/ The RE's Muse: December 2004

The RE's Muse

After 4 years of infertility, 2 surgeries, 1 miscarriage, and 19 months of high risk pregnancies, hubby and I now have two little women in our lives--one a toddler, the other not far behind. Buckle your seatbelts, it's gonna be a wild ride.

Monday, December 27, 2004

Consider me counseled and other holiday news

Well, we went public Christmas eve, the 12 week mark. The night found us at SIL's for dinner with family and before we sat down to eat, A and I passed out everyone's holiday cards. Tucked behind each holiday card in the envelope was a second card--one of those holiday photo holder cards--with a recent ultrasound photo in the photo slot and the inside inscription read "Happy holidays...Love, A, Dee, and baby Dee (due 7/8/05)." To say the reaction was surprise was an understatement.

The entire scenario was v funny--especially since not everyone opened their cards at the same pace--which meant that a dear Aunt across the room cracked hers first and then loudly proclaimed, "A baby!" To which my MIL, who had yet to open her card (protesting that it wasn't Christmas yet) said, "I heard that" and I replied "No, you didn't--now open your card!" And on it went...until finally everyone had opened, etc. My MIL, bless her sweet self, quietly cried at the counter and when my other SIL asked her why, she said it was b/c she wanted to know if it was okay to get excited about this one yet. I told her yes, though I myself am still working on that notion with every day that passes. And yesterday A and I invited her in to come hear the heartbeat when we listened in on the doppler. Generally speaking, a pretty good holiday weekend was had by all.

Then today was the appt with the genetic counselor. All in all, I think it went rather well. A couldn't join me as his first morning back in the office post-holiday was a hectic one so I went it alone. I figured this was one visit I could handle by myself since I likely wouldn't get any bad news. And you know what? I didn't...whew.

We basically went over my family's genetic history as well as A's. Went over my odds for Down's or trisomy 18 (1 in 212 or thereabouts for either) given my age. It seems that the biggest concern of the counselor's was my congenital adrenal hyperplasia (CAH), a recessive condition. We know I have it but we don't know if A has it--though the odds are extremely unlikely that he does. My condition affects about 1 in 30,000 people. So the counselor is going to check and see if there has been any development in the CAH arena as far as testing goes. The last time she had a patient with this condition--5 years ago--there was no known screening test for it. There may be now but she's not sure. If there is, A will be sent for the testing; if there's not, we wing it and test the baby once it's born (again with the optimism these people). The good news is that CAH is largely manageable and not a life-threatening condition.

I did again decline the amnio at this time. At last week's OB visit, I agreed to an Integrated Serum Screen test (a supposedly more accurate version of the standard triple screen test) and if that comes back abnormal--it correctly identifies about 80-85% of Down's and trisomy 18 babies--we'll reconsider the amnio. The counselor recommended the level II ultrasound at 18 weeks when they'll check the baby thoroughly for physical markers of potential problems. Another level II will also be done around 24 weeks for that same reason she said. If the integrated serum screen comes back normal, my odds for Down's, etc., drop to about 1 in 400-500. Simply put, the counselor said, there is a 99.5% chance the baby will be normal, .5% it won't. So we'll see what time tells us.

In other news, corny, yes, but that husband of mine can still manage to surprise me. I am a material girl...there I said it. There isn't much more I truly love for presents (birthdays, holidays, you name it) than jewelry. I don't know why, but I do.

Alas, A is largely anti-jewelry as he doesn't think the expense matches the value (this is the man who wanted to return the Tag Heuer watch I bought him as a gift a few years ago b/c it was "too expensive" and something he would never have bought for himself--yes, I told him, that's why it's called a gift. He ended up keeping it--besides he had wanted one for years.) So imagine my surprise when I opened my Christmas present from him to find a white gold Chopard heart ring. It is beautiful and was completely unexpected, and I like to think it symbolizes so much right now. I lurve it--and my SIL for telling him that it is what I wanted for Christmas (and for going and getting it for him since he is notoriously late in shopping every year). Note to self: must stop taking hormonal mood swings out on A; he loves me, bless his heart, even when I am a raging hose beast. That must be true love...either that or he likes pain.

I hope you each had a wonderful holiday...no matter what you did, where you were, what you got or didn't get. My 2005 wish for you is that the new year brings health, happiness, and your dreams come true...no matter what they may be. Oh, how I wish that....

Monday, December 20, 2004

Welcome...v byenvini...benvenuti

The welcome mat was rolled out this morning. The yard was trimmed--weeds freshly cut, siding cleaned, you name it. And just when Mrs. Hootchkins was lamenting the lack of recent visitors to her single family abode, along came Dr. Proscreen.

Yep, this morning another lucky fella got to have a look inside my nether regions and make my good lady's acquaintance. Today was regular OB visit #1 and things were remarkably normal.

I got to ride the speculum express for free, along with some bonus cultures thrown in for good measure. Oh, and let's not forget the complimentary two-fingered KY palp ride. Yessiree, a good time was definitely had by all. No ultrasound dammit--and given the plush office surroundings, my original idea to pitch a crying fit in order to get one suddenly was a no-go. But I did get a consolation prize: fetal doppler to hear Himorshe's heartbeat--which Dr. Proscreen pronounced as sounding 'great.' My reply to this news? "I'm just so glad it's still alive." Dr. Proscreen chuckled but A said I should have seen the look on his face--apparently the chuckle was peppered with a momentary "WTF?" expression on the good doc's face. Priceless A tells me. Hey, at least I was honest.

After being brought to third base (wink wink nod nod) by the good doc, I then had to give enough blood to supply a small bloodmobile. Which is what precipitated the doc's moniker. After the blood draw, we waited 40 minutes to see him (he had to run to the hospital next door to perform a c-section--scary that he was there and back to us in 40 minutes, don't you think?) and he proceeded to go over the screening tests that I'll have done and asked us what we were thinking about in terms of doing/not doing amnio, given my elderly primagravida state of 35 years. I was honest--at this time, the risk of miscarriage from amnio (1 in 250) simply is not worth it to me.

Yes, I understand I have a 1 in 350 chance of having a Down's syndrome baby, but I've waited 4 years to get to this point. So I told him I just didn't want to chance it at this time. He understood completely he said...but upon his pressing the issue (in a good-natured way, mind you), I did go on to clarify that if any of the screens came back abnormal, then I'd certainly reconsider my stance on the matter. And so it was agreed.

And that, dear friends, was the state of my uterine affairs this morning. Next week, the genetic counselor--who Dr. Proscreen presumes will tell me exactly the same things discussed today. The week after that, back to the peri--now christened Dr. Prevni (a shout out to her Creole heritage--prevni is the creole word for 'prevention' since she's all about preventing any complications I may be at risk for).

My next regular OB visit is in 4 weeks--when yet another stranger will make Mrs. Hootchkins' acquaintance. Apparently, the practice likes you to see a different doctor each time because that way you'll at least have had one chance to (hopefully) meet the doctor that will end up delivering your baby. Hold on a second, you mean these people really think that's gonna happen come early July? Wow...I like their thinking. Let me think about that novel concept....

Nah, too much for the time being. Now excuse me while I go online and rent me a fetal doppler--one can never have too much reassurance, especially when you're an elderly primagravida.

Wednesday, December 15, 2004


Nothing much going on around the Dee house these days and that's just fine by me (not even any puking, Toni--but I'm/we're sending lots of good wishes for your embies!). Nausea comes and goes but it's never for very long and I've managed to not retch yet (knock on wood). I've been tired but feeling good for the most part. Most days it's a struggle just to keep my eyes open until 9 p.m. and I'm still exhausted when my alarm goes off around 5:15 a.m.

The diabetic diet thing is going okay it seems. I'm still somewhat of a spaz when it comes to the finger pricking to check my blood sugar level but I imagine, like most everything else, I'll get better with time (kind of like sex or bicycle riding). So far my levels have been pretty steady. Tomorrow I fax my first set of recordings to the peri's office, then I move on to faxing them twice a week (Mondays and Thursdays) starting next week.

I'm coming up on 11 weeks Friday, meaning my former embryo is now officially a fetus (and since Florida is a southern state--though not truly 'southern'--does that mean I should change the fetus's nickname from 'himorshe' to Cletus?). BTW, yes, I am a dork, thank you for noticing.

My next OB appt is this coming Monday. I'm really hoping I'll get an ultrasound--in fact, I think I'm going to request one if it's not on the plan for that day. I'm hoping that if I remind them that I'm an IF patient, with a history of mc, maybe they'll take pity on me--but I'm also not above pitching a meltdown crying spell to see if that will work--is that wrong? If it doesn't work, hell--I'll offer to pay for it out of pocket--merry Xmas to me. It'd be money well spent so far as I see it: peace of mind is worth a lot to me these days though I haven't been having too many DBTs* recentlly.

Hell, lately A and I have even started tossing name ideas around (I won't bore you with the frontrunning choices--okay, since you asked, Juliana for a girl, Matthew, David, or Jack for a boy). As you can see, we're not exactly the most creative couple around...but please do feel free to share your favorites if you're so inclined (I promise not to steal, unless you're receptive to sharing). Don't get me wrong, I'm not counting my fetus before it's born. The fear is still there but it lets up just the teensiest bit with each day that dawns anew and I'm still pg. While the fear will probably never totally go away, perhaps it's nagging voice will get quieter as time passes...we'll see. Maybe Hope can do some good and tell that bitch Fear to pack her shit and get out, even though something tells me Fear's claiming squatter's rights and intends on sticking around these parts for a long time to come.

(*DBTs = dead baby thoughts)

Wednesday, December 08, 2004

Information overload

Today was my first appt with the high-risk OB and all I can say is 'ohmigoodness.' Really, the amount of info and such that I left there with was completely overwhelming.

First things first, all measured right on. The seahorse is still thriving, now measuring 3.2 cm (1 1/4 inches) and had its arm/hand up to its face and was moving all around. "Himorshe," as my SIL has christened the seahorse, is measuring slightly ahead at 10w1d. My cervix was long and closed, and everything else was good. Now for the not-as-good.

Because of my insulin resistance, I'm at a higher risk for developing gestational diabetes and given my mild hypertension, and I'm also at a higher risk for pre-eclampsia. So...I'm going to be monitored very closely--in conjunction with a regular OB in the practice who I'll see for the first time on the 20th. I will alternate seeing him every 4 weeks and the high-risk OB every 4 weeks so, essentially, the visits will be staggered between them. That means I'll be visiting an OB every two weeks up until my third trimester (given that I get that far) and then weekly from there.

This Sunday, I will begin a 24 hour urine test to check me for sugars, proteins, you name it. Monday finds me at the lab for multiple blood draws (to be done when I deliver my--no lie--big orange sealed 'vat' of 24 hour urine--that must be kept chilled during said 24 hours and delivered promptly at the end of time period). I can do that, no problem. It's the rest of it that gets tricky.

Now I'm not complaining but...wow, get a load of this:

Monday I am to begin a 2,000 calorie a day diabetic diet--even though I'm not diabetic (um, not yet is their thinking). I was given a plethora of papers, food guidelines, etc., to help guide me as I make bold steps into this new world. Oh joy.

But wait, there's more. Come Monday, I am also to begin checking my blood sugar (glucose) level with a glucometer four times a day--even though I am not (yet) diabetic. I will check it first thing in the morning and then 2 hours after breakfast, lunch, and dinner each day. So I then got a lesson in how to do the whole finger prick blood draw with the OneTouch meter. And I'm to fax my daily glucose levels to the diabetes coordinator at the OB's office on a weekly basis. My insurance company was called, notified of this development (meaning the doc told a little white lie that I have diabetes), and they are sending me my own OneTouch glucometer, EDA=Friday.

Oh, and because of our mc back in August, we get to meet with the genetic counselor in three weeks to go over our odds for potential anomalies in this pg. And help us determine if amnio, CVS, or whatever else will be right for us.

They're not fuckin' around at this practice, nosirree. And so come Monday, I'm not fuckin' around either. Diabetic diet--check; finger prick blood levels--check; doing whatever else I will need to do to help see this pg to term--check.

It's going to be a very long 8 months until July 8th. Here's hoping I make it that far.

Thursday, December 02, 2004

Cutting ties...kind of

Well, it's official. As of today, I am no longer Dr. Rub's patient. Sniff, sniff. I have been released to the perinatalogist, who I will see for the first time next week (moniker TBD then).

Today's u/s was lovely, really. Dr. Rub himself commandeered the dildo cam, and the first words out of his mouth about 10 seconds after insertion were "everything looks great; heartbeat looks great." How that man must have known how I needed to hear that; how hearing that meant I could keep breathing. He then turned the monitor toward me so I could see everything and commented that "It looks just like your husband," to which I replied, "Are you trying to say he (my husband) has a big head?" We shared a laugh and got down to stats.

I'm measuring a day ahead of my 8w6d. And in addition to seeing the heartbeat, we saw the umbilical cord as well as the pulse in the umbilical cord, which was pretty cool, for lack of any better descriptive terms for it. We also saw little arms and legs and a big head. All were incredible to see.

The perinatalogist practice that I'll be going to shares the office with Dr. Rub and his partners which means that I'll still get to see the staff and Rub as things (hopefully) keep progressing. Rub even said, "Oh good, I'll still get to see you." Then he went over to speak with the perinatal doc I'll be seeing next week. He wanted to know if she wanted me to stay on the prednisone I currently take (for the congenital adrenal hyperplasia) or if she preferred that I switch to dexamethasone. Dex crosses the placenta (unlike the prednisone) and better suppresses androgen levels--critical for sex organ formation if I'm carrying a girl, which we won't know for some time but apparently starts forming around 9w, so says Rub. Turns out the new doc does want me on the dex so Rub wrote me a new script and I begin that tonight; goodbye prednisone. And goodbye Rub...parting is such sweet sorrow. But I'll still get to see him and the wonderful girls in his front office--each of whom got a small parting gift from A and I today. Yes, I'm a suck up but it just seemed like we needed to say 'thanks' in some small token way. Small word...big meaning.

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