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Archive for the ‘triplets?’ Category

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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First, I should note that this is my 198th post. I’m pointing this out because of the unlikelihood that I’ll notice when it’s my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there’s the fact that I made it to 28 weeks this week. And… I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I’d had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That’s not good. What is good is that he didn’t make me think there was that much reason to worry until it was clear that we didn’t need to worry. But anyway, in a lot of ways, I’m very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people… but stupid people) keep thinking it’s okay to say stupid shit like, “Well, great, you got to 28 weeks, so it’s all good now, the babies can be born any time, right?!?” WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes… 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don’t survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That’s too early. If my babies were born right now, they would be about 2 pounds. That’s not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son’s grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I’d had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

“Hello?”
“28.”
“28?”
“28!” (I’m still trying to figure out who the flying fig is on the other end of the phone)
“What do you mean, 28?”
“You’re at 28!”
“That’s not possible!” (I knew it wasn’t my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there’s no WAY I could have had 28 contractions in an hour)
“What do you think it is?”
“What do you mean 28?”
“28!”
“28??”
“Yes! 28!” (this went on for about two minutes)
“28 what????”
“You’re at 28 weeks!!” (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don’t know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it’s a milestone. NO, it’s not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, “I even talked to my sister who’s an OB/GYN and she said…”). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I’m begging you, stop acting like it’s okay for these babies to come out right now!

I swear, it’s like I almost feel like all these people who think it’s “okay” now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don’t want to find out the hard way. I just want these babies to have every chance possible. I don’t want them to come out now. I’m not ready. They’re not ready. They’re too tiny. I’m too scared for them. Please don’t come now. Please. I don’t know how we’d bear it. I don’t. I know we’d just do it, but I don’t want to find out. I really don’t. I can’t.

I haven’t been a seriously emotional wreck through this pregnancy. I’m not more snippy than I am when I’m not pregnant (I’m very snippy when I’m not pregnant, so who can tell the difference?). I rarely cry, though I’m crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I’ve been okay. I’ve had my moments of “oh my god how are we going to take care of triplets??” but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything’s okay now… I just feel like … like they’re saying it’s okay for all my worst fears from the beginning to come true.

And it’s not helping that the contractions really are out of control. I mean, the good news is they’re not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO…). I’m just lucky. Somehow, that doesn’t bring any peace of mind, because it makes me worry that if there really IS a problem, we’ll miss it. But then again, my doctors have been careful never to assume that my contractions are just “normal for me” when they get up to a certain level. They’ll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything’s different. So it’s not like they’re blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I’m having so many contractions that they keep changing the terbutaline dose. And I can’t keep taking the Indocin (though I suspect I’ll be back on it for another 48 hours next week), even though it worked. Unfortunately, I’ve gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they’ve lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren’t “just” migraines… this is definitely terbutaline-induced). I’m afraid that we’re to the point where even though I haven’t topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we’ll see. I’m trying not to be frustrated. I’m trying not to be angry at people for their good intentions. I’m trying not to be too anxious about these babies. I’m trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I’m trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn’t matter. All that matters is keeping these babies in for another 6 weeks.

Read Full Post »

First, I should note that this is my 198th post. I'm pointing this out because of the unlikelihood that I'll notice when it's my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there's the fact that I made it to 28 weeks this week. And… I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I'd had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That's not good. What is good is that he didn't make me think there was that much reason to worry until it was clear that we didn't need to worry. But anyway, in a lot of ways, I'm very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people… but stupid people) keep thinking it's okay to say stupid shit like, "Well, great, you got to 28 weeks, so it's all good now, the babies can be born any time, right?!?" WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes… 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don't survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That's too early. If my babies were born right now, they would be about 2 pounds. That's not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son's grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I'd had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

"Hello?"
"28."
"28?"
"28!" (I'm still trying to figure out who the flying fig is on the other end of the phone)
"What do you mean, 28?"
"You're at 28!"
"That's not possible!" (I knew it wasn't my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there's no WAY I could have had 28 contractions in an hour)
"What do you think it is?"
"What do you mean 28?"
"28!"
"28??"
"Yes! 28!" (this went on for about two minutes)
"28 what????"
"You're at 28 weeks!!" (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don't know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it's a milestone. NO, it's not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, "I even talked to my sister who's an OB/GYN and she said…"). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I'm begging you, stop acting like it's okay for these babies to come out right now!

I swear, it's like I almost feel like all these people who think it's "okay" now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don't want to find out the hard way. I just want these babies to have every chance possible. I don't want them to come out now. I'm not ready. They're not ready. They're too tiny. I'm too scared for them. Please don't come now. Please. I don't know how we'd bear it. I don't. I know we'd just do it, but I don't want to find out. I really don't. I can't.

I haven't been a seriously emotional wreck through this pregnancy. I'm not more snippy than I am when I'm not pregnant (I'm very snippy when I'm not pregnant, so who can tell the difference?). I rarely cry, though I'm crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I've been okay. I've had my moments of "oh my god how are we going to take care of triplets??" but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything's okay now… I just feel like … like they're saying it's okay for all my worst fears from the beginning to come true.

And it's not helping that the contractions really are out of control. I mean, the good news is they're not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO…). I'm just lucky. Somehow, that doesn't bring any peace of mind, because it makes me worry that if there really IS a problem, we'll miss it. But then again, my doctors have been careful never to assume that my contractions are just "normal for me" when they get up to a certain level. They'll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything's different. So it's not like they're blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I'm having so many contractions that they keep changing the terbutaline dose. And I can't keep taking the Indocin (though I suspect I'll be back on it for another 48 hours next week), even though it worked. Unfortunately, I've gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they've lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren't "just" migraines… this is definitely terbutaline-induced). I'm afraid that we're to the point where even though I haven't topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we'll see. I'm trying not to be frustrated. I'm trying not to be angry at people for their good intentions. I'm trying not to be too anxious about these babies. I'm trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I'm trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn't matter. All that matters is keeping these babies in for another 6 weeks.

Read Full Post »

First, I should note that this is my 198th post. I'm pointing this out because of the unlikelihood that I'll notice when it's my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there's the fact that I made it to 28 weeks this week. And… I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I'd had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That's not good. What is good is that he didn't make me think there was that much reason to worry until it was clear that we didn't need to worry. But anyway, in a lot of ways, I'm very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people… but stupid people) keep thinking it's okay to say stupid shit like, "Well, great, you got to 28 weeks, so it's all good now, the babies can be born any time, right?!?" WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes… 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don't survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That's too early. If my babies were born right now, they would be about 2 pounds. That's not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son's grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I'd had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

"Hello?"
"28."
"28?"
"28!" (I'm still trying to figure out who the flying fig is on the other end of the phone)
"What do you mean, 28?"
"You're at 28!"
"That's not possible!" (I knew it wasn't my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there's no WAY I could have had 28 contractions in an hour)
"What do you think it is?"
"What do you mean 28?"
"28!"
"28??"
"Yes! 28!" (this went on for about two minutes)
"28 what????"
"You're at 28 weeks!!" (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don't know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it's a milestone. NO, it's not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, "I even talked to my sister who's an OB/GYN and she said…"). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I'm begging you, stop acting like it's okay for these babies to come out right now!

I swear, it's like I almost feel like all these people who think it's "okay" now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don't want to find out the hard way. I just want these babies to have every chance possible. I don't want them to come out now. I'm not ready. They're not ready. They're too tiny. I'm too scared for them. Please don't come now. Please. I don't know how we'd bear it. I don't. I know we'd just do it, but I don't want to find out. I really don't. I can't.

I haven't been a seriously emotional wreck through this pregnancy. I'm not more snippy than I am when I'm not pregnant (I'm very snippy when I'm not pregnant, so who can tell the difference?). I rarely cry, though I'm crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I've been okay. I've had my moments of "oh my god how are we going to take care of triplets??" but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything's okay now… I just feel like … like they're saying it's okay for all my worst fears from the beginning to come true.

And it's not helping that the contractions really are out of control. I mean, the good news is they're not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO…). I'm just lucky. Somehow, that doesn't bring any peace of mind, because it makes me worry that if there really IS a problem, we'll miss it. But then again, my doctors have been careful never to assume that my contractions are just "normal for me" when they get up to a certain level. They'll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything's different. So it's not like they're blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I'm having so many contractions that they keep changing the terbutaline dose. And I can't keep taking the Indocin (though I suspect I'll be back on it for another 48 hours next week), even though it worked. Unfortunately, I've gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they've lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren't "just" migraines… this is definitely terbutaline-induced). I'm afraid that we're to the point where even though I haven't topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we'll see. I'm trying not to be frustrated. I'm trying not to be angry at people for their good intentions. I'm trying not to be too anxious about these babies. I'm trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I'm trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn't matter. All that matters is keeping these babies in for another 6 weeks.

Read Full Post »

The long and the short of it (no pun intended) is that my cervix is still short (around 2.4cm), but it’s stable, which is great news. Babies all look fine, good heart rates and good amount of amniotic fluid. Dr. P. was working today, which was a relief (he was the doctor on call this past weekend, so I’d been hoping to speak with him directly today, and I got my wish).

He spent a lot of time talking to me about the changes he’d made to my protocol and why and how he hoped things would progress over the next several weeks. We’re on the same page with the whole, “even though the survival rates for 28 weekers are very high, it would be very bad to deliver right now.” He still wants to get me to 34 weeks before delivering, and I’m all for it.

Two babies are head down and the placenta previa has finally completely resolved itself, so I told him I don’t need no stinkin’ c-section. He reiterated that vaginal triplet deliveries are tricky at best and not always advisable, and I said, “well, I can dream, can’t I?” “Oh yes, you can can dream. And I always wanted to be 6’4″…” Anyway, he didn’t say no, but did emphasize that I shouldn’t get my heart set on it. He has done vaginal triplet deliveries and he’s not dead set against it (for that matter, he’s done a vaginal quad delivery), so it’s not like he can’t do it, but he wants to make sure I realize that it’s a very rare occurrence that things really line up in such a way that it’s remotely advisable. I understand that, but I really want to keep the door open for as long as possible, even though I know it’s probably not going to happen.

He explained that I can’t stay on the Indocin long term, as it tends to result in a lower amniotic fluid level, but that if we need to repeat the Indocin regimen of 48-hour treatment on a weekly basis, we can do that until about 33 weeks… after that, there are bigger problems, but then things get a little less problemmatic if I go into labor anyway. He also explained why he didn’t want to do steroids yet… although steroids are good for about 4-6 weeks after they give them, they are problemmatic for a couple reasons: 1. they’ll definitely raise my blood sugar (which isn’t the end of the world for me, since my blood sugar is stable and normal right now, but why tempt fate if we don’t have to yet?) and 2. steroids have a tendency to increase contractions both in frequency and intensity for several days to a week after administering them. I love irony. So he said steroids aren’t quite as magical as everyone thinks they are. Still, he’ll definitely give me steroid shots at or around 30-32 weeks to give the babies the added edge in lung development that they need, but his preference is to put it off until as late as possible.

He said one of the problems I’m facing is that my uterus is distended further than it would be if I were full-term with a singleton right now and it really does think it’s done, and that’s likely a huge contributing factor to the contractions. He said this is definitely aggravated by the fact that I’ve got a very small pelvis to rib size (read: I’m SHORT), so there isn’t even much more room for things to expand, even if it wanted to. With all that pressure on my uterus and, in turn, all that pressure on my cervix, it’s no surprise that sometimes my contractions get out of control, and the best they can do is try to control it with the medications they have available for the time being. Definitely, though, bed rest is doing a good job, because my cervix is hanging in there and is much improved from how short it became right before I got thrown on bed rest. So I have to keep hanging out in bed/recliner for the long haul.

Oh, he also talked about the fact that most women have more contractions at night… 4pm-4am you definitely see increased uterine activity. I definitely have noticed EXACTLY this, and thought I was losing my mind. But he said it makes sense if you want to take *any* lessons from evolution, this is one you probably could take seriously… that most mammals need to give birth under the protective cover of night. Even though this isn’t so relevant to humans (at least not today), it’s still a documented scientific fact that uterine activity increases between 4pm and 4am. There are also more labors that start in the middle of the night than, say, mid-morning. Interesting! This is why when all hell was breaking loose with me on Saturday night he said he wanted to raise my basal rate on the terbutaline and then let me sleep if I could and see how I was doing in the morning, because doctors are much more concerned if contractions are at a high rate during the morning hours… they tend to be much more troublesome. Since I was still over threshold in the morning, that’s why he called in the Indocin…. because the morning pattern was much more indicative of a problem than the evening-into-late-night pattern had been.

The other thing he’d done Sunday morning was raise my threshold to 8 contractions per hour… and the reason he did that was because he said at this point with triplets it’s a lot more realistic to expect to see 4-6 contractions per hour regularly, but 8 per hour is definitely alarming, so rather than getting up in arms about something which could be normal (and bear in mind that all weekend I was above 8 anyway, so I was still justified in being concerned), raising the threshold would allow us to focus in when there really was something that needed attention.

Anyway, that was the appointment. It was a good appointment overall. Dr. P. wasn’t saying he’s not concerned, because he is, but he’s definitely on top of things, which gives me a lot of hope and peace of mind. Meanwhile, we’ll take it one week at a time, and if necessary, one day at a time.

And now, I really, really, really must go to bed.

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The long and the short of it (no pun intended) is that my cervix is still short (around 2.4cm), but it's stable, which is great news. Babies all look fine, good heart rates and good amount of amniotic fluid. Dr. P. was working today, which was a relief (he was the doctor on call this past weekend, so I'd been hoping to speak with him directly today, and I got my wish).

He spent a lot of time talking to me about the changes he'd made to my protocol and why and how he hoped things would progress over the next several weeks. We're on the same page with the whole, "even though the survival rates for 28 weekers are very high, it would be very bad to deliver right now." He still wants to get me to 34 weeks before delivering, and I'm all for it.

Two babies are head down and the placenta previa has finally completely resolved itself, so I told him I don't need no stinkin' c-section. He reiterated that vaginal triplet deliveries are tricky at best and not always advisable, and I said, "well, I can dream, can't I?" "Oh yes, you can can dream. And I always wanted to be 6'4"…" Anyway, he didn't say no, but did emphasize that I shouldn't get my heart set on it. He has done vaginal triplet deliveries and he's not dead set against it (for that matter, he's done a vaginal quad delivery), so it's not like he can't do it, but he wants to make sure I realize that it's a very rare occurrence that things really line up in such a way that it's remotely advisable. I understand that, but I really want to keep the door open for as long as possible, even though I know it's probably not going to happen.

He explained that I can't stay on the Indocin long term, as it tends to result in a lower amniotic fluid level, but that if we need to repeat the Indocin regimen of 48-hour treatment on a weekly basis, we can do that until about 33 weeks… after that, there are bigger problems, but then things get a little less problemmatic if I go into labor anyway. He also explained why he didn't want to do steroids yet… although steroids are good for about 4-6 weeks after they give them, they are problemmatic for a couple reasons: 1. they'll definitely raise my blood sugar (which isn't the end of the world for me, since my blood sugar is stable and normal right now, but why tempt fate if we don't have to yet?) and 2. steroids have a tendency to increase contractions both in frequency and intensity for several days to a week after administering them. I love irony. So he said steroids aren't quite as magical as everyone thinks they are. Still, he'll definitely give me steroid shots at or around 30-32 weeks to give the babies the added edge in lung development that they need, but his preference is to put it off until as late as possible.

He said one of the problems I'm facing is that my uterus is distended further than it would be if I were full-term with a singleton right now and it really does think it's done, and that's likely a huge contributing factor to the contractions. He said this is definitely aggravated by the fact that I've got a very small pelvis to rib size (read: I'm SHORT), so there isn't even much more room for things to expand, even if it wanted to. With all that pressure on my uterus and, in turn, all that pressure on my cervix, it's no surprise that sometimes my contractions get out of control, and the best they can do is try to control it with the medications they have available for the time being. Definitely, though, bed rest is doing a good job, because my cervix is hanging in there and is much improved from how short it became right before I got thrown on bed rest. So I have to keep hanging out in bed/recliner for the long haul.

Oh, he also talked about the fact that most women have more contractions at night… 4pm-4am you definitely see increased uterine activity. I definitely have noticed EXACTLY this, and thought I was losing my mind. But he said it makes sense if you want to take *any* lessons from evolution, this is one you probably could take seriously… that most mammals need to give birth under the protective cover of night. Even though this isn't so relevant to humans (at least not today), it's still a documented scientific fact that uterine activity increases between 4pm and 4am. There are also more labors that start in the middle of the night than, say, mid-morning. Interesting! This is why when all hell was breaking loose with me on Saturday night he said he wanted to raise my basal rate on the terbutaline and then let me sleep if I could and see how I was doing in the morning, because doctors are much more concerned if contractions are at a high rate during the morning hours… they tend to be much more troublesome. Since I was still over threshold in the morning, that's why he called in the Indocin…. because the morning pattern was much more indicative of a problem than the evening-into-late-night pattern had been.

The other thing he'd done Sunday morning was raise my threshold to 8 contractions per hour… and the reason he did that was because he said at this point with triplets it's a lot more realistic to expect to see 4-6 contractions per hour regularly, but 8 per hour is definitely alarming, so rather than getting up in arms about something which could be normal (and bear in mind that all weekend I was above 8 anyway, so I was still justified in being concerned), raising the threshold would allow us to focus in when there really was something that needed attention.

Anyway, that was the appointment. It was a good appointment overall. Dr. P. wasn't saying he's not concerned, because he is, but he's definitely on top of things, which gives me a lot of hope and peace of mind. Meanwhile, we'll take it one week at a time, and if necessary, one day at a time.

And now, I really, really, really must go to bed.

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I had a ridiculously long appointment yesterday. It’s really sad when the biggest excitement of my week is going to the doctor. But it’s also the most exhausting part. Whew, it takes a WHOLE lot of energy for me to get up and out of my house these days! It’s pathetic. Anywhozit, yesterday was a long appointment because it was more than just my normal weekly cervix check. It was:

1. 1 hour glucose screening
2. Normal prenatal BP/Urine/Weight Check
3. Fetal Fibronectin culture
4. Cervix check
5. Growth scan for the kiddos

A long appointment. Should get the glucose and fetal fibronectin results today or tomorrow. I expect that the glucose test will not be pretty and that the fetal fibronectin will be fine. Blood pressure was fine, as usual. I’ve lost another 2 pounds, but I didn’t get yelled at this time. My doctor isn’t concerned as long as the babies are growing and I’m not anemic (they drew extra blood along with the glucose screening to make sure that I’m not anemic). My cervix was slightly shorter than last week, but still relatively stable. And the kiddos are growing nicely.

Baby A is estimated at 2 pounds 2 ounces (50th percentile)
Baby B is estimated at 1 pound 14 ounces (38th percentile)
Baby C is estimated at 1 pound 13 ounces (37th percentile)

Heartbeats were all lovely in the 150s and 160s. Baby A has listened to my complaints and turned back around and is head down. Whew. Baby B also has sort of turned back around and is somewhere between head down and transverse. Baby C is mostly transverse, slightly breach. They’re kind of in this weird little circle… Baby A’s head down in my cervix, feet up against Baby B’s head who’s feet wrap around to Baby C’s head and baby C’s feet wrap back down and around toward Baby A. Kind of weird.

Contractions have been weird. I’m usually okay in the morning with a few or no contractions. But check out this pattern:

Friday night: 5 contractions, gave demand dose, remonitored, 3 contractions, still really crampy, slept through it.
Saturday morning: 4 contractions (threshold), gave demand dose, remonitored, no contractions, cramping, raised basal rate.
Saturday night:
7 contractions, but hadn’t sent strip in until the next morning, so no remonitoring involved.
Sunday morning
: 3 contractions, no big deal.
Sunday night
: 5 contractions, but hadn’t sent strip in until the next morning, so no remonitoring involved.
Monday morning:
2 contractions
Monday night:
ELEVEN contractions, but hadn’t sent strip in, so no remonitoring involved.
Tuesday morning:
no contractions.

So now I get to start sending in my evening strips as well as my morning strips. Which means I have to monitor earlier in the evening (I usually monitor around 9pm or 10pm, but if I’m going to send them in, they prefer to receive them by 9pm. I don’t like to monitor right at 8pm because that’s when I receive an auto dose, so I don’t think that gives an accurate picture, so this means I have to monitor at 7pm tonight. Yippee.

Oh, and while I was writing this entry, I got a call from my nurse… Yep, I failed my 1 hour glucose screening, apparently not by very much. But here’s the kicker… normally this would mean taking the three hour glucose tolerance test, except I’m not allowed. Because that would mean sitting in the lab for four hours. And I’m not allowed to sit for that long. So instead, I get to have Matria (the company that does my contraction monitoring and terbutaline pump stuff) come out and edumacate me on gestational diabetes and using a glucometer and blah blah blah. And then I get to check my blood sugar four times a day for a couple weeks while they decide if I have gestational diabetes. And if I don’t, I still get to keep checking my blood sugar just for fun, because I can! And if I do, well, the fun’s just beginning!

The bitch of it is that they suspect that the terbutaline plus the whole triplet thing is what’s likely caused the elevated blood sugar. I’ve been losing weight throughout the pregnancy, and have no family history of diabetes nor gestational diabetes. I don’t eat sugary sweets or really many excess carbs in the first place. So let’s say it’s the terbutaline’s fault. What would I rather have: high blood sugar and relatively controlled contractions, or low blood sugar and completely UNcontrollable contractions? Yeah, that’s what I thought. Not a difficult choice to make. And anyway, I needed something else to do with my day, right? Wouldn’t want to get bored!

I knew it was a high likelihood that I’d blow this here 1 hour test, but I was so hoping I was just being a negative nelly. Because seriously… have I mentioned that one of the problems with gestational diabetes is delayed lung development?? And have I mentioned that AT BEST these babies are going to be 6 weeks premature? Yeah. Aside from that, at this point, I have weekly cervix measurements, weekly urine protein checks, daily blood pressure monitoring, twice (sometimes more) daily contraction monitoring, and now I’ll have 4x daily blood sugar monitoring. Seriously… is there ANYTHING they’re NOT going to know about me by the time this pregnancy is over with?

Right. Well, you know, it’s all good. It’ll just give me more toys to play with. 🙂

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I had a ridiculously long appointment yesterday. It's really sad when the biggest excitement of my week is going to the doctor. But it's also the most exhausting part. Whew, it takes a WHOLE lot of energy for me to get up and out of my house these days! It's pathetic. Anywhozit, yesterday was a long appointment because it was more than just my normal weekly cervix check. It was:

1. 1 hour glucose screening
2. Normal prenatal BP/Urine/Weight Check
3. Fetal Fibronectin culture
4. Cervix check
5. Growth scan for the kiddos

A long appointment. Should get the glucose and fetal fibronectin results today or tomorrow. I expect that the glucose test will not be pretty and that the fetal fibronectin will be fine. Blood pressure was fine, as usual. I've lost another 2 pounds, but I didn't get yelled at this time. My doctor isn't concerned as long as the babies are growing and I'm not anemic (they drew extra blood along with the glucose screening to make sure that I'm not anemic). My cervix was slightly shorter than last week, but still relatively stable. And the kiddos are growing nicely.

Baby A is estimated at 2 pounds 2 ounces (50th percentile)
Baby B is estimated at 1 pound 14 ounces (38th percentile)
Baby C is estimated at 1 pound 13 ounces (37th percentile)

Heartbeats were all lovely in the 150s and 160s. Baby A has listened to my complaints and turned back around and is head down. Whew. Baby B also has sort of turned back around and is somewhere between head down and transverse. Baby C is mostly transverse, slightly breach. They're kind of in this weird little circle… Baby A's head down in my cervix, feet up against Baby B's head who's feet wrap around to Baby C's head and baby C's feet wrap back down and around toward Baby A. Kind of weird.

Contractions have been weird. I'm usually okay in the morning with a few or no contractions. But check out this pattern:

Friday night: 5 contractions, gave demand dose, remonitored, 3 contractions, still really crampy, slept through it.
Saturday morning: 4 contractions (threshold), gave demand dose, remonitored, no contractions, cramping, raised basal rate.
Saturday night:
7 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Sunday morning
: 3 contractions, no big deal.
Sunday night
: 5 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Monday morning:
2 contractions
Monday night:
ELEVEN contractions, but hadn't sent strip in, so no remonitoring involved.
Tuesday morning:
no contractions.

So now I get to start sending in my evening strips as well as my morning strips. Which means I have to monitor earlier in the evening (I usually monitor around 9pm or 10pm, but if I'm going to send them in, they prefer to receive them by 9pm. I don't like to monitor right at 8pm because that's when I receive an auto dose, so I don't think that gives an accurate picture, so this means I have to monitor at 7pm tonight. Yippee.

Oh, and while I was writing this entry, I got a call from my nurse… Yep, I failed my 1 hour glucose screening, apparently not by very much. But here's the kicker… normally this would mean taking the three hour glucose tolerance test, except I'm not allowed. Because that would mean sitting in the lab for four hours. And I'm not allowed to sit for that long. So instead, I get to have Matria (the company that does my contraction monitoring and terbutaline pump stuff) come out and edumacate me on gestational diabetes and using a glucometer and blah blah blah. And then I get to check my blood sugar four times a day for a couple weeks while they decide if I have gestational diabetes. And if I don't, I still get to keep checking my blood sugar just for fun, because I can! And if I do, well, the fun's just beginning!

The bitch of it is that they suspect that the terbutaline plus the whole triplet thing is what's likely caused the elevated blood sugar. I've been losing weight throughout the pregnancy, and have no family history of diabetes nor gestational diabetes. I don't eat sugary sweets or really many excess carbs in the first place. So let's say it's the terbutaline's fault. What would I rather have: high blood sugar and relatively controlled contractions, or low blood sugar and completely UNcontrollable contractions? Yeah, that's what I thought. Not a difficult choice to make. And anyway, I needed something else to do with my day, right? Wouldn't want to get bored!

I knew it was a high likelihood that I'd blow this here 1 hour test, but I was so hoping I was just being a negative nelly. Because seriously… have I mentioned that one of the problems with gestational diabetes is delayed lung development?? And have I mentioned that AT BEST these babies are going to be 6 weeks premature? Yeah. Aside from that, at this point, I have weekly cervix measurements, weekly urine protein checks, daily blood pressure monitoring, twice (sometimes more) daily contraction monitoring, and now I'll have 4x daily blood sugar monitoring. Seriously… is there ANYTHING they're NOT going to know about me by the time this pregnancy is over with?

Right. Well, you know, it's all good. It'll just give me more toys to play with. 🙂

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Right. Well, that’s quite enough of the self-pity. Or at least, that particular variety. I will now move on to an entirely different kind of whining. Pregnancy whining. Okay, I get it, there are lots of you out there who would give nearly anything to have the opportunity to whine about pregnancy, and I get that. So I’m sorry if it offends you that I don’t find all of pregnancy all sunshine and light. Maybe I would if I had a singleton pregnancy, maybe I wouldn’t. What I do know is that we infertiles HAVE to give ourselves permission to accept that there’s nothing wrong with us for finding out that sometimes pregnancy isn’t glamorous and sometimes parenting isn’t perfect and sometimes we aren’t always gracious about either one. Therefore, disclaimers aside, here are some of the good and the bad of late:

Good: I had a pretty decent week last week in terms of contractions and other such things. My appointment went well, my cervix had stablized and in fact lengthened somewhat, I even got a little cocky about it (“I don’t need no stinkin’ bedrest!”) but not to the point that I violated doctor’s orders. Contractions weren’t done and over with, but I was generally having a good week, and they were definitely under better control than they had been.

The Less Good: The operative word in that last sentence, of course, is that they were under better control. Until Friday. I monitor contractions twice a day. I’m required to send them in every morning, but not in the evening unless I’m feeling symptomatic. I can also monitor any other time of day if I’m feeling off or feeling contractions or just feel like it or whatever. Friday around 5pm I felt a few contractions, but I sort of ignored them, because that’s not terribly uncommon and I didn’t think much of it. But then a little before 6, I had a few more and I thought, well, that’s 4-6 contractions within the same hour, so I probably should call about getting a demand dose of terbutaline. After any demand dose, I have to monitor and send in the data, so that meant my evening data WOULD get sent in, which was fine.

So I called, asked if I could give myself a demand dose, was told yes, and then told to monitor from 6:30-7:30 and send it in. Fine. Except I couldn’t get the pump to GIVE me a demand dose. It’s a different button than the rest of the buttons and that button stopped working. So they had a work around for it, but that took some time, which put off my monitoring time until about 7ish to 8ish. Which is fine, but Shabbos (the Sabbath) was starting at 8, so the timing wasn’t fabulous. I am allowed to do all the medical stuff I need to do on Shabbos, even though a lot of it isn’t stuff I’d normally be allowed to do (e.g. using the phone). It’s just that there are a couple things I had to do right at 8 (like light candles to bring in Shabbos), so it wasn’t terribly convenient. Still, I made it work.

I expected that the monitoring session would yieled nothing interesting since I’d just given myself a demand dose and usually that takes care of the contractions immediately, but the nurse called back and said I had 5 contractions, which is above my “allowed” threshhold. Which meant I was going to have to re-monitor. Great. Except it’s Friday night, late, I have a cranky 4 year old, my husband is at shul (synagogue), and I have to deal with remonitoring and once my husband gets home in theory we’re supposed to eat a “festive meal” in honor of the Sabbath. (Someday maybe I’ll explain the whole sabbath thing to my non-Jewish readers, but really, if you’re wondering if I’m completely nutso, yes I am, but if you want more details, just email me… there’s a link to my email address in my sidebar) Since 8pm is when one of my automatic doses happens anyway, the nurse wanted me to wait until about 8:30 to monitor again to give the dose some time to work its magic. And so, at 8:30, I strapped the monitor back on while attempting to appease J with some tortellini and some books and a couple cars (yes, he should have been in bed, but it’s not like I can struggle with him alone these days).

And at 9:30 I sent in the data again. And while waiting for the phone call back, we started to sit down to dinner, and then, of course, the phone rang. The contractions had gotten much better..3 short contractions, which is under the “allowed” amount (thank heavens, because otherwise, doctor’s orders would have mandated a phone call to the doctor on call and I REALLY didn’t want to deal with that!), but the nurse didn’t love that I’d been having a lot of cramping and it wasn’t getting a lot better. So she waffled for a bit about calling the doctor anyway, but I talked her out of it (my doctor didn’t seem OVERLY concerned when I’d mentioned it before, plus I promised to call if I couldn’t sleep through it which is always my gauge of whether I should be waking up a doctor). She had me give myself another demand dose and encouraged me to call if it got any worse through the night. Fine.

And the next morning was more of the same. Too many contractions, demand dose (which they still had to use the awkward work-around to do, because the demand-button wasn’t working) remonitor, better but not perfect, still a lot of cramping, so they changed my basal rate on the pump and got to work on getting a new pump programmed and couriered out to me. The increased basal rate did seem to help a bit throughout the day (it had also been increased the day before, so it had cumulatively been increased about 30% from two days prior). I didn’t do an evening monitoring until quite late because I had people here visiting on and off throughout the day. I felt a little funny, but decided not to send in the data until morning since I wasn’t required to and since it was so late. I figured I’d send it in the next morning. Turned out it was both a good and a bad choice not to send it in, because I’d had SEVEN contractions (nearly double my “allowed” threshhold) and a lot of irritability. So if I’d sent it in, I would have ended up having to do a demand dose and remonitor at midnight risking calling the doctor at 1 in the morning and blah blah blah. On the other hand, I’m lucky it didn’t become a huge deal, since I didn’t send it in… Anyway, this morning, all was clear, so life is good. I think I’ll do this evening’s monitoring somewhat early and go ahead and send it in just for the fun of it.

More Good: I did get the replacement pump around noon yesterday and it’s working just fine. I’ve haven’t been alarmingly uncomfortable today. I’ve got all the usual “hey I’m pregnant with triplets” discomforts, but nothing that’s making me go “hey that’s not good!” Also the babies have been kicking like mad and I’m pretty sure at least one of them has turned back around, so I’m hoping the others follow suit and SOON!

The Slightly Less Good: Baby A has discovered that JUMPING on my cervix is much more fun than punching it. I’m fairly certain that Baby A is still breech and is remaining that way simply to torture me. Youch!

Good: J is absolutely fascinated by my ever-expanding belly. “Oh Eema, your belly is getting bigger! It’s a giant belly now! Why is it getting so much bigger??” Yeah, uh, now that I think about it, I’m less convinced this belongs in the “Good” category! 😉 Anywhozit, I said, “Well, what’s IN Eema’s belly?” He giggled… “Bigger Babies!” “That’s right, so Eema’s belly has to get bigger so they can keep growing, right?” “Of course, Eema! You need a bigger belly so the babies can grow,” he said as if it had been all his idea and he was telling me how the world works. He’s really cute.

The Less Good: I absolutely cannot shake this cold. I feel disgusting, and it’s making it even harder than usual to keep food down, and worse, it’s making it difficult even to keep fluids down, which is bad, because the best thing I could possibly do for a cold is drink a lot of fluids. Sigh. So now in addition to waking up a lot with cramping and full bladder and general discomfort and leg cramps, I also wake up because I can’t breathe, I’m parched, and my throat hurts. It’s lovely. I’m not sure why I even bother trying to sleep anymore.

The Really Good: I haven’t been admitted to the hospital and I’m 26 1/2 weeks. That so rocks.

More Good: I’m no longer completey nauseated every time the babies move. This is a good thing, since they do it ALL THE FREAKING TIME, especially at night. Actually, I kind of love it now, and I think I might miss it some day. I mean, I could still do without the cervix stomping, because honestly, I’m not kidding when I say that really hurts. I mean REALLY hurts. But at least I know the kiddos are still moving around, right?

The Somewhat Annoying: Heartburn really sucks. Definitely in Stretch-Mark Land. I have a weird little hematoma right above my ever-shrinking (but not yet popping-out) belly button and I have no idea why or where it came from. Pregnancy has made my belly embarrassingly furry. I wish there were something I could do about this, but I figure my doctor has probably seen scarier bellies. Right? RIGHT? I’m still getting about 3 migraines a week and tylenol with codeine isn’t touching them but I don’t have a lot of other pain-relief options. I’m also getting lower-grade headaches from the terbutaline, but those are easier to knock out. The terbutaline also gives me a very annoying side effect of making it uncomfortable to breathe… as if I’d been breathing heavily after running a long distance or something for a while. It’s like my throat or lungs HURT when I breathe. It’s not like I can’t breathe, it’s just an unpleasant sensation that I keep hoping will go away and it hasn’t. The other terbutaline side effects have at least gotten less annoying even if they haven’t subsided completely, but this one is just as annoying as ever.

The Good: My husband? Completely rocks.

On a Completely Unrelated Note:
An anonymous poster has asked me twice now why there are 4-hour auto-doses in addition to a lower basal rate on the pump, rather than having just a higher basal rate that incorporates the auto doses over a longer period of time. I’m not ignoring the question, I’m actually trying to find a real answer rather than just having my own random guesses. My husband is a pharmacist, so you’d think this would be an easy one to get an answer to, right? Not so much. Never mind that he was sitting shiva for a week, so he couldn’t do any looking up for me, even now that he can he’s super-busy and the bit of research he’s done hasn’t turned up a lot of clear-cut answers.

What he has found is that generally the auto-doses are recommended to be timed with the peak periods of uterine activity if it is possible to predict that pattern (it often IS possible to do so, apparently). This makes a bit of sense to me as one suggestion that was made by my nurse at some point was to change the interval of the auto doses for more effective treatment.

He also found that taking 5mg pills every 4 hours is effective about 30% of the time for uterine contractions. But that terbutaline pump protocols are effective closer to 90% of the time, so for whatever reason, it works.

What he hasn’t found yet (and admittedly, he hasn’t had time while at work to wander over to the Health Sciences Library) is a clear cut answer about why it wouldn’t work to just have a high basal rate given out 24-7 with only denmand-doses as needed for breakthrough contractions. But if he DOES find an answer, I’ll let you know. Also, Erin has a PhD in Pharmacology, I believe, so maybe she can shed some light on this. Or maybe not. I don’t know. But if anyone else does happen to know, please let me know, because at this point, I’m intensely curious. Inquiring minds want to know.

(I also just reminded my husband, so he’s going to do some more digging around now to see what he can find… I’ll update this entry if he finds anything really interesting)

And that’s enough for now.

Update per Anonymous’ Comment:
Comment left last night: Hey, that’s great that you are looking into the auto-dose/basal issue. If there are other options that could serve you better, it would be good to know! Now, are there any at-home IVs you can use for when you can’t keep fluids down?

I’m looking into the basal vs. auto dose issue purely as a curiosity. I’m assuming this is a long tested issue at this point as this is very standard protocol that is used regularly for a large number of patients and has been for al ong time, so I’m not guessing that it would make more sense to raise the basal rate and eliminate auto-doses. It seems clear that the protocol of auto-doses combined with a low basal rate does work for most patients. It may be that it lowers the side effect profile to do it this way, and since the side effects aren’t real pleasant, that’s a good thing. At any rate, I’ve got my husband on it this week. He’s still playing a bit of catch up at work from being out after his father died, but I’m sure he’ll find some time to walk over to the library if I nudge him a little.

As for at-home IVs… the short answer is, yes, there are at-home IVs, but I don’t warrant one. If my nausea were so extreme that I were never keeping fluids down and I were severely dehydrated and had an electrolyte imbalance, they could do an at-home IV-line for Zofran (which I currently take orally). If that didn’t work, they’d admit me. However, my periods of not being able to keep fluids down are generally short-lived and haven’t resulted in real dehydration/electrolyte imbalances, so an IV line would be a bit on the extreme side (nor do I want one! I’m already the bionic woman!!). At any rate, yes, it’s an option, but not a likely one for me. Good idea though!

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Right. Well, that's quite enough of the self-pity. Or at least, that particular variety. I will now move on to an entirely different kind of whining. Pregnancy whining. Okay, I get it, there are lots of you out there who would give nearly anything to have the opportunity to whine about pregnancy, and I get that. So I'm sorry if it offends you that I don't find all of pregnancy all sunshine and light. Maybe I would if I had a singleton pregnancy, maybe I wouldn't. What I do know is that we infertiles HAVE to give ourselves permission to accept that there's nothing wrong with us for finding out that sometimes pregnancy isn't glamorous and sometimes parenting isn't perfect and sometimes we aren't always gracious about either one. Therefore, disclaimers aside, here are some of the good and the bad of late:

Good: I had a pretty decent week last week in terms of contractions and other such things. My appointment went well, my cervix had stablized and in fact lengthened somewhat, I even got a little cocky about it ("I don't need no stinkin' bedrest!") but not to the point that I violated doctor's orders. Contractions weren't done and over with, but I was generally having a good week, and they were definitely under better control than they had been.

The Less Good: The operative word in that last sentence, of course, is that they were under better control. Until Friday. I monitor contractions twice a day. I'm required to send them in every morning, but not in the evening unless I'm feeling symptomatic. I can also monitor any other time of day if I'm feeling off or feeling contractions or just feel like it or whatever. Friday around 5pm I felt a few contractions, but I sort of ignored them, because that's not terribly uncommon and I didn't think much of it. But then a little before 6, I had a few more and I thought, well, that's 4-6 contractions within the same hour, so I probably should call about getting a demand dose of terbutaline. After any demand dose, I have to monitor and send in the data, so that meant my evening data WOULD get sent in, which was fine.

So I called, asked if I could give myself a demand dose, was told yes, and then told to monitor from 6:30-7:30 and send it in. Fine. Except I couldn't get the pump to GIVE me a demand dose. It's a different button than the rest of the buttons and that button stopped working. So they had a work around for it, but that took some time, which put off my monitoring time until about 7ish to 8ish. Which is fine, but Shabbos (the Sabbath) was starting at 8, so the timing wasn't fabulous. I am allowed to do all the medical stuff I need to do on Shabbos, even though a lot of it isn't stuff I'd normally be allowed to do (e.g. using the phone). It's just that there are a couple things I had to do right at 8 (like light candles to bring in Shabbos), so it wasn't terribly convenient. Still, I made it work.

I expected that the monitoring session would yieled nothing interesting since I'd just given myself a demand dose and usually that takes care of the contractions immediately, but the nurse called back and said I had 5 contractions, which is above my "allowed" threshhold. Which meant I was going to have to re-monitor. Great. Except it's Friday night, late, I have a cranky 4 year old, my husband is at shul (synagogue), and I have to deal with remonitoring and once my husband gets home in theory we're supposed to eat a "festive meal" in honor of the Sabbath. (Someday maybe I'll explain the whole sabbath thing to my non-Jewish readers, but really, if you're wondering if I'm completely nutso, yes I am, but if you want more details, just email me… there's a link to my email address in my sidebar) Since 8pm is when one of my automatic doses happens anyway, the nurse wanted me to wait until about 8:30 to monitor again to give the dose some time to work its magic. And so, at 8:30, I strapped the monitor back on while attempting to appease J with some tortellini and some books and a couple cars (yes, he should have been in bed, but it's not like I can struggle with him alone these days).

And at 9:30 I sent in the data again. And while waiting for the phone call back, we started to sit down to dinner, and then, of course, the phone rang. The contractions had gotten much better..3 short contractions, which is under the "allowed" amount (thank heavens, because otherwise, doctor's orders would have mandated a phone call to the doctor on call and I REALLY didn't want to deal with that!), but the nurse didn't love that I'd been having a lot of cramping and it wasn't getting a lot better. So she waffled for a bit about calling the doctor anyway, but I talked her out of it (my doctor didn't seem OVERLY concerned when I'd mentioned it before, plus I promised to call if I couldn't sleep through it which is always my gauge of whether I should be waking up a doctor). She had me give myself another demand dose and encouraged me to call if it got any worse through the night. Fine.

And the next morning was more of the same. Too many contractions, demand dose (which they still had to use the awkward work-around to do, because the demand-button wasn't working) remonitor, better but not perfect, still a lot of cramping, so they changed my basal rate on the pump and got to work on getting a new pump programmed and couriered out to me. The increased basal rate did seem to help a bit throughout the day (it had also been increased the day before, so it had cumulatively been increased about 30% from two days prior). I didn't do an evening monitoring until quite late because I had people here visiting on and off throughout the day. I felt a little funny, but decided not to send in the data until morning since I wasn't required to and since it was so late. I figured I'd send it in the next morning. Turned out it was both a good and a bad choice not to send it in, because I'd had SEVEN contractions (nearly double my "allowed" threshhold) and a lot of irritability. So if I'd sent it in, I would have ended up having to do a demand dose and remonitor at midnight risking calling the doctor at 1 in the morning and blah blah blah. On the other hand, I'm lucky it didn't become a huge deal, since I didn't send it in… Anyway, this morning, all was clear, so life is good. I think I'll do this evening's monitoring somewhat early and go ahead and send it in just for the fun of it.

More Good: I did get the replacement pump around noon yesterday and it's working just fine. I've haven't been alarmingly uncomfortable today. I've got all the usual "hey I'm pregnant with triplets" discomforts, but nothing that's making me go "hey that's not good!" Also the babies have been kicking like mad and I'm pretty sure at least one of them has turned back around, so I'm hoping the others follow suit and SOON!

The Slightly Less Good: Baby A has discovered that JUMPING on my cervix is much more fun than punching it. I'm fairly certain that Baby A is still breech and is remaining that way simply to torture me. Youch!

Good: J is absolutely fascinated by my ever-expanding belly. "Oh Eema, your belly is getting bigger! It's a giant belly now! Why is it getting so much bigger??" Yeah, uh, now that I think about it, I'm less convinced this belongs in the "Good" category! 😉 Anywhozit, I said, "Well, what's IN Eema's belly?" He giggled… "Bigger Babies!" "That's right, so Eema's belly has to get bigger so they can keep growing, right?" "Of course, Eema! You need a bigger belly so the babies can grow," he said as if it had been all his idea and he was telling me how the world works. He's really cute.

The Less Good: I absolutely cannot shake this cold. I feel disgusting, and it's making it even harder than usual to keep food down, and worse, it's making it difficult even to keep fluids down, which is bad, because the best thing I could possibly do for a cold is drink a lot of fluids. Sigh. So now in addition to waking up a lot with cramping and full bladder and general discomfort and leg cramps, I also wake up because I can't breathe, I'm parched, and my throat hurts. It's lovely. I'm not sure why I even bother trying to sleep anymore.

The Really Good: I haven't been admitted to the hospital and I'm 26 1/2 weeks. That so rocks.

More Good: I'm no longer completey nauseated every time the babies move. This is a good thing, since they do it ALL THE FREAKING TIME, especially at night. Actually, I kind of love it now, and I think I might miss it some day. I mean, I could still do without the cervix stomping, because honestly, I'm not kidding when I say that really hurts. I mean REALLY hurts. But at least I know the kiddos are still moving around, right?

The Somewhat Annoying: Heartburn really sucks. Definitely in Stretch-Mark Land. I have a weird little hematoma right above my ever-shrinking (but not yet popping-out) belly button and I have no idea why or where it came from. Pregnancy has made my belly embarrassingly furry. I wish there were something I could do about this, but I figure my doctor has probably seen scarier bellies. Right? RIGHT? I'm still getting about 3 migraines a week and tylenol with codeine isn't touching them but I don't have a lot of other pain-relief options. I'm also getting lower-grade headaches from the terbutaline, but those are easier to knock out. The terbutaline also gives me a very annoying side effect of making it uncomfortable to breathe… as if I'd been breathing heavily after running a long distance or something for a while. It's like my throat or lungs HURT when I breathe. It's not like I can't breathe, it's just an unpleasant sensation that I keep hoping will go away and it hasn't. The other terbutaline side effects have at least gotten less annoying even if they haven't subsided completely, but this one is just as annoying as ever.

The Good: My husband? Completely rocks.

On a Completely Unrelated Note:
An anonymous poster has asked me twice now why there are 4-hour auto-doses in addition to a lower basal rate on the pump, rather than having just a higher basal rate that incorporates the auto doses over a longer period of time. I'm not ignoring the question, I'm actually trying to find a real answer rather than just having my own random guesses. My husband is a pharmacist, so you'd think this would be an easy one to get an answer to, right? Not so much. Never mind that he was sitting shiva for a week, so he couldn't do any looking up for me, even now that he can he's super-busy and the bit of research he's done hasn't turned up a lot of clear-cut answers.

What he has found is that generally the auto-doses are recommended to be timed with the peak periods of uterine activity if it is possible to predict that pattern (it often IS possible to do so, apparently). This makes a bit of sense to me as one suggestion that was made by my nurse at some point was to change the interval of the auto doses for more effective treatment.

He also found that taking 5mg pills every 4 hours is effective about 30% of the time for uterine contractions. But that terbutaline pump protocols are effective closer to 90% of the time, so for whatever reason, it works.

What he hasn't found yet (and admittedly, he hasn't had time while at work to wander over to the Health Sciences Library) is a clear cut answer about why it wouldn't work to just have a high basal rate given out 24-7 with only denmand-doses as needed for breakthrough contractions. But if he DOES find an answer, I'll let you know. Also, Erin has a PhD in Pharmacology, I believe, so maybe she can shed some light on this. Or maybe not. I don't know. But if anyone else does happen to know, please let me know, because at this point, I'm intensely curious. Inquiring minds want to know.

(I also just reminded my husband, so he's going to do some more digging around now to see what he can find… I'll update this entry if he finds anything really interesting)

And that's enough for now.

Update per Anonymous' Comment:
Comment left last night: Hey, that's great that you are looking into the auto-dose/basal issue. If there are other options that could serve you better, it would be good to know! Now, are there any at-home IVs you can use for when you can't keep fluids down?

I'm looking into the basal vs. auto dose issue purely as a curiosity. I'm assuming this is a long tested issue at this point as this is very standard protocol that is used regularly for a large number of patients and has been for al ong time, so I'm not guessing that it would make more sense to raise the basal rate and eliminate auto-doses. It seems clear that the protocol of auto-doses combined with a low basal rate does work for most patients. It may be that it lowers the side effect profile to do it this way, and since the side effects aren't real pleasant, that's a good thing. At any rate, I've got my husband on it this week. He's still playing a bit of catch up at work from being out after his father died, but I'm sure he'll find some time to walk over to the library if I nudge him a little.

As for at-home IVs… the short answer is, yes, there are at-home IVs, but I don't warrant one. If my nausea were so extreme that I were never keeping fluids down and I were severely dehydrated and had an electrolyte imbalance, they could do an at-home IV-line for Zofran (which I currently take orally). If that didn't work, they'd admit me. However, my periods of not being able to keep fluids down are generally short-lived and haven't resulted in real dehydration/electrolyte imbalances, so an IV line would be a bit on the extreme side (nor do I want one! I'm already the bionic woman!!). At any rate, yes, it's an option, but not a likely one for me. Good idea though!

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