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Archive for August, 2007

Guess who doesn't have gestational diabetes? Yep. That would be me. Apparently one of my levels was slightly high, but he said that isn't diagnostic and when he heard what my fasting levels were (this morning's was 75, yesterday's was 65… usually it's around 68-70), he said, "Yeah, you don't have it." So yay!

As for the rest of the appointment, it went well. My cervix is stable. The doctor basically said I'm just going to contract. It's what I do. He's not concerned with the quantity at this point, so much as the quality and the effect on my cervix. So we're on the same page on that one, which is good. Contractions are definitely getting stronger and more uncomfortable. He assured me that if I were in labor, I'd be in enough pain that I would know it. I'm not so convinced, since kidney stones barely make me flinch, but I do think I'd recognize it. We'll see.

He was concerned that all the monitoring was more trouble than it's worth. He wanted to make sure that with all the contractions they weren't making me re-monitor so much in the evening that it was keeping me from sleeping, and I promised him that I knew enough to tell them to just call the doctor if I wanted to sleep instead of re-monitoring and he said that was fine. The important thing is that he wants to make sure that I understand that I have to be assertive about letting Matria know if there's a significant change in quality and that I'm not concerned about quantity alone. So if they're pushing me to re-monitor, and I don't want to or feel that it's unnecessary, I shouldn't feel guilty about having them call the doctor. That's fair. And, he said, if we get a little further down the line and decide that the monitoring is just a bigger pain in the ass than it needs to be, then I won't do it anymore. Mostly, he thinks I have a good enough handle on things that he thinks that I know when to call myself, but he doesn't think the extra data point from the monitoring can hurt.

They want to keep a close eye on me, because things have been a bit dicey, but mostly, I'm doing great, all things considered. I'm astounded that I don't feel crappier than I do… I'm a whale, but not as whalish as I thought I would be… I fit into most of my pre-pregnancy clothes despite the enormous pregnancy belly (that's how much weight I've lost). I'm uncomfortable, but not NEARLY as uncomfortable as I'd imagined I would be. I have trouble walking, but the bed rest probably contributes to that, and I'm not allowed to walk much anyway (I only know how difficult -and painful- walking is because I had to walk down a long hallway to get to my doctor's office today). I have difficulty breathing, but that's not shocking. There are three babies in my very, very short torso. I'm tired all the time, but DUH! I'm still throwing up, but who cares at this point? I really expected MUCH worse. Or maybe I'm just handling it gracefully. Either way, I'm in the home stretch. I'm not there yet, but bit by bit, I'm getting there.

I go back for a growth ultrasound on Wednesday. I'll be exactly 30 weeks. If you're REALLY good, I might post another whale picture that day. We'll see.

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Guess who doesn't have gestational diabetes? Yep. That would be me. Apparently one of my levels was slightly high, but he said that isn't diagnostic and when he heard what my fasting levels were (this morning's was 75, yesterday's was 65… usually it's around 68-70), he said, "Yeah, you don't have it." So yay!

As for the rest of the appointment, it went well. My cervix is stable. The doctor basically said I'm just going to contract. It's what I do. He's not concerned with the quantity at this point, so much as the quality and the effect on my cervix. So we're on the same page on that one, which is good. Contractions are definitely getting stronger and more uncomfortable. He assured me that if I were in labor, I'd be in enough pain that I would know it. I'm not so convinced, since kidney stones barely make me flinch, but I do think I'd recognize it. We'll see.

He was concerned that all the monitoring was more trouble than it's worth. He wanted to make sure that with all the contractions they weren't making me re-monitor so much in the evening that it was keeping me from sleeping, and I promised him that I knew enough to tell them to just call the doctor if I wanted to sleep instead of re-monitoring and he said that was fine. The important thing is that he wants to make sure that I understand that I have to be assertive about letting Matria know if there's a significant change in quality and that I'm not concerned about quantity alone. So if they're pushing me to re-monitor, and I don't want to or feel that it's unnecessary, I shouldn't feel guilty about having them call the doctor. That's fair. And, he said, if we get a little further down the line and decide that the monitoring is just a bigger pain in the ass than it needs to be, then I won't do it anymore. Mostly, he thinks I have a good enough handle on things that he thinks that I know when to call myself, but he doesn't think the extra data point from the monitoring can hurt.

They want to keep a close eye on me, because things have been a bit dicey, but mostly, I'm doing great, all things considered. I'm astounded that I don't feel crappier than I do… I'm a whale, but not as whalish as I thought I would be… I fit into most of my pre-pregnancy clothes despite the enormous pregnancy belly (that's how much weight I've lost). I'm uncomfortable, but not NEARLY as uncomfortable as I'd imagined I would be. I have trouble walking, but the bed rest probably contributes to that, and I'm not allowed to walk much anyway (I only know how difficult -and painful- walking is because I had to walk down a long hallway to get to my doctor's office today). I have difficulty breathing, but that's not shocking. There are three babies in my very, very short torso. I'm tired all the time, but DUH! I'm still throwing up, but who cares at this point? I really expected MUCH worse. Or maybe I'm just handling it gracefully. Either way, I'm in the home stretch. I'm not there yet, but bit by bit, I'm getting there.

I go back for a growth ultrasound on Wednesday. I'll be exactly 30 weeks. If you're REALLY good, I might post another whale picture that day. We'll see.

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So while I was in the hospital I was on Indocin for 24 hours. This isn’t a drug that can be taken long-term in pregnancy because it reduces the amount of amniotic fluid, which is bad (and after 31 or 32 weeks causes bigger problems), but for short term use, it works quite well as a tocolytic, as I’ve discovered a couple of times now. So, while I was in the hospital, my contractions went down to only a few per hour, which is great.

I didn’t bother to monitor the night I got home, because I figured I’d been monitored enough all day. And the next morning (Tuesday morning) I had zero contractions. This isn’t shocking, considering that I still had some Indocin in my system. (Though, honestly, I can hardly remember another time that I had zero contractions in an hour.)

Tuesday night, however, I had fifteen contractions in an hour. The Indocin, clearly, was no longer in my system. (I had my uber-husband look up the half-life of Indocin, which turns out to be 4.5 hours, so that worked out about right) So I had to give myself a demand dose of terbutaline and remonitor (shock of shocks). And I had 10 contractions. So the nurse said “Well, should I have you remonitor again, or just call the doctor?” Uh, yeah, let’s think about this. It was 10:30pm. If I remonitored, by the time I heard back from her it would be close to midnight, by which point if I still had that many contractions, they’d be calling and waking up a doctor. No thank you. So I told her to call the doctor. In an ideal world, frankly, I would have called the doctor, but for whatever reason the after-hours nurses prefer to speak to the doctors directly, so whatever. I suggested that she mention that I do have Indocin at home and ask if I could take that for another 24 hours.

Dr. R. was on call again (she was the doctor on call who admitted me on Sunday), so she knew that my fetal fibronectin on Sunday had been negative, knew what my cervical length was, and knew what the orders in the hospital had been off the top of her head, so she was okay with me taking the Indocin for 24 hours, and was otherwise unconcerned. For the record, I wasn’t concerned either. This is just what I do at this point. I contract. A lot. Often. But, admittedly, if it had kept up at that rate, there was no way I was going to get any sleep, because it was making me pretty darned uncomfortable. And so…. I went back on Indocin for 24 hours last night. Easy enough.

And this morning I had 3 contractions. And tonight? One contraction. Gee, do you think this stuff works? I think so. Shame I can’t take it continuously.

Edit: Jennifer from Arkansas asked You’ve posted about the side effects of the terbutaline (sp?) as far as how it makes you feel. What is the indocin like? Any immediate sife effects to speak of? (other than the fact that it ROCKS in taking care of the contractions!!)

Well, all drugs have a side effect profile, of course, but the short answer is that Indocin doesn’t really have any negative side effects for me. Indocin (or indomethacin) is a non-steroidal anti-inflammatory drug (NSAID) like Aleve or a variety of other drugs. Normally NSAIDs are contraindicated in pregnancy, but obviously there are controlled exceptions like this one, but I wouldn’t recommend taking an NSAID just for fun while pregnant. Anywhozit, the main side effect for me is that it helps my headaches ever so slightly. It can also cause stomach pains or upset, so it’s recommended that one take it with food or Tums, which I find is helpful, but rarely remember to do. (I never found that Aleve hurt or upset my stomach, but I do find that the Indocin does a bit… which is funny because I took a LOT of Aleve before I was pregnant and the Indocin isn’t any more potent) Anywhozit, that’s pretty much it. I don’t think there are any other major side effects.

I’m also now taking the Nifedipine every day which has a few side effects itself, most notably it is a beta blocker, so it can lower blood pressure (which isn’t a bad thing, since Terbutaline raises blood pressure). The lower blood pressure can also lead to dizziness and whatnot, but that hasn’t been a problem for me. Yet.

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So while I was in the hospital I was on Indocin for 24 hours. This isn't a drug that can be taken long-term in pregnancy because it reduces the amount of amniotic fluid, which is bad (and after 31 or 32 weeks causes bigger problems), but for short term use, it works quite well as a tocolytic, as I've discovered a couple of times now. So, while I was in the hospital, my contractions went down to only a few per hour, which is great.

I didn't bother to monitor the night I got home, because I figured I'd been monitored enough all day. And the next morning (Tuesday morning) I had zero contractions. This isn't shocking, considering that I still had some Indocin in my system. (Though, honestly, I can hardly remember another time that I had zero contractions in an hour.)

Tuesday night, however, I had fifteen contractions in an hour. The Indocin, clearly, was no longer in my system. (I had my uber-husband look up the half-life of Indocin, which turns out to be 4.5 hours, so that worked out about right) So I had to give myself a demand dose of terbutaline and remonitor (shock of shocks). And I had 10 contractions. So the nurse said "Well, should I have you remonitor again, or just call the doctor?" Uh, yeah, let's think about this. It was 10:30pm. If I remonitored, by the time I heard back from her it would be close to midnight, by which point if I still had that many contractions, they'd be calling and waking up a doctor. No thank you. So I told her to call the doctor. In an ideal world, frankly, I would have called the doctor, but for whatever reason the after-hours nurses prefer to speak to the doctors directly, so whatever. I suggested that she mention that I do have Indocin at home and ask if I could take that for another 24 hours.

Dr. R. was on call again (she was the doctor on call who admitted me on Sunday), so she knew that my fetal fibronectin on Sunday had been negative, knew what my cervical length was, and knew what the orders in the hospital had been off the top of her head, so she was okay with me taking the Indocin for 24 hours, and was otherwise unconcerned. For the record, I wasn't concerned either. This is just what I do at this point. I contract. A lot. Often. But, admittedly, if it had kept up at that rate, there was no way I was going to get any sleep, because it was making me pretty darned uncomfortable. And so…. I went back on Indocin for 24 hours last night. Easy enough.

And this morning I had 3 contractions. And tonight? One contraction. Gee, do you think this stuff works? I think so. Shame I can't take it continuously.

Edit: Jennifer from Arkansas asked You've posted about the side effects of the terbutaline (sp?) as far as how it makes you feel. What is the indocin like? Any immediate sife effects to speak of? (other than the fact that it ROCKS in taking care of the contractions!!)

Well, all drugs have a side effect profile, of course, but the short answer is that Indocin doesn't really have any negative side effects for me. Indocin (or indomethacin) is a non-steroidal anti-inflammatory drug (NSAID) like Aleve or a variety of other drugs. Normally NSAIDs are contraindicated in pregnancy, but obviously there are controlled exceptions like this one, but I wouldn't recommend taking an NSAID just for fun while pregnant. Anywhozit, the main side effect for me is that it helps my headaches ever so slightly. It can also cause stomach pains or upset, so it's recommended that one take it with food or Tums, which I find is helpful, but rarely remember to do. (I never found that Aleve hurt or upset my stomach, but I do find that the Indocin does a bit… which is funny because I took a LOT of Aleve before I was pregnant and the Indocin isn't any more potent) Anywhozit, that's pretty much it. I don't think there are any other major side effects.

I'm also now taking the Nifedipine every day which has a few side effects itself, most notably it is a beta blocker, so it can lower blood pressure (which isn't a bad thing, since Terbutaline raises blood pressure). The lower blood pressure can also lead to dizziness and whatnot, but that hasn't been a problem for me. Yet.

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Many thanks to my pinch-hitter husband for posting for me this morning. As he said, I was sent to the hospital for monitoring last night after my 4:30 monitoring session had 15 contractions in an hour. Suffice it to say, it was a fun day all around.

So… off to labor and delivery triage we went. Where we quickly discovered I was still having far too many contractions. The nurses were great, the hospital was boring. My doctor called after a bit to suggest some options. We settled on trying 3 doses of Nifedipine over an hour and half and if I was still over threshold after that, she’d admit me over night for observation, get me on Indocin for 24 hours, and check my cervix in the morning and probably let me go after that.

Three doses of Nifedipine later, and just as many contractions, and there was a room with my name on it. And so, my darling husband went home to get some things for me, including (bless him) a toothbrush/toothpaste which hadn’t even occurred to me, but BOY DID I LOVE HAVING THAT! And the fun began. They got me back on the monitors… three fetal monitors and a contraction monitor. Now the ironic thing about that set up is that to keep the fetal monitors in the right place, I had to be laying on my back. But that made the contractions worse. But rolling onto my side disturbed the fetal monitors too much. Finally around midnight, the nurses called my doctor and asked if they could just leave the contraction monitor only on so that I could get more comfortable and hopefully sleep. At 1:30, they came in and took off the three fetal monitors, I rolled onto my side and went to sleep. At 4am I got my second dose of Indocin. At 6am, I woke up and my day started… for the last couple hours I’d only had a couple contractions. Miracle! (Indocin works well for me…it’s just that it can’t be taken long term)

Anywhozit, around 8 I was brought the world’s most disgusting breakfast (kosher hospital food… never a good thing… ick!). and a bit before 9 I was taken down for an ultrasound and to meet with my doctor. My cervix was, at its shortest, 1.7cm… shorter than last week, but not so much shorter than it was 5 weeks ago when this whole bed rest crap started in the first place. She recommended raising the basal rate on my terbutaline pump, adding Nifedipine XR again on top of the terbutaline, and having a fetal fibronectin test done weekly along with the already-scheduled weekly cervical measurements.

She was fully prepared to let me go home and asked if I had any questions. And I said, well, I wasn’t trying to be picky or anything… but I was doing the 4x daily finger sticks for blood sugar testing because I couldn’t take the three hour test, and since I hadn’t had a single blood sugar reading out of the range of completely utterly normal, could I maybe cut back on the number of times I had to test…but I was willing to do whatever she wanted me to. She said I could just do it twice a day if I wanted, but forewarned me that as I got later into the pregnancy, they’d probably still make me return to four times a day anyway. No problem. She went off to type up the ultrasound report and then popped back in and said, “Hey, since you’re in-house right now anyway, do you want to just DO the three-hour glucola test?” Uh, YEAH! Except I’d already eaten breakfast. No problem. I had eaten breakfast at 8, so they’d do the test at 4 and I could go home after that, unless I’d feel better staying another night (NO THANK YOU).

And so… I spent the most boring day of my life in the hospital today, internet-less, bored, with limited things to read or do. But on Friday, I should know whether I have to keep finger-sticking myself! And I was home at 8pm tonight. Safe and sound. All is well, the babies are all healthy and fine. The contractions are better for the moment. And life is good because I have my precious internet back. Gawd I’m an addict. Thanks everyone for your kind thoughts. I suspect this won’t be the last time I have a visit to the hospital before this is all over, but at least this wasn’t a terribly long orientation… 🙂 I’ll try to catch up on your blogs tomorrow.

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Many thanks to my pinch-hitter husband for posting for me this morning. As he said, I was sent to the hospital for monitoring last night after my 4:30 monitoring session had 15 contractions in an hour. Suffice it to say, it was a fun day all around.

So… off to labor and delivery triage we went. Where we quickly discovered I was still having far too many contractions. The nurses were great, the hospital was boring. My doctor called after a bit to suggest some options. We settled on trying 3 doses of Nifedipine over an hour and half and if I was still over threshold after that, she'd admit me over night for observation, get me on Indocin for 24 hours, and check my cervix in the morning and probably let me go after that.

Three doses of Nifedipine later, and just as many contractions, and there was a room with my name on it. And so, my darling husband went home to get some things for me, including (bless him) a toothbrush/toothpaste which hadn't even occurred to me, but BOY DID I LOVE HAVING THAT! And the fun began. They got me back on the monitors… three fetal monitors and a contraction monitor. Now the ironic thing about that set up is that to keep the fetal monitors in the right place, I had to be laying on my back. But that made the contractions worse. But rolling onto my side disturbed the fetal monitors too much. Finally around midnight, the nurses called my doctor and asked if they could just leave the contraction monitor only on so that I could get more comfortable and hopefully sleep. At 1:30, they came in and took off the three fetal monitors, I rolled onto my side and went to sleep. At 4am I got my second dose of Indocin. At 6am, I woke up and my day started… for the last couple hours I'd only had a couple contractions. Miracle! (Indocin works well for me…it's just that it can't be taken long term)

Anywhozit, around 8 I was brought the world's most disgusting breakfast (kosher hospital food… never a good thing… ick!). and a bit before 9 I was taken down for an ultrasound and to meet with my doctor. My cervix was, at its shortest, 1.7cm… shorter than last week, but not so much shorter than it was 5 weeks ago when this whole bed rest crap started in the first place. She recommended raising the basal rate on my terbutaline pump, adding Nifedipine XR again on top of the terbutaline, and having a fetal fibronectin test done weekly along with the already-scheduled weekly cervical measurements.

She was fully prepared to let me go home and asked if I had any questions. And I said, well, I wasn't trying to be picky or anything… but I was doing the 4x daily finger sticks for blood sugar testing because I couldn't take the three hour test, and since I hadn't had a single blood sugar reading out of the range of completely utterly normal, could I maybe cut back on the number of times I had to test…but I was willing to do whatever she wanted me to. She said I could just do it twice a day if I wanted, but forewarned me that as I got later into the pregnancy, they'd probably still make me return to four times a day anyway. No problem. She went off to type up the ultrasound report and then popped back in and said, "Hey, since you're in-house right now anyway, do you want to just DO the three-hour glucola test?" Uh, YEAH! Except I'd already eaten breakfast. No problem. I had eaten breakfast at 8, so they'd do the test at 4 and I could go home after that, unless I'd feel better staying another night (NO THANK YOU).

And so… I spent the most boring day of my life in the hospital today, internet-less, bored, with limited things to read or do. But on Friday, I should know whether I have to keep finger-sticking myself! And I was home at 8pm tonight. Safe and sound. All is well, the babies are all healthy and fine. The contractions are better for the moment. And life is good because I have my precious internet back. Gawd I'm an addict. Thanks everyone for your kind thoughts. I suspect this won't be the last time I have a visit to the hospital before this is all over, but at least this wasn't a terribly long orientation… 🙂 I'll try to catch up on your blogs tomorrow.

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If you read the last post, then you’re aware that there were a lot of contractions – enough that the MD wanted to see Karen in the hospital. After several hours in triage, she was admitted for further observation, medication, etc. Things are under control, and she and the kidlets are well. She’ll be discharged this evening and will likely update again when she can.

-S

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