Jitterbug!

Guess where I'm going today???!?!?!!?

Ummm, yeah, nowhere. Ha, just bed. The walls are starting to cave in on me. Many people are asking me about the terbutaline pump and the monitor, and since I have a wee bit of extra time on my hands these days (pffff), I thought I'd show you what these things are and how they work. I had never seen a terb pump myself until it arrived at my house on Saturday. I had scoured the web in nervous anticipation, looking for pictures or diagrams, or something to ease my mind, but didn't find much. It would've been so helpful to see some pictures beforehand and get a better idea of what to expect.

I'll start by showing you what my belly looks like while I'm hanging out in bed:


There are actually two separate devices here. The first is the terbutaline pump, which is the little black thingy with buttons. It is attached to a tiny blue tube which is inserted into my right leg. The second is a toco monitor, which is the belt around my waist and the little grey box with lights.

First up, the terbutaline pump. Terbutaline is a drug designed to relax smooth muscle (i.e. lungs, uterus). It's actually intended to be an asthma drug, but is widely used "off label" by OB's who want to calm the uterus and lessen the frequency and intensity of premature contractions. Terbutaline comes as a pill (which I have taken with all 3 of my previous pregnancies), or in injectable form. My peri intends for this to be "long term use" (which, by the way, terbutaline has never ever EVER been proven effective at such) ... but since it's supposed to be long-term she feels the best method for me this time is a pump rather than the pills, which are taken every 4 hours. By contrast, the pump stays in 24hrs a day and administers a constant dose subcutaneously. Here's how it works:

I have a million little vials of terbutaline. They live in my refrigerator. The only thing I like about them is the hot pink label ... very "diva":

The vial gets inserted into this little hand-held pump:

It's size reminds me of those rockin' pagers we used to have circa 1998. Though it's a little thicker (width-wise) I think. The vial slides down into the back of the pump ... right underneath the cap you see on the top where the blue tube is attached. Each vial is pumped out at a slow continuous rate and lasts me about 24 hours. So roughly once a day I have to replace the vial with a full one from my fridge. This is a quick process and I only find it to be incredibly annoying b/c the thing beeps incessantly at me for several hours when the vial starts getting low. This morning it was every 10 seconds from about 4:30 am until I finally gave up and went downstairs to change it at 6:30 am. It's the same feeling you get when your smoke detector beeps non-stop until you change the battery (by which time you'd rather just throw the whole freakin thing out the window!)

The pump is programmable, it's all digital, so I can adjust my dose if needed. I can also administer an instant "bump", called a demand dose, if the contractions are bad and I need a little extra. It runs on one AAA battery. And taking a shower with it is quite a hoot. I'll leave that one to your imagination :)

Attached to the pump is a long blue tube, which delivers the medicine into my body through the little round button-looking thing you see on my thigh:

There is a needle, which inserts a catheter under the skin. The needle is then removed and the catheter remains and is taped down. The button-part goes on top and allows the tube to spin so I can move and sleep comfortably. Once it's in, you really don't feel it, promise :) This entire piece has to be removed and changed every 3 days. You have to pick a new location, open a fresh set of tubing and a new needle, and reinsert the whole thing. I think I'm basically planning to rotate back and forth from the left leg to the right leg. I also have the option of using my inner thigh, or my abdomen ... but since I already use my abdomen to inject the Lovenox every night I feel like I need to leave that whole area open if possible!

Once it's all situated, the pump itself can be placed inside an incredibly ugly navy blue canvas case/pocket protector/fanny pack thing, so it can clip to your waistband. Seriously it's the ugliest thing ever! I'm hoping to find a more aesthetically-pleasing cell phone case (if I can make the pump fit inside?) ... or if all else fails I'll just bedazzle the crap outta this navy blue nightmare! Ya know, for entertainment's sake. We'll add some rhinestones and some tacky bling and at least I will laugh when I look at it.

So that's the terb pump in a nutshell. Overall it's not as awful as I expected .... the pump itself isn't really the problem, it's the medicine that makes me miserable. The side-effects are super duper unpleasant. It's a heart-racing, hands-trembling, unable-to-breath type of thing. I'm finding the side effects with the pump to be slightly less severe than what I experienced with the pills. However with the pills you at least get a bit of a break, whereas with the pump it is constant, neverending, blahhhhh. So having done both now, I can't make up my mind which one is "better" or "worse". Obviously the pills don't involve needles so for that reason alone I'd say they have the edge.

My other contraption is a "Home Uterine Activity Monitor", it's identical to the toco monitor at the hospital or the peri's office, but thankfully it's a smaller version:

The purpose of this thing is to record uterine contractions. I have to hook myself up to this monitor a few hours a day, luckily it's not around the clock! The "belt" has the round monitor attached which goes around the belly, and is connected via the grey cord to a little rectangular box with lights and buttons. That's where I can turn it on and off, or if I'm feeling a contraction at the time I can push a special button so it's recorded on my toco strip. The little box also holds all the data recorded from the monitor belt.

When I'm finished recording and I'm ready for a break, I remove the belt, and the little rectangular box gets plugged into this machine next to my bed:

I push a few more buttons and then this machine wirelessly transmits the saved data (via satellite) over to a set of nurses, in FLORIDA of all places! After 5pm, or on weekends, the data gets transmitted to the "on call" nurses, who are in Philidelphia. The nurses download the data and it prints out as a toco strip, just like at the hospital .... the long paper strip with all the little mountains showing your contractions.

About 15 minutes after I transmit my data, I get a phone call from the nurse, who tells me how my strip looked. If I'm having more than 2 or 3 contractions per hour she will have me administer an instant "demand dose" on my terb pump. This forces the pump to give me 1-hour's worth of medicine over the span of 15 minutes. I then have to get back on the monitor for another 30-60 minutes and retransmit an updated strip, then wait for another call back. We continue this process until the nurse feels confident that my uterus is "calm", at which point I get to take a break from the monitor for awhile.

I had a similar monitor during my pregnancy with Jamin, though I like this one better because it's an updated version. The old one was analog and had to connect through my phone line (sort of like a fax machine). This one is all digital and it sends the signals wirelessly so it doesn't tie up my phone. That's a major plus b/c with the old machine it never failed that someone would call me at the precise moment I was trying to transmit my strip ... causing the machine to melt down and I'd have to start all over again. And a pregnant lady stuck in bed has VERY LITTLE PATIENCE for these kind of mishaps!

I'm headed back to Dr. Mann's office tomorrow afternoon ..... to see if all these stupid machines have made one bit of difference! The main things she'll be assessing tomorrow are: (1) cervical length -- has it shortened from 2.8 cm since last week; (2) Amniotic fluid levels -- did the second round of Indocin reduce the fluid or do we still have polyhydramnios; and (3) Placenta's location -- has it moved up at all or do we still have a complete previa.

I will try to do a better job of updating in a timely manner :) Pray for us!