Thursday, June 14, 2012

Five month recap

I've been very bad about blogging. It is now probably five months after my last post and I realize that I left it as a cliffhanger ! So, what DID happen at our first ultrasound ?

Chris and I woke up and we drove to Dr. T's office and got settled into the examination room. We had purchased a little gift from Tiffany's for Dr. T and some jewelry from Blue Nile for the nurses, and she came in and I held my breath. What would we see ?

The image flickered into view and to my relief, I could see the sac. I exhaled. Dr. T turned the monitor so that Chris and I could see and she pointed to this little flicker that was on the screen. It looked like a little star twinkling and she said, "That's a heartbeat." We were smitten. Look at our little baby's heartbeat !!

Then, Dr. T shifted the ultrasound wand a little bit and said, "And here's another heartbeat."

There was a moment of stunned silence. At this point, I usually say, when I'm telling this story out loud, that I then said in alarm, "Our baby has two heartbeats ?" but the truth is that I didn't say that, and all I remember is seeing Chris's face and he said, "I see it." and then the slow realization as Dr. T said, "You're having twins."

I swear I still get so emotional thinking about it. I started rereading my blog today and looking back, I am so glad that I had written everything down because it was, and still is, such a big event in my life. Dr. T was very cautious and told us that she was worried because she couldn't tell if a membrane was separating the two (we thought that meant she couldn't tell if they were identical or not), and we left that office that day, with a few pictures of our tiny babies clutched in our hands, and shock in our hearts (at least, I was majorly in shock .. this whole time I thought there was one !).

We would later learn that we were having identical twins (go figure !), which means that one of our embryos didn't implant, and the other one split. They are mono-di twins, and with that comes great complications as we would later learn.

We saw Dr. T a few more times after that, and then .. the sad graduation. I kept on my Vivelle and Endometrin until 12 weeks, and then transferred to my OB, Dr. Hua, and I was very lucky to get in because it turns out that I should have booked an appointment months ago. Dr. T helped by sending a note to Dr. Hua, who fit me into her schedule.

The next while is a blur. We were excited and nervous, and everything was going well. Dr. T had told us that we would need to go see a perinatologist (Maternal Fetal Medicine doctor) since I was considered high risk, and at our first meeting, we had Dr. K (who we didn't really like, so we switched to the other one). Those ultrasounds are very cool since they are high-res and it took probably around two hours to get all the pictures they wanted to get.

After that, we saw MFM every two weeks and she (Dr. D) would check the babies, and we were content and happy. Our NT scan came back well (one was at 2.4 mm and one at 1.0 mm which was a little alarming since we learned that could be an indicator that they would start transfusing blood down the line, but it was within normal guidelines) as did the first trimester blood work, so it was a shock when the second trimester bloodwork came back abnormal, giving us a 1:120 chance of Down Syndrome.

We were .. devastated. We had thought we were going to be okay (and actually, Dr. K told us at the first meeting that she would be VERY surprised if my second trimester quad screen came back abnormal) and did not plan on doing amnios since I was under 35, but with 1:120 odds, should we do it ? We did end up deciding that we wanted to do it, because we would rather know than not know, and so we met with a genetics counselor and did a double amnio.

A week later (thankfully, it was fast !), the results came back. Both were normal !! Oh, and I should probably mention that we already knew from the first ultrasounds that we would hear the pitter patter feet of two little boys.

That was our first big scare. Then, at our appointment on May 15th, our world was turned upside down. By this point, I think I was in my 19th or 20th week, and we figured that we had all the worries behind us. We were at a MFM meeting when Dr. D came in and said she wanted to take a look herself and I just knew that she was not going to tell us good news.

It turns out that Baby B was measuring behind, and at a previous meeting, she had mentioned that he was 23% smaller than Baby A (normal guidelines are under 20% discordance), but now it had grown to 29% and Baby B was in the 2nd percentile for size and weight (and whatever other tests they run). We knew it was serious, and she said at one point, "I'm very afraid that he isn't going to make it. He may die." She spoke of how since they were identical twins, if one were to pass away, there would be a 20% chance of brain damage to the other twin. She said that UCSF was one of five clinics in the US that did radioablation of the umbilical cord, meaning that they would sever the connection so that the 20% chance didn't exist anymore. She asked if we wanted her to inquire if they did indeed do that procedure. I couldn't wrap my mind around anything she said. We said yes, because we wanted to keep our options open (and wanted a second opinion), but hoped that we would never have to seriously consider it.

I thought we were holding it together pretty well despite all the bad news (though most of me was just in utter shock) but when Dr. D leaned over and rubbed my legs and said, "I am very very sorry. Take all the time you need in here.", I just completely lost it. It was also one of the few times I've seen Chris cry. I couldn't comprehend it. I've felt both of them kick. I've carried them for so long at this point that they are a part of me. I've dreamed of my little boys for months by this point and I needed and loved them both.

The next few days were awful. I cried randomly and my heart was shattered into little pieces. All the stuff I had been buying had both of them in mind. It was too painful to even think about purchasing anything else because I didn't know if I would be purchasing for one, two, or none. I had a hard time sleeping and waited. I researched a lot online about Selective Intra-Uterine Growth Restriction (SIUGR) and posted on Baby Center. I found out that a doctor in LA and Tampa were doing experimental surgery where they would completely divide the placenta into two. I thought I would inquire about that.

At some point, Dr. D did call me back and told me that UCSF does do the procedure and so she helped set up an appointment with UCSF. She said that they would call me with an appointment. One night, my OB called and said she had read the report and wanted to call to see how I was doing. She sounded so apologetic that I knew she didn't have high hopes for us, but it was kind of her to call.

UCSF took their sweet time getting back to me. One day passed, and then another. I started to get frantic because I didn't know if and when they would see me, and here I was, sitting in my room all the time with so much on my mind and nothing I could do. We also had our babymoon planned for Maui and were supposed to leave that Sunday, but how could we go with everything that was going on ?

I did finally get an appointment with UCSF on the 25th of May and it was a full day appointment. We arrived at 9 AM and ended up leaving around 3 PM or so. First, we went to radiology so that they could get their own measurements. The sonographer was very gentle and I appreciated that, but the radiologist didn't seem to know how to work the machine (that made me nervous) and was very heavy handed. It took about two hours and I'm just glad I didn't pass out (at one appointment with Dr. D's sonographer, she must have been pressing on my vena cava or something because I thought I was going to black out and had to lay on my side for a few). Then, we went to the fetal treatment center.

When I had all that free time waiting for UCSF to call, I started to read up on their website about their advances in medicine and was very impressed with what I read. I always knew that UCSF was a prestigious school, but one doctor stood out to me, Dr. R, because not only was he the director, but also because the majority of his research has been on mono-di twins and their complications.

So I was very pleasantly surprised when he was the one who greeted us (I kind of freaked him out because I said, "I was just looking at a picture of you !" and he was like, "Uh, okay.") and we went into his office to talk. I should point out that the reason I was just looking at a picture of him was because the sonographer had asked if we had already met with Dr. R, and so I was on my cell while we were waiting looking through the profiles to see if that was the doctor I was hoping we'd get. Later, Chris would say that I'm such a creeper, lol.

We didn't know what to expect. Would he tell us good news or bad news ? I had been stuffing my face with protein all the time up to this point .. three Boost drinks a day, mostly bedrest, eating lots of beef, chicken, etc. (so much food that nothing sounds good). Well, it was good news ! He told us that he would not recommend laser surgery at this time and said that most patients with our situation end up doing pretty well, making it to an average of 33 weeks (32-34 weeks he said initially). He was extremely thorough and drew us a diagram where he explained that Baby A's umbilical cord was attached near the middle of the placenta, but Baby B has a velamentous cord insertion, meaning it actually goes into the uterine lining and not the placenta, and uses blood vessels to connect to the placenta. This made me very sad because I was thinking about poor Baby B with his two corded vessel and how he was struggling to get food.

Another thing Dr. D had mentioned was that there was intermittent absent end diastolic flow for Baby B. If it was just one baby, that would be very very bad thing to hear. And she didn't tell us at the time, but when it's in identical twins, it's just confusing. Dr. R explained that all mono-di twins are connected in some way. There are artery to vein and vein to artery connections within the placenta and most of the time they even each other out and so there is no transfusion. But what happens when there is an artery to artery connection ? That's where it gets interesting, he said. He believes that Baby A may be pumping blood to Baby B more than the other way, so in essence, Baby A was helping Baby B. This also explained the intermittent absent end diastolic flow. We said that we would meet every two weeks to get more data points and to make sure that Baby B would continue to grow. In California, all decisions have to be made by the 24th week of pregnancy.

We felt so good coming out of Dr. R's office, and he was obviously very knowledgeable in this area and so we felt comforted. 32 weeks ! That would be awesome ! Before this, we had been hoping to even make it to 28 weeks. We then went to do the fetal echocardiogram. It sucked, in short. The technician that we had was obviously having a bad day or just a jerk or something, because not only was he very rough, but he seemed like an angry guy. He would stand up, kick his stool to the wall, press down hard on my stomach, then sigh, over and over .. and complained about how he had two sets of twins recently and triplets a few days before.

In the end, their hearts came back structurally normal and healthy. What a relief ! All in all, it had been an excellent day, and after the EKG, we headed home. We decided to go to Maui because all three doctors had said we could go, and we had no appointments scheduled for the next week.

Some other random tidbits of what was going on during this time .. we sold our house ! Yes, it all happened very fast, but we decided to list our house and move in with my mom for the time being. We figured we wouldn't purchase another house until the end of the year. We officially listed it on May 8th, the broker's tour was on May 10th, the house was open for Mother's Day weekend, and we accepted offers on the 17th. We countered three offered and signed the one we ended up selling to on the 18th.

Mother's Day ! It was my first as a Mom. :) My sister got me these amazing shoes by Nike (they make my feet look like a camel) and a very sweet card. My husband got me a beautiful card and tickets to see Les Miserables .. my favorite ! So it was definitely a day to remember. They are so thoughtful. <3

Maui was fun, except for our trip to Hana road. It became this huge thing, because we did a tour and were assured that the backside of Maui wouldn't be bad (there's a seven mile stretch of unpaved road), but it turned out to be so violently bumpy (and lasted 45 minutes) that I felt horrible afterwards. This led to us filing a complaint with the hotel (though Expedia Local Experts is contracted), and I posted a nasty message on their Facebook page (more on that later), and sent an email.

The good thing is that the next morning, Debbie, a manager for Expedia, called and gave us a full refund, but I was in agony for a day.

Aside from that, Maui was great. But I think mainly what made it great was that I was there with my husband. I don't even know what to say about him. I am constantly amazed by his gentleness, affection and silliness, and it sounds so cliche, but he really does make everything better.

We had rented a car and had a Nissan Versa or something and we were cracking up because it was really a piece of shit car. Chris kept calling it a micro machine car, and it would shake sometimes when we were driving or at a stop, and it just didn't seem that reliable. We went to Lahaina one day, did the Old Lahaina Luau, Hana road, swam a lot in the hotel pool, went to the beach across the street, ate a lot, crashed the Marriott at Kanaapali, and had an amazing time at the spa (Chris is so in love with the eucalyptus steam room there). The spa was very very nice, but I was kind of sad I couldn't take advantage of all of it. Most of the stuff (they had these five terme bath salt bath things, sauna, hot tubs, etc.) isn't recommended for pregnant people, and though I did dip into two termes (the mango papaya green one and the black one), I mainly stuck with the waterfall thing. The massage was wonderful .. one of the best, and Chris really enjoyed it.

Our hotel was also really cool. It had washing machines you could use for free, the rooms were nice, the staff was very nice, and overall it was just a very nice vacation and it was also nice to just kind of get away from it all. I should end it here .. I have to go meet my realtor !

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