cats with passports

33 weeks= 6 weeks 2 days of hospital bed rest

2012-01-30T00:05:00.004Z

So, um, yeah, I had promised to update more frequently, and then, last week kind of fell apart. I waited, hoping it would get better, settle down, but alas….

On Monday, my high risk OB stopped by to tell me that she’d spoken to my perinatologist. He was out of the country on vacation when I ruptured, and my OB had consulted with both of his partners. Even though delivery was on the books for 34 weeks, and the literature states 34 weeks, and EVERYONE (including the two perinatologists) agreed that 34 weeks was the best option, my perinatologist suggested that we might try to get closer to term. My OB said that she planned to talk to him again, after he’d had a chance to talk to his partners, etc…

While we were talking, I found out that she hadn’t received the final report from U of M (NOT happy about that), which stated that they couldn’t rule out a small VSD on Baby B, and that a repeat echo should be preformed after delivery. She wanted to get it done right away.

On Tuesday, one of the other high risk OBs in the practice stopped by. She said that in her opinion, we need to deliver at 34 weeks. It’s clearly in the literature, and what if we keep pushing, and then something bad happens, which it likely will. She said, “At this point, there are too many cooks in the kitchen” and there are already so many people working on this case, we need to draw the line somewhere, versus continuing to ask people for their opinions. She said we can ask 100 doctors, and we will continue to get different answers. There are too many variables in my case.

On Wednesday, this hospital’s pediatric cardiologist and his team arrived in my room to do another fetal echocardiogram. After an hour of scanning, much of which the cardiologist did himself, it was determined that Baby B has multiple small VSDs (ventricular septal defects) and a possible bicuspid aortic valve. He said it’s not clinically significant and probably wouldn’t require treatment. After they left, nurse after nurse came in, teary-eyed, and offering hugs. Hmm, okay, now I was upset. Then my doctor came in, same thing. When she left, she said she was on her way to speak with the cardiologist, as he hadn’t entered his report yet. She promised to return in the evening.

Sure enough, she later came waltzing in the door. She said that she’s spoken to the cardiologist and he felt terrible for upsetting me. I told her that he hadn’t upset me; he basically told me it wasn’t a big deal. It was everyone else that seemed so concerned, which in turn, made me worry. So, as it stands, this is not a big deal and they will repeat the echo after delivery.

And then there was delivery. I asked her the dreaded question, “If you were going through this, what would you do?” Answer, “I’d be done at 34.” Yep, signed, sealed delivered. That is all I needed to hear; I completely trust her. She was going to speak with a few of her partners, but in her opinion, 34 is it. We talked on the phone a bit later, and sure enough, two of her partners (both have super impressive backgrounds, and I’ve worked with both) said 34 weeks. My nurse overheard part of the conversation, which included one of the doctors saying that this case has too many unique circumstances, and that we shouldn’t push our luck. Going further is “begging for complications” and “setting ourselves up for disaster.”

One of the doctors who was consulted on the 34 week delivery plan stopped by the following day. She offered lots of hugs, and then I thanked her for her involvement in my case. Her background is very impressive (training at two world-renowned university hospitals on the east coast.) She has done a lot of research on my case, even though she’s not my primary, and I’m technically only her responsibility when she’s on call. In her opinion, delivery needs to happen at 34 weeks. This is “uncharted territory” in her words, and there is nothing in the literature about a demised twin, PPROM, and continuing to stay pregnant this long. Therefore, we need to play it safe and be done at 34 weeks.

34.1 it is!

Guinness is in kitty ICU (yes, really)

2012-01-29T23:59:00.007Z

Continuing on with the week, on Friday I received a call from my husband. He’s still in Slovakia and had come home from work to find that Guinness was sick, very sick. It appeared that he’d had another episode (history in the cat file on the right.) When he hadn’t recovered by Saturday morning, my husband took him to a recommended vet. They didn’t have the facilities to keep him overnight, so they suggested another veterinary hospital. Guinness is now in the kitty ICU, receiving IV fluids and going through more testing.

The clinic has visiting hours, so my husband was there to see him earlier today. He’s still not eating or drinking, but doesn’t appear to be as weak as he was previously. So far his leukocytes, AST, and urea have come back abnormal. They plan to keep him for more testing. My husband and Bella miss him so much. I'm so sad that I can't be there.

We’d appreciate some good kitty thoughts. I think we’ve had our share of bad news this year.

This week has to be better, right? right?

(poor quality iPad pictures of the brave boy)

Ladies who lunch

2012-01-19T18:56:00.002Z

My high risk OB, bless her, decided that I was stable enough to go downstairs to the cafeteria for lunch. Again, bless the woman. For the past two days, one of the nurses and an assistant, have wheeled me downstairs, at which time we’ve enjoyed a delightful lunch. The cafeteria is always full of hospital staff; it’s been a bit strange to see that many people in one place, a first in over 30 days. Yesterday the assistant commented that it was like sitting at the popular kid’s table in school, since so many people were coming over to say hello, and how nice it was to see me out. I saw people from every hospital department I’ve dealt with, including one of the OBs who was a bit surprised to see me downstairs. Dr. L, I promise, we had permission. Now, if I can just get permission to go down the street to Starbucks!

In other news, they doubled my heparin. I was at 5,000IU twice a day, now it's 10,000IU twice a day. It’s not a big deal aside from the fact that it stings, and now takes twice as long to inject. Unfortunately, this will also mean more frequent blood draws.

And as of today, we’re at 19 on the 19^th. My nurse has been marking off each day on the calendar, and today she decided to do a countdown. So, as of January 19^th I have 19 days left. I can’t believe I’m almost done!

1 month, 34 days, but who’s counting

2012-01-18T20:36:00.015Z

I’ve now been in the hospital for a little over a month, 34 days to be exact. Surprisingly, particularly to me, I haven’t lost my mind, yet. It stays unbelievably busy here. I remember when Kate was born, my husband arrived the following day. Within the first hour of being at the hospital, he looked at me and asked, “Is it always like this?” Meaning, is it always so busy in your room. I don’t know what it’s like to have a normal, low risk birth, or a normal pregnancy, but as a high risk patient, there is a constant flow of activity in my room. To be honest, since everyone is so wonderful, the company has been nice. However, it also leaves very little time for things like blogging. It seems that as soon as I open the laptop, someone is walking through the door.

Updates:

Today I’m 31 weeks 3 days. I continue to have BioPhysical Profiles twice a week, always scoring 8/8. During the most recent ultrasound (yesterday), Baby B was estimated at 3lbs 6oz. I’m on the monitor for an hour, twice a day. Baby B’s heart rate and activity are great, contractions are minimal. Blood work continues to be perfect,and even better, has now dropped down to two pokes a week. I’m also down to vitals every four hours instead of every two. Hooray, I’m actually getting a bit of sleep at night.

For the first few weeks, every morning when the doctors rounded, I would ask about the possibility of going home; the answer was always the same. I had to accept that I’m here for the duration, and they are continuing to make it as pleasant as possible.

A celebratory 30 week balloon and flowers, from my mom and Kate! Plus the constant flow of lattes from Starbucks and necessities from home.

Surprise, and very appreciated, lattes sometimes make an appearance from the staff. Always decaf from the night nurses ;)

One of the nurses paints my toes.

The cards and letters mean so much.

Fruit and treats from Harry & David, thanks D!

Something for Kate. One of the nurses commented that Kate shouldn’t have to play on the cold, hard floor. She and her children brought in a rug for her to keep in her play corner. Kate adores it, and tries to pick up the “owers” (flowers) and “balls” (polka dots).

The mother of one of my favorite nurses (M) makes hats for the NICU. M is sneaky and had asked me about nursery colours one day. I told her that we plan to use white and light pink, again. A few days later, she brought me this white hat with pink bunnies, made especially for Baby B…. (next to a pen for size comparison)

The first week I was here, one of the nurses asked me what my favorite local restaurant is, and what I like to order. For my 31 week anniversary, the nurses surprised me with my favorite salad.

Thank you to everyone for the continued emails, texts, thoughts, and prayers. It all means so, so much!

As for delivery, we are still looking at a 34-week induction. Not ideal, but so much better than what could have happened/ what they thought might happen.

I really am going to make a concerted effort to update more often. I don’t have a journal, so this is the best place to keep track of the good, and the bad. As hard as it is to be away from normal life, and especially from Kate, there really has been a lot of good, and memories for a lifetime.

17th day of hospital bed rest, and 29 WEEKS!

2012-01-02T04:02:00.009Z

Today I’m 29 weeks pregnant. I’m still 5 weeks from the goal of 34 weeks (they won’t let me go past 34), but 29 is A LOT better than where I was on admission, 26 weeks 5 days. EVERY day helps.

Speaking of the NICU, I finally did the tour. The NICU team and neonatologist had been in to speak with me a few times, but I’d been avoiding the actual tour. A few nights ago when my nurse stopped by to take me for my coveted daily wheelchair ride, she announced that we were going to stop in the NICU before going anywhere else. I’ve always been very eye-rolly (is that a word) when women talk about wanting to be induced (for non-medical reasons) or whined about how uncomfortable they are toward the end (hey, that’s part of being pregnant), but spending time in the NICU only confirms the belief I’ve always had, that babies are meant to be born at 39-40 weeks, and wishing for anything earlier is selfish, plain and simple, selfish. Okay, I’ll save that rant for another post.

Moving right along, we’re continuing to pass our Tuesday and Friday BPPs (Bio Physical Profiles) with perfectscores 8/8. On Friday, Baby B was estimated at 2lbs 10oz, 40^th percentile. We also have twice daily 1-hour non-stress tests. Everything looks great. The monitor occasionally picks up a few contractions, but I’ve only felt one.

I also had the Glucose Tolerance Test on Friday, and passed. Yay.

Most hospitals have rules regarding how often IVs have to be changed; the standard being every 72 hours. I’m not going to do the math, but I’ve had a lot of IVs during the past 17 days. I started with several, those were changed after 72 hours, then I was able to drop one, I’ve had one blow, a few that needed to be moved due to redness, etc. Between the almost daily blood draws and IVs, it’s getting harder and harder to start them and find good placement sites. On Thursday, the nurses started talking about a PICC line. On one hand, yeah, it makes total sense. On the other hand, ack. When the doctor on- call rounded yesterday, she decided to give me a break for the weekend. She said she’s not entirely comfortable with not having access (an IV), but we’ll wait until Tuesday and revisit the idea of a PICC. For now, I’m free….

That same doctor is probably the youngest, smallest, sweetest OB ever, and no, I don’t feel this way just because she offered to bring me a latte from Starbucks ;) She’s just very nice, and since I’m the most stable antepartum patient ever (at least that’s how I feel), we really don’t have much to chat about when she visits. So instead we talk about online shopping and the fact that I desperately need a haircut. My mom said she would ask her guy if he could make a house, err, hospital call, but if that doesn’t work out, Dr. Glorious said she could recommend someone. Sweet!

Did I mention that the fabulous nurse, M, who was with me when I delivered Kate, still works here? She’s been my nurse several times and it was so much fun to reminisce about Kate’s delivery. After Kate was born, M was the person who told me I was very polite, as I hadn’t screamed, called her names, used bad language, and always said please and thank you, and did it drug-free. A few nights ago, M was taking me for my wheelchair ride. She’d decided to take me to look at Christmas lights on the bridge on the backside of the hospital, used by the doctors to go back and forth between the clinic. L&D is a locked unit, and you have to be quick to get through the doors, or the alarm sounds. It seems that every time we pass through a door in the wheelchair, we set it off. M left me on the bridge, and stepped just inside the door to turn the alarm off. Of course, my high-risk OB came walking out of the other side, as I’m just sitting there in the wheelchair on the bridge. Many jokes about me trying to escape.

We finally have some snow. I’ve never been in the Midwest during the winter before, and was starting to question the rumors I’d heard about harsh winters and blizzards (not really.) Well, winter is officially here, and we have snow.

Last night, the nurses had a potluck to celebrate New Year’s Eve, and imagine my delight when this was delivered to me. What a nice break from hospital food.

Once again, they’ve surprised me with their kindness. I’m so lucky to be here.

Next goal, 30 weeks!

My nurse just brought me a latte…

2011-12-28T21:34:00.000Z

So, I wasn’t going to do blog posts of all the wonderful things my nurses, doctors, support people, etc, do and say, that make hospital bed rest a bit more tolerable, but on a daily basis, I’m humbled by the generosity, and kindness, of my care team.

Their giving, thoughtful nature was evident immediately upon my arrival after the rupture. When I say I had a full room of people, I mean FULL of people. They were all there to do a job, but they worked so well with each other, displaying a working relationship I’ve rarely seen. And I would say that I’m a fairly harsh judge, due to the years I worked at a major university teaching hospital, one known for not only medical excellence, but outstanding patient care as well. I had amazing coworkers, who clearly cared for each other, and their patients.

I obviously hadn’t planned on this (the rupture and subsequent hospitalization) happening, and therefore hadn’t charged my phone or iPad before coming into the city to do some shopping. That night, one of the nurses came in and said that she and her husband had just purchased a new iPad, and that I was welcome to use it. WHAT?!?! Who offers a patient, a stranger, something like that? I told her that I had my own, but it wasn’t charged. Before I knew it, she was back with a charger; she had her husband bring it to the hospital for me to use. I also found out that the doctor on call was going to run home and grab her charger for me, if the nurse’s husband wasn’t able to bring theirs in.

The nurses find ways to make everything better, even with a simple smile, or a wink. My first visitor was a nurse. She worked in my high risk OB’s office when I was pregnant with Kate, and when she heard that I’d been admitted, she asked if she could come in and visit. Several other nurses have stopped by to say hello, just because they happened to be at the hospital (picking something up, teaching a class), and wanted to run up and see how I was doing, or as some have said, see if I am still pregnant.

The doctors are wonderful, too. You’re supposed to see whoever is rounding that particular day, but in addition to seeing that doctor, my doctor makes a point to stop in as often as possible, just to check in. Her colleagues have been wonderful, and I’m glad they were made aware of my case, before any of this started. Not only have I received a high level of care, I’ve also received a lot of hugs and comforting words. As with anything, I have favorites, but all of the doctors are great, and if worse came to worse, I’d honestly feel comfortable with anyone from that department at delivery.

All of the lactation consultants at this hospital are also RNs. There’s one in particular who worked with Kate and I, extensively, both while we were here for delivery and for weeks afterward. She doesn’t work at this location very often anymore, but when she was here and saw my name on the board, she came into my room. She didn’t know why I was here, and we hadn’t talked in over a year, but she must have known it was a bad situation. She walked in, hugged me, and just cradled my head, as I broke down and sobbed. She ended up visiting with me for hours, and made sure I had her cell number. She also knows that my mom has Kate, and that my husband is overseas, so she offered to be with me for delivery, and said to call anytime, day or night. As if that weren’t enough, she and her husband came to see me on Christmas Eve, and brought me a gift.

The charge nurse has been wonderful, too. She has spent a lot of time in my room, just talking, and seems to know all of the right things to say to someone in my situation, which as no one has to point out, but sometimes do, is extremely rare. She also took on the responsibility of calling the local funeral homes to ask questions about making arrangements for Baby A, so that I wouldn’t have to.

One of the first days I was here, my doctor came bouncing in with Christmas decorations, and decorated my room a bit. She also brought in some books for me to read, books that she chose based on my interests. Even Santa stopped by last week, bringing a small gift for Kate.

I could give example after example of what my care has been like, the attitude of the staff, the way they’ve tried to include me in things (a staff potluck on Christmas Eve, coming in to paint my toes) just so I’d have a few minutes of normal.

And that brings me to today. I think word has spread through the floor that I love Starbucks. Daily, one of the nurses or doctors offers to bring me a latte (not a small offer since there’s no Starbucks in the hospital.) My day nurse and I were talking about Starbucks and coffee in general. She offered to run downstairs to the espresso cart to get me a drink. I repeatedly told her it wasn’t necessary, but she insisted. She just brought me a latte, and refused payment. P, it’s my treat next time.

If anyone has ideas of things I could do for the staff, to show my appreciation, please let me know. I have a basket of Lindt truffles and other candy out for them, but I’d like to do something else, something more tangible. They deserve it!

Guess where I’m spending Christmas, and hopefully the next seven weeks?

2011-12-24T00:23:00.003Z

December 14, I had an appointment with my high risk OB. Her plan, at that time, was steroid shots (for Baby B’s lungs) at 34 weeks, amnio to check lung maturity at 35 weeks, then schedule the c-section depending on the amnio results. She’d also met with her department to discuss my wishes with them. Basically, that I don’t care what the department policy is, or who’s on call, I want her at delivery. Everyone was in agreement that under the circumstances, that was okay. The meeting also brought them up to date on my case and history, information that would prove invaluable in the coming days.

Two days later, last Friday night, at 26 weeks 5 days, I was at the mall with my mom, grandmother, and Kate. All of the sudden, I felt my water break. Blood, amniotic fluid, and a mad dash to the hospital. I’d called ahead and they were expecting me in L&D. I had a room full of people, starting lines, asking questions, making phone calls, blood work, ultrasound, the works. The ultrasound showed that Baby B had a good fluid level and strong heartbeat, and it appeared that it was Baby A’s sac (the “non viable baby” as he’s called, tears) that had ruptured. Then the contractions started.

I was put on a very high dose of Magnesium Sulfate. I’d heard of this med before, but wow, nothing compares to the experience. To be honest, the details of last weekend are a little fuzzy; that is a strong drug and I was so, so sick. Imagine the worst flu you’ve ever had, hot flashes, inability to control your limbs, light sensitivity, vomiting. Yeah, that’s Magnesium Sulfate.

Back to Friday. So yeah, I was now contracting every two minutes and SCARED. It takes A LOT to scare me, especially in a medical setting. I was terrified, shaking, and even tearful. I know 26 weekers can survive, but I really wanted 35 weeks, and still do. While they worked on me, they had the NICU team come in. After speaking with the neonatologist, I thanked him and said I hoped to not see him for 8 weeks or so. The look of disbelief on the staff’s faces was too much. They said they were just hoping for 48 hours at that point, enough to get the steroid shots in for Baby B’s lungs. I also found out they chose the Mag Sulfate because it offers “neuro protection” and because I was on heparin. I couldn’t believe this was happening, most of the time, I still don’t.

Over the weekend they tried to make me comfortable and prepare me for the worst. I am happy to say that I was able to get the two doses of Betamethasone (for lung maturity) and eventually the contractions stopped, so I was weaned off of the Mag, though not before becoming violently ill Saturday night. They did blood work several times a day to test my Mag levels, which I later found out were sky-high. In addition to the contractions, infection is a major concern. The sac that provided a barrier of protection is gone, so I’m getting Erythromycin and Amoxicillin every six hours, vitals every two. The other big concerns are cord prolapse and placental abruption, though one doctor said the risk of abruption goes down after 24 hours of PPROM, so I’m way past that.

After passing the initial 48 hours, people seemed to relax a bit, and then it was time to make longer plans. My perinatologist is out of town, but my high risk OB spoke with his partner. The perinatologist said that he absolutely wouldn’t let me go past 34 weeks. Her response to him was that she was just trying to get me to 30 at this point. I’m sure I was visibly disappointed when she told me that, and I mentioned that I’d hoped for 35. She said no, but that if I make it to 30, we can set new goals.

Strict hospital bed rest is hard. And before I explain, I KNOW I’m in the best place, and I KNOW that every day I’m here, is a day Baby B is not in the NICU, but yes, this is tough, so now I’ll whine, a bit. For the first several days I had multiple IVs, a catheter, 24 hour monitoring of Baby B, and zero privileges. As in, you do not get up from bed for any reason, none. Want to brush your teeth, the nurse brings your toothbrush and a Styrofoam cup. Need to go to the bathroom, voila, the foley catheter is already in. Want to stretch your legs, too bad, you’re hooked up to the sequential compression device, which inflates every five seconds, yes, I counted. Little by little, the doctors have “liberalized” my privileges. I’m now catheter free and depending on which doctor is rounding, I get sitting showers of either 2, 5 or 10 minutes.

The loss of independence has been hard, very hard. I’m used to doing things myself, when I need to. If I go to the bathroom, I have to ring for the nurse, then have monitoring upon returning to bed. My meds are brought in on a schedule. Food is eaten in bed. I’m dependent on everyone for everything. That is hard.

Kate is doing well, under the circumstances. We are VERY lucky in that this (PPROM) happened here. My mom and Kate are close, so she’s enjoying her time with Nana. They visit often, but it’s difficult. She’s too young to understand, and this is a scary place for kids. We’re getting the room decorated and hopefully with more time, she’ll become more comfortable. I’ve just never had to be away from her before, so this is tough.

I’ll be updating the blog a lot more often. As of today, I’m 27 weeks 6 days, and still planning for a 2012 delivery!

Thank you for your continued support and prayers.

Wishing you a very Merry Christmas!

Very sad update

2011-12-22T21:35:00.001Z

I apologize for taking so long to update. I wish I could go back and do things on my schedule, but I was trying to be sensitive to other people, and give my husband time to inform people of our devastating news, versus having them read it on the blog. It turns out that he did notify everyone; they’ve just chosen to remain silent, whatever. I have MUCH bigger concerns at this point.

Our sad news, we lost Baby A in November, during my 22^nd week of pregnancy. The grief is overbearing at times, but I have to be strong for Baby B. She is doing very well, continuing to get at least one ultrasound a week and looking great.

And for the next blog update, you won’t believe where I’m spending Christmas.

another appointment, another diagnosis

2011-11-11T22:22:00.001Z

No, unfortunately I’m not joking.

On Tuesday I saw my regular perinatologist. The detailed u/s showed some growth discordance.

On Wednesday I drove to the University of Minnesota. After another detailed u/s, the new perinatologist and I had a nice chat. He’s a Washington native, too, and very nice. He said he agreed with the original diagnosis, but “we’ll let the cardiologist confirm it.” We discussed delivery and while he wasn’t thrilled with the idea of me delivering locally then transferring the baby, he said, “We’ll keep our options open.”

Then it was off to pediatric cardiology for another fetal echo; this time, on both babies. The new pediatric cardiologist came in to look at the pictures, then we went to talk.

There is a FOURTH diagnosis. Double Outlet Right Ventricle (DORV). So, now we’re dealing with DOVR, TGA, VSD and PS. Devastating news. The newer Arterial Switch Operation is completely off the table, not even an option. The course of action now is an injection of Prostoglandins immediately after birth. Within a week, placement of a BT Shunt (3 weeks in the hospital.) She said these kids have major issues with suck, swallow breathe and reflux, so he needs to demonstrate that he can gain weight and hydrate. He’ll be followed closely by cardiology and at some point, have the Rastelli procedure (she said likely between 5-8 months). They’ll build a Gore-tex conduit in the heart, which of course brings another set of issues, introducing a foreign material, which the body fights, plus the conduit has to be replaced as he grows and with buildup. Estimated hospitalization time for this is 4 weeks.

I asked about causes and she said nobody knows. I told her that I’d heard there’s a higher incidence in IVF babies and twins. She said that was true. I also told her that I’d read things online such as poor maternal nutrition, alcohol use during pregnancy, diabetic mother, etc. She said none of that is true and that I certainly wouldn’t find it in medical/ cardiology literature. As for how common something like this is, she said, “About 10 cases a year.” DORV is very rare.

The cardiologist wants additional chromosome testing, ultrasounds of the head and kidneys, and a few other things, right after birth. She also said the lungs can be compromised, so throughout life, the slightest runny nose means a trip to the pediatrician, concerns about RSV, etc. Six and a half hours later, I left. Then drove the four hours back, in the first snow of the year. Don’t I have all the luck?

Yesterday I was a confused mess. I called the original pediatric cardiologist and he met with me within hours. The discussion was very informative, and he clarified the need for additional chromosome testing (which hadn’t made any sense to me since the amnio was normal.) Apparently there are some cardiac lesions that are associated with chromosome issues that aren’t included in the amnio. He named one in particular, which sent me marching upstairs to my perinatologist’s office (they’re in the same hospital.)

My perinatologist’s nurse showed me the test results, negative. She also said my doctor was in, if I wanted to see him. I waited for him to finish seeing patients, then he and I sat down for another long, very helpful discussion.

This morning I left a message for my high risk OB’s nurse, and had asked that she call me. My doctor called instead; she’d just read the reports from the U. We had another long talk. She also informed me that she’d spoken with the neonatologist and he said that if I wanted to deliver there, he was okay with it. One of her partners brought up the issue of transferring the baby to Minneapolis, in February, the concern being weather/ blizzard related. Of course with the new diagnosis, my doctor doesn’t think anyone will be comfortable with delivering locally :(

So, where does this leave us? Well, obviously in the hands of some fantastic doctors. My high risk OB, original perinatologist and original pediatric cardiologist have to be some of the most caring, compassionate providers I’ve ever met. Ever. Of course we are devastated, beyond words, devastated. For now I’m scheduling appointments with other providers, researching like mad, and making a quick out of state trip for additional opinions.

Baby A is a very sick little boy, and we could use all the good thoughts and prayers you have.

First appointment in Minneapolis is scheduled

2011-11-07T17:24:00.001Z

I received a call from the University of Minnesota. It seems that both my perinatologist and pediatric cardiologist contacted them. U of M wants to see me ASAP, so they have me scheduled for an ENTIRE day of appointments later this week. Repeat fetal echo, another detailed U/S, meeting with another perinatologist, another pediatric cardiologist, then a meeting with the “team” to discuss the delivery plans. She said they want to discuss the delivery plan since I’m “getting so close.” Err, I’m only 21 weeks, and considering my goal is 38 weeks (though probably not very realistic), I don’t feel that I’m getting close, at all. Oh well. The appointment is scheduled and this will be the first of many ‘leave the house by 5am, drive 4+hour’ appointments.

20 weeks 2 days, appointment with my high risk OB

2011-11-04T20:27:00.001Z

On Wednesday I saw my high risk OB. It was a fantastic appointment. Labs and blood pressure are perfect! We discussed the appointment with the pediatric cardiologist and the previous appointment with the perinatologist. After telling her some of the highs and lows of the appointments, she shared some personal experiences, which helped TREMENDOUSLY.

I nervously sat in the chair as I told her of my desire to deliver at her hospital, with her. Much to my surprise, she didn’t say no. Things could still change (much depends on the next fetal echo), but she’s going to move forward as far as discussing it with her partners and speaking with the head of neonatology. Last time I went into labor, and delivered, in the middle of the night, she wasn’t on call. I fear that will happen again, so she’s going to request permission to deliver me, even if she’s not on call. She doesn’t think this will be a problem since they’ve granted special requests for her to deliver other doctors and nurses, in the past. Plus, she’s basically the head of the department, so hopefully speaking with her partners is just a formality. She also wants the neonatologist in the OR when I deliver, so she needs to get his okay too. The BIG problem with all of this is that she’s going to be out of town for most of February (medical conferences). The timing couldn’t be worse.

She has concerns about preterm labor and said that she’ll likely give me steroid shots to mature the babies’ lungs, in case they come early. As for now, everything is stable and she doesn’t need to see me for two weeks. She gave me a big hug and I seriously left my appointment with a bounce in my step, for the first time in weeks.

Then I hit reception…

I told the new receptionist that I needed to schedule an appointment with Dr. Hopeful in two weeks. She told me it wasn’t possible; she was booked throughout the month, and asked who my second choice would be. My jaw dropped. Second choice? Um, no. I explained to her that I was high risk, and only wanted to see my doctor. The other receptionist overheard this and told the new girl to speak with my doctor’s nurse. The new receptionist said she’d do that, but told me to keep a second choice in mind.

At 8:30am yesterday morning, my doctor’s nurse called. The receptionist had spoken with her, she then talked to Dr. Hopeful, and Dr. Hopeful told her to fit me into her schedule in two weeks AND book my next SIX appointments. HOORAY!!!!!!!

As completely awful as this is, and it is AWFUL, I have such amazing doctors!

First fetal echocardiogram, first appointment with the pediatric cardiologist

2011-11-03T18:24:00.003Z

Tuesday started with the echo. For over an hour and a half, I was on the table while the tech took hundreds, yes hundreds, of images of Baby A’s heart. It is clear that something is wrong, and the tech was an angel, absolutely as sweet as could be.

After that, I walked across the hall to meet the pediatric cardiologist. Everyone always asks, “Will someone be joining you?” “No, it’s just me.” A sure sign you’re about to get bad news, and that most people don’t go through this alone.

Unfortunately, the perinatologist’s diagnosis is correct, and lucky us, not one, but three heart defects.

Transposition of the great arteries (TGA)

Pulmonary Atresia/ Stenosis

Ventricular Septal Defect

The pediatric cardiologist drew pictures and diagrams, as we talked. Fortunately I know a bit more than the average bear about normal heart anatomy, so we were able to move through that portion rather quickly. As usual, causes were discussed. As usual, it comes down to a slightly higher risk of heart defects in IVF babies, twins, and sometimes really bad things just happen.

Moving on to the “what does this mean” portion of our discussion…

He started by saying that this is much more complicated because I’m pregnant with twins. They are very concerned about preterm birth, since I delivered a bit early with Kate, and twins generally come even earlier. The “goal”, in his opinion, is to get me to 35 weeks, anything after that is a big bonus. If I can make it to 35 weeks, they should be able to do open heart surgery within a few days of birth, as scheduled. Otherwise, we’ll have some NICU (neonatal intensive care unit) time before surgery.

The best-case scenario is that they’ll be able to do a newer (about 20 years old) procedure called the Arterial Switch Operation (ASO). He said they “think” this operation will ultimately provide the best quality of life, best long-term outcome for TGA patients. Unfortunately, since we have some other issues, the ASO might not be possible, in which case they’ll do an older procedure (plus end up building an additional structure with a foreign material), known to have more subsequent long term effects, additional open heart operations, and possibly leading to a heart transplant one day.

One of my major concerns is being on pump during surgery, as I know many adults have said they’ve never felt the same after being on the heart lung machine. We discussed the consequences, long term effects (not well studied in children), etc. This is one of the times I really, really wish I hadn’t worked in cardiac surgery. I know what it’s like to be in the OR, what it’s like to see a patient’s sternum cut open, to go on bypass, etc. Very different when it’s your child, your newborn. He completely agreed.

We discussed hospitals and surgeons at great length. The bottom line is that bad things can happen anywhere, and things can go downhill quickly in any OR, which I know. It’s important to me that we have a surgeon with a lot of experience, not someone who sees maybe five TGAs per year. He gave me the names of surgeons at Stanford, Boston Children’s, CHOP in Philadelphia, and a few others. Location wise, a hospital in Minneapolis would be ideal, as it’s only 4+ hours (each way) from where I just leased a townhouse (days before the initial diagnosis). There are three options in Minneapolis (U of M, Children’s and Mayo). The pediatric cardiologist doesn’t think that one is better than the others, though he personally knows the surgeons at U of M and is still on clinical staff there. The fetal echo films were already en route to U of M as we were speaking, though they can be sent anywhere, if we choose to go to a different hospital. They are making arrangements for me to meet the “team” at U of M sooner than later, in case of preterm labor, and in case I don’t think it’s a good fit, we’ll have time to go elsewhere.

Another topic I brought up is delivery. I’ve been told repeatedly that I need to deliver at a major cardiac center, which I completely understand the rationale behind. However, knowing that the baby has a severe VSD (which buys some time), and other circumstances, I asked the cardiologist about delivering locally, as originally planned. He said the “team” wouldn’t like it (which I know), but due to our unique circumstances, he’d push for it, if the VSD is still large, and everything else looks stable. Before the judgment starts, please know that I’ve put a lot of thought into this, and I know the risks. That said, I’m trying to figure out how to divide myself three ways, add in that I have a very sensitive, almost 16 month old, who’s already been through a lot over the past few months. I’d like her to have stability as long as possible, before her world is once again turned upside down. The other factor is that often times, TGA is not diagnosed in utero, so it’s a big surprise after delivery, chaos ensues getting the baby transferred, etc. In my case, everyone will know ahead of time, plans can be in place, and if we do end working with U of M, a medical transport from here to there is not a huge undertaking. Plus, I still have time to think about this and change my mind. He repeatedly said he doesn’t envy us, or the decisions we have to make.

The plan is to repeat the fetal echo between 28-30 weeks. He said he’s always available, if I have any additional questions or need anything. Three hours, well spent!

Amnio results, and another appointment with the perinatologist

2011-10-27T16:43:00.004+01:00

Yesterday I had a 45 minute consultation with my perinatologist; we discussed a variety of topics and went over the test results.

I’m thrilled to announce…

amnio results on both babies: normal

22q deletion (ordered on Baby A): normal

infectious disease blood work (rubella, toxoplasmosis, etc): negative

test for the 100 most common mutations of Cystic Fibrosis: negative

The majority of my questions can only be answered by the pediatric cardiologist (appointment next week), but it was helpful to talk to my doctor. I’ll type up a full recap at some point.

Thank you so much for the lovely comments and support. It really does help! Anonymous, watch your mailbox :)

Not the post I wanted to write (very long)

2011-10-22T16:37:00.003+01:00

Once again, I apologize for not updating earlier; it’s been a really difficult week.

Last Thursday (9ish days ago), I arrived at my ultrasound and appointment with the perinatologist, ignorant, at best. I expected the standard detailed ultrasound, confirmation of genders, and had then planned to spend the remainder of the day with relatives visiting from out of town. That’s not what happened.

The ultrasound started as usual, lots of measuring little bones, counting bones in tiny pinkies, looking at the organs, and yes, confirming genders.

Baby A is a BOY!

Baby B is a GIRL!

Thinking back, I do remember noticing some blood flow irregularities on Baby A’s scan, but each time I’d start to concentrate on what I thought I saw, the tech would move the transducer, begin to talk about other organs, etc. I did say something about the lack of space, which she said was due to a contraction. She followed that by saying it wasn’t a big deal. I was surprised by the clarity of the ultrasound. She said they are the newest and best machines in the world, and went on to say how lucky the hospital is to have three of them, words that would later haunt me. An hour later, it was time to do the first cervical length ultrasound. It was like an IVF appointment all over again. She had to redo it later, since I was having another contraction.

My perinatologist entered the room, started scanning me again, looked at the hundreds of images the tech had taken, then said that he was “concerned about Baby A’s heart.” At first I wasn’t worried, then more people entered the room, and my doctor said he would explain what was happening, and draw me some pictures. A nurse walked over and asked if there was anyone she could call. Then I knew, it was serious. The tears started to fall. Pictures were drawn, more scanning, then the recommendation of an emergency amniocentesis, on both babies. I called my parents to let them know what was happening, and ask for prayers.

More people entered the room, supplies were brought in, and I was prepped for the amnio. Having worked in surgery for so long, I carefully watched my doctor sterilize my stomach. Good technique. The amnio hurt (probably the 1000s of heparin injections and subsequent scar tissue), but was over fairly quickly. In addition to the amnio, he ordered several blood tests. They are testing for “anything and everything” at this point. There were questions about whether Cystic Fibrosis runs on either side of our families, to my knowledge, it doesn’t. They are testing that too.

Then it was time for more discussions. It all seems like yesterday, but also so long ago, so I’ll try to remember what was said.

I will not be allowed to deliver at my chosen hospital, or with the high risk OB I want, and have worked with during both pregnancies. The baby will need open heart surgery within days, if not hours of birth. This followed by weeks, maybe months, in intensive care. I’ve been referred to a pediatric cardiologist, and he will do additional testing, and provide more information. I see him on November 1. They didn’t want to schedule anything sooner, since the babies are still so small.

I’m not going to identify the defect, until it’s confirmed by the pediatric cardiologist. When I ask the perinatologist what could have caused it, he said there’s a higher risk in IVF babies, twins, and sometimes just really bad luck, and that we’ll never know which one it was. I’ve also learned that there’s a higher rate of this defect in Caucasian males, versus females. My doctor spent over four hours with me, which was nice, though this is definitely a very serious condition, because four hours with a perinatologist is unheard of.

The following Monday, I had an appointment with my high risk OB. She walked into the room and just hugged me. The appointment was a lot of hugs, and a lot of tears. I’ve lost weight, and she said that while she understands that I don’t have an appetite, it’s dangerous to lose weight, especially with multiples. She suggested liquid protein shakes, anything to get some calories.

When I told her that the perinatologist said I wouldn’t be able to deliver with her, she confirmed it. I have to be at a university hospital with a pediatric cardiothoracic surgeon. She said if the baby were to be born in this area, they’d fly him to the other hospital (a 4+ hour drive).

Even though I’ve always known her to be very pro breastfeeding, she recommended that I not even try this time. I had so many problems with Kate, and with a critically ill baby, it will just be too much stress. Plus, there’s no way to run in and out of the intensive care unit to feed the other baby.

During the appointment, she asked if I’d started searching for a nanny, yet. She said that if I write something up (job description, situation), she’ll make sure it’s posted in the NICUs. She said even if we don’t get an active NICU nurse, they usually stay in touch with former coworkers, and someone might be looking for a part-time job. She said especially in this situation, who better than a NICU nurse as our nanny.

Obviously it’s for the “team” at Children’s and the University to decide, but she thinks they’ll want me to move to the hospital at 34 weeks. Again, it’s up to the other specialists, but I’ll probably start regular appointments with the “team” before Thanksgiving. Wonderful, 4+hour drives, in the Midwest, in the winter.

My high risk OB does an ultrasound every other week. I told her that I just wanted her to do the scan, and tell me that she doesn’t see what the perinatologist saw. She said his machine is much better, and that he sounded “very sure” of the diagnosis when he called her. Again, a lot of hugs, a lot of tears.

Preliminary amniocentesis results (FISH)

The initial amnio results were scheduled to be back on Monday, but I had to wait until Tuesday. The MFM nurses were out (one had a family emergency) and my doctor was in another city learning to do “in utero transfusions on twins.” On Tuesday I met the genetic counselor to discuss the results. The initial amnio tests chromosomes 13, 18, 21, X, Y. So far, everything has come back normal, and there is definitely both a boy and a girl. The genetic counselor said the results (minus the gender results) could still change, but generally they don’t. We should have the remaining results next week. My doctor ordered an additional test called 22q; it’s not back, either. For now, it looks like this is ‘just’ a life-threatening heart defect.

I will keep you updated as I get more information. Prayers and good thoughts are very much appreciated. I’m still in shock.

Kate’s first trip to the ER

2011-10-13T03:08:00.004+01:00

Last Saturday (err, 2 Saturdays ago), Kate woke up from her afternoon nap crying and wanting to snuggle, which is not normal behavior for my on-the-go explorer. After 30 minutes of off and on sobbing, and wanting to be held, I started looking for an urgent care clinic in the area. My mom happens to live in an adorable little town, which is unfortunately, in the middle of nowhere. Having no luck finding an urgent care clinic, and with Kate’s pediatrician over an hour away, plus her hatred of the car, plus it being a Saturday, we took her to the ER.

As we waited (all of five minutes) for the doctor, I started to question whether the ER was necessary. Maybe she was just having an off day, and I was over-reacting. Then I remembered something Kate’s Irish pediatrician had once said. “You know your child better than anyone else. If you think something’s wrong, bring her in, and I’ll figure out what it is.” The only thing that made sense was an ear infection, and sure enough, it was an ear infection.

Now, I know I’ve been out of the U.S. for several years, but look at this thing. How cool is that?

To get Kate’s prescription, I walked into the lobby of the hospital, put a code in this machine, and voila, Amoxicillin. We had a Pyxis machine near the ORs at my old hospital, but that was for our staff to use. High fives to whatever brilliant soul invented InstyMeds and saved me a trip to the pharmacy.

To the staff at the local hospital, you were awesome. Thank you for seeing us so quickly, and being so patient and kind to a very upset, screaming Kate. Yes, dear Kate comes completely undone every time she’s approached with a forehead thermometer. She about lost her mind when the nurse tried to put the pulse ox on her toe, and she was understandably inconsolable while we held her down to have her ears examined. Again, thank you for a great ER experience (as good as an ER experience can be), and thanks for the gifts for Kate (small bunny and stickers). As great as you were, we hope to never see you again.

16 week appointment

2011-10-13T03:05:00.003+01:00

I am so far behind. Shame on me for updating with a 16 week appointment, when I’m now 17 weeks 2 days.

As usual, the appointment started with the nurse going over a few things; then she mentioned that since I’d just had the detailed ultrasound two weeks ago, my doctor would just listen to the heartbeats with the Doppler. When she entered the room, my doctor told the medical student to go get the ultrasound machine. Yay. Both babies looked great, moving all over. In other news, my doctor said she’s fine with me discontinuing the Crinone at this point, so if the perinatologist is okay with it (I see him tomorrow), I’m done. Blood pressure and labs continue to be great!

14 week appointment and med update

2011-09-28T18:00:00.024+01:00

(apologies for the formatting issues, I've been fighting with Blogger for over an hour, and I give up)

Since I’m now 15 weeks 2 days, I thought I should probably update with the 14 week appointment. Where does the time go?!?!

First a med update:

12 weeks 6 days: done with estrogen tablets

14 weeks 3 days: done with Gestone (progesterone in oil)

Yes, this nasty stuff

15 weeks 1 day: done with Prednisone (may the puffiness in my face soon disappear)

Crinone, you are next to go (hopefully within 2 weeks)

Okay, 14 week appointment…

Baby A:

Baby B:

The ultrasound tech confirmed genders on both, and after discussing it with my husband, we will be sharing the news. I want to wait a little bit longer and have a few more ultrasounds (just to be sure). Also, after talking to some friends about what happened last time, the consensus is that some people are just rude and will therefore make inappropriate comments, but that’s certainly not a good enough reason to spoil the fun for everyone else. So yes, a gender announcement within two-ish weeks!

My doctor seems very pleased. My labs are great, BP was 106/68, and she checked my ankles for swelling, none. The medical student that was with her decided to use the Doppler to check the heartbeats and had I not JUST come from a 30 minute ultrasound, I would have been terrified; she couldn’t find Baby B’s heartbeat. Baby A was fairly easy to find, Baby B was, as usual, all over the place and impossible. Finally my doctor took the Doppler and even she was only able to find Baby B for a couple of seconds (not even the 6 seconds necessary to get a decent count).

She’d already received the ultrasound pics and report. Baby A is measuring at 17%; Baby B is measuring at 12%. She said she’s not concerned since they’re within 5% of each other. I did mention the perinatologist’s comment about wanting the babies out by 38 weeks. She said that they would absolutely be out between 37-38, probably closer to 37. There's just too much that can go wrong past that point and particularly with my risks, they're better out than in. Overall, a great appointment. I see her again on Monday.

13 weeks 3 days, first appointment with the new perinatologist

2011-09-18T17:03:00.004+01:00

On Thursday, I had my first appointment with the new perinatologist. Things started as usual, going over medical history with the nurse, and then an ultrasound.

All but one picture I was given are 3-D, so if you find it creepy, sorry. The ultrasound tech guessed the gender of one of the babies, though it’s still really early, and honestly, after a comment we received when we shared Kate’s gender, I’m not sure if we’re going to tell this time, or not.

Babies: both are measuring well, within 2 days of each other (very important) and their heartbeats are great.

The perinatologist was impressive. We covered a lot (most of it was him asking questions and going over the game plan, though he continuously asked me if I had questions, too). Basically every risk with a singleton pregnancy is multiplied 4-5 times with twins. So while there was a great risk of fetal demise with Kate, it’s even worse this time. He wants the twins out by 38 weeks (he said especially because they are IVF twins, which I need to get more clarification on, since I’ve never heard of that before). Though he doesn’t expect me to make it to 38 weeks, anyway. He’ll do the anatomy scan and look for chromosomal issues at my next appointment (17 weeks) and at the 21 week appointment, he’s going to do a fetal echocardiogram. Apparently IVF babies have a slightly increased risk of cardiac issues, again, multiplied risk with twins.

At 32 weeks, if not before, I’ll start BioPhysical Profiles (non stress tests and ultrasounds) once or twice a week. I had them with Kate, and actually found it somewhat comforting to be monitored so closely.

As for travel, the short answer is no. He said that while he doesn’t know what kind of care is offered in Slovakia, he does know what’s offered in the U.S., and it would be too risky for me to travel. We talked about it in detail, but yeah, short answer, I’m not going to Slovakia. He said he “highly recommends against it.” So that’s that.

Tomorrow I see the high risk OB again, and I’m interested to hear her opinion after reading the perinatologist’s report.

12 weeks 5 days, visit to the ER

2011-09-11T17:17:00.005+01:00

first Rhogam shot for this pregnancy

first, and hopefully last, ER visit for this pregnancy

So, I’ve been really bad about updating the blog, but once again, I’ve been plagued by first trimester cramping and spotting. For weeks I excused the cramping as uterine stretching, and it most likely is. Well, the other night the spotting increased, then bleeding, then intense cramping. By yesterday afternoon it was just too much.

And once again, the hotel shuttle driver to the rescue (It was just about time for Kate’s nap, plus my husband had packing to do, so it was easier to go alone). I just have to say once again, I adore the staff at the hospital I go to; EVERYONE I dealt with yesterday was professional and kind.

My first nurse had also done IVF, so I think she took a special interest in me. She was beyond sweet and attentive. When I was being wheeled to ultrasound, she said to be sure to push the call light when they brought me back, so she could check on me right away. I was wheeled back to ultrasound and very relieved to hear the words, “There are two heartbeats.” Both babies are measuring well.

Baby A: 6.3cm, measuring 12 weeks 5 days, heart rate 157 bpm

Baby B: 6.4 cm, measuring 12 weeks, 5 days, heart rate 161 bpm

The ER doctor recommended “total rest” until I see the perinatologist on Thursday. He also thought I should have a Rhogam shot, which I agreed with, but he wanted to discuss it with the OB on-call, first. I knew it was going to be a long wait as he walked out the door and I heard them call the first of MANY traumas.

I waited, and waited, and waited. The night nurse came back to tell me there was a problem in the pharmacy, and they “hoped” to have the Rhogam ready around 8pm. When she finally came to give me the shot, she apologized profusely for the delay. My response was, “Meh, it’s the ER, it’s life, it happens.” She said she wished everyone was as understanding.

Arrived in the ER: 3:15pm

Discharge papers printed and brought in: 4:58pm

Walked out of the ER: 8:46pm

It was a long evening, but the absolute most important thing is that both babies are alive and well.

11 weeks, nuchal scan

2011-09-02T22:03:00.009+01:00

On Monday I had another big appointment (sorry it took so long to update, busy week).

First I had a meeting with the genetic counselor. She gave me several options for testing, including integrated versus sequential, and CVS, and an amnio, and more blood tests. I was already scheduled for the nuchal, not because we would have terminated had there been a problem, but because I’m a type A, organizer, planner extreme and if there were an issue, I would have had time to prepare and get the best specialists on board, etc. Anyway, I'm just not comfortable with the more invasive testing, given the miscarriage risk. I went ahead with the nuchal, as planned, though I learned that the blood test portion isn't really relevant because they can't tell what percentage of the numbers are coming from which baby. Interesting.

The genetic counselor also asked if I knew the conception date. I told her yes, that it was an IVF pregnancy. She asked if I'd had "real IVF." Err, yes, it *seemed* fairly real at the time. She said that a lot of women come in and say they've had IVF, meaning IUI. Wow. I seriously can’t imagine having a medical procedure performed and not knowing the proper name of it.

In other news, we talked about my upcoming appt with the new peri and she said he likes to follow his IVF patients very closely. Which might translate into, I'm not going to Slovakia. We have a lot to talk about. It sounds like between the new peri and my maternal fetal medicine doctor, I'll be in every other week until 20 weeks, then weekly. Wowza.

The ultrasound portion was fabulous. The tech spent a lot of time on each baby (neither was cooperating). And maybe this is normal for the U.S. (if so, I’m insanely jealous), but they had a huge flat screen monitor on the wall, so it was very easy to see what she was measuring and all of the details. Another woman was training to be board certified in the nuchal scan, so she came in after the test and spent another 30 minutes practicing with the ultrasound and taking pictures. During some of the first round of photos, Baby A reached up and wiped his/ her hand across its forehead, as if to say, too many pictures. Kate did the same thing during her nuchal scan. So cute!

The nuchal number was normal for both babies. Full report to follow.

At 11 weeks:

Baby A: measuring 11 weeks 0 days, CRL 4.08cm, heart rate 176

Baby B: measuring 11 weeks 2 days, CRL 4.51cm, heart rate 171

I’m concerned about the difference in CRL, but the ultrasound tech said it wasn’t a big deal.

Follow up: Yesterday a woman from the hospital left a voicemail for me stating that she had the results, and gave me 45 minutes to call her back before she was to leave for the day. Unfortunately I didn’t get the message until really late last night. Why she didn’t call my cell phone is a mystery. Anyway, I called this morning and of course she’s out until Tuesday. The good news is that the results were faxed to my high-risk OB. One brief message and returned phone call (within 20 minutes), and though she hadn’t read the full report, said that everything looks “great.” Great, coming from her, will more than get me through the weekend. Thrilled.

10 weeks, second U.S. appointment

2011-08-26T16:28:00.001+01:00

I saw my high risk OB on Monday, and haven’t updated the blog, because I wasn’t sure what to share, how much to share, etc, until some decisions had been made. Since several days have passed and nothing has been decided, here is an update, and if you feel so inclined to offer a suggestion, I’d love to hear/ read it.

First, a few highlights from the visit. I got a big hug and very warm welcome back. I just feel so comfortable with this clinic. They are all wonderful, from the receptionists to the nurses to the doctors to the lab techs. Just great, great people.

So, my doctor said that the chance of a c-section goes way up with a twin pregnancy, so to prepare for that. I told her that I was prepared for a c-section last year and look how that turned out, so this time I might take a Lamaze class instead ;) She did an ultrasound in the office (sorry, no pictures were printed). Both babies looked great. Baby A was sleeping. Baby B was dancing all over the place as usual, leading to a discussion about their genders. So far, the general consensus has been one girl and one boy. My doctor agreed, for the sole reason that Baby B was so active. It will be interesting to find out if everyone is correct.

Okay, onto the bad news….

My doctor doesn’t want me to travel, specifically, outside of the U.S. Not only do I have all of the high risk issues I had during my pregnancy with Kate, but now I have all of the risks and potential issues that come with a twin pregnancy. To add even more fun to the mix, they also found that I have a Factor V Leiden mutation, which is honestly not a big deal, since I’m already on the recommended treatment (heparin and baby aspirin) for one of the autoimmune issues. My doctor is most concerned about premature rupture of membranes, cervical shortening, preterm labor, and also the ethical issues of whether a 20, 22 week pregnancy would even try to be saved in certain countries (most likely not). At least here, she would do her best to get the babies to viability, so they’d have a chance at survival.

She went on to say that if this were a fourth baby and I had no history of preterm labor, she’d have no problem with me traveling and returning to the U.S. within a reasonable timeframe. While I was getting dressed after the appointment, she consulted with a colleague, who completely agreed with her, particularly since it’s an IVF pregnancy. We’ve worked too hard to take risks, seems to be the standard opinion.

As of now, I’m scheduled for the nuchal scan and to meet with a genetic counselor on Monday. They’ve also scheduled an appointment with yet another perinatologist in a few weeks. Of course the earliest he could see me was the day after I’m supposed to fly from DC to Slovakia.

Needless to say, I haven’t been getting much sleep, stress is at an all time high and I honestly don’t know what to do.

9 weeks 1 day, first U.S. appointment

2011-08-18T21:54:00.005+01:00

I had my first appointment in the U.S. on Tuesday. They had scheduled four hours of time, but I was out within 3 ½. The first appointment of the day was for an ultrasound. Baby A and Baby B still have heartbeats and are measuring well.

Baby A: 2.5cm, measuring at 9 weeks 2 days, heart rate 174.

Baby B: 2.4cm, measuring at 9 weeks 2 days, heart rate 174.

The next appointment was for an intake briefing with the nurse manager. She was absolutely lovely. We went over the usual medical history, family history, meds, travel restrictions (err, this could be a problem) etc.

March 18, 2012 will remain the official due date. She said they don’t adjust the date for twins, but just to be aware that I won’t make it. I didn’t think I would, considering that Kate was early.

On Monday, I see my high risk OB.

We are Stateside!

2011-08-18T21:48:00.002+01:00

We arrived late last week, and as usual, we’ve been busy, busy, busy. Unfortunately, we’ve also been sick, sick, sick. It started with Kate, then me, and now my husband is sick. It’s just the typical gunk you sometimes catch when flying (head cold, fever, runny nose). Despite illness, we’ve been thoroughly enjoying ourselves. Hello huge grocery stores and Target. And Mexican food. And Starbucks (baristas who make my drink correctly every.single.time).

I’ll type up a full blog post soon, but our trip was about as smooth as possible, minus a piece of missing luggage, that was quickly recovered by the airline.

final appointment, 8 weeks 1 day

2011-08-09T16:12:00.007+01:00

There are still two babies!! Dr. Fabulous did my scan. She spent so much time explaining everything, commenting on how cute they are, even saying they looked like they were about to reach out to hold hands :) Then she let me listen to both heartbeats. AMAZING!!

Baby A: 16.8mm, measuring 8 weeks 1 day, heart rate 169bpm

Baby B: 16.6mm, measuring 8 weeks 1 day, heart rat 161bpm

After the ultrasound, we sat and talked for a while. She is so, so sweet. I’m really going to miss everyone at the clinic. I brought in a large gift basket of chocolates and a thank you note, so hopefully everyone is going home with a smile tonight. Then it was time for my last intralipid infusion. Wow. I seriously can’t believe I’m done. Dr. Fabulous started the IV and it was by far the easiest infusion I’ve had. Lots of hugs and well wishes from the staff. It was hard to say goodbye.

After I left the clinic, I went to the pharmacy and purchased of all their in stock progesterone, heparin and other support meds. So much in fact that they didn't have enough heparin syringes to sell me. I’m honestly nervous to have purchased that many meds (as I still can’t believe this will last), but it was something I needed to do. We leave on Thursday. still so.much.to.do!

medical appointments in the U.S. are scheduled

2011-08-08T16:10:00.004+01:00

Last week, I really, really wasn’t ready to make any medical appointments in the U.S., for fear of jinxing the pregnancy. However, knowing how well-regarded and popular my high-risk OB is, and having the doctors here reiterate the importance of setting up an appointment in the U.S. right away, I called.

The receptionist told me that my doctor is booked through the fall, and that she would try to get me an appointment with someone else in the practice, at least for the first one. I really, really didn’t want to meet with another doctor. I mean, I don’t mind having appointments with other doctors in the practice later on, and fortunately I did when I was pregnant with Kate, since my doctor didn’t deliver her, but yeah, for the first appointment, I wanted MY doctor. ::whine whine:: I even pulled the “can you please ask her nurse if she’d see me, and mention me by name” card. IT WORKED!

When I called back a few days later, the receptionist stated that my doctor said that of course she wanted to see me, and to make room in her schedule. HOORAY! The week prior to seeing my doctor, they’ve scheduled me for blood work, an ultrasound and then a 1 ½ hour intake meeting. WHOA! I have no idea what we’re going to discuss for over an hour. The receptionist said they’ve blocked a total of three hours for me. Again, WHOA! The appointment the following week is when I’ll actually be meeting with my doctor. The fact that the appointments are made and everything fell into place much too easily, is causing me great anxiety.

Tomorrow I go for my final appointment at the clinic here (another ultrasound and intralipid infusion). Hoping and praying there are still two heartbeats, but terrified that there are not.

the picture that sums up the past week

2011-08-07T14:45:00.003+01:00

Apologies for the lack of updates, but we were busy, packing. And lest you think we have it easy and just sit back and let the movers do the work, there’s A LOT of prep work that goes into our moves.

First there’s the issue of different types of shipments (storage, UAB, HHE). Items sent to storage are those you don’t want or need in the foreseeable next several years. UAB is the air shipment, items you hope to see ASAP, upon arriving at your next post, or at least sometime within the first month. Unfortunately, the air shipment has a strict weight limit, so you have to choose very carefully what you put in it. And finally, HHE, which is everything else. Of course there’s a weight limit to that too, but it’s much higher than the air shipment, so most items end up being sent by sea freight/ HHE. You hope to see those items within four months of arriving at post.

So yes, that’s what I’ve been busy with, packing, organizing and washing, all with my little helper, Kate, underfoot. Fortunately I started the process months ago, or it would have been so.much.worse. Even better, the embassy had a charity drive recently, so I was able to donate several SUV loads of stuff.

Final count:

UAB: we’re allowed 600 pounds, 50 of that is the weight of packing materials and the crate. 549 pounds! AWESOME!!

HHE: 4,750 pounds. YES!

The coming week is all about packing luggage, last minute appointments, saying goodbye to friends, dropping the cats off (they’re summering here for the next five weeks, lucky cats), and dropping the car off.

the BIG news!!

2011-07-28T15:38:00.005+01:00

It’s TWINS!!

Dr. Fabulous did my scan this morning and quickly announced that there were two, with heartbeats!!

Baby A: 6mm, measuring 6 weeks 3 days, heart rate 122bpm

Baby B: 6.8mm, measuring 6 weeks 4 days, heart rate 120bpm

I’m really pleased that they are both measuring so well; I’m 6 weeks 3 days today. Dr. Fabulous said that both the sizes and heart rates are excellent, and I’m still on lifting restriction, as much as possible. She said not to lift the “princess” too much (her name for Kate).

She was thrilled, gave me a big hug and said I deserved this after everything we’ve been through. I can’t get over how happy she was. It’s such a great feeling, especially knowing what a team effort IVF really is. Another nurse, whom I’ve worked with many times, came in and congratulated me as well. Then Dr. Fabulous took me downstairs for intralipids. Several nurses, including nurses from the operating theatre stopped by to congratulate me upon hearing the news. Word travels fast in that clinic.

My reproductive immunologist started my IV today, so I was able to ask him about additional intralipids. I did them throughout the first trimester with Kate, but we are leaving in two weeks, and I’ll only be 8 weeks 3 days. His suggestion was to have another infusion as close to our departure date as possible, then I’ll be covered through the first trimester. Sounds good to me. Dr. Wonderful, who did the transfer earlier this month, happened to stop by, so I was able to tell him as well.

When I went to pay today’s bill, my favorite receptionist was very happy to hear the news, even asking to see the pictures. The woman in the billing office next door came over to see the pictures, and offer congratulations as well.

I LOVE my clinic so much! Everyone just seems genuinely excited and happy. There is no way I could have done this without them, all of them.

It’s still VERY early and I know that I could lose one, or both, of the babies, but for today, I’m VERY, VERY happy!

ultrasound is rescheduled

2011-07-26T09:58:00.003+01:00

A receptionist from the clinic just called and said they need to reschedule my ultrasound and intralipids. Apparently there's no doctor available on Friday afternoon. I probably should have taken an appointment next week (better chance to see a heartbeat if there is one), but I'm impatient and just couldn't wait. Thursday it is.

I'll be 6weeks 3 days. Has anyone seen a heartbeat that early?

okay, NOW the official third beta is in!

2011-07-22T15:31:00.002+01:00

After yesterday's fiasco of first being told it was 1,400, then the answer being changed to 4,400, I wanted to see the results for myself.

Many, many phone calls and yes, resorting to getting the 'powers that be' at the embassy health unit involved, I present.....

4,400

Sorry the quality isn't great, it's a picture of the pdf document on my laptop screen.

third beta, finally

2011-07-21T15:08:00.001+01:00

My doctor just called and said that the blood work is excellent, then went on to say that the hCG is 1400. I almost fainted, as that would be MUCH lower than where it should be. After a bit of back and forth, he then said it was 4,400. I asked three more times and he assured me, 4,400. For today I’m sticking with that, and will work on getting a paper copy of the results tomorrow (they are once again gone for the day). I had also requested that the progesterone level be tested and the results came back at >140. I was told by both the GP and the receptionist that the lab doesn’t give actual number values for progesterone. What?!?!

I called Dr. Fabulous and left a message for her, just giving her the results and said that I’d see her next week for the ultrasound and intralipids.

Hopefully all is well and the number is in fact, 4,400!

ICLW July 2011

2011-07-21T10:13:00.002+01:00

If you haven't been here before, welcome. This is a bit of my IF history.

2005- married

2007- started TTC

2008- IVF #1, early triplet miscarriage

FET #1, failed

2009- IVF #2, success

2010- welcomed our beautiful daughter, Kate

2011- FET #2, failed

IVF #3, two decent betas, waiting for the results of beta #3. Absolutely no pregnancy symptoms, so I'm not very hopeful.

For a more detailed history, click on the infertility label to the right.

I'm looking forward to finding some new blogs to read this month!

Guess who I met this week?

2011-07-20T20:27:00.002+01:00

The lovely Fran from Everyone Else But Me! And a bonus, she had adorable baby Oliver with her! He is such a happy boy, always smiling!

For those of you who read her blog, she is just as wonderful in person as she is on the internet, or more so. She’s also beautiful! I was rather intimidated, especially with my puffed-up Prednisone face.

We had a lovely time at Starbucks and I felt like I could have spent hours upon hours talking; well, we kind of did :) She was very generous and brought me a bag of Gestone, needles and syringes. THANK YOU!!! We’re hoping to get together next week as well. My only regret is that we didn’t meet up sooner.

hCG frustration

2011-07-20T14:41:00.002+01:00

I’ve now taken six home pregnancy tests, all positive, including the one this morning. It’s kind of absurd to test, since I know I have hCG in my system, but seeing the second line is reassuring. Even though I’ve already had two betas at the clinic, I just couldn’t wait for the ultrasound next week, to hopefully indicate that everything is going as it should, so I scheduled an appointment with the GP for blood work (I needed my thyroid checked anyway). To be fair, I could have scheduled an earlier ultrasound or more betas with the clinic, but then I would have had the childcare issue with Kate, so taking her to the GP with me just seemed easier.

This morning I arrived at the appointment, my GP did the blood draw, then I asked when the beta results would be in. Response, “Late Thursday or Friday.” blink blink. I must have looked utterly shocked, because the answer then changed to “Perhaps this afternoon.” Progress. When I went to pay, I asked the receptionist to call me ASAP with the beta results, and was then told that they wouldn’t be in until at least tomorrow morning, since they (doctor and receptionist) don’t work on Wednesday afternoons. Oh, this was getting even better.

Frustrated, I stopped at a pharmacy on the way home and purchased a new digital test that is so sensitive it will tell you the week of conception (not that there’s any doubt). Sounded reassuring; except I took the test and it’s defective. Now I can’t help but think this is the universe’s way of holding off on telling me the bad news. And no, I still haven’t stopped googling late at night. bad, bad, bad

What does $1336.62 look like?

2011-07-15T14:47:00.002+01:00

Well, $1336.62 or €946.94

This afternoon I went to the pharmacy to pick up a one-month supply of meds, just to keep me pregnant. And this does not include the almost $1000 a month of another med I have to take; I still have enough of it left over to keep me going for another three weeks. It is days like this that I hate our insurance company, which covers nada.

The regular pharmacist was out today, but her coworker was just as lovely. She couldn’t get over Kate, commenting on her cuteness, her outfit, etc. After she brought the bag of meds to the front, and totaled them, she asked the question I’m used to at the pharmacy, “Is this okay?" While I appreciate them asking, because yeah, it’s a lot of money, I’m never quite sure what to say. I mean, it has to be “okay.”

Honestly, right now I’m just hoping that next month I'll still have a reason to drop a couple thousand dollars on more meds. I scheduled an appointment with my GP on Wednesday, thyroid panel and another beta. The waiting is awful. Still no pregnancy symptoms, just a lot of cramping :(

11dp5dt, second beta

2011-07-13T15:45:00.003+01:00

Dr. Fabulous just called! It doubled!! 244

She'll see me on July 29 for an ultrasound and another intralipid infusion. I'll probably have another beta next week when I'm at the GP, just so I know that things are okay.

11dp5dt, a morning of appointments

2011-07-13T14:13:00.003+01:00

First it was off to the pediatrician for Kate’s one-year vaccines. Yes I know, I need to do a birthday post.

We LOVE her pediatrician and were very sad to say goodbye this morning. Kate received a total of 3 jabs (MMR, PCV and Meningococcal C). We’ll do Varicella/ Chicken Pox in the U.S., since it isn’t done here. Her doctor always spends so much time with us; it’s unreal. She also has the most beautiful office. It’s a gorgeous home, err mansion, in a residential neighborhood. I’ve only been on the main level and the walkout basement (the clinical room and waiting area are downstairs), but wow, what a house. I was going to ask if I could take a picture or two, but thought that might be a rather strange request. As we were leaving today, I thanked her for providing such great care for Kate, and she seemed really touched. It's hard to put your trust in someone, and find someone you work well with, especially in a a foreign country. She far exceeded my expectations, which I admit, are high. Again, we are going to miss her. Of course my sweet girl was not happy after receiving three separate shots, but so far she’s handling it well.

Then it was off to the clinic for me. I had a new nurse, quick blood draw and she said someone should call between 4-5pm with the results. I’m still not feeling very hopeful about this beta, and yes, still googling like mad. I had also put in a request for our records, which they had ready for me today. Color me impressed! It was not only free, but everything was organized in a nicely bound notebook. I didn’t see the embryologist’s report from our current cycle, but everything else seems to be in order. Now I’m just waiting for the beta call.

9dp5dt, appointment. Update!!

2011-07-11T10:46:00.003+01:00

I arrived at the clinic and received a warm welcome at reception. I didn’t think the second receptionist knew me, but when I tried to give her my name, she responded by referring to me by first name, and said she had already marked me.

As I was sitting in the waiting area, a nurse came in and I heard her say that the computer system was down. There were maybe 7, 8 other women and couples in the room; she went to each and asked for their names, then asked if they were there for a scan. When she got to me, she called me by name and said that she “knew” me. Strange because I don’t remember working with her before, but I also realized that I am there so frequently, I probably shouldn't be surprised that I'm "known." Meep.

The blood draw was simple enough. Nurse gave it a good luck rub and sealed it in a bag. Results should be in after 4pm today.

And just an FYI, if you go to bed and spend hours on your iPad googling "low beta, chemical pregnancy and cramping", you probably won't get very much sleep.

UPDATE!

Dr. Fabulous just called. My beta is 93!!! I'll go back on Wednesday for a another test. She was very pleased with the number, and is going to call in some additional prescriptions to the pharmacy. She also said to rest and to try not to lift anything. Then we both had a good laugh, as I'm sure she heard Kate.

Today I'm happy with 93. Now we just need it to double!

8dp5dt, 2 more tests

2011-07-10T06:27:00.003+01:00

Despite the horrible cramping, it appears that things are still moving in the right direction. I took two more tests this morning, both positive. I'm convinced this is either a chemical or a late implanter (possibly one of the morulas).

I'm done testing until the beta tomorrow. Hoping and praying for a big number.

A line is a line, or is it? Update!

2011-07-09T09:27:00.008+01:00

I decided to test today, 7dp5dt. Not wanting to jinx myself, I hadn’t planned ahead (purchased new pregnancy tests). So, I used an old (expired 2010) internet cheapie. Guinness woke me up at 5am, I tested, no line, threw it in the bin and crawled back in bed. Cried, cursed the world, and tried to go back to sleep; Guinness would not stop meowing. I got back out of bed and for whatever reason, pulled the test out of the bin. I blinked a few times, as I thought I saw a line. My husband was downstairs and when I showed the test to him, he saw the line too.

I’ve now thrown the test away, and pulled it out of the bin approximately five times; I’m clearly insane. I even got excited for a few minutes until I realized that

1. The test is expired.

2. The test is cheap.

3. The line didn’t show up right away.

Google isn’t helping either. The words “expired” and “evaporation” line might send me over the edge.

I just spoke to the clinic and they don’t do blood work on Saturdays. I have an appointment onMonday morning, and will buy some new tests today. Please let this be a real line. With everything I have, please let this be real. Honestly, I’m not feeling very hopeful :(

I started cramping and couldn't stand it anymore, so I used a brand new test. The line appeared right away. It's very, very light, and with the cramping, it could very well be a chemical. I'll test tomorrow and have the beta on Monday.

Well, and even more disappointing, the line isn't showing up at all on the picture I uploaded. I promise it's there, though very light.

July 4th and 5th, a little late

2011-07-06T15:29:00.008+01:00

A belated Happy July 4^th. We went to the official party at the Ambassador’s Residence. I believe the turnout this year was just over 2500 people. Big party, food, football (hey, when your ambassador owns the Steelers, there’s bound to be football). They even had a Starbuck’s booth set up. Unfortunately there was no decaf (I’m only drinking decaf right now, just in case). Though I did realize that I must go to Starbucks entirely too often since a few of the baristas from our local store recognized me and Kate. Oops. The weather was absolutely perfect and I think everyone had a great time!

Yesterday I had an intralipid infusion, again. I noticed that there was a new television in the immunotherapy room, but didn’t pay much attention until the program came back after the commercial. The television was set to MTV and “Teen Mom” was on. It was so wildly inappropriate that it was actually funny. The nurse caught it and changed the channel. Yep, just what adult women going through IVF want to watch, dumb teenage girls who get pregnant easily, and by accident. From the few minutes of the show that I did see, TRAIN WRECK! Those poor children :(

I was able to see some of my favorite nurses, and it was hard, because for all I know, that may have been the last time I’ll ever be at the clinic. Dr. Fabulous was busy when I left, but I’ll at least call her to say goodbye before we leave Dublin. My absolute favorite woman in the front office did my paperwork and billing yesterday. I will miss her so much, and I did drop off a request for my records. As I was leaving, she asked if I needed to make another appointment. ::sigh:: Not yet, but I hope so.

IVF #3, embryo transfer

2011-07-02T15:38:00.005+01:00

I’m home, and on bed rest. Dr. Fabulous didn’t end up doing the transfer, but the owner of the clinic/ top RE, aka Dr. Wonderful, did. He did my egg retrieval for IVF #2, and did one of my ultrasounds last week. When I last saw him, I asked if he planned to do my retrieval again this time, but he was going on holiday for a few days. He then said that anyone can do the retrieval, but transfer is very important. I remember him looking at me and saying that he ‘would’ do my transfer. Honestly, I would have been very happy with Dr. Fabulous or the RE who did the transfer for IVF #2. Anyway, I was pleased when the OR nurse told me that Dr. Wonderful would in fact do today’s transfer.

There was a slight hiccup when the embryologist came in to speak with me about the embryo quality, and then told me that I could only transfer two. I told the OR nurse that I wanted to speak with Dr. Wonderful. He arrived quickly, and after a bit of back and forth, looking at my chart (4 previous cycles, 9 embryos, 1 child, speaks for itself), he agreed to transfer three. Unfortunately they are not all blasts :( We ended up with one blastocyst, one cavitating morula and one compacting morula.

During the actual transfer we talked about clinics in the U.S., various IVF technologies, the fact that my previous RE at the clinic, Dr. Spectacular, will be the new director of a fancy, schmancy clinic in LA, and just like that, transfer was over. The nurse played back the ultrasound video of the actual transfer, which, even after going through this as many times as I have, is still amazing to watch.

Dr. Wonderful started his post-transfer speech on what to do, not do, then looked at me and said, “Never mind, you already know this.” I got a warm farewell, best wishes, then he and the nurse wheeled me back to recovery, I had a bit of a rest, changed out of the gown and it was time to go.

Now I’m hoping for a relaxing day, or two. Positive thoughts, crossed fingers and prayers are still very much appreciated.

IVF #3, another embryology update

2011-07-01T18:38:00.002+01:00

And so, the roller coaster continues. I had been simultaneously waiting impatiently for, and dreading, the embryology phone call all.day.long. I honestly didn’t think we’d have any embryos to transfer tomorrow, after the previous update.

Well, I spoke to the embryologist this afternoon. I had a very hard time understanding her, but it sounds as if all five embryos are still alive. ::faints:: That said, only two of them are compacting (on their way to becoming blasts), two more are rather slow and one is not doing well at all.

Since we are leaving next month, we really can’t/ don’t want to freeze any and leave them behind. Add in that I’ve failed both of my frozen cycles. Add in that they probably don't meet freezing criteria anyway. It sounds as though we’ll probably have two, maybe three tomorrow, so I’ll talk to Dr. Fabulous in the morning, and see what number she feels comfortable transferring. True to form, I’ve done research on transfer numbers, ad nauseam, and I know what I’m comfortable with, but the final decision is that of Dr. Fabulous and the clinic.

As always, I’d appreciate healthy embryo thoughts for tomorrow. I’ll update when I get home.

IVF #3, embryology update :(

2011-06-29T18:49:00.007+01:00

This afternoon I spoke with the embryologist. She said that three of the embryos are showing significant degrees of fragmentation; the other two are doing well. She went as far as to offer me the option of doing a 3-day transfer tomorrow (as in, we might not have anything to transfer on day 5). It is 100% certain that we will have nothing to freeze.

Having previously done more research on this than I care to admit (I've also had both a 3-day and a 5-day transfer), I decided to take a chance and grow them out to 5-day blasts. The risk of course is that we’ll have nothing to transfer. That said, many REs believe that if embryos don’t make it to day five, they weren’t healthy enough to result in a pregnancy anyway, so basically you’re just getting the bad news earlier. If we have a blast to transfer, the chances are better that we’re putting back a good quality embryo.

After I got off the phone with the embryologist, I was rather upset, so I left a message for Dr. Fabulous, highlighting the conversation I’d just had. She called me back within minutes (have I mentioned how much I adore her). Upon listening to my message, she immediately spoke with the embryologist and based on their conversation, agreed that I’m doing the right thing (hoping to get to blast stage). We talked for a bit and she said to call back anytime if I need to talk, so sweet. She also promised to check on the embryos and call if there are any significant changes. Otherwise, I’ll hear from embryology on Friday and schedule transfer for Saturday. Dr. Fabulous will be at the clinic on Saturday, too. At least if there’s really bad news, I’ll be in good hands.

Please pray, think good thoughts or whatever you do. Thank you.

We have embryos!!!!!

2011-06-28T15:03:00.003+01:00

Late this morning I glanced at my phone and noticed that I’d missed a call from the clinic. My heart dropped; the embryologist wasn’t supposed to call for at least four more hours. As I called the clinic, I had the absolute worst, heavy feeling in my stomach. I was put through to the embryologist right away.

Imagine my delight, and surprise, when she said we have FIVE embryos!!!!! I’m stunned. We had a long talk about the fact that we’ll be lucky to have two, maybe three on Friday, but still, five is a lot better than the numbers I’d had floating around in my head.

She told me not to stress, (yeah, right) and that she’d be in touch later this week. As we ended the call, she said I could ring tomorrow for an update, late afternoon. I’m positive this is the same embryologist I spoke to for IVF #2, as she used the word “precious”, when speaking of our embryos. This is also the same embryologist who told us that our second embryo arrested before transfer for FET #2. She is so sweet and comforting. I just know they are in the best hands.

Five, we have five. Please, please grow.

The stats:

IVF #1: 8 eggs, 5 embryos (transferred 3, froze 2)

IVF #2: 7 eggs, 4 embryos (transferred 2, froze 2)

IVF #3: 7 eggs, 5 embryos (to be determined)

IVF #3, Egg Retrieval

2011-06-27T18:24:00.006+01:00

Seven eggs were retrieved. Obviously I wish the number were higher, but given my age, DOR status, etc, I’m pleased with seven.

IVF #1= 8 eggs, 5 embryos

IVF #2= 7 eggs, 4 embryos

IVF #3= 7 eggs, to be determined

We arrived at the clinic this morning and the guilt feelings (bringing Kate with us) continued. I felt like I was entering the building with contraband. The surgical area was still quite busy, so we waited in the general waiting area. Kate did beautifully, sitting on my husband’s lap, quietly looking around.

They called for us fairly quickly, and we passed Dr. Fabulous in the hall, who seemed very pleased to see Kate. Once downstairs, we were shown to a private, curtain area. I changed, then the nurse went over discharge instructions. I asked her if Dr. Fabulous was still going to do my retrieval and she left to find out. My husband held Kate, keeping her entertained with her favorite books. The nurse said that another doctor would go over our consent paperwork, then Dr. Fabulous would be down to do the retrieval. The other doctor came in and honestly, she’s a favorite, too. She actually did the embryo transfer that gave us Kate. She was very sweet with her, and with us. I kind of felt bad for insisting that Dr. Fabulous do the transfer, as I’m sure the other doctor would have done a great job too. By that time, they were ready for my husband, so I waited with Kate. The nurse stopped by and asked if I needed anything for Kate. I just can’t get over how lovely everyone was about us bringing her to the clinic. I was so nervous, and felt terrible about doing so, but their attitudes really put me at ease, as much as possible.

Kate checking out the bed

Soon it was time for my husband and Kate to leave. My favorite surgical nurse came to get me. We had a nice chat on the way back to the theatre, quick prep, then Dr. Fabulous and the other RE came in. Dr. Fabulous started my IV and after a quick discussion of meds (it’s the anesthesia nerd in me), it was just about time to start.

Perhaps it was being surrounded by some of my all time favorite staff at the clinic, perhaps it was the Sopadol (Tylenol with Codeine) tablets I’d been asked to take 45 minutes earlier, or perhaps it was the emotions of finally being in the operating theatre again , but I couldn’t help but think that if not for the lack of insurance coverage, and expense of IVF, I would do this over and over and over, to build our family. I really want another child.

Perhaps now it’s my post anesthesia fog, but it was really a full-circle feeling today, having Kate in the clinic with us. It was less than two years ago that we were there, surrounded by the same staff, going through the same procedure, and to think that this now walking, talking almost one year old, was conceived in that lab, is just amazing to me.

Dr. Fabulous announced it was time for my “gin and tonic”, err Midazolam and Morphine, and that was that.

I woke up in recovery, a bit groggy, but otherwise okay. Though I did find out that I was awake and talking during part of the retrieval, eep. Dr. Fabulous later told me that we spoke about Kate, nothing embarrassing.

They gave me two bags of fluids, then I was ready to go. I did ask to speak to Dr. Fabulous regarding transfer, as things will be significantly more complicated since we are leaving Ireland next month. We had a nice conversation and she seems to understand my concerns regarding extra embryos (should we even have them).

My husband had planned to pick me up, but Kate was just going down for a nap, so Dr. Fabulous called me a taxi. Warm wishes from her and the front office staff, and off I went.

Please think good fertilization report thoughts for us. The embryologist will call tomorrow evening, good news or bad.

one more bag

all done

A few announcements…

2011-06-26T14:22:00.003+01:00

I triggered last night! Sorry, no pictures like last time. I’m not a night person, at all, but this was obviously worth staying up for. Of course then when I finally did wander upstairs to bed, I couldn’t sleep. After I gave the cats their bedtime treats (yes, I keep a container of cat treats in the drawer of my nightstand, and yes, they expect, okay demand, treats every night), I grabbed my iPad and started googling bad things like “ovulation before egg retrieval”, and other non sleep-inducing phrases. Must learn to stay away from Google at midnight.

In other news, this September, catswithpassports is moving to…..

BRATISLAVA, SLOVAKIA!!!!!!

We are thrilled! Bratislava was our number one choice, and after going through the bidding process, plus a promotion, plus the wait, it seems that we are indeed going to Slovakia. As everyone in the Foreign Service knows, nothing is certain until you are on the ground, but it looks promising. So yes, three glorious years of Christmas markets, easy travel, four seasons, and the arts. Oh, and did I mention that Vienna is less than an hour away?

And one last bit, from this morning…

First of all, I loathe “food” smells in my house. Weird, I know. My husband on the other hand, thinks he’s died and gone to heaven if I occasionally make a “big breakfast” (omelet, bacon, etc). Since I’ve been full of hormones for the better part of two years (IVF #2, pregnancy, breastfeeding, FET #2, and now IVF #3), I try to indulge him from time to time, and this morning I made breakfast.

After we ate, Kate and I were alone in the kitchen, so I opened up one of the windows to air out the room. Several minutes later I walked to the front of the house to speak to my husband, and happened to glance down and see Bella. As I walked back toward the kitchen, noticing the open window, I nervously shouted, “Is Guinness with you?” As I asked, I looked out toward the back garden and sure enough, Guinness had escaped through the window and was standing on the patio. I ran outside and of course he ran away from me, and under the patio table, fortunately within reach. I brought him inside and all is well. Though it might be a while before I make breakfast again.

planes, trains and car seats

2011-06-25T16:47:00.002+01:00

My long vent of the day.

First, my sincere apologies for posting something so baby-centered during ICLW week. I really try to avoid Kate-heavy posts during this time, but ugh, I need to vent.

Here’s the deal. We’re moving in August. We’ll be Stateside for a month, then we need to fly back to Europe, where we’ll live for three more years. Before Kate, I really didn’t care, nor pay much attention to, which airline we flew. Well, now that I have an infant, who I insist ride in a car seat while flying, I’m paying much more attention to our choice of airline.

Kate is my daughter and whether she’s in a car or a plane, she’s strapped into her car seat. Our upcoming travel is not leisure, it’s work related, and therefore, we don’t have a choice about flying. To keep the nasty, anonymous comments at bay, can we just leave it at that? Please? Yes I know that a lot of people are comfortable flying with their infants in their laps, I’m not. Yes I know that if the plane falls from the sky, it’s likely, though not certain, that we will all die anyway. I worry more about take-off, landing, turbulence, aborted take-offs, and my personal desire of not having a squirmy, one-year old in my lap for 8+ hours.

So, here’s the problem. The European carriers are notorious for being anti-car seat on board, and there are no U.S. carriers that fly into our destination city. I have spent hours upon hours researching online, and yesterday, hours upon hours on the phone with several of the European airlines, trying to get a straight answer about their car seat policies.

Today, I’m more frustrated than ever.

Airline A: Website policy looks phenomenal, even listing specific makes and models of car seats. I wasthisclose to telling my husband to book with them, without even talking to a customer service rep. Fortunately the little voice in my head told me to call. Sure enough (after 30 minutes on hold), I was told that car seats are not permitted on board and the agent was shocked when I read her the policy from their website. So I called back, hoping to get a different agent, and therefore different answer. Once again, no car seats are allowed on board. When pressed for a reason, I was told it was a “security issue.” WHAT? So, I called again. Same thing. No car seats allowed on board, and no explanation as to why the website hasn’t been updated to reflect the policy change.

Airline B: Website states car seats are allowed. Internet research for passengers’ experiences with this airline tells a very, very different story. Add in that the armrests are fixed, making car seat installation difficult, if not impossible.

Airline C: Website states that car seats are allowed, forward facing only. Kate is too young to front face. I mean yeah, it’s better than nothing , but when questioned about using a car seat on board, the agent said it was at the discretion of the flight crew.

Airline D: Website policy looks good, with one, MAJOR exception. Car seats can’t be used during take off, landing, or when the fasten seat belt sign is on. I had to read that about 10 times. Um, isn’t that the most critical time of the flight, the time I most want her strapped into her car seat? Having hit severe turbulence going over the Atlantic when she was seven weeks old, I was very grateful that she was safely nestled in her car seat. There is no way I could have held onto her during that flight anymore than I could have done it in a car. I asked the agent about the policy and she said she had no idea, other than they might be worried about the car seat “tipping over during take off.” WHAT? It’s held in by the same seatbelt that keeps all of the adult passengers in their seats.

I AM BEYOND FRUSTRATED! As of last night, I’m leaning toward Airline D, and hoping for an understanding flight crew. Plus it’s the only direct flight from Dulles to our next home, so only once will I have to show my angry face, I mean, sweetly explain that I need to use the car seat for Kate’s safety, and for the comfort of other passengers.

IVF #3, sixth appointment

2011-06-24T10:37:00.004+01:00

Good things really do come to those who wait!

As I was walking into the clinic this morning, I saw Dr. Fabulous passing through the foyer. She greeted me with a big smile and wave. She’s just so awesome! She also did my ultrasound and blood work today. During the ultrasound, she stated that the lining is “beautiful.” On the left side, she counted 11, yes, ELEVEN follicles!!!! I about fell off the table. I guess 14 days on 450 of Gonal F really pays off.

The REs usually rotate through the clinic, but I requested that she do my retrieval on Monday, which she agreed to. I just adore her!

The weekend plan is fairly simple, continue all pills, another 450 of Gonal F tonight. Last dose of Ganirelix in the morning. Trigger shot at 11:30pm on Saturday. Start antibiotics on Sunday. No injections at all on Sunday; I even get a one day break from Heparin. HOORAY! Egg retrieval on Monday.

Dr. Fabulous and I also discussed baby Kate. The plan is to take her to the clinic with us. I’ll entertain her for a bit in the surgical area, then my husband will take her home. I really feel awful about bringing her, but Dr. Fabulous was very reassuring and we’ll just do what we have to do.

Thank you so much for the supportive comments and kind words. It really does make a difference!

Can’t wait for Monday!

IVF #3, fifth appointment

2011-06-22T11:16:00.004+01:00

This morning I was seen by the head RE/ owner of the clinic. He did my egg retrieval in 2009 and remembered me. After the ultrasound, he input the details into the computer. Unfortunately, one follicle is way ahead of the others, so he wants to push back the retrieval until Monday (it was supposed to happen on Friday). This is bad news bears for several reasons.

1. We have no childcare for Monday. None, zero, zilch. Finding someone to watch Kate for a few hours on Friday was already difficult, Monday is impossible. My doctor said we could bring her to the clinic, but eep, I hate the thought of doing that.

2. This also messes with my husband’s work schedule, again. Under normal circumstances, coming in a few hours late, taking a few days off wouldn't be a huge deal (especially with the amount of time he has built up). However, he’s one of two people in the entire country who does what he does, so yeah, big deal. His coworker has been amazingly understanding but really, how much more can we ask.

3. Meds. I’ve already been on 450 of Gonal F and Puregon for 12 days. Now I have to do another two days. Fortunately the clinic was able to find enough Gonal F to get me through to Friday; ugh I hate not having insurance coverage. HATE.

4. It’s more money, again, no insurance coverage for infertility treatment. Every time I go to the clinic it’s yet another $172 for blood work (blood work isn't included in the IVF cost). Doing this every other day adds up.

5. Thinking into the future, if we have embryos, and if they make it to blast stage, transfer will likely happen the following Friday. This throws a major kibosh on attending the biggest embassy event of the year. Really, it’s not a huge deal to miss it, but I ordered Kate the most adorable, monogrammed dress, and it would have been one of our last opportunities to see people before we leave in August. My husband absolutely has to attend (work-related), so I guess worst case scenario, Kate and I stay home, and I somehow try to manage not lifting an 11-month old, since I’m supposed to be on bed rest.

This just never gets easier. I am so unbelievably bitter and jealous of people who don’t have to go through this to have a child. IF is so unfair.

Welcome ICLW June 2011!

2011-06-21T10:06:00.005+01:00

If you haven't been here before, welcome. On the ICLW website, I'm listed as doing a FET this month. I actually did the FET last month and found out it failed a few weeks ago. Since I'm apparently a glutton for punishment, I'm doing another fresh IVF cycle this month. Again, welcome. I look forward to reading your blogs, too.

History

2005- married

2007- started TTC

2008- IVF #1, early triplet miscarriage

FET #1, failed

2009- IVF #2, success

2010- welcomed our beautiful daughter, Kate

2011- FET #2, failed

IVF #3, in progress

For a more detailed history, click on the infertility label to the right.

IVF #3, fourth appointment

2011-06-20T14:46:00.006+01:00

This morning I saw Dr. Fabulous, AKA, doctor of finding missing right ovaries. She was pleased with my lining, using such words as “gorgeous” and “beautiful.” Thank goodness, something is going well. The follicles are also continuing to show improvement. I’m to remain on the high dose of stims, and she’s still seeing six on the left, two on the “why bother” right. I go in for another ultrasound on Wednesday, and will probably have retrieval on Friday.

For those who have been through an IVF or FET cycle, or 5, you know that there’s an insane amount of blood work. Both of the clinics I’ve been with do ultrasounds and blood work every other day while cycling. When I first started all of this, oh, 4 ½ years ago, my veins were fine, seriously, one of my best physical characteristics. In fact the physicians I used to work with often joked that I better wear long sleeves during medical school, because everyone would want to practice on me. I had GREAT veins. Now, not so much.

Dr. Fabulous was going to take blood this morning, but changed her mind when I told her that I was due for an intralipid infusion as well (both of my arms are bruised and she wasn’t sure a nurse would be able to start the IV later, if she took blood first). She walked me down to the intralipid infusion area and started the paperwork. A nurse soon arrived and started the IV process. She did a great job, considering what she had to work with, and eventually was able to get enough of the cannula inserted to take blood and start the IV. I just hate being *that* patient. I used to be, and want to be, the easy patient, the patient who’s easy to start IVs on, whose veins jump out screaming “use me, use me.” Today was by far the slowest infusion I’ve had. I’m not sure if it was just bad luck, scar tissue, or what, but it took forever. Sigh. I wonder if anyone’s ever had a PICC line done for an IVF cycle. Kidding, sort of.

intralipids today

IVF #3, third appointment

2011-06-17T11:07:00.003+01:00

Well, it’s not over, yet. I had a different nurse today; she remembers working with me before, maybe in 2009. I mean, she looks familiar and is very nice, but I don’t remember her doing my scans or bloods. This morning she did the ultrasound and sort of quietly made observations, which started to worry me. She asked about the med dose, cycle day, etc. She was also aware that Dr. Fabulous (doctor in charge of finding missing right ovaries) had previously done all of my ultrasounds for IVF #2, and had been called in to finish the ultrasound a few days ago. The nurse said she was going to have a look first, then, might get Dr. Fabulous. You know how this will end….

More probing around, then she had to change the paper on the printer. When I mentioned that happened on Saturday as well (printer was out of paper) she told me that I must be unlucky because that only happens every few months. I thought, “unlucky? yeah, you don’t know the half of it.” More probing, not offering much hope, and off she went to get Dr. Fabulous. Commence the tears.

Dr. Fabulous walked in a few minutes later to find a teary-eyed patient in the stirrups. Lovely. She had a look and it seems that all hope is not lost, for now. The right ovary is still a complete, worthless loser (two small follicles today). The left side is showing a bit of promise with six, okayish follicles. She tried to comfort me, but the fact is, I have DOR, I’m old (in the world of reproductive medicine, mid-upper 30s is old), and even at a crazy high dose of stims, my body is not responding all that well. With every IVF cycle, there are fewer follicles and therefore, fewer eggs and therefore, fewer embryos.

The plan is to stay on the high dose of Gonal F through the weekend, and see Dr. Fabulous on Monday. She said just to book with her and she’ll do the scan on their new machine. That way we’ll know exactly what’s happening. I have an appointment for intralipids on Monday, too.

The day now looks like this…

AM: thyroid meds, Prednisone x 5, Centrotide injection, Heparin injection

noon: prenatal vitamin, calcium x 3, baby aspirin, folic acid x 2, B Complex

PM: Heparin injection, Gonal F injection, Luveris injection

In other news, the clinic has a shiny new photo album in the waiting area. I suspected it was full of the “success” pictures, and I was correct. Imagine my delight when I opened it up to see Kate’s pictures on the front page. Of all the clinics I’ve been in, all of the bulletin boards of pictures, you sit and wonder, will I ever have a baby on that wall, or a picture to put in that book? Even though I gave Kate’s pictures to the clinic, it was really something to see them on display. Wow, we really did it. I so hope we can do it again.

IVF #3, second appointment

2011-06-15T11:16:00.002+01:00

This morning I had another appointment. I was able to finally meet the fabulous nurse who had so generously arranged to give me the extra meds. As soon as she started the ultrasound, she asked about the famous missing right ovary., the one that’s difficult to find, the one they didn’t even bother to retrieve from in IVF #1 and IVF #2. I told her that the Dr. who’s famous for finding missing right ovaries did all of my scans during the previous IVF. She said, “I was just going to go get her.”

Dr. Wonderful finished the ultrasound. Lining looks great, follicles are meh. It’s only CD 5, but still, nobody in the room was jumping for joy. It looks like 5 on the left, 3 on the right. Though it’s doubtful that they will even attempt to retrieve from the right. I am understandably disappointed, and hope that there are a few hiding on the left. Five follicles doesn’t give us much to work with. Blood work will be back this afternoon and they’ll let me know if I need to increase the Gonal F.

Update: The nurse just called. They want me to increase the Gonal F, back up to 450 for a few days :( Hopefully Friday's ultrasound will show some results.

Guinness had a rough night

2011-06-15T10:56:00.007+01:00

(if you are a new reader, Guinness’ history and previous posts can be found under the “cats” label)

Guinness and Bella decided to chase, chase, chase last night. The excitement was just too much for sweet Guinness. I went upstairs to look for him and as soon as I entered the guest room, noticed vomit on the floor. I found the boy in the guest bath shower; he’d lost control of his bladder, and was panting heavily. We cleaned up the mess and tried to make him as comfortable as possible. Ugh. I do not want to go through this again. My heart just breaks for him. As long as he’s not chasing his sister, or under a considerable amount of stress, he’s absolutely fine.

The boy was exhausted after his episode, and after a few bedtime treats and snuggles, slept by my feet all through the night. This morning he was back to normal, and even stopped for a little bird watching with Kate.

Of course as soon as I grabbed the camera, causing Kate to turn and notice that Guinness was within reach, bird watching came to a quick halt.

ready for summer

2011-06-12T11:05:00.002+01:00

My sweet girl is all ready for summer, new sunglasses, new hat. Now if only the sun would come out.

Good news, bad news IVF #3, first appointment

2011-06-12T10:44:00.006+01:00

The good news…

We had the first appointment yesterday for IVF #3. The nurse we met with is one of my favorite people at the clinic. She did the blood work for my first beta with Kate, and is super, super sweet. The ultrasound showed that my body was ready, so last night I started Gonal-F, Luveris, and Heparin.

evening cocktail

The bad news….

I was given a bag of meds, and when I brought them home, I discovered that the HCG trigger had not been stored in the refrigerator, so I’m not comfortable using it, and the Gonal F is expired. I have enough new Gonal F to get me through to the next appointment (when I’ll discuss the possibility of still using the expired meds with the RE), but ugh, it looks like we might have to buy more Gonal F.

donated meds

meds I purchased (most of this is leftover from the FET)

As for the blood work, the nurse drew the standard hormone panel, then looked at my chart and said I’d need to redo the EU bloods. Bah, I JUST had them done in the middle of May, but since it’ll have been just over a month when I have egg retrieval, I had to have them redone. My husband had to have his done as well. There goes another $617. For the readers in the U.S., this is infectious disease blood work that’s required by law in all EU countries, to be repeated EVERY month you are in treatment. Dr. Spectacular (the American superstar) has commented about this several times and thinks it’s absurd, I agree. The other day he actually said that it’s more likely a person would get hit with a meteor than get an infectious disease at an IVF clinic, but whatever, we have to follow the law.

My second appointment is in a few days, and egg retrieval will likely/ hopefully happen June 23 or 24. Now I'm off to start working on the 50 bazillion pages of consents and legal forms.

I have an appointment tomorrow…

2011-06-10T09:29:00.003+01:00

For an ultrasound and blood work. IVF #3, it’s time to get started!

As you know, the FET failed. I kind of expected it, but still, you put your hopes, your dreams, your money into it, and BAM, done. It’s over.

Honestly, I’m still kind of numb and haven’t really had much of a reaction. Though, I didn’t really have much of a reaction to the last failed FET either, though I had a lot of distractions while that was happening.

Tuesday morning I could have gone to the clinic for a beta, but I took two more home tests, negative, and declared it over. I called the clinic and asked for a consult with my RE. On Wednesday we had a straight, to the point, this is what needs to happen, chat. I think doctors are sometimes a bit unprepared by my type A, what’s the bottom line approach. I VERY rarely need my hand held or want to chat. I’m all about records, spreadsheets, and let’s not waste each other’s time. Dr. Spectacular and I had a nice conversation, covered A. B. and C. and yes, we are going to cycle, again.

During the course of the conversation, I mentioned to Dr. Spectacular that we don’t have insurance coverage, for meds or treatment. Those who know how much IVF costs (especially IVF with DOR and autoimmune issues, may now commence choking). Anyway, I told him that I’d previously donated my unused meds and that if by chance, another patient had done the same, I would really appreciate some Gonal F, Follistim, or Puregon, and anything else that happened to be wandering about the clinic.

Yesterday the fabulous nurse called to discuss the schedule, and meds. She said that as soon as my cycle returned, they wanted me in for an ultrasound. WHAT?!?! I thought we’d be cycling in July. Doing it now actually works so much better. (in July, we have the pack-out and upcoming move to worry about).

We also went over what meds I have left from the FET that can be used for a fresh cycle, what needs to be ordered, and again, I said that if there is anything around the clinic that needs to be used, I’d gladly take it.

She called me back later in the day and I was STUNNED by what she said. She was able to find some Gonal F, Luveris, Prednisolone, Orgalutran/ Ganirelix, and an HCG trigger. I still need to buy some Gonal F, heparin, and antibiotics, but wow, our med costs for this cycle will only be around 2K. We still have to pay for some additional testing (EU bloods, a repeat SA, etc), the actual IVF procedure, and intralipid infusions, but getting that much help with the meds is such a blessing. I told the nurse that I will donate everything I have leftover, as I’ve done in the past.

I’ll update tomorrow after my appointment.

Just thought I should explain that the Irish patients have their med costs covered under the Drug Payment Scheme, so please don't think I'm being completely selfish by accepting so many. Most of the other patients get their meds free or at a greatly reduced cost. I was also told that some of the meds I was offered are donated to the clinic fairly often, so there's plenty to go around. Too bad Gonal F is in such short supply ;)

First ear infection

2011-06-06T10:14:00.005+01:00

Last week, Kate developed an upper respiratory infection, basically, her first illness ever (not counting newborn jaundice and reflux). Following that, she’d cry, then scream, upon being put down for her afternoon nap and bedtime. I immediately suspected an ear infection. On Friday we took her in, and sure enough, first ear infection. Not bad considering she’s 11 months old. Her doctor (whom I adore) said that the ear was red, and she recommending treating it. Hooray for catching it early.

My sweet girl is now on her first round of antibiotics, and fairly miserable, especially at night. We tried giving her Motrin (she had a reaction to it) and Tylenol, but she’s still in pain in the evening. Our previous, easy bedtime routine has turned into an hour + of crying, rocking, and sometimes, an additional small bottle. She has the saddest eyes, too. She looks at me as if to say, “Mommy, I just hurt.” It’s heartbreaking.

Hopefully she will start to feel better soon. Of course now she’s starting to pull at the other ear.

99% sure it’s another failed FET

2011-06-04T21:51:00.002+01:00

I tested again this morning (9dp5t), using both a cheapie test and a brand new Clear Blue digital. “Not Pregnant” soon appeared, and punched me in the stomach.

I hate this so much; I hate it for all of us (infertility community). I'm angry and sad, so before I type something I might regret (feeling very bitter tonight), I'll say goodnight.

Thanks so much for the kind words and prayers. More updates tomorrow.

Not the news I was hoping to share today (FET #2)

2011-06-02T17:31:00.004+01:00

I took two tests this morning (7dp5dt), and both were negative. I know it’s early, but this is the day I got a positive test with IVF #2 (Kate). It was even earlier than this that I got a positive test for IVF #1 (which ended in the miscarriage of triplets). For now I’m going to continue taking the meds and injections, and I’ll retest on Saturday. It feels like insult to injury that I have to keep taking everything. I can’t help but think I’m wasting it, and that I should be saving the meds for another cycle, or at least donating them to another patient, like I’ve done previously.

Speaking of another cycle, I told my husband this morning that if this FET is a failure like FET #1, I want to do another IVF cycle before we leave Dublin. The timing will be AWFUL (transfer would be near or during our pack out), and of course there’s the money issue. For now I’ll wait (not so patiently) and if I get a positive test, I’ll go in for a beta. Between the negative tests and constant cramps, I'm not hopeful.

What’s under the kitchen sink, you ask?

2011-06-02T17:27:00.002+01:00

water, water, water

If I had to count the number of times a plumber has been to this house, or our previous house in Dublin, it would likely be over 20. Most of the plumbing issues seem to occur, not surprisingly, in the kitchen. Upon finding a rather large leak at the previous house, the plumber repaired it with a paper towel and a rubber band. Much to my surprise, it worked fairly well. Not perfect, but good enough.

We’ve had some electrical and plumbing problems at this house, but nothing compared to the first place. Last month, the dishwasher stopped dissolving the soap pellet in the little drawer. Meh, I didn’t want to be a pest, so I just left the drawer slightly ajar, which, usually, worked. Two weeks ago I found a large amount of water on the lower shelf under the kitchen sink. Since it was affecting the wood, I did go through the proper channels and arrange for the plumber to have a look.

I gave him the history of the dishwasher and the leak (the soap, and the fact that water only appears after the dishwasher has been run), and left him to work. I later found out that he repaired “a loose connection” with tape.

Well, wouldn’t you know, this afternoon we discovered a rather large leak on both the top and bottom shelf, under the sink. Someone will be here to have a look tomorrow. We’re placing bets on how this will be fixed. Glue? Staples, perhaps?

This Memorial Day, remember the diplomats, too

2011-05-29T10:21:00.005+01:00

From the Dallas Morning News:

WASHINGTON — They are the proud, the few and the unarmed. They dodge bullets in the mountains of Afghanistan and brave the deserts of Iraq. They serve as America’s face to the world, from violence-ridden Mexico to the financial hubs of Asia to the capitals of Europe. They promote American business and protect American citizens abroad. They are the men and women of the U.S. Foreign Service.

On Memorial Day, we rightly pause to remember those who serve our nation in military uniform. But we should also recognize the more than 12,000 members of the American diplomatic corps who serve in Washington and in 271 missions across the globe.

“They are the ones out there on the front lines trying to advocate and explain [American] policies, regardless of which administration they are serving,” said Karen Hughes, former Under Secretary of State for Public Diplomacy under President George W. Bush.

She praised the Foreign Service as “a very dedicated group of public servants” who “work and make sacrifices around the world in some very difficult assignments.”

You may think of diplomats as tuxedo-wearing statesmen sipping cocktails at summits in Switzerland, but American diplomats are deployed in places like war-torn Africa and Afghanistan, where they often face the same dangers as members of the military. One diplomat I spoke to said he has been shot at five times in the line of duty.

Yet, even as America’s engagement with the world is growing more crucial, budget hawks are circling over the State Department. Speaking to the National Conference of Editorial Writers this month, Secretary of State Hillary Clinton warned, “There’s a huge gap between perception and reality … and people think that we can balance our budget on the back of our foreign operations.”

The continuing resolution passed to fund the government cut $8 billion for the State Department and USAID — while increasing the Defense Department’s budget by $5 billion. The demands on the State Department are growing, but the budget isn’t. “It is so out of whack with what we have to be doing,” Clinton lamented.

Part of the problem is that many Americans misunderstand diplomats’ role. Diplomacy isn’t about throwing money at the world. Yes, foreign aid — which accounts for only about 1 percent of the total federal budget — is a useful diplomatic tool. But too often diplomacy is dismissed as wasteful global charity or useless hemmin’ and hawin’ at the United Nations. Whether working to secure access to natural resources (like oil), leading reconstruction in Afghanistan or screening hundreds of thousands of visa applicants, diplomats are producing concrete results. They are the facilitators of globalization.

In an interconnected world, diplomacy is becoming ever more relevant to the daily lives of Americans, especially when it comes to the economy. Diplomats pave the way for American businesses to make profits at home by expanding overseas.

“If companies want to grow, if we want to grow our GDP, if we want to be competitive on a global basis in the 21st century, people really have to step up to export and export more, because that’s where the growth opportunities are,” said Lorraine Hariton, U.S. Special Representative for Commercial and Business Affairs.

Texas definitely enjoys the dividends of diplomacy. According to the latest figures from the International Trade Administration and Bureau of the Census, in 2009 the Dallas-Fort Worth area exported $19.9 billion worth of merchandise. And because of the Open Skies agreements liberalizing international air travel,Dallas/Fort Worth International Airport will see “billions of dollars in new business,” Clinton said this month.

Members of the Foreign Service play a crucial role in making that kind of lucrative international agreement possible, part of a government-wide campaign to help American businesses increase exports.

“We need to set up partnerships and relationships all around the world so we can understand the market needs in Kenya as well as the market needs in Fort Worth,” Hariton said.

Indeed, to maintain America’s global competitiveness and to capitalize on the opportunities globalization creates, we need a well-funded diplomatic corps.

“Diplomacy used to be thought of as the quiet, behind-the-scenes, government-to-government communications,” Hughes told me.

It’s now so much more than that. “In order for America to enact the kinds of policies we want to enact around the world,” Hughes explained, “we have got to build a public case for those policies, for our values and for our interests.”

Our diplomats are out in the trenches doing just that, often at great personal danger — remember the Iranian hostage crisis? Foreign Service officers have also been the targets of drug violence, insurgent attacks and kidnappings. Yet they man their posts, safeguarding American interests and protecting U.S. citizens overseas.

This weekend, as we salute our military, we also owe a tribute to America’s diplomats, many of whom are in conflict zones riding in the same Humvees as the troops. The only difference is that they can’t shoot back.

*Clayton M. McCleskey is a contributing writer for The Dallas Morning News based in Washington. His email address is letters@claytonmccleskey.com.*

*I found this post at Life After Jerusalem

3dp5dt, FET #2

2011-05-29T09:59:00.001+01:00

Well, I feel nothing. I had some slight cramping yesterday, nothing today. My mom and husband are taking good care of me (lots of pineapple core smoothies and water). Unfortunately all of us have come down with the bug that Kate has (fever, congestion, sore throat).

I’m still not feeling hopeful about this cycle.

May 27, 2011

2011-05-28T12:33:00.004+01:00

Yesterday was the 1 year anniversary of my medical evacuation.

Fortunately it wasn’t nearly as dramatic as it sounds. This had been in the works for months, as 'the Powers That Be' insisted that I deliver in the U.S. So, after months of planning, and moving to a new house the previous week, it was time to say goodbye. A temporary goodbye to the new house, my husband, and the cats.

It’s strange to think that just a year later, I’m lying on the couch, hoping and praying that we’ll be able to give our daughter a sibling (not feeling hopeful right now).

FET #2

2011-05-26T19:46:00.002+01:00

We were taken back to the OR and the embryologist came to speak with us. Unfortunately, one of the embryos didn't survive. She said it started to thaw, but under the microscope, it began to 'darken and disintegrate." I admit, I cried. I'm not very hopeful about this, given our history.

The other embryo is excellent and she said there's no reason to think this won't result in a pregnancy, but I know she had to say that. She stayed to talk to us for quite a while, and tried to comfort me.

My reproductive immunologist did the actual transfer, and the OR nursing staff remembered us from last time, which was nice.

We're home and I've started the dreaded 72 hours of bed rest.

Oh, and to add to the fun, Kate is sick (congested and fever). I was up with her until 12:30 this morning. My husband took tomorrow off, and my mom flew back to Ireland on Sunday, so at least I’ve got some help.

Thanks for the prayers and good wishes. It means A LOT!!

nervous, scared, desperate (FET #2)

2011-05-25T22:06:00.006+01:00

These are my feelings as we’re now 18 hours from transfer time. Of course, the embryos first have to survive the thaw. Knowing that these two were our slow starters, I honestly don’t know if we’ll have anything to transfer by the time we arrive at the clinic tomorrow.

It’s strange; I don’t remember being nearly this anxious during our last fresh cycle. I haven’t slept in days (stress? Prednisone side effect? both?). I think part of it is the sheer desperation of this cycle. We could very well be done; these are our last frozen embryos.

Our health insurance doesn’t cover IVF or meds, so just the expense of cycle after cycle is mind-blowing, add in that just any old IVF clinic won’t do, since I have the auto-immune issues. I HAVE to use a specialized clinic, which are unfortunately, very hard to find; in fact, almost impossible overseas.

We leave Dublin in August, so perhaps I could fit in one more fresh cycle, but again, the money. Then of course there’s the added stress of leftover embryos, would we leave them here and travel back to transfer, try to ship them to a clinic in a different country? There are just no easy answers, so I sit, and worry.

Our first frozen transfer was a NIGHTMARE, and I know, as hard as I try to change this, that some of the feelings about that time, and the circumstances, are at the forefront of my mind. The logical part of my brain says that our current clinic is much more advanced, the embryos are much better quality and we were not forced to rush into this cycle. The emotional part of my brains says, well, here we go again. Another failed cycle.

I'll update tomorrow.

Please Act Now!!!!! The Family Act of 2011, S 965

2011-05-24T16:21:00.004+01:00

This is a ground-breaking bill intended to help millions of couples build their families. We, like millions of other Americans, are completely out of pocket for all infertility procedures and medications. We are very fortunate in that we've been able to afford the staggering cost of IVF. Unfortunately, that is not the case for many other couples. Please show your support, and help all of us build the families of our dreams.

about the bill

how to support The Family Act of 2011

American Society Of Reproductive Medicine Press Release

Kate's first POTUS "Meet & Greet"

2011-05-24T15:50:00.012+01:00

As most of my friends and family already know, we took Kate to her first POTUS (President of the United States) “Meet & Greet” yesterday. The Obamas were in town, and without saying too much, we were invited to the event.

Unfortunately it took place during Kate’s afternoon naptime, so she was less than thrilled to be there. I’d decided to stay toward the back of the room in case I needed to make a quick exit, however, during his speech, President Obama stated that he particularly enjoys meeting the children of the U.S. Foreign Service, so I made my way to the front, with an increasingly unhappy Kate.

The Obamas were only able to “greet” the people in the front row, and by the time I was up front, they were making their way toward the other side of the room. I handed Kate a bottle and made my way past some people who were more than happy to push and shove a woman carrying a small child.

Once up front, President Obama came over, asked Kate's name, and quickly realized that she was less than happy to be there. He made a comment about her being excited to meet him. Hey, at least he has a good sense of humor. We exchanged pleasantries, he patted me on the back, shook my hand, and that was that.

I have several pictures of him right next to us, but I’m still iffy about sharing pics of Kate on a public blog, so these (pics from the side and back) are all I’m going to post here. Hope to have some additional pics to share soon.

Worth the read (immune issues and intralipids)

2011-05-22T09:35:00.002+01:00

Please take a moment to go over to Dr. Sher’s blog. His latest entries cover immune issues and intralipids.

I have followed his work for years and recently learned that my RE spoke to Dr. Sher many years ago, while he (my RE) was still in training. My RE, not surprisingly, spoke very highly of Dr. Sher.

There is some additional information on autoimmune issues and intralipids in my history and under the “infertility resources” label, to the right.

the infertility alphabet game

2011-05-22T09:16:00.011+01:00

This is a survey that seems to be very popular on the IF blogs, so why not…

A. Age when you started TTC: 32

B. Baby Dancing or Sex: Err, sex

C. Children wanted: 2-3

D. Dogs/Cats/Fill in Children: Two cats, Guinness and Bella. One adorable daughter, Kate

E. Essential Oils/Vitamins/Snake Oils: Levoxyl for Hashimoto's Thyroiditis. Vitamins: prenatal, folic acid, calcium, low-dose aspirin, and currently taking Heparin for the FET

F. Fertility Meds I’ve taken: Estradiol, Gonal F, Estrofem, Crinone, Progynova, Luveris, Gestone, Duphaston, Follistim Cetrotide, Lupron/ Diphereline, Novaril, Buserelin, Orgalutran/ Ganirelix, Estrace, Pregnyl

G. Gain: Oh yes. Fertility meds add weight.

H. HSG (Hystosalpingogram): Yep. I had it done in Belarus. Wowza, was that an experience.

I. Infertile Pet Peeves: the dumb things people say

J. Job title: SAHM!!

K. Kid’s names you’re afraid will be taken by the time you can use them: I’m not sharing. Though I will say that we like classic, traditional names

L. Length of time TTC: 4 ½ years

M. Miscarriages: 1. Early triplet miscarriage with IVF #1

N. Number of times you’ve switched OB/GYNS, REs, FSs: I’ve seen 4 OBs, 4 REs and 4 MFM/ Perinatologists (I’ve been pleased with all of them, and only switched due to moving)

O. Ovarian quality: Poor. Dominished Ovarian Reserve

P. POAS or wait for AF: POAS

Q. Quote from an obnoxious fertile: Oh where to start. I have an entire post about this.

S. Sperm: Great! This is not one of our issues.

T. Time you tried naturally: Approximately 14 months from TTC to IVF#1, though I did consult with an RE approximately 6 months after we started TTC.

U. Uterus quality: Great

V. Vagina: Err, yes, I have one

W. What baby stuff do you already have?: Everything since we have Lady Kate

X. X-tra X-tra Hear all about it! How many people know the ins and outs of our crazy TTC journey? I’m fairly open with friends and family, though only if they ask, or read the blog

Y. Yearly Exam (do you still go in even though someone sees your lady parts most months?): Yes.

Z. Zits: Only when I’m on fertility meds

Welcome ICLW!

2011-05-21T07:55:00.008+01:00

After a long absence from blogland, I’m back. I couldn’t think of a better way to jump back in than to participate in ICLW this month. Looking forward to reading some great new blogs, and catching up with old friends.

The quick run down…

2005- married

2007- started TTC

2008- IVF #1, early triplet miscarriage

FET #1, failed

2009- IVF #2, success

2010- welcomed our beautiful daughter, Kate

2011- FET #2, in progress

For a more detailed history, click on the infertility label to the right.

blog housekeeping

2011-05-21T07:50:00.001+01:00

As I’m just now catching up on blogs, I need to do some housekeeping. Over the next few weeks, I’ll be going through my blog list, adding and deleting. This is for both FS and IF blogs. Since I’m doing ICLW this month, I hope to have some great new IF blogs to add. There seem to be some up and coming FS blogs too. Stay tuned. Housekeeping is underway.

FET #2, Appointment #3, and a bad day

2011-05-20T10:21:00.002+01:00

Yesterday I had the final ultrasound before transfer, which is scheduled next Thursday. The nurse said that the lining is “perfect.” 9.1mm. I stopped the Buserelin injections and will begin the Crinone and Gestone PIO tomorrow.

I also had a mini ‘feeling sorry for myself’ moment the other day :( As I was putting on my nightgown before bed, I caught a glimpse of my stomach in the mirror. Bloated and bruised. Then I pulled the sheets back on the bed, and saw blood stains. Apparently my heparin injection sites bled the previous night, all over my brand new, high thread count, WHITE sheets. So, I did what any other infertile woman would do, I cried. It only lasted for a few minutes, but it’s just so unfair.

Of course it doesn’t help that I’ve been trying to catch up on blog reading and EVERYONE seems to be pregnant right now. Insult to injury is reading things about pregnancies happening at a bad time, being a surprise, or hoping for one gender over the other. Since I can’t even begin to imagine what it’s like to have any of those feelings, I think the best thing to do is sign up for ICLW through Stirrup Queens. Reading blogs is fun, and even better when you share common interests, ups and downs. Plus, with the limited amount of internet time I seem to have, I’d rather support ladies who really need it. Here’s to a great week of blogging!

Flying “home”

2011-05-17T10:12:00.005+01:00

After several months in the U.S., it was finally time to return to Dublin.

4 suitcases

a stroller and full-size stroller bag

laptop bag, diaper bag, backpack, purse, breast pump bag

car seat and of course, Kate

Since my husband was only able to spend about two weeks in the States, Kate and I would be flying back to Dublin, alone. I had spoken to the airline numerous times requesting assistance between gates, only to be told repeatedly that there was nothing they could do to help. Finally (lucky phone call #8) someone took pity on me and offered to have a wheelchair waiting at the gate. YAY! At least I could stack bags, and maybe a car seat, on top of it.

We arrived at the airport and aside from checking-in, the first order of business was to get the stroller into the stroller bag so it could be checked. Now, common sense says that we should have already done this or at least known how to do it. Well, yes. Except that the stroller bag hadn’t arrived until the last minute (another fiasco) and I was busy packing and pumping. My mom came to the rescue, again, and figured out the stroller, including taking the wheels off. I love my stroller, but it is far from easy to travel with. While she was doing that, I was busy with the check-in agent. She couldn’t find Kate in the system. After the first supervisor came out to help, we were asked to step aside in line. As I turned around, who should I see behind me, my high-risk OB (the one who was supposed to deliver Kate). Sure enough, she was on our first flight. I was definitely a bit anxious about that. Would she judge my parenting? Would Kate cry on the flight?

Forty-five minutes and two supervisors later, we were ready to go to the gate. The story I was given was that the agent couldn’t find Kate in the system because she was looking her up as an “infant”, which only brought up “lap babies”; Kate was a ticketed passenger. I’m still not sure I entirely believe this, but whatever, by then we were late.

Knowing that I had to haul a laptop, diaper bag, purse, breast pump bag, chilled bin of milk, car seat, and Kate, through security, I requested assistance to the gate, and eagerly offered my mom. The check-in agent happily passed over the necessary paperwork and we were on our way.

Kate was less than thrilled to be removed from her car seat to go through security, but you have to do what you have to do. TSA was wonderful in their handling of all of our carry-ons, specifically the pump and milk.

Quick goodbyes at the gate and a friendly flight attendant helped me carry everything onto the plane. The things you can’t make up: we were seated in the row directly behind my doctor. I fastened in the car seat and Kate started to cry. EEP! My wonderful doctor turned around, smiled, and said that, “Yes, the first flight is always the hardest.” Sigh of relief.

Kate immediately settled down, until I had the bright idea to try to nurse her in the middle of the flight. We had less than an hour between flights in Chicago, so I knew I needed to feed her on our first flight. I took her out of the car seat, put on the nursing top, and she howled. I struggled for 15 minutes or so, declared defeat, and strapped her back into the car seat.

When we landed, my wonderful doctor offered to carry some of our bags up to the gate. Thank you! She gave me a hug, said she’d see me this summer (I hope), and said goodbye. A nice young man was waiting with a wheelchair, so we loaded it up and set off for the next gate. As we were walking, a passenger from the previous flight came over to us. He told me that I was doing a great job and that he hadn’t even realized there was a baby on the flight. Liar, liar, pants on… No really, thanks for the compliment. I’m positive he was just being polite and obviously, very kind, but the fact that he went out of his way to say those things made me feel so much better. Mr. middle-aged businessman, if you happen to be reading this, thank you!

At the next gate, the young man offered to leave the wheelchair for me to use, which I gladly accepted. We had a few minutes before boarding, and I needed some water, so I walked over to a little café and quickly realized that traveling with a baby, pushing a wheelchair full of stuff, did not make for an easy in/ out experience when buying water. In fact, there wasn’t enough room to get the wheelchair into the store. A woman noticed that I was alone, and offered to watch Kate while I went in to pay for the water. I must have looked at her like she had three heads, because then she offered to take my money in to pay, while I stood outside with Kate. Yes. I will trust a stranger with $20, not with my newborn. She returned with the water and change and said that she was on my flight, loved babies, and that if I needed anything, to come and find her. Very sweet.

I pushed the wheelchair back to the gate to enquire about pre-boarding and maybe getting some help with the bags. The gate agent was beyond rude. She accused me of having too many carry-ons and started to lecture me on traveling with less stuff. I pointed out that Kate was a ticketed passenger and that according to the airline baggage policy, we were actually under the limit of carry-ons (diaper bags and breast pumps don’t count).

The flight was full, completely full, and I admit that I was a bit anxious while pondering who would be seated next to us. I was praying for the president of LeLeche League. Due to all of the feeding issues (again, another post) and the length of the flight, I knew I would need to feed Kate and pump several times. Well, I didn’t get LeLeche League, but I did get a nice woman who didn’t seem overly irritated about being seated near an infant. I was also grateful for the young guy seated in front of Kate. Upon sitting down, he looked back, saw the car seat and asked if he would be able to recline. I apologized and said no, but offered to buy him a drink for the inconvenience. That was that. Another sigh of relief.

Fortunately, the flight crew was awesome; all men, and one in particular was taken with Kate. He stopped by often to make sure that I had enough water and that “little miss sunshine” as he called her, was okay.

It wasn’t an “easy” flight, but it could have been so much worse. Kate basically slept and ate, the entire way to Dublin. I didn’t even attempt to breastfeed her. Even though she had her own seat, there just wasn’t enough room. I did have to pump a few times; thank goodness for a small portable pump and a nursing cover. The woman next to me didn’t even realize what I was doing; she made a comment about me being cold when I put the nursing cover on. That was it.

We landed, and I had planned to be the last one off since I had so many bags to gather and didn’t want to be in the way. The woman next to me ended up waiting with her relatives to help me, but the flight attendant offered to do it. As we came down the stairs, there was another young man with my last name on a card. It turned out they were expecting us. Hallelujah. Dublin Airport, you are the best!! The young man loaded us into a van, drove us to the main airport, then helped me inside. Yet another group of men were waiting and found a baggage cart for me to use. I piled everything onto that while they “oohed and ahhed” over Kate. I made my way to customs and waited, and waited, and waited. By this time I was starting to feel sick, really sick (feverish, shivery, dehydrated). After I’d been in line for almost 45 minutes, a custom’s agent approached me and asked if we were traveling alone. He then opened up another line and let me through.

My husband was waiting in baggage and THRILLED to see his little girl, and perhaps his wife. I’d purchased one of those “I Love Daddy” bibs for Kate to wear when she saw her daddy for the first time, in almost two months. We found the bags, went to the car, and drove home.

That’s when I realized, I had the flu, oh and to add to the fun, clogged ducts. I fed Kate, took ashower, pumped, and promptly took the first, and only, nap I’ve had since she was born.

At least we were finally “home”.

At some point in the near future, I will do another post on helpful hints when traveling with a newborn.

FET #2, Appointment #2 (ultrasound, blood work, and intralipids)

2011-05-16T16:02:00.004+01:00

This morning I had another appointment. They took more blood, ultrasound was fine, and I had my first intralipid infusion for this cycle.

I found out that my fabulous American RE is moving back to the States. I asked the nurse if she could have him stop by, so I could say a quick goodbye. He soon appeared and sat down to chat for over 30 minutes. It turns out that he’s moving to California, to be the IVF director for a major clinic. He didn’t tell me it was a major clinic, but I recognized the name as soon as he said it. I can’t say I’m terribly surprised, given his extremely impressive CV.

We talked about living overseas, the field of reproductive medicine, and of course, the upcoming FET. I admitted to him that I was nervous, given the outcome of the previous FET. We discussed how very different the circumstances would be this time, and he went to his office and brought back some published literature for me to read, frozen versus fresh transfers. We said our goodbyes and he mentioned that we were taking quite a souvenir from Ireland, Kate :)

One question for the FET experts. When did you have your last ultrasound before transfer? I’m scheduled for transfer on the 26^th, last scan on the 19^th. Doesn’t that seem like a long time between scans? For my previous FET, I had scans every 2-3 days. I guess my concern is that the lining could drastically change during that week, though when I spoke to the nurse this morning, she said it wouldn’t. Thoughts?

Next appointment is Thursday.

PS- Fran, I didn’t work with Dr. L this morning, so I didn’t have a chance to pass on your message. I just briefly saw her in the hall.

Hoping and praying I need more of this in a few weeks!

Late Pre-Term info

2011-05-16T15:44:00.008+01:00

I’ve received a few comments and emails regarding “late pre-term infants”, so I thought I’d share the limited information I have. Personally I’d never heard the term. I was under the impression that there were preemies and full-term infants, which I thought was 37 weeks.

While taking a breastfeeding class, the director of lactation services informed us that there is a relatively new category called “late pre-term”, babies born between 36-38 weeks. I wrote it down in my notes, but didn’t think about it again, since Kate was supposed to be born at 39 weeks.

Shortly after she was born, the staff brought in the following form (I hope it’s big enough to read)

Kate born in the 37^th week, and did have several of the issues listed on the paper. Would she have had them if she were born at 39 weeks? It’s hard to say, maybe, maybe not.

The first, most noticeable issue was temperature regulation. A nurse was just about to take her away to the special care nursery to go under the heating lights when a wonderful lactation consultant/ RN suggested Kangaroo Care. A few hours and lots of cuddle time later, we narrowly missed special care by .1 degree.

She also lacked the suck, swallow, breathe coordination. To keep herself alive, breathing was of course most important, and fortunately not an issue. We had to work on getting her to suck and swallow. For the first day, aside from practicing breastfeeding, she was fed pumped milk by syringe, then graduated to little bottles. They did test her blood sugar before she ate every time. Poor girl.

At some point they tested her bilirubin level which was high, so she was diagnosed with jaundice. As for weight loss, she lost a total of 11 1/2 oz, but weight loss is common in all/ most newborns, so I wasn’t concerned.

Throughout this time I spoke with a few pediatricians and found out that “late pre-term” is a well-known term in their field. One friend, a practicing pediatrician said, “Technically, a term baby is 38 weeks (some would even say 39). There has been a reclassification of the 36-38 weekers as "late preterm" since they tend to not act like term babies (keeping temps up, eating well, sleeping easily, etc). We don't worry about 36-38 weekers as much as say... a 30 weeker, but we do realize that there are still some adjustments that baby needs to make."(Hope you don’t mind being quoted, S)

A few other people told me that you would never hear a neonatologist refer to 37 weeks as full-term, as they see too many of them in the NICU. Apparently 37 weekers have a 50% higher mortality rate than 40 weekers.

Here are a few articles I found, and that is the extent of my knowledge on the subject. I’m just beyond grateful for a healthy, thriving little girl. I’ve always been a fan of letting babies stay inside and grow as long as possible, this information definitely confirms that opinion.

From the CDC: “Term” births (37-41weeks) have traditionally been viewed as one homogenous group [8]. There is, however, growing evidence of increased neonatal morbidity among early term (37- 38 weeks) infants, compared with those born full term (39-41 weeks) [37-39]. In response, organizations such as the March of Dimes are recommending that researchers differentiate between early and full term births [40]

New Research Shows Why Every Week of Pregnancy Counts

Rethinking the Definition of "Term Pregnancy"

A Push for More Pregnancies to Last 39 Weeks

The Late PreTerm Infant and Breastfeeding

I recently did a little shopping …

2011-05-15T16:38:00.004+01:00

Yes, it’s that time again. Frozen Embryo Transfer #2. I really struggled with when to do this. I’m A. getting old, and B. we are leaving Dublin this summer. I had two consults with my wonderful RE, and after discussing the pros and cons, agreed that now is the time. The biggest issue was that I wanted to breastfeed Kate as long as possible. A lot of the meds used for IVF and FET are contraindicated while breastfeeding, and with my supply getting lower and lower, it was time to stop.

As for shopping…

Crinone: 90 units

Heparin: 14 vials

Estrofem: 168 tablets

Buserelin: 4 vials

Prednisone: 175 tablets

Gestone PIO: 30 vials

I’m already taking folic acid, prenatal vitamin, aspirin, calcium, etc, etc, etc…

The pharmacist was fantastic. She stayed in weekly contact during the months of trying to put my order together (apparently there was a Gestone PIO shortage in Ireland), and since I was buying everything at once and don’t have insurance coverage, she gave me a 10% discount. When you’re spending several thousand dollars, every bit helps. Thank you, C!

Last week I had my first appointment (ultrasound, check meds, hand over a small fortune). The clinic has moved to a new location which is phenomenal because it’s A. closer to my house and B. has a big parking lot!

The new clinic is absolutely gorgeous and it was strange to see so many familiar faces, though I saw several new faces in the nursing department. I waited and hoped that I would be working with someone I’d worked with in the past. Imagine my relief when the fabulous Dr. L (AKA finder of missing right ovaries) called my name. It was great to see her again, catch up, and show her pictures of Kate. She asked if she could keep them, which I thought was very sweet.

The ultrasound was “perfect” according to Dr. L. I have all of the necessary meds, and then I stopped in billing so they could empty out my Irish bank account.

Tomorrow I go back for another ultrasound and the first dose of IV intralipids. Here we go again….

A few things

2011-05-15T11:08:00.003+01:00

Until I’m caught up, posts will be all over the place, some current, some old.

Since I won’t be posting pictures here, and to make things less confusing between this blog and the new blog, baby girl will from now on be known as “Kate”. No need to ask questions, just accept, her nickname is Kate ;)

Thank you for the warm welcome back. I’m looking forward to catching up, and commenting, on your blogs. I’m slowly getting back into this.

As for the new, private blog (with pictures), I think I’m going to use WordPress. From what I can tell, you will need to create a WordPress account to view the blog. I know this will be a huge pain for those who don’t already have an account, and I am sorry about that. I still haven't made a final decision though, so there's no need to rush over and create an account, yet.

If anyone has another suggestion (besides posting pictures here) regarding blog websites, what's easy to use, not so easy, etc, please leave a comment or email me.

the birth story, or what could be titled, I don’t need to read about labor and delivery,

2011-05-12T19:12:00.003+01:00

and other lies I told myself.

On a dark, stormy, Monday night last summer, I took a shower, gave myself a heparin injection, set the syringe and vial on the table, and felt a pop. Sure enough, at exactly 9pm, immediately after doing my evening heparin injection, my water broke.

I called my mom (who had just driven home and was an hour away), called L&D, took another shower and went down to the hotel lobby to have them call a taxi. Thinking back, I don’t know why I didn’t call the taxi myself. It really was like a scene out of a movie. People checking-in at the front desk, young guy nervously offering a bottle of water to the visibly pregnant woman surrounded by hospital bags.

In the end, the hotel employee suggested their driver take me to the hospital, so the Hilton shuttle driver grabbed my bags and we went out to the parking lot. As I was getting in the van, I noticed a USA Today newspaper in the backseat. I sheepishly suggested that perhaps I should sit on it. Much to my relief, the shuttle driver and his wife have 6 children, so he understood. During the short ride to the hospital, he had very comforting things to say. When we arrived, he insisted on carrying my bags into the hospital. Since it was getting late, I had to be admitted through the ER. I thanked the shuttle driver, who again, offered some kind words, and started to walk toward the admit desk. While I had fortunately stayed dry during the ride to the hospital, I was not so lucky while standing at the admit desk. I asked for the ladies room as I dropped my bags, and ran.

After a very quick admission process, I took the elevator up to L&D. They started the fetal monitor, and told me that I was ½ a centimeter dilated. Fortunately the doctor on call was one I had previously seen and really liked. In addition to OB/GYN, he’d done an RE (reproductive endocrinology) fellowship. Ironic, no? I told the nurse there was no reason to have him come in, to let him sleep, and that I would wait for my regular doctor to arrive in the morning.

At midnight, 6am in Dublin, I called my husband to tell him the news. I could hear the disappointment in his voice, as he knew he’d miss the birth. I tried to be strong and remind him that we knew this was a possibility, and it was just part of the Foreign Service life. At that point, the plan was that my OB would arrive around 6 and I’d have the c-section shortly after that.

My mom had arrived at the hospital by then and I told her to go to my hotel and get some sleep, since her house is an hour away. The hotel was fairly close, so she’d be in the area and ready to come back for the c-section in the morning.

I started having contractions and the nurse thought I might be more comfortable walking around, so I did a few laps around L&D. A bit later I felt like something was really happening and asked her to check me again, 4 centimeters. She said I wouldn’t make it until morning and that she was calling in the doctor and anesthesia team; she was also going to call my mom and tell her to come back for the c-section.

As soon as the nurse came back into the room, I asked her to check me again. She said she didn’t want to because she had “just checked me and there’s no need to risk infection by checking too often". I told her I really wanted her to check, so she reluctantly did; I was at 9. I called my mom and told her to come back ASAP.

The OB and anesthesia team arrived a few minutes later and things got busy. I obviously couldn’t have the c-section because I still had a ton of heparin on board, so they said it was going to be a med free, vaginal birth (there wasn’t time for any drugs, plus the heparin was still in my system, so no epidural either). They said if there were more time, I could have a c-section under a general, but I obviously didn't want that, plus she was coming too fast and the OR wasn't ready. I thought my doctor was going to faint when he heard that the OR wasn’t prepped.

I had been admitted into one of the old rooms, used for overcrowding and c-section recoveries, so they had to move a labor and delivery bed into the room. The new bed was too big for the room, so they had me switch to the other bed and announced we were moving to one of the nice, new, big rooms. Yay, as if I cared at that point ;)

My mom came running down the hall as I was being wheeled into the new room. As soon as the bed was broken down, I was told to push. Pushing was difficult since I didn’t know how to push (I skipped the labor and delivery chapters in the books since I was supposed to have a scheduled c-section). The anesthesiologist ended up holding one of my legs since she was already there with nothing to do. There were two other doctors, the nurses, and my mom in the room. I just kept looking down at the OB saying “I just want to go to the OR”, “I wish I could have some drugs”, and “I don’t want to tear.”

Forty-three minutes after I started pushing, baby girl was born. She was absolutely perfect. The doctor told me it was the “most awesome birth he’d had in a long time” and kept telling me to tell my other OB that it was “awesome.” He also said I was very polite because I always said please and thank you, didn’t swear, yell, or call anyone names, and then he asked if I was a perfectionist. Err, yep. He said he was too, which was a relief because we were having this conversation as he was stitching me up. The nurses also commented on my polite nature and thanked me for not calling them names. Do people really do that?!?!

Unfortunately because I was full of heparin and everything happened so fast, I lost a lot of blood. One of the nurses commented that it looked like a crime scene, which I didn’t appreciate (more about my post-partum care in another post). The other thing I just want to mention is that a lot, most as I’ve found, people think that fast labors and deliveries are a good thing. This was actually listed as a complication on my delivery report, “precipitous labor”. Apparently it’s very uncommon for a first delivery (less than 1%) but knowing my history, should we have expected anything other than uncommon? I was also told the contractions during a precipitous labor are a lot more intense and painful, but since I have nothing to compare it to, I’ll just say that yes, it was intense.

Time line:

9:00pm: water broke

2:47am: nurse called my mom to tell her I was at 4cm (though it was around 2:30 when she actually checked me)

2:57am: I called my mom to tell her I was at 9cm

3:15am: started pushing

3:58am: My sweet girl was born!

It was suggested that I also add my initial reaction. When she was put on my chest, we just looked at each other like, WHOA, what just happened? (I have some great pictures of our expressions to each other). I just looked at her and said, "Wow! You were worth it". And she definitely is!

apology, and a bit of an explanation, part 1

2011-05-10T20:00:00.003+01:00

I finally sat down and checked the email address I use for this blog (I haven’t actually read the emails, yet). WOW! My sincere, sincere apologies. I had no idea that I had that many readers or that so many people cared about me and baby girl. I think between all of the adjustments and the exhaustion that it never occurred to me that people would actually miss me or be concerned.

My plan is to go through the account, one by one, and you will receive a personal email in return. Again, I’m so sorry, and yet so thankful.

Now, on to the explanation. Before I begin, please know that I’m not trying to make excuses for my absence, though it will probably appear that way. So again, I’m sorry.

Part 1, the U.S.

I’m sure that living in a hotel suite sounds great (to be fair, in some ways it was), and I did the best I could, but it’s just not like being at home. I also didn’t have everything done the way I should have. Even toward the end, it was really hard to believe that I was actually going to have a baby. Taking care of the last minute details was really hard, because I thought something bad was going to happen. I also wasn’t sleeping at all, so when I did go into labor, I was already exhausted. My doctor continued to offer me Ambien at my appointments, but I just wasn’t comfortable taking it, so I declined.

The time in the hospital was absolute chaos. There was medical personnel in my room almost nonstop, add in the lactation consultants (LCs)/ RNs who were also in the room, basically nonstop, for 14 hours a day. I was trying to manage paperwork issues (yes, The Powers That Be expect you to work on their paperwork while still IN the hospital) and a new baby. Made even more fun by a horrible internet connection and non-existent cell coverage.

Things were a bit more complicated because she was late pre-term. They had to do glucose tests on her before she ate, constant vitals, and then she wouldn’t regulate her temperature. One nurse was just about to take her away to the special care nursery, when a fabulous LC, also an RN, suggested Kangaroo Care. While it was wonderful to have baby girl so close, I couldn’t do anything else while lying with her on my chest, under a mountain of blankets.

We had major feeding issues, so again, the LCs were in my room constantly, and when I wasn’t trying to feed baby girl, I was pumping. To add to the chaos, my husband didn’t arrive until almost 40 hours after she was born. He was so jet-lagged, he could barely keep his eyes open. Oh, and then she was diagnosed with Jaundice. Fun times.

To sum it up, as we were walking out of the room when I was discharged, I noticed a tv cabinet. I LOL and thought, you’ve got to be joking. Who has time to watch tv with a new baby.

My husband was with us for about two weeks. We did the best we could, but jet-lagged husband + stressed out, new mom, neither of whom have any baby experience, = an interesting time. As I said in the previous post, the time in the U.S. was busy. There was no down time, or at least I don’t remember there being any. It seemed like every day we had at least one appointment, if not more (medical, lactation, and breastfeeding support group twice a week).

The paperwork for The Powers That Be took up a lot of time, too. Apparently the pediatrician is supposed to be a mind reader, and so instead of just checking a box under a question AND writing “okay” on the newborn medical clearance form, he was supposed to give a detailed account that yes, baby girl was fit for travel. So that was yet another appointment (to go back and have him write a detailed note to MED). Plus every time she had a billirubin check, I had to call Washington to update MED. Ugh. It just seemed like everything was far more complicated and took more time than it should have. Add in that I was feeding her and pumping every 2-3 hours, which took at least an hour, then washing pump parts, etc.

I also learned very early on that my child doesn’t like to sleep, nor does she like to be set down. The first night “home” from the hospital I honestly thought the hotel staff would knock on the door and tell us we had to leave. She was just inconsolable. As it turned out, the hotel staff was WONDERFUL. I’ll post about them separately. Even though they told me not to worry about her crying, I did my best to keep her quiet, out of respect for the other guests. Most of my nights were spent rocking her, walking around the hotel suite, and listening to “The Vacuum” and “The Womb”, both downloaded from iTunes.

The saving grace in all of this was my mom. She lives an hour away from the city I was in, but she drove in nearly every day, and even stayed with me many times, after my husband flew back to Dublin. While my husband was still with us, my mom would drive in and drive us to every.single.appointment.all.day.long. This on top of running errands and taking all of our laundry back to her house to wash and iron. She brought meals, lattes from Starbucks (she knows how to keep me going), and overall just did anything and everything she could, and somehow made it seem like she was never around, giving us the chance to bond as a new family. Mom, you are the best.

Another person I’d like to recognize is one of my BFFs. She just happened to be in the U.S. on home leave, and drove 8 hours, each way, to attend my baby shower, and visit with me. The visit was much too short, 24 hours, but it was right before I was to leave for Ireland and she was to leave for her next assignment. It was really awesome to see her and she was truly a zero-stress visitor. I told her what hotel I was at and she made reservations for herself just down the street. I told her the name of the location of the shower and she said not to worry, she’d find it (I was a bit frazzled when she called and not that familiar with the city, in the first place). She got on famously with all of the shower guests and when asked to give an impromptu speech, did so with such elegance and poise, everyone was moved. Her words brought me to tears. She has been with us through this entire horrid journey of infertility (we’ve been at previous posts together) and it was breathtaking to hear her put her thoughts into words. Later that night, my mom offered to stay with baby girl so I could go have a bit of time with BFF. We went to dinner and had a fabulous time. It was the first opportunity we’d had to openly talk since everything happened in Belarus. The following day we met up again for lattes, my mom took us to lunch, and it was time to say goodbye. It was just so great to see her and she was awesome about doing everything around my pumping, nursing, crazy new mom schedule. C, thanks so much!

There were plenty of not so enjoyable events and situations, but this is long enough, and it’s always better to end on a positive note, so… more later.

The blog wouldn't be complete without an update on Guinness and Bella

2011-05-09T19:19:00.014+01:00

Guinness has proven to be a FABULOUS big brother. We are so proud. My husband thought we would have major jealousy issues since Guinness is such a “mama’s boy”, in his words, always snuggling on my lap and wanting attention. Within a day of being back in Ireland with the baby, I was in the bathroom brushing my teeth, when Guinness appeared out of nowhere, meowing as if the house were on fire. I turned the water off and heard baby girl crying. I went to get her, Guinness right on my heels, meowing all the way. He’s very protective of her. When she was 4ish months and moved into her nursery, Guinness slept right outside the door. I always have the baby monitor with me, but if I’m a second late in responding to the baby, Guinness comes to find me, meow, meow, meow.

I’m very sad to say, Guinness has been having a few episodes lately. He’s at the point that he knows to settle down and rest when it happens. The episodes are usually brought on by over-exertion (chasing Bella).

Bella is, Bella. She’s small and sassy. When the baby was little, Bella would crawl up on her while she was eating. Now that the baby is bigger and more active, there have been a few incidents of ear and fur pulling, and a chomped tail, but Bella has proven to be patient and comes back for more.Hopefully she will soon develop the healthy fear of the baby that Guinness has.

Their reaction when I came home from the airport with the baby.

Guinness helping me shop for baby girl

Bella making herself comfortable in the bouncy seat (hey, it's not like the baby ever used it)

Bella making herself comfortable in the stroller

Bella doing tummy time. Notice a pattern here?

Checking out the new big girl car seat!

Guinness jumped in, and was a little worried about getting back out before I put the baby down. Though it's fair to say, Guinness was probably in it longer than the baby has been.

All in all, the adjustment for the cats has been beautiful. They've done very well.