30 Weeks -- The Final Countdown

So I'm sorry that it's been such a long time since I've last posted.  Goodness knows there's been enough to post ... it's just that things have been so crazy on the life front with the other kids.  My eldest was knee-deep in college applications so that took up a good deal of my mental capacity.  Helping him out with his college essays by editing them and helping him do research on the schools and scholarships turned out to be a full-time job!  I'm glad to say that after a fortune and 13 school applications later, we're finally done!

Then my youngest was coming home practically daily with a new virus or bacterial infection from the petri dish they call Pre-K.  Of course, with my lowered pregnant immune system, I promptly caught everything he had.  I think this is the first week where I've been able to breathe out of both nostrils in a very long time.  I could go on about the workings of the 4th and 8th grades with my other two kids, but I think you get the gist that things have been nutso.  Oh yes ... let's not forget the holidays.

So let's do a quick rewind here:

27 weeks -- I met with the gynecological oncologist, Dr. B at NYU's Cancer Center.  Let me first say how surreal it was to be sitting in a waiting room with patients suffering from cancer-related illnesses when you're pregnant.  It's just not a thing that you'd ever expect in your wildest dreams to be doing when you're nurturing life.  I had a bout of light spotting the night before and was on the telephone with my regular OB, Dr. G in the hallway.  I knew how out of place it sounded to be talking of babies and such in front of everyone else so I tried to lower my voice as much as I could.  Wouldn't you know it, Dr. G couldn't understand a thing I was saying so I had to repeat myself in my normal tone.  Now half a dozen other strangers near me know my cervical length.  I wish I could have felt more embarrassed but by that point, I'd given up all hope of privacy and decency.

While ridiculously thorough, that visit with Dr. B was the longest doctor's visit I'd ever had!  I empathized with cancer sufferers who need to do this on a regular basis.  By the time you leave your hour and a half appointment, you're drained.  My hat off to you, you brave people, you.

Dr. B was born to be a surgeon.  Sitting with her at her desk, I couldn't help but stare at her long, graceful fingers.  I imagine if she wasn't a surgeon, she should have been a pianist.  To not put those digits to good use would have been such a waste.  Dr. B basically went through the same things that I'd already known.  Not much of a surprise thanks to all the reading I'd been doing the past few weeks.  It was rather anti-climatic really ... that's a good thing, right?  Isn't that what you want?  To be so prepared you're not caught off-guard by anything?  The same thing with my visits with Dr. G.  That is, until today.  But I'm getting ahead of myself.

28 weeks -- I was having contractions like a mofo.  First they were coming on every 10-15 minutes before getting to 5-7.  I did everything I was supposed to ... I stopped whatever it was I was doing, lied down on my left side, and drank enough water to sink the Titanic.  They wouldn't go away.  I called Dr. G and had his partner who was on-call that night tell me to high tail it to L&D at NYU Medical.  I started having contractions around 6:30PM and we got there around 9PM after waiting for the sitter.  I was hooked up to fluids, did a cervical sonogram, and ran a few tests which came back with a positive bladder infection.  Aha! That was the culprit behind the contractions.  After finishing a bag of saline and a nice prescription for nitrofurantoin, I was sent home around 3AM.  All in all, the visit wasn't in vain.  It was a pretty good dress rehearsal ... the residents were all ridiculously thorough.  There's nothing like hearing "percreta" and "previa" to get people to pay attention to you.

29 weeks -- It was a quiet week.  No spotting.  I felt terrific after the antibiotics for the bladder infection, at least initially.  The contractions had quieted down and I was thinking that I really could make it to 34 weeks, no problemo.  But once I finished with my dosage, the same feelings I had before (that I didn't even know were due to the bladder infection since pregnancy is known to mask the usual symptom) came roaring back.  Hello contractions.  I've missed you so.  Not.

30 weeks -- I've been doing the final countdown until 34 weeks.  I had in my head that Little Boy Blue would be here around January 28 or so.  Au contraire mon frere!  After seeing him today, it would appear that Dr. G wants to deliver the baby exactly THREE weeks from TODAY.  WTF??  I'll only be a little over 33 weeks by then.  It would appear that he wants to make sure he bypasses any large bleeds from the placenta previa.  He said I've been very lucky not to have had a major bleed thus far.  Since he's already put The Plan in place, if I were to bleed spontaneously, it would throw everything out the window and we'd have to switch to (literally) survival mode.

He's also not thrilled about the light spotting I had again this past weekend.  He said it was probably a good idea that I didn't call the office to report it because "no one wanted [me] anyway."  Huh?  He explained that he and his partner, Dr. M were away for the long weekend and the other doctors they had covering for them didn't want to see me because of the Christmas holiday.  However, Dr. G said he was off for everyone except for little ole me.  He'd already told his wife that if I called, that he'd drive back in from South Jersey to  take care of me.  Have I said before how much I love this man?  He also said that everyone in L&D knows about me ... they're all on high alert in case I come in.  Dr. G informed me that if I do call again for anything, he's just going to admit me for the duration of the pregnancy.  From a medical and legal standpoint, if I felt something was severe enough to alert him, then it's severe enough for me to be on strict hospital bed rest.  Note to self:  be really, really careful of phone calls here on in.

So our bundle of blue joy will be here in 21, now 20 days.  Yikes!  I have nothing prepared for the little bugger.  I have one Rubbermaid bin of infant clothing down in the basement that I need to wash for him, a mobile from one of his brothers, a crib bumper, and that's about it.  After our fourth child, I gave all of our baby gear away thinking there's no way I'd need it again.  No swaddling blankets, no car seat, no baby stroller, nada.  Not even a breast pump.  I've quickly thrown things into my Amazon shopping cart and all that's awaiting me now is a click of a mouse button.  I love technology.  Unfortunately there's nothing technology can do to help me get the rest of the house ready.  Egad.  Life is going to be a bit of a bear for the next few weeks.

Dr. G also sprung on me a couple of other surprises.  The first one is the inclusion now of a gyne-urologist to help reconstruct the bladder.  He thinks that maybe the reason why I can't get rid of the infection is because the bladder wall has finally been breached.  They won't know for sure until they cut me open.  I also get to have ureter stents beforehand.  Can't wait.

The other goody is actually cuckoo if you ask me.  The darling man wants to attempt to have everything done -- the baby's delivery, the hysterectomy, the bladder repair -- with me under an epidural alone.  Is he crazy??  His reasoning is that if I'm put under for the birth, they need to rush to get the baby out and I'll have to be intubated and then put in ICU afterward.  He wants it so I'll just come out from the surgery, go in to recovery, and will be able to get on with seeing the baby soon thereafter.  I'm dubious about this.  Maybe I don't want to be asleep?  Of course, my sick husband doesn't mind this.  This might mean that he won't have to leave the room during the rest of the surgery.  The sadist wants to be witness to the surgery because it reminds him of the days of his hospital residency.  Nice.  Sicko.

Okay ... I have 5 minutes left on my laptop's battery.  That's it here.  Will try to post more often.  Thanks for everyone's support who's reached out to me when I was in that terrible funk.  I really appreciate your concern.  xoxo

26 Weeks ... and now the countdown's on ...

So the past couple of weeks have been a bit hectic with Thanksgiving and whatnot ... I've been so busy with my other kids, trying to finish college applications with my 17-year old, dealing with a snotty, sick and cranky 4-year old, and all the rest in between.  On the pregnancy front, it's been trying to say the least.  

I saw Dr. G Monday for my regular visit and finally got the results back from the MRI last Tuesday.  I must say, I went into the MRI with such trepidation that the actual event was ... rather anticlimatic.  After dealing with insurance issues -- the freaking company denied my claim of all things, saying the MRI was "not medically necessary" -- for an hour and a half, I finally went in for the procedure.  For anyone who's pregnant and unlucky enough to warrant an MRI and is worried about the ill effects on the baby, be cautious, but don't panic.  I had what's called a "visceral pelvis without IV contrast" MRI, which means I didn't have to ingest any of that nasty tracer agent.  I laid down on the table, had a couple of shield placed over my abdomen, requested my favorite radio station on the headphones, and stayed still as the technician slid me into the tube.  Half an hour later I was done.  

The good news is that Dr. G gave me a copy of MRI report so I don't have to rely on my faulty pregnancy brain to recount our conversation.  It could have been better.  The report impression reads: 

"Abnormal appearance of the anterior inferior placenta-myometrial interface with bulging, lobulated margins, dark intraplacental bands and irregularity at the border of the posterior bladder/uterine margin.  Findings are most compatible with a placenta increta.  Focal percreta at the left lateral superior bladder wall cannot be excluded (possible.)"

Placenta increta -- Irregular interface (lobulated) between the placenta and adjacent myometrium. Enlarged vessels extend through the placenta to the serosa surface.

An irregular interface between posterior aspect of the bladder and adjacent uterus.

Placenta previa

Basically, what this means is that a placenta increta has been confirmed and it's still "suspicious" for a placenta percreta in the left corner of my bladder.  They don't know for sure if it's definitely breached the bladder but they believe it's gone through the serosa, the outer membrane of the uterus.  Results from an earlier color doppler ultrasound found that there were placental vessel imprints on the outside wall of the bladder.  As my darling husband likes to put it, "It's like someone's knocking on the door but no one's opened it yet."  Yup.  That pretty much describes it.  Again, I'm told there's a caveat:  no one knows for sure what is really in there until they cut me open.

I'm partial to previa ;-)  ... just a joke to lighten the mood.

I was also given Dr. R's MFM consultation write up on me.  I'm chuckling a bit over my "active problem list": -- placenta accreta/increta/percreta; history of preterm labor; partial placenta previa; uterine fibroid in pregnancy, and here's the best part ... AMA (advanced maternal age).  She made the recommendation that I'd have a repeat ultrasound at 30 weeks with Dr. T, keep up with the cervical length ultrasounds every two weeks, and if my cervix does, indeed, shorten, or if I have regular contractions (6+ an hour), or if I start bleeding, then I should get the steroids immediately.  However, if I don't have any of these things, then the steroids would be administered at 33-1/2 weeks with a scheduled cesarean hysterectomy at 34 weeks.  (This means we've got exactly seven weekends to get everything ready before the baby gets here and I'm incapacitated for a while.)

I'm a little annoyed at both Dr. R and Dr. G.  It would appear that both expected the other to refer me to a gynecological oncologist but neither did.  So now I have to wait for Dr. G to decide who he wants to work with and make the appointment myself.  It's got to be made in the next week or two.  I think I'm burying the lead, but the contractions are becoming more and more frequent and pronounced -- sometimes 4 or 5 an hour-- and on Sunday I started spotting (today's Wednesday).  The stabbing pain is so much more and have migrated toward the left side of my lower abdomen.  Now that I know the MRI results, it all makes sense, right?  Dr. G thinks that I'm basically a walking time bomb.  According to him, there's no knowing when I'll start bleeding but he thinks I probably will if I've already begun to spot.  I could go into labor prematurely -- thank you positive fFN -- any time between now and the scheduled delivery.  

Dr. G and I discussed bed rest at length.  I told him that my contractions occur regardless if I'm lying down or standing.  Yes, they absolutely do get more frequent and painful when I'm active, but we've agreed that I'll take it as easy as I can.  That means no exercise, no walking for more than a few minutes at a time, and plenty of chair breaks.  Having been through this before, I know the drill.  I lie down on my left side when I have too many contractions, drink a lot of water, and sometimes they'll go away, sometimes not.  There's not much else I can do.  Luckily, I've managed to hold off on going to the hospital again for preterm labor.  At 26 weeks+4 days, that's a record for me.  I usually have my L&D frequent customer card punched a few times by now.

Wayne and I have been trying to put on a brave face for the kids but Sunday and then Monday after my visit with Dr. G were hard.  Something inside me broke and I spent the better part of both days crying. I couldn't help it.  The boys all saw me, but only my little one said something as only four-year olds can do.  I feel myself withdrawing, pulling back from friends and family outside of Wayne and the kids.  I just want to envelope myself into them and not deal with anything else.  They are my priority.  

One of the reasons, I know, of why I'm retreating has a lot to do with not wanting to hear other people's comments.  I've gotten a few from folks who are essentially clueless about this, despite what I've already told them.  People who tell me to stay away from the internet, to stop reading about the condition because they think it's making me crazy.  But that's not it.  A journalist before I had kids, I was and still am an amazing researcher.  It's in my nature to till information forwards and backwards until I understand the scope of a matter.  I really took offense at those comments and found them patronizing.  I know I'm sensitive now, but people telling me that everything's going to be alright, to not read anything, to keep up positive spirits ... well, first of all, they don't know that for sure. Plus, I just want to turn it around and ask them, if this were you, what would you do?  I dare anyone who's been diagnosed with a serious condition to not read as much as they can on it.  Can you imagine telling a cancer victim not to research their prognosis?  Why, then, is it so galling to some of my "friends" that I should do the same?  Does it make me feel any better to know that maternal morbidity has been reported to occur in up to 60% and maternal mortality in 7-10% of cases with placenta accreta?  No, but at least I have my facts and I'm prepared.  It's always easy to talk when the discussion isn't about yourself. 

Also, I've found that most don't people understand the whole concept of a preemie baby.  I've gotten some comments in the vein of, "Well, at least you won't have to go through the last trimester and be uncomfortable."  Others seem to think that a preemie baby is just a small baby and all they need to do is "feed and grow."  Ah, to be clueless.  Never mind the fears of NEC, open PDA, ROP, brain bleeds, lumbar punctures, high jet vents, desats, and bradys, and so on and so on.  Wayne and I have been through them all. Again, some of the comments have been pretty ridiculous and infuriating. So I'm barricading myself for the time being because if I leave myself open then I'll say something I'll regret.

Another thing that I'm bugged about ... I had thought that Dr. R was was going to be in charge of the operation since she's the MFM.  Nope ... turns out that Dr. G will be handling the C-section and the oncologists would do the hysterectomy.  I love Dr. G. I've been with him for the past 15 years, but what's niggling at me is that he didn't catch the increta initially.  The sonographer at the hospital where I was taken into the ER found it.  Once he knew about it to look for it, he easily found it.  So that begs the question, if I meet all the risk factors for placenta accreta, then why wasn't it ever discussed?  The women I've spoken to with this condition certainly had never heard of it before their diagnoses.