Saturday, September 27, 2008

I knew it couldn't be that easy...

I knew the delivery went entirely too smoothly. Why, there were no major medical catastrophes at all! I thought maybe my body had FINALLY decided it had dished me out enough crap, and that all would go well for a bit, at least until the inevitable tussle with mastitis.

Wednesday afternoon, we had a diaper disaster occur -- the girls are TERRIBLE about taking off their diapers, and the nanny hadn't taped their diapers thoroughly enough. She had to leave early early that day, so I went up to get them from their nap, and the wave of poop smell hit me before I'd even opened the door. Little monsters that they are, they'd gone fingerpainting, and I had no choice but to bathe them immediately, before Daddy got home to help. I was sore that evening, but thought it was just because I'd lifted them into the tub.

I was a little worse Thursday morning, and I thought perhaps I might have a UTI. I called the doctor's office, talked to the nurse, and they called me in a prescription for it. I took Andrew with me to go get it, and we stopped into the Big Baby Store to pick up a few more clothes for him -- I had bought mostly 0-3 month stuff rather than newborn, and he's still pretty little. I put him in the sling rather than carrying around baby + carseat, but I was still pretty sore when I got home.

By Thursday evening, I was really starting to hurt badly, and Friday morning, I could barely move. I wasn't running much of a fever, though, and my external incision looked fine, so I figured it couldn't be all that serious. G nagged at me to go to the doctor, but I didn't want to make him leave work to take me, and I wasn't very keen about the idea of getting out of bed. I took some more pain medicine and stayed in bed with the baby all day, hoping I'd start getting better.

I didn't. I got worse instead, and by the time I felt like it might be a good idea to go see the doctor, their Friday office hours were over. I got a lecture from my husband, another one from my mom the RN, and a third one from my brother the MD, and they all made me promise to go in to the hospital if I wasn't substantially better in the morning. I wasn't, and we did.

Turns out I have a "mild" uterine infection -- mild because my white count isn't really elevated. However, I definitely have what the doctor described as "uterine tenderness", and I would describe as AAAAAAAAAAAAAAAAHHHHH STOP PLEASE OH MY GOD THAT HURTS. Seriously, I haven't hurt this bad since the ovarian hyperstimulation nightmare, which actually felt quite a lot like this. The pelvic exam left me sobbing and shaking, once I finished with the screaming and the moaning, so yeah, I guess you could call that tenderness.

I left with a prescription for a different antibiotic and for more Percocet, and I am a bit more comfortable now. The doctor didn't want to hospitalize me for IV antibiotics if he can help it, given that I'm nursing and all, but if I get any worse, that's the next option. Hopefully it won't come to that, but since this is me we're talking about, I'm not betting against it.

I swear, if I have to have any kind of pelvic surgery as a result of this, I will tell them to just yank the sucker out. Ridiculous isn't even the word for it.

Tuesday, September 23, 2008

Here, have some baby cuteness

The birth

While it lacks the excitement of the middle-of-the-night "honey, it's time!", there are some definite advantages to having a scheduled C-section. My in-laws had arrived to stay at the house with the girls, my hospital bag had been packed and re-packed, and my clients had been notified. I'd even gotten to take care of some minor details like folding laundry and assembling casseroles. When we pulled out of the driveway at 5 AM, it felt great to know that everything was all squared away and ready for the baby.

When we got to the hospital, they started an IV, did my pre-op meds, and monitored the baby, and they wheeled me into the OR at 7:02. I had been concerned about the spinal, since I'd had some trouble with my first CS and had also had a failed spinal for one of my knee surgeries. However, the anesthesiologist (who, in an odd coincidence, is the wife of my former RE Dr. Boss), took her time placing it, and in short order I was lying down on the table. I thought I was doing well, but while Dr. Pro was beginning the incision, I did start to feel nauseated. Anti-nausea meds and ephedrine helped, but not before I threw up several times. Let me tell you, it's surreal to be throwing up while listening to the scissors going snip-snip through your uterus.

Dr. Pro announced that the baby's head was out, and that he had a full head of dark hair, and I started to cry. Some tugging and pushing, and there he was, squalling like a scalded cat. She brought him around for me to see, then off to the warmer for cleanup. With the girls, that took place in a separate room, but this hospital has the warmer right in the OR, so I could see and hear him the whole time (he was Not Happy about the proceedings). I didn't hemorrhage this time, and wasn't so messed up from the meds, so I was lucid enough to talk to him and ask about him while they were stitching me up. They told me he had "wet lungs", i.e. transient tachypnea of the newborn, and that he'd need observation for a while. However, it's not an urgent condition, and he wasn't in any real distress, so I got to hold him and kiss him before he went off to the nursery and I went to recovery.

The immediate recovery period is the only part of the experience that was not much fun. I started to hurt as the spinal wore off, and was given a shot of Demerol and Phenergan (in my thigh for some reason, rather than via IV). They brought Andrew back in for me to try to nurse, but he wasn't the slightest bit interested in latching, probably due to the TTN. I did enjoy holding him, though, and G and I tried to decide who he looked like and where he'd gotten his freaky monkey toes. Unfortunately, my pain medication was starting to wear back off about the time they took him away. They gave me some Percocet right before taking me to my room, but the Demerol wore off much faster. I try hard not to be a baby about pain, so when I'm hurting enough to feel like I need more drugs, I expect to get them. When it got bad enough that I was crying and unable to keep my legs from twitching, and the nurse told me I couldn't have anything else and that I just had to wait for the Percocet to kick in, I was very unhappy indeed. They relented after an hour and gave me a shot of Nubain, which got me back to feeling human, but it was a very, very unpleasant hour. After the Nubain shot, I did fine with just Percocet from then on, but I don't think they managed it very well in the immediate post-op period -- the hospital I used for my first delivery did a much better job.

Andrew spent most of the day in the nursery, with my husband popping in to visit him every half-hour or so. He was finally brought to me late in the afternoon, at which point we tried again to nurse, but he didn't actually latch on until later in the evening. I knew it was because of the TTN, so I wasn't too fussed about it, and they assured me that his blood sugar was fine and that he didn't need formula or sugar water. He stayed in the nursery that night for observation, but was brought to me for nursing and cuddling every time he woke up. Honestly, I didn't mind all that much, because I was able to get some rest in between visits. At mid-morning Friday, he was moved to our room for good, by which point I was feeling much better prepared to be his mother!

After the initial post-op misery, I actually recovered much quicker from the surgery this time around. I was able to get out of bed much more easily, and was starting to wean off the pain meds by Saturday. My milk began to come in on Saturday, whereas with my first birth, it didn't show up until the fifth day. Once Andrew got the initial idea of nursing, he proved to be a good eater, and of course it didn't hurt that I've done this before. His breathing began to slow down as the fluid cleared from his lungs, and he began to be very alert and interested in the world. In retrospect, we could have gone home on Saturday, rather than on Sunday morning -- it would have been one less night of the Grand-Central-Station experience.

I'm feeling very nearly back to myself, and better in some ways than I have in months. The asthma is just about licked, now that I'm back on my inhaled corticosteroids, and it's nice not to have any contractions or heartburn. I did not get nearly as engorged as I did with the girls, and aside from some minor soreness and chapping, I'm having no breastfeeding trouble at all. I'm moving almost normally, though I'm still a little sore if the girls start crawling over me. My lower back hurts a little bit, and for some reason I'm having some trouble with dizziness, but nothing too bothersome. Andrew is a very good baby indeed, so I'm getting a reasonable amount of sleep, especially in comparison to the nightmare that is newborn twins. Overall, I think I'm doing pretty darn good for six days postpartum.

So, that's the birth, and our current physical status quo. I've got much more to say about having a singleton this time, and about the girls meeting the baby, but that will have to wait until after a few more feedings and snugglings of Mr. Monkeytoes!

Friday, September 19, 2008

Thursday, September 18, 2008

Andrew Leon

Born this morning at 7:27 am, with a full head of dark hair, 7 lb 5 oz and 20". He's under observation for transient tachypnea of the newborn, but he should get over that quickly. He's gorgeous and adorable. Pictures to follow soon.

Monday, September 15, 2008

All done, part 2

My CS has been moved up to Thursday at 7 am. Like, two and a half days from now. I got a steroid shot at the pulmonologist, too, so it's a double helping of awesome.

All done, indeed!

All done

Claire loves to be "all DONE!" with things. I never thought about how many times you say "all done" over the course of the day, until I had a two-year-old to parrot it. After every meal, every cup of water, "all DONE!" Diaper changes are "all DONE!", getting dressed is "all DONE!", putting anything away or closing a door is "all DONE!".

Well, today it's my turn. I am "all DONE!".

Other than the lung stuff, I'm pretty much okay. Oh, sure, I'm tired of the heartburn, and getting generally impatient to meet the baby, but I'm not otherwise physically miserable. I'm pretty small still, only measuring about 34 weeks, so it's not like I'm hauling around 12 lbs of baby like last time. I've had zero swelling, and I haven't outgrown all my maternity clothes. I'm sleeping fine at night, and my hips don't hurt except when the baby occasionally twists himself into weird positions. I still enjoy feeling him kick and wriggle. The random bouts of contractions are tiresome, but I don't have a problem toughing those out for ten more days.

I'm all recovered from the cold, too, except that someone forgot to send the memo to my lungs. I'm basically done with the cough and the snot and the sinus stuff, but it's been more than a week since I had even 70% of normal lung capacity. I'm hovering around the 60% mark most of the time, and while albuterol opens me up a little bit, it's short-lived, and wears off well before I'm supposed to take my next hit. I still feel tight all the time, get winded walking into the kitchen, can't get out a full sentence without needing to take a breath. It's the asthma exacerbation which won't end.

If I weren't pregnant, this would have been fixed a week ago with a round of steroids. That's how I got diagnosed with asthma in the first place -- I went to the pulmonologist to find out why my colds lasted for three weeks and required steroids to clear up. After the disaster last October, the plan was that we'd start with the steroids sooner rather than later, once my peak flows started going downhill. For a wonder, and probably because of the pregnancy, I didn't catch any kind of upper-respiratory infection last winter/spring, so we never had occasion to try it.

I understand where Dr. Pro is coming from with avoiding steroids. When you take oral steroids, it can suppress your body's ability to produce its own hormones. If you've been on steroids recently and have any kind of major physical stress happen, you can go into a full-blown adrenal crisis if you don't get extra doses of steroids. Since childbirth and major abdominal surgery definitely count as major physical stress, it's sensible to avoid them if at all possible in a patient who could deliver literally any day.

But you know what? I like to breathe properly, and would very much appreciate the chance to do so again. I don't feel like we've got this under control, and I feel like I could easily over the edge into being in bad trouble. It's pretty clear to me that I am not improving, and past history suggests I won't for at least several more days. So, if I can't get better without steroids, and I can't have steroids because I'm pregnant, well, I've got a brilliant idea.

I will be 38 weeks tomorrow by LMP. The dating is iron-clad, and I even have the extra edge of having had steroid shots during all the PTL fun. However, at 38 weeks, the risk of transient lung issues is still a little bit higher, given that I'm having a repeat c-section. If it were just a matter of being tired of being pregnant, yes, we would probably do better to wait another week. But when you put the baby's theoretical lung issues up against my actual ones, I am thinking that maybe the picture changes a little bit.

I see the OB this afternoon, and the pulmonologist after that. We're going to talk about steroids again, and if everyone feels that those are off the table, I'm going to ask if delivering the baby is an option. I don't know that it will be -- there are anesthesia considerations too, if the spinal fails and I have to have general, so we'll see what all the doctors say. But I'll tell you, I am "all DONE!", and ready to bring this nightmare of a pregnancy to a close.

Friday, September 12, 2008

The dinosaurs who came to breakfast

... and lunch

... and to bed

Notice a common theme?

Wednesday, September 10, 2008

Still ugly

Went to the doctor this morning, because not only am I completely unable to breathe normally, the baby wasn't moving at all. Even a breathing treatment didn't get him going, and those usually make us both fairly wired. He finally woke up and started hiccuping while I was sitting in the waiting room, and I nearly cried in relief (as well as out of general misery).

The doctor did a non-stress test and said he looked good, but she still sent me to L&D for a pulmonary workup and a few hours of monitoring. Chest x-ray was clear, white count was OK, so it looks like it's just a garden-variety upper-respiratory infection and asthma exacerbation. My peak flows were rotten -- I'm only breathing at about 40% of my normal capacity, though a couple breathing treatments put me closer to 50%. However, there's just not much to be done about it right now. She doesn't want to give me steroids as long as my oxygen saturation levels are OK, so I'm just supposed to keep sucking down the albuterol until I start to kick this.

Tuesday, September 09, 2008


I have now entered the mythical land of the full-term pregnancy.

Of course, because it's me, there is a complication. I caught the girls' cold, and like all of my colds do, it headed straight for the lungs. It's ugly. Really ugly. Like, nebulized-albuterol ugly, and if I get any worse, it'll be ER-ugly. No such thing as "just a cold" for an asthmatic.

I hope the baby holds off for two more weeks, because right now, I'm too sick to take care of him.

Saturday, September 06, 2008

Happy Birthday

Lyme disease/incipient colds/uterine irritability notwithstanding, we had the girls' birthday party yesterday evening.

I thought their first birthday would be the big meaningful birthday-to-remember, and I made a big production out of it last year, invited a bunch of people and cooked a bunch of food. There was the requisite amount of cake-smashing, but the girls were a bit overwhelmed by all the goings-on.

This year, I didn't have the energy to do much of anything. I ordered cakes from a local cake place, a Wubbzy cake for Claire, and a Birdie Bird cake for Katherine (characters from Wow Wow Wubbzy, which is TV crack for toddlers). I had my in-laws pick up a few pizzas, blew up a 99-cent package of balloons, and invited immediate family and two close friends with toddlers. I was pretty sure it was going to be small and quiet.

Know what? It was AWESOME. This year, the girls were old enough to understand the concept of presents, and to get really excited about the unwrapping. All of the kids had a fantastic time bouncing the balloons around the living room. Both girls were wide-eyed with excitement when we brought out the cakes and started singing Happy Birthday. They're also really into all of their new toys, and loved the train table G and I bought them. I get the giggles seeing Claire carrying around the large plastic T-Rex (which she insists is a "hossie"), and I could hire Katherine out if the toy vacuum cleaner and lawn mower worked.

I loved having little babies (and am so looking forward to another), and I used to be afraid that I wouldn't enjoy the toddler era as much. Let's face it, we all have ages and stages we prefer, and I've never been as keen on the toddlers as on babies and preschoolers. In all honesty, I do think 18 months was the hardest age for us -- most twin moms find it's the infant period, but my girls were really good babies, and we had a relatively easy time then. By 18 months, though, they had developed all the physical capacity needed to get into trouble, without the understanding to stay out of it. They were relatively slow talkers, and couldn't communicate wants and desires very well. They wouldn't hold hands reliably or sit still in chairs, so taking them out in public could be an ordeal. It was still neat to see them learn things, but there were a lot of frustrations too.

In the last three months, though, they have grown up so very much. I hate that I've spent so much of the time confined to bed and missing it, because I am purely loving this stage. They follow simple directions, and they love to "help" -- give them something to carry or put somewhere, and they're happy as clams. They're still not as talkative as some two-year-olds, but they have a lot of words and several phrases, plus incomprehensible sentences. They can ask for water or a cracker or a hug, and they identify each other as "ti-tuh" (Sister). (My favorite verbal idiosyncracy: "Katherine, what's your name?" "ME!") It's amazing what a difference basic communication makes.

Yes, there are challenges. Katherine in particular has very, very definite ideas about how the world ought to work, and she does NOT appreciate it when things don't go accordingly. Since the Katherine Plan includes things like collecting a large pile of toys in a box or arranging all of her peas just so, it is frequently ruined by her sister or her parents. Katherine comes by her OCD tendencies honestly, to be sure, so it's easy for me to draw on my own childhood to foresee years of "MOOOMMM! She got in my STUFF!". Claire is much less attached to the idea of personal property, and doesn't care so much about the world being orderly, but she wants very badly to know how everything works. She gets very frustrated when she can't make something work right, or when we drag her away before she's done investigating, or take something away precisely because she's gotten it to work. Of course, there are also the generic toddler meltdowns, and the days when naps don't happen, and the boundary-testing to see what happens if we hit the dog or throw our toy.

All in all, though, I am enjoying them now more than I ever have, and so is G. He loved them as tiny babies and was tremendously helpful with them, but it was clear he didn't have quite the same hunger for the smell of their little baby heads, wasn't as captivated by the way you could nestle one in each side of your neck. Understandably enough, he looked forward to the period where he could interact with them more, and that's where we're at. A few weeks ago, he told me that he's no longer waiting for them to grow up and do X, and that now he wishes they'd stay right where they are for a while! I couldn't help but laugh, because now he understands how I felt their entire first year, but I also agree with him. It's great to be the mother of two-year-olds.

Friday, September 05, 2008


From the Department of OF-COURSE-It-Would-Happen-To-Me:

Two weeks ago, my sister asked if the girls could come visit her and my niece for the weekend. Since G's been doing solo weekend duty for all these weeks of bedrest, I packed them off without a second thought to her house. M lives in a very rural area about an hour and a half from here, and the directions to her house include "turn off the paved road".

A fantastic time was had by all, and we picked up two worn-out babies on Sunday. The next day, I noticed that Claire had two little bites on the back of her arm. I figured they were just mosquito bites -- both girls welt up badly in reaction to them, just as I did as a child. We applied a little hydrocortisone cream for a couple days, and didn't think much about them after that. I remarked a few days later that they were still there, but again, I thought they were just slow-healing mosquito bites.

Yesterday afternoon, there was an... incident (I will spare you the details)... involving one of the dogs and the girls. It led to an unscheduled bath, the first one I've given them myself since the preterm labor fun began, and when I took Claire's shirt off, I was horrified to find that those two little bites had grown into giant rashes, each the size of a silver dollar. They were warm to the touch, red on the outside with a lighter inner ring and a red center, like a bullseye. In short, they looked EXACTLY like the classic Lyme Disease rash. Surely not, I thought, but I called the pediatrician this morning and brought her in.

Wikipedia says that "Of cases reported to the United States CDC, the ratio of Lyme disease infection is 7.9 cases for every 100,000 persons," and the state health department says that "very few cases have been reported in the state". After Katherine's ITP, I thought that we HAD to have met our statistical-anomaly quota for the year, even leaving my pregnancy complications out of it. Right?

The pediatrician, while admitting that she's never actually seen a case of Lyme in person, is reasonably certain that's what it is -- the rash is unmistakable, and the history fits. She drew blood for the antibody test, which may not show positive yet (it often doesn't until you've had it for several weeks), but felt confident enough to go ahead and treat Claire for Lyme. Three weeks of amoxicillin, and she'll be fine.

Unless, that is, a meteor falls on our house in the meantime. Honestly, given our luck over the last year, I don't feel entirely confident ruling that out.

Tuesday, September 02, 2008

High-water mark

As of today, I'm officially more pregnant than I've ever been before. Despite a lot of contraction activity over the last, I'm still not dilated, so I might even make it to term. In any case, I think NICU is off the menu, and that's very good indeed.

I'm starting to get excited to meet the baby, though I'm a little nervous as well. I recall feeling very much the same way with the girls, though. At the time, it was apprehension about coping with newborn twins, and now it's apprehension about coping with a newborn and toddler twins. I did just fine then, or at least I felt like I was doing just fine at the time; it was pretty tough in retrospect, but I had a massive post-birth high, which helped a great deal. This time around, the mechanics will be easier if nothing else, so I think it will all work out just fine.

Now, I've just got to try not to have him until after the girls' birthday on Saturday. We are doing nothing more elaborate than cake/ice cream/pizza on Friday night for a few friends and relatives, but they're two, so it's not like they know the difference. Still, I would like not to miss it, and I would also like for Brother to have his own birthday and not share with the girls. One birthday for three children would be a little bit skewed!