A GOOD Day ...

Well, it's been a while since I've had a visit to the doctor that didn't end with me in tears, either in the office itself or on the sidewalk outside.  But today it finally happened! I left the appointment feeling lighter than I have in weeks thanks to the lack of new news from Dr. R, the new MFM.  Yessirree ... no news is good news, that's what I always say.  Or, at least that's what I'm going to start saying from now on.  Before, it was always something ... I'd dread going to Dr. G because I'd always learn some new thing, condition, complication, you name it that it became a joke between Wayne and I.  "What are you going to have this week? Leprosy?"  Who knew anymore?  

So when it became apparent during the meeting with Dr. R that we were just going to talk and discuss overall strategy, and look over Dr. T's doppler ultrasounds, I was mightily relieved.  The visit turned out to be cake!  Then on top of all that, Dr. R whipped out the cherry to put on top by saying that since yesterday's cervical length measurement was so long, I wouldn't need to go on bed rest after all unless I started to bleed or have changes in my cervix. She gave a couple of reasons for her decision, both of which I've heard before:  

1) Bed rest hasn't been shown to definitively prevent preterm labor unless you have a weak cervix.  That doesn't seem to be my case because when I go, it doesn't matter if I'm lying down or running a marathon. I just go from zero to 10 cm in record time.

2) I've got four kids and the chances of me staying on bed rest with them around are slim to none.  She's totally right. I tried to stay in bed a couple of days ago when I was still told I should, but after three hours I'd had enough of daytime TV, I went downstairs and cleaned the kitchen countertops because I thought I was losing my mind.  

So basically, if I had a short cervical length on top of my positive fFN, I'd be marched straight to my bed, or worse, to the hospital bed.  But since I've only got one out of the two, I'm safe for now.

Dr. R also told me that she wants to hold off on the corticosteroid shots until I really needed them.  She wants to time their administration to about a week before an elective C-section or, God forbid, when I go into preterm labor as the medication is most effective two to seven days after the first dose.  After that , it loses its efficacy.  Dr. R said that since things seem to kick into gear with me around the 27/28 week range, it was imperative that we get everything into place within the next two weeks since I'll be 25 weeks on Friday. 

That said, she scheduled me for an MRI bright and early next Tuesday.  Dr. R assures me that having the MRI is perfectly safe for the baby and will give a clearer picture as to the extent of the damage wreaked by that naughty placenta.  From what she saw on Dr. T's ultrasounds, it looked like in places where it wasn't a percreta, it was just a plain old increta instead.  Oh gee ... that makes it all so much better!  Regardless, she echoed Dr. G and Dr. T by saying, yup ... I'm going to lose my uterus.  Replying to my question of whether or not I'd also lose my cervix, she replied that I would, only if there wasn't too much blood "clouding the operating plane".  Okay.  Fair enough.  If you can see it, you'll take it.  If not, then it stays.  I get it.

She explained to me that as a teaching hospital, I'd have a few more bodies than normally would be present in the OR with us.  First, the delivery will take place in the main operating room. (I'm not sure if it's the main OR in L&D or THE main OR.  Wherever it is, my surgery is big enough so that it warrants something big, not the little ORs I've had in the past.)  Among the people present will be Dr. G leading the cavalry, Dr. R or Dr. P and some OB/GYN fellow and residents, the gynecological oncologist (whom I've yet to meet) and his/her team (a Fellow, a resident, and their nurses), the anesthesiology team (about two to three of them too), and the neonatal team for the baby.  From past experience, I know this last team to consist of five or six people alone.  There is always the attending, the fellow, a couple of residents, and one or two nurses.  And then there's Wayne and I ... all in all, about 20 or so bodies watching our little one make his debut.  I wonder if I can start charging admission ... it would be an interesting show, that's for sure.

I asked if I could be awake when he's born, to which she replied, absolutely.  It would be in the baby's best interest if he was born while I was on an epidural instead of general anesthesia; he would be less groggy that way.  After that, they would most likely put me out.  The baby would go up immediately to the NICU, since that's where all babies born before 35 weeks need to be if they're born at NYU, for evaluation.  Wayne could stay until the baby was born but then he'd have to leave the OR and wait outside.  This is actually something my husband, the sicko, is disappointed about.  During the Weet's C-section birth, he shocked everyone by standing up to look over drape and watch them work on me because he wanted to say he knows me inside and out.  Like I said, sicko.

Dr. R also explained that prior to surgery, the oncologists would probably want to insert surgical stents into arteries and ureters to control hemorrhaging and to illuminate the "plane".  Because so much blood is involved during an accreta/percreta surgery one of the common mistakes is to accidentally nick one of the ureters.  If that happens, then you're F---ed.  After the uterus is removed, the oncologists will then shoot methotrexate, a chemo drug into placental blood vessels around the bladder to kill them and hopefully shrink whatever tissue is left in, on, or around that organ.  She reminded me that I will most likely lose a lot of blood and will require several, if not more, transfusions during the process.  I told her that my good friend, Barbara, wants to hold a blood drive for me.  Dr. R thought that wasn't a bad idea, but we're limited with the issue of freshness of the supply since we don't know for sure that I wouldn't need it prior to 34 weeks.  Plus, she wants to wait until the MRI results come back to see what it is that we're going to be dealing with ... 

So the next steps are to 1) have the MRI; 2) meet with the oncologist(s); 3) go back to Dr. G to hash out an emergency contingency plan; 4) see Dr. T again between 28-32 weeks for another ultrasound; 5) get the steroid injections; and 6) have a baby at 34 weeks.  Granted, this whole plan goes out the freaking window if the fFN test proves right and I go into labor within the next two weeks.  Not gonna lie ... that would really, really suck and you might be getting more maudlin posts from me.  

This little man just has to obey his mama and stay put for a while:  "There's nothing for you outside the womb now dude!  Stay in! Stay in!  You have all your meals served to you without even asking for them.  It's nice, warm and a 98.6 degree cozy, whereas outside it's a cold New York autumn/winter.  You can sleep when you want, eat when you want, pee when and wherever you want ... it's all good inside!"  Gosh, I hope this kid listens.

Before I go, I just wanted to thank those of you who've reached out to Wayne and I with your thoughts and prayers. Honestly, I had given up on prayers for a while because I didn't think they were working for us anymore in light of everything.  However, a good day like today was all I needed to give me that sense of hope again.  I think your good vibes did the trick.  It really meant a lot to me to hear from friends, old and new, and even those of you who I've never even met but cared enough to reach out.  It really raised both Wayne's and my spirits when we were feeling pretty low.  I hope that you're never in a position that brings you down to where we were, but if you are, you can bet your bottom dollar that we'll be there to repay the favor.  

xo,

L