Mile 11

Today is 34 weeks!  We made it to our first goal!!!  The count down is on now!  We will have a baby in 21 days or less!!! (As long as nothing in my labs change before then)  I will find out our exact delivery date tomorrow at my doctor's appointment.

Today, my emotions have been in full force.  Everything is making me cry.  Even the good stuff!  Maybe it's everything that I've experienced, all built up. 

I started thinking about this pregnancy and comparing it to my half marathon that I ran almost a year ago.  I've made it to Mile 11.  Less than a 5k left.  I've already ran over 3 5k's so far in this race... surely I have one more left in me.

Everyone has told me, all along, how good I am doing through this pregnancy.  I truly appreciate those comments, but honestly, until today, I haven't felt like I've done much.  Other than research, try to stay positive and try to hold myself together, I felt like I haven't done anything.  I felt like I can't make my body do what it needs to do for this baby.  But today, those thoughts have changed.  I HAVE researched and tried to do everything possible that is best for this baby.  I HAVE held it together.  I HAVE learned strength and patience and perseverance through this pregnancy, although I thought I already had plenty of each.  I have made it to Mile 11 of this race.

I say Mile 11, because I remember my half marathon like it was just yesterday, even though it was almost a year ago.  You can read all of my lengthy details of my race recap in my old blog here.   At Mile 11, I knew I was almost at the end.  We came upon this older lady that was singing out loud.  She apologized for being crazy and singing but said it helped her.  My friend, Shannon, told her that she liked her singing, and the woman broke out into "We Are the Champions."  It was such a powerful few moments of the race.  We joined in signing with her.  Right around that point, we rounded our last corner and knew we were on the last stretch of the race, and it was all straight ahead from there.

I thought about this comparison with this pregnancy today while I was in the shower.  I sang, "We Are the Champions" and cried all at the same time.  I have made it this far!  We're not sure how many more days we will make it... We're hoping for between 36 and 37 weeks, but we've made it this far!  I don't know if this race will end at 37 weeks or sooner, but I've made it to the ever gratifying Mile 11!

We will have a baby in 21 days or less, and as excited as I am, it still seems very surreal at times.  I want him to stay in as long as possible, but I'm ready to meet this sweet boy!  Our end is just up ahead.

Hotel Hospital

Patience is a virtue... or some crap like that!  I've said this before, and I'll say it again.  I've always heard that you shouldn't pray for patience because God doesn't grant patience; he gives you trials to build patience.  Well... God, that wasn't me!!!  Wrong person!!!  I didn't pray for patience!

But, wow, has this pregnancy tried to teach me patience!  Maybe that means I'm going to need more than what I had once Tristan gets here.  I'm gonna have my hands full!  Haha!

So, I had my regular 2nd doctor's appointment of the week on Friday.  Things were looking good, until they took my blood pressure.  It was 154/105.  Not good.  They don't like for the bottom number to be over 100.  The nurse said she would re-take it at the end of my non-stress test and see if it had gone down.  Nope, 154/114.  I knew it had been up since last weekend, but I hadn't seen it this high, and it hasn't been this high at any of my appointments.  So, after seeing Tanya, she told me to go home, grab some lunch and my stuff, and come on back to the hospital.  I asked if this was for the duration of the pregnancy, or just a day or two.  She said she didn't know.

When I got here on Friday, the gave me a gown and a cloth to wipe my belly, just in case I had to have a c-section.  Wow...it got real.  I mean, I've known the whole time that this was an option... but I wasn't planning on it right then.  Sometimes, even though I feel Tristan move, and see my belly getting big, and the nursery is (mostly) ready, it is still very surreal that very soon, we will have a baby.  Some fear set in right then.

Once I got settled, they drew blood for the bile acid test.  This is one of the most important ones with cholestasis.  We had already done regular labs at the office that morning.  They hooked me up to monitors to keep an eye on Tristan's heart rate, and they started me on a low dose of blood pressure medicine.  Then, we waited for lab results.  And waited, and waited.  Oh, by the way, my wonderful friend, Marissa gave me this tip... if you're in the hospital for any amount of time, ask for the egg crate thing for the mattress!  It really does help!  She was a life saver!

Saturday was spent mostly waiting.  I saw Dr. Taavon Saturday morning, but he didn't really have anything to update me on.  Through Saturday, they noticed the bp meds were working too well and my bp was getting too low, so I think they lessened how much they were giving me.  We THOUGHT we would have bile acid results back and that we would get to see Tanya to hopefully discuss our plan.  More of that patience building on Saturday.  My dad and his girlfriend, and our cousin came to visit on Saturday (although I didn't get to see her, because she brought her 18 month old with her and they wouldn't let her in due to flu season), but it was otherwise fairly uneventful.  We did finally get called down for an ultrasound, which I THOUGHT was going to be our growth ultrasound.  The tech was clueless.  I may or may not have called her Wack-a-do.  I hate to be mean, but I seriously don't know if she could have told me her name if I had asked her to.  I asked if she could give me his foot measurement, because there is a correlation between the length of the foot and the length of the femur in the leg, in skeletal dysplaisas.  She didn't know how to measure the foot.  Then she said that I wasn't there for a growth ultrasound.  She called Tanya to double check.  Tanya WAS going to have her do all measurements, but when she told Tanya that she had never measured arm bones and wasn't sure how to, but she could try... Tanya just told her never mind.  So, hopefully today (Monday) I will get to see the specialists again and get the growth ultrasound done.

I finally got to put real clothes on Saturday evening, instead of the raincoat gown they gave me on Friday.  It is supposed to be a moisture wicking material that removes the sweat from your body.  Obviously, whoever made those has never been a runner or any type of athlete that actually wears moisture wicking materials.  That thing was TERRIBLE!!!  It made me sweat like a pig and it felt like a shower curtain.  I also got to take these lovely compression leggings off, except for when I sleep.  They are hot too!

Super Bowl Sunday... spent in the hospital.  Not exactly how we had planned it.  We finally got the bile acid results back.  They were at 25.  Anything over 10 is high, but mine have been in the 40's before.  However, these were taken on Friday, so it could have changed.  And my itching has increased tremendously.  I seriously wanted to claw my skin off at one point.  They gave me something similar to benadryl for the itching.  Tanya said there's nothing that really helps with it, but it would make me sleepy and if I slept, hopefully it would take my mind off of the itching. 

This came with my lunch!

Tristan got his first football!  Now I have to save it for him and tell him the story of how he got it.  I mean, dang, I would have just bought him a football if that's what he wanted! :)

Dr. Taavon and Tanya both came by yesterday.  Since they have had Tristan on the monitors, they noticed he is having long periods without as much acceleration as they would like.  Tanya said that typically babies around his age sleep for about 45 minutes at a time.  His hear rate is remaining steady and very good, they are just seeing periods of 3-5 hours without a lot of movement and acceleration.  This could just be his normal pattern, or it could be caused by the cholestasis.  It's another one of those things that we just don't know.  They want to watch him a little longer because of it though. 

This part is scary to me, because they know that decreased fetal movement COULD mean that the cholestasis is getting to a dangerous level.  So could increased itching and increased bile acids.  But, Tanya said that so much of that is NOT measurable.  Like, how much did people's itching increase?  And it's all relative.  So, being here has sucked, but I'm glad that they are keeping such a close eye on Tristan.

My bp jumped yesterday afternoon to 137/99, and this is with me on the meds.  So, I'm not sure what Tanya will say about that today.

We did still have our Super Bowl food last night! :)  Rocky went out and bought spring rolls for us to share, wings for him, and grilled chicken strips with wing sauce on the side for me.  We watched the game in the room and he stayed with me again.  He has truly been wonderful throughout this whole experience.  He has taken excellent care of me and made sure that I didn't need or want anything at any time.  I told him if he's as good of a daddy as he is a husband, we're going to be alright!

I woke up early with him this morning.  He had to get ready and go into work, at least for a little while, since he had to leave early on Friday too.  He has a few things he has to get done and then plans on coming back.  And with as much waiting as we've had to do so far, I told him I'm sure it will be a while before we know anything today anyway.  There is a possibility that we MAY go home today... but then again, they could continue to keep me here for monitoring.  Like I said, it sucks being here, but I know they're keeping an eye on the baby, and knowing that he is okay gives me a peace of mind.  I think they're going to do more labs today, and HOPEFULLY get the growth ultrasound done, so maybe we can develop a plan and know what the future holds for us.  We'll be 34 weeks on Wednesday.  That's been our first goal for a while now.  Ultimately, we would like to make it to 37 weeks, but we're not sure if my body is going to cooperate.  Dr. Taavon said that if we have him at any point now, it will be certain NICU time for Tristan, but it's not a life or death situation.  He's okay with how far we've made it, although we're happy with each day that we make it a little further.

So, all weekend I've been trying to give updates, and people have been asking, but there really isn't but so much that we have to update people on.  So much of it is wait and see, and things could literally change at any point depending on test results and the monitoring.  We have received an outpouring of love, support and prayers through this time and through this whole pregnancy.  That really means so much to Rocky, Tristan and me. 

Baby Maybe?

Well, tomorrow could be hospital day. 

I'll get back to that in just a second.  I haven't updated in a little while, because most of everything has been "wait and see."  I've had a few mentally and emotionally tough days over the past week or two.  I've had quite a bit of anxiety, about nothing in particular, and about everything. 

We had our shower this past Saturday.  It was great!  I had planned to include pictures, but I haven't had a chance to upload them, and tonight has been filled with more important things.

Like packing my bags for the hospital.  I had my first bi-weekly appointment today.  I knew last week that my labs weren't looking so great.  My numbers that need to be up are down, and the ones that need to be down are up.  My platelets are dropping, my bile acids and blood pressure are rising.  Tanya wants to see how today's labs come back before making a decision tomorrow, but we're getting to the point of needing continuous monitoring.  She prefers to err on the side of caution, and with the cholestasis (liver stuff), the risk of still birth is increased.  And we don't want to take any chances. 

She said if we make it to 34 weeks (next Wednesday), in her opinion, we're golden... if we make it to 35 weeks, that's icing on the cake, and she said if we make it to 36 weeks, we get sprinkles and a candle too!  So, I'm still aiming for that candle!  But the time in between may just be spent at the hospital. 

We still don't have a definite answer from the specialist, and she doesn't think we will without an amnio, before T's birth.  If it IS some type of skeletal dysplasia, a natural delivery could put him at a greater risk for neurological damages.  So, Rocky and I have discussed (and Tanya is in agreement), that we will probably opt for a c-section, regardless of the next growth ultrasound findings, just to keep Tristan away from any unnecessary risks.  We want a healthy baby and a healthy mommy. 

So for tonight, I'm packing my bags and waiting to see what tomorrow holds. 

And The Specialist Says...

They're still not very concerned.  This is great news!

Rocky says I can't accept good news, though.  That's not it at all.  I don't want to get my hopes up.  His long bones are still measuring short... and they've fallen further behind than they were at the last appointment.  The doctor (a different one this time) said that Tristan isn't displaying other signs of skeletal dysplasia.  My concern, though, is what is making his measurements short?  Can they really be that far behind if he's just going to be a not tall person?  His head is measuring in a "normal" range and most of his short bones are "normal" too, so it looks like it's just his long bones that are small... not everything overall.  And they're not concerned with IUGR, as my fluid level looks good, the placenta and umbilical cord look good, and the flow of nutrients and blood to and from him all looks good.

At the December appointment and today, his femurs are measuring less than the 3rd percentile, and all other long bones less than 5th percentile.  In December, his bone measurements ranged from 1w2d behind to 3w6d, with most of them falling around 2.5-3 weeks behind.

Today, his bone measurements range from 1w3d behind to 4w5d behind, with most of them falling around 3.5-4.5 weeks behind.

It just doesn't make sense to me.

I want good news.  I need good news.  I'm ready for good news.  It just doesn't logically make sense in my mind.  How can they be that far behind and still be "normal"?

The doctor made a follow up appointment for 4 weeks, but I'm not even sure if I'll still be pregnant at that point.  He did tell me that some children aren't diagnosed until birth, or even later on down the road.  I'm going to discuss all of this with my regular doctor Monday and get her input.  

Good news that I will accept is that he is weighing in right at 3 pounds!  Grow, Tristan, grow!  

Hormones and Doctor's Appointments

I seem to have an abundance of both of those these days.

My hormones and emotions seem to be out of control these days.  My mood goes from one end of the spectrum to the other, in the matter of minutes.  So, I go from feeling great and like I can handle anything that is coming my way, to not knowing what in the world to do or which direction to turn.  Thank you, pregnancy!

 I had my first appointment of the week today.  Last week, everything looked fairly stable.  Well, things change quickly!  My doc confirmed that I have cholestasis.  My bile acid levels have jumped quite a bit.  In normal pregnancy, they are between 1 and 10.  When they first checked mine, it was around 13.4... the last one came back in the 40s.  From what I've read, if it gets above 100, they take the baby.  She said it doesn't look like we'll make it to 37 weeks, and that 34 is our goal now.  I'll be 31 weeks on Wednesday.  My blood pressure is up and down.  We'll wait to see what the specialist says and to see if it gets to a point where it stays up before we try meds, because that could affect the baby's measurements. 

Tanya said that it's not enough to admit me today, and as long as my labs don't come back showing anything crazy, we'll see what the specialist says on Thursday, and see where we stand on Monday.  It's literally a day by day process now. 

On a happy note, here's a few pictures of my sweet Tristan!

Kissing his biceps:

All that working out makes him tired:

Oh, how I love my sweet boy!

So, What Is it?

Another afternoon in the doctor's office.  And apparently, I'll be spending a lot of my time there.  They did a non-stress test (nst) on the baby, an ultrasound to measure fluid levels and then we waited to see Tanya.
She said everything with him looks beautiful, based on the nst.  His heart rate is good and the fluid levels are still good.

Based on all of my labs, she thinks I'm developing both pre-eclampsia and intrahepatic cholestasis of pregnancy (icp).  ICP is a pregnancy related liver disease and pre-e is basically elevated blood pressure that can lead to much more serious things.  Those are my own personal medical definitions of each, so take that for what it's worth.  It's very rare for someone to develop both of those simultaneously in pregnancy.  Also, I'm still quite early in my pregnancy to begin experiencing these symptoms.  The biggest risk of ICP is stillbirth, and that is usually related to elevated bile acids, later in the pregnancy.  Mine are already starting to elevate.  She prescribed me a medicine to help my body eliminate the bile acids, since my liver isn't doing a good job of that on it's own.  I'm 29 weeks 2 days, today.  They don't let people with ICP go past 37 weeks, to prevent stillbirth.

So, if we make it to 37 weeks, we'll be doing fantastic.  She said she predicts something more along the lines of 34 weeks though.  So, we're probably having a February baby.  His due date is March 19.  Monday and Tuesday I will do steroid shots to help develop his lungs.  It takes 48 hours for the steroids to work, so after Thursday, he will be "ready" for delivery at any time.  As ready as we can make him, I guess.  She said that a baby at 32 weeks with the steroid shots can do as well as a baby at 34 or 36 weeks without them.  We're trying to prevent NICU and ventilator time.  We may do another round of steroids later, depending on how everything goes.  With the steroids, we have to watch my sugar, because it can make that go up.

I will see Tanya twice a week from now on.  We will do weekly nst's and ultrasounds to monitor his growth and fluid levels.  We will do labs at least weekly.  If at any point, any of my lab levels shoot up, she will admit me to the hospital, until delivery- how ever long that may be.  She also gave me a few symptoms to look out for and to call her immediately if I experience.  Next week will be my last week of work until after delivery.  

We still don't know what's going on with his long bone growth.  She's hoping my follow up with Dr. Decker (the specialist) on the 17th will give us more insight there.  IF Dr. Decker isn't concerned and if he doesn't show frontal bossing and increased chest size (both typical, but not ALWAYS seen in achondroplasia) and IF I make it to 37 weeks, I can still try for a vaginal delivery.  But if any of those things should go awry, it's a c-section for us.

It's been quite a bit to take in.  However, I feel like I'm in good hands, and they are doing a good job monitoring everything very closely.  At least now, we know what we're looking at and what we can do to keep both me and him as healthy as possible.  And that gives me a little peace of mind.  Things could change at literally any minute, but right now, we're good, and I'm good with that.

Thank you for all of your thoughts and prayers!  Keep them coming!  We've got a baby to keep cooking for as long as we can! 

Seriously?! You've got to be kidding right now!

Yep, that's how I feel. I hate to sound like I'm complaining or always writing about the bad stuff. But, damn! Just damn! I'm almost at my breaking point today. 

I took my 24 hour urine collection to the doctor's office and they drew more blood. 

Then, the nurse called to tell me that Tanya (my doc) had sent me a message on the patient portal system, but I hadn't gotten it yet. 

Here's Tanya's message: 

Bridgette

Your liver enzymes are stable but still remain elevated - other testing for preeclampsia is still normal range. It does not exclude this as a developing condition - so we need to recheck labs often. I mentioned to you that I added an additional test called bile acids to check for another possible cause of your liver enzymes being elevated. That test came back today elevated to 13.5. 

I had Dr Taavon review all of your results and we are working on a plan for you as I am typing. I will send a copy of all of your labs to Dr Decker as well. It may help her differentiate the differences in measurements knowing that you have more than one thing going on that affects fetal growth. I want to see you tomorrow to discuss all of this and formulate a plan - too complicated to do via email.

One of the nurses is working on an appointment for you tomorrow - I want to do another ultrasound to look at fluid volume and a non-stress test for a baseline on your baby's heartrate patterns. I will send another message when we have a time for you.

Have you started your 24 hour urine test yet??

Tanya

On the phone, the nurse told me that Tanya is going to do further testing to see if I have Intrahepatic Cholestasis of Pregnancy. This is basically a pregnancy related liver disease. From my dear friend, Google, I've learned that the greatest risk of this is stillbirth. So, maybe  no pre-eclampsia (although we can't rule it out just yet)- yay... But now this??? 

I'm trying to look at the positive side if things and be hopeful that all of the testing will give us further insight as to what is going on with his growth, and thankful that we have caught all of this, whatever it may be, early enough and that they are keeping a good check on him. 

So until tomorrow afternoon, I wait some more.