Hello Darkness, My Old Friend

Let me start out by saying that baby is fine.

But we had a scare. And I have anxiety. Not a good combo.

I’ve talked on here before about my tendency to fret and worry, mostly in a jokey way, but I’m not sure if I’ve ever come right out and said that I have legit clinically diagnosed anxiety. It’s a disease just like infertility. And also like infertility, it’s not really something that’s readily understood or discussed in society. You can’t make it go away by positive thinking or relaxing. You can’t shut it off. You can do cognitive behavioral therapy, traditional talk therapy or SSRI meds, and all of those things help (although I personally haven’t tried meds), but they’re not a cure. I am currently in therapy. My therapist is good, but I only see her once a week. That leaves six other days for my mind to spin into circles.

Overall I’ve kept my anxiety fairly in check this pregnancy. I for sure had some very anxious bouts. The first trimester in particular was super scary, as was Christmastime. I’ve been keeping it together, though…for the most part.

But now? Sh*t has gone off the rails. Ever since I entered the third trimester, my anxiety has been building. My antiphospholipid antibody syndrome puts the baby at higher risk for stillbirth, so naturally I’ve been obsessing about stillbirth. Is this a productive or beneficial thing to do? Nope. Rationally, I totally know this, but anxiety doesn’t play nice with rationality. It actually beats the crap out of rationality on a regular basis.

Things kind of reached a peak over the last few days. On Tuesday evening I noticed that baby wasn’t moving as much as she normally does, so I did a kick count. A kick count is where you count the baby’s movements—you’re supposed to count 10 movements in two hours. She did her required ten movements in a pretty short span of time, so I stopped worrying.

Then later that night I woke up around 3:45 am. Baby usually wakes up every time I wake up in the night, without fail. The kid likes to party all night long already. But she didn’t wake up this time. I gave her about 20 minutes to start moving and shaking. Nothing. I ate a banana and waited. Nothing. I drank some orange juice. By this time I was wide awake, but baby wasn’t. She did eventually bust out ten movements after the OJ, but it took her the full two hours. Usually it takes her, like, five minutes. I got out of bed and was about to go into Labor & Delivery to get her checked out when Tim suggested I try drinking a Coke as a last ditch effort. I drank a Coke and it worked. She did ten kicks in about two minutes. I was semi freaked out, but figured baby was fine.

That brings us to this morning and my appointment with maternal fetal medicine. I have weekly non-stress tests now, and from 36 weeks on I’ll have them twice a week. A non-stress test is basically where you chill in a lounge chair and a nurse hooks the baby up to monitors. They are looking for baby’s heart rate to accelerate three times in 20 minutes. If that happens, they are assured that all is well. I was figuring the non-stress test would be a breeze like it was the previous week, and that it would provide me with some reassurance.

Only, the baby didn’t pass the test. The nurse told me that the baby did have some accelerations, but they weren’t fast enough. She then sent me for a biophysical profile. This is an ultrasound where they look for three things within 30 minutes:

  1. Baby needs to be seen practice breathing for at least 30 seconds
  2. Amniotic fluid levels must be adequate.
  3. Baby has to move her core back and forth three times, and she also has to show muscle tone, which means things like opening and closing her hand or flexing her leg.

She aced the practice breathing. She also had good amniotic fluid levels. But she wasn’t moving. It took that little runt almost the full 30 minutes to do her required movements. She did pass the test, but only in the nick of time. The nurse assured me that she was fine. She said she was the most conservative nurse there, and that she always errs on the cautious side, but even she felt confident baby girl was good.

So baby is ok. But I am not. I really am not.

I’m 33 weeks today, and my OB has already talked about inducing me around 39 weeks (common practice with antiphospholipid antibody syndrome), so there is an end in site. But I don’t know how I’m going to make it through the next six weeks. I’m not trying to be dramatic by saying that—I really feel like I’m losing it a little. I feel completely overwhelmed with fear and anxiety. I’ve talked to my OB about these feelings. She doesn’t want me to take any anxiety medications because I’m already on so many other meds this pregnancy. She suggested therapy, which I am already doing. Basically the only course of action is to wait it out. I want this baby to be safe and healthy in my arms so badly, but right now that seems so far away.

Letter To My Littlest Love: Acorns, Stars & Other Things

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Dear Little Acorn,

You have many nicknames already, most of them generated by your sister. At first, you were Staircase Ball-Jar, followed by Cupcake Christmas Tree. Your current name du jour is Rocky Stone.

But there’s one nickname that belongs to you and I alone: Little Acorn. There is a story there, of course.

The day before I found out I was pregnant with you, your dad, sister and I were wandering through a boutique near our house. Hanging on the wall was a bright green onesie. I’m partial to crazy, happy colors, so it immediately caught my eye. On the onesie was an illustration of an acorn, and beneath it the words, “I will be mighty.”

Truth be told, I’m a little slow sometimes, so I didn’t immediately get it. “Wait. Why does it say ‘I will be mighty’ with a picture of an acorn?” I asked your dad.

“You know,” he said, “because an acorn starts out tiny and then grows into a big, strong tree.”

Oh. Oh. My heart started racing right there in that store. Because at that moment I knew: that onesie was for you. My little fighter embryo, destined to grow into a mighty oak.

I didn’t buy it, though. After all, I wasn’t even sure I was pregnant. I hoped, oh God did I hope, but I didn’t know. But I promised myself that I would come back and buy it for you if I was indeed pregnant.

Even though I found out the next day that you had decided to stick around, I didn’t go back. I was too scared. It took me almost six weeks to go back and purchase that tiny green onesie. And even then, when I was asking the sales associate about sizing, I didn’t tell her it was for my baby. I pretended it was for another baby, maybe a friend’s baby, or a random nebulous baby belonging to no one.

You see, I was worried sick. And if I’m honest, I still am, most days. (It’s no secret that your mom is a first class worrier. If you ever want to go skydiving or something, talk to your dad.) I feared that my instinct was wrong and that you weren’t a fighter after all, that you weren’t here to stay. That you weren’t mine to keep, not this time.

But you have proved me wrong time and time again. Out of dozens of embryos, you’re the only one that decided my inhospitable body was a fine place to hang out for a while. So far you are surviving and thriving. And just now you kicked me, as if to say, “That’s right, mom. Here I am!”

Yesterday, your sister and I watched a planetarium show. We learned lots of cool things. One of Jupiter’s moons contains frozen lakes with liquid water churning underneath. The hottest stars are blue. If you get lost on a clear night, you can always find your way home by the Big Dipper—it points right to Polaris, the North Star. The sun is so big that it could hold 1.3 million earths.

And even beyond our sun and our solar system, there are infinite stars and planets. An ever-expanding universe—over 10 billion light years that we will never discover.

It seems hard to believe, then, that with all of those things out there bigger and more awesome than we can even imagine, that something so small—an embryo, an acorn, a baby—could even matter.

But you, mighty one, are our whole world.

We are all counting down the days until we can hold you, kiss your new, soft skin, and see the stars in your eyes.

Love,
Mom

The Things She Carried

[inspired by Tim O’Brien’s novel, The Things They Carried]

She carried 758 needles, 170 suppositories of the vaginal variety, and hundreds of blood draws—she was told she had good veins, like that was some kind of prize to win. She was weirdly proud of her awesome veins, because in this game of carrying and dropping, losing and winning, there’s not much else to be proud of.

She carried 63 ultrasounds, some of them a routine check for follicles, some looking in vain for beating hearts, some checking to make sure “the products of conception” no longer existed inside of her.

She carried names of drugs she could barely pronounce—Menopur, Follistim, Ovidrel, Ganirelix, Intralipids, Lovenox, Prednisone.

She carried four IUIs, three IVFs, 66 follicles, 33 eggs and 20 embryos. Some of these embryos were placed back inside of her, and some never grew beyond a handful of cells. All were loved.

She carried lesions on her ovaries, cervix, uterus and bladder. She carried a blood clotting disorder called antiphospholipid antibody syndrome. She carried overactive natural killer cells, which weren’t really killing much except teeny-tiny embryos too little to fight for themselves.

She carried one laparoscopy attempt. One actual laparoscopy. Three egg retrievals. Two transfers. Two D & Cs.

She carried 1,938 miles of travel—from the house to the fertility clinic; from the clinic to work; from Philadelphia to Manhattan for surgery; from Philadelphia to Woodbury to visit what she hoped would be a miracle doctor; from Philadelphia to Woodstock to spend the day with a fertility visionary. She carried $726 in parking garage fees, and even one parking garage accident.

She carried Please Gods and plea bargains. She carried what-ifs and what-will-I-do-nows.

She carried special diets—no gluten, no dairy, no sugar, no air.

She carried the love of a good man, but she carried it clumsily and sometimes carelessly. She lashed out. She yelled. “Why can’t you carry any of this for me?” she wanted to know. There was no good answer to that question—he knew it and she knew it, and at the end of the day she was lucky to still be holding his heart.

She carried the memory of lost babies—three at last count. First was Gabriel. She lost him on the bathroom floor at work, and by the time she got to the hospital she was so bloody it looked like she was starring in a Carrie remake. Then there was Anna, who was confirmed genetically normal and therefore should have lived, but didn’t. Anna, who said au revoir to the world on Christmas day, but who would never open a single present. Finally, there was Baby B, a loss too new to even get a name.

She carried a persistence that even she admitted was insane. She carried advice from relatives, friends, acquaintances, the checkout lady at Target, wondering why she was doing this to herself, why she didn’t just give up. Stop this nonsense. Be happy for what you have. Halt. Cease and desist before you ruin yourself, your job, your marriage. And she did want to stop, she did. But she needed to try one last time. One more needle, one more blood draw, one more doctor. One more.

And now.

Now she carries a baby inside of her, a little girl, no bigger than a winter squash. She feels her kicks, taps and nudges, and they feel like hope. She still carries the what-ifs—so many what-ifs—but now she carries something else as well—trust. Trust that this is the soul she is meant to meet. She sings to her baby every night, hands on her belly, heart wide open as a summer sky: ‘twas grace that brought you safe thus far, and grace will lead you home.

18 Weeks & Everything’s Still OK

Hi, friends. First of all, thank you for your comments on my last post. They were all wonderful and heartfelt, and made me feel significantly less crazy town. I’m sorry I haven’t responded yet, but I will. I love you guys.

I don’t have a single profound thing to say today. I’m thinking this is going to be a semi-boring update, so get your yawn faces on. In a nutshell: baby and I are ok. As of today, I am 18 weeks and 2 days. I had an OB appointment on Wednesday and that kid was moving around so much that my doctor couldn’t lock down a heartbeat! All we could hear for a minute were these swishing sounds. I’m thinking that means there’s a hyperactive boy growing in there. Anyone else have any gender guesses? When the doc finally got the heartbeat locked it sounded nice and strong at 158 bpm.

Following that appointment, I went to my dentist and got two more root canals. I only have three non-root-canaled teeth left in my mouth now. Can you even believe that? I kind of can’t. I half-jokingly asked my dentist if I had the most root canals out of any patient he’s ever had and he said “yes.” The man has been practicing for 33 years. Dude. I don’t even know what to say about that, so I’ll just leave it right there. Anyway, the one root canal went smoothly. The other was bleeding so much he couldn’t finish it. The dentist said he suspects it’s cracked, which means the root canal might fail. Which means a tooth extraction. The last time I had a tooth extracted, it took two hours and the head of dental surgery had to call over his colleague to help. Apparently I have the longest roots this side of the Mississippi. I do not want to go through this ordeal while pregnant. It’s already stressful enough getting root canals while pregnant. I’m really bummed about all of this, but it’s beyond my control.

I’m not sure if I told you guys about this yet, but I got a call from Dr. Braverman a few weeks ago. My long-awaited test results came back and according to him my immune system was “acting up again.” He doubled my prednisone dose. Dr. B assured me that he wasn’t worried about miscarriage at this point, but rather complications later in pregnancy. This increased dose will supposedly help prevent that. I was supposed to stop my intralipids after the first trimester, but those are continuing on for now, too. For those of you who don’t know, prednisone is kind of evil. I really try not to complain about it because honestly I am just grateful that it’s helping me stay pregnant. However, it causes major insomnia. I lay awake from roughly 1 am to 5 am every night. Once in a while I’ll take a Unisom and that helps, but I don’t feel comfortable doing that every night. More or less, this lack of sleep makes me feel insane. In-f*cking-sane. Like totally bonkers. I prowl around the house at night like a freaking cat, scouring the fridge for midnight snacks. Speaking of snacks, another fun little side effect of the pred is that I’m huge. I’ve been gaining a pound a week and my face is like a mylar balloon. Again, I’m growing a human, so whatevs, but it’s a little freaky to see the scale jump so much every time I go to the OB. The good news is that Dr. B wants to wean me off the prednisone by 24 weeks, so there is a light at the end of the tunnel.

All of the above BS aside, I really am doing ok. I’m still nervous as hell about our anatomy scan in two weeks, but other than that, I’ve been managing the anxiety. Here’s a couple of things that have been helping:

*The gym! I haven’t gone to gym with any regularity in three years (you can thank fertility treatments for that). But now that I don’t have endless doctors appointments and the first-trimester nausea has subsided, I have a little more energy (even with the lack of sleep, boom). It feels awesome you guys. I only do a half hour on the eliptical machine like three or four times a week, but even that feels like such a treat.

*I’ve been taking some space from Blog Land. I’ve found that it’s for some reason easier to manage my anxiety if I just keep my head down and don’t write about it.

*Staying busy. If I’m constantly moving or doing something I don’t dwell as much on the what ifs. I’ve been doing a lot of baking, organizing and even (gasp!) folding laundry.

*Planning a staycation. Tim and I booked a hotel in the ‘burbs next weekend. Lettie will spend the night with her grandparents. We’re going to get a couples massage and eat in a chain restaurant and swim in the hotel pool. I’m gonna get me a bottle of non-alcoholic wine, pop a Unisom and get a full night’s sleep. Romance, people!

Speaking of sleep, if you’re not snoozing yet, you deserve an award. I mean, I know how riveting reading about me folding laundry must be. Anyway, that’s about all she wrote. I’m still scared every single day, but I’m doing fine.

 

 

Dr. Braverman, Helper Embryos & Why I’m Never Googling Again

First of all, thank for all of the awesome comments on my last post. I’ve said it before and I’ll say it again: I sure do love you guys.

The morning of the Dr. Braverman appointment started off kind of disgustingly. I typically leave a banana by my bed and take bites throughout the night if I wake up feeling nauseous. That morning I woke up and realized the banana I had been eating was covered in ants. I ate ants, you guys. Probably lots of them. Gag.

After de-anting myself, we drove from Tim’s parents’ house to Dr. Braverman’s office. I fully expected to wait a long time, since I had read in reviews that the wait times were out of control. However, we were seen right away. Dr. B. came in wearing a pink polo shirt and got right to business. The ultrasound screen was tilted away from me, so I couldn’t see what he was looking at. He immediately said, “You have one viable pregnancy with a heartbeat and another sac.” The heart rate of baby A was 115 bpm. Doc B. said 90 – 110 was normal, so 115 was great. Then he let us listen to the heartbeat. It was freaking awesome. He said that Baby B could still develop a heartbeat because it had a fetal pole, and the sac looked normal and not collapsed. He gave it a “better than 50% chance” of seeing a heartbeat at our next ultrasound. He then looked at blood flow to my uterus and said that looked good as well. I was expecting to not be wowed by his personality. The one time we Skyped with him, he was short and not super personable. I don’t actually care at all if he’s personable because he knows his stuff, and that’s what matters. That said, I liked him a lot better after meeting him. He seemed gentler somehow. All in all, it was a great visit. If fingers-crossed-all-goes-well, I will see him again at 10 weeks. And oh yeah, he told me the burning I’m experiencing is “just pregnancy,” so that made me feel better..

All was well. And then I had to go and ruin it. On Tuesday, I had the brilliant idea to google “normal fetal heart rate 6 weeks 4 days.” Whhhhhy did I do that to myself? WHY?! I found lots of people whose babies had higher heart rates that 115. And then I found this terrifying study that said 110-119 bpm between 6.3 and 7 weeks was “borderline” and had a “slightly elevated risk of fetal demise.” Then I asked my OB friend and she gave me a range of normal, and 115 was at the bottom of the range. So then I was just a wreck. And completely pissed at myself for googling in the first place. I emailed Dr. B in a panic and he wrote back right away saying 115 is a very common heart rate in his practice for that stage in the pregnancy. After reading his kind email, I felt better, but not as much as I should have. Like, ok, one of the world’s leading miscarriage specialists said it was fine, so it’s probably fine. Still, I was ridiculously nervous for my next ultrasound on Friday.

Finally, after about six years, Friday arrived. I barely slept the night before. But all was well. Baby A’s heart rate had gone up to 132 bpm, solidly in the normal range. I can’t even tell you how relieved I was. And then I vowed never to google again.

Baby B now had a “flickering” of a heartbeat. A faint flickering is obviously not great for 7 weeks, though. The doctor gave the twin a 10 -15% chance of making it. I asked what the chances of it being genetically normal if he or she did make it, and the doctor immediately started talking about CVS and selective reduction. Whoa, whoa, whoaaaaaaa. Slow down there, buddy. I am NOT ready to think about any of that scary stuff. Eesh.

Anyway, we are still in limbo with baby B. My greatest wish at this point is that we have a clear resolution one way or the other soon. Our doctor said that in animal science you see a lot of “helper embryos,” These are basically embryos that exist for the sole purpose of assisting the stronger embryo, and when their job is done, they pass on. He suspects that Baby B is a helper embryo. This is a really sweet thought and makes me feel better about the whole thing.

I talk to both of my babies every day. I tell Baby A I am thankful he or she is growing big and strong. I tell Baby B that I love him or her no matter what happens. If he or she decides to keep growing and turns into a healthy baby, well then that is just amazing. And if he or she is just there to help out a sibling, then thank you from the bottom of my heart. And once he or she is done helping, it’s ok to go.

And that’s about all there is to tell at this point. Next ultrasound is Friday. I’ll let you know how it goes.

Interstitial/Cornual Pregnancy: Follow-Up From Yesterday

I’ve learned some new information since yesterday, and I wanted to share it here in case I can help anyone else searching around for it. There’s not a lot out there currently.

I have two resident OB friends, and right before I posted yesterday, I emailed them to ask about my ultrasound. They obviously hadn’t seen the scan themselves, but both said, “It sounds like your doctor is concerned about an interstitial pregnancy.”

An interstitial, or cornual (these are actually two different things, but most people use them interchangeably), pregnancy is a rare type of ectopic pregnancy. The pregnancy implants in the uterus, but close or attached to the place where the fallopian tube connects with the uterus. It’s so rare that it represents 1-3% of all ectopic pregnancies. But apparently it’s more commonly seen with IVF. I’m not sure why. Unlike typical ectopics, beta numbers often rise normally.

Of course after hearing about this, I immediately emailed my doctor. She definitely did not mention interstitial pregnancy yesterday, so I wanted to hear what she had to say about the topic. Instead of emailing she called me back. Unfortunately, I missed the call.

Her voicemail was as follows:

“Hi, it’s Dr. G. I don’t think you need to worry. We obviously do need to keep an eye on it, but I think that this is not going to be an interstitial pregnancy.”

So that is very good, and I should just be reassured and go off into Happy Land, right? I know I should. But I have to be honest, you guys. I am really struggling. I don’t know if it’s the hormones or the stress of fertility treatments finally catching up with me, but I spent most of yesterday crying. Of course, it was stealth crying because I was at work. I’ve been doing all my usual visualizations and breathing and none of it is really working.

I can’t with the curve balls. They are so sneaky. I was worried about possibly not seeing a heartbeat at my six week ultrasound. I wasn’t really worried about the ultrasound yesterday. I certainly wasn’t worried about the rarest type of ectopic pregnancy. After all, my numbers were rising normally, so I thought I was in the clear there. Yet, it snuck in there, reminding me that there is no safety in this world, and there is no surefire way to protect your children, even when they’re in your own body.

I know I’m sounding dramatic here. I recognize that, but I just can’t shake it. Next ultrasound is a week from Wednesday, on Christmas Eve. I’m really hoping to get some good news then. Until then, I’ll be here, trying to get my peace back!

IVF #1: Beta Number 3

First of all, thank you so much for all of your comments and well wishes on my last post. You guys really know how to make a girl feel loved. And guess what? I love you right back!

Today’s beta was 2760. The nurse said that was great, but of course I had to look the number up on a beta calculator after the call. Can’t leave well enough alone, obviously. I found out that the doubling time was 47 hours, which means that things have slowed down from my last doubling time of 36 hours. I’m guessing this is fine, as it’s still within the normal range, but I do wonder if it’s normal for it to slow down. Does anyone know?

I have an ultrasound scheduled on Monday. The nurse said they are just looking for a “speck” in my uterus to confirm that the pregnancy is in the right place. My doctor won’t be doing the scan, which I’m pretty bummed about (it also won’t be the Ovarian Overlord, though, phew), but I’m going to request that she does the rest of them from there on out. I’d rather wait a few extra days between scans if that means she will be there to do them.

The anxiety has been creeping in today, big time. I think the first few days I was riding the high of hearing such good news, but now that things are starting to settle I feel uneasy. I’m a little nervous about Monday’s ultrasound, but I’m even more nervous about the one that will be after that if all goes well on Monday — the ultrasound at around six weeks, the one where we may or may or may not see baby’s heartbeat. I feel sick just thinking about it. As many of you unfortunately know, it’s terrifying to be pregnant after a loss.

Mainly, what’s freaking me out is this: I’ve just realized that I am wholeheartedly invested. After letting the news digest that I am finally pregnant, I’ve quickly become attached to this baby. My baby. And to lose everything now…well again, the thought makes me sick to my stomach.

But I am just borrowing trouble at this point. Right now, everything is ok. Everything is ok! And that is what I need to keep telling myself.

One day at a time, you guys. I can do this.