Magic 24!!!

Today is a day to celebrate.

It's a day of victory .... I have officially reached "viability", 24weeks gestation. This is such a huge deal for us, thank you thank you thank you Jesus!!! If the baby were born today, he would have approximately a 50% chance of surviving delivery, though the chance of severe disabilities is much higher at this point. The survival rates and long-term outlook gets better and better each week beyond 24.

Basically what all of this means to me is that I'm praying for week 28, when the survival rate is over 90%. My plan is to get to week 28 and then to begin praying for week 32! Dr. Mann's ultimate goal at this point is week 34.

Sara brought Jamin up this morning, we were able to visit for about an hour. He makes me so happy. I could just sit here and smell the top of his head all day ...... if only he'd hold still for longer than ten seconds! And some girlfriends stopped by around lunchtime. Jill brought me a ridiculously giant bag of chocolate and Chelley brought some pizza. Yummo.

So overall it's been a much better day today. I'm trying to stay positive and just to be grateful for the fact that we've made it this far. My contractions are picking up a bit this afternoon. I've had several doses of Indocin and will be getting my first betamethasone shot in about 10 minutes (sitting on an ice pack at the moment!) Dr. Grogan and Dr. Matsumoto (aka HOT-su-moto) came up to see me this morning. Dr. Matsumoto warned me that sometimes contractions will start picking up frequency within the first 24hrs after betamethasone. So that's something they will be watching out for.

Nurse just came in with my shot ..... eeeeeeeeeeeekkk wish me luck! :)

NOT HAPPY.

So it turns out that a much-anticipated ultrasound scheduled for "early morning" translates in hospital time to 2:30 pm. I was just about outta my mind all day waiting and waiting and waiting.

They finally wheeled me down just after 2:00 and then I sat alone in an exam room for what felt like an eternity. More waiting.

At last the ultrasound tech appeared, got me changed into the lovely white sheet and we finally got started a little after 2:30. She spent a great deal of time observing and measuring baby's heart, brain, and other anatomy. Repeatedly she kept saying how beautiful and how perfect he looks. Thank you Lord. He is actually measuring big for the first time today -- about a week ahead of schedule. She was very pleased with this, since he's likely to be a preemie so the bigger the better. He now weighs 1 lb 10 oz.

Finally came time for the dreaded "transvaginal" portion of the exam, to measure the cervix. I seriously think I stopped breathing for like two minutes ........ anxiety overload. I've been so desperate for a good long measurement that would allow me to go home.

Alas, not today. Once again I knew the instant I looked at the screen. I could see clearly .... short cervix, and placenta hasn't budged. The tech took some measurements, said she was "stretching it" as best she could for my sake ..... but only came up with 2.0 cm.

I layed there alone again for another 20-30 minutes waiting nervously for Dr. Mann to come in and deliver her verdict. When she finally appeared I could tell she was pretty disappointed too. She knows how badly I want to go home to my family. She apologized and then confirmed what I already knew: I'm stuck here.

She then measured my amniotic fluid and said the polyhydramnios has returned. It's measuring 20 cm, which is not terribly high, but it's still enough to put extra pressure on the cervix and cause it to further shorten. We have seen repeatedly now with the last two pregnancies --- every time the fluid goes up, my cervix shortens. She ordered another 72-hour course of Indocin (my fourth now with this pregnancy), which should help reduce contractions and hopefully lessen the fluid.

She also ordered the betamethasone injections to begin tomorrow. This is a series of 2 steriod shots, given 24 hrs apart, which help to ripen the baby's lungs. It's basically a precautionary measure they take, so that if/when the baby comes early then they've already gotten a jump-start on lung maturity. I've had these before with both Jamin and Gracie so I know they work! Only downside is they hurt like @%$!!!!! ...... way worse than all my other shots combined ....... so I'm definitely not looking forward to getting those again. Maximum benefit of the betamethasone is at 2 weeks after getting the shots, and there is some benefit at 4 weeks post-shot. After that the beneficial effects seem to wain. She said they would repeat them again 8 weeks after, if baby hasn't arrived yet, which would be 32 weeks. They can only be repeated once.

Baby is head-down and sitting low, which - together with the extra fluid - explains the pain and pressure I've been feeling all week in my cervix. I'm reeeeeeally hoping the Indocin may help with this. The placenta has not moved since lsat week, so at this point we're still dealing with a marginal previa.

She's keeping all my other meds the same --- I got my weekly 17P shot yesterday, to fight pre-term labor. I'm still getting my lovenox shots and aspirin every night to prevent a blood clot. Subcutanous terbutaline which I get through my pump 24/7 to reduce contractions. I'm on Macrobid for the bladder infection. Colace and Metamucil twice a day for the inevitable side-effect that happens when you're laying still 23.5 hours a day. I get an additional calcium supplement and a folic acid supplement to counter-act bone loss that's associated with long term use of lovenox. Librax for the irritable bowel syndrome, which allows me to eat. Ambien at night so I can sleep in this awful bed. Protonix and handfuls of Tums for the heartburn. Oh, and a prenatal vitamin. And now of course we're adding Indocin and Betamethasone.

So basically I am single-handedly keeping the hospital pharmacy in business. I hate hate hate hate taking this much medication. Especially while I'm pregnant.

James is on his way up to see me, he tried to sneak out of work an hour early so he could get here before dark this time. I had sat here and cried for like an hour after my ultrasound, and in an effort to cheer me up my nurse called Dr. Mann and requested "wheelchair privileges" for me. This means that my visitors are allowed to wheel me downstairs to a little garden area where I can sit outside for a bit and get some fresh air. I am really looking forward to it .... everyone keeps saying how crisp and fall-like the weather is this week, and I haven't breathed outside air in 8 days so I'm eager to feel it on my face, even if it's just for a few minutes. It might just be enough of a relief to keep me from jumping out the window for another few days.

Please continue to pray for me. Emotionally I'm having a hard time with the idea of being here for another week or longer. My body and mind are both weary. I want my family back. I want my bed back. I want my life back.

Tick. Tock. Tick. Tock.

Today is Monday ..... my 7th day as a guest at Hotel Northside. My stay so far has been long, boring, and torturous. Under these circumstances, though, I suppose boring is actually a good thing, because at least there's no immediate disaster taking place.

Not much has changed since I got here, I am continuing to have painful cervical pressure which worries me. At first they were telling me this was just caused by a bladder infection (which we discovered at 4am on my first night here), but now after being on the antibiotic for several days with no improvement in the pain, they have determined it's apparently not bladder pain afterall. The doctor has ordered that they do not perform cervical checks unless absolutely necessary, simply because I have a previa and repeated checks can kick off a bleeding episode. So they are a little hesitant to investigate too far when I complain of pain. The midwife did check me again Saturday night, and said no change. Dr. McDaniel (who is Dr. Garcia's partner) and Dr. Gomez (who is Dr. Mann's partner) were on call all weekend, and each came to see me several times. They are guessing the pressure and pain I'm feeling is caused by the baby's position -- meaning his head is way down low and he's just pushing right on the cervix. I am nervous that this will cause additional thinning, but we won't have any way of knowing until tomorrow's ultrasound measurement.

In the meantime they are recommending that I lay completely flat for as many hours as I can stand it. This means reclining my bed so it's completely horizontal, putting a stack of pillows under my butt, and laying on my left side. I am unable to do anything in this position ...... the computer and reading are pretty much out so the only distraction I have is the TV, which I can see from that angle thank God. I can usually only stand to be this way for about 2-3 hours at a time, and then I have to sit up for a bit and take a break for the sake of my sanity.

My entire body is aching from lack of movement. I am in bed for about 23.5 hours a day. I take a 10-15 min shower each night before bed, and otherwise I am only allowed up to go to the bathroom. My back hurts, my sides hurt, my neck hurts, my legs hurt ........... everything just aches. And the longer I lay here, the more uncomfortable I get.

I've been on complete bedrest for 5 weeks now and physically it's really starting to show. I'm suffering from muscle atrophy in my legs. I started noticing the beginning signs when I was at home about two weeks ago. Walking up the stairs to my bedroom caused intense burning pain in my thighs and calves; and overall my legs visually look significantly shrunken. Apparently it's obvious to others too, because my very first morning here on the HRP floor the nurse examined my legs and immediately scheduled a physical therapy consult.

The physical therapist showed up Friday morning to teach me some exercises I can do each day in bed. They are pitifully simple things .... like point and flex your toes, raise and lower your leg about 12 inches off the bed, etc. When we first started, she would give me specific instructions on a particular exercise and ask me to do a set of 20 reps on each leg. I was internally rolling my eyes and thinking .... seriously??? Any 100-yr-old grandma could do these, this is silly. Then we'd get to rep #7 or 8 and I was out of breath and my legs were trembling. I found myself incredibly embarrassed, because these simple little movements were really difficult for me. I was laying there listening to her count repetitions out loud, having flashbacks to 6 or 7 months ago when I was in the gym with a personal trainer lifting a ton of weight. And now it's a struggle to lift just the weight of my own leg off the bed.

She explained that the burning pain I felt trying to walk up the steps is likely nerve pain, since over time the non-use of those muscles will mean that the nerve endings no longer fire normally. She said I would be unable to regain the muscle and nerve loss until after the baby is born, but regular repetition of these exercises (twice a day) while on bedrest can help prevent further loss from happening. I found this to be super depressing, as you can imagine. I am forced to lay here day after day, month after month, and watch my health decline and my body shrivel up into a shadow of it's former self. There's not a single thing I can do about it and that just frustrates me to no end. I get even more annoyed when I consider that when the baby finally arrives, I will be expected to suddenly get out of bed and run 500mph and physically function at 110% .... caring for a newborn and two other little ones all day and all night. Yet I won't be able to walk or stand normally. After Jamin was born it literally took about a year before I felt like my body had fully recovered -- before I could do everyday things, like walk to the mailbox or climb the staircase, with ease. So now I find myself, 6 months or so after finally returning to "normal" ....... starting the process all over again.

SHEER FRUSTRATION.

These kind of thoughts have my head spinning most days. Being here has turned into a bit of a mental battle. Luckily I've had a handful of visitors come by to distract me and that's been a huge help. On Friday I had a fluffy visitor show up unexpectedly:

A little spaniel named Rugby, who is part of the hospital's "Happy Tails" program. The doggies come around every Friday and visit bedrest patients. He was super sweet! They put a sheet down over my bed and he just jumped right up and made himself at home in my lap for a few minutes. I enjoyed talking to his owner and getting a few little puppy kisses.

And I finally got to see my kiddos Saturday afternoon, which made me soooo happy! I have missed my family like crazy, it is really hard being so far away from them. Gracie had an upper respiratory infection all week (which James has been forced to handle alone, a first) ... but by Saturday she was finally feeling well again and a visit was in order. Jamin was super wiggly and wanted to explore every nook and cranny of my hospital room, but Gracie just plopped herself right up in my bed and cuddled the whole time she was here. Which is just what I need! Can't get enough kiddie lovin'. Look at this card Gracie made for me .....

She is so sweet I could just eat her with a spoon. Seriously.

I've had visits from a few friends and family members too, which I'm incredibly grateful for! It gets really lonely here and I am such a social person so I hate being by myself this much. I've been so desperate for human interaction that I've caught myself trying to make long conversation with any and everyone who walks in my room .... nurses, food service ladies, housekeepers, lab technicians ..... I'm not picky. Come to think of it, they probably think I'm incredibly annoying because I won't stop talking whenever they come in. I am super grateful to my friends who have visited, sent notes and flowers, made meals for James, babysat the kids, and offered to pray for us. We are so fortunate to have you guys and your generosity really does make days like this a little easier to handle. And can I also just say ......... THANK GOD FOR SARA, our nanny! She has been invaluable, I seriously don't know how we would be surviving the day-to-day without her, she is managing the kids and household and keeping us afloat. God has placed all these people in our lives at just the right time and is providing for all our needs.

I am seeing Dr. Mann tomorrow, for ultrasound #17. My last one was Thursday morning and showed my cervix had lengthened quite a bit since my hospital admission. Dr. Garcia came by this morning for rounds and told me that Dr. Mann might consider discharging me tomorrow if my cervical measurement is excellent and we have no other surprises going on. I am trying not to get my hopes up, but honestly I am just DESPERATE to go home! So I am praying that by some miracle my ultrasound will be all roses and she'll agree to let me outta here.

I will update when I know more .... should be early tomorrow morning (hopefully) when I'm taken downstairs for the ultrasound. Pray for us!

HOTEL NORTHSIDE ........

I'm trying to pretend that it's similar to the Ritz-Carlton or the W Hotel (afterall, I do have a nice skyline view of the city) .... but when mealtime comes it's pretty hard to fool my tummy. Alas ... the food sucks, the decor is depressing, and the smell is pretty sterile. It's not a posh hotel. IT'S A HOSPITAL.

My stay here started unexpectedly on Tuesday. I had two doctor's appointments scheduled, my OB at 11:00 and my hematologist at 2:30. At the OB's office, I saw the midwife Wendy for the first time, since Dr. Garcia is on vacation. Wendy came in and chatted for a bit about my lovenox, measured my belly, and announced I was all set to leave. Skeptical, I asked her, "aren't you gonna check my cervix?" Since Dr. Garcia checks it every single week, it was hard for me to believe I was gonna get out of there without wearing the tissue paper sheet for a least few minutes. Especially since the night before I had been up until 2am with excessive contractions -- 7 per hour -- and a malfunctioning terbutaline pump.

She agreed a cervical exam was a good idea. Two minutes later I heard her announce that I am dilated 1cm, and immediately we both knew how lucky it was that we checked. Prior to this exam we have been seeing cervical thinning, or effacement, for several weeks. But no dilation until now.

Wendy instructed me to get dressed, and by the time I made it out to the hallway she already had Dr. Mann (perinatologist) on the phone. Dr. Mann's office is just around the corner on the first floor of the hospital, so plans were made for me to head straight over, sit on the toco monitor for a bit, and then have an ultrasound.

I grabbed a quick sandwich at the deli in Dr. Garcia's building and went straight over to Dr. Mann's. I only had a few contractions while sitting on the monitor, so I was hopeful that she would check me out and send me home. That hope faded the second the ultrasound technician got started and I saw the image of my cervix on the screen. Instantly I knew it was bad. It was visually shorter (effaced), and before the tech even began taking measurements I knew I had just landed myself in the hospital.

Dr. Mann entered the room a few minutes later, and with a sarcastic smile she said:

"WELCOME TO HOTEL NORTHSIDE! Your room is ready and waiting."

I tried to remind her that I've been a guest of "Hotel Northside" several times before and it has never been a relaxing stay. But she wasn't dissuaded. My cervix was measuring 1.7 cm long, down from 2.8 exactly one week ago, and dilated 1cm on top of that.

I asked her if I could at least go home and pack a bag, which prompted her to look at me like I had six heads. She responded, "Absolutely not. But I will allow you to put your pants back on, and those cute high-heeled shoes which you won't be wearing again for a really long time". Super. Then she told me I would be staying for "a while". I asked her for clarification, "do you mean I'll be here for weeks and weeks?", to which I got a resounding YES.

They literally brought a wheelchair to the ultrasound room, and wheeled me straight upstairs to admissions. Before I even had a chance to make a few phone calls, I was a in labor & delivery room on the high-risk floor hooked up to the monitors. I scrambled to call my hematologist's office to cancel my 2:30 appointment, and started making a list of necessities for James to pack and bring to the hospital. Of course, the list included my makeup and flat-iron, so maybe I'm presumptuous to call the entire list "necessities".

They started me on Indocin, the 72-hour tocolytic, and re-inserted my terbutaline pump. The rest of my meds stayed the same. I was poked, prodded and jabbed about once every 45 minutes for the next 24 hours or so. The steady stream of nurses coming in and out with medications and such made it impossible to sleep. I began having what felt like cervical pain "down low" sometime around 3:30 am, which prompted the midwife to wake me up for a cervical exam at 4:00. She took a urine sample and decided I had a bladder infection somewhere around 4:30 am ...... which meant more medicine ......... and as it turned out I got a total of about 2.5 hours of sleep that first night.

Yesterday afternoon, Wednesday, I was moved upstairs to the "HRP" floor. This is the high-risk perinatal unit, where they send women who are on hospital bedrest to gestate for endless weeks. I was settled into room 105 just before dinner and had yet another terbutaline pump placed in my leg. Around 8:00 pm I began hearing the most horrific noise emanating from the room next door, which I quickly discerned to be the sound of an unfortunate woman barfing her guts out. She vomited violently, without stopping, for about an hour and a half. When she wasn't puking she was crying loudly. It was so pitiful (and yucky) to listen to, I felt so sad for her. My nurse finally came in and explained that my neighbor had hyperemesis and has these violent spells of vomiting day and night. In her next breath she said she had already put in a transfer request so I could get moved to a quieter room. Everything in a hospital seems to run in slow motion, of course, so it was midnight before I was finally transfered down the hall to room 120.

This morning I was taken downstairs to Dr. Mann's office for an ultrasound. We found my cervical measurement had increased significantly since my admission, up to 2.9 cm! So this was fantastic news, but not enough to inspire confidence from Dr. Mann. She said she was keeping me here, for three reasons: (1) I gave her a "really good scare" and she wasn't quite over it yet. (2) My cervix seems to be voilatile, and just as quickly as it increased length, likewise it could loose length overnight. And (3) I had only about 16 hours of my Indocin course left, and we had no way of knowing if the crazy contractions would return as soon as my last dose wore off. She did not want me at home when coming off the Indocin. So her plan is to re-evaluate me with another ultrasound next Tuesday. Depending on how the cervix looks at that time, and what's going on with my contractions, she will make a decision on how much longer I stay at Hotel Northside.

For now I'm settled in and trying to make the best of it. It is incredibly hard being so far away from home and I miss my family like crazy! As much as I really don't want to be stuck at the hospital for weeks and weeks, at the same time I know that if I'm lucky ........... I'll be here for weeks and weeks. "Viability" is considered 24 weeks, this is when premature birth carries a 50% survival rate. My immediate goal is to get to week 28, when survival is over 90% and the long-term outlook is relatively good. Once God gets us to week 28 then I will start praying for week 32. Please join me!

21 Weeks and still standing! Well .... mostly laying.

Oh gosh .... where to start??? There is so much swirling in my head right now, I've got a major case of Kristi-brain at the moment. Worry overload.

First a bit of good news: I saw Dr. Mann last week for my weekly ultrasound (Lucky #13!!!) and we finally saw something to be happy about. The Polyhydramios is gone. Yep, that's right: GONE. Praise the Lord! The second round of Indocin did it's job, and my fluid is now measuring 16cm, which is considered perfectly normal. It's been so long since I've had anything "normal", I was beginning to forget what that feels like. But now I remember ...... ahhhh yes it feels fabulous.

My cervical measurement was stable, in fact it actually increased ever so slightly to 3.1 cm, so that was also good news! Our other big concern, the placenta previa, has not moved. It's location remains unchanged (boo). Before now, Dr. Mann kept expressing confidence that it would eventually move, though that was weeks and weeks ago. So I asked her, "Are you still feeling confident that this thing is gonna move?" .... to which she got very quiet and paused for an awkwardly long time, and then responded "Well I really hope it's gonna move!"

Ummm, yeah. I really HOPE it's gonna move too, obviously! But you conveniently didn't answer my question.

A week has passed since that conversation, and so as you can imagine that's more than enough time for my brain to kick it up a notch in the worry department. This stupid previa has scared the crap outta me since the day we found it. When you combine a previa with blood thinners and preterm labor ..... the possibilities are downright terrifying! The potential for disaster is way too high for my liking.

So today, at my OB appointment with Dr. Garcia, I had to pick his brain for a bit. He is always such a straight-shooter with me, he doesn't sugar-coat things. I ask him a detailed question, and he gives me a very detailed answer. 100% of the time. It is the reason why I trust him so completely. So many times before, with other doctors, I felt like I had to ask the same question 4 different ways before I was given a semi-complete answer. But Dr. Garcia does not beat around the bush, he doesn't leave me wondering, and I absolutely adore him for it.

So I asked him today .... at what point will we know whether or not this previa is going to move?? He told me 28 weeks. He said the next 2+ ultrasounds I have with Dr. Mann should be very revealing ... if the thing is gonna move we should start seeing some form of slow migration happening in the next 4-6 weeks. If we get to week 28 and it's still a complete previa, we can be pretty certain that we're stuck with it and we will have to develop a plan for how to deal.

So of course I had to ask .... in the event we're stuck with it, what will our plan be? He explained that he would have to consult with Dr. Mann and they would have to get creative and, as he said, "put our thinking caps on". But as of today, his recommendation would be:

1. Switch immediately from Lovenox over to traditional heparin (these are cousins; Lovenox is a form of heparin). The reason for the switch is to increase your chances of not having blood thinners in your system at the time of delivery. A single shot of Lovenox stays in your system for 24 hours. And once it's in, there is no way to reverse it. So if you go into labor, or need to do an emergency delivery, within 24hrs of your last shot ...... you're in trouble. Traditional heparin, however, stays in your system for 12 hrs (which means you need two shots a day instead of just one). But the advantage is that if an emergency delivery is needed, or you spontaneously go into labor, you've just bought yourself 12hrs. Also, the effects of heparin can be reversed, with another drug (can't think of the name), which can be given as a shot at the hospital. This shot can fully reverse the effects of the heparin within a few hours, at which point it is safe to deliver.

2. Immediate hospitalization if I have any bleeding at all from the previa. If the bleeding gets "bad" (exactly how much is considered "bad" I have to wonder???) ... then he will deliver via C-Section regardless of gestational age. Assuming we have no bleeding, and we can get a few weeks further, then ....

3. Administer betamethasone (steriod) injections around week 33. This is a series of 2 shots, given 24hrs apart, which boost the baby's lung maturity. Because lungs are the very last thing to develop in the unborn baby, premature delivery means that major lung problems are frequent and dangerous. I've had these shots with both Jamin and Gracie, and I firmly know they work! They also hurt like a $%&@!!!!! but that's beside the point :)

4. Perform an amniocentesis at week 34. This will assess the baby's level of lung maturity. I had this with Jamin as well. There is some particular type of protein that they look for, it's presence indicates the lungs are mature enough and it is safe to deliver. Assuming all looks well, then ....

5. Deliver via C-Section at week 34.

I'm obviously freaked out that the doctor's best case scenario assessment with a previa involves delivery 6wks early. But I know that he would never ever in a million years recommend that unless it was the absolute best alternative for the baby. And there are a lot of "if's" to get to that point so there are many factors playing into this scenario which could change. So to a small extent it's like trying to predict the unpredictable. At the same time, though, it's the unpredictable part that has me so worried. There are so many things that could happen which would force a delivery even earlier than week 34.

My biggest fear at this point, which I shared with Dr. Garcia, is that I will have further cervical change, which will cause the previa to start bleeding, and since I'm on blood-thinners it will be really bad .... they will be forced to deliver, and we'll end up with a very very very premature baby. Nodding his head, his response was "that could very well happen, and that is my biggest fear too. But we are already doing everything humanly possible to prevent that from happening. At this point all we can do is react quickly if/when something happens".

He did say that sometimes cervical thinning by itself won't be enough to cause bleeding, it depends on how quickly the change is taking place. He said cervical dilation is more likely to cause bleeding. So I took this as a glimmer of goodness because in the past I have tended more toward very early thinning, like 20+ weeks, but then not dilated until like 30+weeks.

He stated repeatedly that the previa still has a chance of moving sometime over the next seven weeks, and twice he said "I really hope it moves". Hmm, now where have I heard that before?