Monday, September 29, 2014

High Anxiety

Today's title happens to be the name of one of my favorite Mel Brooks movies.  I need a laugh.  And I need a laugh because I am crazed and jangly with nerves and anxiety.

Sometime this week, assuming there was enough fetal DNA to extract in my blood sample, and assuming there were no other unforeseen lab errors, I will learn the likely fate of this pregnancy.  My 11-week fetus is the size of a lime.  That's a pretty significant-sized fruit, right?  Every day I become more and more accustomed to being pregnant, grabbing my belly, unwittingly basking in the love I feel for this growing life inside of me.  There has been so much deja vu this go around - harkening back to my first trimester with Niblet - which makes the prospect of learning a poor outcome just horrifying.

I am also *just* beginning to show. Husband and I attended a rather fancy dinner party thrown by my employer.  When we got home that night, he says, "I think you're showing" - Ummm, you couldn't mention this before I chose the dress???  Sure enough, I saw a photo of myself tagged on facebook, and yup, much to my dismay I do look kinda knocked up.  "Maybe I just looked a little chunky?"  I asked Husband.  Nope, being a dance instructor with ordinarily decent abs, I apparently look like someone with a bump.  For contrast, I was able to hide Niblet from the world until I was maybe 5 months along. 

When I am not literally passing out from exhaustion (I suffer from what I call "the sleepies" just as I did with Niblet at this stage in her development), I try to throw myself into work and zumba.  Anything to avoid turning over possible conversations in my mind when the genetic counselor calls.

"I have bad news" the imaginary call begins.... and I envision scrambling to cancel meetings in order to schedule an emergency CVS procedure to confirm the Panorama test results...

Wednesday, September 24, 2014

Well, I have an OB. And a living Kumquat*

Being me, I had steeled myself for a meh appointment.  Perhaps Dr. H would be *okay* - maybe she'd listen to me, but maybe she'd push back on my being concerned about MTHFR, and incompetent cervix, and my generally waiting to fall into a cavern of doom.

Wow, I love being wrong (sometimes).  Dr. H met with me for a full hour.  We talked in detail about my convoluted history (and she was rather impressed with my surgery/miscarriage/event date recall abilities, thank you very much).  She asked me about my first childbirth.  She asked me about my daughter.  She smiled and laughed and joked and commiserated about breastfeeding around male colleagues, and was by every measure a normal woman (in other words, I don't think she'd be cracking jokes at my D&C the way my first OB did back in 2012). 

She performed a full exam and then proceeded to move on to the doppler.  And boy, was she worried along with me when it took her a minute to find a heartbeat on this little kumquat.  "I really hope we find this, I would hate to send you out of here in a panic," she said. "I would just beg you for a requisition for an ultrasound," I responded.  "And I would write it for you," she replied.

But finally (!) there it was, the sound of galloping horses.  170bpm.  We both smiled and breathed again.  I noted while lying on the table that the only way I can handle this pregnancy is to take it week by week, to get through each benchmark and live to see another day and think about the next week.  She nodded and smiled and said that was the right approach. 

The rest of the visit was a discussion about my next steps:  The Panorama Screen, the CVS is there's a problem with it, the nuchal translucency scan, and then I enter the second trimester.  No, I'm not crazy if I still want to top off the panorama with an amnio, and the doctors who perform amnio at this hospital ONLY perform amnios, so they are the best.  No, I am not crazy to want to get my cervical length checks started a little earlier, we can start at 16 weeks. Yes, I should absolutely keep teaching zumba classes.

And then the moment when I think I knew I would be the wandering patient no longer:  the MTHFR discussion.  Dr. H was fine with my supplementing with a baby aspirin.  My manner of speaking (I can pull lawyerly authority out of my ass when necessary) apparently convinced her I wasn't a wackjob pulling insanity off of the interwebs (ha!), and she believed that my supplementing with the super-disgusting methylated natural vitamins was reasonable. So much so, that she plans to do a little more research on my homozygous MTHFR mutation AND plans on asking an MFM she knows whether she has any thoughts.  And the MFM she is going to talk to?  YES, the same woman whose office I attempted to call a few weeks ago.  How awesome is that?

We live to see another week.

*According to the exotic fruit loving minds over at babycenter, at 10 weeks pregnant "Your baby now weighs less than a quarter of an ounce and is a little over 1 inch long from head to bottom," and "is the size of a Kumquat."  And fuck if I didn't have to go and look up what a kumquat actually looked like.

Tuesday, September 23, 2014

10 weeks

Yesterday I handed over more vials of blood for the Panorama screen. Now I am in waiting hell for the next 1-3 weeks.

(Hmmm, is it just me or is there too much hell in pregnancy?  Beta Hell.... Screening Hell.... Waiting Hell....)

Last night I had some abdominal cramping, went upstairs to lie in bed, and just stretched there, wondering, "Whoa, is this how it all will end?" 

When you google "abdominal cramps at 10 weeks pregnant" you will get a whole lot of hits and that will serve to calm you a little.  Because abdominal cramps are apparently quite common at this stage, particularly after multiple pregnancies.  Supposedly my uterus is stretching and the fetus is in one of its rapid development stages.  Every WebMD-ish site out there will note that unless the cramping is "rhythmic" and accompanied with bleeding, I should not worry.  These cramps were the opposite of Funkadelic - more the occasional odd stabby pain on one side which subsided to a dull ache - which felt a whole lot like menstrual cramps - and then disappeared into the night. 

Tomorrow I go in for my first official OB appointment, and first face-to-face meeting with Dr. H.  Man, I really hope I like her, because I am so sick of wandering around this town with my stack of medical history, looking for doctors. Not to mention, if we discover a problem on my expected doppler scan or ultrasound, well....let's just say that I have yet to be in the company of a doctor who offered much comfort during those scans in the past.

Wednesday, September 17, 2014

Resource update coming soon.....

Just an FYI - In the interest of being of actual help to someone, I plan on adding a few more additions to this blog, including "Resource" pages for both Asherman's Syndrome and Molar Pregnancy.  I am not a doctor (because we all know the Juris Doctor doesn't count), but I would like to try to provide some FAQs for those poor souls who may have wandered over into the rather unscientific ramblings of my brain and could use the information.  Plus it will give me something tangible to focus on, and prevent me from indulging into to much navel-gazing.... well, that was an unintentional pun.

Tuesday, September 16, 2014

The beginning of the end of the beginning

I sit here at a little over 9 weeks along (9+2 maybe?).  I visited not one but two doctors yesterday, expecting both appointments to be filled with angst, and finding myself pleasantly surprised at the lack of angst-i-ness on display.

Dr #1 was Dr. K, the RE I had made an appointment to see way back in June before I found myself surprisingly knocked up.  This you may recall, was the Doc who treats high FSH-patients, many of whom are also kicked to the curb by the same IVF-clinic that unceremoniously kicked me to the curb.  Dr. K wanted me to keep my appointment, a) to offer me an ultrasound to calm my fears, and b)  because she too recognizes it's good to have a Plan B if this one doesn't make it.  An RE-in-training, Dr. W, sat in on our appointment (this clinic is affiliated with a large nationally recognized teaching hospital).

Dr. K, the warmest yet most competence-exuding RE I have ever had the pleasure of meeting (since the great Dr. Isaacson in Boston) gave me so many happy tinglies. She was an older woman, and one word that came to mind when talking with her was "gravitas."  Husband himself remarked that he felt like we would be in good hands with her if we needed her services (as opposed to Dr. H, aka "Dr. Cuddles," the scary woman who told him he should drop a few pounds).

I will cut to the chase:  Yesterday morning we saw a moving baby, this time a slightly larger blob, with a clearly defined head, torso, umbilical cord and a fast flickering heartbeat on the ultrasound monitor. Dr. K then looked at Dr. W, the baby RE in training, and said "Do not ever think that a woman with a FSH of 18 can't get pregnant." She then looked at me and added, "this is an important lesson for Dr. W to see.  I am happy to have you here today."

In fact, Dr. K explained to me that FSH is only indicative of egg reserve for IVF purposes.  High FSH would indicate that we wouldn't capture many eggs at retrieval, but offers no insight on to the quality of my eggs. And clearly I still have eggs in there.  "It's all a roll of the dice" as to whether any pregnancy of mine would succeed.  It was irresponsible for a previous doctor to suggest to me that I would never have a healthy baby with my own eggs, because that simply wasn't true.  In fact, I ever want to proceed with IVF at this fertiility clinic, they will absolutely treat me.... But for now, seeing a moving baby at this stage "precipitously drops" my risk of miscarriage.  And furthermore, in Dr. K's view, I am not a high-risk pregnancy.  My cervix should hold, though she wouldn't discourage early checks by my OB.  My MTHFR mutation does not warrant lovenox shots since my homocysteine levels are normal.  And so off she sent me, to see my OB next week, with a warm wish for me to never have to walk into her office again.

My next appointment was with a genetic counselor.  This one had me tied up in knots as well, because these are the people who say awful things about your age and statistical likelihood of having abnormal babies.  Well, again, yesterday was the day for pleasant surprises.  In fact, this nice young woman with two kids of her own did not hand me any stats. "I think you guys have had really sucky luck" she refreshingly said to Husband and I.  "I know it's been a really long road for you to get here, and I know you're nervous," she continued.  The long story short:  we have had three very random chromosomal losses but neither of us are carriers of anything.  So moved from a conversation about risk to a conversation about next steps.  Here's the plan:

At the end of the week I will take a blood screen, an amazing new tool in the genetics world that is offered to elderly mothers like myself.  The version of the screen I am taking is called the Panorama Test. It's kind of astounding really, because a lab is able to draw out the fetal cells in your blood and test them for downs, other trisomies and triploidies.  It has a 99% accuracy rate and will hopefully inform us that I am carrying a genetically healthy baby.  IF the test comes back with a positive (and there is still apparently a teeny-tiny chance that it could come back with a false positive) then I would have a CVS immediately afterwards.  If not, I could sit tight until 16 weeks, and top off my reassurance with an amnio if I choose (amnio is reportedly far safer than CVS, which does carry a small but real risk of miscarriage).  I will have the test performed around 9 weeks 4 days, and the results will come back 1-2 weeks later.  I have also scheduled a 12 week nuchal translucency scan to determine if there are any other potential defects we need to be aware of (e.g. heart defects).

The bottom line, is this:  assuming this baby continues to grow and thrive, I will know in about 3 weeks time, whether I need to start planning for maternity leave.  Whether we need to clear out our office to create a new bedroom.  Whether I can breathe again.

Tuesday, September 9, 2014

Pregnancy, continued.

Somewhere in the 8 week range (+2  or 3 days depending on the dating method).  Yesterday I attended a work-strategy meeting at a satellite office, far far away, catered with sandwiches and sides.  So what did this idiot do?  Oh, lookee here, pickles.  Great!  That's sure to go well.  A tuna sandwich (don't judge!), two bags of chips, two cups of lemonade and five pickles later I was going to cry in public.  My stomach was in knots. Sitting on a commuter train to return home I wondered if I was losing a fourth baby in such a public place.  Sure, technically anyone would be in an awful lot of pain after snarfing down such a lunch, but well, you know, this is me after all.  Eventually I made it home, safe and sound and according to my husband, looking fairly green.  I am happy to report that this morning a little ginger ale has made the world a better place.

In the meantime I am waiting for my OB, Dr. H to call me with a next step.  You know, I did actually try and reach out to that MFM last week but unfortunately, that didn't go so well.  As in, I couldn't even get my call past the fucking reception desk to schedule a consultation appointment. The lines of this practice were completely jammed - I would get put on hold and then I kept getting disconnected. Eventually, after about 15 minutes of waiting I wound up on the hospital switchboard, and the operator said "Oh, yeah, I will try to reconnect you but I warn you, they're having a lot of phone traffic." I got reconnected and then the phone just rang unanswered ten times.  So much for that plan.  While I know rationally that I should try to call again, this did not provide a good omen about this office.  I had flashbacks to the cluster-fuck that was my first OB's office (the nice people who gave me the wrong appointment time for my D&C). I mean, things shouldn't be this hard, right?

I've been trying so hard to not get emotionally attached to this pregnancy.  I realize that's an inane statement, it's impossible, I mean at the last check there was a baby growing inside of me... yet, that was a few days ago.  It's so tenuous. Each additional day of nausea, fatigue, and the ridiculous crying from youtube videos because I am a hormonal basket-case, makes this so much harder.  I feel like someone with a personality disorder.  It's like, a sliver of me laughs and works and goes about my day with a little extra joy in my heart and a little extra spring in my step, wondering about the possibilities for the future. Calculating rough benchmarks on the calendar.  Imagining what steps need to be taken to make a new nursery in our home.  Daydreaming about baby names and maternity clothes. Doing all of the things that a "normal" pregnant woman does.

But right next to that sliver of a personality exists another self.... an anxious creepy soul who bites her nails while silently waiting for the bottom to fall out from under her.  "Don't plan," she whispers. "Don't fall in love with this dream.  The dreams have a way of turning into nightmares, you know."

Thursday, September 4, 2014

We live to see another day

There is still a living baby inside of my uterus.  Measuring 7 weeks 4 days, with a heart rate of 166bpm.

I have to call that MFM after all.

Tuesday, September 2, 2014

Hedging Bets.

I am somewhere just past the 7-week mark. I am mainlining ginger-ale.  I am exhausted.  I feel nauseous.  Just the sheer thought of certain foods makes me want to barf. The smallest daily activities -the stairs in my home, walking Niblet to school -  feel like swimming through sand. Actually swimming at our pool felt like swimming through sand.  I have no clue how I survived teaching two zumba classes this past weekend without keeling over in front of my students.

This pregnancy is packing so much more of a wallop on me physically than the last two.  And it will be so much harder to lose if this one goes the way of the last three.

Getting through the day without building up dreams and emotional attachments to whatever has attached itself to the lining of my uterus, challenging.  And I recognize the sheer fucked-up-edness of that sentence. I mean I should be able to use actual words here.  There's a baby inside of me right now.  Last we looked, it had a heartbeat.  My pants are getting tight.  I am actually stressing about what to wear to a wedding in two weeks because if I make it that far, I could be showing by then,  Sweet Jesus. 

Our next scan is on Thursday.  I just don't want to imagine any of the possibilities, they stop me in my tracks.  But I have to steel myself to the possibility that this baby could be dead.  I know that sentence makes many people uncomfortable.  Hell, it makes me uncomfortable.  "Be happy, you're pregnant now" the world screams ("Pregnant until proven otherwise" aka "PUPO" - a popular acronym among ladies who are ttc that I find less than confidence building).  Of course I'm happy.  Absolutely, I am pregnant now.  But ignoring the possibility that this baby could die would do me far more of a disservice.  I have to face this thing with honesty.  Is there are strong chance that after seeing a heartbeat and feeling as sick as I do that I am carrying a healthy baby?  Sure.  But does the possibility remain that I could be in that "small percentage" where the healthy baby is elusive?  Absolutely.  Everything I read suggests that at my age, with my RPL history, I have about 80% odds of carrying a sibling to term for Niblet.  But 20% is nothing to fuck with, and it's certainly not a small percentage.  It's real, and I have to acknowledge that 20% with honesty in order to survive this experience.

My acupuncturist has raised a legitimate question as to whether I should see a high-risk OB or MFM (Maternal Fetal Medicine) specialist.  The fact that my OB didn't have much familiarity with Partial Molar Pregnancies was troubling.  The amount of surgeries my sad little cervix has been through is troubling.  My age and repeat pregnancy loss history is troubling.  Reproductively, I'm a fucking blues song.

Through my vast network of online friends, I have identified a potentially good doctor to call, an MFM recommended to me by a fellow Asherman's, RPL and AMA traveler.   I suppose I'll call and ask to speak with her, or her nurse, and inquire whether my history warrants being under her care....though I'll only even consider it after my scan this week.  Because there may be no reason to.

It's sort of empowering to be able to take your medical care into your hands.  I have met so many women in my online communities, trapped in HMOs, or living in countries with so many wait-lists and restrictions to specialized care.  I should be jumping for joy that under my insurance, I can just call a doc and say "Hey, Doc, should I be your patient?  Can I be your patient?"  (Railing against the human exploitation that is often driven by my country's free market is something of a way of life in my career.  But make no mistake about it, I am incredibly grateful for my access to the kind of specialized care I have come to need on this road.)

And no, I haven't yet cancelled my appointment for September 15th with Dr. K, that supposedly great new RE who doesn't discriminate against High-FSH patients, and would advise me on next fertility steps.  Yes, I'm really hedging my bets on that one. 

Wow.  My next scan is going to be a doozy in terms of life planning, isn't it.