Ouch! Miss A Has Another Accident

When I was pregnant with Miss A, a male co-worker told me how his only goal when his daughter was born a year or so prior was to keep her alive. I laughed and commented that I hoped to aim a little bit higher than just "alive".

Now I'm beginning to understand the wisdom of his words.

Miss A is just shy of 26 months, and already she has had a broken wrist and now has had to have one of her top front teeth pulled. If she continues to have injuries at this pace, we are in for a heck of a time!

This latest mishap occurred last Wednesday afternoon, at day care. Apparently, she was running around and collided with another little kiddo. In the process of trying to recover from that, she tripped, fell, and slammed (and I do mean slammed) into one of the little tables they sit at to eat.

I arrived to pick her up just a couple minutes after it occurred. There is nothing that prepares you for having your child open his or her mouth and seeing blood-covered teeth pointing in directions that teeth should not be pointing in.

She must have hit the edge of the table at an angle, because one of her top front teeth remained all the way down, but the bottom of it was pushed back toward the back of her mouth to the degree that it popped out of its socket and could not be re-positioned and salvaged. The dentist said it risked becoming infected within a couple of days and that an infection would damage the adult teeth that are just starting to solidify from a gelatinous texture right above it, so we agreed that the best course of action was to remove it.

The tooth to the outside of that one seems to have been shoved back up into the gums a little bit. He said the nerve may die and the tooth may discolor, but he thinks she'll be able to keep it. The other front tooth should also survive the incident, but it will take a while to look normal again - it was pushed a fair ways up into the gums, and the bottom of it is pointing out a bit now, so that tooth seemed to move in the opposite direction of the other one.

Miss A's poor little face is also horribly bruised, mostly on the right side. (It was the right front tooth that had to come out.) She has a dark blue/gray line of bruising that runs literally from the corner of her eye where it meets her nose, down to the corner of her mouth. Then there's more bruising to the side of her mouth and on her chin. She's very fair-skinned, so the bruises show up even more than they would on someone with less pale skin. She literally looks like she's been beaten up. When we go out in public, I feel like having her wear a sign that says "My parents don't beat me, really they don't..."

The bruising was more than the dentist expected, so he had us take her to the pediatrician to confirm that she did not have any facial fractures. Thankfully, she didn't.

I have to hand it to Miss A, though - she is quite the trooper. She had a couple doses of Advil the night it happened and the next day, but other than that, she has not asked for any pain meds. She's had to adjust the way she eats and drinks, but she's figured out how to put food on her molars in the back of her mouth so that she can still chew them up. Fortunately we had started to transition her to drinking out of an open cup without a lid about a month before this happened. She is able to do that quite well with very little spilling, which is helpful since sucking on a straw is probably going to continue being too painful for at least another week or two.

In a few weeks, we'll go back to the dentist so that she can get an impression made for a cosmetic fix. I don't know exactly what it involves yet or how it works, but we'll find out more details then. The dentist said it would be okay to leave the gap where that tooth was until her adult tooth comes in 5-6 years from now, but I don't want to do that to her. Right now her 2-year-old friends don't know enough to tease her about it, but I could see that changing as she gets a little bit older.

Boys are supposed to be even more rambunctious than girls, so if this is what things are like with Miss A, I can't imagine what sorts of calamities we may have to deal with from Kiddo #2!

Speaking of, we had our most recent checkup today. I'm 27w3d, and Kiddo's estimated weight is 2.5 pounds. So trucking right along. Twice-a-week biophysical profiles/non-stress tests start at 32 weeks, and then things should move quickly from there.

We're in the neighborhood of about 10-11 weeks away from delivery if all goes smoothly. It still seems very far away, but I have a feeling it may pass quickly. Hard to believe!

Gestational Diabetes...Or Not?

Since I had gestational diabetes with Miss A, this time my doctor had me test during the 24th week.

I was hoping that maybe somehow this time it would be different. But not surprisingly, I failed again. Normally I'm a pretty good test-taker, but this is one that seems to have me beat.

Overall, my numbers were a bit better than they were with Miss A. Then again, I also tested 2 weeks earlier, and I realize that pregnant women's insulin resistance increases as pregnancy progresses, so who knows if my numbers still would have been better if I hadn't taken it earlier this time around.

I went straight for the 3-hour test, so that I wouldn't have to drink the stuff for the 1-hour, fail, and then drink it again for the 3-hour.

My fasting level was 97. In men and non-pregnant women, it's supposed to be 99 or less, but in pregnant women, they want to see it at 95 or less. So I was just slightly off. My 1-hour was the one that was most out of range - I think it was 214, and it's supposed to be 180-something. Then the 2-hour level is supposed to be 155 or less, and I was at 177. I don't know what the 3-hour level is supposed to be, but whatever it is, mine was in the normal range at 86.

I met with the nurse practitioner at my doctor's office on Friday afternoon to review what I need to do to test at home. I decided to eat the way I normally do this weekend so that I could see just how far off my numbers are when I'm eating like I typically do, rather than guzzling the equivalent of 2.5 cans of Coke in 5 minutes.

So far, it turns out that when I'm eating like I normally do, my levels are just fine.

My fasting has been at 91 both days, and most of the tests I've done 1 hour after the start of eating have been below the 2-hour limit. (The glucose level is supposed to be 140 or less after 1 hour and 120 or less after 2 hours. Most of mine have been less than 120 after just 1 hour.)

As I said, I know insulin resistance increases throughout pregnancy, so I will continue to monitor for the duration. With Little Miss, minor tweaks in my diet - making sure I was including an adequate amount of protein at each meal, mostly - was all that was necessary to keep my levels within range. Hopefully that will continue to hold true this time around.

Other than that, we're continuing to do great, aside from me being annoyed by the fact that I'm now (as of yesterday) 25 weeks and still don't look very big.

When I went to the lab to take the test, I was wearing my regular jeans and a regular shirt. The tech who was checking people in looked at me and said "You're pregnant??" even though it was all over my lab orders. (I also had lab orders for a couple of other things at the same time, and all of them referenced my pregnant state.)

And then my mom felt compelled to share this little gem the other morning. It's her version of a compliment: "You're doing really well. If someone didn't know you were pregnant, they'd just think you were fat, not pregnant." R choked on his smoothie.

I'm still trying to figure out how looking fat is better than looking pregnant...

Viability

Yesterday was 24 weeks, which is technically the edge of viability.

From what I've read, Kiddo has a 50/50 chance of survival at this point, and every day during the 24th-25th weeks increases those odds by 3-4% per day, then 2-3% per day during the 26th and 27th weeks.

In my usual fashion of not counting my kiddos before they hatch, I am still holding my breath a bit and cheering for every extra added chance of survival that each day brings. But overall, I'm more calm this time around, as evidenced in part by my lack of constant "dear God, please let this end well" posts.

We had the fetal echocardiogram last week to get a better look at Kiddo's heart, since Miss A was born with a couple of cardiac issues and R has Brugada Syndrome. Everything looked as expected, so barring the perinatologist's ultrasound tech suddenly seeing something obvious and unexpected between now and birth, we don't have to visit the cardiologist for this Kiddo again until 2 weeks after birth. At that point, they will do an EKG to see if any abnormal rhythm pattern indicative of Brugada's is appearing. My guess is that it won't, and that will be just the first of many EKGs to come for Kiddo, as it has been for Miss A. She gets her next EKG in a few weeks.

Next up - This week will be the gestational diabetes test. Since I had it with Miss A, I asked to just do the 3-hour version of the test and save myself the trouble of having to chug down the stuff you have to drink for it twice.

I hope all of you are having a lovely spring!

Happy 2nd birthday, Miss A!

Two years ago today, this amazing little girl entered our lives, and our world will never be the same.

Happy birthday, Miss A!

Anatomy Scan

We had the Kiddo's anatomy scan recently. Overall, everything looked good.

There is a 4-chamber heart, 3 vessels in the cord, 2 kidneys, and the brain looked good. The only thing that was kind of unusual was the ultrasound tech couldn't get a clear picture of the stomach.

She is the opposite of an alarmist - in all of our scans with Miss A and up until this point with Kiddo, she had never given even the tiniest, slightest hint of any concern. So I started to get nervous when she kept fixating on it. But then the peri looked and felt like she saw it clearly, and while she was looking, the ultrasound tech left the room to go look at the images from our past ultrasounds. She came back and reported that she found very clear images of the stomach on a couple of recent ultrasounds, so then she was satisfied, and I breathed a little easier.

Since Miss A was born with pulmonary valve stenosis, we'll have a fetal echocardiogram to get a closer look at this Kiddo's heart in mid-April. After that, the gestational diabetes test is planned for the end of April, at 24 weeks. The peri is ordering it a little early since I had it with Miss A.

Once we have the GD results back, we'll pick a day to schedule the C-section. The peri and I have not had an in-depth conversation about this, but I did bring it up at a high level a few appointments ago.

I talked about my concern that my water breaking with Miss A was actually likely a minor placental abruption, and my concern about being at even higher risk for it this time because of that history and because of the large SCH in the first trimester. Because GD, high blood pressure (which was actually very good at the last appointment - 111/64), and advanced maternal age can also all cause the placenta to start breaking down early, she was receptive to my concerns.

She wants the GD results before we pick a date because she wants to know if that is going to be an additional risk factor, but she actually seemed open to delivering during the 37th week. She prefers her singleton patients to wait until 39 weeks, and in an ideal world, I'd be all for that. But given that Miss A came at 38w0d on her own and the risk factors that I have, 39 weeks feels a bit unlikely to both of us.

I'm all for going as far into the 37th week as possible, but I really don't want to push it beyond 38 weeks. Call it mommy instincts, call it fear, but whatever it is, there is something inside me that feels like the 37th week is the safest option, and anything beyond 38 weeks feels risky.

But at this point, even 37 weeks feels like forever away. I'm 19w1d today. How is it that I'm not even at 20 weeks yet? It feels like I should be in the third trimester by now. Not that I'm impatient or anything...

So This Was My Friday...

The perinatologist's office must be updating the patient portal they recently implemented, because I received about a dozen - literally - e-mails from them today.

Most of them were appointment reminders, with a few appointment cancellations thrown in for good measure, all related to past appointments. Then came an e-mail titled "Important Health Information Message". It sounded, well, important...so I clicked on the link.

It told me that based on my most recent appointment on Tuesday, I have high blood pressure.

First of all - um, yeah, no surprise there, I've been on medication for that for more than a year. Second of all - thank you for taking the wind out of my "yea, my blood pressure is doing well!" sails. I was actually quite pleased about my reading on Tuesday (122/64), particularly given that I had forgotten to take my medication that morning and because it was my first ever peri appointment without R there. (He was at home with Miss A, who somehow came down with scarlet fever on Sunday night. She is doing much better now and is mostly recovered.)

About 15 minutes later came another "Important Health Information Message" e-mail. Having not learned my lesson from the first one, I clicked again.

It told me I was fat.

Well, not in those words exactly, but something about a BMI above 30 and obesity, and well, you get the picture.

"But, wait!" I wanted to tell it. "You don't understand! I was wearing tennis shoes. And jeans. And I had just eaten lunch. And drank a lot of water. So my number isn't really quite as dire as you're making it out to be."

Except that e-mail messages about your BMI don't really care about what shoes or clothes you're wearing, and what you just ate. In reality, I know I need to lose a good bit of weight. And as much as I wish they did, the shoes and clothes and even the late lunch don't add up to enough to move me down to below 30, into the overweight category instead.

A couple of hours later, a nurse from my PCP's office called. She was calling to follow up on whether I had gone for an ultrasound on my leg.

It's a long story which I won't bore you with, completely unrelated to the bulge on my other leg that I mentioned in my last post, and nothing I was worried about. I had tried to get the ultrasound a couple days ago, but when I got to the imaging center there was a mix-up and they wound up not being able to do it, and I hadn't gotten around to rescheduling yet.

The nurse asked if I could drop everything and go get the ultrasound this afternoon.

So I did, and as soon as the ultrasound tech put the wand on the spot, she said, "Oh, look at that - you have a lovely varicose vein!"

Normally, my age doesn't bother me much. But today, after that little pronouncement, I'm feeling a bit middle-aged for the first time.

Then when we got home tonight after picking Miss A up from day care, I opened the mail. I had asked R last month if we had paid the December IVIG bill, and he said yes. It turned out we had paid the November one but not the December one. We owe more than $4,200.

So now I'm feeling middle-aged and financially broke.

But Kiddo's heart was still beating strong and he was wiggling around on Tuesday. And Miss A is on the mend, spends her weekdays in a wonderful day care where all the teachers truly care about her and where she loves hanging out with her little friends, and she continues to amaze us every day.

So overall, even middle-aged and financially in a major hole, life is still very, very good.

It Wasn't Amniotic Fluid

Thank you all for your comments and concern. Kiddo is doing well - he was moving around when we checked on him on Monday, and the ultrasound tech said there was plenty of amniotic fluid.

Apparently it really was just sweat. It didn't happen again to anything nearly that degree, so I wasn't too worried by Monday. I'm probably going to have to get used to it happening though, because I'm not due until August, and I live in a place where we're going to have 100-degree-plus temperatures long before then.

I apologize for the silence. I've gotten into my head again and gotten freaked out about something, so I've been ruminating on that for the past several days. I won't go into great detail, because I'm sick of me being in what seems to be a perpetually worried state about something, so I can't imagine how tired you guys are of hearing about it. I had been doing pretty well with the health anxiety, but it seems to have returned in full force lately.

Suffice it to say that I have what is best described as a bulge above my knee. (I'm not calling it a lump, because I can't feel a distinct mass - it feels more like the muscle is enlarged.) I've shown it to the perinatologist, and my PCP has ordered an MRI, which I will be getting on Wednesday. Odds, of course, are that it's nothing serious. However, I Googled "lump on quadriceps" and "bulge on thigh", and that was a mistake, because very scary things came up. Hence, the ruminating.

This is Hard (And, Gender Revealed)

The roller coaster continues.

Things looked great at our most recent appointment on Thursday afternoon. This afternoon, I wound up having to page the doctor on call because I'm concerned I may be leaking amniotic fluid. The doctor is concerned enough that she is having me come back in on Monday morning.

First, our Thursday appointment - Kiddo looked good, and was moving around and active. It is amazing how arms and legs go from being little stubs to looking like they are one long bone to two bones with a connecting joint in between, all in just a few brief weeks. The growth is amazing.

Arms and legs weren't the only thing we were able to see. Kiddo cooperated with giving us good views this week, and I was brave, so we found out.

We (ok, I) told a couple of people, but overall, we're still holding off on telling most people in our offline world, including our parents. But all of you have been so great at holding my hand, and I trust you to keep the secret, so:

Kiddo is a boy!

We knew that we had either 8 or 9 male embryos left, and only 3 or 4 females. So it wasn't really a surprise, more of a confirmation of what we expected.

If you're sensing a lack of enthusiasm in my words, please know that it has nothing to do with Kiddo himself. It's just that every time I start to let myself relax a little, things get scary again. And we still have a really long way to go since today is only 15 weeks. I'm just tired. Tired of this being so hard.

I finished weaning from progesterone last weekend. My levels had been in the upper 20s. It was rechecked on Thursday, and I got the results yesterday - 19.7. The clinic prefers it to be 20 or above, but the nurse said 19.7 was close enough and that I was officially released from their care.

With Miss A, my numbers were slightly lower and the reproductive immunologist had me go back on the suppositories for a few weeks. I decided that since I was close to 20, I would not freak out about it but would just ask the RI for an order to recheck the level again at the beginning of next week.

I don't think that progesterone necessarily has anything to do with the potential issue that arose today. It's just one more thing, and I'm really ready to be done with "one more thing".

This afternoon, I laid down to take a nap, and I realized my jeans were wet. Not so wet that liquid could be wrung out of them, but definitely far more than damp. And it wasn't just one small spot, it was a couple inches down both of the inner thigh areas, too.

I've read that amniotic fluid has an ammonia-like smell. Whatever the fluid is, it didn't seem to smell like that, but it also didn't smell like urine.

I've also read that a subchorionic hematoma, especially a large one which is what mine was, can cause water to leak or break early. The doctor on call, who is the other doctor in the practice, confirmed that is true. She said that odds are it's not amniotic fluid leaking, but it could be.

She also said that I could go to the ER if I wanted, but that they would keep me in the ER and not send me to L&D since I'm not yet 20 weeks. She also mentioned that an ER ultrasound tech is unlikely to be able to tell us anything other than whether there's a heartbeat, because they are not as likely to be well versed in what a normal vs. abnormal level of amniotic fluid looks like. So I don't think we'll go to the ER unless I start to leak heavily or gush.

I know there are still a lot of reasons to be positive. This may not even be amniotic fluid at all.

I just want it to be July already, for Kiddo to be here, safe and healthy, in our arms.

'Believe in Good Things to Come'

An IRL friend who has been through IF and IVF sent me a text with that message today. Even after having Miss A and several encouraging ultrasounds with this pregnancy, sometimes I still need the reminder that this has the possibility of turning out well.

Today's ultrasound went well. Kiddo is continuing to grow on track. I decided to be brave and go ahead and find out the gender, since R wants to and he was so patient with waiting until 30 weeks with Miss A.

Kiddo did not cooperate in that plan, so we'll have to wait until next time.

Optimistic, Optimistic, and Just Plain Nervous

This post was going to be titled "Optimistic, Optimistic, and Nervously Optimistic." Apparently, the universe found that a bit too cocky.

We had another ultrasound and appointment yesterday. It went perfectly. And now, today, there is cramping and spotting. Mostly brown spotting, with maybe just a tiny bit of pink, but still. Spotting. And cramping with it. Sigh.

Yesterday was 11w6d. Kiddo's heartbeat was 160, and s/he measured exactly on track at 11w6d. We could see feet and hands at the ends of the legs and arms, could even mostly make out the individual fingers. The bones of the face were all very clear.

The nuchal fold measurements were all good, and the nasal bone was clearly present, making the chance of Down Syndrome pretty low, although since we had done CGH, we weren't particularly concerned about that anyway.

The ultrasound tech searched and searched, but she could not find a sign of the hematoma anywhere. Yea for that! She also announced that my placenta is mostly anterior, although it is not completely covering the right side, so she said to pay attention to the right side to feel movements when I get further along. (Apparently an anterior placenta makes it more difficult to feel movements.)

After the scan, we met with the peri. She said that with everything measuring right on track, looking good, and no sign of the hematoma, the risk of a loss at this point is low, and she is optimistic about this pregnancy. R is optimistic, too - he even wants to find out the gender as soon as we can this time around.

Realistically, I know I'm never going to be able to fully commit to boarding the "optimistic train" the way that they are, but I told R after our appointment that I am "nervously optimistic". For me, given our hisstory, I think that allowing myself to classify my outlook as "optimistic" this early on in the process, even if it is qualified with "nervously" in front of it, is still a huge leap ahead of where I was with Miss A's pregnancy.

Then this morning, Miss A and I had a playdate with a friend and her young son at an indoor jungle gym place. It's the first time we've been. I was on my feet a bit more than usual, keeping an eye on Miss A, since she was one of the littlest ones there. Toward the end of our visit, she wanted to go on some of the slides in the bigger kids area, so I had to slide with her. We were fine sliding multiple times on one of the open slides, but then I decided she might enjoy going down an enclosed slide. The only thing was, I had to hunch over a little, and as we went down, I felt a few stabbing pains.

I took it easy after that, and my friend took Miss A on the slides a few times so that I could sit down. We came home soon after, and everything seemed fine, so I didn't think anything more of it.

But then I went to the restroom and there was a tiny bit of brown spotting. And then the cramping started. It is mild and intermittent, but still, it is cramping, and you all know how I feel about that. And the amount of spotting seems to be increasing a little bit.

So now I am laying in bed, feeling every little twinge, and trying not to get up every 2 minutes to see if the spotting is increasing or turning to bright red.

I feel like there is no point in calling the peri, because all they are going to be able to tell me to do is what I am already doing - stay off my feet as much as possible and drink plenty of fluids. In the absence of bright red bleeding, I don't think there's any point in going to the ER, especially since we just had a scan yesterday.

So here we are, 12 weeks, and I'm back to just plain "nervous". It's going to be a very long 26-27 weeks if things continue like this...

Feeling Nervous

Apparently, 10 days is my limit between ultrasounds before I start to panic.

Nothing is super-obvious wrong, but I have been having some pelvic pains today that I don't totally like. The best way I can describe it is if I was in the 3rd or 4th week, I'd be thinking "Yea, maybe these are implantation pains!" and I'd be happy about them. But now, in the 11th week, I'm thinking, "Why am I feeling these pains now? What do they mean?" And I don't like that.

I called the peri's office. When I'm there in person, they always tell me I can come in early if I need extra reassurance, but when I call, the nurse usually finds a way to put me off unless there's a critical sign, like bright red bleeding, which thankfully there's not.

So the nurse told me to drink lots of water because she thinks I'm probably dehydrated and that's what's causing the pains, and call them back if bright red bleeding develops. Otherwise, they'll see me on Friday, which is still 84 or so hours away. Not that I'm counting or anything.

I tried the Doppler again over the weekend, but still no luck. I don't think that's necessarily a bad sign - I'm "fluffy" and I have a titled uterus, so I realize it may take a few more weeks (or longer) to start hearing it on there.

I want this to work. For the obvious reason, and also because I am really, really ready to be done with the infertility treatment phase of our lives.

Reprising my refrain from Miss A's pregnancy: Please, God, let this end well.

Double Digits

The most recent ultrasound was on Friday. Kiddo continues to measure 2 days ahead, the hematoma continues to remain the same size.

I was 9w6d on Friday, so assuming all is still well, we're officially in the double digits in terms of weeks.

Continuing with the trend of being more mellow this time around, I have not tried to break out the Doppler again. The ultrasound tech was able to do the ultrasound abdominally this last time, but barely, and their equipment is of course much more advanced than my $50 monitor.

It'll probably be at least a few more weeks before I'd be able to hear anything with it, other than the blood flow to my ovaries or uterus that I heard when I tried a few weeks ago. Since I hear the exact same thing on both sides and I know there's only one Kiddo in there, I know I'm not hearing fetal-related blood flow...

Since everything was looking stable, they gave me the option of having my next appointment in one week or two weeks. I opted to schedule for two weeks out. If it goes well, I may try to stick to that schedule, because with a toddler in the picture, it's just harder now to have weekly or more frequent appointments.

During Miss A's pregnancy, I think I only had one two-week interval between appointments and two 10-day intervals, and other than that, it was 1 or 2 appointments a week. So far I seem to be okay with it, but then again, it's only been 4 days. I may feel differently in another 4 days. :-)

And The Beat Goes On...

Somehow, amazingly, Kiddo still has a heartbeat.

It was 10 days between ultrasounds. I actually did pretty well with the wait - I'm a bit calmer with this pregnancy than I was with Miss A.

The heart rate was 183 bpm, which is great, and Kiddo is measuring 2 days ahead, at 9w1d. Out of all 8 pregnancies, there is only 1 other where we saw a heart beat as far along as 9 weeks, and that was the pregnancy with Miss A.

One wrinkle that came up is that I woke up yesterday really not feeling well. We saw the nurse practitioner after the ultrasound, and she thought I had the flu, so she prescribed Tamiflu. Miss A and R also started not feeling well, and today R got tested (the peri's office didn't have the rapid flu test), and he does indeed have the flu. So I'm pretty sure that's what Miss A and I have too. The nurse told R today that one of the main strains of flu going around wasn't included in this year's vaccine, so a lot of people are getting it even though they were vaccinated.

I have been working crazy hours since Tuesday, and I was supposed to work all weekend and all week next week, but the nurse practitioner said I need to rest, so she wrote a note for me to be off work "until further evaluation". She wants to see how I'm feeling and how things look during the next ultrasound next Friday.

It's pretty much the worst timing from a work perspective, but the baby's health has to come first. Thankfully, my boss is very understanding and supportive. My vice president is in town, and I have been working closely with him this week. I was supposed to meet with him on Monday.

I wasn't planning to inform him of the pregnancy unless I made it to 20 weeks, but my boss asked for permission to share my situation with him. She wants him to be clear that I'm not just flaking out of work for a minor cold, that the flu on top of a pregnancy with a serious complication becomes an even more serious situation.

Speaking of serious complication, the pesky hematoma is still there, and still unchanged in size. I was kind of surprised it wasn't smaller, because there continues to be blood every time I wipe. Now, every time I cough hard, there's a bit more bleeding. I just wish it would go away.

While I'm doing better (more calm) with this pregnancy, I'm still not close to being a "normal" patient. The peri's office doesn't even bother to try to schedule more than 1 appointment at a time for me - they just stick to scheduling the next appointment every time we're there. (Normally, if their patients are on a weekly or every-other-week schedule, they schedule about 4 weeks worth of appointments at a time.)

And I'm still refusing to look at the due date. It's listed on some of the ultrasound photos they give us, but I just hold my finger over that part of it. I know it's some time in August, because both of the ultrasound techs have forgotten after I've told them I don't want to know and started to say it. They said the month, but I managed to stop them before they got to the day. Given that Miss A's transfer was on July 13th and her EDD was March 30, since this Kiddo's transfer was on Nov. 21, I'm assuming the EDD is around the end of the first week of August, but I just don't want to know for sure yet.

18 Years (And Still Incubating, I Hope)

So the Christmas Eve ultrasound went well - Kiddo's heart rate was up to 150, and s/he was measuring 7w4d (one day ahead). The sac continued to look better, and the neural tube (where the spinal cord will grow) was visible as a thin black line in the middle of Kiddo's body.

Now I am counting down the hours to the next ultrasound, which is on Friday afternoon. It's about 64 hours away at this point. There's no reason to think anything is wrong, but I am nervous. There has been persistent brown blood almost every time I wipe, and occasionally a bit of pink, but no bright red since one week before Christmas. Most days, I've had mild nausea that usually starts around noon and lasts for most of the rest of the day.

So what's making me nervous? Well, I haven't been feeling as much round ligament pain or joint loosening the last couple of days. And I just don't feel as pregnant. I lost that "pregnant" feeling during the beginning of week 9 with pregnancy #4, and then we found out the following week that that Kiddo's heart had stopped beating during the 8th week. But then again, I also lost that "pregnant" feeling with Miss A during her 8th week, and she was still in there, heart beating strongly. My uterus is probably still too tilted to hear anything with the home Doppler that I have, so I've decided (so far - I could certainly cave at any point) not to torture myself by trying to use it.

In the meantime, plenty of other things have been keeping me occupied.

First of all was the magic of Christmas. It was wonderful with Miss A last year, but even better this year! She was able to tear the paper off her gifts much more easily, and she has several that she loved. We got her a set of traditional wooden blocks, and one of her favorite things to do is stack them high and then watch them fall over. It is the first time she has full-on belly laughed. Up until now, there have been lots and lots of giggles, but for some reason, the site of blocks falling over (even if it's just 2 or 3) brings out the biggest laugh that she has ever had. It is so much fun to experience that with her!

She also loves her little rider, complete with drum, horn, and keyboard. She rides it around the house, and we also try to go for a walk with her around the neighborhood whenever we can. It's great exercise for all of us. (And, selfishly, we always hope all that exercise leads to a long, deep nap afterward. :-) )

In addition to the holiday, the end of the year also brings our wedding anniversary. R has been putting up with me for 18 years now. We celebrated by going out to breakfast, then coming home and trying to clean up as much as possible. (These days, we've gotta take those rare opportunities when we get them!) After that, we went to a movie, which we haven't done since Miss A was born, and then out to dinner. Overall, it was a lovely day and a great chance to spend some time re-connecting one-on-one, even if it was while we were picking up the house.

The other thing that has been keeping me distracted and busy is work. We're getting ready to enter our busiest time of year tomorrow, so the last few weeks of December and first few weeks of January are always crazy busy, with an early start to the day once the year begins. (I'll be working on and off tomorrow, and starting work at 5 a.m. beginning on Thursday for the next couple of weeks.)

There have been a lot of interesting changes at work this year with a new team being formed, and figuring out how that new team will work with the existing teams, including the one that I am on. A couple of days before Christmas, one of my co-workers approached me with an offer to join the new team that has formed.

There are pros and cons to this. The particular offer she made to me is probably the only time I will get an offer like this in my career, so it warrants serious consideration. On the other hand, I feel like any time you make a transition to a new position, even if it's with a company you're already with and with colleagues you already work with, it requires stepping up your time/energy/effort commitment.

I have not talked with my co-worker about the Kiddo situation yet. We are meeting to discuss the offer some more on Friday before the ultrasound. I will probably wait to see how that goes before saying anything about it. It's still early, and I'd rather wait until the second trimester (early February) to share that news. But if I do wind up transitioning to the new team, I don't think I'll be able to wait that long. All of the colleagues I'd be working closely with are in another state, and I will need to explain that I can't travel to meet them.

We'll see what happens, both with Kiddo and with the job situation, in the new year. 2013 has been an incredible year. Here's hoping that 2014 is equally incredible, not only for us, but for all of you, especially those of you who are awaiting your miracles this coming year!

Still Incubating (7w0d)

Every time I start to think things are settling down, I wind up seeing a pinkish color that is closer to red than I am comfortable with. After a while, things turn back to brown, and the cycle seems to start over. So hopefully things won't change in a drastically negative way after I post this update...

We had ultrasound #3 yesterday morning. Thankfully, I have not passed any other large clots since Monday night, and the last truly, definitively, without-question-it's-bright-red-blood incident was Wednesday morning. So I knew the gestational sac was still in there, and I was hopeful there was still a heartbeat.

There was, and it's speeding up appropriately - 135 bpm. Growth is exactly on track, measuring 6w6d, which is what yesterday was.

It's amazing how much an embryo changes in such a short period of time. There was less than 94 hours between ultrasound #1 and ultrasound #3. At #1, the baby was measuring 0.66 cm and looked like an ever-so-slightly curved line attached to a circle (the yolk sac). By yesterday, it was 0.87 cm, it was obvious which end was the head and which end was the rump, and the ultrasound tech said she could see the brain beginning to form. Incredible.

That is one of the silver linings of all the infertility/pregnancy drama we have to endure - we get a view of our Kiddo's in utero development that few people ever get to experience. It is so amazing to witness it.

The gestational sac looked a bit better, too. Still not as perfectly shaped as I'd like to be comfortable, but not nearly as squished by the hematoma as it looked on Tuesday. The tech who did our ultrasound yesterday was the one who had done most of our ultrasounds with Miss A. She hadn't done the first two this week, but she said she looked at my images from Tuesday before calling us into her room, and she was very happy about the way the sac looked compared to Tuesday. She couldn't see much fluid in the sac on Tuesday, and that had concerned her.

To me, the hematoma still looked about the same size as it did on Tuesday, but R said he thought it looked smaller, and when the tech measured it, she said it had shrunk considerably, from 16 ml to 5 ml. (She measured the width and height, but gave me the volume measurement. I'm not sure why. The tech on Tuesday did the same thing.

Based on how that scan went, we decided to go ahead and do the next round of IVIG. It's scheduled for Monday at 4 p.m., and the next ultrasound is scheduled for the next morning, on Christmas Eve.

For now, we are just continuing to take things one day at a time, and I am trying to stay off my feet as much as possible. Today, I've been feeling some low-grade nausea all day, along with a slight sensitivity to smells. My progesterone and estrogen meds have not been increased, so I am hoping that is a sign that my body is starting to kick in with its own contribution of hormones. Whatever the reason, nausea always makes me so happy. (Especially low-grade, but I'd even be thrilled with the lay-in-front-of-the-toilet-all-day variety.)

R laughs when I get so excited about it, but what can I say? I love every moment that I feel pregnant. And since we can't exactly afford our own personal in-home ultrasound machine so that I can see visible proof of the pregnancy at all times, I'll gladly take nausea as some form of reassurance.

Not Feeling Confident About This

Ultrasound #2 wound up being this afternoon. As of now, I am still incubating, but we are not feeling great about the chances.

I wound up having a lot more bleeding last night. I knew at least some of the hematoma had evacuated, I just wasn't sure if it had taken the baby with it. Unfortunately, the RI says that I need another round of IVIG, so I wanted to make sure there was a reason to do it before we fork out another $4,000.

The heart rate had increased by 3, and there was a day's growth. So, yea for those things.

Unfortunately, not all of the clot had liquefied, and the part that is still in there is pressing on the gestational sac. From what I've read online, in general, SCH tends to increase risk of miscarriage to about 10 percent. But the peri gave us only 50/50 odds since the clot is taking up more than half of the uterine cavity. She thinks if this does not go our way, it will probably end within the next week.

The bleeding stopped by this afternoon, and I was hoping that would be the end of it, but bright red has shown up again, and I'm starting to feel pain again.

I know there is a chance this could still work out, and we're not discounting that. But on the other hand, because it is a large clot, that makes me a bit nervous about what our increased risks would be if this pregnancy does continue. Large SCHs tend to be associated with higher risk of placental abruption, PPROM, and pre-term labor.

The peri wanted us to still keep our Friday morning ultrasound appointment, although she said if something else significant happens between now and then, they will bring me in sooner. Without me even saying anything about it, she also said she wants to monitor me 2 or 3 times a week until this resolves, instead of the planned weekly appointment. I appreciate her concern, but honestly, at this point I know there's not really much that can be done other than wait and see. So unless I wind up in a situation again like last night, where I'm not sure I'm still pregnant, I may try to stick with weekly appointments.

R and I also decided to hold off on the IVIG for now. If this pregnancy ends, I don't think it will be because of lack of a second round of IVIG - it will be because of the hematoma. The RI's nurse said they believe IVIG can help heal SCH. I did some searching online, and the doctor's (Beer) thought was that elevated NK cells can contribute to hematomas. But the thing is, my NK levels and my T-reg levels were fine as of the most recent testing last week. The only thing that was elevated (34.7, when they want it to be below 30) was cytokines. And, I did a round of IVIG right before the transfer, and yet the SCH still developed, so I don't think IVIG is necessarily the solution to this particular hematoma.

So Much for 'Normal'

About that last post - everything uneventful, no bleeding, no staining. Yeah, not so much anymore.

The bright red bleeding started this morning, followed by back pain and general lower pelvic achiness. I called the perinatologist's office and got our first ultrasound moved up from Wednesday to today.

I was totally expecting bad news. So imagine my surprise when there was a heartbeat - 121 bpm at 6w2d, and the Kiddo measured at 6w3d.

I also knew as soon as I saw the ultrasound screen that there is a large subchorionic hematoma in there, too. It looked slightly larger than the gestational sac. The ultrasound tech said that the uterus is still small at this point, so it all looks close together, but the Kiddo is actually on one side of the uterus and the hematoma is on the other. So at least it's not right under it. I'm choosing to be thankful for that.

There's not really anything to do but stay as hydrated as possible and keep my feet up as much as possible, which is tough to do when the Little Miss is home. And right now she's feeling ill, so I think she's going to wind up being home all day tomorrow.

The next ultrasound is scheduled for Friday morning. I had a lot more bleeding this afternoon, so I don't know what the current state of things is, but there's no point in going in every day for ultrasounds - there's nothing anyone can really do but wait and see and pray.

I've said for a long time that I'd like three Kiddos. But if we are fortunate enough to wind up with two, it's very possible we may stop at that point. I forget how hard this is until I'm in the middle of it.

This is Bizarre

Today is 5w3d. I had blood drawn yesterday to check E2 and P4 levels. The results came in this afternoon: normal.

"Normal" is not what we normally experience. This feels very bizarre, surreal.

It's still very early. I've gotten this far before, only to have it fall apart. But so far, there has been no bleeding, and there hasn't even been any staining in the last couple of weeks.

The first ultrasound is scheduled for the afternoon of the 18th, which is a week from tomorrow. Assuming nothing starts to look wrong between now and then. That will be 6w4d, so if this is truly on track, a heartbeat should be visible at that point.

The perinatologist's office has a new receptionist. Everyone there is fantastic, they totally get all the mental stuff that IF inflicts on their patients. But I don't think the receptionist has much experience with that yet.

She asked who my ob was. I explained that I don't have one - Dr. H manages my entire pregnancy from start to finish. She insisted that I need a regular ob. I told her I would not go to one. She put me on hold, came back, and proceeded to schedule the appointment.

Then she asked when my last menstrual period was. I had to explain about the FET. I told her I would give her the LMP date, but only if she promised to not tell me what the estimated due date is. I told her that I know vaguely that it would be sometime next summer, and I don't want to know anything more specific than that at this point.

Then I brought up that I want the ultrasound tech who did my first ultrasound with Miss A to also do this first ultrasound. She explained that they don't schedule a specific ultrasound tech, only the doctor. I replied that I know that, and I still want that particular ultrasound tech to be the one to do it. She had to put me on hold again to confirm that the tech will be there that day. (She will.)

I swear I could hear the receptionist's eyes rolling skyward. I totally recognize that I give a whole new level of meaning to the words "difficult patient". And frankly, at this point, I don't care.

Emily Erin, since you don't have a blog that I can comment on to answer your question - We did the immune testing before this cycle. We had already decided that regardless of the testing, we would not do LIT again, even if it means never having another child. The situation at the border has changed significantly since we went 3 years ago. The process requires both of us to go, and we just weren't comfortable with the risk, given that Miss A is here now. Thankfully, the testing showed that we did not need LIT again.

It showed that I did need IVIG. While I was pregnant with Miss A, I had great insurance that covered it. Unfortunately, that insurance changed in June, and IVIG is no longer covered. However, we do feel that the immune treatments we did were what made the difference to result in success last time, so we paid out of pocket. It's expensive - the initial testing was about $1,300, the IVIG itself was $3,500 (I need to lose some weight - the amount is based on weight, and the cost is based on amount), the nursing fee for it was another $400, and the next round of testing, which I had drawn yesterday, was another $1,000.

I wound up doing 3 rounds of IVIG with Miss A. If they recommend that I do it again, we'll have to move some balances around on credit cards, but we'll do it. Assuming this all ends well and we try for a third child at some point, we may give it a try without IVIG and see what happens. Maybe if it works twice, my body will start to recognize that it's okay to allow kiddos to grow in there...

When I was pregnant with Miss A, eventually the monthly testing cost settled down to about $400, so hopefully we'll get to that point again soon. Between that, co-pays (I have to pay one every visit, because it's a perinatologist rather than a regular ob/gyn), co-insurance, and meds, the pregnancy with Miss A cost us about $1,000 per month out of pocket. Paying IVIG out of pocket, this one is going to average $1,500 to $2,500 per month, depending on how many rounds we wind up needing to do. That's $12,000 to $20,000 before the kiddo even arrives, assuming I go through 8 months of pregnancy like with Miss A. And that's not counting the cost of the transfer or travel for the transfer.

Tenants moved into our old house at the end of last month. Now we need the real estate market to keep improving at a healthy (not crazy, but healthy) rate for the next couple of years to have any hopes of paying all this stuff off...

2nd beta

I spent all day biting my nails, then got a call from the clinic at 5:45 p.m. saying they hadn't received the results yet from the local REs office where I had it drawn. Fortunately, I was able to get a hold of the local RE, and he was still in the office.

Beta #2: 329, a doubling time of about 41 hours. And P4 is up to 45. Yea!

Out of all 8 pregnancies, I believe these are the best beta numbers I've ever had. (With Miss A, the first beta was 2 points higher, but the second one didn't double.) It still doesn't feel real.

Assuming there are no concerning signs that appear in the meantime, the next steps are repeat E2 and P4 in a week, and then an ultrasound in a little more than 2 weeks. With Miss A's pregnancy, we wound up doing our first ultrasound on 6w0d. That would be a Saturday in this case, so we won't be doing it on that day. I'd like to hold out until 6w5d if possible this time around. We'll see what happens - that is still too far off to talk confidently about it. I likely won't even call the perinatologist's office to schedule it until about 1 week before, assuming we get that far...

In the meantime, we are having such a blast with Little Miss this holiday season. My mom put up a 4-foot tree today, and when Miss A came home, she saw it, let out a happy squeal, and ran right to it. She stared at it with such joy, so mesmerized, reaching out to gently touch the ornaments. That angelic look - pure childlike joy and delight - was such a beautiful, amazing thing to witness. We continue to be so thankful, every day, and not just because it's the season of thanksgiving.

1st Beta Results

It would be really nice to have a time where a nurse called with test results that were nothing but good news, but we don't seem to have that kind of luck. I knew immediately from her tone of voice that not everything was ideal.

HCG - 147 (With the pg that resulted in Miss A, it was 149, but we transferred 2 that time, and we think that both initially stuck. This time, we only transferred 1.)

E2 - 300-something. Normal.

Progesterone - 14-point-something. This is the issue. I didn't even ask and she didn't say, but I think it's supposed to be above 20. She asked if I was doing the suppositories 3 times a day. (I am.) She confirmed that I am taking the PIO daily instead of every other day like their typical protocol. (I am.) She made sure I'm using a 1.5" needle and not a 1" needle. (It's 1.5".) Then she sounded stumped. So she told me to bump my PIO to 1.5 ml, up from 1 ml. She's not sure the increase will show up within 2 days, so tomorrow's number might still be low.

I'm not overly freaked out about the progesterone level at this point. With Miss A's pg, my level dropped down to 5-point-something. That was back when the clinic's standard protocol was suppositories only, and no PIO, and at that point, they had me add PIO. So from that perspective, 14 isn't horrible. And when I tried to wean from the progesterone with Miss A, my numbers dropped down below 20, and that was when I was at the end of the first trimester. So I figure to be at 14 at this point isn't all that bad, comparatively speaking.

What's worrying me more is that I've continued to do daily FRERs, and the line is not getting darker. Yesterday's line was about as dark as the control line, but this morning's looked slightly lighter than yesterday's line. R was a quick thinker, and managed to be pretty convincing when he said he thought the control line looked lighter than yesterday's, too, so he thought it was just a variation in the test, and not necessarily a reflection of a declining HCG level. (Both were tested with FMU, and both were from the same box.)

On the bright side, there has been no more staining. We'll see what tomorrow's repeat tests show. Even if all the numbers look good, we're certainly not anywhere close to out of the woods. I'm only 4w1d today, and it's usually between 6-8 weeks when things have fallen apart for us in the past.