23 weeks, phone call to OB #4

 Today officially makes 23 weeks. I'll start with the good news:

Blood pressure- still normal (or normal enough, almost always under 120/80 though both numbers seem to be creeping closer to 120/80 more often than not, but my blood pressure machine always runs a little higher than the office readings anyway.)

Swelling- none, it turns out my fingers are just fat.

Pain and heartburn-None lately (thankfully)! My back hurt much more in the first trimester than it ever does now. Weird.

Baby- Moving often, kicks seem like they are a lot harder, and my belly does seem like it's getting bigger and bigger. I feel pretty good that his growth will still be right on track for our ultrasound next Tuesday, that's what we're praying for anyway.

The bad:

Inexplicably, yesterday afternoon, I started feeling a bit lightheaded and dizzy. Not so bad that I couldn't walk or stumbled, but enough that I just felt off. Like I'd had a couple of drinks and was a bit buzzed/tipsy. We still went to the angel and picked up a few groceries and then ate dinner. My blood pressure was still normal, but nothing made it go away. Not eating something sugary, not eating in general, and not laying down (on my left side). It lasted about 8 hours or so, basically until I fell asleep for the night. It wasn't bad enough that I thought it warranted calling a doctor on a Sunday, especially with the baby acting normal and my blood pressure normal, but it was annoying and slightly troubling.

This morning I woke up feeling normal. I did a few things around the house but nothing strenuous. I ate normally. And around 1 or 2 this afternoon, the feeling came back. I took my blood pressure again and it was normal. Joe and I went car shopping (didn't like either of the cars we drove), dropped my car off to get inspected and a new tire,  and then ate dinner. The dizziness has gotten worse as the night has gone by, not really better. It's not so bad that I can't drive or walk, it's mainly kind of annoying. I have no signs of a cold or any other illness.

As we were driving to go car shopping and I could tell that the dizzy feeling was not going away, I decided to give my ob a call just to make sure this isn't something especially concerning. I left a message reminding them of my history, explaining the situation, and telling them that I see the high risk doctor on Wednesday. (Joe laughed and gave me crap "you don't need to tell them your life story". I almost punched him in the face.) They told me to be careful walking, make sure I eat small meals throughout the day (if it had to do with food/my blood sugar, wouldn't it be better after I eat? Tonight it's gotten worse and I made sure to even eat fruit tonight.)  If it gets really bad to take dramamine or something like that, and to make sure to tell the high risk doctor on Wednesday. That's fine by me, I just wanted to make sure this didn't warrant going into the hospital or anything, I'm not especially worried about it right now.

Joe thinks I have gestational diabetes (a possibility but I hope not!), I think I might be anemic (but again I hope not! I'm going to be uneasy about taking iron supplements since there are some studies out there that think too much iron may be linked to unexplained stillbirths,) and when I told my mom about it yesterday, she thinks I may have a symptomless inner ear infection (um, doubtful.) I don't know what it is but I hope it goes away, like now, would be nice.

But anyway, except for the dizzy thing, everything seems to be good and I'm feeling pretty good, so hopefully this will be a very uneventful week. Wednesday will make me as far along as I got with Olivia, and Thursday I will be more pregnant than ever before.

January 23rd.

It was a couple of weeks ago that I realized I would be 23 weeks (technically today is 22 weeks and 6 days) on January 23rd, my due date with Olivia (2010). Olivia was born at 23+2 weeks. And my "official" due date with Lucas is May 23rd. That's made me a little extra leery of this week, all of those 23's.

In the scheme of things, today wasn't really significant, except for that it represents what could have been, should have been, and isn't. If my first pregnancy had been normal, Olivia would be just turning one sometime around now. We remembered and celebrated her birthday back in September instead, and even if by some miracle she had lived, we would have never made it to January. At my last OB appointment the week before I was diagnosed with HELLP, my ob was already saying we would probably have to deliver very soon because she was so growth restricted, they were afraid that she might stop growing completely and/or be stillborn. We didn't know it would be the next week, we were hoping to make it to Halloween, but January quickly became out of reach. So, I guess it's more of a symbol of an impossible out of reach fantasy that was never our reality.

With all of the snow, plus Joe having to work today, we decided to go to the angel statue today instead of the cemetery. That didn't work out so well, because the path to angel was covered in about a foot of snow, plus they had plowed the foot of snow that had been in the parking lot along the edge of the path. It was almost as tall as me, so we quickly agreed it wasn't going to work. Joe did brave the snow to go down to the angel and leave a rose while I watched from the car. Hopefully we can try again in a couple of weeks.

22 weeks + ob appointment

Monday brings us to 22 weeks (so today is actually 22 +2). I'm not sure when/how it happened, but it seems my belly has exploded.

By this time with Olivia, she was measuring about 2 weeks behind, I had already started having the upper right quadrant pains under my shoulder blade and back and around my rib cage, and it was pretty much the beginning of the end, we just didn't know it yet. My last appointment whilst pregnant with my ob was at 22+2 weeks exactly, it was an impromptu appointment because of the pain, but my blood pressure was normal, urine was normal, and nothing else was glaringly obvious wrong so she chalked it up to baby growing pain and said try prenatal yoga. I think that if she had done bloodwork then, it probably would have been normal even despite the pain, because even a week later when I was admitted to the hospital, my labs were *nearly* normal at first (my liver enzymes were just a little elevated, but that was it, it wasn't until 6 hours later when they had more than doubled and my platelets had dropped by more than 100,000 that the problem became apparent.) I've pretty much come to peace with the fact that we were just flat out doomed with Olivia. So much went wrong so early, so drastically.

So anyway, I do feel like we're in better shape this time, that we'll at least make it to the 24 week "viability" milestone and possibly even the 28 week milestone. (I suppose I should probably be more optimistic but I prefer to take it one milestone at a time and not get my hopes up too much about a 36 weeker.)

My blood pressure was up to my "call us" number Sunday morning and again in the afternoon, (but the instructions are to take it again in 20 minutes and if it's still up to call, and my numbers had gone back down plus I knew I was seeing my OB the next day and I felt fine, so I didn't call). Anyway, my OB isn't worried about it yet- it was normal again Sunday night and all day Monday and has stayed normal (albeit a little bit higher for me than my numbers a month ago, but not even a 10 point difference), she thinks it may have been something with the cuff. Anyway, so far, so good.

My ob is concerned about the notching and was surprised that high risk doctor hadn't put me on bedrest or modified bedrest because of it. She was happy to hear I'm "taking it easy" on almost bedrest and thinks it's a good idea. She said they'll be looking at the blood flow at every ultrasound from now on, and if the notching gets worse and possibly if it stays the same, I should expect official bedrest, and she forewarned me that it's a good idea to "tie up anything" now, basically saying she does expect me to end up on bedrest sooner than later.

It turns out that Dr.Everyone Hates at the perinatal center did not mention if the notching was unilateral (in one spot) or bilateral (two spots) in his report. It's kind of an important detail because it gives us a lot less information for a "baseline" to compare to later. (So if it's bilateral next time, we don't know if it's gotten worse or if it was bilateral all along. And if it's unilateral, we don't know if it's gotten better or it was unilateral all along.) I'm glad he's not my regular (high risk) doctor because he clearly sucks, and I'm hoping someone different will be there for my next ultrasound- the high risk doctors all have different days in the perinatal center keeping an eye on the ultrasounds, I'm going on a Tuesday instead of Friday next time, so it should hopefully be someone else.

My ob does want me to get the high risk doctor to schedule my amnio when I see her next week, so she can put me on the schedule for my c-section. (I have to deliver at our local "baby factory" hospital because it is the only level III NICU, and apparently they book up quickly so my OB wants it scheduled asap.) High risk doctor said amnio will be at 36+1, which would be April 26th, and provided his lungs are mature (they should be because I'm going to push for steroid shots at 34 weeks and my ob agrees that I should get them for just in case), delivery day will be 36+2 on April 27th. If anything comes up or starts acting up sooner (or I start having contractions), we deliver sooner without the amnio, which I think my OB suspects will probably be the case.

 I'm starting to get a little bit excited to be 22+2 weeks with no glaringly obvious issues except for that freaking notching, but it will be even better to be 24 weeks. My OB pointed out that we're only 6 weeks away (ha! "only"! She must not know how slowly these past 3 weeks have gone by) from the 28 week milestone.

Better

Thanks for all of the kind comments and thoughts, first of all. We really appreciate them.

So far, physically everything is still good as far as we know. It might be in my head but I feel like Lucas is kicking harder already. He's been a little quieter so far today but yesterday he was busy busy. I've noticed that's how it goes, a busy day followed by a quieter day and then a busy day again. Last night I was on Facebook and I swear he kicked me so hard I was startled by it and jumped. Freaky and awesome. I love being pregnant, most of the time.

Mentally, I'm feeling better for now. It helps hearing a few others that had notching after a history of severe pre-eclampsia and made it 30+ weeks. Still, we're kind of anticipating/hoping/mentally preparing for just a 28 weeker at this point. I figure that with Olivia, it was about 4 weeks after she first started falling behind that the HELLP really set in, so hopefully that means we still have at least 6 weeks considering Lucas has so far been ahead. But, a lot depends on how his growth is in a few weeks, and apparently it's not totally unrealistic to think that the notching might actually get better or go away. In any case, I'm not quite as panicked about it as I was Monday, but I don't think I'll sleep very well the night before the next growth ultrasound. (Luckily I scheduled it for 8:30 am so we can just get it over with and I can come home and sleep or freak out. ) I find myself getting superstitious, too. With Olivia, every time I got really bad news, like the bad quad screen results, and then when her growth was way behind, and then even in the hospital when everything was seemingly normal, I talked Joe into going home and letting the dogs out and getting food-since they were trying to starve me to death and there was no way he could eat in front of me, and I had convinced my parents everything was fine too...every time, even the half hour I was alone in the hospital, bad news. I'm a little relieved that Joe can go to all of my ultrasounds this time, and really lucky. (His off days are Friday and Saturday so I normally schedule them for Fridays, but I can't wait that entire week for the next growth scan, so I scheduled it for Tuesday and he's arranged to work a different shift that day so he can be there.) If only it was that easy to keep the bad news away.

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.

20 wks +4 days ultrasound and pics

Today we had another good ultrasound. (And a bonus was that my mom was able to go with us.)  He's still a boy, still measuring ahead on everything-about 5 days when they average all of his measurements (and all of the individual measurements were 4+ days ahead). His estimated weight is 1 lb, +/- 2 oz. (I had said that he should be about 13 oz now, so that was a pleasant surprise that he's already 1 lb or close.) And he was still crazy active moving everywhere and anywhere, upside down and wherever.

Heart rate was 142 beats per minute, for us the old wives tale has been totally true, Olivia's heart rate was always in the 160's- high 150's even when she wasn't moving much. Lucas almost always has a heart rate in the 140's even when he's moving like crazy, sometimes it will get up to the low 150's on the dopplers, but our boy has consistently had a lower heart rate than our girl had.

He really likes his hands and feet already, and there was even a moment where he caught his foot in his hand, which unfortunately she didn't get a still picture of but we all saw it.

And now the pictures:

 Profile shot whilst kicking me, his hand is pointing towards his face on his chest.

 This is a view from the top of his head, a few very long fingers. (There were 5.)

 Another shot from the above his head, with fingers again near his face, and I think the circle at the bottom is a knee.

 Some of his crazy movements and complete position changes (at one point he even spun around completely while she was trying to get a picture.) I'm kind of in awe of the little leg/thigh, this is one of the best shots of an entire baby leg that I've seen. And he's busy with his arms and hands though they didn't come out very clear

And here's a shot of him looking up, facing us, with his arm and hand reaching above his head and waving. (Even when it's my baby, I think baby face ultrasounds like this on 2D ultrasounds are kind of creepy so I don't usually bother to even scan them, but since he's waving this will be one of the few.)



Monday, I see the high risk doctor and we go back for another growth check ultrasound in 4 weeks.

20 wks, ready or not, here it comes.

So here we are safely in 2011 and still pregnant. My first ever January being pregnant. I'm still very very wary of what this month and year has in store for us. Basically, I'm not going to believe I might possibly still be pregnant in February until I'm here writing, "well, it's February and I'm still pregnant". It's just too hard to believe until I see it.  (Picture taken Monday which was 20 wks exactly.)

The good: So far, almost everything seems to be okay, normal, even good. I feel Lucas moving every day, some days more than others. (Yesterday and today he's been pretty crazy in there. But he's also a little stinker, every time I put my hand on my belly to see if I can feel him from the outside, he stops moving! I've been convinced he was moving/kicking strong enough for Joe to feel a few times now but by the time I put Joe's hand on the right spot, he stops. Hopefully we'll catch him soon.) 

Mediocre news: my blood pressure has been normal, albeit a little "high for me" more often than not.(My normals are 110-120/70-80, but lately my bottom number has been in the low 80's and high 70's more often than not.) I had an incident with my heart racing yesterday (when I took my blood pressure because of it, it was high- 133/97, and my pulse was 124, and I had just been laying on the couch watching Ellen on tv, not exactly running around or anything.) I didn't call in because it was the end of the day, it stopped, and my blood pressure a few minutes later was normal. I think I may just hold off on calling until I see the high risk doctor on Monday, unless it happens again in the meantime. (My blood pressure and pulse has since been normal.)

The bad is that I can't decide if my fingers are just fat or if they are starting to look puffy. It's too bad I didn't analyze them more before I was pregnant. (My wedding ring hasn't fit since I was pregnant with Olivia.)  They aren't big to an alarming extent, but I'll bring it up to my high risk doctor when I see her on Monday and it will probably earn me a 24 hour urine test.

When I was in the hospital with Olivia, before we knew what was wrong, we were asked countless times if we noticed any swelling in my hands, feet, or face. And I said no and looked at Joe and he agreed with me. But now that I look at the pictures from that time, and even the week before I was diagnosed, I was SO SWOLLEN, my face and my hands at least.

The other thing is heartburn. I never have it when I'm not pregnant, but I had it really bad the 2 weeks before I was hospitalized with Olivia. Well, I started getting it again, every night pretty much, starting last week or so. I know it's normal especially in pregnancy, and it's not that bad yet-it's usually just a little annoying but I don't actually have to take anything, but still, between my fat/swollen fingers, heartburn, and my history, it makes me a little anxious that we're heading towards impending doom in another week or two or three.  So, it's all just kind of screwing with my mind, and I'm good at messing with my own mind even without these possibly fishy symptoms. 

But I'm also trying to come to a relative peace that this is totally out of everyone's hands at this point. (I've probably said this before.) Basically, whatever happens in the next few weeks, there's not much if anything I or any doctor can do to fix. Either we'll make it or we won't, but worrying about getting sick won't keep me from getting sick. So I just have to suck it up and tough this month out and see where we are in February. Easier said than done.