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Archive for the ‘Maybe baby?’ Category

Two quick things

1. I’ve decided heartburn must be Mother Nature’s method of getting me to drink more milk. Since Friday, I’ve started wondering if it would be cheaper to just buy a cow.

2. The appetite has seriously picked up. That’s good and bad. Good because, up to this point I haven’t put on a single pound and I was just on the verge of getting a little concerned. Bad because, well, see number one. I am trying to uphold a modicum of table manner standards, but I don’t recommend getting between me and my food these days. It isn’t pretty. I look like Cookie Monster when he loses control!

Ok, that’s all I’ve got. Now that I’ve scarfed down a lunch of cold leftover tuna noodle casserole straight from the pan while standing at the counter, I’d better go fix a glass of milk. And ask Shannon to stop for ice cream on the way home ’cause I bought strawberries today. 😉 We might need some cookies too. Ginger snaps sound good…

(How slow am I? It never occurred to me that C. M. was the source of “Om nom nom”. )

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Today just might be

five months and, not to get too excited or anything, but I might have been feeling movement on and off all weekend.

🙂

That’s all.

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19 weeks, 3 days

Just a quickie abdominal sonogram today. Ask and ye shall receive, I guess because Dr. T didn’t want any measurements or anything so this really was just a “Let’s take a peek before we do the cervix check” kind of thing.

Sonogram 19w3d

I also got a “Since your cervix is still a record setting length, those pains you’re constantly feeling are just round ligament pains. Congratulations, you’re just gonna be pretty miserable for awhile.” Lovely. Sigh. I”ll just carry those pictures around with me in the meantime. 🙂

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According to the OB, I’m carrying REALLY low, which may explain why I’m so uncomfortable lately. Instead of moving out into the open where there’s a little more room (and where our little long-legged starfish would make me actually LOOK pregnant), she’s snuggled in to my pelvis. I seem to have a history of carrying stubborn little girls. I hope she decides she’d be more comfortable a little higher up really soon!

But, after tracking the wiggly girl down, she had a nice 155bpm heartbeat, so all is good. Still wish I could get a peek at her.

We’re testing me on a slightly lower dose of metformin, down to 1000/day from 1500/day. My blood sugar values have been really good, although my fasting levels are just a tad higher than one would hope, which means I’ll probably have to be on something for the entire pregnancy. I’m just hoping moving back to the non-extended release metformin doesn’t bring back all the issues that sent me over to the ER formula in the first place.

I keep a dry erase calendar in the bathroom. It’s the one place I can guarantee that both of us will see it. Each month, I fill out the dates and put in all the stuff we have scheduled…stepson stuff, Shannon’s on-call schedule, birthdays, whatever. Then, I add in stuff like doctor’s appointments as they get scheduled. Each Sunday, I write in which week of pregnancy we’re starting. I don’t write the count in advance anymore. I’ve had to erase too many weeks-that-weren’t in the past. I can’t help but notice that before we get through this month, I’ll write in week 21 and 22. That puts us right in the time frame when the world turned upside down before. I’m trying not to focus on it, but it’s there, just on the edge of my peripheral vision like a big, hairy monster in the closet. I know things are different this go ’round. No twins. No surgery. No infections. Weekly doctor’s appointments and an MFM who is taking this pregnancy as his own personal challenge. A cervix that grew 3 millimeters in less than a week. The luxury of being able to stay off my feet all day if I feel like it. I know this. WE know this. Still, those blank Sundays where I haven’t written 21 and 22 yet, and the Sundays that don’t even show up on the calendar yet…23, 24, 25, 26…they’re there. Waiting. I think we’ll breath easy again once we get to Week 26. That would feel like cresting the mountain and looking at the gently sloping downhill trail. It just feels like a rough uphill climb, gasping for breath, just focusing on putting one foot in front of the other until then.

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Another week

another cervix check that beat the previous week’s measurement. And, I have a regular OB appointment this week which means I’ll get a few seconds with the doppler. I REALLY miss abdominal sonograms. Dr. T will do one at my final appointment with him in about a month, assuming I continue to have no problems requiring one before then. I am behaving myself and not trying to come up with excuses to take a peek, I promise.

Sunday marked 18 weeks. Assuming I’ll have my section at 37 weeks, that makes this Wednesday the half-way point. It seems like it both took forever to get here and that it took almost no time at all. August still feels very far away though.

So far, the second trimester hasn’t been all that exciting. I don’t think I’m going to end up as one of those women who look back on their pregnancies with much fondness. To be honest, it’s sort of felt like a really long case of the flu. I’m bone tired, the digestive issues are never ending, and there’s sort of this all over body discomfort with itchy skin and stretch marks thrown in for fun. I kept waiting for that second trimester burst of energy and so far, it just ain’t happening. It’s just a means to an end, just like all the crap that went along with the fertility treatments. I got through those. I’ll get through this. I had just hoped to enjoy it a little more. Of course, now that we’re approaching that same stretch of time where things all went to shit before, the anxiety is cranking up. It’s just hard. And I’m having a brief dip into the “It isn’t fair” pool for the time being. I wanted to be all glowy and round and happy pregnant. Instead, I’m exhausted, fat/bloaty/itchy/can’t sleep/my back is killing me, sort of getting by pregnant.

I wonder if just really needing a pick-me-up counts as a good enough reason for an abdominal sonogram. If not, it should.

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For the record

Round ligament pain SUCKS! Honestly? It ranked right up there with the gallbladder attacks of ’07. Kept me up all night last night and is only just now starting to feel better. It’s one thing when it’s a few seconds because I rolled over in bed. It’s a completely different animal when it’s gone on for hours and hurts no matter how I try to position myself.

Sitting in the MFM’s waiting room torture device, I mean chair, for over an hour this morning didn’t really help either.

Then, there was the migraine…

I’d like a do-over for today.

On the plus side, my cervix measured longer today than it did on Friday. Whoo hoo!

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The question was asked on the last post, “What is the difference between PIO and 17-p?” so I thought I’d do my non-scientific/non-medical-background best to answer. I’m not a doctor, I’m just a woman who’s been to this circus a few times and I’ve figured a couple of things out.

When you go through infertility treatment cycles that use a suppression method, essentially what you are doing is overriding your body’s natural production of hormones necessary to create and maintain a pregnancy. This allows the doctor to control those hormones more precisely. The downside is that, if you are fortunate enough to have an embryo implant, you still have to provide the hormone support until the pregnancy is advanced enough to take over. That’s where the progesterone in oil injections come in. They maintain the higher progesterone levels needed (increased progesterone is what prevents you from having a period. In a “normal” month, if you did not conceive, the progesterone levels that increased to help build the endometrial lining starts to drop and that decrease is what triggers your uterus to expel the unneeded lining and start the cycle all over again). PIO injections are continued until the placenta is established enough to produce progesterone on it’s own. That’s usually close to the end of the first trimester. Every doctor seems to have their own timetable for when to stop PIO injections.

17 Alpha-Hydroxyprogesterone Caproate or 17-p as it’s known to it’s friends, is used in high-risk pregnancies when there is a risk of preterm delivery. It is given as an intramuscular injection, like PIO, usually starting around gestational week 16 and continuing until week 36 or delivery (although I think I’m only doing it until 34 weeks since 36-37 weeks WILL be delivery for me). According to a study conducted from 1999 to 2002 by the National Institute of Health, the 17-P relaxes the smooth muscle, blocks the action of oxytocin, and inhibits the formation of gap junctions. Now, if you’re like me, that went in one ear and out the other. What Dr. T explained to me is that women in the study displayed better cervical competency, with improved length of the cervix and a significant reduction in the rate of preterm delivery (although in the very high risk cohort of the study, the rate of preterm delivery still remained high at 36.3%, indicating that more research into the causes of preterm delivery are needed. I agree!).

The shots are essentially the same as the PIO injections used from just before an IVF/FET transfer to sometime around the end of the first trimester. It is a compounded suspension of progesterone in an oil base injected into the glutes. We had a home healthcare nurse come over to teach Shannon how to give the shots. There were a few minor differences in this shot and how we were taught to give the PIO injections (basically, wipe the area, hold the skin tight, inject and withdraw, massage).

First, he was taught a technique called z-tracking. After locating the area for the injection and cleaning it with alcohol, he takes the palm of his non-injecting hand and pushes the fat layer out of the way. Ever done one of your injections and had a bead of PIO ooze back out after withdrawing the needle? This method prevents that. You shove the subcutaneous fat to the side, inject the medication, withdraw the needle and “close the door” by releasing the fat.

Second, the nurse told him that after he removes the air from the syringe to make sure he’s drawn up the correct dosage, to then draw back a small bubble of air. This bubble will move to the back of the syringe (the plunger end) when the 17-p is being injected and it will ensure that all of the oil is pushed from the needle while still in the muscle (apparently that will help with the itching and stinging as the oil can be irritating to the skin and surface layers) and the air is not harmful in either the muscle or the fat layer as it will simply be absorbed.

Third, the 17-p injection is given over a 60 second period. I will tell you right now, that is a REALLY long time to have that needle in your hip. I’m not happy about it at all, but that is the technique used in the study and that’s the technique that is being taught for the highest success rate. It’s a 1cc injection, so that’s veeeeery slow.

Fourth, the nurse said DO NOT RUB, MASSAGE, ICE OR HEAT. I’m supposed to just walk around after the injection to help work it in. The injection site was sore to the touch for a few hours afterwards, to the point that leaning back in a chair was uncomfortable, but once that passed, it was fine.

Fifth, the 17-p is administered once a week instead of once a day. Thank goodness! I’m not sure I could take a 60 second injection every day. I’ve only done one so far. We’ll see how it goes over the next 18 weeks. If anyone is interested in actually reading the New England Journal of Medicine article on this study, I’ll be happy to scan it and send it along, or you might be able to find it at NEJM.ORG. The study is called “Prevention of Recurrent Preterm Deliver by 17 Alpha-hydroxyprogesterone Caproate” and the volume information is N Engl J Med 2003; 348:2379-85.

Hope that answers the question! Basically, one helps you stay pregnant in those early days and the other helps keep you pregnant later of if you’ve had problems with that before. Since our best guess of what happened to Lennox is that my cervix softened enough to allow bacteria to come into contact with the sack and infect the placenta, leading to the membrane rupture (we don’t know for certain because we hadn’t gotten to a point where anyone thought to start checking my cervix) anything that keeps my cervix long and tightly closed is a good thing.

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