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!

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!

Solitary Confinement; Day 3 of 148

Friends, I have landed myself in the Slammer. The Big House. The Black Hole. The Pen. Or as my doctors and I like to call it:

THE COMPLETE LACK OF INDEPENDENCE AND MISERABLE CONFINEMENT ALSO KNOWN AS EXTENDED BEDREST.

Ugh. Extended .... as in .... a really long period of time. Twenty-one full weeks to be exact. Or 148 days. Or 3552 hours. But who's counting?

The last few weeks have been crazy and overwhelmingly stressful and ....... let's just say I haven't been in the best mood. Needless to say, blogging has landed somewhere around #450 on my list of Top 500 Things to Worry About. So while there are so many complicated things going on at the moment (more than I can possibly blog in one sitting), let me try to summarize how I got here:

12.5wks: I started having contractions

13wks: I began the weekly 17P injections and was told to reduce my activity and "put my feet up" as much as possible. Though Dr. Mann never explicitly said the dreaded "B" word, James and I knew what was coming and decided to plan ahead. So we began searching for a nanny to help out here at the house during the week.

14.5wks: My home nurse started making her weekly visits. I had ultrasound #10 and found out we are once again on TEAM BLUE - it's a boy! Dr. Mann also discovered I have Placenta Previa. These are categorized in order of severity as marginal, partial, or complete. Mine is a Complete Previa ..... because, it just wouldn't be a Kristi pregnancy if it weren't the worst case scenario, of course! I was told there was a "very good" chance the previa would resolve on it's own as the pregnancy progressed. If it didn't resolve, however, this would exponentially complicate matters since the biggest risk with a previa is hemorrhaging and of course I'm on blood thinners (Lovenox and Aspirin, to combat the Protein S Def), and also I tend to have early cervical thinning / preterm labor which in the case of a hemorrhaging previa would require immediate Csection, and could potentially be a very premature delivery.

17.5 wks: We hired a nanny, though she needed to work out a notice with her previous employer so she hadn't started yet. I had ultrasound #11, at which Dr. Mann reported a slight improvement in the location of the placenta, though I still had a complete previa. But she was hopeful that it may continue to move and eventually resolve itself. My cervix measured 3.5 cm long, which was down from my last measurement (4cm) a few weeks ago but still on the lower end of the "normal" range so cautiously we considered this a bit of good news. However she also found a new problem: Polyhydramnios. I had this with Jamin's pregnancy as well, it's basically too much amniotic fluid around the baby. There are several risks associated with this by itself, for me the most urgent being that it increases pressure on the cervix causing it to thin and dilate too early (which is already an existing problem for me). So again it's one more issue to further worsen the other issues. While all the complications are happening independently of one another (the previa, the preterm labor, the Protein S Deficiency, and now the polyhydramnios), the end result is that they all interact to negatively effect eachother and essentially make the next problem even worse.

I was given an oral medication called Indocin, which I also took repeatedly during my pregnancies with Isaac and Jamin. This drug is used to help slow contractions, though one of its (normally undesirable) side-effects is that it tends to reduce amniotic fluid. For most women this would create a problem, but for someone like me who has polyhydramnios, this side effect is actually what we're trying to achieve. The downside is that Indocin can only be taken for a max of 72 hours, because any longer than that can cause heart defects in the baby.

18.5 wks: Dr. Garcia signed a "Georgia Disabled Persons Parking Affidavit" and I was able to obtain a temporary handicapped parking pass. This felt a bit upsetting at first, but I quickly found it to be incredibly helpful and quite a relief for me, particularly during my weekly parking adventures at Northside. I had ultrasound #12 with Dr. Mann, which showed the previa unchanged and the polyhydramnios still present (meaning the 72-hrs of Indocin I took last week did not work). Worse news was that my cervix was now measuring 2.8cm (down from 3.5 just one week ago). I'm told a "normal" cervix at this gestational age should be somewhere around 4-5cm long .... whereas 2.8cm would be normal sometime around 36-38+ weeks gestation as delivery approaches. All of this brought Dr. Mann to finally utter that awful word that I've been so desperately hoping to avoid: BEDREST. She also told me to repeat a second 72-hr course of Indocin, and ordered a terbutaline pump and home monitoring of contractions with a toco machine (will blog more on this tomorrow).

I left there feeling extremely unhappy though not one bit surprised .... we knew all of this was coming, it was more just a question of when. The only thing that kept me from going into a complete panic was the fact that the new nanny, Sara, had just started working. Her first day was on Monday, and I was ordered to begin total bedrest on Tuesday! Yep, that's God's timing folks.

Today I finished my 3rd day of bedrest. Only 145 more to go! (Let's pretend that makes me feel better). I'd be completely lying if I said I'm not immensely freaked out by the long road ahead of us .... the list of complications we're facing and the potential for disaster has my mind spinning most days. But even still, I have this peace knowing that I seriously have the most amazing and highly-qualified team of doctors, and they are throwing everything but the kitchen sink at me. There is no medicine I'm not already on. There is no treatment, no intervention available that we're not already doing. They are literally doing every single thing in their (limited) human power to make this work ....... and guess what that means?? It's no longer up to us. This entire journey rests solely in God's very capable hands, as it has since Day 1 before my doctors and I even knew what obstacles were waiting for us. I don't know for certain that God has another happy ending in store for us, though of course that's what I'm praying for. But I do know that regardless of how this whole thing ends, He will carry us through and we will survive.

Please continue to pray for us!