everywhere, so maybe sitting with my feet up for a while helped my heart get prepped for sleep. We'll see if that works tonight too.

Best thing is, neither doctor sees this as a medical problem per se, it's not hurting me or the baby, primarily just a comfort one. It would be great if there was a solution (preferably one that didn't require more meds), but hey, if all it is is just another uncomfortable pregnancy symptom, then no biggie, I can deal.

Next up: Growth ultrasound (more baby pics?!?) on Tuesday, 28-week OB appointment on Wednesday, and the echocardiogram on Thursday.

I hab uh cold :(

Ugh. Last night at our Bradley class I started to notice my throat felt scratchy, and this morning I woke up with a full blown sore throat, my eyes are watery, and I feel drained.

Came in to work for a meeting, but going home right after. Might grab some work to bring home, but probably it all can wait.

I need rest. I've been running around like crazy for the past few days, and stressing out about, oh, everything (childbirth classes, my birth plan, epidurals, daycare, pediatricians, baby shower, registering for said baby shower, ordering a crib, organizing the nursery, getting ready for maternity leave at work... I could go on) and it's all catching up to me.

Calgon, take me away! Or chicken soup... whatever works.