Tuesday, November 21, 2006

"May cause anxiety in parents"

So ... we got the amnio results.

I decided yesterday morning that it was time to take the bull by the horns, and wade into the bureaucracy of California Pacific Medical Center to try and get some answers on the amnio. I called in the morning and tried to reach a genetics counselor by selecting the voice mail button that supposedly lets you talk to the "next available counselor." Well, the next available counselor appeared to be coming in to work via mule team from the Himalayas, because after an interminable wait, I was finally shunted off to their appointments line, where someone offered to take a message and relay it to the genetics counselors. We did that, then I got right back on the line and tried again, pushing different buttons.

This time I got one of the senior genetics counselors, whom I've talked with before. She was very nice but said that the information still had to come in from the lab, and she would put a message in to "our" genetics counselor (the one we saw before the fetal reduction, who was very nice, but I had lost her phone number) to get the information and call us as soon as possible.

That held me until afternoon. At that point I was on the phone with my aunt, catching up on things and swapping pregnancy stories, when the "boop boop" sounded and I dumped my aunt from the line rather unceremoniously, explaining that the clinic was calling. It turned out to be a young woman from the lab, who had apparently called me only to tell me that the genetics counselors would be the one to call me. "But isn't it ready yet?" I whined. "We came in on November 8!"

Lab Girl allowed as how that had been some time ago, and this time actually pulled up my chart to see about things. "Oh," she said after a moment, "it looks like someone should already have called you. I'll patch you through to one of the genetics counselors."

I gratefully agreed. She then proceeded to connect me with Juanita Somebody's voice mail, which informed me that Juanita would be out of the office for the entire freakin' month of November.

Now that's what I call service.

(Would it be belaboring the obvious to point out that while the Professional Types I have dealt with at CPMC have been nothing but lovely, extremely competent, and a joy to work with, the CPMC bureaucracy and lower echelons do not seem to be able to find their collective asses with both hands?)

My heart rate and blood pressure both skyrocketed, and I started punching phone buttons with both hands, ready to do battle (again) with the CPMC phone lines to try and reach a genetics counselor. But then the "boop boop" sounded, and lo, it was "our" genetics counselor, ready at last with the amnio information. I called out to D to get on the line so he could hear it too, and then noticed that while my anger had dissipated, my heart rate was still up there. "Anxiety" would just about describe it.

The first thing she told us was (drum roll, please... ) that all the chromosomes for both babies were normal. NORMAL. Normal, normal, normal. I felt myself wilt, and said quietly, "Oh, thank God." On the line, I heard D draw a shaky breath and say something similar.

We had to ask her again, of course (just to hear it, really), so she nicely reiterated it several times, and then we started to feel cheerful, to say the least.

And then she asked if we wanted to know the sexes. D had recently come around, deciding, I think (though I didn't press him about it) that the whole naming problem might just go away if we knew the sexes (and didn't I say that several weeks ago?). So we said yes. And she said that they were both the same ... (another drum roll, please!) ... and they were ... BOYS!

Oh, my goodness. It was a party on the line for a few seconds there. I think it would have been the same no matter what she said, really, but the happiness and relief of hearing that we had two normal, healthy baby boys on the way was just too much for us. What joy, what quiet delirium. It was lovely.

But ... there's always a fly in the ointment, isn't there? In this case, our counselor revealed that they had also done an AFP assay on the amniotic fluid, since they had it there. (Normally the AFP is done as a maternal blood test, earlier in the pregnancy, but because of the multiple placentas present, they were not able to do that in our case.) She said that one twin had tested normal, but the other one had had a slightly elevated AFP, testing as a "weak positive."

We had no clue what any of that meant, but she explained. Elevated AFP levels are commonly associated with neural tube defects such as spina bifida, a condition in which the developing spinal tube does not close up properly and therefore leaves nerves exposed. The effects of spina bifida on the child can range from nearly no effect, to paralysis (of different levels) and anencephaly.

She said, however, that because we had had several ultrasounds which all indicated that both babies were normal, it was very possible that some AFP had crossed over from the other placentas, and caused this weak positive -- in which case, our baby not have the condition and would not be affected. But we just don't know yet.

But she had been extraordinarily efficient (our counselor being one of those aforementioned people at CPMC who are a Joy to Work With), and set up a followup ultrasound to examine the spine on Wednesday morning (tomorrow, that is), with Dr. Tex, who had said he would do this ultrasound at no charge, bless his heart.

So tomorrow's another Big Day. I have to admit I am nervous, though it is not as bad as it could be. If there is a problem, hopefully it will be on the smaller end of the scale, especially since it was a weak positive (as opposed to off the scale). And spina bifida does not cause mental retardation, though of course it does cause physical problems.

I also have to admit I didn't know jack about spina bifida before yesterday (and don't know that much about it now) except that one takes folic acid to prevent it. (And yes, I have been taking 1200 micrograms of folic acid daily since before we conceived, so that has helped me remain calm as well.) I also didn't know jack about the AFP test. Here's one good page I found on that: Elevated Maternal Serum Alpha Feto Protein. It is mostly about elevated AFP found in maternal blood samples, but also discusses AFP in amniotic fluid.

But this one sentence from that otherwise useful page seems a bit obvious:

"Elevated maternal serum AFP may cause anxiety in parents."

Hm. Ya think?


Blogger casey said...

Hazah! What great news (the amnio, that is). Can't say that I wouldn't worry about the AFP, but I never took one with my daughter because I heard they were so damn inaccurate. I suppose they give them for a reason....

However, all in all, what wonderful news! Since I don't assume D will want to name a boy Cordelia, you're out of the woods on that one! Go for two showers. And as far as presenting a unified front with the kiddos, my guess is that rarely happens in any family. And the ones it does, someone is usually lying or repressing. Hopefully you'll figure out how to let both of your styles come into play when needed, and try not to undermine each other when possible. (Ha! Good luck! :) )

7:36 PM  

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