Monday, April 25, 2011

RE Appointment Today

I had a post op appointment and consultation with my RE today. I seem to be recovering well from the miscarriage and D&C. They did test the tissue they got from the D&C and it was placental tissue, so it was a good thing I had it done to clear everything out. She said it looks like I am about to ovulate. To confirm that, I took both a pregnancy test and an ovulation test tonight. The pregnancy test is very faint and it is a sensitive test, so I would guess my HCG level is below 20. The OPK is pretty close to positive. It looks like my RE knows what she's talking about ;) No surprise there!

We talked for a long time during our consultation about our different options in moving forward to try for another baby. The problem is there is no perfect solution or medication for what we are experiencing. The chromosomal abnormalities I have had with two of our babies are abnormalities that can be compatible with life and live births, so we can't be certain that is what caused my miscarriages, although it is the most likely cause. There could be other factors even though most of our testing has come back fine, aside from being PAI-4G/4G, but my PAI levels are in the normal range.

One option is she could send us to Chicago to see Dr. Kwak-Kim who specializes in immunological diseases. I *could* have natural killer cells that attack the babies and cause me to miscarry. Dr. Kwak-Kim can test for that and if I test positive, she does a therapy that I don't fully understand. What I understand her treatment to be is she infuses your blood several times throughout your pregnancy with something that helps block the natural killer cells. It is quite expensive, around $1500 per infusion and can cost up to $20,000 for an entire pregnancy. Chances are I don't have that because we have our daughter but natural killer cells can develop at any time, so it is a possibility.

Another option could be a new medication that is an insulin sensitizer since the Glumetza didn't work for me. My RE is not familiar enough with it and wants to check more with a doctor who is.

IVF is not recommended for someone in our position. Since we are not having problems getting pregnant and since our chromosome problems are too broad, they don't recommend that for us. IUI will not increase our chances at a healthy baby either. So both of those are out. My Clomid challenge to test my FSH, egg quality, and ovarian reserve looked good, which is better than looking bad, although no guarantee we can have another healthy baby. She said from the ultrasounds my ovaries look good, not polycystic, and it looks like there are eggs in there.

The plan we think we are going with for now is as follows: 100 mg of Clomid CD 3-7, ultrasound to check follicles on CD 12, HCG trigger shot when follicles are the correct size, and heparin shots once I get a positive pregnancy test. We are hoping taking Clomid CD 3-7 will produce more eggs so that my body naturally selects the highest quality egg for pregnancy. The HCG trigger shot will ensure the egg releasing before it gets too mature and starts to deteriorate. I need to make an appointment with my general practitioner and set up either a CT Scan or an MRI for my brain because brain aneurysms run in my family and we want to make sure everything looks okay before starting heparin injections. The heparin will help if any of my miscarriages were caused by blood clotting disorder factors. It will be something that I will inject twice per day (in my stomach *cringe*)  for the entire pregnancy (or at least until it's close to delivery time). They will monitor my platelet count and my red blood cell count and I will increase my calcium and vitamin D because it can cause osteoporosis. I am also starting back up on baby aspirin and will probably continue with the Neevo DHA prenatal vitamins. I'm already on an increased vitamin D3 dose.

It always feels good to have a plan. I am afraid of having the CT Scan or MRI because I'm terrified of getting bad news. Once that is over, assuming all looks good, I think I'll feel a bit more confident in our plan. It is disheartening to me that she basically laid out all of our options and let us choose which course we thought was best for us because there is no course of action proven to work for our situation. It looks like our problem may be more advanced than medical science is at this time. We are holding on to hope though and trying our best to bring another healthy baby home.

Thursday, April 21, 2011

Some People Can Be So Heartless

Honestly, just about every person I have come across in this trying to conceive/miscarriage journey has been loving and supportive, but every once in a while someone blindsides you with their lack of empathy and compassion.

I have shared some general information about our losses on facebook. Typically a simple statement that we have lost a baby followed by some very generalized testing answers or vague information about needing surgery. I know not everyone on there would want to know many details, so I keep it straight forward with little detail. I feel like I can share much more detail here on my blog than I would ever think of sharing anywhere else in the world. I also feel quite comfortable being honest about our losses and think that it is healthy to reach out to people for support in a time of difficulty. I think being open and honest about loss can be helpful to others who struggle with loss in private and feel alone, hopefully giving some comfort.

With that being said, I was quite surprised that someone who I was facebook friends with (someone I went to college with) would come at me on facebook telling me that miscarriage is a "dirty little secret" like "cheating and venereal disease" and they don't want to hear about it. She went on to tell me how shocking and uncomfortable it has been for her to read about my miscarriages and that she doesn't want to hear about the gory details and the play by play while drinking her morning coffee. That "Trust me, if you posted about your new herpes sore I'd be just as offended!" And that one should "save gory details for someone who might care or relate!" There was more said in the couple of posts and private messages she sent me, but this gives you the general idea.

One thing I found so hurtful about this was the fact that she lumped miscarriage in with STD’s as if it should be some dirty little secret to keep to yourself. The death of a baby is hardly in the same category. Sharing the heartache can make the pain less lonely. Reaching out to people to find support in a difficult time is something that many of us, as humans, do. There is nothing abnormal about that, be it on facebook, blogs, message boards, the phone, wherever.

I have been so upset by this (which just irritates me more because she isn't worth my concern). I just can't understand how someone could come at a person who has been through so much with such disregard for their feelings. But, apparently my dead babies have made her uncomfortable while she tries to enjoy that coffee of hers. Hope she doesn't turn on the news or Oprah because there may be other people out there who she doesn't know well sharing intimate things about their lives, how uncomfortable! Perhaps she should look to a different source of entertainment with her morning coffee, something where people don't regularly share things about their lives. Or perhaps she could have just defriended me or blocked my status updates if they were offensive to her. Needless to say, she is no longer on my friends list. I am just surprised that at my age there are women out there who still like to act like "mean girls," what's the point in that?

Thursday, April 14, 2011

The Procedure

Tuesday, April 12th was the big D&C day. Medical procedures give me a lot of anxiety so I spent the night before and the morning of all worried and worked up. Afraid I was going to die and not be there for my little girl. Needless to say, she got a million kisses and hugs before I left. My parents came to watch her while I went for surgery. My husband and I arrived at the hospital at 11AM, got all checked in, then they told my us to give our hugs and kisses, that he would not be allowed back with me while I get all hooked up and ready to go. This is apparently a newer policy and not one that I'm a fan of, especially for something like this. We are dealing with the emotional loss of a baby in addition to the stress of surgery.

The staff at the hospital was amazing. They were all so kind and compassionate. They all expressed how sorry they were for our loss and I received a lot of encouragement to keep trying. There were a handful of nurses tending to me and I felt like each one genuinely cared. What a difference that makes!

My IV experience was not so good. No surprise with my veins though. I had a blood draw at my doctors office the day before and had 3 pokes and some bruises from that already (including my right hand). I found out from those tests that my beta HCG level is now down to 416. The nurse felt so bad, but it took 5 or 6 tries, 2 nurses, and lucky for me, some lidocaine to help numb some of those spots first. My hands look like a pin cushion and are so bruised and sore. More insult to injury and I think the pain and stress from that started my emotional plummet. I couldn't stop shaking. I got some medicine for my GERD, pepcid through my IV and this awful sour stuff to drink.

They gave me some magazines to read, plied me with warm blankets (I love those blanket warmers they have at hospitals. Wouldn't it be great to have those at home on a cold night!?!), offered some music, but I still couldn't hold it all together. I heard the woman next to me talking to her doctor. She was there to have her tubes tied and get her IUD out. She is lucky enough to have 4 children and can decide it's time to stop having them, while I'm sitting here waiting to for my 4th, much desired baby, to miscarry. Even more insult to injury. The tears started to flow. My doctor poked her head in about that time and came over to comfort me. She got me some tissues and talked to several different people about getting my husband back with me while I waited. She couldn't believe they stopped allowing that. I don't know that I've ever seen my doctor genuinely mad until that moment. It was nice to have her in my corner for that. At that point they gave me some medicine to relax me which helped.

I think it was around 12:45PM when they wheeled me back to the OR. Back there my RE sat up by my head to comfort me and I met my anesthesiologist. He was such a kind and interesting man. He was a priest before he started doing this and offered to bless our baby once it came out. I told him that wasn't necessary (A: I'm not Catholic and B: There is a good chance the baby had already passed and was no longer in there), but it really touched me and was such a beautiful thing to offer. He was also really funny and helped put me at ease. He made a joke about holding my hand as I went to sleep and hoped my husband wasn't the jealous type. I started to feel the warm burn of the meds in my arm. I felt so safe and cared for and in good hands, which was exactly what I needed. It was a very emotional and difficult day.

It was a little after 2PM when I woke up. Apparently the surgery went well. She only used suction, no scraping. She did get some additional tissue which she sent to the lab to test for fetal tissue. We won't do any chromosome testing even if fetal tissue is found. We still aren't sure when we passed the baby. I tend to think it was already out before the surgery. It's hard to tell when the sac is so small.

I was nauseous when I woke up, so I got some meds for that and something for the pain from cramping. They gave me some cookies and soda while I finished coming around. I asked for my husband right away and they brought him back. My doctor had talked to him before she left and filled him in on how everything went. Within an hour we were able to leave. I've had very minimal bleeding and mild to moderate cramping since I've been home. My body is achy and I'm still a little weak. I've been taking vicodin to ease the pain but it makes me really loopy and tired, so I've been napping a lot and needing help taking care of our daughter. She is at her Grandparents' house today. I'm not supposed to lift her for a few days and I'm certainly not capable of caring for her safely on vicodin.

Again, I am touched and thankful for all of the wonderful people in our lives. Thank you for your kind words and thoughtfulness. It really means more than you could ever know.

I go back to my RE for a post op check up in about two weeks. Then we'll start over yet again...

Monday, April 11, 2011

D&C Scheduled

The second round of misoprostol and a weekend filled with lots of walking to help move things along did not quite do the trick. I went in for another ultrasound today and still have tissue or clots in my uterus. My doctor scheduled a D&C for noon tomorrow. I have so much anxiety when it comes to medical procedures, especially surgery. She reassured me that this will be minimally invasive. She will only use suction, no scraping so that there will be no scar tissue. I won't have to be intibated and it will be a short procedure. Hopefully it will go smoothly and once the procedure is finished I'll be finished physically with this miscarriage.

Thursday, April 7, 2011

Miscarriage Complications

It never fails. My body likes to hold on to these little babies. I went in last Saturday to have the misoprostol inserted. Just like my last miscarriages, about 4 hours later I started to cramp, bleed, and pass some tissue. The cramping continued but the bleeding let up after a few hours. Sunday there was continued cramping but little bleeding. I was hoping I was done with it all, but knew the bleeding was much less than I had with my other miscarriages. Finally, Monday afternoon I started having major cramps and really started bleeding and passing more tissue. The heavier cramps continued through Tuesday but the bleeding tapered off again so I went to see my doctor. She did an ultrasound and sure enough, there was a large clot blocking my cervix. She yanked it out, Oh My Goodness that HURT! I was cringing, crying, wanting to puke and my husband was restraining himself from leaping across the exam table to knock my doctor away from me. Apparently she hit the side of my cervix or uterus with a tool. I went home with some vicodin and continued taking my oral misoprostol and antibiotic.

I went back today for another ultrasound and there is still tissue in my uterus that hasn't really moved in 2 days. I'll go in tomorrow morning for her to insert more misoprostol. Hopefully that will create some strong enough contractions to expel the rest of it.

My body is sore and exhausted. Cramping and having contractions for 6 days straight will really do a number to you. The vicodin helps ease the pain and allows me to sleep through the night, which is nice, but it also makes me hazy and unable to safely care for my 2 year old. My husband has been home most of the week to take care of the both of us. My parents were down for a while to help out so my husband could do some work from home and so our toddler wouldn't have to come to doctor's appointments. Today she went to Grandma and Grandpa's house (my husband's parents) and had a ball. Thank goodness I have so many caring people who are willing to help out. I feel so bad pulling people away from their lives. That has been happening a lot over the past year. One of my husband's coworkers and his wife brought us a wonderful dinner. They have done that for every miscarriage we have had. I finally announced our loss on facebook and am so touched by the emails and messages we have received. I feel so blessed to have such wonderful people in our lives.

Friday, April 1, 2011

Our 4th Angel Baby

The 9 week ultrasound did not go well today. The baby has not grown at all since our last ultrasound. There is still no heartbeat. The sac has something in it that our doctor said may be remnants of a yolk sac. She called it a blighted ovum. I can't say we expected much more but we had hoped for a miracle. She also said that blighted ovums are most often due to a chromosomal abnormality.

Tomorrow morning I will go to my doctor and have misoprostol inserted, then go home and miscarry. I think that is the best way for me to miscarry. I know what to expect and there is some closure with it, even though it is pretty uncomfortable. She offered a D&C but I just don't want to have the anesthesia and the procedure done. I think it is healthier for my body to miscarry naturally. My body likes to continue to produce progesterone even when our babies aren't going to make it and that just makes my body hold on and not miscarry. For a healthy pregnancy, that's a great thing and at least that's not an issue I have to worry about.

My vitamin D level did come back a little low. It was a 26 and they like it to be between 30-100. She is having me start a 2000 iu per day supplement. Hopefully that will help something.

We will make another consultation appointment with her to see how we should proceed for a future pregnancy. She brought up heparin shots, I'm not so sure...I need to learn more. It seems to me if our issues are due to chromosomes that heparin wouldn't help that, but I'll see what all I can find out about that.

Tonight I am enjoying our 2 year old blessing (and a little extra junk food)!