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Archive for January, 2010

Enormous

I was at a meeting last night for J’s school. On my way out, I said good night to the security guard, with whom I am friendly. He had someone there talking with him, but he paused to say hello and to ask when this baby of mine is due. I told him I’m due in May and the woman sitting with him nearly fell out of her chair in shock. “How many do you have in there!???? You’re huge!” She commented several times on how she didn’t see how I could possibly keep growing all the way to May – how much bigger could I possibly get, she wondered out loud.

Um.

Am I? I didn’t think I was. I’m still below my pre-pregnancy weight. My fundal height is measuring exactly on target. The baby is growing exactly on the curve, and I have an appropriate amount of amniotic fluid. It wasn’t like this woman was rail-thin, either. She easily weighed twice what I weigh. So what’s the deal?

I mean, yes, I’m definitely showing. I’m definitely showing even more than I was when I was growing three entire humans. But… I don’t look like I’m about to pop.

And anyway, even if I am a huge hippopotamus right now, what on earth do you say to a comment like that??

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Not Funny Ha-Ha

I’ve felt funny all day – a lot of weird pelvic pressure and horrific cramps. I just saw my perinatologist on Tuesday, and everything was fine. I have an appointment with a midwife tomorrow and I’m sure everything will be fine then, too. Meanwhile, I just feel funny.

I started on weekly IM Progesterone injections a couple of weeks ago. The theory is that progesterone injections can slow smooth muscle function – so the uterus contracts less. It’s definitely making a difference – After the first injection I got two weeks ago, I went from having very regular contractions (5-6 per hour, sometimes more) to having only sporadic contractions. By the end of the week, the contractions were getting more regular and more intense. Within 24 hours of getting the next injection, the contractions were back down. So, we’ll see.

I’ve been on a course of IV Steroids for the last month or so. We’d been hoping it would eliminate the hyperemesis symptoms… but not so much. I felt a little better for a few days, but back to awful once I started titrating down. Interestingly, despite the fact that it didn’t solve that issue, it fixed a whole lot of other things. My sciatica disappeared (mostly), the inflammation around my PICC site was completely gone, my migraines were way down, and the itching I was having head-to-toe (my skin was RAW from all the scratching) was gone overnight, and even the restless leg syndrome that was triggered every time I took Phenergan sent mostly away.

I’m now down from my original 16mg three times per day to 2 mg twice per day – a huge drop. And my migraines are back in full force, RLS is back, I’m itching EVERYWHERE, I’m more nauseated, and it sure does look like I’m having yet another skin reaction / inflamation under the tegaderm at my PICC site. Good times.

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The Perils of my Tether

Have you met my friend, the Zofran pump?  I take him with me wherever I go – but I’m beginning to understand the hazards of my tether.  Sometimes if I’m sitting down for a while, I actually forget that I *have* the pump and I’ll stand up and walk away, only to be tugged back by the weight of the pump sitting on the chair or the floor.  Still, a minor inconvenience given that it’s giving me continuous medicine which, theoretically, is making me feel better.

But there are other perils as well.  The being woken up in the middle of the night because the syringe was displaced, or worse – empty.  The inconvenience of always having to bring it along and explain myself to curious onlookers.

But it’s really the five feet of tubing from my PICC line to the pump that presents the biggest hazard, most of the time.  The other day I hopped in my car to move it to a better location so my nanny could have easy access to it – but when I hopped in for this really simple move that should have taken 20 seconds at most, my tubing got caught around the steering wheel and it wasn’t easy to untangle it.  My 20 second task took over five minutes.  Later, I was driving my husband’s car (Accord) instead of my van (Odyssey) and my tubing got caught in the door of the car.  I hadn’t noticed until my pump started beeping at me that the line was occluded.  For some reason, I never get the tubing caught in the door of the van, but it seems to happen every time I drive the Accord.

Worst and best of all is that my pump provides important medication on a continuous basis.  Obviously, this is a good thing.  But occasionally, it’s less good – I never realize exactly how crappy I feel until something goes wrong with the pump – it turns out I’ve become quite dependent on that 42+mg/day through the pump.  By far the most perilous thing about this pump is that it is man-made, and therefore, not without flaws.

Friday afternoon, the display on my pump became non-functional.  Unfortunately, I didn’t notice the issue until a few minutes after 5pm – which meant that I could only call the after-hours center in Philadelphia, rather than calling the local office where my primary nurse works.      The nurse at the after-hours center said I should turn off the pump and disconnect, since we couldn’t know whether the pump is working properly without a working display panel.  Fair enough, but their solution was to suggest that I take oral Zofran in the meantime.  Um.  Right.  So a large part of the reason that I’ve got the pump is because I couldn’t tolerate the oral medicine – not even the ODTs – I just throw them right back up.  Fortunately, I do have IV Phenergan, so it wasn’t a *total* disaster .  Just mostly.

I did finally get a new pump Saturday afternoon, but I definitely do feel the ill effects of not having the continuous medication push for 16ish  hours.  Well, at least I know it works, right?

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Holy Cramping, Batman!

So, I’ve often heard that it isn’t uncommon to get leg cramps in pregnancy – but it wasn’t one of the things I experienced in my triplet pregnancy, at least not any more than usual. People seem to suggest eating bananas to help prevent them. I expect that the reason is that people are attributing muscle cramps to low potassium levels. Turns out, low potassium does occasionally cause muscle cramps, it more frequently causes muscle weakness. Also? That banana everyone keeps suggesting? Has about 400mg of potassium in it. You’ll get more than double (sometimes triple) the amount of potassium found in that banana in tomatoes, wheat bran, apricots, currants, potatoes… Why bananas have such a reputation for being the potassium-king is beyond me. Low magnesium and low calcium levels more frequently contribute to muscle cramps – particularly those that occur with pregnancy.

So… who cares about any of that? Not me, but it’s still relevant.

About a week ago, I started having an issue where my thumb or the rest of my hand would seize up and be impossible for me to move. For a while it was just in my left thumb, which was annoying, but I could deal with it. Now it’s my whole left hand – and it happens at random times. And then, in the midst of muscle spasms in my hand (not remotely related to what kind of work I’m doing with my hand at the moment – just that it seizes up.

And then yesterday, my legs and even my feet started cramping- I woke up at 2:30 this morning in tears from the pain. Ugh. I just hope this is transient and will go away once my little parasite is evacuated from its temporary home. Sigh.

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Protected: Tired of Fighting

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I can’t recall a year in which I was more eager to say “Good Riddance!” as this one. 2009 can suck it – and I can only pray that it wasn’t just the appetizer course to a long road of sucky years ahead. I often do a month-to-month matrix with the over view of the Good vs. Bad things that happened each month. Usually this reminds me that the good always outweighs the bad. I’m not making quite the same matrix this year – because frankly, 2009 sucked and I don’t need a fancy little grid to rub it in.  So good BYE 2009.  Don’t let the door hit you on the way out.

I’ve read through some of my archives from last year and I see in those posts an over-stressed, over-extended, sleep deprived, and severely depressed person.  And small-wonder, really.  I spent the first couple months of the year not sleeping at all because I was working to coordinate an extraordinarily large volunteer effort for a local triplet family that lost their house to a catastrophic fire.  We had a $6000 plumbing problem in our front yard.  Shortly thereafter, Ellie landed herself in the hospital when she got what was probably RSV which triggered her RAD (reactive airway disease).    This left us fearful every time she got a cold or a sniffle for the several months following.    Sam landed himself in the ER after getting a deep (but small) gash above his eye.  Abby, thankfully, was spared any hospital visits.

Our tax bill was astronomical, as we’d made some … poor calculations at the beginning of 2008.   Our oven door was shattered thanks to our cleaning lady – it would have been fine if it hadn’t been just a few days before Passover started, and you know, if we weren’t dealing with an enormously large tax bill, so that $400 or so to get it replaced really hurt.   I had four failed IVF cycles.  The upside, of course, is that I had a fifth, successful, cycle and found out I was pregnant.  Just after I’d been laid off from my job and Seth was starting a new job, so the insurance situation was… precarious.

I got admitted to the hospital for 8 days (all of Sukkot) and while there, Seth landed himself in the hospital with a back injury for three days.   True, we got a little quiet time together, but not the ideal way to make that happen.  Seth, fortunately, did not need surgery (yet?) but did get a series of epidural steroid shots and still isn’t quite back to his normal self.  Hopefully PT will help.    The hospital bills for us both are still coming and it’s a convoluted mess because neither of us had insurance coverage when we were admitted to the hospital, though ultimately the COBRA election was processed for us both and we were able to get retroactive coverage – but it’s a nightmare to sort out.  My OB fired me, several OBs “declined to accept me” as a new patient.  I’ve had two PICC lines and several emergency room visits.  Yes, it’s great to be pregnant – but gosh, does it have to happen like this?

I’ve never spent a year more tired, more stressed out, or less capable of truly enjoying the blessings that I do have.  And I have a multitude of blessings – I have four beautiful, amazing children who, despite their challenges are by and large good kids and have nothing but love for the world around them.  I have an amazing husband who, despite his own state of exhaustion and stress, takes care of me even when I’m not capable of asking for help.    There were times in 2009 that I wanted to walk away from all of it.  And, frankly, I’m pretty sure I would have been justified in doing so.

And still, I’m reminded that 2009 wasn’t all bad.  Several women that had IVF cycles at the same time as some of my cycles brought babies home before the end of 2009.  Women that I care about reached their dreams of motherhood in 2009.  None of them deserved infertility – no one does – but they kept a sense of grace and humour and pushed forward and achieved their dreams.  For some women, 2009 was the year that made their dreams come true.

So although 2009 wasn’t my best year – well, it was good for many.  My family is one step closer to completion.  I have everything I ever dreamed of, despite the struggles throughout 2009.  My best hope is that 2010 is slightly less of a struggle to see all of the good.

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As you know, I didn’t love the new OB who agreed to take me on as his patient. I’ve been thinking about it all week. I remember the first time I saw my perinatologists’ office with the triplets. The doctor rubbed me completely the wrong way. I wasn’t ready to hear anything she was going to say that day.  A week or so later, I concluded that part of what was going on with me not liking her was that I picked out the things I didn’t like and those were the only ones that formed my initial impression.  I did the same late in my pregnancy when I met the one member of the practice who I hadn’t seen up until that point.  I hated her from the first time I talked to her on the phone through the day of that first appointment with her.  By the second appointment I had with her, she was one of my favorite doctors in the practice.

Truthfully, pregnancy is such a difficult time to be making emotional decisions, judgments, etc.  My judgment can’t be trusted these days.  So in the interests of fairness, I must remember that odds were against me liking this OB from the get-go.  I don’t like change.  I don’t deal well with new people, new situations, particularly when I’m this stressed out.  So the obstetrician gets at least a partial buy on account of my emotional instability.

Truthfully, there was a lot more good than bad in that visit.  The OB didn’t have any qualms with me wanting to have a VBAC delivery.  He didn’t bat an eyelash at me stating unequivocally that I do not want an epidural in place (with the caveat that I needed to understand the risk that I may have to have general anesthesia in the event of an emergency caesarian).  He never questioned whether he would take me on as a patient – it was a given from the minute he walked in the door.  He was fine with continuing the protocol that I’m on for the hyperemesis, didn’t push TPN (he agreed with me that so long as I’m not nutritionally compromised, which I clearly am *not*, that we didn’t need to move to TPN).  His office staff is exceptionally nice, and although his office isn’t nearly as convenient as my former OBs office, it’s not exactly off the beaten path either.  Possibly most importantly, the practice has a midwife practice within it.  I have an appointment with one of the CNMs for January 14th.  No telling whether they’d be willing to let me have a midwife-attended delivery, but I can hope.  My perinatologist pointed out that even if they’re not willing to deliver me, I might get more personalized care from the midwives than the OBs, making for an overall more positive experience for the rest of the pregnancy.

So there’s lots of good.

Speaking of good:  I had my anatomy scan on Wednesday and Dr. P. came in and went over every detail of it with me after the sonographer had finished getting all her measurements.  I don’t remember going over the anatomy results in such detail with the triplets – though truthfully I’m not sure I could have laid on a table for that long with the triplets.  The baby has all the requisite parts – fingers, toes, all the proper parts of the brain, heart, etc.  It was hard to get a visual on the kidneys because the little monster was curled up like a pretzel, but we’re pretty sure they’re both there.  Baby is measuring just on time.  My cervix was shorter than it was 2 weeks prior, but still in a more than respectable range.  So far, so good.  Except, you know, the hyperemesis etc.

I know that this is all “worth it” for the toy surprise at the end, though I could certainly live with an uneventful pregnancy while still getting the toy surprise at the end, but since that’s not an option, I’ll take what I can get.   At least with my history/current medical state I’m getting a lot of looks at this little one – I’m at the perinatologists’ office every 2 weeks, and will at some point move to every week.  This kid may end up with almost as many ultrasounds as I did with the triplets – I had 33 ultrasounds with the triplets.  Crazy!

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Soap Fairy Redux

Some of you may remember my tales of the Soap Fairy from over a year ago.  If you don’t, here’s the heart of the matter:

Until these babies came into our lives, I never realized how well Seth and I work as a team.  We never talk about it, but our lives are just pieced together seamlessly… effortlessly… in a way that makes our world keep moving.  For example, the babies came home I was washing my hands so much more often than I used to and I ran out of soap in the dispenser in our bathroom.  I scratched my head for a minute and realized I had absolutely no idea where we keep the soap to fill the dispensers.  It’s not so much that it’s “Seth’s Job” to fill the dispensers, it’s just that in six years of marriage there’s always been this magical “soap fairy” that has gone around filling soap dispensers and it had never occurred to me that this was a job that had to be done by an actual person.  I decided to look under the sink, and lo and behold, there was a very large container of soap which I used to fill the soap dispenser.  Turns out, there’s one in each bathroom.  My soap fairy had not let me down.  I had never realized that this was something Seth had always taken care of for me, and I called him that day to thank him for being my soap fairy for six years.  The first thing he did was apologize for not having filled it before I needed him to.

I’ll point out that I don’t think I’ve re-filled any soap dispensers since the night of that post.

Fast forward to today – now I’m pregnant, high maintenance, and, well, needy.  I have this stupid PICC line.  I get home IV fluids, I have a Zofran pump, I have IV medications and a million needs.  You’d think I could take care of myself, but I don’t – I’ll sooner sit there counting contractions than have it occur to me that I might need fluids.  Seth takes one look at me and sets up my IV without a word.  I invariably fall asleep without checking to see if I’ve got enough Zofran in my pump to get through the night – but Seth changes it when he comes to bed without a word.  He’d be so justified in telling me to take care of my damn self, but he doesn’t.   He draws up my meds, he reminds me to get fluids, he prepares my fluids (vitamins etc. get added to them) at night.  If I disappear without warning, he takes it in stride and then asks me if I’m okay when I return.  He’d be justified in being annoyed with my utter incapability to be dependable, but he’s never mentioned it.

I couldn’t ask for a better person to share my life with.  Sometimes, it’s really nice to know that you’ll be taken care of.  I never have to wonder who’ll take care of me.  I’m taken care of even despite myself.

I can’t imagine being more blessed.  Four kids and another on the way, and the best husband in the world.  Could a girl ask for more?  (okay, don’t answer that)

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