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?

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!

Never a Dull Moment: 14.5 weeks

Oh how I have longed to be one those lucky lucky women who seem to sail right through pregnancy; whose bodies just naturally know what to do ... whose biggest worries consist of what color to paint the nursery and what style of shoes best accommodate their swollen feet.

Alas, I will never be one of those women.

I used to feel a little bitter about it, but really, that's just ugly. Over the last few years I've learned to let go of the envy and instead embrace the struggle. God gets to show off in a major way every time I am pregnant, and that's pretty cool, right?

But being in the midst of the battle means there's never a dull moment at the Wren house. Such has been the case over the last few weeks. Around 12 weeks I began feeling abdominal cramping, which at that time felt like a dull ache similar to menstrual-type cramps. Upon seeing that I had a higher white count in my urine, Dr. Garcia assumed I must have a bladder infection, and started me on an antibiotic. Two days later we got the test results back showing there was no bladder infection afterall. Nurse Debbie called to share the "good news", and I immediately began to cry. Indeed this was not good news to me ... it meant that the cramps must actually be contractions.

Since that time they have strengthened a bit, in frequency and severity. They are now more distinguishable as contractions, coming and going, worsening at different times of the day and under different circumstances. In addition I'm now feeling pain and pressure in my cervix whenever I stand or walk for more than a few minutes. Today I saw Dr. Garcia and he insisted on an ultrasound to measure the cervix, even though I am seeing Dr. Mann tomorrow and she will be doing the same measurement. I love that he takes no chances, waiting 24hrs was just not even an option for him. He is a better-safe-than-sorry kind of guy, and that is just one of the many reasons why I adore him so.

The ultrasound showed my cervix to be 4cm long, which is great news! Dr. Garcia ordered me to start the 17P injections today rather than wait until week 16 as we originally planned. The 17-Hydroxy-Progesterone is the weekly intra-muscular injection that is thought to reduce the risk of pre-term labor. Aetna Pharmacy had already shipped the vials and needles to me about a month ago, but had not yet finalized arrangements for a home nurse to administer these to me each week. So when I came home from Northside, I retrieved my medication and began searching for someone qualified to inject it for me. My first stop was to the sweet servants at the local fire station, who helped me repeatedly while I was pregnant with Jamin and having blood pressure problems. They were eager to help today but explained that their regulations forbid them from administering an injection unless I became a "patient" which meant I would have to go to the ER! No thanks :) I almost got up the nerve to inject myself in the leg muscle (pure desperation!) when I remembered two sweet friends with some medical training. Gotta love generous friends who don't mind getting their hands dirty to do you a favor!

So I was able to get my first shot this afternoon, and beginning next week Aetna will be sending a nurse to my home each week to do these for me. The "standard" protocol requires 17P to continue weekly until 34 weeks gestation (though the thought of "standard" is almost laughable to me!) ... but if this is the case I will have about 20 more of these shots left. This got me thinking about my Lovenox shots, and for the sake of entertainment I decided to count those too. Now I'm wishing I hadn't counted! So far I've had 67 Lovenox injections (tonight will make 68), and if my math is right I have about 196 more to go. I haven't shared the bad news with my tummy yet (it won't be too happy).

In happier news, we are insanely anxious to finally learn the gender of the baby! I've had three ultrasounds in the last three weeks (one today in fact), each time hoping to learn whether we'd be on Team Pink or Team Blue this go-round. Alas, each time the technician could only manage to tell me: Team Yellow. Ugh! I hate hate hate hate hate not knowing! And yes I do realize I am an impatient brat and yes I know that most women have to wait until 20 weeks to find out. I have no earthly idea how these women control themselves that long because I would literally pull my hair out if I was forced to wait until then! So kudos to you ladies! You have much more self-control than I do!

Hopefully our waiting game will end tomorrow, when I see Dr. Mann. She assured me at my visit 3wks ago that we would definitely be able to tell the gender this time ... so unless the baby is curled into a teeny tiny ball with a metal plate covering the pertinent parts, I think our membership on Team Yellow will finally come to a close. James, Gracie, and I are all hoping for Team Pink this time, though James says he has a "feeling" it's a boy. Gracie has her heart completely set on a sister, who she plans to name Moe. She has very firmly made up her mind and I'm pretty sure she's not changing it. I tried to talk to her about the possibility of another brother, to which she declared that we will just dress him in pink and call him Moe anyways. So this could present a slight problem. And I am cheering for a girl, just because the last two have both been boys and it would be fun to have some pink in the house again. But of course I know that my plans are not God's plans (only took me 31 years to figure that one out!), so I will take whatever He gives me :)

Stay tuned for the big announcement tomorrow!

How Low Can Ya Go?

Last week I got a call from Dr. Duncan's nurse at Emory telling me the results of my latest Protein S labs, which were taken at 10weeks gestation. My "Free Protein S" had fallen to 19 (!!!!), down from 25 at 7weeks gestation and roughly 48 pre-pregnancy. "Normal" is considered to be somewhere between 60-150ish.

We knew this was coming, since Protein S naturally falls during pregnancy (even for the "Normal" folks). So while we were expecting them to fall, we were never expecting them to fall this low. The hematology nurse who called freely admitted she's never seen numbers in the teens before, which I also expected, but even so hearing it out loud didn't feel too good.

I managed to confine my mental freak-out to just a day or two, and now I'm just taking comfort in the fact that God's got me covered. And the icing on top of that cake is knowing that Dr. Duncan is monitoring me very closely, and there is no doctor more qualified for this scenario than he is.

In fact, I'm feeling so confident, that I'm now taking bets on just how low my Protein S will drop before this is all over with. We expect that it will continue to fall as the pregnancy progresses, the lowest point being at the end of the pregnancy. So now it's just a game of "How Low Can Ya Go?" .... without triggering a disaster, of course. Anyone want to take a guess? We need to award a prize to the person who gets closest without going over!

I'm thinking if numbers in the teens are nearly unheard of, would I just be a complete freak of nature if I had a single digit number? If so, then that's my goal. Just another chance for God to show off!

BRING IT ON PROTEIN S!!

Tonight I'm reminded once again what a complete miracle Gracie is. I'm always calling Jamin my "miracle boy" and eager to share with anyone who will listen how God brought him here. But knowing now that my Protein S drops to unheard-of levels in the first trimester of pregnancy ... and knowing that I was clueless and unmedicated for my entire pregnancy with Gracie ... and knowing that we both survived ... seriously blows my mind!

I'm also resolving not to whine anymore about those stupid Lovenox shots. Yes they hurt and yes I absolutely hate injecting myself every night, but since they are keeping me alive right now I suppose it's only fair to stop complaining about them.

Thank you God for Lovenox!

Fast Forward!

A few weeks have passed since my last post, I've been generally whiny and feeling an overwhelming lack of energy ... to the point that the very thought of blogging was enough to make me tired. Blahh. Here's a condensed version of the last few weeks:

I've had three more ultrasounds ...... the 5th being at the Perinatologist office due to sudden onset of heavy bleeding around 9 1/2 weeks. Dr. Mann was not available, so I saw one of her colleagues Dr. Matsumoto ... or as she calls him: Dr. HOT-su-moto. She calls him this because, well, he's kinda young and hot. Not really the guy you want to see when you have to explain how you have blood gushing from your nether-regions. Yeah, so that was a pleasant experience. The good news is that he was able to very clearly see that the blood was originating at the cervix -- not the placenta -- so that was a best-case scenario for us really. Disaster averted.

My 6th ultrasound was done about a week later, another "quickie" scan at Dr. Garcia's office. And the 7th was last week, with Dr. Mann during our nuchal translucency screening. It was so fun to see the baby again ... wiggling and spinning and waiving. The best part was that I got excellent results from the screening and all seems to be progressing just as it should. I was only 12w1d at the time of the scan, but even so Dr. Mann offered to take a peek at the "special parts" to try and determine the gender. She squinted and strained and did everything but stand her her head ..... but alas, just too early to tell. She said if we'd had one more week it would've been so much more clear. I knew ahead of time that the chances of being able to determine the gender at 12wks is super slim so I really wasn't surprised or disappointed. I see her again in 2 1/2 weeks and she promised we would know for sure by then! :) I am still hoping for team PINK, all the while recognizing I get absolutely zero say in the matter and will simply have to take whatever is given to me! James says he is cheering for team Pink, but has a "feeling" it's a boy again this time. Only time will tell!

I saw Dr. Duncan (aka Dr. Genius) about two weeks ago for my hematology appt. My bloodwork from the previous appointment (taken around 7wks gestation) came back showing my Protein S levels to have plummeted down to 25. It is normal for Protein S to decline naturally during pregnancy, but it's definitely not normal for it to drop this low. We expected it, though, since the exact same thing happened at the very beginning of my pregnancy with Jamin, when my level was about 24 at week 7. The concern comes from the fact that my Protein S will continue to fall throughout the pregnancy, so then it becomes a game of "how low will it go???" All we can do is continue to watch it and adjust my Lovenox dosage as needed. But oooohhh how much better I feel this go-round just knowing I am in the hands of one of the most competent hematologists in the country and he is watching me closely. He took another 800 bottles of blood from me at my last visit and I am still waiting on those results. His nurse is actually supposed to call me tomorrow, fingers crossed.

I am now 12w5d and beginning to have some painful cramping. I saw Dr. Garcia today for my regularly scheduled appt ... he says I have a high # of white cells in my urine so he's speculating the pain is caused by a UTI, aka bladder infection. He sent off a culture of course, but the results will take 48hrs to get back to us so in the meantime he's already started me on an antibiotic just in case. Tonight the pain is literally worsening with each passing hour, so I'm beginning to feel a wee bit nervous and praying it's really just a UTI and not something more worrisome. I began having contractions with Jamin around week 16, and with Isaac at week 12 so of course my mind is already running away with that possibility. He also gave me a pap while I was there today (just because it was time), and so now I'm bleeding profusely again because my stinkin cervix apparently is so frail it begins to bleed if the wind blows too hard or if someone stares at me too long. Doesn't take much.

So I'm back to where I started: feeling generally whiny. Now you see why I took a break from blogging?? :)

Fingers, Toes, and Pink Hair Bows...

So I had my 3rd and 4th ultrasounds this week. The 3rd being on Wednesday at Dr. Garcia's office. I was 9w0d at the time. This was a "quickie" ultrasound just to make sure we still have a heartbeat and all is well, since I'm too early for them to pick up the heartbeat on the doppler. He has a mini-sized bedside machine which he can wheel right into the exam room and do a quick scan, no need to schedule with the ultrasound tech and use the "Mucho Grande" machine. I think that's so cool that his office does that ......... have I mentioned lately how much I adore my doctor?!?!?! Gosh I'm here to tell ya, having a doctor you completely trust with an office staff that's caring and efficient -- well unfortunately that's extremely hard to find and therefore is pretty much priceless in my book.

Baby measured exactly 9w0d so growth is right on target. I was reminded once again how amazingly developed an unborn baby is, even this young ... we could see little arms and legs clearly visible, and an irresistibly cute profile that reminds me a bit of a gummy bear. As Dr. Garcia fumbled with the machine trying to get a good recording of the heartbeat I asked him, "Do ya see a pink hairbow in there?!?!" He laughed and explained he was trying to look at baby's heart (okay okay, slightly more important than the hairbow), but then joked that maybe he did in fact see something sparkly around the cranial area. He later printed a picture for my memory book, asked the nurse for a red pen, and stepped into the hall. He came back a moment later and handed me the photo, which had one small hand-drawn modification. It didn't show up well when I tried to scan the image and make it digital, so I used photoshop to enhance it a bit. You get the idea:

Still too early to tell for sure, but undeniably I am already itching for some more pink in the house. It will be at least 4-6 weeks or more before we'll get an actual ultrasound view that will tell us pink or blue (poo! I hate waiting!). So until then I'm thinking lots of pink and sparkly thoughts and pretending to be patient.

My 4th ultrasound was this morning, and it was 100% medically unnecessary. Just for the sake of a good cause (well, okay, and my own entertainment too)! My pals at the Pregnancy Resource Center, where I volunteered for a few years before Jamin arrived, called me this week asking if I would be their "model". They were training some new ultrasound technicians today and basically needed a preggie person to be their guinea pig. I was happy to oblige! I got to stare at my little one on the screen for almost two hours and share time with some sweet women so it was definately a win-win for me! I didn't spot any hairbows this time, but I did get to see something even cooler: the baby is moving already! Seriously, I'm certain I've had at least 50 ultrasound scans between the 4 pregnancies but there's something about seeing those little hands waiving at you that just never gets old. I was so tickled to have the chance to see baby kicking and wiggling, especially at 9w3d, and struck once again how God can pack such amazingness into something so tiny.

Here's a little video glimpse from this morning .... it's a pretty blurry image but you're looking at baby's head on the left side of the screen, belly in the middle, then legs and feet kicking on the right-hand side.

Hebrews 11:6

I had two more ultrasounds this week (details to come in a later post, promise). Baby's measurements exactly matched my LMP this time, so growth is going just perfectly and the heartbeat is strong and right where it should be! I dunno why exactly, but for some reason I was surprised by this good news. It's either my general lack of a positive attitude, or my lack of faith in God's goodness and power, or maybe it's a combination of both. But during the week I spend waiting in between doctor's appointments I find myself convinced that the pregnancy is doomed and I begin telling myself not to get too attached. For my last two OB appointments, in fact, I've shown up there fully expecting to hear some kind of tragically terrible news. I mentally prepare myself for it days before I get there. And then we do an ultrasound and I lay there like a dumbfounded fool because all I keep getting is perfectly fabulous good news. So I leave the office feeling fantastic and excited, and roughly 2-3 days later the doom and gloom sets in and the process repeats itself.

It is a constant mental battle -- and a spiritual battle, I'm embarrassed to acknowledge -- and I'm trying really hard to fight harder and stay focused and not allow myself to fall into that pitfall each week. At church this past weekend my pastor spoke about how fear will give us memory loss ...... we get so scared that we forget the miracles God has already done for us in the past, and instead we focus only on the scary circumstances we're in at the present and we begin to think surely we're doomed.

Well as you can imagine that message certainly hit me like a ton of bricks.

He might as well have cued a big spotlight right onto my chair and waived to me from the pulpit. Hello! Kristi! God is speaking to you! Are you listening? DUH. I mean, could I possibly be a more ungrateful, unfaithful doubter? Look what God has already done for me! Look at the miracles He has performed! They are all right here recorded in this very blog, should I need a reminder. Not to mention the fact that there is living proof of His miraculous power, giggling and toddling around my house with a big baldy head and chunky little legs, and I stare at him all day long ... how could I possibly forget?? How could I have the audacity to doubt? Is my faith so weak and my trust so frail as to think God isn't capable of doing the EXACT SAME THING He's already done before?

Well I'm determined to fight the fears and the unbelief, and I know the only way to do that is to get my head in the Word and keep it there each and every day. But I need help, friends, I need accountabilty. So if you are my brother or sister in Christ I'm asking you first to pray for me and second to call me out when you see me. Hold my feet to the fire! Ask me how I'm doing and if I'm standing firm. I know myself well enough to know this is a serious area of weakness for me and I also know that without faith it is impossible to please God, so this is certainly not something I'm willing to ignore any longer.

Also feel free to smack me in the head every once in a while, it's for my own good so I'm giving you permission. I promise not to freak out. It will be like that V8 commercial ....



"And without faith it is impossible to please God, because anyone who comes to him must believe that he exists and that he rewards those who earnestly seek him."
Hebrews 11:6

The newest member of "Team Wren" ....

..... is a jolly 'ol Scottish lad named Alexander Duncan, or as I've nicknamed him: Dr. Genius. Seriously, this guy is insanely brilliant. And he has spent the last 40+ years researching and treating thrombosis patients just like me.

Most hematologists are actually practicing as an oncologist/hematologist, this was the case with my previous doc, Dr. Munjal, and 95% of other hematologists in practice. These doctors must have a wide range of specialty .... they primarily treat cancer patients and as such they usually specialize in bone marrow, stem cell transplants, and the like. The result is that these doctors, though considered "hematologists", only end up with a basic working knowledge of the less-common hematologic issues like Protein S Deficiency. Dr. Genius, on the other hand, does zero oncology. And he does not specialize in a wide range of hematology problems .... instead his entire career has focused on basically TWO THINGS: 1) Congenital and Acquired Thrombophilia (yep, that's me); and 2) Complications of pregnancy due to hemostasis (hello! me again). He literally sees more thrombosis patients in a week than most "specialists" will see in a year (or at least, that's what he told me!).

He is widely published, highly regarded as an expert, and patients travel from all over the country to see him. Not to mention, he's kind of like a big teddy bear with his irresistible Scottish accent and his grandpa-like demeanor. How fortunate I am that he practices in Atlanta, and moreover that he is now officially the newest member of "Team Wren". I would love to brag and say that I researched this guy and sought him out for his clinical specialty, moving mountains in order to score an appointment with him ... but that's not so. The truth is that I landed in this guys' lap without even knowing it, all of which was God's work and I was oblivious at the time. I consider this the first miracle of Pregnancy #4, and the details are just too cool not to share....

On May 13th I was having my annual "pow-wow" with Dr. Munjal, my hematologist of almost 4 years. Outside of pregnancy, I just see her once a year to check on my numbers and make sure all is well. My last visit with her had been shortly after Jamin was born (April '09), and at that time they actually scheduled my next visit for May 13, 2010. So I literally had this appointment written on my calendar for a full year. Mid-way through our visit, Dr. Munjal began telling me some things about Protein S Deficiency that totally didn't make sense to me .... things which were 180 degrees contrary to everything she had told me for the previous 3.5 years, and things which were completely contrary to everything I'd read and researched.

This was not the first time I'd had a bad experience at her office. Recall Nurse Know-Nothing advising me to "google it" last year when my Protein S #s were dangerously low. There were other little things too, which bothered me from time to time but I ignored them b/c the thought of switching doctors was too overwhelming.

So here I sat in her office that Thursday afternoon, completely dumbfounded and confused by these crazy things she was telling me, feeling like I was in the twilight zone or something. Always being one to wear my feelings clearly on my face, Dr. Munjal obviously noticed my displeasure and finally asked if I wanted a second opinion. I thought for a moment and then agreed to her offer.

She proceeded to refer me to her own partner, at a second office .... gee thanks. When I caught on to that I told them NO THANK YOU, I would like a referral to someone outside of this practice please. The nurse suggested Emory, and I said fine.

A few moments later I was sitting at the receptionist's desk while she set up my referral over the phone and faxed all my medical records over to Emory. I asked her the name of the doctor I would be seeing, she told me she didn't know -- it was a large group with many doctors and they would decide who wanted to see me once my referral went through. I left there annoyed at my experience with my doctor of almost 4 years, but feeling grateful that I would be getting someone else soon who would probably be better in the long run. I wouldn't really need to see them for another year anyways so in the grand scheme of things it wasn't a super big deal.

TWO DAYS LATER I DISCOVERED I WAS PREGNANT.

And immediately it became a super big deal! So as I laid there on the bathroom floor that Saturday night bawling my eyes out, with all the fears hitting me like a ton of bricks, it suddenly occured to me: I don't even have a doctor right now!!! Could there possibly BE a worse time to be in-between hematologists?!? Of course, you know the rest .... I completely freaked out because, well, I am Kristi afterall, and that's what I do.

Monday morning I got a call from a lovely lady at Emory who had received my referral and wanted to bring me in sometime in July or August for a consultation. I sheepishly explained ...... "well, something major has changed ..... uhhhhh ..... I'm pregnant." She managed a polite "Oh my!!" and immediately understanding that July or August would not work, she scheduled me to come in within a matter of days. Just as we were hanging up the phone I asked her the name of the doctor I would be seeing. She gave my Dr. Genius' name .... which I scribbled on a piece of paper .... and as soon as I hung up with her I consulted my good friend, Google. When I pulled up Dr. Duncan's profile on Emory's website I nearly fell outta my chair. Here I had just obliviously fallen into the lap of one of the most highly esteemed experts at precisely the time when I would be needing him most.

Instantly it hit me that God had orchestrated this entire thing, and for the first time in days I stopped crying and felt a bit of peace knowing that God was in control of this entire pregnancy and He already had all the details figured out for me.

Dr. Duncan is the Medical Director of the Special Coagulation Laboratory at Emory University Hospital. He is also the Medical Director of Emory University Hospital's Hemapheresis Unit. And now he's been appointed as the Hematology Director of Douglasville's own Team Wren, which I'm certain has to be the single most minuscule accomplishment of his career but nonetheless I'm quite thrilled to have him!!

Meet Baby Wren #4!

Well, it's official. We had our second ultrasound last week, this time we saw a teeny tiny embryo and a perfect little heartbeat fluttering away at 133 beats per minute. Baby is measuring 2-4 days small but Dr. Garcia feels that all is well.

My actual due date is January 19, though of course our ultimate goal will be 36wks again which would put us around December 22-ish. At this point I feel compelled to confess:

I am still in complete disbelief that this is actually happening.

Dunno why I can't seem to wrap my brain around the whole thing ... we've known for weeks now and yet I haven't seemed to move past the shock and denial of it all. I certainly am beginning to feel pregnant --- a little nausea here and there and fatigue so severe that most afternoons I have to prop my eyelids open with toothpicks. I'm still in the gym twice a week (trying to hold on as long as I can ...) but in general I just feel WEAK. It's weird how something so tiny can physically wreak havoc on you in a matter of days really. From an emotional standpoint I would be lying if I didn't admit I'm feeling quite disconnected from this little life, which I know from experience is just a self-defense mechanism so I'm trying not to heap guilt on myself for it. I know the bonding part will come in time .... I'm planning to not let myself wait until 20+ weeks like I did last time!

I've been back on the lovenox injections nightly for about three weeks now .... needless to say my poor abdomen is completely covered in dark purple spots. I actually never completely got rid of the bruised-tummy look, despite the fact that I was off the shots for a total of 1 year and 4 days. I've been carrying around two gigantic brown bruises, about 2-inches in diameter, on either side of my belly-button for over a year now. These are souvenirs from Jamin. I've had several different doctors look at them (hematologist, dermatologist, obstetrician), and they've all told me various versions of the same thing: these are signs of deep tissue damage caused by repeated trauma of lovenox and heparin shots. They may continue to fade with time, but all of my doc's have gently suggested that I try to get used to them, as they are likely to be permanent without some kind of laser treatment. My hematologist explained that the heparin is probably to blame more than the lovenox ... bruising and scaring on heparin tends to be worse and I was injecting heparin for a total of 16 weeks due to preterm labor, rather than the 2 or 3 weeks we had originally planned. I am quite offended that nobody warned me about this ahead of time! And I'm secretly hoping that maybe if I am able to stick with the lovenox for a longer period of time this go-round maybe I can avoid more ugly scars. Well, a girl can hope anyways. In the meantime I've been trying to rotate my injection sites around every night, in an effort to share the love so to speak, and not bombard one or two spots repeatedly. I have no idea if this means that I am less likely to get two giant areas of "tissue trauma", or if it just means I will end up with twenty little spots of "tissue trauma". I also can't decide which is worse.

A month ago I was actually looking forward to getting a new bikini this summer. Now ........ mmmmm ......... notsomuch. Here is the last "normal" picture I will probably have of myself for awhile, taken on Memorial Day (7weeks) before the bruising got bad:

Please excuse my ultra-grumpy expression .... I think I was annoyed at James because he was rushing me. :) Not my fault ......... it's the HORMONES!!!