Saturday, September 30, 2006

A long, long day

Sorry for this hiatus ... but I have still been gathering myself together the last couple of days, even after being off bed rest. (And bed rest SUCKS. I hope to goodness I am not stuck on serious bed rest in the End Times of this pregnancy. [Although I would of course prefer that to an unhappy ending for this pregnancy.] But in addition to being mind-numbingly dull, bed rest makes me exhausted for days and days afterward. I did bed rest after my myomectomy, and again while we were trying to conceive, and each time, the aftermath was as annoying as the rest itself. The tiny bit of muscle tone I lay claim to just leaves town altogether during bed rest, and it takes me forever to coax it back again.)

Monday seemed to me like the longest day ever. It reminded me of some endless trips I've taken overseas, where you get up at zero-dark-thirty to take the shuttle to the airport, then sit twiddling your pinkies at the airport for an hour or two, then finally board and do a short hop to some jumping-off point, then unboard and reboard, and finally have an excruciatingly long flight to wherever you're going, and then even afer you get there, there's some 2 hour bus trip to get to your final destination. And then a taxi. And then you get to your hotel bed and figure, finally, I can rest, but then you can't sleep because you're just so enervated by that time. And it's just the day from hell, not because of anything particularly going wrong, but just because it's so damned long.

Monday felt like that. I felt so sad, and yet knew that I had to be determined. It had to be done and that was all there was to it. But first, I got up early because I had to feed the cats and try and arrange some final things around the house, and then there was the hour drive to the city, and the search for parking. And then when we got to CPMC and went up to the proper floor, we thought for a moment we'd wandered into a war zone. It turned out they are in the midst of serious renovations on that floor (think: jackhammers and dentist-like drills) and it was damned loud. Of course, my first thought was that the doc was going to be startled by some bazooka going off in his ear under these MASH-like conditions, and screw something up at some vital point. Therefore, in addition to being sad I also became crazed. Not a good combo.

D and I also managed to work in a short but vicious spat, and got bonus points for doing it in front of an audience. (Though I must say that during all the rest of the day, he was a complete angel and did all he could to make things easier for me.) When we checked in at the reception desk, they told us to come back after the nuchal fold ultrasound and pay for everything at that point. I wanted to clarify, so I asked if they really meant after the ultrasound, or after the procedure. Of course, said the receptionist, she meant after the procedure. I sat down with D in the waiting room, and a couple of minutes later they wanted us back again at the desk to sign something. I sent D, who came back with the news that they wanted us to come back after the ultrasound to pay for everything. No, said I, they want us after the procedure. "But she said--" "I already asked her!" "But she said--" "I know! I know! I clarified it already!" "But--" "If you'd let me finish, dammit--"

All with an interested audience in the waiting room, and a background of jackhammers. Fun was had by all.

We met with a genetics counselor first, who took us to a blessedly quiet meeting room down on the first floor, and proceeded to worry and depress us. She was very nice, and took a fairly in-depth genetics history from both of us. It turns out that neither of us have much worth worrying about in our family tree, but none of that matters because I am of "advanced maternal age" (i.e., older than dirt, and so are my ovaries) and therefore our children, if any, will be born with two heads. Or something like that. The figure that got to both of us was the 1 in 14 chance that each fetus would be afflicted with some chromosomal abnormality, whether a serious one or less so. That's a damned big number. Had I known that before we got started, I'm not sure I would have had the courage (or, possibly, foolhardiness) to proceed with my own eggs, despite my desperate desire to do so.

After the genetics session, we went back up to the war zone, and were conducted down a very long hall which gradually got quieter. By the time they ushered us into the procedure room, it was actually normally quiet. I changed into a gown, and we started off with a very long and involved ultrasound of my tummy, done by a technician. I had no idea there were so many angles that my interior could be viewed from. In addition to finding and labeling the four fetuses (A through D), she also located 3 (or 4 -- I lost count) new fibroids of about 1 to 1.5 inches each. This sent me into a new tizzy, but the tech said that most fibroids stop growing at about the end of the first trimester (where we are now) so with any luck, that might be as big as they'd get. I could tell when she was pressing on a fibroid with her wand because it would suddenly hurt.

When she was done at last, she printed out a long string of u/s pictures and went off to consult with the doctor. Then Dr. Tex came in and introduced himself, and we got going. He took over the ultrasounding and went back over things, sometimes pointing out various findings on the screen to a young female med student he had in tow. He told us what he was finding: two fetuses with normal growth, that had nuchal folds below 2mm, and two that had nuchal folds over 3mm. All four had visible nasal bones. He also pointed out to the med student what he believed to be a cystic hygroma, and also an exhibition of flexion in the hand of one of the fetuses (a soft marker for Down syndrome). Cystic hygroma can also be a marker for a number of different chromosomal defects, such as Down syndrome, Turner's, etc. It occasionally will resolve before birth, but usually cystic hygroma is a very bad thing.

It was difficult for us to watch the images on the screen, knowing that two of them would soon be no more. D finally gave up and sat beside me with his head lowered, but still holding my hand. I had initially not thought I wanted to see the images at all, but I found that it helped me to see the difference (visible even to these untutored eyes) between the necks of the okay fetuses and the suspect fetuses. The possible cystic hygroma looked immense, compared to the necks of the >2mm fetuses.

I had prayed to The Big Guy that the selection would be cut and dried. I don't know if He answers prayers along those lines, but the selection of which fetuses to reduce was indeed obvious. Dr. Tex didn't waste any time, but as soon as we were agreed, set right to work. First he numbed the skin with an injection (which hurt in itself, but not for long) and then, using the ultrasound as a guide, guided the needle in. The procedure was that the fetus's heart would be stopped with an injection of some chemical (I've forgotten what exactly) and then some of the amniotic fluid would be removed. (He explained the reason for that but I've forgotten. Maybe just to make more room.) I had my eyes squeezed tightly shut, so I avoided seeing the needle (which was quite large) but I couldn't avoid feeling it. It was more a feeling of intense soreness than sharp pain, but I could definitely tell that things were being messed with. A nurse stood at my feet and rubbed them a bit, to distract me, which did help some, but on the other hand I did not want to ignore what was going on. D and I made the best decisions we could all along the way, but it was due to our decisions that this was having to happen, and I did not want to ignore or ever forget that it had happened.

Each one took 3 or 4 minutes to complete. The first one was definitely more painful than the second (I think the xylocaine had kicked in by then), but during the second one I began to cry, and then had to suppress it since I could feel the sobs building up, and I didn't want my belly moving and causing problems. But I felt so wretched. It was actually my praying that set me off. I am a Buddhist and believe in reincarnation. But I am also a Deist, which is why I'm always having these interesting one-way conversations with The Big Guy, and I was asking Him to let the little ones reincarnate in a good place where they would have healthy bodies, and be loved and wanted by their new families.* And that really set me off -- but I didn't have the luxury of letting myself indulge in tears at that moment.

This is all making me sound crazed, I know, but I was a little crazed at that point in time. In any case, Dr. Tex was soon done, and checked by ultrasound to make sure that the two remaining were doing okay -- which they were. He talked with us about our doing amnios on the two remaining fetuses (he was strongly in favor of it, given the odds we had received from the genetics counselor) and gave us some advice on how to pick a good operator to do the amnios. (Someone with LOTS of experience. He told us that his own statistics on miscarriage following an amnio are about 1 in 400, which is significantly below the national average of 1 in 200.)

Afterward, I got dressed while D went down the hall and wrote CPMC a nice big check (though with the 35 percent discount). I was exhausted, and then we had to walk down that long, long hallway just to get to the elevator. Given that the nurse had just given me quite a strict lecture on how important it was for me to do strict bed rest for three days (she even advocated eating in bed, lying on my side, which made me think she actually had some beef against me and wanted me to choke on my food), I thought it was insane that they made me walk so far to leave their facility. What, don't they have any wheelchairs there? But I was too tired and upset to worry too much about that so I just shuffled down the long hall, clutching D's hand and letting him tow me along.

That was pretty much the day. I sat in the waiting area downstairs until D brought the car around, and then we drove home (with mercifully little traffic). At home I crawled into bed and read for hours instead of going to sleep -- because I was afraid, as Shakespeare said, of "what dreams may come." But apparently my unhappiness has been near enough the surface that my subconscious has not felt the need to take up the issue. No dreams about this, so far.

But I do have a new worry. I have found myself worrying more or less constantly the last couple of days about the state of the little ones that are left. Today I was in tears over it. I am not exactly terrified, but certainly very concerned that the two left may have chromosomal issues as well. And if they do, what then? Shall we just terminate our way down to no pregnancy at all? This has been such a long road ... starting in June 2005 with an abdominal myomectomy (that took me months to recover from) and then our efforts all this last year to conceive, first naturally and then with IUI's and finally with two IVF's ... and it just feels like we've been slogging up this mountain forever. And the mountain isn't getting any smaller, as far as I can see.

# # #

*This may be neither the time nor place, but just a note on the coexistence of Buddhism and Deism in one brain: People often have the notion that Buddhists are not allowed to believe in any deity. This is not correct. Gautama Buddha himself, when asked about the existence of deities, refused to make answer, saying that neither the existence or non-existence of any deity had any bearing on what he was trying to teach. There are actually a number of people who are simultaneously Jewish and Buddhist (so much so that they are sometimes jokingly labeled Jew-Boos in the Western Buddhist community), and indeed, there is even a Buddhist-Christian Journal that is put out by a university in Hawaii.

Tuesday, September 26, 2006

Quick update

I'm flying low since I'm not supposed to be out of bed at all, so please excuse any typos, etc. Yesterday went as well as it could have, I think. Dr. Tex was great and so were the various personnel. In case anyone asks you, yes, the procedure does hurt. It doesn't reach the level of what one might call "PAIN" but certainly does reach "damn that hurts!" (And keeps on hurting, since the procedure takes several minutes.)

However, at least the choice of fetuses was clear. Two of them were on target with their growth for their age, and had nuchal folds under 2mm. Two others were also on target for growth, but their nuchal folds were both over 3mm. (You notice the jump of at least one mil in between.) On Dr. Tex's advice, we reduced the two with the larger (and suspect) nuchal folds. Dr. Tex advised us to also get amnios done on the two that are left, and now that I've talked to a genetics counselor, I concur. It turns out that the rate of all chromosomal defects for babies conceived by women of my age (44) is 1 in 14. That's damned high. Some chromosomal problems can be lived with but others are life-altering.

Thank you so very much to everyone who has expressed their support and prayers for me. I can't tell you how much that means to me. Think of yourselves as all being grabbed and hauled into one big teary group hug right now, will ya?

Tuesday, September 19, 2006

Two Ton Mama

I held out on buying maternity clothes for quite a while. It just seemed like asking for trouble. Just begging the Fates to zap this pregnancy and make me take the stuff back to the store unworn, weeping all the while.

But my body has a mind of its own, and frankly, the one pair of jeans and one pair of shorts I own which I still fit into are rapidly shrinking. I seem to have the Amazing Growing Belly. When I first got pregnant, I shot up about ten pounds almost instantly. (Which was a little startling at the time, since I already had a BMI of 25, which put me squarely in the "overweight" category.) But since September 1, I have only gained one more pound. And yet my body is definitely reconfiguring itself. My waistline expands more and more, and when I look at myself sans clothes these days, I definitely have Preggo Belly. I have no idea where it's coming from, since I'm not gaining weight. I have a theory that my body is sucking fat out of my ass and using it to nurture the fetuses, but it's only a theory. (Like all theories, it's hard to prove. Nice idea though, huh?)

So a couple of weeks ago, after I had to use a rubber band to fasten my jeans (over the button, through the buttonhole and then back over the button), I caved. I went to Target to see what they had in the way of maternity clothes. They had some decent stuff, though I had my usual complaint about clothes-shopping at Target: They never have my size. I am an Average Fat American and therefore everything in my size has already been snapped up by other Average Fat Americans. I don't know why the buyers don't realize they should buy three times as much stock in the Average Fat American sizes.

After going to two different Targets, I finally wound up with three pairs of casual pants in three different maternity belly styles. (One under the belly, one traditional full panel, and one expandable panel that pulls up almost to my armpits but feels great, as though my Fat American belly is being cradled in a sling.) Of course, since I am also the average height for an American woman, at 5'4", and these pants are apparently all cut for pregnant Amazonian warriors, I will need to hem them all before I can actually wear them.

But I have yet to buy a single maternity top. Not for lack of trying, mind you. Today I went to the mall, and went into five different stores looking for a maternity top or something that could pass as one, and found nothing. Everything fell into two categories: Cutesy-poo Empire-style blouses that cradle the tits and then bell out over the tummy, all of which made me look as if I were either an aging Summer of Love refugee or else expecting Jane Austen to tea at any moment; or enormous tent-like dashiki things that were huge on my shoulders and added another fifty pounds visually. (I hardly need tell you I don't need another fifty pounds added, even if only visually! It's well within the realm of possibility that I'll get there for real in this pregnancy, but I'm content to wait until then.)

The best possibilities I've found for tops so far are in the J.C. Penney maternity catalog, which has some simple tee shirts cut for preggos like me. That's all I want, really -- something to cover up my belly and my pants' belly panel, that doesn't make me look like I'm trying to be cutesy and pass for 22. I hate ordering things from catalogs since I inevitably buy the wrong size and have to return it, but I don't see that I have a lot of choice here.

But I have to thank the Penney's catalog for my most entertaining moment in this search. There is a type of top known as a "surplice," which simply means that the top does a criss-cross thing. Penney's had a couple of blouses in this style, and had, in their infinite wisdom, labeled them both "surplus blouses."

Heh. Heh. They said "surplus." Heh.

Monday, September 18, 2006

Amazingly enough

... I accomplished both my big goals today. I got my blood test records from my HMO (to be faxed off to CPMC tomorrow), and also talked to the doctor who will be performing the reduction on the 25th. And his timing was perfect -- he called after I stepped out of the shower, but before I left to do battle with the HMO. Sometimes ya gets lucky.

Also luckily, the doc seems like a very nice guy, as well as very knowledgeable. A little chit-chat before we got down to business established that he is a fellow Texan (yeehaw!), so we'll just call him Dr. Tex. (Though I have a feeling that he hasn't actually spent that much time in Texas, since his accent was undetectable. But then, people tell me that I don't sound like I'm from there either, so who knows.)

Dr. Tex told me that there is about a 4 to 5 percent chance of miscarriage of the entire pregnancy when you do more than one reduction (odds similar to those of amniocentesis). Basically, whenever you start sticking needles in your belly, you're looking for trouble -- and in this case, hoping you don't find it. And yes, that is how the reduction will be accomplished -- a needle through my belly, and into the fetus, which is then injected with a chemical to stop the heart. (I don't like this. I'm just reporting it. If I don't have the guts to look all this in the face, then I have no business having started any of this. A man should be able to shoot his own dog, and a woman should be able that she is having an abortion at least partly as the result of her own lack of judgment.)

He said that they numb the skin where the needle goes in, but there will still be some discomfort, since the needle goes through muscles and that doesn't get numbed. It's not like I'm not used to needles, having gone through IVF twice, but I must admit that a needle in my belly will be a new experience. (However, there's a masochistic side of me that's telling me I deserve it. If not worse.)

Dr. Tex will perform a nuchal fold ultrasound before the procedure, looking for "soft signs" of chromosomal or other problems -- a thickened nuchal fold (a fold of fat at the back of the neck), the lack of a nasal bone (a sign of Down syndrome), lack of growth of the fetus, etc. I asked him if CVS was an option, and he said no. He told me that even with twins, they sometimes have problems with contamination of the samples, and with four, there are just too many placentas in there to be really sure of which one you're sampling. I mentioned to him that there had actually been six sacs to begin with -- the four fetuses plus the two empty sacs -- and he said then that absolutely, CVS was out of the question. Even though it is a much more reliable test in terms of getting specific genetic information, it is a lot harder to get hold of a reliable sample to do the test in the first place. (And since Dr. Tex also does countless CVS procedures every year, and has been doing all this for 15 years, I have decided to take his word for it. I have no reason to think that he would steer me away from CVS unless there was a good reason, since he does so many of those as well.)

I asked Dr. Tex if he did many quad reductions, and he said that he used to do a lot more (as well as quint reductions) but that with advances in IVF, you didn't find that situation so much anymore. He said that these days, it was mostly a reduction from triplets to twins. I also told him that we wanted to choose the fetuses to be left solely on the grounds of health, not as a means of sex selection. He said that was good, since gender is still a little hard to see at 12 weeks, and that way he wouldn't have to spend time trying to figure out which was what.

And then I asked Dr. Tex about my biggest fear with this procedure -- that we'll go through with it, and then later we'll discover that the two we left in have Down syndrome after all. He said that it wasn't absolutely impossible that that would happen, but he told me that in his 15 years of doing these procedures, it never has happened. So actually, I'm pretty content with that. I mean really, am I so special that our pregnancy will be the first he misidentifies? Well, I hope not, and logically I find it pretty unlikely. At least that's one fear that has been (mostly) crammed back into the closet.

I'll be on pretty strict bed rest for three days after the procedure on Monday, so don't expect an update on these pages until the following Friday. (He said that getting up for meals and to go to the potty are okay, but not to go anywhere, do meal prep, or anything else. I have to infer that sitting upright in front of the computer for the half hour or so I need to write these is probably out.) Although if I'm feeling well, I'll try to sit here for five minutes and just give a quick thumbs up or down. (Hopefully -- as is appropriate for The Hopeful Baby Blog -- it will be thumbs up.)

I'm so glad Dr. Tex got hold of me today. He seems very knowledgeable (and therefore, one would hope, also quite competent), he seems like a nice guy, he comes highly recommended, as does his clinic, and the scuttlebutt I found about him on the Internet was all positive. I feel better now about doing this procedure than I have throughout this whole planning stage. My general modus with doctors is to find a doc that I feel like I can really, really trust, and then just ... trust him. (Or her, of course.) I did that with Dr. Enterprise (I could bore you for hours with the research I did on her and her clinic -- I've even read the papers she published on the Internet, which I'll bet you a doughnut none of her other patients have), and that worked out well for us. (Not perfectly, obviously. But I am pregnant, at the doddering age of 44, with my own eggs and my husband's rather haphazard sperm.) So I am hopeful, baby, that this will work out equally well.

Sunday, September 17, 2006

Believing what you know

Last night I had a little exercise in self-doubt, and experienced the peculiar hubris of "Yeah, but this is about ME!" All I had to do was actually believe what I already knew -- logically -- to be true ... but I found it almost impossible.

Yesterday evening, D. and I watched "The Seven Year Itch," which is a charming movie (if a little rambling) and will explain to you exactly why every male in 1950's America was gaga about Marilyn Monroe. (I must say that in addition to being physically spectacular, she was quite a good actress -- though as far as I could tell, she only ever got to play one role.) After the movie, I toddled off for a potty break -- and about jumped out of my skin when I discovered a large-ish amount of bright red spotting on my panty liner. Blood red. Miscarriage red. Very different from the trace amounts of pinkish-brown I had been seeing all week.

Instant hyperventilation. I had to start counting my breaths ("In, two, three, four, five, out, two, three, four, five") to keep from passing out before I got my undies back up. I checked for further bleeding and discovered a little, but certainly not what I would consider "gushing" (what I had heard of as a description for a miscarriage-type flow). Still, it was enough to send me into a tizzy.

The thing is -- and why this is a blog entry on hubris -- is that lately, I have routinely counseled my preggo Internet friends not to panic at a little spotting. I say this to them because that's what Dr. Enterprise told me, what Nurse Helpful at my HMO told me, and what every baby book in the universe tells us all. A little spotting is (let's say it all together, class!) -- NORMAL. (Especially in an IVF pregnancy, which for some still-unknown reason tends to be more prone to spotting than a normally achieved pregnancy.)

Except that it was ME bleeding like a stuck pig. (Okay, maybe like a pig with a paper cut.) MY pregnancy. MY babies bleeding out their lives into the panty liner. I found it completely impossible to be calm. And I was excessively irritated when I went tearing back into the living room with my news, only to have D. be very calm and infuriatingly rational about the whole thing. He patiently repeated what Dr. Enterprise had told us both, that a little spotting, even bright red spotting, was completely normal. In return, I wanted to act like Charlie Brown's Lucy and knock his block off.

(None of this was helped by the fact that D. had picked this night to have a few brewskies. He wasn't drunk -- at that point -- but not sober either. I found it completely infuriating that someone who was two sheets to the wind could be more rational than I was, cold sober.)

I did at least follow my own advice and get off my feet. I put down dry food for the cats and went off to bed, where I read a Terry Pratchett and tried to stop hyperventilating. The night ended up a long one, since I kept waking up worrying, and each time had to go pee and see what was going on.

By morning, activity had tapered off, and I began to feel better mentally. Today we are back to a little brownish spotting, and I actually believe now that the pregnancy is not -- at the moment, anyway -- in danger. I'm not sure I would have been able to achieve this level of sanguinity, except that this morning I was able to get hold of a nurse at my IVF clinic, who passed my questions on to Dr. Enterprise. (I have no idea when Dr. Enterprise ever gets a day off. She is the only doc there, and does all the embryo retrievals and transfers herself, on whatever day of the week they fall on.) Dr. E said that now that I have discontinued the progesterone suppositories, the two empty sacs are no longer artificially supported, and therefore are probably degrading -- hence the bleeding. (It's also possible that embryo #4, the little one, might have finally given up.) Either of those explanations is fine with me -- as long as the main pregnancy is continuing on its way.

And speaking of the main pregnancy continuing apace, tomorrow I will have to try and track some people down in their lairs, to make sure that continues smoothly. Last week when I met with Nurse Helpful, she said she would send bloodwork information off to Cal Pacific. However, when I tried to actually get in touch with her on Thursday, she first said she would call me back in an hour, and then while waiting for her call, I had a little domestic emergency and had to run out of the house -- and found when I got back that she had left me a very convoluted message detailing when she would be in her office to talk to me -- which was not going to be until next Wednesday. Wednesday! Nearly a week away from Thursday, in case I have to point that out. I think she's just downgraded herself to Nurse Not So Helpful. Now I'll have to drive up to my HMO and go to their business office in person to get my blood results, then come home and fax it myself. Not the end of the world, but irritating when someone else has already told you they'd take care of it. Hah.

The doctor who is supposed to do our reduction also called on Thursday night, when I was out. (Of course.) His message said he'd call again the next day, and of course he didn't. He's on my "hit list" for tomorrow, too. (And let me tell you just how much I am looking forward to wading through the various guardians of the CPMC gate to try and leave him a message.) On the plus side, I've been doing some Internet snooping regarding both him and Cal Pacific, and according to the highly unscientific gossip one finds on various pregnancy boards on the Internet, both CPMC and my doc are highly regarded in doing CVS, amnios, and other tricksy procedures involving needles. So that's a plus, at least.

And in a final bit of good news, me old da' continues to improve. He had his staples out last week (staples! in your chest! I don't even want to imagine that), his blood pressure is holding steady, he dismissed his baby sitter and makes his own lunch now, and most reassuring of all, his voice has returned to its normal full baritone timbre. (It really upset me when I talked to Dad in the hospital and heard how frail and reedy his voice sounded.) Thanks muchly to everyone who expressed good wishes for him! Now, God willin' and the creek don't rise, I think he is back on the road to health.

To sum up, today is better than yesterday. I just hope that trend continues.

Tuesday, September 12, 2006

Hen's teeth

Pulling hen's itsy-bitsy sharp little teeth ... had they any, of course, which is precisely the point ... might be easier than getting info out of Cal Pacific about our scheduled fetal reduction.

Howsomeever (as my grandmother from Kansas used to say), I finally did get a phone call from someone there this morning, though I'll admit I don't know who, exactly. Her name went by in a high-pitched, girlish squeal, and I just didn't care enough to make her spell it for me. (I'll just call her Tiffany, shall I?) In any case, after a lot of back and forthing, Tiffany finally vouchsafed me the information that the whole thing is going to be somewhere in the neighborhood of $2000. Now, mind you, despite the laundry list of costs she quoted to me for the various aspects of our visit, she didn't have the exact cost of the nuchal ultrasound, and told me I will have to call up the hospital section of their clinic to get a price on that. She did at least give me their number. I suppose that's service, of a kind.

Also, she quoted me a price of $238 on the Papp-A and expanded AFP blood tests, which are part of the Integrated Test for Down Syndrome and other things (the third leg of said Integrated Test being the actual nuchal fold ultrasound). We went on to other things, then I circled back and asked her if the Papp-A was useful for a multiple pregnancy, since someone had mentioned to me that they thought it gave false positives for multiples.

"Oh!" she squeaked. "I don't know if it works for multiples."

We had already gone over the fact that I was having a freaking REDUCTION, thank you, since I am carrying four fetuses at the moment. And yet the idea of my dealing with multiples had apparently not crossed her mind. All I can say is that I really hope this young lady is not in fact one of their supervisors.

She did eventually hook me up with one of their genetics counselors, a lovely woman who seemed sharp as a tack and kind as a mother's hug. I fell for her instantly, in a very platonic way, and if all of Cal Pacific's employees were like her, it would be an impressive place indeed. This young woman, call her LB, straightened out the mystery about the blood tests. She told me that the Papp-A test would not be an option for me, since if you are carrying more placentas than the number of fetuses you are testing for, you get false positives, etc. I currently have at least four and maybe five placentas in there (depending on how fast that empty one is degrading), but we would be testing for twins, and so the markers would be useless. So the Papp-A is out. LB said that the expanded AFP, which is typically done in weeks 15 - 20, might give me some answers. But it all depends on whether we are down to the proper number of placentas by then, as to whether we can profitably do the AFP. In any case, the expanded AFP by itself will not give as complete a picture as it plus the Papp-A (and the nuchal fold ultrasound) would. In the end, LB told me that if anyone tried to take blood from me on the 25th, I should shoo them away.

This whole thing about trying to get prices from Cal Pacific has been really odd. They act as if in the history of their clinic, no one ever asked them this before. Although maybe they haven't. I suppose that their actual paying customers might be few and far between, with the majority of their work being paid for by insurance companies. Their confusion at being asked doesn't leave a very good impression, though. (However, their willingness to give us a 35 percent discount if we pay up front does sweeten the whole thing for me, at least a little.)

In other news ... I had it out with the nurse-dragon at my HMO yesterday. Except she wasn't a dragon at all, unless you think of a cute little stuffed toy of a dragon; she was perfectly lovely. Somewhat astoundingly to me, she actually tried to be helpful rather than obstructive. Nurse Helpful (as I believe I shall call her) even volunteered to make some phone calls to see if she could find a way for the HMO to pay for the reduction at Cal Pacific. (Didn't work; the HMO has a contract with UCSF instead.) And when I told her that I wanted one of the two female OB's my IVF doc had recommended to me, she mildly pointed out that since both of them work part time (being busy raising families themselves), it would be impossible for her to guarantee me appointments with them. (Drat them both anyway, by the by -- what business do they have actually raising families and having a life? I ask you.)

Nurse Helpful and I finally worked out a compromise. My supervising OB will be one of their so-called "high risk" docs, who also happens to be head of their prenatal department. However, for pelvic exams and such, I'll see one of the two women OB's. This seems like a lot of rigmarole to go through, I'll admit, but one of the phobias I have not yet been able to rid myself of is that of male doctors staring up my cooter. It makes me nutsy, and worse than that, it makes me nutsy for a couple of days in advance of the actual appointment. I cannot believe it's good for the developing kiddos for me to be having panic attacks for days on end.

I'm afraid that my endless questions put me well past my allotted time with her, but Nurse Helpful was very gracious about the fact that our appointment ended up lasting an hour and a half. The whole thing ended with a bit of unintended comedy. As I left, she gave me a scrip for the standard pregnancy blood tests, and a urine test. (I don't know what the urine test is actually for; I hope nothing important, as things turned out.) I took the paper and headed down the hall, starving, dying of thirst, and with a bursting bladder. (Don't forget, I'm gestating here. Everything is on overdrive these days.) I had food out in the car, so I decided to just pick up a drink in the next building over, then go to the lab for the blood. Oh, and on the way, I just ducked into the restroom to take care of the bladder problem.

You've spotted the issue here, haven't you? I didn't, until after I had already peed, washed my hands, and was in the next building over, sucking down my Creamy Italian Raspberry Soda (with whipped cream, of course -- as I said, I'm gestating here!) -- when it occurred to me that perhaps I should have held onto some of that golden liquid. Oh, dear. Then I sucked on the soda even faster.

I made them take my blood first, and then let them give me a cup (which I got to take to the restroom down the hall, out amongst everybody -- it kills me that they're nuts about privacy everywhere else, but are apparently fine with you toting bottles of your own pee along a public thoroughfare). I actually stopped along the way, sat down, pulled out a magazine for a few minutes and drank my soda, hoping I was producing something while I waited. Then I went to have my try ... and was, well, somewhat successful. The instructions said not to fill up the cup past halfway. I have to say I followed instructions -- it certainly was not filled up past halfway.

But the main thing that little episode did was to make me feel like the biggest jackass in Christendom. Member of Mensa, hah. I don't dare tell any of my fellow Mensans about this -- they'd make me take a retest!

Friday, September 08, 2006

Plodding along

It looks like we are a go for the reduction at the California Pacific Medical Center on the 25th. (I can say their name here, can't I? I won't name individual doctors, how's that.) I never did hear back from the supervisor who was supposed to tell me how much the whole shebang (genetic counseling, nuchal, and reduction) is going to set us back, so I called the appointment scheduler back today. She nicely apologized for her supervisor's lack of contact and said the supe would get back to me either today or Monday. The scheduler also said something that made me happy (well, as happy as I'm going to get with this whole thing): namely, that she spoke with the doc who does the reductions, and he told her that his usual modus operandi is to do the nuchal and the reduction together. (Just like Dr. Enterprise originally told us.) So I'm not going to have to wheedle him into it, and he does this All. The. Freakin. Time. Which is what I want.

On a side note, just on the off chance that Dr. Enterprise would say, "Oh, him. Yeah, he's fine," I had emailed her asking her opinion about the HMO doctor who does reductions. Her reply was very much to the point, and made no bones about her opinion that the man was in no way qualified to do a reduction. (She did say he could deal with other perinatalogist issues down the line, should they arise.) So, we're paying for it. Stay tuned for the damage assessment.

I have to do a little circling back here and explain that the way I found out exactly who does the reductions was that one of the HMO nurses in their Infertility department called me about something else altogether, and while I had her ear, I quizzed her about that issue. (I also got an okay for the blood tests, which I'll do on Monday, when I go in to do battle with the HMO nurse/dragon. More of that anon.) The HMO is interesting ... some individuals there do excellent work, and some just don't. The key seems to be to get in on the scuttlebutt and find out who is doing good work, and insist on going to them. For instance, the doctor who did my abdominal myomectomy -- call him Dr. Empathetic -- was just terrific. He had the best bedside manner, and was incredibly patient in answering my thousand-and-one nervous questions about the whole thing. In addition, he did an excellent surgery for me, which healed quickly (though I do have a lovely six-inch scar below my bikini line -- not that I've worn a bikini since I was oh, ten) and apparently was quite effective, since I have since managed to get preggo with quads. But this perinatalogist my IVF doc warned me about? Uh-uh, I don't theenk so.

So on Monday, we're getting into the "insisting" part. I have an appointment to see a nurse at the HMO who is supposed to sort through my various obstetrical issues and help me pick an OB. The HMO has a "high risk team" of four OB's -- all men, natch -- who do their multiples cases. That would be fine ... except that I looked them all up on the HMO website, and in my layperson's eyes, it appeared that not one of them had any extra training to help them be a "high risk" doc. I asked Dr. Enterprise about this, and she confirmed it -- she kind of rolled her eyes and said they just had an "interest" in high risk cases. Oh, great. I really don't want a male OB to begin with, since it stresses me out terribly to have strange males looking up my cooter, and I feel stressed enough over this entire pregnancy. Dr. Enterprise gave me the names of a couple of female OB's at the HMO, who she said she refers all her patients to. Good enough for me. But I have a feeling I am going to have to pull out my lance and do some jousting with the nurse/dragon to get the OB I prefer. (And what if I do get the female doc and she screws things up? Then I'll feel awful about that.... Aaargh. Ignore me while I rip out my hair, please.)

On a happier note, when I talked to me ol' da today, he said that the visiting nurse had actually shown up and taken his blood pressure, and it was fine. Yay! He also sounded stronger. So I decided today would be a good day to Tell All. And now my father finally has the good news from Ghent regarding this little pregnancy. (I told him we were expecting twins, but not all the stuff about the reduction. We're really keeping that on a need-to-know basis.) My dad is a low-key kind of guy, so there were no wild expostulations, but he was puh-lenty surprised! But also very pleased. (Though mostly because I'm pleased, I think, rather than because he's been harboring some wish to be a granddad.) We didn't talk that long today, since he was starting to get tired, but it will be interesting to see what questions he comes up with about all this, once he's had time to think about it.

And on a minor note, I'll add that I did not feel ill today (unlike yesterday, when I felt so wretched that I started to wish I would throw up) and even made meatballs to go with my spaghetti. And ate them! Progress, definitely, since lately even looking at meat has made me want to hurl. It didn't hurt that the sauce had fresh tomatoes from our veg garden. We don't seem to be able to grow much in our garden except cherry tomatoes, but those we have coming out our ears. We have two kinds: some Sweet 100's that are tiny little things that almost taste like candy, and some generic variety that was labeled simply Large Cherry Tomatoes. Those are a little smaller than a golf ball, and are just the best damn tomatoes ever. And they're large enough to slice up and put on a sandwich, or throw into your tomato sauce or whatever. And they're mine, all mine! Bwahahaha! (Okay, I have to share them with D., who eats them by the handful. But luckily there's more than enough for the two of us.) And for some reason, bugs don't even look at the cherry tomatoes, though I've never been able to raise full size tomatoes without losing half the crop to the insect world.

Ah, yes, cherry tomatoes to burn ... and maybe, with lots of continued luck, some healthy squirming twins on the way. Hm. You know, when you look at it that way, things actually look pretty good.

Wednesday, September 06, 2006

The soap opera continues

First things first: my dad is home from the hospital and doing reasonably well. He's been home since Monday evening, and today my brother carted him over to the Big City to see his surgeon for a follow-up. My dad was too tired to talk much tonight, but I gather that things went all right there. Luckily, my brother requested that they take my dad's blood pressure there at the doctor's office (they showed no signs of even thinking of such a thing, even though of course my dad had been through a scary drop in BP only a few days before). They found it was somewhat low, and so told him to lay off his BP meds for the time being (normally his runs high) until things got back to normal.

His surgeon's office had also somehow managed to mislay the paperwork (or something) that was necessary in order for him to have a visiting nurse come by every day for a while and check his BP, etc. Said nurse is supposed to show up tomorrow, but I'll believe it when I see it. It's starting to sound to me like the surgeon is a good surgeon, as such, but he needs to hire a new office administrator. Luckily, my dad is good at following up on things, and he said he would call their office tomorrow to make sure things were actually arranged as promised.

My dad is also supposed to have someone from a local caregivers company come by tomorrow for four hours, and fix him lunch and do the dishes and so forth. He could probably use someone all day long, but they're $14/hr and my dad, while not exactly penurious, definitely has Scottish blood. (Well, actually, it's Welsh, but close enough.) The fun part about that whole thing was trying to arrange it from here (California) since my dad was stuck in the hospital and my brother was busy either working or running back and forth between their rural home and the Big City hospital to see my dad. But the Internet was a big help. I got the phone number of the local hospital's geriatric care unit, and called them for a referral for care givers. Still, I cringe when I think of my long distance bill this month!

And in the main plot of the soap....

Today, I called and made an appointment to do a selective reduction on two of the four fetuses, on September 25. I'll just be starting my 12th week then. Making the appointment upset me less than I thought it would. I think I am becoming numb to the whole thing. I just hope it doesn't "hit" me later on. But I think, in part, I have finally come to the understanding that some parts of life just suck. They simply do. And there's nothing to be done about it but roll with events and try to get past to the other side with as little damage as possible. I found myself taking that attitude when I had my shots for IVF. The subcu shots were a piece of cake, but sometimes the intramuscular shots that I took in the backside hurt like a bear. Of course, I never knew which ones would hurt, which somehow made it worse -- it was just when my husband would happen to get a little too close to a nerve or such. And I had the choice of either whimpering and getting upset before each shot, or just baring my butt and getting on with it -- especially realizing I had volunteered for the whole thing. So I think that attitude has carried on here, a bit.

Of course, the logistics of getting this reduction done couldn't possibly be simple. Dr. Enterprise recommended a clinic down in San Francisco to do the work. They are not, of course, in our HMO's network. So now we will either have to pay for this out of pocket too (and I'm sure it won't be cheap) or else wheedle our HMO into paying for it. I doubt they will, since basically they only pay out of network providers for things that are (a) medically necessary (though I think you could make a good case for this being, in fact, necessary) and (b) that the HMO cannot provide through its own providers. Well, I'm sure our HMO has some hack who does this procedure once every six months and would be glad to take a crack at it for us, but I want a specialist who does this so much he could do it in his sleep, and that is what I am assured this clinic's doctor is. So if we have to pay, we pay. (But I'll bet it's gonna hurt.)

September 25 is going to be quite a day for us. For one thing, we'll be at the clinic for about four hours. Dr. Enterprise said they could probably combine a nuchal fold transluscency test with the reduction. I thought that was an excellent idea, since I cannot tell you how volcanically enraged I would be to go through this selective reduction, only to be told a month later that oh, by the way, one of the two you decided to keep has Down Syndrome. I think that would make me lose it. As in, chairs flying out windows, etc.

But the woman who was arranging appointments said they did not always do it that way (combining the nuchal with the reduction). Yes, I responded, but can it be done that way? Well, she would have to check with the doctor. Fine, I said (trying not to let her hear me gritting my teeth) but if possible, I'd like to do it this way. Usually, she said brightly, the doctor chooses the ones that are easiest to reach. And at that point, I was thinking, not with MY fetuses you don't! Because I swear I will get medieval on them (what does that mean, anyway? Like Vlad the Impaler?) if we go through all this and they get rid of the healthy ones. I really will.

She also suggested we could do CVS on each of the fetuses beforehand -- but then immediately contradicted herself, pointing out that would be very difficult, with four fetuses. That's fine with me, really. I would much prefer to do as little invasion of the womb as possible. These fetuses seem settled in for the long haul, but I don't know if that would remain true if we start poking around too much in there.

There are also, just for grins, several blood tests the clinic requires beforehand. To get my HMO to do those, I'll have to try and sweet talk my doctor into ordering them for me. But actually, she has been willing to do that before, so I'm hoping she might again. We'll see.

I do wish this blog entry had had some grand, overarching theme. I admire writers who are good at that, who can start off with a premise, spin it through loops and arches and round-the-worlds like a yoyo, and then come home to rest by rounding off their initial premise. But this entry is merely recording the slogging of this day. Maybe that's enough.

Friday, September 01, 2006

Events are overrated

I am getting seriously tired of these eventful days.

I woke up this morning, not only mindful of the ultrasound scheduled for 1:30, but also antsy, cranky, and extremely nervous. I woke UP that way. I had one hope for the day, which was that when Dr. Enterprise (who "goes boldly where no doc has gone before -- with 11 embryos") did the wanding and started peering at the screen, she would announce that lo and behold, of the four embryos, the littlest embryo had taken the hint and gone away, poof! (I knew that two of them being magically gone was too much to hope for. But I was hoping for one, particularly since I had some spotting this week.)

And I hated it that that was my goddamned HOPE for the day. What an awful thing to have to hope for, that one of your long-sought and jealously guarded embryos has gone ahead and offed itself so that you won't have to.

You know, back during the 2ww, and then afterward before we knew I had a whole tribe in there, I used to talk to the embryos. I would tell them how wonderful the world was, how it was a great place with kitties to pet and flowers to pick and gardens to plant, and wonderful discussions to be had about timeless books, and fun and loving people they would meet along the way and learn to cherish as friends and family. (In fairness, I also mentioned that the world can be a sucky place sometimes, but I fear I played that down too much.) I had fun talking to them, and found myself tearing up at times, and realized a lot of things about what I cherish most, during this process of telling them all the wonderful things about the world and why at least one of them should come and stay here a while.

And now I don't talk to them at all. Because the only thing I can think of to say is, "I'm so sorry, but you can't all stay!"

Well, they were all still there. The good thing is that of the four, there are three good strong ones. So we are now down to a 5 percent chance of total fetal loss for the entire pregnancy. Translation: there is a 95 percent chance that at least one and more probably two of the little buggers will make it here to pet kitties at some future date.

Caveat: Those are the odds ... IF we do fetal reduction. And I don't see that I have a realistic choice not to, really. First, let's look at the odds of fetal death, even if we went down to just triplets. For triplets, Dr. Enterprise told us, there is a 25 percent chance that you will lose all three fetuses, usually around the six month period. As she then pointed out, not only would that be traumatic for us, but it would effectively nix our chances of ever having biological children. I'm 44 already. By the time we went through all that and then were ready to try again, I'd be at least 45. It is, frankly, a little bit of a miracle that I am pregnant right now.

We also have the circumstances of my myomectomy, which was traumatic enough to my uterus that I've been forbidden to go through the contractions and pushing of vaginal birth (let alone carry three infants in there).

So I was a mix of conflicting emotions after our appointment. On the one hand, we were virtually guaranteed parenthood. I really do regard this as something of a minor miracle, and I am honestly incredibly grateful for this chance. When I was younger, I knew I wanted a family of my own but felt so royally fucked up from my childhood with my birth family that I wondered if I'd ever actually be fit to be a mother. As an older person, I finally knew down deep in my bones that yes, I was ready to be a mommy, and a good one at that -- but the biological years had meanwhile gone whizzing by me, and now it was a crapshoot whether we'd achieve biological parenthood or not.

So it was a thing of awe to me to realize that yes, it was really, absolutely, very probably going to happen. After all this time. How truly amazing and awesome.

But it is bitter to me that the way to parenthood is paved with this necessary sacrifice. I do not blame Dr. Enterprise at all for letting us use all 11 embryos. She did warn us, quite seriously, that we might end up having to reduce. But she also pointed out it was our best chance to conceive at all. We agreed to gamble at this table, and now we have to pay up.

I don't want to make it sound as though I'm heartbroken, because I'm not. I am blessed with a certain lack of imagination in some matters, and this seems to be one of them. I don't see the fetuses as anything but fetuses at this point. According to my research, they are not aware (unless in the most rudimentary sense) and they are certainly not self-aware. I believe in reincarnation, so that even if there are actually souls in there, I feel sure they will immediately be bounced over to some other developing embryo. I don't think I'll go to Hell for this. I think God reserves the hell-realms for more weighty sins -- if, indeed, this is a sin.

But it just seems so wasteful. And I am afraid of one thing. I am afraid that when I look at our children in the future, in my mind, I will see two other versions with them.


For the record, here are the sizes of the fetuses today (at 8w5d):
20mm - 8w3d size
23mm - 9w0d size
21mm - 8w4d size
17mm - 8w0d size


In other news of the day:

After the appointment, I did a couple of errands, so when I came home, I was beat and went to bed for a while. When I got up, I realized I hadn't called my father (who is still in the hospital and as of yesterday, was in a normal room rather than ICU, and recovering nicely). However, I couldn't call right them because it would have been during the nurse's shift change, and they request you not to do that if you can help it.

So I called a little later, about 9 p.m. his time. It rang and rang, with no answer. Hm -- perhaps they had shifted him to another room. I re-checked my answering machine. Nothing. So at last I called and requested his nurse's station. They informed me that he had been moved back to cardiac ICU.

Oh, shit oh shit .... Bouncing back and forth between a real room and ICU is never a good thing. My mother did a lot of that in her short and eventful stay in the hospital, just before dying there. My stomach immediately started hurting. I called the ICU and got his nurse, who immediately informed me she couldn't tell me anything because of federal regulations, and then went on to spill almost everything anyway. (Nurses tend to be a compassionate lot; they are crappy at keeping secrets if they realize you are dying inside.)

It turned out that my dad is not dying (at least, not at the moment -- hopefully not anytime in the near future) but he had given them a good scare. His heartbeat had gone wonky and irregular earlier in the day, and his blood pressure had also misbehaved badly (up or down I don't know; she didn't say). They tried medication but that failed to control things, so they gave him a shock to get his heartbeat straightened out. She reassured me that it wasn't a big shock, just a small one (what, like sticking your finger in a socket?), but then allowed that they had given him medication afterward so that he would relax and forget having gotten the shock, since, she said, "It's not very pleasant." It's not pleasant picturing this in my mind's eye, either. Not at all. I am just praying that this was a minor blip on the road to recovery, and not the beginning of something worse. (You can pray with me, if you like -- any type you like is fine.) It's just that with my mother, I saw this slow escalation of events turn into something hideous and ultimately fatal. I am really hoping not to see anything like that again in the near future.