Monday, August 3, 2009

Not what we wanted to hear.

Today I am 22w1d (13 days until viability) and my weekly appointment was... not great.

I am gaining weight well, my uterus measures at 32 weeks (!) and my blood pressure is nice and low. They did my glucose screening and CBC to check for anemia, and I will get results tomorrow.

The scan of the babies showed them healthy and active, but with some fluid issues. Baby A has plenty of fluid, but Baby B and Baby C are both low. While this is most likely caused by the fact that I have been taking Advil for contractions (hence the reason you should not take it without the doctor's approval) we are still a bit worried about TTTS. We don't ever want to see a difference in A's and B's fluid. Dr. P was confident that once I have been off of the Advil for a few days, their fluid should increase, but we will be watching closely to ensure no other signs of TTTS emerge.

I asked her what we'd do if they developed it this early and she said I'd have Selective Photocoagulation surgery (or Laser Ablation) to treat the condition. This is an amazing procedure only offered at a few hospitals around the country (one of the reasons I chose the practice we are in) but they literally shoot a laser through the abdomen and uterus into the placenta. SCARY, but very effective. If they develop it later, after 28 weeks, they would do serial amniocentesis to draw of excess fluid from the recipient twin. More info on TTTS here. Dr. P seems very confident that the discrepancy in fluid is due to the Advil, not TTTS, but we'll be paying more attention to their fluid.

As if that was not already enough to cause me to enter high-anxiety mode, my cervix shortened. Just a little, but STILL. It was about 3.5 last week and this week it was down to 3.1, 2.7 with pressure. Again, not an incompetent cervix but it is reacting to increased contractions. I have noticed and reported many more contractions this week, so my Niphedipine was doubled in an attempt to stop their effect on my cervix.

Also, my bed rest is now much stricter. Not yet "strict" which means bed pan and being horizontal all day, but much more limited. I am only allowed to stand up to use the bathroom, shower and get meals, but should remain reclined the rest of the day. No more outings, puttering around the house or walking much to the car. My activity has slowly increased lately, without me meaning to, and I need to stay down all day now. Hey, at least I got to scoot around Target a couple times.

I asked her:

1. When will we do an fFN (a test on the cervical mucus to determine if labor is imminent in the next two weeks)?

Starting at 24 weeks. If we ever get a positive test, then I will be admitted to the hospital for the rest of the pregnancy and given steroid shots.

2. Will we get to 28 weeks?

Yes! Prepare that you may be in the hospital and will certainly be resting much more.

3. Why else would you put me in the hospital?

If your cervix shortens again, if you have four contractions in an hour consistently or if the twins develop TTTS.

The good news is the Nifedipine has worked for me in the past, and we assume the higher dose will help. Also, the twins have NO OTHER signs of TTTS and we hope the fluid thing will normalize next week... yes, I have to wait a whole week! These are the positive things to which I am clinging.

Feeling pretty anxious on the couch over here, and wishing there was a way to know for certain that all will be well. I cannot imagine losing these boys now, and hope with my whole heart that the rest and medications will help my body hold on for another 10 weeks or so. Thanks for reading this extremely long post, and for all of your support. Hopefully next week will bring us news of normalized fluid levels and a longer cervix.

40 comments:

  1. Sending positive thoughts and warm vibes your way. We are here to help and entertain A at a moment's notice!

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  2. It sound like you have a great doctor with a great team at hand and I am sure your babies are gonna be just fine. My prayers are with you! {HUGS}

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  3. I am sorry it wasn't all good news today, but it sounds like your docs are on top of every possible situation. You and those little ones are in my thoughts!

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  4. I wish I could look into the future and calm your fears. But I will keep praying for you and the boys... I hope the next visit brings better news.

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  5. I know that this is SOOOO not what you wanted to hear. It is so scary but you are doing a great job. Hopefully stopping the Advil will return fluid levels to normal; that is the case with Indocin and they work very similar to one another.

    I really want to see you get into the 30s. I know you do too. The longer we go, the less they are in the NICU and the more they are in our arms! We can do this, sister!!! I know we can.

    BTW, hubby just got here and guess what he brought! Mail!!! Your package arrived. You are too sweet. I have the magnet next to the bed (marked with "I'd rather be sitting on the beach") and the calendar is flipped to day 12 on my bedside table. You are SOOOO AWESOME!!!

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  6. I'm so sorry it wasn't the appointment you were looking for. It really does sound like you have some great doctors, though, and that they're doing everything they can to keep those little ones safe and sound as long as possible. Get lots of rest! and I hope next week's appointment brings better news.

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  7. I'm so sorry that it wasn't all good news today, but your doctors sound pretty amazing. I'm hoping that the fluid levels normalize, and that your cervix starts behaving a little better. Does it want to hear all of the songs again?!?

    Thinking of you and hoping that you're able to focus as much on the positive as possible.

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  8. sending you and your boys an enormous amount of positive energy! take it easy sweetie! :)

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  9. Not sure how I stumbled on your blog but just wanted to tell you to hang in there. You are doing great! My triplets are now 3 and I remember bedrest like it was yesterday. Keep those babies cooking!

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  10. You and your boys are in my prayers!!

    Roadnew

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  11. I came across your blog recently and just have to check back on you and your boys regularly... I am keeping fingers, toes, everything crossed that they will stay in past 28 - no, let's make that 30+ - weeks!

    I had twins a year ago and remember the worries and bedrest very well - and that is nothing compared to carrying triplets! Keep up the good work, you are doing great - and your doctors sound really good indeed. Take care!

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  12. Wow....just wow. This all sounds so overwhelming to me. Hang in there!

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  13. Just came across your blog via someone else's today. You're doing great so far! I hope you make it to a lovely 30+ weeks despite all these pesky contractions.
    I've watched a few TTTS surgeries in the past, and it's pretty amazing to see. Where I was, there was heavy sedation for Mom, I think Dad was in the operating room while they were working, and the laser was actually only used over very short distances right near the blood vessels they were working on on the placentas. A very thin metal telescope-like-thing was put through tiny holes in the skin and uterus to get the laser light to the right place, and it was amazing to directly see the beautiful little hands and feet and faces via the camera. Hopefully you won't be going there at all yourself, but the women I saw go through this tolerated the procedure extremely well.
    Here's hoping the extra nifedipine does the trick!

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  14. Hey there! Sorry about the worries from this appointment-I completely understand! We are just taking our fluid and cervix checks week by week now too. I am sure you have done the same research I have done on TTTS, and I have been trying to do the extra bed rest with high protein Ensure drinks. My doctor seemed to be on the fence about if it helps or not, but I figure it can't hurt! I slacked off on the drinks and was a lot more active last week, which I am hoping are the reasons baby B's fluids were up. Hopefully by stopping the Advil yours will stablize and even out again-I'll keep thinking good thoughts for you and the babies.

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  15. I'm sorry that your appointment has raised new fears and reinstated old ones. If you need any more book or movie recommendations, let me know.

    Consider the prayers for you and your boys said (now and often)!

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  16. Came right over when I saw your FB update. So sorry about the increased bed rest. I know watching movies and reading didn't do much for me and I was only on mostly self-imposed modified bed rest. Knitting? Maybe, but not in this heat. I hand-pieced and hand-quilted an entire crib size quilt...that helped a little I guess. Let me know please if there's something I can do. Luckily, you are getting the care you need. Hang in there!!!
    Zarqa

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  17. hey this might help to reassure and inspire you - a blog by a lady with triplets in hong kong. they were born early at 26 weeks but are now A-OK and aged about 4 years - www.tesspeak.typepad.com.

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  18. Fingers crossed, my dear. It seems like you couldn't possibly be in better hands.

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  19. I just said a prayer and lit incense for you and those boys. Here's to keeping them baking for as long as possible and no TTTS!!

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  20. Sending you lots of love and peace, hon! You're in good hands and your doctors are doing an AMAZING job! As are you! Keep up the good work!
    *HUGS*

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  21. youre attitude is amazing. Everyone else had said everything already so I will just add a hug and the very best of peace and health.
    EB

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  22. Sorry about the tough apt. Stay strong. I know that you may be going a bit stir-crazy on the couch but just imagine all the running around you'll be doing in just a couple of months! Get hubby to pick up some good magazines and Netflix! Catch up on recently released movies. Take care - chin up! So far, so good!

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  23. Oh Sweetie. I'm sorry you had such a questionable appointment and are now wracked with worry. :( It is all such a rollercoaster of emotion. The highs are so high and the lows so low. And all the uncertainty - enough to drive you stark raving mad!!! Hang in there, know that I am thinking of you and your darling boys and sending lots of love and prayers.

    Please keep me posted! Also, I sent you a message on FB. Please send info...:) xoxo

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  24. I'm sorry you had a "not so great" appt. I do think it's great that they might have an easy explanation for the low fluid levels. I know how easy it is though to focus on the worst reason for the levels. It is how we cope, prepare for the worst and be happy with anything better- It's the Wemberly Way.

    Your cervix sounds like its hanging in there too. I bet the minor shortening is from all the scooting you've been doing in Target. :) With a little more rest, I'm sure it will lengthen in no time.

    You are doing so good! Sounds like you are in the best care possible. Try to hang in there. We are here for you.

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  25. Sending lots of good wishes your way; sounds like you have great people taking care of you and all of us hoping for the best too!

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  26. Oh honey..I'm sorry!! I will be here praying that all goes well!! Your boys WILL make it...keep telling yourself that! ((HUGS))

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  27. Wow...this is all really intense stuff. I find myself in awe of everything you described. I can't even imagine how YOU must feel. But you sound so in control, so level-headed about it all. Good for you. I admire your strength!

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  28. Carrie,
    I read your blog all the time, but for some reason am not usually able to leave comments. (THe box for comments does not come up on my broswer usually. ??) Anyway, I can write today, so writing I am! I am thinking about you a lot and am definitely keeping you (and your cervix and your contractions and A and B's fluid levels) in my prayers. I know the stricter bed rest is not fun, but you do get used to it pretty quickly, and it will do wonders for your cervix. make sure you are not sitting up too much, and feet up, feet up! You are doing great! Keep up the good work. :)

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  29. I'm sending lots and lots of good thoughts and wishes in your direction! I hope taking away the Advil is exactly what your babies' need, and that your cervix behaves for another 6 weeks (at least!).

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  30. oi. I'm sorry for the scary appointment. I am hoping that the advil was the cause of the scare and now it'll go away.

    You stop that (talking to your cervix)! You had better behave. Ms C. (Ms. Cervix)

    ..thinking of you.

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  31. I am keeping you in my thoughts! Here from LFCA

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  32. Keeping you and the little ones in my thoughts and prayers. I know how tough it can be ...the worrying and all. I was on bedrest and in the hospital for much of my recent pregnancy with preterm labor and incompetent cervix after our cerclage. Know I'm here if you ever want to talk! ((Hugs))

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  33. Hang in there Carrie. The boys are going to be GREAT! I learn so much from your blog. I knew nothing about testing the cervical mucous. I need to ask my Peri about that next time. YOur 3 weeks ahead of me, so your my inspiration, so you just keep growing those baby boys. YOU CAN DO IT!!! Feel free to email me anytime: nikmjnj@yahoo.com. It would be nice to have someone to talk to who knows what each other is going through. :). Take it easy and relax. Your doing fabulous!

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  34. Wow, your doctors are amazing. I'm seriously taking notes here. I'm wondering why I wasnt offerred your cocktail for contractions. You're in good hands. Hang in there. Im thinking of you and chanting 28 weeks for you. By the way, I moved my blog to butterflybaby15.blogspot.com

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  35. Thinking of you and your family.

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  36. Very scary news of TTTS indeed, but I hope there's great news waiting for you a week from now. So sorry about the increased bed rest, and the extra stress and worry of TTTS. You, your husband, your daughter and 3 boys are in my thoughts. Aside from the TTTS that you have no control over, you're doing absolutely everything right - from the weight gain to low blood pressure, to your still-strong cervix, etc.

    Fingers crossed that your glucose and other bloodwork all came back normal yesterday.

    Hang in there. 11 days & counting. ((HUG))

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  37. Hang in there Carrie...I know the appointment brought more worries, but you're doing great!

    Holding you and the boys close in my thoughts and prayers.

    ((HUGS))

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  38. I came over from LFCA, just want to wish you strength, patience, and (most of all) good fortune moving forward so your triplets can keep growing safely inside you for many weeks to come.

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  39. Hang in there.

    I've given you a blog award! You can stop by my digs to check it out

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  40. Sending cervix lengthening thoughts. Hang in there.

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