Thursday, July 30, 2009

The Dog Days

You have probably heard at least one person you know who lives in the Pacific Northwest complain about the record-setting heat and humidity. It is currently about 90 where I live and we are nowhere near the daily high. We were made for weeks of rain and flooding, gray skies and North Face jackets and few of us have air conditioning. Seattleites are sweaty and cranky.

While I am worshiping my air conditioning, I still feel a bit hazy, out of focus. I am not sleeping much and my feet look like they are wearing foot-sized fat suits. Here are some of the happenings from the dog days of summer, straight from the couch.

- We all know I am counting the days until 24 weeks (17 more!) which is August 16th. Today I discovered that the BEST SHOW ON TV, or "Mad Men" is making its long awaited, third season premiere on... you guessed it! August 16th! This must be a good sign, right? RIGHT?

- From the mouth of my three-year old (emphasis is hers):

"I have twins named Scratch and Lucy and they were too small for bottles so they had to drink out of my breasts and they stayed at the hospital for two weeks but now they came home with me and you!""

"My tummy is big and I have to be on bed rest. Actually it is couch rest because I am really tired and it holds the babies in. That is what my doctor told me and I don't like it. It's no fun bed restin'."

"I am having so many contractions today!" (Said while clutching her tiny tummy.)

"Mommy, are your nipples getting bigger?" (She also asked the nanny that the other day.)

-And last, but not least, for your enjoyment, a picture of me (snapped by my mom's iPhone) scooting my way through Target. I get many strange looks, some annoying questions and knock over displays occasionally. Those little seat backs are not made for someone lugging around extra boob-age and babies in their body. I was so uncomfortable that I stuffed a package of (super cute, boyish) onesies behind my back for added support. This may have been the cause of some of the staring.

Monday, July 27, 2009

Busy Boys

I would like to dedicate this post to Air Conditioning, without which I would not be able to function in the humid, 95 degree Seattle weather. Even with it I am still too hot and cannot sleep at night, but I am so thankful we have it at all.

Okay, back to your regularly scheduled programing.

I saw the boys today, and they look great! Still no signs of TTTS, and my cervix is... wait for it... still over 3.5! This is wonderful news. Dr. P has returned from abroad, and she had no idea I'd be waiting with an itemized list of questions for her. That'll teach her to take a family vacation! (I am really kidding and eternally grateful to her for all her excellent care). Here are some of the highlights:

- I got in trouble for losing a pound. Must drink more protein shakes.

- She is thrilled with my "competent" cervix and said it is doing a nice job... let's hope it continues to do so!

- She said, in a triplet pregnancy at 21 weeks, this is the best case scenario. My bed rest and meds are controlling the contractions and she said I could stay like this (modified bed rest) until the end as long as all continues the same.

- She told me that we need to pick a day for my C-section. I almost fainted! Is this really happening? She said to choose a day the week of Halloween and we will make it our goal. I keep thinking of how our daughter could visit me in her costume and then go trick-or-treating with Daddy. Makes me smile from ear to ear. If I go into labor before then and we cannot stop it, they will do an emergency C-section, but we will aim for our C-section date.

- I felt SO much movement out of B last night! It felt like he was kicking constantly for an hour and at one point, I felt his feet sticking out. At the appointment, we saw that he has flipped himself completely back to head down position. That takes some effort given the space considerations.

Everything (aside from the enormous growth every day) has stayed the same which is JUST how we want it. I am feeling more hopeful, hoping my boys make it, hoping they will come home with me in a few short months.

Me and the boys at 21 weeks:

In this picture, it looks like A (on the right) is whispering to B, or maybe giving him a little kiss. Regardless, this picture makes me smile- to see them snuggling together is hopefully, a glimpse of what is to come.

Here is Little C, oblivious to A and B's shenanigans. Could his nose BE any cuter?

Saturday, July 25, 2009

Paper Charts

In my last post, I wrote about the mental milestones for my higher risk pregnancy. The period of viability begins at 24 weeks and by 28 weeks, babies almost always survive with lots of medical help to begin. These dates are burned into my mind: August 16th and September 13th, respectively. I certainly hope they do not make their entrance until Halloween or so.

Gone are the days of keeping busy to distract myself, although I do have many wonderful visitors to break the monotony, and my family is always around, which is a huge blessing. My daughter and I made a "Countdown until 24 Weeks" calendar. I cannot wait to wake up tomorrow morning and see there are only three weeks, or 21 days left until our first milestone.

She loved the idea and made one for the next time her 13-year-old friend and "mother's helper" comes to play in three days. Her 3-year-old spirit wants to tear all the sheets off in one day, and while I tried to explain why we can only do one page for each day, I completely understood her wanting something that cannot come sooner to happen likerightnow. I want to be in the safer zone, to know that if something happens suddenly, there will be a chance for our babies.

For now, seeing the days pass and torn away to reveal a new day is comforting.

Wednesday, July 22, 2009

It is really hard to type while laying down.

My marathon appointment (3 hours plus!) yesterday went very well. My sweet little boys are growing so well and are actually bigger than most singletons at this stage- great news for babies who will definitely be born before 40 weeks. The average 20 weeker is about 10 ounces; A and B were both exactly 13 ounces and C was 12 ounces. Almost three pounds of baby inside of me! It is reassuring to see the twins the same size and their fluid even (no signs of TTTS there) and know they are growing well.

My cervix was a nice 3.7 cm! Even with pressure it never went below 3.2 which is great news. Something we are doing, or more specifically, the combination of what we are doing is still working to slow and weaken my contractions and lengthen my cervix. WOOT WOOT! The protocol stays the same, although we will decrease the Advil a bit as it can affect the babies' heart development.

Dr. K, who I've been seeing in Dr. P's absence was truly thrilled and said this is what we wanted to happen. She reminded me again, I do not have an incompetent cervix, and that contractions are easier to treat. We need those boys to stay in a long time and grow big for the big world. All the good news lifts my spirits and helps me to be hopeful until the next appointment. I keep telling myself, three appointments from now and I will be 24 weeks! Please let me get there.

When I was a little girl and was counting down to something like Christmas, vacation or a relative's arrival, I would make a countdown chart with the number of days left on sheets of paper, and tear one off each day. Somehow it seemed to get me closer to the date and I felt that each day was an accomplishment. That is how I feel now. In my mind, I check off a day closer to 24 weeks, then 28 but I am thinking I might just have to make another chart of paper. I know my daughter would love the project, would adorn the numbers with bug stickers and crayon swirls and colored glue. It would feel so good to tear off a day each morning and know the babies are getting closer, minute by minute.

Last post, I told you of Stacey who had her twin boys at 27 weeks after a long bed rest. Devastatingly her and her husband lost their son, Connor. The doctors are hopeful his brother, Colby, will continue to fight as he's been, but they need all of our support and prayers.

Monday, July 20, 2009

20 weeks!

Okay, this is getting a little insane. I am officially bigger than I was when I had my daughter, and the boys and I are only 20 weeks! I have a feeling stretch marks are imminent.

Bed rest is turning my usually steel-trap-like mind into mush, but here are a few things happening:

- We are 4 weeks from some viability, 8 weeks until the MAJOR milestone of almost 100% survival without problems. Please keep cheering for us as we get there!

- There is some kind of party happening in my uterus and I was not prepared. They move so much and are already so strong. I love feeling their kicks, rolls and occasional foot, knowing they are thriving inside, and stretching out. Space must be getting tight!

- Tomorrow (Tuesday) I have a full growth ultrasound in the afternoon along with the usual Doppler studies (checking for TTTS) and a (gulp) cervical measurement. They told me to plan for 3 hours, and bring snacks. Sort of like seeing "Harry Potter". (Which I was allowed to do yesterday and loved it, but movie seats suck.)

- Bed rest is not so fun, but I do it happily knowing the boys need me to rest. I cry easily and generally worry and fret more since I cannot distract myself with doing anything. A motorized cart trip to Target may be in order.

I will update tomorrow after the appointment. I cannot say it enough: thank you for each comment, cheer and prayer. They mean the world to me and the boys!

Also, Stacey had her babies yesterday at just over 27 weeks and all are doing remarkably well for their gestational age! Go say congrats!

Saturday, July 18, 2009

Musings of a Couch Potato (more like Watermelon!)

Here I sit/lay, with not much to do but think and worry, rinse and repeat.

I am feeling so many fewer contractions since my new regimen started. The Nifedipine, Advil and rest combination have certainly slowed my contractions to almost nothing, and yesterday at my appointment, we saw my cervix is now 3.3-3.9 cm! This is great news. Someone commented to me that they had not realized the cervix could go both ways; indeed it can, and it does. With more activity and less meds, it would probably lose some length and we hope it grows even more or stays the same for the rest of the pregnancy now. I have spoken with several friends who were on the same meds and rest combination who all carried their babies well past 28 weeks. Both of them have noted the marked decrease in contractions with the Nifedipine in particular.

Dr. K was extremely pleased and said this is what we want to see: the cervix responded to the relaxation of the uterus and lengthened as a result. Of course that means my bed rest will continue until the boys come (hopefully around 14-16 weeks from now). She gave me more guidelines which really help me know how much is too much activity, and what I can still do. Dr. K reminded me that she is more liberal with bed rest than many at our practice, so enjoy it while I can. :) I trust these doctors so much, and will follow their instructions to the letter.

For now, I need to remain mostly on the couch, sitting or laying on my side, with a little walking around my house. I am not supposed to pick up my daughter, take too many trips up or down the stairs or do any housework or carrying. I asked if I could go places (besides doctor's appointments) and she said she encouraged it for mental health, but I need to go somewhere and sit, not go somewhere and walk around. For example, I can be dropped off at the door of a friend's home or a restaurant, and sit the whole time, or even go to a movie. I cannot, however, walk through the parking lot of a store and shop. She is going to get me a handicapped parking sticker to use for appointments to minimize even that walking. She reminded me that I can ride in a wheelchair through the mall, or use a motorized scooter at Target. I laugh when I picture this, but in about a week, I am going to be ready to go ANYWHERE that isn't my house!

I have been a bit crampy this morning, and get worried so easily. I will call the doctors (who may think I am a little nutty, but oh well) if I don't feel better soon. I know things can change quickly, and I am afraid that despite my doctor's efforts and my compliance, my body will not hold on. Please, body, continue to carry these boys as you should... they need a while longer inside of me. Dr. K said yesterday she would be very surprised if I delivered before 28 weeks, and has much higher hopes for me. Music to my ears! You hear that, body, we are going to 34 weeks at least!

Here are some pretty cute boy pictures for your enjoyment. I really think A and B look so alike and C is his own little person. It will be interesting to see if the identical twins look noticeably different from their brother.

Baby A

Baby B

Baby C

Also, there is a rumor going around that I gained 4 pounds from Tuesday to Friday, but I cannot confirm or deny it. ;) YIKES!

Thursday, July 16, 2009

My Cervix heard YOU!

I am overwhelmed by your support, Readers. I was moved to tears more than once, and laughed out loud often when I read your commands and musings to my cervix. Yes, I am referring to it as "my cervix" again since it is shaping up and doing a better job. Thank you, thank you, thank you for your support. How do I know this? Glad you asked...

Yesterday afternoon I had more contractions than normal and pretty soon also had tremendous rectal/vaginal pressure which reminded me of labor with my daughter and freaked me out. I called my MFM and they told me to go to Labor and Delivery since their office was closing. My mom, the saint she is, came right over and took care of our daughter while we raced out. Dr. G, a wonderful man who I've spoken with on the phone before would meet me there. The ride there was long due to rush hour, and I was shaking with anxiety. What would they find when I got there? Would my cervix be shorter with all of the contractions? I tried not to panic, but inside, I was terrified.

When we got there, I was met by Dr. G and he did a scan of my cervix, showing it at 3 cm +!! I was quite relieved, but it had still gone from 4 to 3 or lower in a week. I asked him about cerclage and he said, "I love cerclage. I use it ALL the time and think it is an amazing tool for some women. You, however, do not have an incompetent cervix, you have preterm labor contractions, and your cervix is trying to hold strong, but it cannot hold on if you continue having contractions that affect it. The bottom line: we need to treat your contractions and cramping, not your cervix."

What a relief to me! Pre-term labor is real and scary, but much easier to treat than a cervix that cannot hang on at all. When he explained it that way, I was still nervous about the contractions, but much less so than with a renegade cervix. It looks like my one day of resting had already improved its length. Which leads me to... my treatment plan.

1. More resting. He feels "half time" bed rest is not enough. I need to be resting almost all of the time with my feet up.

2. Antibiotics. Apparently, any time he sees preterm contractions, he prescribes two strong antibiotics to ensure there is no infection or bacteria in the vagina or cervix. Either of these issues could weaken the cervix and irritate the uterus, causing contractions.

3. Nifedipine. This is a blood pressure medicine that is commonly used to reduce contractions. It can cause dizziness, fainting and headache. I already feel the headache. Dr. G feels this will be the "mainstay of my therapy" and we can increase the dosage. If this isn't effective, we are on to Terbutaline with all its ugly side effects.

4. Continue Ibuprofen. Also relaxes smooth muscles (like the uterus) and can control contractions. I am supposed to stagger this with the Nifedipine for the best effect.

5. More Folic Acid. The March of Dimes did a huge study last year that shows 4 mg of Folic Acid (I was taking 3) reduce preterm labor by 70%. You cannot OD on it, so whatever your body doesn't need, it doesn't absorb.

6. Magical Pills. This is a sleeping pill that has the effect of, you guessed it, relaxing the smooth muscles while you sleep. It made me sleep like a DREAM last night, and before I passed out, I laughed hysterically about some not-that-funny game my mom and I were playing. My husband Googled it to see what its side effects were, and "reduces anxiety" was one. Perfect!

Overall, I felt great about my treatment. It really feels like we have a lot more options to treat the contractions than to treat the cervix. Of course, it could continue to shorten, but we hope it does not. It is awesome to not have to think about cerclage yet (and hopefully not at all) since my cervix does seem to be responding to a contracting uterus. If we can get that under control, we hope the cervix will hang in there, long and strong for at least 9 more weeks.

Again, thank you so much for all the words of support, encouragement and humor. I particularly like Miss MVK's Billy Joel song dedicated to my cervix! All of your experience and kind words are appreciated beyond measure.

Tuesday, July 14, 2009

The Disappointing, Shrinking Cervix

The cervix is no longer "nice and long". I don't really even want to call it "my cervix" since clearly it is not doing what I want it to do. I need it to hang on for another 9 weeks and then I might disown it.

Last week's measurement: 4.0 cm.
This week's measurement: 2.7 cm.


While this is not an alarmingly short measurement, the change is what is cause for concern. I was extremely upset by this, of course, and Dr. K (who I completely misjudged) hugged me for a good few minutes while I sobbed into her shoulder. I am still pretty upset and terrified, so a bullet list it will be.

- We discussed a cerclage (okay, I begged for one). At this point, the risk of rupturing A/B's sac is greater than my risk of delivering too soon. If it shortens again, we will do a cerclage (probably this or next week) but if it hangs in at 2.7, we will not do one. You pretty much cannot do one after 24 weeks, so the sooner we do it if we have to, the better. I will be measured again on Friday.

- I am now on Ibuprofen until I deliver. Every 6 hours, I take 600mg. This drug is extremely efficient and relaxing the uterus, which should cause less contractions which change the cervix.

- She did a pelvic and said it "feels better than it looks" and was hard, although shorter.

- I told her that I am a worrier, and am terrified. She said, "I am too! I think we'll see you twice a week. Would that make you feel better?" Would it ever!

- Modified bed rest it is. I am restricted from much activity at all. She told me to get more childcare NOW so my amazing mom and mother-in-law as well as a great nanny are all coming to help. I should not be lifting my daughter, chasing her around, carrying her up and down the stairs which I usually do. Dr. K told me the calmer the body is, the calmer the uterus is, and that is why bed rest helps with any kind of preterm contractions.

- Although it can stay this way for the rest of the pregnancy (and we HOPE it does!) the next steps would be cerclage, other drugs like Terbutaline, more strict bed rest or hospitalization.

- I asked her if she thinks we can get these babies to 28 weeks, and she said, "Absolutely!" which did so much to make me feel more calm. I hope and pray she is right. I want my boys to stay in as long as they can, where it is safe for them.

I am pretty much drained, and oh so frightened. Every twinge is making me think I just lost more length on the cervix... I am trying to find solace in the fact that I do have excellent care and they know what they are doing.

The beautiful boys, however, look perfect. No signs of TTTS, great heart beats and very active. I am so happy they are healthy, now my body has to do its job, and keep them inside for a long time. Next Tuesday I have a full growth ultrasound, so we will get weight estimates and more detailed anatomy on each of my sweet hearts.

When I came home, I was talking to my mom, crying, and my daughter touched my tears and said, "Why are you crying?". I told her that Mommy would have to rest all the time to help the boys grow big and strong and I was a little sad about it. She snuggled me and said, "Honey! It is going to be okay. You don't have to cry." My little angel, I hope she can understand when I cannot take her outside to play or tuck her into bed at night for a while.

Please, faithful readers, feel free to try to talk to the cervix. It is not listening to me.

Sunday, July 12, 2009

19 Weeks

...and only FIVE weeks until the V-DAY! For those of you who think I am crazy for counting down until Valentine's Day in August, I am actually referring to Viability Day. Babies begin to have a CHANCE at surviving if born at 24 weeks, and since multiples can come earlier than most, it is more of a milestone. Although their chance of survival is about 50/50 then, it shoots up to almost 100% by 28 weeks. Of course we hope to be having big 35 weekers, to know that they could survive outside my body in a couple months (with lots of medical help) is amazing to me. Stay inside a long, long time Boys and stay closed and long, Cervix! (Yes, I frequently converse in my mind and out loud with my cervix.)

My husband and I took a "Life with Multiples" class at our hospital. It was so fun to be around other pregnant-with-multiples parents, although we were the only ones who already had a child. At one point, we had several couples sitting around us, taking notes about the newborn experience, car seats and breast pumps. The second half of the class was mostly about what to expect from the NICU and how to begin breastfeeding preemies. I learned much about how parents can be involved with NICU care, and what the reasonable expectations for them are depending on when they are born.

Out of 11 couples in the class, 9 had twins, and 2 (including us) had triplets. The other BBB triplet mom there was in "bed rest" chair which reclined, and she looked much more comfortable than I. Those chairs were BRUTAL and I am thinking at the next class in about 3 weeks, I need one of those, too. She is almost 28 weeks and looks miserable. She looked at me and said, "This is going to be you in 8 weeks. Get ready for it." She also sees Dr. K at our MFM and was put on bed rest 4 weeks ago when her cervix went from 3 to 2 cm in a week. She has held strong there and they are hopeful there won't be anymore changes to it. It frightens me how much it can change in such a short time. Frequent readers must know that every twinge or cramp makes me worry about mine.

And, the 19 week belly. Wow, is it growing. I am surprised at how much harder it is already to bend over, get up off of the couch or roll over in bed. My body is changing rapidly making yoga pants my favorite thing and it necessary for a new bra, STAT. The one I am currently in (already up from my normal size) leaves large indentations all over me. I am loving feeling the boys move more now, and laugh at how active Baby B is compared to his brothers. Baby C likes to snooze, and A is more of a sporadic mover, but B seems to move almost constantly some days. I have a feeling A is still kicking him in the head, poor guy.

My next appointment isn't until Tuesday (how DARE they make me wait 8 days? Don't they know about the neuroses in my head?) afternoon, so I will update then. Hoping to have more good news, with the twins sharing their placenta evenly, and my cervix still over 4 cm. I also need to talk to the substitute doctor about activity and bed rest since she is less concerned about it than my own doctor. I might start calling her the too-relaxed-for-my-taste-doctor but it takes a long time to type. Oh, how I miss my conservative Dr. P. I think she returns from Europe next week, thank goodness. She is not the hugging type, but I might just have to tackle her when she gets back.

Off to watch "True Blood". Nothing to take one's mind off preterm labor like sexy vampires and the Deep South!

Monday, July 6, 2009

18 Weeks and CUTENESS!

All right, I admit it. I have been a bad blogger. Weekly updates are all I am managing right now, and it is usually because whenever my daughter is napping, so am I. Also, my laptop has been heading down hill. Right now, for example, I have to hit the "k" key about 5 times before it will produce a letter. Makes for slow blogging. Today I have some cute pictures to share of my boys, and a quick update from the doctor (the in-a-hurry-substitute doctor since mine is in Europe).

First of all, here is the 18 week belly in all its glory. Today, they measured my uterus and it is measuring at 28 weeks. Holy Hell!

This morning I had a long ultrasound which again showed no signs of TTTS and a long cervix... now let's hope it stays that way for another 18 weeks! The boys are so very active in there, especially Baby B. He head down, along my right side, lowest. Baby A is the long way across my belly button, and Baby C is at the top on the left side, usually taking a big old nap, since no one is kicking him in the head.

I had a scary incident at 5 am on Saturday when I had severe cramps that I would NOT go away. I called the on-call doc who was had me take 600 mg of Advil and call if it had not gone away in an hour. It did go away, and he checked in with me later that morning to tell me to continue the Advil until I saw Dr. K today, and to call if it came back. I was terrified, having visions of my water breaking, of losing the boys, but it really didn't come back at all. When I saw the stand-in doc today, she said it was most likely growing pains (since my cervix remains unchanged) as this is a rapid growth period for the babies, but if it returned, she'd want me back in this week. Stand-in freaked me out a little- she kept saying, "With triplets, the cervix can change rapidly, but I think you;ll be okay..." which I already know, but seriously! Don't remind me of my biggest fear!

She also said that unlike Dr. P, she does not automatically put people on modified bed rest at 20 weeks unless there is a reason. She kept saying, "I am more liberal than her" and we'd wait and see. Honestly, I don't know what to think! I will continue taking it easy, but I guess I might have a few more weeks of freedom before the serious resting starts.

The awesome sonographer asked if I'd like to see my babies in 4-D... UM YES!!! Here are my little boys, looking so beautiful to their mommy. I could not help but cry when I saw their faces.

Baby A:

Baby B:

Baby C:

I know they are a little blob-like but I see their Daddy and their sister already. I cannot wait to meet you, boys, but keep on growing inside for 18 more weeks!