Tuesday, January 17, 2012

First & Second Visits

Okay, I promise this blog isn't going to be only about the pregnancy, but, frankly, I feel like crap and have no energy so for the time being, I'm just hitting the highlights that may prove relevant to the overall story...and maybe in a few weeks I'll be back to raving about Becca and her ridiculous adventures.  Right now most of my conversations with her go like this:

Becca:  Mommy, you want to pway wif me?
Me:  Baby, I'd love to play with you, but I don't feel good right now. I need to lay down.  Do you want to see if Daddy can play with you?
Becca:  Aw, Mommy.  Are you sick?
Me:  Kind of.
Becca:  I'm sorry, Mommy.  I give you a kiss.  Dat will feel you better.  (Kisses me super-sweetly)  Do you feel better now?
Me:  Of course I feel a little better now.  I love your kisses!  But I still need to lay down.
Becca:  Mommy, you want to pway wif me now?

She is soooo sweet and compassionate...and persistant. 

So there's your Becca fix.  On to the doctor...

I saw Dr. Sizemore last Wednesday, when I was 6 weeks, 3 days (or so) pregnant.  His nurse, Liz, is awesome - she knows our whole story and has really been pulling for us.  She asked me if I wanted him to come in and talk to us first or just go straight to the ultrasound.  Of course I wanted the ultrasound immediately - I HAD to see that heartbeat!  She said, "Oh good; I didn't think I was going to be able to wait!"  So sweet.  So - we did the ultrasound, saw the teeny tiny heart beating, everything in the right place, etc.  Looks great.  And there's only one, which is good for my risks (and probably my sanity as well).  They didn't give us an official due date, as he wants to wait until 8 weeks and actually measure the baby and set it from there, but he saw everything he expected to see at 6 and a half weeks.

We talked over my treatment plan and changed a few things.  By this point, I was feeling really nauseas (WHY is my spellcheck not working?!), so we decided to nix the Metformin, as the, um, intestinal distress it caused combined with the aching tummy was too much to handle.  I think that's the only medicine change we made.  We did decide to co-manage with the Maternal-Fetal group at Vandy, and he's setting up my first appointment with them.  I haven't heard back, so I don't know when it will be, but he thought they'd like to see me fairly soon.  They gave me the supplies to do a 24-hour urine collection (hooray!) so that we have baseline numbers for protein in my urine.  I've been putting it off...but if you at church in the next few days, be careful when opening refrigerators.  :)  They took 10 vials of blood in order to get baseline numbers for a million other things, and that was in addition to the blood panel that my PCP had just run the week before.  Good thing my blood supply is increasing so much!  We are, of course, hoping to go full-term and pop out a big ole baby, but the good doc and I (and poooosssibly my overly-optimistic husband) agreed that a good, realistic goal will be to have a take-home baby, one born around 34-35 weeks who gets to go home from the hospital when I do.  It may be earlier; it may be later, but it's probably wisest for us to shoot for this age and be somewhat prepared (at work, etc) to see this babe a few weeks early, at least.  Dr. Sizemore is, as I've said before, AWESOME and wants to see me back in 2 weeks for another ultrasound and the official setting of the due date (da dada dA!)...but he said he'd be happy to give me another ultrasound this week if I needed to see that everything was okay again.  You'd think he knows me or something.

But...we actually ended up with another ultrasound just 2 days later.  I have been spotting some for the past couple of weeks, but I know that can be normal, and I had some similar spotting with Becca.  But on Friday morning, I woke up with more significant bleeding, so we went in to take another peek.  Everything still looked fine, and in the absence of any anomaly in the ultrasound and/or significant cramping, the doctor (this time Dr. Sizemore's partner, Dr. Didier, whom we also really liked) chalked it up to the blood-thinning effects of the baby aspirin and the Lovenox.  He figures that any bleeding I do have is going to appear more significant because, well, there's going to be more of it because the meds are doing their job...which hopefully means that the placenta will form without clots.  I talked to him about my nausea (which had gotten so bad tht I stayed home from work on Thursday), and he gave me a prescription for Zofran, which has heped some.  So, all is well.

And all is well...but I'm having trouble remembering that.  I'm feeling pretty awful now (with a pretty bad cold on top of tummy troubles), and I think the nausea is reminding me so much of Becca's pregnancy and everything that went wrong with it.  My anxiety has been really high lately, so I'm not planning on dropping my Zoloft dose anytime soon.  Sorry, baby...Mommy's got to take care of herself, too.  But my new mantra is, "Nothing's wrong until something is wrong...and nothing is wrong [yet]."  I don't have much patience for people who tell me that everything is going to be fine because, well, they have no idea a) what we've been through, even you know the story; and b) that everything IS going to be fine.  They just really want it to be fine, and that's sweet and all, but hold the bullshit.  You don't know that, so don't try to convince me of it.  Still...nothing is wrong until something is wrong.  And there are a million things that could go wrong.  But nothing is wrong now.    

Saturday, January 14, 2012

Initial Plans

In the name of not re-inventing the wheel or some other time-sucking and energy-draining analogy, below I'm posting the e-mail that went out to our parents after my initial conversation with my OB.  It outlines the basics of my plan of care, and I'll update/fill in more another day.  But now I've got to put the first plus sign to  bed.  :)

Sent 12/28/11 (or so):

So - I talked to Dr. Sizemore, who has been my OB/GYN for the past year and a half or so.  He also delivered Becca when he was a resident at Vanderbilt.  So you could say that he knows my case inside and out.  Literally. Because of my history (namely, severe pre-eclampsia and HELLP syndrome before 28 weeks), I've got significant risks.  (Duh.)  The most significant change we've made in my care is to, oh not be in the job I was in when I was pregnant with Becca.  No overnight on-calls, no rushing to the bedside of dying pregnant women, no skipping meals because I'm the only chaplain in the hospital.  The most stressful thing I have to deal with is my 5th and 6th graders...and working with the likes of Paul Bonner and Mark Price.  While the effect of stress on a pregnancy can't be measured, I think it's obvious that my work situation definitely did not play in our favor with Becca's pregnancy. So I think that might go a long way towards a healthier pregnancy. 

We're also handling my medicines very carefully.  Here's the run-down on those, starting with changes to my regular meds:
- Zoloft - which I've been on for over a decade now for anxiety/depression - we're dropping my dose, leaving it for a few weeks, and then POSSIBLY dropping it again to see how low I can go and still feel okay.  Since my last pregnancy (when they were handing Zoloft out like candy), they have determined that there is some risk to taking Zoloft in the 1st and 3rd trimesters, so they want me as low as possible - but there's also a great deal of risk with a depressed and/or anxious mother, so we're looking for the balance. 
- Prilosec - thankfully, I get to keep it!  That is very exciting because, even though I am only, oh a couple of hours pregnant, the pregnancy heartburn has already begun.  Yuck. 
- Zytec - I get to keep it!  Breathing is a good thing.
- Symbicort and albuterol - Speaking of breathing, my inhalers are good to go.  Very few inhalers are considered risky, I think because they don't act systemically. 
- Trazadone - my beloved sleep medicine - it's gotta go.  It's also an antidepressant and in the same category as the Zoloft, so it's out.  So far, I've tried to replace it with Ambien, which makes me totally panicked and worthless the next day, and Tylenol PM, which was like taking a sugar pill.  Or a caffeine pill.  Next up is Unisom...so we'll see how that goes tonight.  I really, really love to sleep, and my body really, really needs it right now, but I really, really can't sleep without help...so cross your fingers that the Unisom or something else does the trick.
- Baby aspirin (81mg) - I've been taking this for over a year so that I would be on it when/if I ever did get pregnant.  Some studies have shown that this can help prevent pre-eclampsia in subsequent pregnancies.  The science isn't clear on it, but there's plenty of anecdotal evidence that it works, and it's certainly not going to hurt.
- Vitamins - I've been taking over-the-counter prenatal vitamins since before I was pregnant with Becca (as should every woman of childbearing age), but now I've switched to Rx ones, specifically one called PreQ10.  It claims that it can also be effective in preventing pre-e, but, again, the science is kind of soft on it.  But it's certainly not going to hurt, either, so as long as I can get those, I'll stay on them.  (Unfortunately -- and very stupidly -- our insurance doesn't cover prenatal vitamins, so staying on these depends chiefly on my ability to get samples of them - and they don't sample these a lot.)

We're also adding some new ones:
- Metformin - I had actually just started taking 500 mg of this, prescribed by my PCP for a number of reasons.  This is the drug that helped me get pregnant with Becca (but I JUST started it, so it's not to blame for this adorable blastocyst in my belly).  Women with PCOS have a higher risk of miscarriage (even apart from my crazy history), and there is some evidence that Metformin can help sustain a pregnancy through the first trimester.  So what the heck.  I'll take it.
- Prometrium - which is just progesterone - the brilliant Lauren McCormick, APN, suggested that I take this through the first trimester, also to help sustain a pregnancy by giving it bonus progesterone.  During the 1st trimester, it's up to my body to produce progesterone, so if I'm low, these little pills should help compensate.  After the 1st trimester, it's up to the placenta to produce progesterone, but it's not making it then, there's not much we can do (and we have SUCH good luck with placentas...).  Anyway, Lauren started me on it, and Dr. Sizemore thought it was a very wise call.  (Good job, Lauren!)
- Lovenox shots - yep, I get to give myself a shot everyday now.  Becca and I can do them together, I guess.  Last time, I tested borderline positive for a clotting disorder in pregnancy, so I eventually started the shots then.  We're going to be proactive and go ahead and start them now.  Anything we can do to help the placenta (again, our best friend/worst enemy in Becca's pregnancy) is a good thing, and while we're not sure it will help, again, it won't hurt, so I'll certainly do it! 

Dr. Sizemore will see me soon after I get back in town, right around 6 weeks, and they'll do an ultrasound (hopefully visualize a heartbeat) and run a BUNCH of baseline tests.  There are lots of levels that we will have to keep checking throughout the pregnancy (liver enzymes, protein in my pree, blood counts, platelets, etc), so they will want some baseline readings to compare then to.  I've still got my blood pressure meter, so I'll be checking that regularly at home.  We'll formally decide which specialists I want to see at my appointment - I know Dr. Sizemore likes the guy just above his office at Williamson Med, but they only deliver at Centennial for Level III NICU care, and, while I've got friends who have had positive experiences there, it's not Vandy.  And I know enough about the NICU's around here to know that the absolute best care a preemie can get in Nashville is from being IN-BORN at Vandy - not getting transferred there later.  So I think we'll co-manage with Dr. Sizemore and the Maternal-Fetal group at Vandy (the only high-risk folks who can deliver there).  Like John said yesterday, I'm just not going to be comfortable going anywhere else.  And my being comfortable is half the battle here.

Emotionally, I am doing okay.  Of course, I am OVER THE MOON excited, but I'm also anxious.  It would be impossible not to be, given our experiences.  I had a moment today when I was at the pharmacy to pick up my Lovenox shots when they told me that I'd have to come back tomorrow because they had to order them.  I started to freak out about waiting a day to start them and was trying to think of a way to demand that they get them to me (crazy preemie mama coming out)...but then I realized that one day is probably not going to make a difference, and besides, the doctor wasn't 100% sure we needed to do them anyway.  But of course I'm going to freak out a little bit.  Not only am I facing trigger after trigger for the former trauma, I have very real risks that I have to take seriously.  So I'm trying to give myself some grace and let myself freak out when I need to...but then come back around to the really good plan we have in place.  It sounds cliche, but I am finding it easy to really and truly experience every day that I am pregnant as a blessing.  It was damn hard to get here and there's not telling how long it will last, but at the moment, today, I am pregnant, and I am loving it - the pregnancy and the little bitty poppy seed itself. 

Physically, I am (predictably) exhausted.  And really hot.  And somewhat heartburn-y.  And really hungry.  And when I get too hungry, I start to feel faint and just a touch nauseous, so I'm afraid that the nausea may be on its way.  Cross your fingers on that one, too.  (I was very sick the entire pregnancy with Becca.  I could give you a tour of most of Louisville, just showing you all the restaurants and roads I throw up in and on.  It was a rough 7 months.)  There's a chance that the extended nausea I had with Becca was linked to the placental issues, so maybe if we avoid the big stuff, we will also avoid the puking.  Of course, I will take puking for 9 months if that's what it takes, but it would be nice not to feel awful the entire time. 

So that's what I know.  I'll keep you posted.  (Yes, Mom, I will.  See?  I am.)  I'm hoping there won't be much to talk about.  And like I said, I'll probably switch to the blog format soon to keep our adoring public happy.  :)  But for now (and then), we'd appreciate all the kind and healthy thoughts and prayers you can conjure up! 

Wednesday, January 11, 2012


I have dreamed of writing this post a million times.  Sometimes I even had it down, word for word, in my brain.  But now that the time to write it has finally come, I'm so overwhelmed with emotions (joy, excitement, and terror, to name a few) that I can't even be creative about it.  So I'll just go ahead and tell you what we found out on Christmas day and actually started believing when we saw a heartbeat this morning:

I'm pregnant.

Yep, there's a baby in there.  An embryo, actually.  But a healthy-looking blob of an embryo with its heart all a-flutter and everything.  I'm 6.5 weeks along, putting the technical due date somewhere around September 2.  I'll give you more details later, along with my (extensive) plan of care, but for now, let's just revel in the news...there's another Itty Bitty Hill in the mix!  Though there will always only be one Itty Bitty...so maybe this one is Eensy Weensy Hill.  Let's try that on for a few days.  :)  Please join us in praying for a very loooong and healthy pregnancy.