21 weeks, not good news, hello couch.

I had my high risk doctor appointment yesterday, which was 21 weeks, and it still kind of has us all reeling even today.

The short of it is that several weeks ago, when they did the blood flow study at 17 weeks, the doctor who was in the perinatal center (Dr.Everyone Hates, I've nicknamed him though I've never met him), noted in the ultrasound report that there actually WAS mild "notching". (How angry I am that I've been led to believe for 4 weeks that it was normal when it wasn't, is another post for another day entirely.)

Anyway, there's not really a rosy way to paint the notching thing, especially at 17 weeks. Basically, what happened was when they watched the blood flow via ultrasound, there was occasionally a "notch" of less blood flow. (I think I gave the analogy of someone stepping on a water hose in another post.) Normal is for there not to be any notching, so that it was mild isn't really good news. I was so surprised about it that I'm not sure it was in one place (unilateral) or two places (bilateral)...I read the note and I don't remember seeing either of those terms, he might not have even mentioned it, I'll ask my OB next week. (One would be a lot better then seeing two, but even one is not good.)

What this means is that "they need to watch me even more closely", says high risk doctor. She was emphatic that it does not mean that I will get sick for sure. She calls this our "baseline", which leads me to believe they'll be looking at it again, not sure when. (Apparently notching can sometimes get better/correct itself, and sometimes get worse, and sometimes stay the same. Obviously we want it to get better or at the very least not get worse.) What she didn't say, but I've learned from reading too much online (and I'm not reading articles from babycenter or junk like that, what I've reading is scientific research and studies,) is that the odds of pre-eclampsia are extremely high, now (my odds were already 60%+ of getting pre-e, just from my history.) It also puts us at very high risk for growth issues and "adverse fetal outcomes" (ie. stillbirth). She's seeing me again in 2 weeks, I'm not sure if this will be the new routine or if it was because she saw how freaked out I was and  in 2 weeks will be when I got HELLP the last time.

They aren't that worried, yet, because my blood pressure is good (this makes me want to kick someone- I keep saying it until I'm blue in the face but my blood pressure was good last time, even when I had HELLP, yet they keep pointing to my blood pressure being normal as a promising sign. As far as I'm concerned, normal blood pressure is not any reason to be encouraged.) And no other red flags. Most importantly and most promising, his growth didn't slow down in the 3 weeks between my ultrasound at 17.5 weeks and my ultrasound at 20.5 weeks, even with the notching at 17.5 weeks, in both ultrasounds he measured 5 days ahead. Since Olivia's growth (and my quad screen) were the first signs of trouble, long before any symptoms started, they don't think we are headed for trouble, at least not yet.

The reassurances are falling on deaf ears, because they completely underestimated how quickly and badly things went downhill the first time (and with my blood pressure remaining just fine as everything spiraled out of control.) We are resigning ourselves towards *when* they will go downhill this time, it's not really much of a question of *if*. (And if they don't go wrong, we can be pleasantly surprised.) I'd rather not be blindsided this time, and I don't want to wait until he's already behind in growth to try to do something. That's one of my huge regrets with Olivia, that I kept working and trying to convince myself it would be okay even when things went wrong and more wrong and then ended in disaster. My doctor didn't think I needed to be on bedrest, didn't send me to high risk, and a week later it was over. (I had several co-workers who even told me the week before that they really thought I should have been on bedrest, I did not look well.) I don't really blame my doctor for what happened, I don't think even if I had gone on bedrest that it would have saved us, and my case was 'atypical' to say the least. I'm only mentioning it to emphasize the point, I don't intend to make the same mistake twice, regardless of how worried or not worried my doctors are.

Unfortunately, there isn't really very much to actually *do*, I'm already on blood thinners (lovenox injections 2x a day, and a fairly high dose at that) and low dose aspirin. The only options left that they use to try to stretch out pre-eclamptic pregnancies for as long as possible are blood pressure meds- which obviously aren't necessary at this point- and bedrest (which there's not really any research to support that it helps.) So, I'm not on doctor ordered bedrest (though I won't be surprised if on Monday when my OB sees the report and I point out the notching to her, if she recommends it this time, she tends to be a lot more realistic/pessimistic than my high risk doctor these days. She told me at my first appointment she didn't want me working beyond 20 weeks while my high risk dr would probably let me work even now, and my ob saw how quickly things went bad the first time, which I think makes her less inclined to take the chance of history repeating itself. At my first appointment, my OB said "if you can just make it to 28 weeks...", while my high risk doctor was acting like I'd make it to 37 weeks.) 

We (Joe and I) did decide I'll "take it even more easy" because we don't know how many weeks left we have and if this can buy us even a few extra days, it's worth it. Once/if he starts falling behind, it's not likely that he's going to be able to catch up given everything we already know, so I'd rather do something now then wait until we have something serious to be worried about, I think notching and my history is serious enough. I'm spending most of the time on the couch/bed/sitting on my butt, try to limit my time up and about to a few hours a day, and cross our fingers that this helps or that at least things don't get worse.

As far as doctors and stuff, I see my OB next week for a routine appointment (22 weeks), I see the high risk doctor the following week at 23+2 (the day I delivered Olivia), and our next growth ultrasound (and possibly they'll do a follow up blood flow study) is the next week at 24 weeks. So they are watching me fairly closely the next few weeks. 

In the meantime, I'm just trying to take it one day at a time.