Ultrasound Update

Sorry for the delay - so busy and tired since our appt last Thursday. The ultrasound was good, all normal. Again it was looking at the two umbilical arteries and measuring the flow, looking for abnormalities and something called "notching" which is often a predictor of pre-eclampsia. Best description is here. No notching. Growth also appeared to be on target. My perinatologist reminded us that this is no way guarantees we will avoid pre-eclampsia nor HELLP. We will have no guarantees until that baby is safely delivered, nuzzling and I am released from the hospital! That being said it certainly is good news, and another positive sign (along with the AFP level and other blood-test markers). At the least I think we can safely assume it isn't looming around the immediate corner and we can most likely get past the micro-preemie stage (ie no reason I shouldn't make it to 28 wks).

As expected, I got "white coat" the minute she said she needed to check my BP and it zoomed up. So she had me try a different cuff, relax a few minutes and it came back down to a comfortable 116 over 69. Sigh, at least she realized first-hand how much I am affected by white coat syndrome.

Next big ultrasound in 4 weeks.

Tomorrow!

Thursday morning is an important ultrasound. Praying for healthy blood flow through the cord and placenta!

Had a nice experience in the bath today. Feeling baby kick and seeing the water ripple ever so slightly and seeing just a bit of movement under the skin. Baby's been active, always a good thing.

Do Looks Matter?

Friends and family have been commenting often this pregnancy, "Wow, you look great!!" Which is nice to hear of course, especially when you can't fit into much. The funny thing though is with that comment is also another truth, that I looked pretty darn bad my last pregnancy. Not the image of healthy pregnancy glow. Seriously, true, I'll walk you through the pics and explain.

First off, this was taken last September, about a month before getting pregnant. It's rare these days I curl my hair and find time for much makeup but it was our anniversary, so on top of spending more than 10 minutes to get ready, I even shaved my legs. I'm not skinny but I was a healthy weight and running at least 20 miles a week.




Now let's backtrack to my pregnancy in 2005. I had a one hour commute each way, crappy-ish job, got little sunlight, didn't exercise much. Ate fairly well but didn't pay nearly as much attention to nutrition as I do now. And as the weeks progressed, I got fatter...but I never really looked pregnant? Just fatter. And then swollen. And then more swollen. This picture was taken on vacation in Hawaii at about 21-22 weeks, where I am now in this pregnancy. I wasn't eating like a glutton but I don't know...I just don't look right, and I don't see much baby bump that's for sure. It gets much worse....





By the time 27 weeks rolled around, it looked like you could pop me. This picture was taken at my sister's graduation and was probably about 10-14 days before I delivered Liam. This isn't fat -- this is the face of pre-eclampsia. This is about 25 pounds of pure water weight because my kidneys were starting to not do their thing. At the previous doctor's check there was an indication that things were starting to look wrong (higher BP, protein in urine) but I wasn't on bedrest and had no clue just how bad things were going. I was simply going to come back in a week for another check. It is horrifying to look back now at this picture, but back then I really had nothing to compare it to. I knew many pregnant women swelled.

So what about now? Let's see...

This one was taken 4 weeks ago, so about Week 18 or so. Good bump starting. 14 pounds gained but mostly in the stomach and still able to wear normal non-maternity sweat pants.

19 weeks or so after a run one morning

And then another one sitting a few days ago. (Can't really see how big the tummy is with me sitting). But I look normal-ish, I think??? I don't seem to have any swelling as of 21 weeks.

So the question is, is looking healthier going to make for a better outcome? Has my being in shape this time going to get me to 40 weeks? I sure as heck feel better this time. I've gained 15 pounds in 20 weeks but by Week 19 I already had a bigger belly than I did when Liam was delivered at 28 weeks. On the other hand, this young woman had a major stroke from HELLP and is the frickin picture of good health, is she not?

Pre-eclampsia doesn't just strike the non-fit and I've known several gals with worse cases that were marathoners. Fitter than I will ever be.

But alas, you can only change your own situation and your own variables. And for me, not being fit and not having a good weight clearly didn't help me last time. Maybe it won't prevent it but getting say from 28 weeks to even 32 weeks could be the difference between cerebral palsy or not. Or my baby making it or not.

So I am putting my money on trying to stay healthy.

20 Weeks

So, the truth is this past week, week 20, has been the hardest. I mentioned previously that the past 19 weeks have been fairly easy emotionally. I mean morning sickness was no fun, but I sailed through for the most part. Exercise has been key for me maintaining a good mental state (I ran 3 Half Marathons prior to getting pregnant) and have been walking/running 2-3 miles a day, every day of pregnancy. Then for some reason the mental milestone of hitting 20 weeks has hit like a brick. Several reasons: Home monitoring by Kaiser started (someone calls me to check in on my BP every week now). I am supposed to check my urine for protein daily. And then this week we have an important ultrasound to check blood flow to the placenta. And then of course in the words of my Ob Gyn, "Weeks 12-20 are coasting." In other words, pre-e doesn't happen by definition prior to 20 weeks so there was no cause for worry. I know what she meant but I sure wish we were still in coasting period! I mentioned earlier the monitoring is vital, but it has gotten to be too much at times.

So all of this culminated last week. In 37 years I have had plenty of stress at one time or another, and certainly lots of nervousness while Liam was in the NICU for 76 days or when I've done public speaking. But anxiety is a different beast, the likes of which I can't compare to anything previously. It's irrational, and it grips you at different points. A good friend told me "just relax. breathe." I wish I could explain that it is not that easy. I can only liken it to this: Imagine you almost drowned in a pool. Later you come back to the pool, you have a life preserver, you have people around to help you out, maybe you even know how to swim now?....regardless, you will experience a certain amount of anxiety being back in that situation. And for those that haven't been in that situation, you don't understand the complex physiological reaction triggering anxiety that makes it harder to brush off than just having someone tell you "relax". And of course the real shitter with anxiety is that it makes BP go up, so when I check it and it is up it only makes things worse.

I've been using these strategies: Did yoga one night last week - great. Got a facial and pregnancy bath at a wonderful local spa over the weekend. (I'm convinced if I could live at Burke Williams the next 4 months I'd deliver a healthy 9-pounder no problem!) Trying to repeat positive affirmations when I am out walking/running. Going to speak to a counselor at a local birth center this week. Lots of deep breathing when the "what-ifs" start. Praying. And while in 37 years I have never had a mental health issue requiring professional help, I do plan to discuss it with my doctor this week, and consider all options. Gotta do what I gotta do and know when to get help.

So there you go! Being honest and hoping my words someday help someone else in this situation. And on a fun note, this is my 4 year old and a hint of my baby bump in the corner!

AFP

After Friday's minor scare, I did receive a bit of good news regarding the AFP level. AFP stands for alpha fetoprotein and you can read more about the definition here. When you do the 2nd trimester blood test for Down's and other chromosomal abnormalities, AFP is one of the blood markers. An elevated AFP I believe can signify a neural tube defect and that is usually why it is measured. But an elevated AFP can also be a predictor for pre-eclampsia development later. It's not a definite (ie some folks have high AFPs and do not get pre-e; some folks have normal AFPs and still go on it get it). But...an elevated AFP in the absence of a neural tube defect like spina bifida can mean a placental abnormality (thus the link to pre-e). AFP is measured as a multiple of the median (MoM) so the closer to 1.0 the better, or the more normal I should say. 2.5 is the program cut-off for considering it to be elevated. My number was 1.07! So very positive, and a good sign of being "normal." Again in itself does not mean much but we shall take the good result and move two steps forward in this journey!

19 Week Appointment and First (Minor) Scare

Wanted to post sooner but we headed up to the snow Friday night and just got back. I had my first minor scare at Friday's 19 week appointment. Blood pressure was fine (I get White Coat Syndrome but that is another post), however the urine test showed a trace of protein. Not in itself a big deal, in fact the nurse at first said it was "normal" til I realized it wasn't negative but actually a "trace" amount. Now, "trace" is fairly common and certainly not unusual. For those not aware, pre-eclampsia usually has 3 identifying factors: high blood pressure, swelling, and protein in the urine. The kidneys begin to spill protein and the amount gradually increases from the baseline (negative) to trace, then 1+, 2+, 3+, 4+. So staying in the negative range is ideal of course.

I was discussing it with my Ob/Gyn when she came in, and then she explained how you can get false readings from not getting a clean urine catch. In other words, not first cleansing the area immediately beforehand and not catching urine mid-stream. Well I didn't know this and did neither!! I'm always worried I won't have enough pee so I pee in the cup from the get-go! Why I think this, I do not know as I can normally overfill the cup!!?? So we both agreed this may have been the cause and no need for panic, but I would be sent home with urine strips to test at home, as I do with the BP. Further, given the fact that my BP is still fine it probably wasn't a sign (the rise in BP normally goes hand in hand with the protein).

Long story short I tested it again at home later that day and got "negative". Good.

Overall, I've been fairly positive the past 19 weeks. I had one bad dream, and from time to time I get anxious, but generally I've felt good and remained optimistic. I have a certain peace of mind knowing there is nothing more I could be doing to bake this bun just right. But that day, off and on, I must admit that the panic gripped me a couple times. The old feeling of going down that road, where there is no stopping pre-eclampsia, just trying to slow its path and get as far as you can before your body starts to poison itself and the baby. I try to have the mental fortitude to handle it and stay tough all the time, but I'm no superhuman.

Last night Liam was resting on me while we watched TV at my Mom's cabin after a long day of him skiing and playing in the snow. The baby started kicking, probably upset that he was being squished by his big brother. I remind myself that this is what I am doing it for, my two little boys, and that I can do this. I can do this.

Valentine's

Because in between the blood tests, the blood pressure checks, and the doctor visits (another tomorrow!) life goes along merrily and busily. So we just made mini-cupcakes for Valentine's Day and enjoyed one. Or two. The baby is doing somersaults in me, the 4 year old is doing somersaults down the hallway. Chaos reigns.

19 week appointment with the Ob/Gyn tomorrow.

The Barometer

It's odd how different this pregnancy is. In 2005, I barely knew what pre-eclampsia was and thought, having had low blood pressure my entire life, I was the least likely candidate. This time around, I am monitored closely, and I know so much. I know what PAPP-A and HCG levels in early blood screening can mean. I know that a pregnant woman's blood pressure should dip below normal in the second trimester. I keenly await results of my blood test to learn the AFP number, not just as an indicator for Down's but for what it can mean for pre-eclampsia as well.

Some may say such knowledge is scary. Perhaps. That it's better to simply pray and hope for the best, which I do as well. But I'd rather know. I've read too many stories over the past 4 years of women who weren't aware of the danger signs and passed them off as regular pregnancy complaints, and as a result did not survive or become gravely ill.

While I have a superb team of doctors, they also know how critical it is that I listen to my body. And for this, they all acknowledge that my barometer will be the monitoring of my blood pressure at home. Pre-eclampsia can strike between Ob/Gyn appointments with ferocity.

This little machine represents so much. It's been my companion the past 19 weeks and hopefully for many, many more weeks to come. It's a barometer for whether my little bean's home inside of me is still hospitable. To date my blood pressure numbers have been great, with the usual 2nd trimester dip. (92 over 64 is great at 19 weeks), and I breathe a sigh of relief every day for now.