The Twin Project

Six months

2009-03-30T15:53:00.003-05:00

So, Andrew's six months old. I love this stage of babyhood, because he's old enough to have personality, but he's still easy to keep up with. That will be short-lived, because he is rolling/squirming himself all over the place, and I think we are no more than a month or so away from actual crawling. He still tends to fall over when sitting up, but he's figuring it out day by day. He's a very happy baby as long as he is being played with, held, talked to, and otherwise interacted with, full of smiles and giggles. Until this weekend, he'd been doing very well about sleeping through the night, and even the 45-minute naps are slowly stretching out to an hour, sometimes an hour and a half. In most respects, things are going well.

The not-so-good respects is our old bugbear milk supply. At his six-month checkup last week, he weighed 15 lb 14 oz. That's 25th percentile, not terrible of itself, but it's only a six-ounce gain in five weeks. The doctor pronounced herself unconcerned, because babies do often slow down at this point, but now he's started acting hungry again. He's nursing every two hours again, biting and acting mad at me after feedings, and waking up at night again. He feels lighter to me than he did a couple weeks ago, and my mom also noticed a difference. When the wet diaper count started to drop off, I was pretty sure we had a problem again.

I had weaned myself mostly off the Reglan, mainly because I was tired of taking pills, so the first thing I did was to go back on it three times a day. I've taken Reglan for months now, and took it for months during my pregnancy with no problem, but apparently I've crossed some side-effect threshold. After just two days of increased dosage, I've been jumping out of my skin, restless and anxious and weepy and sad and obsessive, in a way that is very much not like me. My LC's nurse thinks this is probably due to the Reglan, and told me to get off it posthaste. Low milk supply is better than emotional instability, to be sure, but I'm not happy about losing the Reglan just when I need it more.

I had started Andrew on solids on his birthday, beginning with mashed banana and pureed pears and applesauce. He's been showing signs of readiness for a while -- watching our food like a hawk, stealing off our plates, gumming anything you hold up for him to taste -- so I was surprised when he wasn't enthusiastic at all about the fruits I offered. After some experimentation, though, I think perhaps he just doesn't like fruit much, because he likes oatmeal just fine, and any bits of our food that are soft enough for him to eat. Rice with vindaloo sauce was a huge hit, and I thought the kid was going to take my hand off over mashed-up new potatoes -- I couldn't get them in his mouth fast enough.

So solid supplementation will take some of the pressure off the milk-supply thing, I hope. I'm giving him a bottle at bedtime again, too, which he attacks with enough vigor to reassure me that he needs it. I don't intend to wean him yet if I can help it, and would really like to keep nursing to the one-year mark, but it looks like I just can't keep up with breastfeeding alone.

Low milk supply is a real thing and does happen, even to women who do everything "right". I've never doubted that, but I just didn't think it would happen to me. I had hoped the first episode was a temporary hurdle, but it looks like something I'll have to fight for the rest of my time as a nursing mother. It's not just the Reglan talking when I say I'm sad today.

To everyone who ever asked me

2009-03-19T12:12:00.002-05:00

"Why don't you just adopt?"

I come down on the pro-life side of the abortion continuum, if mildly so. Obviously, I am less than hardcore, as I was prepared to proceed to IVF, and got up-close-and-personal with the possiblity of high-order multiples and of serious genetic defects. I would not, I think, have chosen termination under either circumstance, and I am sure that I would have gone down the embryo-adoption path had it come to that; but I've at least thought it through enough to know that I am somewhat mushier on the subject than, say, the Catholic Church. However, I have much greater reservations about ending pregnancies which are merely unwanted due to age or circumstance, which don't fall into those exceptional categories or involve rape, incest, or maternal health.

That doesn't mean I can wave my hands and talk about how adoption is always such a wonderful alternative. It can be, under some circumstances, and under others, it can be hideously damaging. We most likely would not have considered adoption, although you never know until you get there, and this article illuminates one of my major reservations. I have deep misgivings about taking another woman's baby just because I happen to be wealthier and have a broken reproductive system. It's one thing if we're talking about babies who are already in a foreign orphanage or the foster-care system, and another thing entirely when the baby's mother isn't out of the picture before the subject of adoption arises.

There are no easy answers, and I think it's important for pro-lifers to understand that adoption is not a panacea. It's possible to believe that an unborn baby's right to life is important, while acknowledging the real consequences of that belief. Rights are about more than just the least-unpleasant alternative, but that doesn't mean you get to pretend the collateral damage doesn't exist.

I am contractually obligated

2009-03-01T11:10:00.002-06:00

If you have a parenting blog, it's mandatory to do a sleep post at some point. (I'm sure it's in that terms-of-service legalese SOMEWHERE.)

We started out with Andrew in the co-sleeper, swaddled and pacifiered, and initially it was lovely to roll over, feed, and put him back to bed. As newborns do, he napped wherever he happened to be, in the swing or in the crib or especially in the bed for naptime with Mama. We've fought the 45-minute nap monster his whole life, but he seemed happy enough, and went to bed at 8 PM or thereabouts without complaint. In November, he started sleeping until 7 AM, and I thought we had the sleep thing more or less licked.

In retrospect, the return of the night wakings should have been a clue that my milk production was on the wane. Once I got clued in to the great milk supply debacle, I started making sure he got a supplemental bottle at bedtime, and resigned myself to night feedings for a while. There was no question he was getting hungry in the middle of the night, and straightening out his weight gain was the top priority. Eventually he dropped the 2 AM feed, but was still waking up at 5 AM and then getting up for the day somewhere in the 7-8 AM range.

The milk supply seems to be pretty well fixed now. I gradually weaned him down to one 4-oz bottle a day, and when he gained a whole pound in a week on that single bottle, the doctor gave me the okay to discontinue it. (He even had RSV and needed a nebulizer during that week, and still he gained a pound!) I'm still on the Reglan, mainly because I'm scared to mess with non-brokenness. He's obviously gaining weight, and during the day seems very content. He's spacing his feeds out to be more like every three hours, instead of wanting to eat every hour and a half or two hours, which is a really nice break.

Now that he's knocking on the door of six months old, I'm getting really ready to get him out of our bedroom. He is a light sleeper, easily disturbed by the TV on the other side of the wall, or the barking dogs, or toddler wails. I miss not being able to read before falling asleep, and fold and put the laundry away in the evening, and have conversations with my husband in bed at night. To that end, I spent last week painting his room and setting up his nursery (total case of third-child syndrome, that).

More importantly to Andrew, I took his pacifier away and stopped nursing him down. He got to where I couldn't put him down unless he was so deeply asleep that he didn't care if it fell out of his mouth, and couldn't get back to sleep without it if he started to wake up. I'm still rocking him to sleep, and he fusses for a minute or so about wanting something to suck on, but then he goes down and stays that way until he wakes up for a feed. I'll be dropping the swaddle tonight, since he is outgrowing the blanket and also keeps winding up on his tummy, despite the sleep-positioner foam blocks I bought to prevent that. No plans to drop the rocking -- that was a major production with the girls and involved some crying-it-out, which I'm just not big on at his age. (I don't consider the pacifier removal fussing to be CIO, given that he's crying while being held, rocked, and sung to.) He's still waking up to eat in the middle of the night at least once, but at this point I'd rather go upstairs and either nurse him there or bring him back downstairs.

I'm pondering night-weaning, but I'm not ready for it yet, especially given that I am probably about to disturb the milk-supply equilibrium with endometriosis treatment stuff. After almost three weeks of good days, I've had some pain trouble again for the last several days; and I can't explain without going into TMI territory, but the endo has clearly been growing. I'm going to see the RE for another scan this week, and depending on what the ultrasound shows, it's probably time to start treating it, before it gets too invasive. I am half leaning toward asking for another lap excision, but I expect he will want to at least try BCP first. We'll see.

The sleep thing could certainly be worse, and it makes me realize just how fantastic the girls were at this age. They slept from 8 PM to 8 AM with three 1.5 hour daytime naps, which is as close to textbook sleep habits as you can get. I could wish Andrew napped better and didn't still wake up in the night, but I know the status quo really isn't too bad.

I am full of random

2009-02-11T17:10:00.002-06:00

I have more random than time to blog, so here, have some bullety goodness:

The Percocet-free days count is now up to six. My last post started a string of bad days, but I have been feeling almost normal since last Friday, with only NSAIDs

I am not sure if this is a natural good streak, or if it's due to the new NSAID (Ponstel) I started taking on Thursday. My RE has had other endo patients do quite well with Ponstel, so it may be working for me too. Regardless, it's a good thing.

Andrew learned to roll over back-to-front, but cannot push over again onto his back. He expresses much TINY BABY RAGE whenever this happens, but promptly goes and does it over and over again.

He can even do it when swaddled, which produced a couple nights of acute misery. However, the purchase of a sleep positioner seems to have solved the problem for now.

I am still going to try to wean him out of the swaddling blanket, because he's outgrowing the thing.

He weighs 14 lb 8 oz as of Monday, so I've dropped another bottle, and he is now getting just one 4-oz bottle a day.

The improvement in my milk supply has brought me within 2.5 lbs of pre-pregnancy weight, if not quite so close to pre-pregnancy shape.

I have zero enthusiasm for doing anything else about that, and am thankful that "low milk supply" gives me an excuse not to diet.

As if I needed an excuse, being a grownup and solely responsible for my own weight and food behavior. Insert Shapely Prose rantage here.

Or I could try eating like a toddler. Claire in particular is getting rather thin, having better things to do than eat.

Having had a bout with eating disorders as a teenager, I'm acutely aware of the many pitfalls of raising girls, and modeling healthy behavior, and walking that fine line.

I am watching this story play out with my seven-year-old niece right now, who is just slightly overweight enough to have triggered my mother and sister into making comments about her weight and suggesting that she change her eating behaviors.

This probably deserves a post of its own, or a series of them. I'm pretty upset about the thing with my niece, and pondering how I'll handle the issue when it comes up (as I strongly suspect it will, especially with Katherine).

After months and months of bedtime/naptime chaos, I have finally instituted Project I-Said-Stay-In-Your-Beds. Bedtime is going supremely well, naptime less so. This too deserves a full post.

I think that's enough random, don't you?

Like an industrial accident

2009-02-02T18:28:00.000-06:00

Pain-free days: 0

So much for that bright idea.

Dammit.

This is not my beautiful life

2009-02-01T19:04:00.002-06:00

I'm still trying to wrap my head around the whole endometriosis thing. Out of nowhere, I have a chronic disease that's going to have daily effects for the next ten or fifteen years, and all I can do is blink and say, "the hell? How did I get here?"

I have now had three relatively pain-free days in a row. Even the good days haven't been entirely good, I've still had some pain at here and there, but they've at least been good enough that I haven't had to take anything other than my usual handful of prescription-strength naproxen. It should illustrate the whole state of affairs, that three days of relative normalcy is noteworthy. Prior to that, the last week has included two days where I had to resort to narcotics, two other days where I made do with soaking in hot water, and daily cuddles with my rice bag heating pad.

(Some people make lemonade when life hands you lemons. Me, I sew up rice bag heating pads. If you can sew a straight seam, or have a friend who can, I highly recommend them. Take a 17 x 21 piece of 100% cotton fabric, fold it in half, sew it up on two sides, turn inside out, fill with 2 lbs of rice, and stitch up the remaining seam. Microwave for 2 minutes and it's a warm slice of heaven. Mine has a pretty cover with a zipper, but that's not essential for functionality.)

Anyway, so I've had a couple not-terrible days where I've almost felt like my old self, and it has really made a sharp contrast with the "new normal". I am hoping the feeling-good days are related to where I am in my cycle, because if that's so, at least I can expect a good week, maybe even two. If it's not, well, that's going to pretty much suck.

The reason I am trying to still make jokes about it is because I don't really have a choice. This isn't going to go away, at least not until menopause, although I have some hope that some treatments might help. I've decided against Lupron and Danazol, due to high failure rates and unpleasant side effects, but I'm going to try BCP. I want to make it to the six-month mark first, since I may well wind up having to wean Andrew. I'm going to ask for another ultrasound first -- I am deeply suspicious my left ovary's got some nastiness going on, which would push me toward surgery first. If not, I'll try BCP, and then another lap if things don't improve quickly.

I kept hoping we'd get this thing figured out, treat it, and be done, and I'm now having to come to grips with the fact that it won't happen that way. There's been a shift in the status quo, but it's taking me some time to make my peace with it.

Endozilla

2009-01-21T13:40:00.003-06:00

The whatever was still present on today's ultrasound, and it's now obvious that it is contiguous with my endometrium. Instead of being all tucked inside my uterus like it should be, my endometrium appears to literally keep going right through my scar and to expand on the outside of my uterus. Dr. Boss says it's probably either more endometriosis or adenomyosis, and that there's really no good way to distinguish short of laparoscopy or hysterectomy. I'm a long way from ready to discuss the latter, and he doesn't recommend the former at this time.

This is logical enough, I suppose. Adenomyosis requires hysterectomy (or at least removal of a substantial chunk of uterus), but it's less clear-cut for endo. It's in a tricky spot, on the front of my uterus directly behind my bladder, and he is reluctant to go poking in there if it can be managed medically by cutting off the estrogen supply. Reading between the lines, it will probably happen sooner or later, but he wants to try drug approaches first.

Medical options are somewhat limited at the moment because I'm breastfeeding, so BCPs and Lupron and Danazol are all off the menu. I don't have much enthusiasm for them anyway, given the side effects and the limited effectiveness. We know I was hypoestrogenic for at least some of the time the endo was growing anyway, so it's questionable whether artificially-induced hypoestrogenism would help. On the other hand, I had bad periods as a teenager but was fine for all those years of BCP, so the BCP may have held it in check. BCP is easily reversible and has relatively mild side effects, so I'm more okay with that than the other two, after weaning.

The current plan is to do a pain-management approach. The pain has backed off some since I quit bleeding last week, and is mostly manageable at the moment with daily NSAIDs and the odd Percocet right now. We're going to keep doing that until I'm ready to wean or until I am dysfunctional enough to decide to do something about it. After that, we'll see. The simple fact is that we don't know what my natural progression is, and what my "normal" cycle will look like. I had four periods between the girls and Andrew, none of which were really terrible. Since Andrew's birth, things have been so muddled, with the infection and the endo and the lap, that it's just really not clear how things will settle down.

Another lap and/or a hysterectomy is probably in the cards eventually, because this stuff seems to be pretty aggressive. Four months ago, I didn't have endometriosis at all. Six weeks ago, the endometriosis was removed. In the four weeks after that, it appears to have regrown enough to flip my uterus around and escape its boundaries. At this rate, Tokyo better watch out.

One problem resolves, two more crop up

2009-01-16T19:40:00.002-06:00

The whatever in my cervix was gone on Wednesday's ultrasound, but now there's something outside the uterus, like it's attached to my scar. They don't *think* it's what they were previously seeing in my cervix, but it's possible -- my normally-retroverted uterus has now flipped forward, so everything looks different. Dr. Boss thinks it is probably not an abscess in the absence of an elevated WBC, so I'm to go back on Wednesday and look at it again. Bleeding started again on Sunday but stopped yesterday, so who knows. I'm running a fever at the moment, but I also have a nasty cold that's about to turn into an asthma flare-up, so it could just be that.

Andrew clocked in at a whopping 12 lb 15 oz -- that's a gain of a pound and a half in two weeks, which is pretty impressive. I'm reasonably sure he weighs more now than ever before, and he feels so nice and solid when I pick him up. He's slept better at night the last couple days, although naps are a disaster. Supplementation is down to about 8 oz of formula a day, so the Reglan has made a definite difference.

The cold has sapped the last of my enthusiasm for, well, anything. I'm probably going to have to start on steroids tomorrow, since my peak flows are going rapidly downhill. I do have some on hand now to start whenever I need them, so at least I won't have to go into the urgent-care clinic for a steroid shot. Happily, the kids don't seem to have gotten it, although Andrew's a little stuffy, and they've been just as happy to have a pajamas-and-TV day.

Progress

2009-01-09T13:49:00.002-06:00

I finally got back in to see Dr. Boss this morning for a second opinion. Things look better in there than on Monday, as the free fluid and the fluid in my uterus are gone, but I'm still hurting. The whatever-it-is in my cervix is a little smaller than on Monday, but it's still pretty sizeable. Dr. Boss didn't know what it was today, either. At first he thought it might be a fibroid, but after fiddling with the ultrasound, thought it might be some blood instead, trapped in my cervix. Where it came from, and what it's doing there, are good questions, to which we don't have answers just yet. He allowed that it's possible it could be infection, although with a normal white... and then I interrupted to remind him about how I didn't ever have an elevated white count with the tube-eating infection of doom, and he said, hmmm, yeah, that's a point.

He wants to give this a few days to see which direction it's headed and see me back on Wednesday. At that time, we'll consider doing an endometrial biopsy if I'm still feeling gross. Hysteroscopy's also potentially on the menu, but he's wary of potentially spreading around infection. He doesn't want to do antibiotics right now, because I've had so many rounds that he is worried about antibiotic complications popping up. That seems a fair point to me, especially given how wonderfully they've worked so far. In the meantime, he also gave me some pain medicine, so the waiting will be more comfortable.

As for Andrew, he is doing much better. He was up to 12 lbs 2 oz at his weight check today, for a gain of 10 oz in a week, which is great. He's consistently been taking about 12-14 oz a day, but I can tell that my milk supply has noticeably increased over the last day or so, and he's only had 4 oz so far today. We'll keep doing what we're doing for another week and let him regain some more weight.

Since I had to take him to the pediatrician as part of all this, I wound up being the asshole with the baby at the reproductive endocrinologist. I brought him on Monday too, but there weren't any patients around then. It wasn't crowded today, but there was another patient waiting, and he was in full-on squeal-and-laugh mode. I told her I was sorry, and she said it was OK, but I still felt like a jerk. At least I'll be leaving him at home on Wednesday, since I don't have to take him to see any doctors then.

--------------------------------------------------------------------

My mom just called and said that my records from Dr. Pro had finally gotten scanned into their EMR system, including my op notes and the pathology from the various biopsies taken during my surgery. Dr. Pro told me after the surgery that she thought that the infection had resolved, and that the damage was leftover rather than ongoing. When I spoke to her on Tuesday to ask for my records, she reiterated that viewpoint, that I had not had an active infection at the time of surgery. Guess what the pathology showed in the removed tube?

Chronic salpingitis, that's what. The inflammation wasn't just leftovers -- I forget the exact wording, but basically there was active infection. TOLD YOU SO, says I. That infection survived two rounds of clindamycin, plus the useless amoxicillin. So it's not a stretch to assume that it survived somewhere else (like, say, MY CERVIX, or that left ovary that still hurts like a bitch), and that explains why this latest round of clindamycin didn't fix matters either. I presumably had antibiotics during my surgery (none were hung while I was awake, but I assume I got them), but obviously, they weren't enough or the right kind, or it wouldn't have come back.

Now we wait and see if that changes Dr. Boss's treatment plan.

More doctors

2009-01-05T18:54:00.001-06:00

That's pretty much what today was about, or at least what it was supposed to be about.

I met with the lactation consultant (also a family-practice MD) today, and she was pretty encouraging that I'll be able to work back to full breastfeeding. She put me on Reglan (which I used for hyperemesis with no side effects), which she is hopeful will bring me close to adequate supply levels. Judging by the amount of supplemental formula he's consuming, I'm producing about half of what he needs for maintenance. We've got some weight regain to do, but it's not a dire situation just yet.

Supplementing is a pain, and I don't want to fight that battle forever, but it's worth it in the short term to get my nursing relationship back. I like nursing, and I find it far more convenient for my lifestyle. Being a SAHM, I'm feeding the baby all day anyway, so I might as well do it in a way that doesn't involve preparing bottles. (Well, Katherine is "helping" me feed him, which is really pretty cute but not much actual help.)

Dr. LC agrees with everyone else that the problem is almost certainly rooted in all the physical issues, and that solving those will go a long way to improve the situation too. She also feels that the infection situation has been mishandled, and said that she had been taught to do hospitalization with three different kinds of IV antibiotics for post-cesarean infections. I mean, I knew that, but it was nice to hear someone say it.

After leaving Dr. LC's office, I went to go see my old RE Dr. Boss to get a second opinion about the infection crap. Since my mom is his nurse, it's easy to get an appointment on short notice, and I don't have to explain my entire history to a new doctor. I did not actually get to see him today, as he got caught in surgery while I was having yet another ultrasound, but he's going to review the ultrasound images and call me tomorrow, and possibly have me come back in.

Still, the ultrasound showed some interesting things, even to my untrained eye. I have a 16-mm cyst on my left ovary, which was present on Friday's ultrasound and does not appear to have grown appreciably from the picture I saw then. Something appears to be coating that ovary as well, according to the sonographer, who pointed out a funny bright-white border. I have free fluid in the cul-de-sac, not a lot but some, and I have fluid in my uterine cavity as well. I didn't ask what thickness the lining was, but it looked to be scanty. She said my cervix looked thickened and enlarged, and that she thought she might see something in it. From what I can Google, some of those findings are indicative of infection -- and this is after almost four days of clindamycin, too.

I've got to see what Dr. Boss says tomorrow, and then see what someone wants to do. The political situation is a little unusual in that he was a professor and attending for Dr. Pro's med school and residency, so he may suggest I go back to her and tell her this is what he recommends for treatment. Alternately, he may just decide to treat me himself. I don't much care, as long as someone does something other than give me more damned clindamycin.

My dog died, and the rest of the week hasn't been much better

2009-01-02T15:34:00.003-06:00

Short version of today because I'm on Percocet and want a nap:

-- Andrew weighed 11 lb 8 oz at the pediatrician
-- No other reason for concern, so we're calling it a feeding/milk supply issue until proven otherwise
-- I'm to supplement with formula after nursing for now, and will be seeing the LC on Monday to talk about fixing the milk supply problem
-- This morning, he screamed and bit me and spit the nipple out, and I could barely express any milk at all
-- That's first time I've actually seen him be dissatisfied with nursing
-- I'm thinking maybe this is a recent development that's just going downhill fast
-- He chugged 3 oz of formula like a frat boy after a keg party, and has been sound asleep for two hours now
-- I fed my other two children Pop-Tarts in the car for breakfast, making me the official Winner Mother of the Day

-- Ultrasound showed a large cyst (follicular, maybe)? on one ovary
-- Could not get a straight answer about uterine lining. First she said it was "proliferative", i.e. preovulatory, then that it was hard to see because there was "fluid" in there
-- Cervix was blocked with thick mucus, preventing said fluid from coming out
-- This is exactly what happened with my postpartum bleeding, and why my uterus was full of blood
-- How that squares with 2+ weeks of daily heavy bleeding, I'm not sure
-- Removal of said mucus was AWFUL, screaming-thrashing-cursing awful
-- WBC was 5, not indicative of infection, but it wasn't elevated when I had a known infection, either
-- Hematocrit was 35, down from 38 pre-op, so yeah, still anemic despite iron/prenatals
-- Got prescription for more clindamycin. If I'm not better by Monday, we'll reevaluate
-- Reevaluation may include another D&C
-- No pathology results from surgery, still

Did I mention that we lost my oldest dog on Tuesday, in the middle of all this? She was old and quite ill with congestive heart failure, so we knew it was coming. She was getting close to the point where we'd have to put her down, and I'm glad she went peacefully in her sleep before it got too painful, but I still miss her. This week really has been a steaming pile of shit on toast.

We interrupt the scheduled whine

2009-01-01T11:03:00.002-06:00

I'm most of the way through a long post about how the infection is back (short version: still bleeding, increasing pain, now running low-grade fever, seeing useless doctor on Friday), but I found something else to worry about instead.

Andrew hasn't pooped since Sunday, and I've noticed he hasn't been having a lot of wet diapers either the last few days. I've also been thinking he's looking a little thin the last couple weeks -- his 3-6 month size Christmas outfit was enormous on him. This morning, it finally occurred to me to stand on the scale with him to see how much he weighs.

Eleven pounds. My three-and-a-half-month-old weighs eleven pounds.

He weighed twelve pounds at his two-month checkup, an appropriate weight gain from the 8 lb 4 oz he weighed at two weeks. So not only has he failed to gain any weight in two months, he's lost some. I know scales vary, so we might be off by a pound or so, but it's quite clear that something is amiss.

He's nursing about every two hours during the day, from waking up at 7 to going to bed at 9, but the girls did that too when they started sleeping through the night and had to cram 6-8 feedings into the day. He nurses 6-7 times total, for five to ten minutes, and usually seems content when he's done, although occasionally I have to nurse him on the other side (I usually do one side and swap at each feeding). I nurse him on demand, he latches well, gulps milk, and nurses until he's done. I exclusively nursed twins for a year, so it's not like I have intrinsically low supply or don't understand the mechanics.

I'm suspicious it's a milk supply problem caused by the surgery and the returning infection and the bleeding. I've got to be anemic at this point -- I had barely made it up to the bottom of the normal range pre-surgery, and I've been bleeding for two weeks now. I've also been on naproxen for a while, and given the amount of bruising I've got going on, I suspect my liver is unhappy too. Put that together with the infection and the fever, and it can't be good. I don't *feel* good, so it's really not all that shocking, I suppose.

I'm seeing the doctor tomorrow, and I know she'll do a CBC to check for infection, so I'll see what that has to say. I'm planning on taking Andrew to his pediatrician for a weight check immediately afterward, and after that, I may call the breastfeeding clinic to get the opinion of the LC there.

When midnight struck last night, I told my husband that I hope 2009 is a healthier year for us all, but this is not a promising start.

TMI question

2008-12-21T23:43:00.003-06:00

Major TMI, don't say you weren't warned.

Little gushes of bright red bleeding two and a half weeks after a D&C. Not a lot, maybe a teaspoon a couple times a day, but it's happened consistently every day for five or six days now. Some cramping, nothing too major, just enough to keep reminding me that hi, I'm your uterus. No fever. Normal at this point, or time to call the doctor tomorrow?

Or, more properly, time to call the doctor and yell until someone pays attention? I mentioned that I was spotting when I saw her for my post-op visit last week, and she said spotting was normal. At that point, I had only had some pink spotting for a couple days, and a single gush of red the day before, so I thought, okay, fair enough. However, this is getting beyond what I consider spotting -- it's more like a light period, and it's bright red, and it's happening every day. And honestly, I'm not overly trusting of her right now, not after the infection debacle, and I'm not that inclined to take her word for it.

I know a little bleeding probably isn't all that big a deal in the grand scheme of things, but I'm gun-shy now.

ETA: they said it was normal (OF COURSE THEY DID) unless I'm having a fever or severe pain along with it. I'm letting it go for now, but if I have to call again, there will be a stink made, oh yes indeed.

Christmas scorecard

2008-12-19T14:16:00.002-06:00

Win: Christmas tree decorated
Lose: On December 17

Win: Christmas shopping completed
Lose: Wrapping? AHAHAHAHAHA.

Win: Knitted one lace shawl and three socks for Christmas gifts
Lose: Three socks left, and men have really big feet

Win: Baked awesome chocolate chocolate chip cookies
Lose: Ate three-quarters of awesome chocolate chocolate chip cookies

Win: Worked out a reasonable holiday in-law visit schedule
Lose: Said plan probably does not include the presence of my husband. Curse you, holiday deadlines.

Lose: I have no outside decorations this year, not even a wreath
Win: The girls are so impressed with the neighbors' lights that they don't care

Lose: No Christmas cards sent this year
Win: Sanity and fresh scar left intact after choosing not to drag all three kids to the photo studio

On zebras

2008-12-08T21:49:00.003-06:00

You know you made the right choice when you already feel better, just three days after major abdominal surgery, than you did beforehand.

Even though the surgery turned out to be a bigger deal than previously foreseen, I'm recovering quickly. I have a 2" incision in my CS scar as well as the laparoscopy ports, which I assume is where the tube was removed, so I have some lifting restrictions and incision pain that we hadn't anticipated. However, it's still better than the pain I was having in that junked-up left tube, and I think in a couple days I'll be feeling like a new woman.

Right now, I have to say that I'm a little angry. Losing the tube shouldn't be a big deal to me, since I was having it tied off anyway, but I'm upset nonetheless. It's not so much that I lost the tube, but that the tube was diseased enough to need removal. I'll know more when the pathology comes back, but it certainly suggests the infection wasn't treated adequately. If I'd been given the right antibiotic or an ultrasound when the infection was first diagnosed, if I'd insisted on a D&C when we found all that stuff in my uterus, if I'd gotten IV antibiotics after the first recurrence, if we'd gone to surgery in early November instead of waiting around until an elective tubal ligation could get scheduled, could it have been avoided?

I understand that my doctor is conservative by nature, and that I didn't have a very high fever or highly elevated WBC. I know she didn't want to rush into potentially complicated (and expensive) surgery or IV antibiotics unless she were positive I needed them. Thing is, apparently I did need more aggressive treatment than I got, because the infection took root and ate up my tube. It might have turned out the same way even if we'd gone after it sooner and harder, but what we did wasn't enough. And I had to fight to get even that much -- she had originally wanted to wait another week after the first antibiotic failed before proceeding to ultrasound, and didn't want to do the lap unless I were having a tubal anyway.

Maybe my presentation really was unusual, and infections which do that much damage generally have more outward signs. To be fair, it's not like she ever suggested it was psychosomatic, just that she didn't see any indications to proceed, other than the pain. Still, she blew the pain off, even when I made it clear that it was affecting my life, and that I felt something was really wrong. And so I lost my tube, maybe my ability to have children, because of it. No, I didn't want to have any more, but what if I had? I shouldn't have lost that option, or have had to push so hard to get the pain taken seriously. If I hadn't wanted to get my tubes tied, this would have gone untreated for months more, and yeah, I'm not happy about that at all.

I really do like my doctor. I think she's very capable, and conservatism is usually a good quality in a physician. However, if we'd been more aggressive at any point along the way, I might have had less damage. Of course, it's a much easier call to make with the benefit of hindsight, and I do understand why she wanted to proceed with caution. Still, she and I are going to talk about whether she should not have been so quick to dismiss my symptoms, just because there wasn't a strikingly obvious cause.

The end of the fertility journey

2008-12-05T19:13:00.002-06:00

So, now it's conclusive: I will never be pregnant again.

Yesterday, I got all teary-eyed about knowing that I would never hear another newborn baby's first cries, and I had a moment where I thought about backing out. What if I might change my mind someday, when the trauma of my last pregnancy and birth has faded?

I'm currently.. not overwhelmed exactly, just whelmed, with the three children I've got, but I imagined changing my mind when Andrew goes to preschool in a few years. I love babies, and I'm having such a good time with him right now -- those wide gummy grins make me melt. And I've discovered that I love toddlers just as much, and that there will soon come a day when nobody in the house thinks that being chased around the living room with a plastic duck is the height of entertainment. So I feel some loss to know that those stages will pass away and never come again.

Since Andrew's birth, I've been wrestling with the question of whether I've had a mild form of PPD or even PTSD. I literally get the shakes at the idea of being pregnant again, and sometimes I feel so short-tempered and emotionally fragile. I've been through a lot, so I think I'm justified in feeling this way, but I've had to ask myself if I think I can manage, or if I need to get some therapy and/or meds. I've come down on the side of trying to manage, at least until we got through this diagnostic process and found or didn't find an explanation for the chronic pelvic pain. Given all that, I've wondered if I decided to have my tubes tied out of fear, rather than for good and rational reasons, and if I would regret it in five years.

Now that it's done, I might still have regrets in five years, but I know it was the right choice. Given what they found, I might have had a very hard time getting pregnant again, and my chances of an ectopic would have been non-trivial in that messed-up left tube. The tube and the adhesions and the endometriosis would have continued to give me pain until I'd had them fixed, and I would not have done well with an IUD. Plus, in five years from now, I'll be 37, and advanced maternal age + one lost tube + internal scarring and adhesions + a history of infertility adds up to make it a moot point. So I'm really at peace now that I know another pregnancy would have been a long shot. I made the decision not to have any more children, rather than holding out hope and going through the emotional rollercoaster of infertility, and being able to make the choice makes all the difference.

This may not be the end of my reproductive troubles. Adhesions come back, and so does endometriosis, and I might get another infection from this surgery (my temperature's slightly elevated right now, which I'm watching like a hawk). There may be another lap, or even a hysterectomy, in the future, because this is my crappy body we're talking about. But we took a big step toward being done with it today, and I feel good about it now.

Tubular

2008-12-05T13:25:00.002-06:00

I went in this morning for a laparoscopy, D&C, and hysteroscopy to explore the chronic pelvic pain, plus a tubal ligation. Going in, I was concerned they wouldn't find out what was wrong, or be able to fix it, but that turned out not to be the case.

Hysteroscopy revealed a lot of endometrium, which the D&C removed, and that's being biopsied. No retained placenta, so that's good news. When Dr. Pro got to my ovaries, she found that the left fallopian tube had several cysts, extensive scarring, plus there was some nasty stuff coming out of it. Clearly, that one got badly damaged by the infection, and now we know why I had pain on my left side. She removed that tube entirely, and clipped the other one. I also had some adhesions at another point where I'd been hurting, and she snipped those out.

The big shocker, though, is that I had quite a few endometriosis implants, on the back of my uterus, on my bladder, and attached to my pelvic wall. Nobody has ever even suspected I might have endometriosis, so both Dr. Pro and I were pretty surprised about that one. She also pronounced herself "concerned" that they are already there, given that I'm hypoestrogenic from breastfeeding. She hopes that nursing will keep the endo under control until I'm ready to wean, but we may have to address that again at some future point.

I'm groggy and sore, but not too miserable physically, and very relieved mentally. I KNEW there was something wrong, and that it wasn't in my head, and I feel very vindicated at the moment. I'm not especially overjoyed about having endometriosis, but at least now we know it's there. I'll take known unpleasantness any day of the week, so even a bad diagnosis is better than none.

And the great day came...

2008-11-23T22:21:00.003-06:00

Andrew's new trick: sleeping through the night! For about the last week, I've been able to put him down at 10 PM or thereabouts, and then he's woken up at 7. We backslid last night and woke up at 2 AM, but I'm hoping he goes back to staying down for the count tonight. His night wakings really haven't been too bad, since I just pull him into bed, nurse him, and (sometimes) put him back. Still, no night wakings at all is better yet! I'm hoping he shifts to going down earlier, but I'll certainly take this for now.

(To be clear, I'm not doing any kind of sleep-training with him, nor do I plan to until he's much older. I'm just lucky enough to have kids who like to sleep at night. Yes, I know you hate me now.)

Naps are much more difficult, partly because of the chaos created by his sisters, partly because he's still a little thing, and partly because I think he may just not be a great napper. He is slowly starting to develop a three-nap pattern, but it's still not consistent, and the naps rarely last longer than an hour. Some days we don't have any naps at all to speak of, which turns him into a gnarly thrashing beastie, and since the girls have basically given up naps, such days are looooong. We'll see what happens with that as he gets bigger.

He also has enough head control for a Bumbo seat.The head-control thing was a big deal with the girls, because it's just plain hard to maneuver two tiny floppy babies. There's only one Andrew, of course, so it didn't make quite as much difference, but it's still helpful. Also, he loves the Bumbo, which I speculate is because it makes him feel like he's more a part of things than when he's just lying in his bouncy seat. The kiddo does not like to be ignored, and he seems to have more patience for sitting in the Bumbo while I fold laundry or whatever than for being in his bouncy seat.

At his two-month checkup, he was 23" tall and weighed 12 lbs even, up from 8 lb 4 oz at two weeks. For comparison, Claire weighed 12 lbs even at her SIX-MONTH checkup. I don't quite know what to do with a child who is growing in accordance with his age. Claire and Katherine wore 6-9 month clothes until around their first birthday, and even a few 3-6 month things. Andrew's in 0-3 months still, and probably will be for another couple weeks, but I think he'll be moving up around Christmas.

He is generally a happy little guy, and he's starting to get really cute. He's smiling, at me and G and Grandmama and the dogs and especially his sisters. He's starting to make happy noises at his toys, and to wave his hands at them. Today, he managed to get the ear of his giraffe into his mouth, and he cooed and squealed about it like anything. He's also starting to gnaw on his fist, though he really prefers his pacifier.

He's a joy, but it's going so fast!

Twin dilemmas: the potty edition

2008-11-17T09:24:00.002-06:00

So, we're potty-training here. Katherine is ready for it -- she's very interested in matters scatological, wakes up dry, and announces when she has dirty/wet diapers. Claire likes to sit on the potty, but she is clearly not as interested in it as Katherine, and not as aware of when she is going in her diaper. If she were a singleton, I wouldn't even try to train her for a little while.

Problem is, she insists on doing everything that Katherine does. Right now, I'm sitting in the kitchen with them, doing the bare-bottomed thing. We did it yesterday morning, and Katherine peed in her potty, while Claire peed on her chair. Today, Katherine has peed twice(!), while Claire hasn't done anything so far. When Katherine goes, I get really excited and praise her, and then I dish out a piece of Halloween candy. Since they are old enough to understand about fairness, this causes a giant problem, because Claire wants a piece too.

On the one hand, it seems wrong to give her a piece, because it's a reward for using the potty, which she is not doing. On the other, not treating her just causes a tantrum, and I worry she will transfer the frustration to the whole potty process. But then, she is at least sitting on her potty enthusiastically, which is a good thing, and is all I should expect of her at this point. I don't really expect Katherine to go exclusively in the potty either, for that matter -- I'm just working on getting her going there on a regular basis right now -- but if Claire goes, it's really just a matter of good luck.

I'm compromising by giving Katherine two pieces for each potty usage, and Claire gets one "because you sat on the potty so well!". However, it's an inherent problem of having multiples, the conflict between fairness and individual maturity. I suspect future versions of this conflict won't be so easily solved with a few extra M&Ms.

All better?

2008-11-16T01:47:00.002-06:00

I haven't posted about my postpartum appointment, largely out of frustration. The short version is that I'm still anemic despite supplementation, the pelvic exam was AWFUL, but neither that nor the ultrasound (also miserable to the point of tears) showed any smoking guns. I'm not running even a low-grade fever, and don't have an elevated white blood cell count, so Dr. Pro doesn't think I have an active infection. She did some hand-waving about breastfeeding and hypoestrogenism, but basically said she doesn't know why I'm hurting, since there's nothing obviously wrong.

I am still hurting, though, and consistently. I sometimes wonder if I'm just being a whiner, because after all, it's not crippling pain, and I can function normally most of the time. It's like an uncomfortable period, where you're aware of feeling crappy in the back of your mind, but don't hurt so much that you're balled up and writhing. Still, I haven't made it through a day without naproxen in... I dunno, weeks, and on bad days I wish I had something a little stronger. The funny thing about pain, though, is that it's two-dimensional -- there's the level of sensation, and then there's the duration. Even a low-level pain which goes on for weeks takes on an outsize presence in your head. The longer it goes on, the less you feel like just tolerating it, and the less energy you have for coping with everything else.

We talked about what to do next, and that wasn't a very satisfactory discussion. She initially didn't seem inclined to pursue it farther, but when I mentioned that I was very seriously considering getting my tubes tied, she said she'd want to do a D&C and a hysteroscopy at that time. I don't understand the linkage -- if she thinks they're worth doing, they shouldn't be dependent on the tubal ligation, but if she doesn't, don't do them just because you're there -- but it's a moot point now. I'm booked for the lap, the tubal ligation, the D&C, and the hysteroscopy at some point in December (I don't know the exact day yet).

I hope some answers come out of it.

Moving

2008-11-04T23:18:00.002-06:00

For months now, I haven't seen what the fuss was all about, never felt the much-vaunted charisma. Tonight, though, I'm watching his acceptance speech on CNN with tears pricking in my eyes. I've watched election night since 1984, the year I had a playground fight with my friend Daniel over Reagan vs. Mondale, and I've never been so moved.

Tomorrow, I'll remember all the reasons why I voted for the other guy today. I'm pretty sure that in a year or two, I'll be griping about him, because I have some fundamental disagreements with his policies. But I wish that weren't so, because I like feeling as proud of my president and my country as I do right now.

Waiting to exhale

2008-10-23T10:17:00.002-05:00

I finished up the third round of antibiotics on Tuesday morning. Last time, it took about 48 hours for the infection to come back, so I'm somewhat hesitant to declare that they've worked just yet. I'm still having some pelvic pain (it never entirely cleared up this time, even with the abx) but no fever or malaise at this point, so who knows.

I feel like my uterus is still a ticking time bomb, but that's probably to be expected after the events of the last four months -- I definitely have some work to do to sort out the psychological ramifications of it all. I'm still feeling pretty traumatized by the whole thing, and every little twinge and ache seems like a harbinger of doom. I am also very conscious that, even if the infection is healed, I'm still very physically debilitated from everything. My mom and I strolled the kids around the neighborhood on Tuesday, 30 minutes of leisurely walking, and that was the limit of my endurance. Still, it's progress, and I hope I can keep advancing now.

Andrew is a good baby overall -- he wakes me up at night about every three hours, which is as much as you can expect from a month-old baby. He seems to be a little needier than I remember the girls being at this age; they were content to sit in their bouncy seats between feedings, but Andrew mostly wants to be held or at least talked to. He doesn't really nap right now with any consistency, just dozes off whenever he's comfortable and wakes up and complains whenever I decide he's asleep and put him in his crib. He's reasonably fond of his paci, but cannot reliably keep it in his mouth, and I'm half-hoping he decides to switch to a thumb soon. He is also growing like a weed, and I'd be shocked if he's not ten pounds by now, the little piglet.

My nanny is still taking care of the girls right now, but G has been working some late nights recently, so I've been flying solo with all three of them in the afternoons and evenings for the last couple days. This was, quite frankly, a terrifying prospect. The reality hasn't been so bad, but I wouldn't exactly call it easy either. Since Andrew isn't keen on being put down, I'm less able to wrangle the little girls when needed, and they need more wrangling than normal lately. They usually play pretty independently, but this is complicated by the fact that they LOOOOVE the baby. They want to hold the baby all the time, and fight constantly about who gets to hold him. They're very good with him by two-year-old standards, which means that they only pinch his nose or poke his face about every five minutes, but they will. not. leave him alone, at all. If I can get him asleep in his bouncy seat, they immediately begin being "helpy" by covering him up with his blanket (face included), giving him his paci (whether he wants it or not), and patting him and saying "sssh baby no cry" (especially when he is sound asleep).

Honestly, they are fantastically good with him for their age, although it's a lot of work to manage at the moment. I'm looking forward to when he is a little sturdier and they are a tiny bit older. Two or three months makes such a difference in their maturity level, and it's obvious that he will adore his sisters when he's ready to be played with. When they're not messing with him, he seems to find them entertaining -- he'll be content in his bouncy seat or on his quilt if they're around, which is not the case if he thinks he's being ignored. A lot of people told me I was crazy for having Andrew with the girls still so little, but my MIL told me that there are definitely advantages to having children close in age, too. I think I'll see it soon, and that right now is the hardest time.

Round 3, and what comes after

2008-10-14T11:40:00.004-05:00

I think I spoke too soon about the infection's being cleared up. I started hurting more again on Sunday, and the low-grade fever came back. I gave it yesterday to clear up, then when it didn't, called the doctor back this morning. She wants to do another round of the same antibiotic, about which I have mixed feelings. I felt much better while I was on it, but obviously, as soon as I stopped it, I started getting sicker again. Did I just not take it for long enough, or is it inadequate to the task at hand? I'll give it one more go, but if it doesn't clear everything up for good this time, we'll revisit the question of the D&C.

Speaking of questions to revisit, this whole infection business has pushed me to revisit the postpartum birth control question. We knew all along we were probably done after this one, but I couldn't quite bring myself to get a tubal done with the CS. I hated to rule out even the outside chance we might want another in a few more years, when the girls will be in school and I could better handle another awful pregnancy. Also, this may sound silly, but I wanted to make sure that Andrew was born and that everything would be okay with him. After all the drama of this pregnancy, some part of me didn't believe that we'd really have a live, healthy baby, and I knew that if something awful went wrong, I'd eventually want to try again. So, I said no to the tubal, and had planned on getting a copper IUD (not the Mirena, don't care for hormonal birth control after the events of the last several years).

However, this infection has officially been the straw that broke the camel's back. I can't handle the thought of ever doing this again. I held up through the hyperemesis, the T18 scare, and the months of bedrest for preterm labor. The asthma exacerbation was almost funny, in that "now what!" way where you have to choose whether to laugh or cry. But there's nothing funny about the fact that, four weeks after my son's birth, I'm still spending most of my days in bed because my pelvis feels like it's full of rusty nails and barbed wire. I was feeling so cheery last week when I was feeling well, but now I'm right back to wondering what it's going to take to cure this, and what kind of permanent damage I'm going to be left with before it's all said and done. For all I know, it may not even be possible or prudent for me to conceive again -- endometritis is a type of pelvic inflammatory disease, after all.

In any case, I never want to have another pregnancy, even an accidental one, unlikely as the idea of that seems to someone whose bathroom cabinet still holds a sharps container. I don't want my husband to get a vasectomy, since that is even less reversible in the event of future circumstances than a tubal ligation. If I get myself sterilized, I'd have the option of doing IVF if I wanted another pregnancy badly enough; but if he gets sterilized and anything happens to me, any future wife would be like my sister, permanently infertile as a result of a choice made in another marriage.

I haven't decided whether I will do the Essure procedure or a traditional tubal ligation, but this is mostly a question of logistics. I have to see what is covered by my insurance, and will cost me less. I have to see whether I'm going to wind up being anesthetized for another gyn procedure like a D&C or a lap, where it would be convenient to tie my tubes while I'm already out. Heck, for all I know, this still could end with a hysterectomy, which would render the whole question moot.

In any case, we've got to get the infection cleared up before I can make any decisions. I hope this round of antibiotics does the trick, though I'm less confident than I was.

Cognitive dissonance

2008-10-08T13:45:00.002-05:00

Lady behind me in line at the Dollar General: "Oh, how old is your baby?"
Me: "Three weeks tomorrow."
LBMILATDG: "Oh, he's so big for three weeks old!"

Nobody EVER told me how big the girls were for their age. Oh, they'd ask the birth weights and say "They're a good size for twins!" or the like, but if anyone ever commented on their actual size, it was to say how tiny they were. So, it really threw me for a loop when LBMILATDG said that Andrew was big for his age.

Of course, it might actually be true. He's got to be above nine pounds by now -- he was gaining 2+ ounces a day as of a week ago, and it's not like he's slowed down his eating. He feels heavy to me, and he's starting to really fill out his newborn clothes. I can't tell whether he's bigger than other three-week-old babies, because everyone else's babies have always looked like giants to me, but I know he's not small. Still, it's just not something I had really expected to be told. Weird.

On another note, Claire is hobbling around the house pretty darn well for a kid with a fractured tibia. Casting the leg was definitely the right choice -- she's moving much more easily than before, even if she does look like Peg-leg Pete. She still prefers to sit on the sofa a fair bit, and be indulged with coloring books and Wow Wow Wubbzy, but she's not as hindered by it as I expected her to be. Good news, that.

From the department of I-am-not-making-this-up

2008-10-07T13:34:00.003-05:00

Claire tripped over her toy vacuum cleaner yesterday afternoon. She wouldn't put any weight on her foot yesterday or this morning, and there was some swelling, so we took her to the pediatrician this morning, who sent her to the orthopedist.

No fracture was seen on the X-rays, but some types of fractures don't always show up very well. The orthopedist suspected that there probably was a fracture, and said that in children her age, he'd rather treat the kid instead of the X-ray, and proceed as if there is a fracture.

She's now in an over-the-knee cast, which will protect her ankle and hopefully make her more comfortable. She threw epic tantrums throughout the doctor's visits, for which I really can't blame her, but stopped crying and got fascinated as soon as the doctor started wrapping the cast on her leg. It's not precisely a walking cast -- her foot is pointed, rather than flexed for easy walking -- but she was already putting a little weight on it at the doctor's office. We hope that as she gets used to the cast and as the pain abates, she'll be able to move around a little bit better. Still, we're probably looking at a lot of time on the sofa for the next two to three weeks.

What ELSE is going to happen to us -- raining locusts and frogs? This year has been just such an extraordinary string of bad luck in all things health-related, that I can't even imagine what we'll be in for next.

Continued improvement

2008-10-05T20:23:00.003-05:00

I was well enough yesterday to go over to my mom's with the girls for two hours (while G cleaned up yet another diaper disaster, on which more later). Today I sat at the sewing machine for a little while, dealt with some laundry from the diaper disaster, and then went over to Mom's again for our usual Sunday supper. That was the absolute limit of my endurance, and I'm now thoroughly wiped out, but it's more than I've been able to do since the infection took hold.

The low-grade fever is gone, I'm off the painkillers, and I'm feeling so much peppier. I still half-worry that it will come back when I finish out the antibiotics, but that's just because I can't quite fathom being fully well again after all this. Realistically, my odds are good, and I think I've dodged the D&C for now.

Cautiously optimistic

2008-10-04T11:06:00.002-05:00

Yesterday afternoon, I was still pretty worried that we were heading for a D&C after all. I had a little spotting, but certainly not the kind of uterine fireworks Dr. Pro had led me to expect, and my uterus still hurt. I'd felt so relieved when we left the doctor's office, crying this time from the shiny new hope that we were finally getting things back on track. By the evening, with nothing much happening so far, the gleam was starting to wear off a little bit.

However, I did start cramping more as the evening went on, and my bleeding picked up some. I've never been so glad to bleed in my life, even with my first period after all those months of hypothalamic amenorrhea. I'm still not reenacting Carrie or anything, but I'm having what seems like a normal period, so that's definitely progress.

This morning, my temperature was actually normal for the first time in weeks, and I didn't hurt as much even before the pain meds kicked in. Better still, I don't FEEL sick any more, have lost the underlying icky awfulness I've been carrying around since this started. I am still dreadfully fatigued -- my SILs came over this morning to see the baby, and the effort of sitting on the couch for an hour has nearly undone me. Clearly, I will be looking at several days yet before making a full recovery.

However, today is the first day since the beginning that I can unequivocally say I'm better than the day before. I'm really starting to believe that I'll get over this soon.

I want a new drug

2008-10-03T14:02:00.002-05:00

I was really a lot more upset than I let on in yesterday's post. I didn't just cry in the doctor's office -- I cried on the way home, and on the phone to my mom, and later when my mom came over, and before going to bed. When I woke up this morning, got out of bed, and still hurt as much as ever, I found myself at the end of my rope, and I couldn't stop crying this time.

After bawling my way through a long hot shower, I decided it was time to do something about it. If there was a physical thing to fix, I wanted to get working on it; if not, then maybe it would be time to start talking about postpartum depression. In any case, though, I didn't have a week's worth of patience left. I called the doctor's office and told them I wanted to have bloodwork and an ultrasound done today instead of next week. That involved tears too, but I think those were actually useful, since they realized what kind of shape I was in and told me to come in ASAP.

Lo and behold, turns out I have a uterus swollen full of blood. I'd stopped bleeding before I even left the hospital, and while that was different from my previous pregnancy (in which I bled for eight weeks straight), I didn't think it was anything to be concerned about. Nobody even asked me about my bleeding, so I never mentioned it to anyone. However, the doctor thinks that is very likely the root cause of the problem.

We discussed doing a D&C today, but Dr. Pro was pretty clear that she wants to avoid that if possible. It involves anesthesia and surgical risks, and would cause breastfeeding problems too, so she wanted to take one more shot at fixing it surgically. I left with a prescription for a different antibiotic, as well as one for methergine, which will cause my uterus to contract and expel all the junk. Since that's probably going to be unpleasant, I have more pain medicine too, which is good because I'd run out. We're going to try that over the weekend, and if I'm not substantially improved by Monday, we'll do a D&C then.

I already feel better just knowing that we've got a different strategy in place. I'm not the world's most patient patient, and I have just about reached the limits of my ability to cope with crap, but I can hang in there for a couple more days. The space of a weekend, with enough pain medication to be comfortable and a new Plan B in place, is an entirely different prospect from waiting an entire week just to begin investigating.

No milk supply problems here

2008-10-02T20:47:00.004-05:00

When we came home from the hospital on 9/21, Andrew weighed 6 lb 10 oz, down from his birth weight of 7 lb 5 oz. Eleven days later, he weighs... 8 b 4 oz. That's a gain of more than two ounces a day. Nope, I don't think we have any milk supply issues!

I also went to the doctor today for a follow-up appointment. I'm feeling a small bit better, but still more crappy than not -- I'm still in worse shape than I was the day after the CS. The doctor said that the antibiotic I've been taking is the only one she really wants to prescribe a nursing mother, and that in her experience, uterine infections either get rapidly worse or slowly get better. Since I'm not getting a whole lot sicker, she thinks I'm going to improve, and it will just take some more time. I'm to come back in a week, and if I'm still fighting it, then we'll do bloodwork and a sonogram to check for abscesses.

I think that's a reasonable answer, on the merits, but it wasn't really what I wanted to hear. I know there's rarely such a thing as a magic pill, but... dammit, I wanted one. I'm so TIRED of struggling, and feeling rotten, and needing to wait just a little longer. I've spent FOUR MONTHS now trapped in my bedroom, and I am so sick of it and so desperate just to be able to get outside. I kept telling myself I had to hold on until the third trimester, until 32 weeks, until 34 weeks, until 37 weeks, until the baby was born. I really thought that once the baby was born, I'd be able to start leading a normal life again. When the infection started, I thought I'd go to the doctor and get antibiotics, and they'd start working. After a day or two, when I wasn't progressing, I thought I just had to hang on until today's appointment, and we'd try something different. Now, I have to hang on another week, and while a week isn't really a long time, I'm just flat out of patience.

I cried in the doctor's office, and she asked me if I felt like I had postpartum depression. I replied that there's nothing wrong with me that won't be fixed by getting healthy and being able to live like a normal person instead of an invalid. I *do* feel pretty freakin' depressed and disheartened right now, though. I don't need anti-depressants to fix it, though; a walk around the block, or a trip to the bookstore, would be all the medicine I need, if I just felt well enough to be able to do them. I hope that happens soon, I really do.

One is the easiest number

2008-10-01T15:12:00.003-05:00

I'm only now coming to understand just how grueling the first couple weeks of the girls' life was, now that I have a singleton to compare it with. I had very easy babies, so my stint as a new mom of multiples was easier than most women's, but it really is a whole different ballgame when there is only one baby to contend with.

The memory of the girls' insane feeding schedule makes me thank the sweet baby Jebus whenever Andrew wakes me up to nurse. He's waking up at 1-2 am, 4-5 am, and 7-8 am, which was about the same frequency as the girls did. However, I don't have to turn on the light, strap on the giant twin nursing pillow, struggle to latch two tiny little mouths, spend the nursing session gritting my teeth in pain from cracked nipples, change two diapers, and then pump. With Andrew, I have achieved the impossible dream of being able to reach over, pluck the baby from the co-sleeper, latch the baby, and go back to sleep. (G is currently on diaper duty because the uterine infection makes it so unpleasant for me to get up -- as of today, I'm starting to feel a tiny bit better, but I have a long way to go still, and am likely to spend several more days recovering.)

Nursing is somewhat easier simply because I'm experienced now, but the bulk of the difference is physical. I don't have cracks this time, because my nipples are only subject to half as much abuse, and it doesn't hurt that Andrew was as big at birth as Claire at six weeks. With the girls, I was so aggressive about ramping up milk supply so that I could nurse two babies AND supplement with pumped milk that my production went crazy -- I would nurse them, then turn around and pump 6-8 oz after each feeding. When you're making that much milk, you have to be religious about removing it promptly, which is why I constantly struggled with engorgement, plugged ducts, and mastitis. I haven't pumped at all with Andrew so far, though I really ought to start building a freezer stash, so I don't know how much extra I am making, but the oversupply troubles are far less. He's having some gas issues, which implies a foremilk-hindmilk imbalance, but this time I can actually use block feeding to resolve it.

Andrew likes to cluster-feed during the day -- really, what he does is nurse on one side, fall asleep for a bit, and then wake up for the other side 30 minutes later. I nursed the girls "on demand", but when one baby woke up and wanted to eat, I woke the second baby and fed her as well, and I made them stay awake long enough to eat full meals. With Andrew, I don't have to be as hard-core, and can allow him to nurse more frequently if that's what he wants to do; sure, I spend more time nursing, but it's nice not to force him to stay awake. As he gets a little older, I'll guide him to finish his meals more promptly, but I don't feel the need right now.

I also spend so much more time holding Andrew during the day than I did with the girls. He sleeps in his co-sleeper without complaint at night, but during the day, he takes one or two naps in it, and spends the rest of the day snuggled up with me. He might be soundly asleep on my chest, but should I try to put him down, he'll start howling like his bed is full of baby-eating crocodiles. Again, I'll steer him toward more naps in his crib or bouncy seat as we go along, but I really actually like holding him, so I'm indulging us both.

As a result of all the one-on-one nursing time and the holding time, I do feel like I'm closer to Andrew than I was each to the girls at this point. For the first month or two, they were a unit to me -- I did things with "the babies" or "the girls", not so much with Claire and Katherine, if that makes sense. Newborns don't express a lot of individuality anyway, so pair-bonding was the default. Now, there is just Andrew, so I can focus twice as much on him. We noticed this literally even in the delivery room -- G wasn't running back and forth from baby to baby, trying to focus on both at a time.

One luxury I do have is a nanny for the girls, so Andrew is an only child for me right now. I'm not physically capable of taking care of them myself, due to the infection and the c-section recovery before that, any more than I have been for most of the pregnancy. However, in a few weeks from now, I'll be letting the nanny go and spending some time as a full-time mom to all three kids. Our nanny is pregnant, and not having the easiest time of it, so she's pretty ready to stop chasing after three toddlers (her son is two years old, and she brings him and cares for all three children). I'm not sure what the long-term plan is -- we're discussing putting the girls in day care after Christmas, and I will stay at home and work around the baby for a few months -- but again, it's great to be able to focus just on the baby, instead of juggling the needs of all three children.

Even when the girls were tiny, I loved having twins. I always felt like they had a companion, and I think they found each other's presence comforting, even as tiny babies. Now that they're a little older, they have a built-in best friend, and entertain each other to a degree that makes my singleton moms envious. They fight too, especially in the last couple weeks (new baby upheaval, I'm thinking), and right now Katherine is sporting a set of Sister's toothmarks on her forehead. Plus, at 30 pounds each, they can be physically different to manage when they want to be ornery. Still, I'm glad that they are twins and sisters, and during my pregnancy, I wondered if Andrew would feel lacking because he didn't have a twin.

I still think he may do so, as he gets older, but at the moment, my perspective has completely changed. I feel that he's getting a chance the girls never had, to be my only child. He has not yet had to cry in his crib because I am feeding or changing his twin -- this will come in a few weeks, I'm sure, but for now he's able to get what he wants when he wants it. I'm able to give him undivided attention and love, and I'm wistful that I missed out on that with the girls, even if I didn't realize what I was missing at the time. I'm really thankful that I'm getting to experience what it's like to mother a singleton, and to have a "babymoon" with him.

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

2008-09-27T14:05:00.002-05:00

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.

Here, have some baby cuteness

2008-09-23T13:55:00.001-05:00

The birth

2008-09-23T13:54:00.000-05:00

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!

My handsome man

2008-09-19T06:58:00.002-05:00

Andrew Leon

2008-09-18T13:16:00.002-05:00

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.

All done, part 2

2008-09-15T18:38:00.002-05:00

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

2008-09-15T09:16:00.002-05:00

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.

The dinosaurs who came to breakfast

2008-09-12T00:52:00.002-05:00

... and lunch

... and to bed

Notice a common theme?

Still ugly

2008-09-10T16:41:00.002-05:00

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.

37

2008-09-09T11:07:00.003-05:00

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.

Happy Birthday

2008-09-06T09:51:00.002-05:00

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.

Blymey

2008-09-05T13:24:00.002-05:00

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.

High-water mark

2008-09-02T17:41:00.002-05:00

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!

The good and the Gustav

2008-08-27T16:49:00.002-05:00

Good: 35 weeks! Six more days, and I'll surpass my first pregnancy. The birth is now officially scheduled for September 25, although Dr. Pro says she really doesn't think I'll make it that long. I'm mostly effaced, which while not uncommon for this point in pregnancy, doesn't necessarily bode well for going another month. I kind of have the feeling it may be getting close -- restlessness, nesting, and some fairly intense contractions. If I had to guess, I think he'll be born the next week or two, and my money's on early next week.

Thankfully, I have been able to engage in some intensive shoppiness, so I have clothes to put him in and blankets to wrap him in. My mom had bought a few things, but she simply cannot be convinced of his likely size. I called her on Monday to tell her about the things I'd bought, and she was all, I hope you bought them in 3-6 months! Um, no, because he likely won't be wearing that size until NOVEMBER. I understand, to an extent -- my sister was nearly 11 lbs, and I was a hair short of 10 -- but I'll be very surprised if he clocks in at 8, or chunks up quickly afterwards. I had a hard time not picking up a few preemie-sized things, just in case...

The other interesting wrinkle:

Yeeeaaaah. It's early days yet, but if it follows the projected track, it's gonna hit almost exactly where Katrina did, potentially at close to the same strength at landfall. Katrina was still a Category 1 hurricane when it passed over my house, 150 miles inland. We personally came out of it relatively easy, with no significant damage and without power for less than 24 hours, though my mother went without it for over a week less than two miles away. However, the entire city was a giant freakin' mess for more than a week -- trees down everywhere, no power, and no gas. It felt like (and was) a disaster area, even this far north, and was much worse for G's family on the Coast.

Understandably, everyone is a little bit on edge, and that most definitely includes me. Of course, Murphy's Law would seem to imply that my odds of going into labor increase during a natural disaster, particularly one which may well strand my in-laws at home for days. And did you know that there's apparently a well-established correlation between falling barometric pressure and onset of labor?

Of course, hopefully the storm will go elsewhere, or peter out before landfall, or otherwise become no big thing. But if you're picking days in the betting pool, Tuesday/Wednesday wouldn't be terrible ones to pick, methinks.

Nearly there

2008-08-19T12:42:00.002-05:00

34 weeks, people. No matter what, he'll be at least a near-term baby.

Actually, it is looking like we have a really good shot at going all the way -- 10 weeks of near-constant irritability doesn't seem to have had any effect at all. Dr. Pro wants me to stay on the Procardia for another two or even three weeks, but I can ease up on the bedrest to some extent. I'm still supposed to spend most of my time sitting or reclining, but I'm free to move around the house more, run a few short errands, and I even have the OK to go out to dinner or a movie or some other "quiet" activity.

Yesterday's ultrasound showed an estimated fetal weight of 5 lbs even, exactly consistent with gestational age. Dr. Pro says she'd be shocked if he actually weighs that -- I'm measuring a full 5 weeks behind, and I am neither tall nor long in the torso, so there's some question about where exactly I'd be keeping 5 lbs' worth of baby. In any case, it looks like he probably won't top 8 lbs even if I make it all the way to my scheduled CS. Guess I'll be picking up a few newborn-sized things for coming-home wear after all!

Black velvet in that slow Southern style

2008-08-03T23:20:00.004-05:00

One of the few joys of a late-summer pregnancy in the Deep South? Fresh local watermelon, ripe and chilled.

I've eaten three-quarters of the melon all by myself, and it wasn't a small melon. I eat it till I'm stuffed, and I would go back for another chunk if I had anywhere left to put it. It's out of control.

Into the threes

2008-07-23T23:06:00.003-05:00

As of yesterday, I'm 30 weeks along. It's such a relief to be into a week that starts with a 3, even if I still have several more goalposts I want very much to pass. 32 weeks, not that far away now, and we'll be past the "very preterm stage". 34, and we're into late prematurity. 36, and I'll feel reasonably confident about avoiding NICU time. One more week after that, we'll be into the fabled land of the full-term baby.

I can't really imagine what it's like to actually have a full-term baby. The girls were born at 35w6d, late enough to avoid any serious morbidity, but early enough that they were still clearly "not done". They were a good size at birth, 5 lb 7 oz and 6 lb 4 oz, but both lost over a pound in the first few days, and Claire didn't reach 5 lbs again until she'd been home nearly a week. I remember thinking their chests looked deformed, because they didn't have enough fat to cover their ribs the way a baby's should be. They were sleepy, and we only just scraped by without phototherapy for the jaundice. They wore preemie clothes and preemie diapers for weeks, and were three months old before I finally put away their newborn-sized stuff.

Of course, 30 weeks, or 32 weeks, is a whole lot scarier than almost-36 weeks. Still, it seems a much shorter distance now than 30 weeks did from the vantage point of 28.

It's strange to think that I'm in my third trimester of pregnancy. In some ways, I feel so much less pregnant than I am -- I've gained less than 20 lbs, and measure several weeks behind. I actually even think my belly's shrunk in the last few days, as the baby seems to have finally gone head-down for good, and his head has settled into my pelvis, rather than poking out in front. I worry that this is the prelude to cervix change, though. I haven't had many contractions the last few days, but I'm more aware of the baby's weight in my lady business even when I'm not contracting. I've got an ultrasound scheduled for the morning, and I won't be surprised if there's shortening/funneling going on.

I don't miss the bladder fandango of a breech baby, but the crippling heartburn and nausea is beginning to make its appearance. I have heard other women with hyperemesis talk about the dreaded third-trimester relapse, and I was miserable at this point in my first pregnancy too (despite almost never being sick in the first trimester that time). It's more a mechanical issue, rather than the all-over constant seasickness of first-tri HG, but the result is the same. I lost 10 lbs in two weeks because of this in the last pregnancy, and somehow I don't think I'll be putting on much weight from here on out either. Thankfully, I am not suffering the joint pain I did last time, which is good because the joint pain came with permanent soft-tissue damage. I guess there are some upsides to having had most of the poorly-behaved joint removed and/or reworked. I do notice some extra joint laxity, especially in my fingers (no joke when you're double-jointed to begin with), but at least it's painless. No carpal tunnel, though, thank goodness, and no ridiculous swelling either.

Aside from the contractions, I really feel pretty good, especially in comparison to a twin pregnancy. I'm so glad I'll never have to go through a third-trimester twin pregnancy again, though in all honesty, I'm not sorry about the idea of being done with pregnancy, period. Assuming all goes well with the Lagniappe, G and I both feel like our family will be the right size, and God knows neither of us want to go through another pregnancy like this one. The infertility chapter of my life is very nearly over and done with, and I'm not sorry to be bidding it farewell.

A good week

2008-07-18T17:48:00.002-05:00

I've made it a full week without having to go in since getting out of the hospital last Friday, a first since the preterm labor started. I had a couple runs of contractions this week, but they subsided before I felt like it was time to go in. There's a reason I wait until I've been having them more than every five minutes for 2-3 hours (though I wouldn't do this if I weren't also getting frequent cervix checks and in possession of negative FFNs). Sometimes they will slack off on their own, no matter what I do, and sometimes they will continue and get worse, no matter what I do. Likewise, I don't think that making it a week without a PTL admission is a sign of improvement, just the way it randomly worked out this week. Still, I'll take it.

I finally ordered a crib and crib bedding today. We'd seen the style at our local baby store, but in a finish we didn't care for, and stopped at a baby store in Birmingham while on our vacation in June and saw it in another finish we did like. I'd meant to order it the week we got back, but when I got admitted that Wednesday at 24 weeks, I got spooked. Now that I'm 29+ weeks, I'm a lot more reassured about the odds of making a few more weeks without delivering, and making it out with a live baby if I do. At this rate, the baby is likely to be here before the crib, but as we'll be keeping him in the co-sleeper for the first couple months anyway, it doesn't matter much. The bedding set I picked out for him is cute, even if it's not as cute as the quilt I'd planned to make, and includes a valance for the window, so that's something. I had seen it in the store a while ago, and liked the colors of it so much I used them for the fishie blanket I'm knitting.

Unsurprisingly, I have been doing a metric ton of knitting. The fishie blanket is half-done (ends woven in and strips crocheted together, even, as I go along!), and my Clapotis is complete except for blocking. I finished one pair of socks, started on another, and acquired yarn for three more -- I have a little sock problem, can you tell?. Of course, I also hate doing plain socks, and while the Monos Locos lace pattern is quite easy, it's not post-mag-sulfate easy. I am usually pretty much useless for about 12 hours after I get off the mag, and plain stockinette is about the limit of my abilities. So there's a Wicked sweater in progress, in bulky-weight wool I dyed a nearly-solid forest green a while back. I'm skipping the pocket, so other than a little waist shaping and collar/hem, it really is just straight knitting, easy enough for the mag aftermath. Finally, there is a Snowdrop Shawl (PDF) in progress, if you count "sitting at the bottom of my knitting bag under the needlepoint I also restarted" as being in progress. Yeah, project monogamy isn't my strong suit lately, but given the overall state of crashing boredom that exists around here, I think I can be excused for not putting up with knitting boredom too!

If you ever get put on 12 weeks of bedrest, I highly recommend being a knitter, or a crocheter, or a needlepointer, or a hand-spinner, or *something* -- thank the gods and little fishies I'm a handworker. Or, really, thank my mother for being a handworker, and for teaching me to cross-stitch when I was six. I look forward to teaching the girls to knit and embroider in a few years (and Lagniappe too, if he wants to learn). Claire, I think, has the makings of a knitter, and already loves to play with my yarn and needles, often to the detriment of whatever project she gets a hold of.

So, not a very exciting week around here, but those are the best kind I can ask for lately.

CODA: or it wasn't, until poor Claire slipped and fell on the hardwood floor just before I got around to posting this. She landed smack on her face, and immediately spouted blood all over everything from her nose. I'm actually somewhat concerned that her nose may be broken -- nothing feels out-of-joint, but the bridge of her nose is swollen, as is her upper lip, and one of her eyes looks like it might be blackening. The pediatrician said that as long as she's not having trouble breathing, give it the weekend to let the swelling subside, and see if there's any crookedness (they won't do anything for it if it's not). I iced it a little and gave her ibuprofen, and then sent her off to Nana and Pops for the weekend as planned -- I came thisclose to keeping her home, but decided there was no rational reason for doing so, as Nana and Pops are perfectly able to apply ibuprofen and kisses and popsicles. She didn't seem like she was in that much actual pain, so much as very scared and upset about it, poor girl.

See? Boring = good!

In and out

2008-07-11T13:24:00.002-05:00

More contractions yesterday sent me back to L&D -- for those of you keeping score at home, that would be the SIXTH visit in one month, since my first admission on July 11. Sedate-and-hydrate worked, and after keeping me overnight for observation, I got to come home this morning, grateful to have avoided the mag. Still no dilation and a negative FFN to boot, though the baby can't seem to make up his mind about whether to be breech or vertex).

BTW, I have tried DIY sedate-and-hydrate at home, with adult beverage of choice. I did that toward the end of my last pregnancy, when I was past the point of tocolysis but wasn't continuing to dilate. Lagniappe has all his important bits by now anyway, so it's not like a drink or two will hurt him. I was having contractions Wednesday night -- in retrospect, usually a sign the next day will be bad -- and I got a really dirty look from my husband when I cracked open a Blackhook Porter, but he quieted right down when I told him to think about it as being like five minutes of mag sulfate. I mean, hey, I give the baby Stadol all the darn time, a little alcohol isn't going to do much on top of it.

Why, yes, I *am* a prime candidate for Mother of the Year, now that you mention it.

Anyway, the beer worked on Wednesday night, but not on Thursday. I tried a Phenergan after that (mixing alcohol and heavy-duty prescription drugs! the good parenting just keeps on coming!), but all it did was make me groggy for the three minutes in between contractions. I laid around for a while and felt sorry for myself, and then realized it was probably time to go in -- when I start getting miserable enough to cry, it's time to call it. The contractions don't hurt that bad, but when they're coming right after each other, it gets upsetting, as does the realization that I'm going to have to go in AGAIN.

For real, y'all, I know all the nurses at L&D by name now, as well as all the OBs. I also know the hospital admission clerks, and the lady at the front desk, and the night security guard recognized me the last time I came in after hours. The nurses even know my "good" veins now -- like it's hard, you just look for the marks from the previous IVs that aren't also surrounded by old bruises. It is to laugh, because crying is the only other reasonable alternative.

On the bright side, I have survived four weeks of bedrest, so I'm one-third of the way to my 36-week goal.

52 days to go.

Fireworks

2008-07-04T20:50:00.002-05:00

My uterus decided to kick off some fireworks of its own, so it was back to L&D last night. Sedate-and-hydrate calmed things down partially, but they started back up again this morning, so I'm getting magged again. They started it at about 11 am, and as of 8:45 PM, I'm still not quiet enough yet to be weaned off it. Hopefully that will happen at some point over the night.

Two pieces of good news: cervix measured 3.8 cm (down from 4.8 at 21 weeks, but still a good number), and baby had flipped himself head-down. If I do start dilating, it's not so worrying with a vertex baby. Of course, that's assuming he stays vertex -- he was amusing himself doing somersaults this afternoon, and I think he turned back to breech for a bit before rolling over again.

59 days to go.

Big-girl bed night #1

2008-07-02T11:41:00.003-05:00

We wound up only converting Claire's bed, because I can't really sit up and watch the children for longer than a few minutes. G took the girls up to see, and great fun was had climbing in-and-out-and-in-and-out. At bedtime, there was more crying than usual, mostly from Katherine -- I really think she wanted a bed too.

Both girls quieted down after about 5 minutes of crying, and we didn't hear any rumpusing. We heard a thump at about 10:30, and Claire cried a little bit, so we thought she might have fallen out. When G went up to check on her, though, she was still in her bed. Unfortunately, that woke both children up, and there was a few minutes of more crying before they calmed back down. At the final check of the night, both girls were asleep, and amazingly enough, Claire was still in her bed.

She was up at the nursery door this morning, of course, but didn't seem to have done anything other than play happily. Of course, we basically stripped the nursery of anything get-into-able, so there wasn't much she could have done. (Our nursery is upstairs, so it is literally just the room they sleep in -- all clothes, toys, diapering materials, etc. are downstairs.) Still, it seems to have gone well enough for a first nursery night.

We'll see how naptime goes in a couple hours.

The end of the cribs

2008-07-01T12:09:00.002-05:00

Claire was standing at the door of the bedroom this morning, so it looks like the age of the cribs has drawn to a close. We bought convertible cribs for them which turn into daybeds and later double beds, so when G gets home this afternoon, I'll be sending him upstairs with a screwdriver. Tonight, the girls will go to sleep in "big girl beds". Trouble is, I don't have the faintest idea of how the mechanics of this are going to work, either at naptime or at bedtime.

We don't have an ironclad naptime or bedtime. The nanny feeds them lunch at noon, and then takes them upstairs when they seem to be getting tired -- one baby first, and the other a little later. If the first girl is very tired, she will be asleep by the time the second one is obviously ready for a nap. On many days, though, they go up together or in such short order that they're awake together. At bedtime, some days Katherine will outlast Claire by a substantial margin, but on other days she demands to go night-night as soon as Claire gets taken upstairs. (Naptimes are variable, but Claire is almost always ready to go to bed first.)

Whenever both babies are awake together, there will be talking. They will often spend half an hour or more talking to each other from their separate cribs, reading the books we let them take to bed, and playing with their "babies". I have no doubt whatsoever that if they're not confined to the cribs, they won't stay in bed even as long as it takes us to walk out the door.

What do you DO when multiples are too young to be reasoned with, but too old to be restrained? If they were a little older, we could perhaps explain to them about how we stay in our beds at night, and institute rewards/consequences, but they're not. I think it will be a long time before this will happen -- we have to teach them to resist not only their own impulses, but also the persuasions of Sister, which at just short of two is THE prime directive. With a singleton, we could create a quiet and boring environment which is conducive to sleep, but with multiples, there is always a built-in playmate.

Me, I'm thinking that we just lost naptime. At bedtime, they can play in the semi-dark for a while, and they probably will eventually fall asleep. I'm sure this will happen on the floor, but we can always go up later and move them back to bed. At naptime, I don't think this will work so well, because it's harder to fall asleep in the daytime, and the shorter duration of naptime means they're not likely to be moved into bed easily. I have thought recently that Claire is preparing to drop her nap -- she skips it at least once a week, or fights it hard and takes a very short one -- but she still can't really make it through a full day without one.

I've had the luxury of not having to worry about sleep issues for a very long time now, but I think that just got thrown out along with the cribs.

Four

2008-06-30T10:52:00.003-05:00

I didn't get around to posting that I got released on Saturday. But I guess you didn't miss much, because I'm back in L&D this morning.

This is RIDICULOUS.

Update: Sedate-and-hydrate did the trick, so I'm back home now.

Off the mag

2008-06-27T14:49:00.002-05:00

It took a while, but I got off the mag at noon, though I am still in the post-mag coma. Currently still in L&D, but I'm theoretically being moved to the floor any time now, and will stay until tomorrow.

Still no dilation, so I'll get to go back home. I guess they really weren't kidding about how we'd keep doing this every week if we had to. And I guess it looks like we'll have to.

67 days to go.

Thursday

2008-06-26T18:57:00.000-05:00

... is, apparently, the new Wednesday.

The trend is broken

2008-06-25T23:03:00.002-05:00

It's Wednesday night, and I am NOT in the hospital. How sad, that this is a deviation from the pattern.

Things have been... not exactly quiet, but not enough to make me feel like it's time to go in, for which I have a reasonably high threshold. The standard advice is 4 contractions or more in an hour. I don't even NOTICE if I have that -- I can't be bothered to time them until they get under 10 minutes, and I don't do anything about them until they've been well under that for a couple hours. Otherwise, I really would just check into the hospital for the rest of the pregnancy, and the food is much better at home.

26 weeks, 1 day. 69 days to go.

Home again

2008-06-20T18:12:00.002-05:00

After a quiet night of almost no contractions at all, I was released this morning to the comfort of my own bed. I've had a few contractions here and there, but nothing that seems to want to fall into a pattern, so it's back to the routine of bedrest and Procardia. It's nice to be home.

74 days to go.

Uterus alert level: yellow

2008-06-19T11:59:00.003-05:00

So, no prizes for guessing that I got a second scenic vacation to L&D. (I got the same room as last week -- no new scenery, even!) I had had a lot of contractions Tuesday evening, aaaallllmost enough to push me over my go-to-hospital threshold, but they settled down enough for me to fall asleep. I suspect they might have continued throughout the night, though, because I woke up with them in the morning. It eventually became clear they were settling in for the long haul, and after a couple hours, I called G to come home and take me in.

For a while, it looked like the second verse would be the same as the first -- get on the monitor, verify that yes, those are contractions, give me some terb and fluids, and wait a while for it to not work. However, the baby started going a little bit off-script during that waiting process, and decided he was tired of having his head squeezed every four minutes. He started having early decels with the contractions, and dropped off the monitor entirely here and there, and generally started freaking everyone right the heck out, so they quit fooling around and got a mag bag hung.

Mag sulfate is pretty much just as lousy as I remember it being from last time. I felt really miserable while I was getting the initial bolus dose, enough to make me ask for some Stadol so I could just go away for a little while. After that, it settled back down into general queasiness and fatigue, which is pretty much where it stayed. Most importantly, it got the job done with the contractions.

They took me off the mag this morning, because in addition to not having contractions, I stopped having some skeletal reflexes. Mag sulfate works by interfering with the calcium ions that cause muscle cells to contract, so it tends to stop *all* your muscle cells from contracting very effectively. So no, your uterus doesn't contract, but it also gets hard to do things like stand up or focus your eyes, or have your leg kick out when something hits the front of your kneecap. I've been off the mag for quite a few hours now, and I still feel like I'm just kind of half-melted into the bed.

Since my uterus decided to get with the program, I've been moved to a regular room, and fed, and heplocked off, and allowed to go to the bathroom. All of these things are fantastic. There's sunshine coming in my window and cool white sheets on my bed, and I'm content to just lie here and not contract and not have a baby. I'm not dilated or effaced, and nobody has said anything about yesterday's FFN being positive, so I'm assuming it's negative. I tested positive for a mild UTI, although I had no symptoms of one, and I'm kind of hoping that maybe that's what's been behind all this uterine uproar.

I fully and completely expect that I'll be making more visits to L&D over the next few weeks. I'd like to avoid having one *every* week, but Dr. Pro says if that's what it takes, that's what we'll do. There's really nothing else *to* do -- not much point to trying a terbutaline pump when the terbutaline shots never work, and I'm already on Procardia. As long as I don't dilate, she'll keep throwing me back out to home bedrest.

75 days to go.

Hint: it's not Tahiti

2008-06-18T15:25:00.002-05:00

Guess where I am? No, really, just GUESS.

76 days to go. I hope.

Day 5

2008-06-16T15:01:00.003-05:00

For Father's Day yesterday, my husband got up at 7 AM with the girls, mediated four fights and two tantrums, then took them to Toys R' Us, Target, Best Buy, Linens N' Things, and Wal-Mart. He put up with naplessness and the ensuing whining, grilled pork chops for supper, bathed the girls, and did the dishes and a load of laundry. He got up at 6 this morning, so he could get to work by 7 and be home for more child duty by 4:30, when the nanny has to leave.

I think I may have to cave and let him buy the giant widescreen TV he's lusting after, as a reward for being Father of the Year. He certainly deserves it, poor man.

I got to leave the house today and go to a doctor's appointment. It was nice to see some sunshine, although it is freakin' HOT outside today, 96 degrees with heat index. I'm already flushed all the time from the Procardia, and heat doesn't help. Procardia isn't as bad as mag sulfate, which is like the aftermath of a day at the beach on spring break -- you didn't use enough sunscreen and drank too many margaritas, and you feel sunburned and nauseated and dizzy so tired you can barely move -- but it's vaguely reminiscent of it.

The doctor's appointment itself wasn't too exciting. Baby sounds fine, and I just need to keep doing what I'm (not) doing, and come in if I have contractions. Dr. Pro did say that she will be concerned if I do begin to dilate at all, because the Lagniappe is breech, and therefore at even higher risk for things like cord prolapse If I do start dilating and he is still breech, we'll be talking about hospital bedrest, and we will make the decision to deliver sooner than we would with a vertex baby. Clearly, the thing to do is not to start dilating.

78 days to go.

Bedrest

2008-06-14T10:07:00.002-05:00

So, two days of bedrest down, and hopefully about 80 left to go.

I'm supposed to be on complete bedrest rather than just house arrest, although of course I've been experimenting to see what I can and can't do. I sat on the sofa for a couple hours yesterday and chatted with my girl Stacey, with the girls crawling up into my lap and all over me (and ran out of nifedipine to boot). That was good for a round of contractions, although they settled down after I popped a pill and lay down for a while.

My husband the jail warden says no more sitting on the sofa with the girls around, which is just rotten. I'm in the bedroom with the door closed -- can't even leave it open and baby-gated, because the poodles can jump the baby gate, and they will get excited and leap on me. (The dogs in question are 50-lb standard poodles, mind, not your grandmama's teacup Fifi.) Basically, I'm locked up alone in the bedroom, without my children or my dogs, alone with the laptop and the knitting. Doesn't that sound pathetic?

I'm hoping that the contractions will settle down in time, and I'll be able to move around the house a little more. Today, I am having them whenever I stand up, sit up, sit back down after standing up, roll over, get kicked in the cervix by the Lagniappe, or do anything other than stay in a semi-recumbent position. There's no pattern to them yet, but it feels like they're just waiting for a good excuse to fall into one.

There's a lot I wanted to do before the clock ran out on this pregnancy. I was going to make a crib quilt and bumper set for the baby's quilt -- I should show you the play quilt I made for him, it's adorable -- but that involves lots of standing up and cutting fabric, and then lots of sitting at a sewing machine. I have a maternity top cut out and ready to piece together, but I don't need it now, because I won't be leaving the house to speak of. The nursery is nonexistent (well, right now it's an occupied guest bedroom, which is a whole 'nother story), and I guess I won't be picking out paint or window treatments or decorations or furniture. I wanted to get my hair cut next week, and sort out a bunch of old clothes and take them to Goodwill or sell them on eBay, and replace the dead pansies in the flowerbed, and fold and put away the laundry. I planned to go to my sister's wedding next weekend, and my niece's birthday party the week after that, both of which are over an hour's drive away, and held outdoors. We were going to take the girls down to the Coast for the weekend, and try to get away for an evening to see a movie or two. I have business meetings to go to, which will either have to be canceled or held in my living room.

Most of all, though, I have to hang on to the baby for a while longer. I don't think I'm in imminent danger of delivering any time soon -- it's reassuring that I'm not dilating or effacing -- but that's not something I want to put to the test.

Round One

2008-06-12T06:24:00.004-05:00

Last week, we went on a family vacation to a cabin in the Smoky Mountains. It wasn't much of a vacation for me -- no hiking or whitewater rafting for the pregnant woman, and the girls were less than amused by the sleeping arrangement. I had some episodes of contractions while we were there, but nothing too major. They started up again after we got home Sunday evening, though, so off I went to see Dr. Pro on Monday. She put me on nifedipine every three hours, and told me to rest and drink water and come to L&D if they kept up

They stopped for a while, then started back up again, and stopped and started several more times through Monday and Tuesday. Every time
I was about to make up my mind to head in, they'd quit. By Wednesday afternoon, though, they had quit quitting, so in I went. Terbutaline wasn't very effective -- it never does much for me except give me the shakes -- but they ran some fluids and gave me some Stadol, and eventually they tapered off. They're back again this morning, though, so I'm sitting here waiting to see what they're going to do about them.

My cervix was still closed, so I am probably not in imminent danger of actually having the baby. From past experience, my uterus is capable of producing plenty of sound and fury, without actually doing much. Eventually, I'll most likely get sent home with instructions to take it easy and come back if anything changes, and I'm ready to skip to that part of the program (especially the part that involves breakfast). Still, I'm a little dismayed that this has started so early. I was hoping to get to 30 weeks or so before we started playing this game -- 24 weeks is, well, a little premature.

Update: the good news is that Dr. Pro let me go home, under strict instructions to come back if I feel the slightest need. The bad news is that I'm bed-resting it for the next 12 weeks.

Finally, some reassurance

2008-05-25T11:37:00.003-05:00

G was adamantly against doing an amnio to check for T18, but when I called my OB back and told her how worried we were, she called the perinatologist and was able to schedule us for a Level II ultrasound this week. The peri took a very thorough look at the baby, and he has none of physical abnormalities associated with T18. The peri said he would be "shocked" if the baby turned out to have a chromosomal defect, and feels that the normal ultrasound reduces our risk level enough that he wouldn't advise an amnio. Needless to say, I am VERY reassured, and have managed to dial the worrying back down to my normal level of paranoia.

Sorry for not updating sooner, but between insane work levels and my brother's graduation from med school, crazy isn't even the word. I'm so glad the baby stress has been more-or-less removed, because there's enough other stress in my life to go around, and then some.

Not reassured

2008-05-12T14:57:00.002-05:00

I had a bad run of contractions Saturday morning, two hours' worth of them, every three minutes or so. I thought about going in, but at just shy of 20 weeks, they wouldn't do anything anyway. Doesn't make me feel very good about how likely I am to avoid preterm labor and premature birth, though.

Also not reassuring were my quad screen results, which came back at 1:100 for Trisomy 18. (That is, 1 of 100 women with those levels will have a baby with T18.) My OB said she still would "absolutely not" recommend an amnio, given that we didn't observe any of the other T18 anomalies. However, 1 of 275 women with nothing other than CPCs will have a T18 baby, so the quad screen has actually raised our risk profile.

Dr. Pro wants to wait and do a Level II ultrasound at 26 weeks, to look in more detail for the other T18 anomalies (echogenic bowel, clubbed feet, ventricular septal defects, and so forth), which are easier to spot after the baby gets bigger anyway. However, six more weeks is a long time to wait, when there's a 1 in 100 chance that your baby will die. 1% is actually a pretty significant chance, higher than the risk of uterine rupture in a VBAC, higher than the risk of death in a breech birth, higher than the risk of miscarriage from an amnio.

I have struggled since the beginning with the nebulous intuition that things are not going to turn out well for this pregnancy. For the most part, I've just dismissed it as paranoia, but it keeps getting harder to ignore. Now, I can't even imagine making actual preparations for the baby. The thought of picking out a crib and furnishing the nursery, knowing that there's a 1% chance we'd have to take it back down, makes me ill.

One in

2008-04-29T14:49:00.001-05:00

Yesterday morning was our "official" ultrasound, the 18-week anatomy scan. We saw the gender two weeks ago at my mom's office (the perks of being the daughter of your RE's nurse!), so we were just expecting to confirm that it really was a boy, and to find out if his legs really were as long as we think they are.

Yes, he's still a boy, and yes, his little baby legs are measuring over a week ahead of the rest of him.

He also has bilateral choroid plexus cysts in his brain.

The cysts aren’t dangerous in themselves, and aren’t associated with any sort of developmental delays. None of them are especially large, although he has more than one in each hemisphere, and chances are good that they’ll spontaneously disappear before he’s born anyway. However, they’re a soft marker for chromosomal disorders, especially trisomy 18, which is vaguely similar to Down’s but is usually fatal before birth or in infancy.

No other soft markers were seen on ultrasound, which is good (although the whole scan took less than 20 minutes, so I’m not sure exactly how closely they looked for some of the subtler signs). Pubmed is all over the place on what exactly the odds are that a baby with isolated CPCs has Trisomy 18, but it seems to be something like 1:275, depending on things like maternal age and abnormal quad screen results.

I had not planned on having a quad screen done, because I didn’t want to wind up having an amnio, with its associated risk of miscarriage. However, since the torment-yourself-with-potential-false-positives part of the program is already taken care of, I signed the form for the quad screen bloodwork yesterday. If it comes back suspicious, we’ll have the amnio ASAP, because it’s very important to me to know *for sure*, regardless of my feelings about termination (which I don’t especially feel like discussing now). I don’t know when the quad screen bloodwork will be back -- I’m supposed to see the doctor again in two weeks, though I will probably call and ask about the results well before that.

My husband keeps insisting that 1:275 is really low odds, and that it’s useless to worry about this now, but I don’t think those are so low at all. Someone has to be in those numbers -- to be exact, about 150 someones this year across the US -- and I’ve been the one-in-a-large-number on more than one occasion. It most likely won’t happen to us, but there is a real and non-zero possibility that it will, and we just have to wait and find out.

Everything else was okay-ish at the doctor’s visit -- cervix looked OK on ultrasound, although they didn’t measure length or anything. We started 17-alphahydroxyprogesterone shots just in case, as a preventative measure for preterm labor, and Dr. Pro wants to follow me more closely from now on, every two weeks. We’ll start talking about nifepidine or terbutaline in a few more weeks, especially if my cervix starts looking iffy.

I hate that I am having to worry about all this -- I just want to be happy and paint the damn nursery.

My baby will not be named...

2008-04-17T21:32:00.003-05:00

Amelia
Bella
Cecilia
Diana
Elaine
Frances
Gabrielle
Harriet
Isabella
Julia
Kristin
Laurel
Marjorie
Nina
Ophelia
Penelope
Quinna
Rose
Sophie
Tabitha
Una
Virginia
Willow
Xena
Yvette
Zoe

Nope, we've known what to name this one for six or seven years.

Andrew Leon, our son.

Back to the nethers

2008-03-31T21:57:00.004-05:00

Five-minute OB visit for me this morning (not including the hour wait). I told Dr. Pro I'd been having contractions on and off for a week, and she made the frowny face at me, but reminded me there's nothing to be done about uterine irritability at this point. We discussed 17-hydroxyprogesterone shots down the road, but those aren't even an option for another four weeks.

I'm not actually all that panicked about it yet. I'm expecting to experience at least one bout of preterm labor -- I think contracting is just what I do -- and to spend some time on bedrest and perhaps in the hospital. It'll be scary and un-fun when it happens, but I also expect that they'll be able to shut it down, as they did last time. With just one baby, it may not even happen until I'm far enough along that labor wouldn't be stopped. While it would be nice to take home a full-term baby, I've had near-term babies before, so it's maybe not quite as frightening a prospect as last time.

I do worry about not going to L&D until it's too late, because I'm so used to ignoring contractions. If I called my doctor every time I had four contractions in an hour, I'd be in her office every single day of my third trimester. Last time, my personal rule was that we went to L&D when they'd been five minutes apart for two hours, and the first-line remedies like drinking water hadn't worked. Since you dilate quicker in second pregnancies, I'm mildly concerned that I will cross the threshold of "active labor" before going in, and wind up having to have the baby. We'll see what my doctor sets her threshold as later on in the pregnancy.

--------------------------------------------------------------------------

In other news, we bought potties for the girls on Saturday. We're doing more potty familiarization than potty training at this point -- we sit them on the potties before baths, and if they should happen to use it, wonderful. They seem to get a big kick out of sitting on the potties, and both girls have peed in them. It's coincidental at this point, but that's how it starts.

I don't expect them to be fully potty-trained any time soon. I think they'll get that potties are for peeing and pooping pretty quickly, but I expect they'll be slower to catch on that we *only* pee and poop in the potty. In my ideal world, I'll have them day-trained by the time the new baby gets here, with pull-ups for naps and bedtime and maybe outings. I don't think that's completely unreasonable, and every diaper I don't have to change will be a win.

In which I talk about things unrelated to my offspring

2008-03-30T11:16:00.002-05:00

I don't really consider myself "creative", although I suspect anyone who knows me might disagree with that assessment, given the amount of time I spend doing handwork. I started cross-stitching at six, did various forms of embroidery in high school, picked up crochet a few years ago, and have knitted enthusiastically for two years. I've been sewing a good bit lately, with my beautiful and wondrous new Janome, and started learning to spin a month ago. I do some form of fiber work nearly every night, and almost always have a project within arm's reach.

Yesterday, "fiber creep" took a whole new direction. I signed up for a beginning quilting class, and started cutting and piecing some fabric left over from a tote I made last week. I'm assembling a stacked coin pattern, although I haven't much idea what I will do with it once the piecing is done. I want to make a quilt and bumper set for the Lagniappe's crib, but I can't use this fabric (hot pink floral and stripes, although I'm going to add some brown and either lime or blue) unless it proves to be a girl in a few weeks. Possibly I'll make doll quilts for the girls instead, or pillowcases.

Quilting is an odd thing for me to pick up, in some ways. My personal style, such as it is, trends to the minimalist, not "rustic" in any way. I'm terribly perfectionistic, and I don't like for my finished pieces to look charmingly handmade. Nor am I an art quilter in the making -- I am good at adapting and executing rather than conception, engineering rather than design. Other than the impulse to decorate for the new baby, I'm not sure why I feel like I need to learn to do it. But clearly, I do, so there's nothing for it but to sign up for classes and start fiddling around at home.

If you should be wondering how I'm going to find the time to knit or crochet a blanket and some hats for the Lagniappe, make a quilt and bumper set for it, decorate its nursery, sew myself the maternity skirt I bought fabric for, do a couple A-line dresses for the girls, finish the two pairs of socks and the shawl I'm currently making, and progress on the Christmas knitting (set to include a beaded lace shaw for my MIL), LA LA LA NOT LISTENING.

Latest stunts of my monkey children

2008-03-25T09:52:00.004-05:00

[Claire] Said "bye-bye!" and opened Grandmama's back door
[Claire] Jumped up and down on the foot petal of the baby gate until it popped open
[Claire] Learned to unzip her PJs and take her diaper off
[Claire] Learned to wiggle her arms out of her backwardly-zipped PJs and push her diaper down inside them
[both] Learned to stick their fingers through the baby gate on the gas fireplace and pull out the lava rocks
[Claire] Spat milk all over my laptop keyboard and shorted out the question mark
[Claire] Learned to pull the outlet covers out of the outlets
[Claire] Learned to unplug network cables
[Katherine] Learned to bite when her will is thwarted
[Lagniappe] Moved
[Lagniappe] Caused the onset of uterine irritability by moving
[Lagniappe] Made me leave church in the middle of the Easter sermon to go throw up
[Lagniappe] Made me throw up in a Wal-Mart bathroom -- with twins and a cart full of groceries in tow
[dogs] Pulled two bags of Easter candy out of a bag on the counter, ripped them open, and ate the contents, including the wrappers

It's pretty obvious who is the monkey-in-chief...

Tentative improvement

2008-03-17T16:13:00.002-05:00

On another note, I think I may be through the worst of the hyperemesis. With my Reglan pump, I've been increasingly well-controlled, and the ratio of good days to bad has been increasing. I have not thrown up very much at all over the last week, except under extreme provocation, such as when Katherine threw up in the hospital. I've felt very nearly normal, and have even gained a couple pounds back.

My pump went haywire on Sunday, just as we were preparing to be discharged, so I just yanked it out and decided to fool with it at home. I left it out for a shower and a nap, and since I was still feeling okay, decided to live dangerously and see if I could get by without it for a bit. I needed a Phenergan by the evening, but I was able to take it and keep it down, and it worked.

I popped a Zofran this morning, got my OB to call in a prescription for oral Reglan, and seem to be doing well enough so far. Late afternoons and evenings are my bad time, and I'm starting to feel a little queasy, but not enough that I think I'm in danger of vomiting. I wouldn't want to go completely unmedicated just yet, but at twelve weeks, it's a good time to try tapering down to oral meds.

I can always go back to the pump if I get in trouble, but I'm hopeful I can go un-tethered!

Heading home

2008-03-16T09:21:00.002-05:00

Katherine's platelets were up to 62,000 this morning, so we'll be discharged in the next little while.

Needless to say, we are all thrilled to be going home. It'll be great for her to be at home and free, not stuck in a hospital room and tethered to an IV pole. It'll be great for me to have a shower and a nap -- I didn't get much sleep last night, since she threw up four times. It'll be great for G, who won't have to alternate between taking care of Claire and being with us here. It'll even be great for Claire, who has been rather subdued without her sister (and her parents, and her normal routine).

We will be watching to see, over the weeks and months to come, whether her platelets stay up or continue to drop back down. The IVIG she received raises the platelets in almost all kids with ITP, but when it works out of her system in three to four weeks, her levels may go back down. It's possible we may have to repeat the IVIG treatment again; she will probably recover within the next six months, but she may have relapses during that time which require treatment.

I hope we're done with this, though!

My brave little soldier

2008-03-15T10:17:00.002-05:00

Katherine has been such a trouper about this. There were lots of tears, from her and a few from me, yesterday when her IV was getting placed and her CBCs drawn, but other than that, she's been as good as can be. Today she has been happy -- right this minute, she's amusing herself by throwing her toys around the room -- and didn't even cry at yet another finger-stick. She slept through the night last night, despite the constant parade of nurses, and showed no signs of vomiting or headache.

Her platelet count this morning was 26,000, a slight increase from yesterday's count of 21,000. The doctor says that's an okay improvement for this point, although we will expect to see a bigger increase tomorrow. We'll do another round of IVIG tonight, and if her platelets are up more tomorrow, we'll go home. If they're not, it may be another round of IVIG, or they may just send us home and check up on her.

Most kids, 80% or so, go into spontaneous remission within six months, so we'll check her CBC frequently for the next several months. I'm really hoping we'll be in that category. Of course, 2% of kids die, and that's when I wish I didn't have a good understanding of statistics. Katherine is one of 3750 children in the US who will be diagnosed with it this year, 75 of whom will die. I am praying we come back out on the large end of the odds, and indeed there is excellent reason to think we will.

I am also thankful that it's ITP, rather than any of the other things it could be. Cancer is a major cause of low platelets, and here in the cancer hospital, I can't help thinking of the other mothers like me who took their children to the doctor for something or nothing, only to get the worst news a mother can hear. I am so grateful she "just" has ITP. It could be a lot worse.

Scary medical term of the day

2008-03-14T20:02:00.002-05:00

Idiopathic thrombocytopenia purpura. Go on, I'll wait while you google.

I thought Katherine might have a UTI, so I took her to the doctor this morning. The CBC showed no UTI, but it showed a platelet count of 30,000. We thought it was a machine error, until the second CBC showed 34,000. That was good enough to earn us a trip to the pediatric hematologist.

The good news is that she doesn't have cancer, and ITP usually resolves. However, because of her age, they've admitted her for IVIG therapy, and we'll be here until at least Sunday.

The incidence of ITP is 50-100 per million. I am so very tired of being on the small end of the statistics.

Diet for a healthy pregnancy

2008-03-07T09:50:00.003-06:00

Breakfast: eat handful of dry cereal, because milk is vomit-inducing
Mid-morning snack: heave up handful of formerly dry cereal
Lunch: eat brownie and a few Pringles.
Afternoon snack: attempt more Pringles. Fail.
Supper: ZOMG husband brought home french fries must have NOW nom nom nom.
Bedtime snack: another brownie. Retain brownie, after some debate.

Total: two brownies, 1 oz pringles, french fries

And that was an OK day around here -- on the bad days, the failure rate is substantially higher. Alternately, I just quit eating altogether to save myself the trouble, because I don't throw up as much if there is no food to begin with.

Today's sorta-amusing discovery is that I can spin my wedding rings around my finger. At this point in the last pregnancy, I'd already quit wearing them, after my fingers swelled up during the OHSS misery. Today, I put them on my middle finger, where they fits quite well.

Eight pounds down in a month, with probably another month to go.

Does this make my belly look big?

2008-03-04T16:56:00.004-06:00

By this point in my last pregnancy, I'd purchased and begun to wear maternity clothes. I quit being able to button my regular pants even before the beta, thanks to the joys of OHSS; rubber bands and a Bella Band got me through to about ten weeks, but after that, it was time to break out the shirts with the stupid ties on the back.
I wasn't really measuring more than a couple weeks ahead, but I have such a short torso that the belly popped right out front from the get-go.

Obviously, it's different this time. (I think that is my tagline for this pregnancy.) I've lost enough weight to have gone down almost a full clothes size, but in the last week, I've started to think my waist has been thickening up. Why, I might even start to look pregnant soon!

Then I saw Amalah's belly shot at ~7 weeks, and I wondered who I'm kidding. If current trends continue, I'll start wearing maternity clothes sometime in July. I have a formal event to go to, nausea permitting, in a couple weeks -- my little brother the almost-doctor's Match Day banquet, when they announce where the students will do their residencies -- and I don't feel the slightest need to drag down the maternity formal I wore to a wedding at twelve weeks with the girls. Instead, I'm wondering if I can fit into the dress I wore on our honeymoon cruise.

I actually bought a couple maternity tops the day of our first ultrasound, on the principle that the good stuff goes fast in the size you want. I was smaller going into this pregnancy than my last one, so all of my old stuff is between one and three sizes too big, depending on when it was bought. I'm mostly going to have to buy new stuff when the time comes, and until then, I don't have much in the way of spring clothes which fit. I'm ready to go ahead and have a visible belly and dress like it, instead of being stuck in this weird HG-weight-loss-bumpless-limbo.

This is an uncomfortable stage of pregnancy anyway, when you know you're pregnant but nobody else can tell yet, and maybe you've just got the worst case of stomach flu in the history of ever. Awkward clothing just makes it that much less pleasant.

The body knows

2008-03-03T22:05:00.002-06:00

One piece of natural-childbirth "wisdom" I purely loathe is the bit that goes "your body knows what it's supposed to do." The list of things my body hasn't managed to do right over the last five years is as long as my arm, from hypothyroidism to infertility to preterm labor to two knee surgeries.

I did manage to get close to term, to breastfeed, and to spontaneously get pregnant, but then my body forgot how to eat and retain food, and it still hasn't figured it out. I have good days, but they're usually followed by bad days. Today was a good day for the most part, until I decided I was starving and desperate for protein. Unfortunately, just like my husband told me, the particular protein I picked is not sitting well, and now I'm wondering if I'm going to hang onto it or not. I do that on a regular basis, eat exactly the thing I crave desperately and later regret it.

There's a theory of morning sickness that postulates it evolved to keep pregnant women from eating potentially-toxic foods, and another that you crave the nutrients that your body needs most. In my case, I'm pretty sure it's not true, unless I'm really deficient in the bagel vitamins. I know I really need protein -- I'm eating a quasi-vegan diet at the moment, not from choice -- but it's the hardest food to keep down.

The good news is that the pregnancy itself continues to flourish. The Lagniappe itself had a nice strong Doppler-able heartbeat at this morning's OB appointment, and Dr. Pro even thought she could hear it moving a bit. I expect I'll feel it before much longer -- I felt the girls early, at 13 weeks, and they say you feel it earlier in second pregnancies. Other than the HG, I have no complications so far, no spotting or cramping. I'm down another two pounds in two weeks, still spilling ketones, but on the good side, I am generally managing to stay hydrated and haven't needed any more IVs.

Ten weeks tomorrow. Every time I have a good day, I think maybe the HG is tapering off, and then I'm disappointed when it comes right back the next day. One of these days, though, it will go away for real. I can't wait.

Cute things my kids do

2008-02-21T09:49:00.004-06:00

or, Let's talk about something other than vomit

I haven't posted about the girls in a while, but they're continuing to grow and develop and be twice as adorable as any other babies on the planet.

Katherine's big advance for January was full-time walking, to the great relief of everyone. It's so nice that I can hold their hands and walk with them, rather than holding Claire and carrying Katherine. Of course, they still aren't reliable about staying with me if I have to drop someone's hand to open a car door or something, so I think we'll be acquiring safety harnesses. I remember being a kid and seeing other kids on leashes, and thinking it was just so mean, but now I understand, at least if you have multiples -- it's either that or stroller them everywhere.

February seems to be the month of language. My girls have been much slower to talk than, say, Eva's kids, who are one day older than C&K and to whom I occasionally compare them. We have had a couple of basic words, mama/dada/uh-oh/bye-bye and the like, for months, but they didn't show much interest in acquiring any more. In the last week or two, though, Katherine has learned "baby", "puppy", "oopsie", "water (wawa)", and begun to reliably mimic things you ask her to say.

Claire has "water" as well, and "night-night (ni-ni)", and in the last couple days she has learned both "no!", complete with head-shake, and "mine!" Yesterday one of the dogs was licking her in the face, and she shook her head and said "nononono!" I suppose it's not surprising, because "no" is a word she seems to hear an awful lot. "No, Claire! We don't climb the outside of the stairs!" "No! We don't hit Mama with the book!" "No! We don't stand on the back of the sofa!" "No! We don't steal sister's toy!"

Claire has also started, in the last several days, to sing. When the girls go down for naps together, or wake up from naps or sleep, they love to stand in their cribs and chatter. However, Claire now sometimes does what even Daddy the skeptic recognizes as singing -- she makes little tunes of nonsense syllables and repeats them over and over. She has always been more interested in music than her sister, and I'm now thinking that she is going to be musically inclined, and foresee a future of piano and voice lessons.

I am contemplating potty-training for them, once the HG eases up (right now, I can't face dirty diapers at all, and even wet diapers aren't so great). I would really like to get them day-trained before the new baby arrives, but I can't help thinking that they are awfully young. Still, I suppose eighteen months is an appropriate age to take the first steps, and anything that cuts down on the post-CS diaper changes will be welcome.

The nanny situation is working out beautifully, which needless to say is a real lifesaver with the HG situation. Her son is the girls' age, and they are playing nicely together for the most part. There were a few bumps and bruises in the beginning, as A. learned how to play well with other children, something I take for granted because C&K do it so well, but they've got their dynamic figured out now. Unfortunately, I am not getting much work done, because I still feel icky enough sometimes that it's hard for me to focus on code. Plus, I'm sleeping a lot because I'm still way undereating and continuing to lose weight (4-6 lbs in 10 days of hardcore HG, depending on hydration status, and I'm noticeably thinner). I'm hoping that will even out in time, though.

Pump up the volume

2008-02-19T00:44:00.002-06:00

After seeing my new OB this morning, I'm now the proud owner of a Reglan pump and another round of IV fluids. I figured the fluids were coming, because I knew I needed them, but I was pleased to find that the doctor could set me up with home health care for them, rather than having to go to the ER.

Dr. Dreamboat left the practice shortly after delivering my girls, so I switched practices, and I think I'm really going to like my new OB. She's nice and friendly and such, but the overriding impression I get is of professional competence, if you know what I mean. I think I'll call her Dr. Pro. Anyway, she had hyperemesis too when pregnant, so she didn't dork around or "cracker" me, just sent me over to the home health people. They got me fixed up, and things are starting to look up.

After one bag of fluids and twelve hours on the Reglan pump, I'm already feeling like a new woman. I successfully ate a little bit of chicken and drank a whole glass of tea (not at the same time), and my wicked starvation-induced headache is gone. Best of all, I haven't thrown up, or even really felt too nauseous. I think this might be the ticket.

She said I can probably expect another six or eight weeks of this, because sickness usually lasts longest in those who have it worst. I knew that going in, but if the pump works and home health can handle rehydration, it's a lot less grim a prospect than I'd thought.

Ugly

2008-02-15T15:21:00.002-06:00

My mom and brother hooked me up to IV fluids at home last night. After two bags, I felt much perkier, enough to eat a sandwich, and I went to bed hoping today would be better.

It's not better, though. I ate some breakfast and drank some liquid, but I lost most of that, so progress is not being made. I'm working my way through a glass now, but it's slow going. I need to try harder, or I'll be back on the IVs before the end of the weekend, but I have to force myself to take sips. It's miserable.

I guess this is the other shoe I was worrying about, since this pregnancy came relatively quickly. There are worse shoes, and I am mostly grateful not to have them. Doesn't make this easy to take, though.

Good and bad

2008-02-14T09:31:00.002-06:00

The good news is that the baby looked great at yesterday's ultrasound, with a beautiful heartbeat, and measured bang on the nose at 7w1d. I've got an appointment set up with my new OB practice for March 6th, and under ordinary circumstances, I'd be done with the RE.

Only problem is, someone's got to take care of me until I start seeing the OB, and that may be a more involved job than we'd thought, which brings me to the bad news.

I have stopped worrying about what food I can keep down, and started worrying about what liquids I can keep down. Yesterday, I managed a can of diet sprite (which I lost most of), a mug of chicken broth, and a glass of mountain dew. Today, it's been a few sips of sprite. This is a fast road to dehydration, and to IV fluids, if it keeps up.

Drs. Boss and Yacht conferred yesterday and sent me home with scrips for Zofran and Phenergan, which I am dutifully taking. I'm also trying a combo of Unisom and B6, which supposedly help reduce the nausea -- Zofran and Phenergan help the vomiting, but the sea-sickness of the nausea is just as crippling. So far, the Phenergan seems to help more than the Zofran, but neither of them is what I'd call great.

I think I'm in for a rough few weeks.

Careful what you wish for

2008-02-12T12:24:00.000-06:00

I don't remember having much morning sickness in my first pregnancy. Despite having twins, I only threw up a handful of times, and while I recall a few distinct episodes of queasiness, it just wasn't an everyday concern. A few things, such as raw chicken, would set me off, but as long as I avoided those and ate lots of pizza, I was mostly fine.

It's different this time around. I spent two weeks fretting because I didn't feel any nausea or other symptoms, but the very next day after my ultrasound, it hit me like a ton of bricks. As a general rule, I have an iron stomach, and I'm still not actually throwing up much as long as I am careful to avoid anything that makes me nauseous. Sadly, that appears to be smelling, handling, or thinking of any carbon-based food substance.

I can manage Diet Sprite and peach tea, but not much else. I kept down a bowl of chicken soup and some buttered noodles yesterday, but the chocolate cake I so desperately wanted was rejected. Today, even the buttered noodles aren't passing muster, and I'm not sure I even feel like trying anything else. I realize I have to eat something, sometime, but really, I'd just rather not. I'm rapidly approaching the point where I won't even be hungry any more -- I was starving yesterday, today I'm just a little peckish, and by tonight or tomorrow, my appetite will most likely be completely gone.

Currently, I've lost a little weight, just two pounds or so, but I'm going to drop more if this keeps up. I've got a little bit of extra padding to spare, so it won't hurt *me* to lose ten pounds or so. The baby's needs are minimal, given that it's the size of a rice grain, and it will get what it needs. I'm staying hydrated, and I'm not throwing up enough to feel like medication is worth it yet. However, I'm really nervous about where it's going. I'm 7 weeks today, and have been getting progressively worse since the weekend. If I keep going downhill, it may be time to talk about better strategies than just crackers.

Ugh, and just typing the word made me think about their disgusting taste and texture, and that was not a good idea. Tomorrow's ultrasound had better look good, to make up for this!

One

2008-02-07T10:42:00.001-06:00

One baby: check
One heartbeat, 108 bpm: check
One very relieved mother: check

We couldn't date the pregnancy conclusively based on CRL -- it measured somewhere in the 0.4 range, just under 6 weeks, but as I was 6w1d, that's close enough. We'll have another scan next week just to be sure, but for now, it looks good!

The night before

2008-02-05T22:16:00.000-06:00

If you ask me, the night before a first-trimester ultrasound is one of the undocumented minor levels of hell.

In my last pregnancy, the entire first trimester was one long stretch of anxiety. I knew I carried double the risk of miscarriage, because I had double the babies, and at that stage, it's too early to feel them move. I had very little morning sickness, and most of my other discernible symptoms could have been produced by the progesterone supplementation.

I relaxed as I began to visibly grow toward the end of the first trimester, and to feel them move early in the second trimester, but for those first six weeks or so after the beta, I worried myself to the point of nausea before each ultrasound, sure that one or both would have died. I got a lot of ultrasounds because of the OHSS, so that was a lot of nausea, but it didn't leave me with long stretches of in-betweenness, and that's a fair trade for a little puking.

Today, I am six weeks pregnant, and my first ultrasound is tomorrow. This time around, I have no clue if the baby's disappeared into a black hole. I have little more than the posts on this blog, and the photo of my pregnancy test (the test itself faded away), to reassure me I'm not just making this all up. I'm not nauseous at all, my breasts aren't sore or bigger, and while I am occasionally tired and hungry, that could just as well be the result of not getting enough sleep or eating a decent lunch. The one symptom I have is moderate cramping, low and always on the left side, and that's not exactly reassuring.

I know the odds are in my favor. I'm young, I have no history of miscarriages or ectopics, and I had three good betas, with appropriate levels and doubling times. I also know that none of that is a guarantee of anything, and I am more than half expecting bad news of some sort. It's irrational, but I can't make the idea go away, that things will not be what we expect. This baby doesn't seem real yet -- it was too easy, no dues paid.

Plus, I'm having real trouble wrapping my mind around the idea of just one baby. The odds of having twins are quite low, just 1 in 300, and in theory, I don't *want* another set. After all, it's all I can do to keep the one set from climbing the bannister/biting sister/wearing their pants on their head/using the dogs as stepstools. Still, I apprehend that I'll feel a small flicker of sadness when we see a single solitary baby -- in my world, babies come in pairs. This is, of course, the greatest hubris, to imagine disappointment over seeing a live and healthy baby, and I fear that I'll be up for karmic retribution.

Two years ago today marks the first time we saw Claire and Katherine's hearts blink into pixellated life. I hope tomorrow's news is as good.

Third time's the charm

2008-01-28T11:09:00.000-06:00

Beta #3 was 1690, for a doubling time of 1.36 days. Now we just have to see the heartbeat, and all will likely be well!

Ultrasound is scheduled for Wednesday, February 6th.

Beta #2

2008-01-25T15:42:00.000-06:00

368, for a doubling time of 33.6 hours. Very respectable indeed!

Anxiety

2008-01-25T09:37:00.000-06:00

I'm waiting for the nanny to get here so that I can leave for my second beta, and I'm nothing but a big tangled ball of nerves.

I am so nervous that this isn't going to work out. I feel as unpregnant as it is possible to feel -- not even sore boobs. All of these started very early for me the last time, although I was both carrying twins and on PIO last time. I felt nauseated on the way to my first beta, and do again this morning, but I am quite sure that is just anxiety. Worst of all, I have had some fairly aggressive cramping, and only on one side.

I know all of the above is perfectly normal in very early pregnancy, and that it's natural to worry about it as well. However, to a certain extent I am waiting for that other shoe to drop. I got pregnant, well, easily enough, and without any serious intervention -- I haven't "paid my dues" this time. Surely there is some bad juju out there somewhere with my name on it.

Beta will probably be back at some point around 1 PM CST. Three more hours or so, and I'll know.

Crow! Nom nom nom

2008-01-22T14:46:00.000-06:00

Um, yeah. About that anovulatory cycle thing:

Beta was 83.7. No idea what DPO exactly I am, because I never had a positive OPK, but presumably fairly early based on the CD 15 ultrasound. We'll repeat the beta Friday and Monday to check for appropriate doubling.

Ho. Ly. Shit.

(Sorry for bad blurry photo, taken from my iPhone in the car with some VERY shaky hands.)

Size matters

2008-01-20T11:38:00.000-06:00

In a new but not wholly unexpected development, Claire has now mastered the art of taking her shirt and pants off. I discovered this in the usual way, which is to say that I went upstairs to fetch them in the morning and found a bare-ass-naked baby sleeping soundly on top of a very wet bed.

At that point, our pajama stash consisted of four zip-up footed sleepers and six two-piece combos (one of which snapped together). I've shifted Claire into the zip-up sleepers and am putting Katherine in the two-pieces, since the latter hasn't shown much inclination to strip them off yet. However, they're about to outgrow a couple of those pairs anyway, so I went in search of more PJs.

On previous shopping trips, I'd already noted that 18M is the Worst. Size. Ever. There is a great void between the infant stuff, which stops at 12M, and the toddler stuff which begins at 2T. Of course, this is even worse if you're looking for footed sleepers, especially those which don't involve licensed characters of one sort or another.

I have now scoured BRU, TRU, three department stores, and TJ Maxx, and turned up exactly four sleepers. I was tremendously pleased with myself when I brought them home on Friday, until Claire proceeded to go through three of them in a ten-minute timespan. (She has a cold, and is spitting up a bit from snot accumulation.)

Why oh why is 18M so hard a size to find? There's a plethora of options in 12M, and a large assortment in 2T. Do the manufacturers think little girls somehow magically shift straight from one to the other?

Baby love

2008-01-18T09:29:00.000-06:00

An interesting development has occurred here in the last week: the girls have discovered baby dolls.

Nana and Pop gave them a set of "newborn twins" baby dolls for Christmas. I was somewhat skeptical they'd get the idea, and initially, they showed no interest at all. However, all of a sudden, the baby dolls became favored toys. Katherine has just spent the last hour bringing me her "bah-bah" and its hat. I have to put the hat on the baby, and pantomime feeding and burping and rocking the baby, and then she wants to take it back to do the same. Claire, meanwhile, tries to feed the baby a sippy cup of milk. Both of them love to hold it and kiss its head.

I find it fascinating that they recognize it as a baby, and that they try to feed it and love it. It really seems to be innate -- I didn't show them how to play with the baby doll, or encourage any interest in it.

One odd thing: when I pretend to feed the baby, I put it to my breast. After all, that's how I fed Claire and Katherine, and will hopefully feed any future babies. I'm a big proponent of breastfeeding, and will strongly encourage them to nurse when they grow up and have babies of their own. So why does it weird me out to fake-nurse a baby doll?

And this is how much cheaper than treatment, again?

2008-01-17T10:33:00.000-06:00

CD 24 today, and still no sign of impending ovulation. I have exhausted the remnants of a 20-pack of el cheapo OPKs, a 6-pack of regular Clearblue OPKs (the package was short a stick), and I've put a good dent into the 7-pack of Clearblue Digital OPKs. I do quite like the digital ones, but wow, the cost is out of sight. I paid $34 for them at a local Walgreens, and then shelled out for the regular Clearblues as well.

I did, however, throw in the towel and buy a Clearblue Fertility Monitor off eBay. I got a fantastic deal on it, though, so it will actually amortize itself somewhat, given the number of OPKs I seem to go through. Yeah, I know you have to buy sticks for it too, but I'm buying those anyway, so it's just spreading the monitor cost out over the months. Besides, who knows? Maybe the Perversity Goddess will take this one as a suitable offering.

I'm going to ask my mom about another US, but I suspect she'll say it's not even worth fooling with at this point. The only thing it'll tell us is whether the follicle grew at all, and that's kind of a moot point. If a few more days' worth of sticks don't show anything, it's probably time to take Provera and put the squash on this cycle.

G is still waffling about the Clomid, which I kind of don't get. The fundamental disconnect here is that he thinks it "might" happen normally, and that it's worth giving it a little time, when the alternative is a somewhat increased risk of multiples. I suppose it might, but I think the weight of the evidence swings the other way. This is my fifth post-nursing cycle, and while we know I've ovulated for sure on some of them, and probably done a reasonable facsimile on others, I'm not doing so within the proper horizon for a successful pregnancy. Moreover, it seems to be worsening, rather than improving.

To me, it's so obvious: you have a history of problems, you currently have demonstrable problems, you stop hoping for rainbows and puppies and just do what it takes to fix the problem. Sure, there's a chance it might resolve spontaneously, but there's also a certainty that you will stress about it until it does. I don't see the point of waiting another couple cycles "just to be sure". If you know you're going to go there eventually, and if your chances of a successful pregnancy in the interim are low, why wait?

One-liners

2008-01-15T00:16:00.000-06:00

I'm so sad for Alexa today.

CD 21, and not really any impending signs of ovulation. I'm not sure if I'm even going to see a delayed ovulation this month, or if the whole thing is just a wash.

I'm unabashedly happy for Nico. When she announced her first pregnancy, I read the post on Christmas morning, after a particularly rough Midnight Mass the night before, and literally wailed out loud. This time, I'm just happy for her, though I'd like for it to happen for me too. Secondary IF is so much *saner*...

Katherine is finally really walking! She took her first steps in November, but didn't ever move beyond that. On Christmas Eve, she was across the room, and stood up and walked over to me like she'd been doing it all her life. She's now walking most of the time, although she still knee-walks fairly frequently. I'll be so glad when that stops.

15-month checkup last week. Katherine is 23 lb 13 oz (50%), Claire 22 lb 13 oz (25%), but at 31" tall (50%), she is a full inch shorter than Claire (32"/75%).

In retrospect, I just don't think Claire was a very good nurser. For the first six months of her life, we struggled to even keep her on the chart at all. Once she started on solids, she went from being itty-bitty to normal for her age. Milk supply wasn't a problem for me, rather the opposite, but I don't think she was very efficient about getting it.

Talking is about to take off, I think. We have mama, dada, bye-bye, hi, and then several partial words -- "ba" for ball, "buh" for book, "baba" for button.

I've got a full-time nanny starting next week. I'm somewhat more enthusiastic about this development than I was last time I mentioned it, but still a long way from thrilled. Some SAHM I turned out to be, huh?

Reassuming the position

2008-01-09T16:40:00.000-06:00

Today is CD15, and since the OPKs have started to darken, I was optimistic that an ultrasound today might show us a maturing follicle.

As is usual, though, the optimism thing didn't work out too well. I have a beautiful lining, 9.65mm, but my only real follicle is 13mm, so it definitely looks like we're up for another long cycle.

I'm going to keep OPK-ing to see when a surge might happen. We may do another ultrasound then, or we may just do a P4 on 7DPO to verify ovulation. After that, and assuming this cycle isn't the one, the Clomid discussion will resume.

Christmas ate my life

2007-12-31T22:30:00.000-06:00

Sorry for the radio silence. Christmas is a tough time for posting -- there's traveling, and family, and more family, and then I throw a party every December 30th. We're spending New Year's Eve alone at home tonight, as we often do, because we're just flat worn-out.

So, the interesting question at hand was what happened last cycle. Turns out it was a mixed bag: I got my period twelve days after the progesterone draw was taken, so that probably was the real O date, and that's a decent P4 level for that point in my cycle. On the other hand, that means I O'ed on CD 24, which is awfully late in the game, and the ovulation process is long and drawn-out and bodes poorly for things like egg quality. And, well, I got my period, so the cycle was a bust, and that's obviously teh suck.

However, if you happen to find out you're unpregnant on Christmas Day, a shiny new iPhone takes out some of the sting.

So, where to go from here? Well, Dr. Boss's opinion is that I "probably need a little Clomid", so it looks like we're heading back down that path. However, because my husband is a stubborn ~~mule~~ iPhone giver, it won't be this cycle. We're going to monitor me more aggressively this cycle, with temping and OPKs and an ultrasound or two as needed. I'm going to shell out for the new schmancy digital OPKs -- somebody finally got smart and invented ones that have clear indicators rather than making you play the how-dark-is-it-really game. I'm going to ask for an ultrasound when I think I'm starting to peak, and then another if I do the same second-peak thing as last month. After that, assuming I don't actually get knocked up, we'll probably start a Clomid cycle. Maybe it'll even work. Wouldn't that be novel?

I don't know where I'll be this time next year. Will we still be a family of four, or will I have a new baby arrived or on the way? I do know that it'll be OK, though. Admittedly, we only qualify as secondary infertile under a generous definition -- we haven't been at this very long, and we're just getting to jump the queue because I have a medical history. However, I'm already handling it much better this time around, and I think that will continue even if this drags on for a while.

I want very much to get the reproductive show on the road, so that we can either get pregnant or give up and accept that we've done what we could. I don't deal well with uncertainty, and I'm not very patient, and I'm personally pretty dubious that things will work out without medical intervention. I hate to stand around twiddling my thumbs waiting until the requisite time period has passed for us to be declared REALLY infertile. Why not just skip over all the months of failed cycles and start addressing the problems we know to exist? But after that, after we've put as much energy and money and tears into it as we have to spend, I think we can walk away.

Two years ago, I started the IUI cycle that turned into Claire and Katherine. I love them more than life itself, and if they're all I get, that'll be OK. I'll be sad -- I won't lie and say that I'm not already a little sad to be back on this particular horse -- but failing to have a third child is not such a tragedy.

Test results

2007-12-17T15:34:00.000-06:00

It took them until today to get around to running the progesterone from last Wednesday, because of a broken machine, but I got the results a little while ago: 4.27. Per Mom, this indicates some level of ovulatory activity, but it's somewhat tricky to evaluate because of the two LH spikes.

If the first peak, on CD18, was the "official" one, this was not a good ovulation, and is not sufficient to sustain a pregnancy. On the other hand, if the second peak on CD24 was the "real" one, it's better news. This isn't a bad result at all for just after ovulation, and would probably correspond with a reasonably good peak level. However, the egg quality could be dicey, after a previous near-peak and long growth cycle.

Rather than do another draw, Mom thinks we should just wait to see when my period shows up, and work backwards to decide which day was the correct one. If the total cycle length is around 32 days, the first case applies; even if the second peak was the real LH surge, we'd be talking about an 8-day luteal phase, which is problematic. However, if it's more like 38 days, the second peak was the real one.

In either case, we're almost certainly going to do monitored cycles for the next month or two, so that we can know what's going on throughout the cycle rather than getting a single-day snapshot. After that, Clomid is the next step, although I don't know how quickly we'll go there -- G is expressing what we will politely term "reservations" about "rushing" into treatment, and about the risks of multiples. That's a subject for discussion in and of itself, but worrying about it at this point is premature.

ETA: Thyroid results are back. TSH is suppressed and free T4 is 1.09. That's within normal limits, if somewhat low for me -- I'm usually more like 1.5. The suppressed TSH is normal for me, since my variety of hypothyroidism is hypothalamic in origin.

We interrupt this important dilemna...

2007-12-12T12:40:00.000-06:00

... to discuss an entirely different one: Infertility 2.0.

You know how I've been thinking I've been ovulating a bit later in my cycle, based on OPKs? Well, yesterday was CD23, and while I'd thought I'd O-ed on CD18, I was having some symptoms that made me suspicious, so I used another OPK.

Positive, on CD23, six days after a positive on CD18. Or, at least, what I *thought* were positives. Of course, I immediately thought, what if I'm pregnant, and the OPKs are picking up the hCG instead? Well, that turned out not to be the case, so I tried again today, with a different brand of OPK I had lying around. This one was negative, but middling negative, not what you ought to see the day after your LH surge, or a week after it.

So, of course, the next thing I did was to pick up the phone and call my clinic's head nurse, better known to me as Mom. (It's so helpful sometimes, having a mom with 20-plus years as an RE nurse...)

My mother said that 1) Answer brand OPKs (the cheap 20-pack you can get at Walgreens) suck -- their patients get more false positives and false negatives with those than any other brand. They recommend ClearBlue. 2) if they were legitimate readings, not stick errors (which the middling negative I got today supports), something's not right.

Mom says that late ovulation is usually bad news. If I'm really legitimately ovulating today, on CD24, the egg is probably not going to be very good quality -- long cycles, with long periods of hormone activity, cause them not to mature very well. On the other hand, if I ovulated on CD18, it might not have been a very "good" ovulation either. Even if a follicle released an egg of OK quality, I may not be producing enough progesterone, or there may be something else wacky with my LH/FSH.

If it's just the one wonky cycle, OK, fine, that's how they go sometimes. However, it also calls into question the legitimacy of all those other "ovulatory" cycles. This one isn't especially different -- I just happened to retest even though I thought I'd already ovulated.

My mom said, maybe you just need a little bit of Clomid. Now, Clomid and letrozole both were complete failures for me the last time around, but things are at least somewhat different now. I'm having regular cycles, and there's some kind of ovulatory activity working, even if it isn't completely right. There's reason to think it's a reasonable option.

I went into the clinic for a progesterone level today. If I did O last week, it'll be elevated, though possibly not enough to sustain a pregnancy. If I didn't, it'll be negative, and we'll recheck in a week to see if I'm ovulating today. Either way, it's time to at least think about doing some monitoring next cycle. After that, who knows?

I dislike the thought of Clomid. I didn't enjoy it the last time around, and I'm unhappy at the idea it might have come to this. We'd talked about how, if we need more aggressive treatment, we'd wait a while, maybe a year. We know that ART comes with downsides for us, namely high risks of OHSS and multiples, and we haven't yet sorted out whether we'd try another IUI cycle or head directly to IVF. And now, we're talking about starting up the "gateway drug". If Clomid doesn't work, will we be able to say, no, let's sit on it for a while before deciding to move down the path?

Lots of questions, and not a lot of answers today.

Working hard for the money

2007-12-07T21:32:00.000-06:00

So, I've got a dilemna I'm trying to resolve about going back to full-time work.

I'm not sure I ever really posted about my decision to stay at home after the babies were born. Prior to the infertility, I had spent four years working as a freelance computer programmer, but I'd gotten burned out even before adding the infertility upheaval into the mix, and I took a full-time job a couple months after I started blogging.

I stayed with that company throughout my pregnancy, and sometimes wish I could have continued. I really liked the job, especially in the first few months, loved what I was doing and the people I was working with. Later, the new VP of Operations brought a different atmosphere, but not really a bad one, just more corporate and less free-wheeling. This is pretty common for tech companies moving out of the small startup stage, but it's a bummer if you *like* the startup approach to life, which I mostly do.

The most notable change was that the programmers, who had previously been free to work from home or in-house as they chose, were now required to work mostly in the office. Initially, this didn't affect me that much, because I actually liked going into the office, and getting dressed up and interacting with people, after years of barely leaving my house. Ironically, it was not long after that point when my doctor strongly encouraged me to begin working from home, due to the uterine irritability issues. I worked from home the rest of the pregnancy, and if I could have continued to work mostly from home, I would probably have stayed with the company after the babies were born.

However, that wasn't an option, and for me, going back to an office job wasn't an option either. I was nursing, and I was very hesitant about leaving my tiny babies with a non-family caregiver, and frankly I just didn't want to leave them. So I turned in my notice, didn't work at all for a couple of months, and then went back to freelancing on a very part-time basis. I meant to work just a couple hours a week, in the evenings and while the babies napped, enough to bring me in a little bit of extra cash while allowing me to basically be a SAHM.

This worked well throughout the winter, when the babies slept a lot. It got harder in the spring, as they became more awake and demanding, and by the start of the summer, I hired a college student to babysit in-house for three afternoons a week. When she left in August, I found a high-school student, who comes (theoretically) every afternoon for three hours. In a lot of ways, this is ideal, and I'd recommend something like this to any mother of twins, even if you're not working from home. It's really nice to have a few hours to go to the grocery store, or to pay the bills and run errands, or to go and get your hair cut, without hauling a toddler or two around all the time. The babies also go to Mother's Morning Out twice a week, and I take my laptop to a coffee shop and work while they're there.

However, my work situation has gotten more and more demanding. My old clients keep handing me more work, and my business partner's gotten us involved in some new projects which require some very specialized skills -- I literally don't know of anyone else in town who's capable of doing the work. I worked nearly full-time in the weeks after my knee surgery, when I had a babysitter there anyway, and I think that also encouraged everyone to pile work on me.

The upshot of it all is that I have enough work to keep me busy for at least two months, realistically more like three, if I bill as much as I reasonably can with my current child-care arrangements. And it's not like I'll finish that and be done, either -- I expect more work to come in while I'm taking care of this stuff. The nature of the freelance business is to have ups and downs, but for the foreseeable future, there's as much work available to me as I feel like doing. On top of this, I have some school commitments necessary to complete my master's degree this spring.

I have enjoyed being a SAHM. I like spending time with my children and doing motherly things, even the not-very-exciting ones like laundry and baths. I like the freedom of being a SAHM, the ability to go hang out with my mom friends and their kids, to go have lunch with Daddy any day we like, to go to the park because it's a beautiful day and there's nothing else I have to do.

The part-time work was the optimal situation, because it's a little bit of intellectual stimulation and some extra cash, but it wouldn't interfere with my lifestyle too much. At least, that was the theory. I'd still have every morning and two afternoons a week to spend with the babies... or, every morning... or, now, Tuesday, Thursday, and Friday mornings. They nap from roughly 12 to 2, the babysitter's here from 2:30 to 5:30 or so, and then it's pretty much time for supper, baths, and bed. I've essentially turned into a full-time working mother without quite realizing it. I'm still pretending I'm a SAHM and can do SAHM-type things, but underneath the denial I know that's not really the case.

Part-time isn't working any more. I knew this would probably eventually happen, because that's the nature of the freelance industry -- work tends to expand to fill all available time. So, I've got to decide whether I'm going to go back to full-time freelancing, with an in-house full-time nanny, or to hang it all up and be a SAHM. My mother's found a potential nanny, and I've been chewing the idea over for weeks. I think I've more or less made a decision, although I can't say I really like it, but I don't see what else I can do.

So, gentle readers, what do you think that decision is?

----------------- to be continued -----------------

You know your day sucks when...

2007-12-06T14:32:00.000-06:00

The dog throws up on the floor...

twice...

and the children find it before you do.

We teased my sister for years about how she liked to eat dog food when she was a baby, but my children have just taken it to an entirely new level. At least M didn't eat pre-digested kibble...

Silver lining

2007-11-19T23:24:00.000-06:00

The upside to being unpregnant?

FryDay and Beerball.

I may not be very eligible for the ball part of it -- repeat ACL surgery isn't on my agenda -- but I can damn skippy do the beer. And if I don't deserve a fried Snickers bar, who does?

Rhetorical question

2007-11-15T18:25:00.001-06:00

Is there anything cuter than watching your babies play hide-and-seek with each other?

Sometimes I really love being a mother of twins.

Katherine's Box: a photo essay

2007-11-12T09:05:00.000-06:00

Here, have some cute baby pictures of Katherine and Claire fighting over The Box.