Letter for My Sons

At long last, tomorrow we meet you son #2. I think some people talk about waiting 9 months. And 9 months/40 weeks is a heck of alot of time. But the truth is the journey has been so much longer. 5 years really. I remember even as early as when Liam was in the NICU wondering if we were ever going to have another child or if the decision had basically been made for us (we felt at the time we could never risk it again). Throughout the past 5 years it's always been on my mind, sometimes in the back hidden away, sometimes actively discussing the risks with the husband. But it's always been there. So many times throughout we leaned more one way than another. Even last June, we went in for a pre-conception appointment with the perinatologist and had alot riding on the meeting, basically if we had no trust in their care and their gameplan, or if they recommended we NOT try again, we wouldn't have gone forward. And I would not be here about to give birth tomorrow afternoon. Ultimately we would have made peace with that decision, because you have to make peace with what life deals you, and in the words of Mick Jagger you can't always get what you want.

But alas, we went ahead. It's worked out. It's been scary as hell at times. I don't take it for granted. And I won't count my chickens until the baby is here and we are released and start a new chapter in our lives. And I can return the darn blood pressure machine to Kaiser.

My second son and my first son will have had the most completely opposite of birth stories and arrivals. I wonder how your personalities will differ. I can't wait to see your bond develop despite the five-year difference. I wish you both could have had the same opportunity to have been born safely and calmly. I wish son #1 could have had the additional 11+ weeks son #2 has gotten in the womb. But your stories are all part of who I am, and hopefully will have made me the best Mother I could be. It is what it is.

And tomorrow we welcome you to the world!

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Edited July 1st: Oh good Heavens! Called the hospital. No beds so we have been bumped a couple hours. Haven't eaten since 4am and can't have anything by mouth. Hoping to get in at 4pm. Oh well I suppose this is the irony of having had an emergency c-section 5 years ago and bumping everyone else out of the way :)

39 Weeks

Unless things change, we are looking at 48 hours to go until we meet The Tenant. Tenant has been very active and seems like he is ready to come out. I wish he'd come out on his own volition but am glad he's been healthy. Back in September I could only have dreamed of reaching 39 weeks with no signs and a BP recording taken a few minutes ago of 114 over 66. Feeling very uncomfortable and think I have doubled in size this week but have had an easier time with husband off work and grandparents out. More later. Must take final belly pic. I have my last exam with my Ob tomorrow.

The Last Blood Test....Maybe?

Update below (5/25/10)

Just doing my usual Thursday night wait for my lab test results to come in. We've had labs run at different times throughout the pregnancy and then went to weekly since about Week 34? Can't quite remember. Anyway I go on Thursday and get results emailed that night, which is so nice about Kaiser. While I have no reason right now to be concerned it is always with a touch of anxiety that I await news of what my blood is doing. Can I just say I am so relieved this will be over and I will meet my second son in exactly one week? Enough blood checks, enough urine checks.

Otherwise doing well. Ankles started to swell a tad but seems to be normal at 38 weeks. Not exactly pretty but not abnormal. BP still really good for 38.5 weeks. Still walkin a bit as it helps circulation and then putting my feet up when I can :) At the moment we have a c-section planned in a week, though if we go into labor before then we will attempt VBAC. I would love that but it doesnt seem the fellow wants to come out. Discussed pros and cons of waiting longer than 39.5 weeks for labor to happen naturally. Tough one - this is not a normal situation and lots more potential risks in waiting for VBAC than with someone who did not previously develop preeclampsia so severely last time.

Anyway sorry my writing isn't too clear lately. We have Grandparents flying in tomorrow from England and just an absolute shitload of stuff to get done still. Changing table is still in a box. Oh and we haven't decided on a name yet...or should I say haven't agreed!

Update: Blood tests came back same as last week, ie no change. So good! I believe they may take one more blood sample the day before the c-section but the official pre-e bloodtests are over unless something should suddenly change with my home monitoring. Dealing with insomnia, up at 5:30am. Sigh...

Anyway short prayer to my body, please hang on for 6 more days and continue to support my baby. It's been a long road.

Question re Blood Thinners

Someone asked me a question in the comments awhile back as to whether I am on blood thinners and if I had the underlying tests done. So all the tests were done after I had preeclampsia and HELLP in 2005 and all came back negative for any condition or gene mutation. With my new perinatologist she also tested homocysteine levels (which has something to do with the body not processing folic acid right) and these were normal. I believe if you have the MTHFR gene mutation - which many people do - sometimes your homocysteine level is high (possible link to preeclampsia and increased stroke risk) Anyway truth is I was never tested for MTHFR and my perinatologist's reasoning was that mutation is common in Caucasians and what really matters is whether your homocysteine level is high or not.

So...being there were no known underlying causes we went with low-dose baby aspirin rather than any of the hardcore blood thinners like Lovenox used by many in post pre-e pregnancies. I started the LDA before conception. I know some folks are more comfortable waiting til after 12 weeks and this is something to consult a doctor about - I only offer my take. But I figured if preeclampsia is something that starts to form right at conception and is essentially a problem with bad implantation of the placenta, then I wanted my blood to be in as good a condition as possible from that moment.

Of course it would be nice to not take anything during pregnancy but it's a risk/benefit analysis at end of day. I was encouraged by a smallish study out last year showing no increased risk of brain bleeding in babies whose moms were on LDA: http://www.businessweek.com/lifestyle/content/healthday/634272.html

Less Than Two Weeks Til Showtime

My son celebrated his 5th birthday this week. We hit full-term (37 wks) on Tuesday. Good week all in all (with the exception of England's performance in the World Cup today and US getting robbed of a goal in a separate game. Husband is British so we all get into this :)

This week's bloodwork came back good. Everything stable. Platelets continue to creep down a tad and are at 161K this week from 166K last week.

We tentatively have a c-section planned in 13 days and if we go into labor naturally before that will attempt a VBAC. No really signs that tenant is ready to come out (Why would he? He's been getting ice cream sandwiches every night) Still trying to do daily walks - a bit uncomfortable at times with a head pressing down on the vag, but doin what I can :)

I will try this weekend to answer some of the questions I have been getting in the Comments. My son was off preschool this week so have had very little me time.

You Just Don't Know the Future

On this exact date 5 years ago, I was hospitalized with preeclampsia and rode in an ambulance for the first time ever. On this exact date 2 years ago, I did my first triathlon. Today, we are one day short of being full-term with this bean. You never know what is going to happen in life from year to year. Thus, you just gotta keep on truckin. I've had a rich life because of the good and the bad.

36.5 weeks

Jesus, I have the world's worst acid reflux tonight. Overall felt good this week. Had a burst of energy most of the week (well relatively. A burst being like 15 mins at a time). Today felt exhausted though. Latest weekly bloodwork looked fine though two markers were not ideal. Uric acid has been trending slightly upward each week (this represents kidney function) And platelets still falling (down to 166K). According to doc's email today, both still well within normal levels, just something they will keep an eye on. (I think uric acid falls mid-pregnancy and then rises back to normal by end so this rising may actually be perfectly normal) On the positive side the big markers for preeclampsia still look good. BP trending around 112 over 65, urine negative for protein. Creatinine looked fine (kidney function again) and hematocrit level where it should be (too high means not enough expanded blood volume and correlated with pre-e). Still little to no swelling. Did a mile or so walk this evening waddling around neighborhood, having a big craving for a trail run once I am back in the post-pregnancy saddle.

Cramping and some contractions but no really sign my tenant plans to come out anytime soon.

3 days til full-term. Holy shit we just might make it.

And June 14th will mark the 5 year anniversary since I was hospitalized with preeclampsia.

Thanks!

Just a quick note to say thanks for the comments I receive on this blog! And I haven't officially signed up as a "follower" but I do also follow the blogs of all the Moms leaving comments, and try to check in at least every couple days to see how everybody is. I'm just getting more and more limited on how long I can sit for before my butt goes numb so I don't always comment when I read a new post. And my wireless mouse is driving me nuts this past week making it hard to surf the Web. And I crave birthday cake -- like all the time! Couldn't say no to two pieces last weekend at a party :)

Exercise, Healing and Preeclampsia

This isn't a post about the benefits of exercise in reducing preeclampsia risk or how exercise is beneficial in general before and during pregnancy. No, this is something I have wanted to write about for a long time - how exercise helped me heal in the years after a traumatic train-wreck of a pregnancy. And how it's saved my sanity the past year. I just hope I can put it into words well as it's 10pm and my butt hurts from sitting. Any position hurts lately.


When you have a pregnancy that is troubled, that ends in the worst way you ever imagined, or when things just basically go really really wrong, there is so much questioning afterwards. Anger, sadness, guilt, confusion, helplessness -- all of these feelings that many of my followers I know can relate to -- whether it was preeclampsia or something else that went wrong. You guys know what I'm saying. Especially when you thought you were doing the right things like taking your prenatals, avoiding alcohol, going to your appointments. So many of us end up with a feeling like our bodies failed us somehow. Failed us and failed the children we intended to carry for a full 40 weeks. Comments from folks who do not understand the complex physiological causes of preeclampsia usually don't help either! Some of us recover quickly physically, some of us are left with lingering health issues as a result of whatever developed in pregnancy. Not to mention the huge toll when one has a preemie and all that goes along with that (because prematurity does NOT end with the NICU). Anyway, everyone has their own way of coping. So here's my background:


I was into sports from an early age and in a Track and Field team by the time I was in elementary school. Ran cross-country later, did softball, volleyball, you name it. I did something every season. Got into cycling in high school and did that for quite a while. Went to university and was still a bit active but by my later twenties it was career, dating, other stuff that got in the way and made exercise less of a priority. I got back into running a bit before my wedding in 2002 but it was more to fit into the dress rather than as part of a lifestyle. Husband and I used to mountain bike some in our early years, but then homeownership and working long hours in high-tech sucked more and more time.


I certainly wasn't obese when I became pregnant but looking back wasn't where I had wanted to be. Add in a 1-1.5 hr job commute daily, with somewhat long hours. I think I've already blogged enough about early swelling in my last pregnancy and generally feeling unhealthy plus stress so let's just skip to the next chapter - After Preeclampsia.


In the two years after having my son in 2005, I kept wanting to get into shape but just never found my groove. Well for the first year my energy was focused on my son and his health, after a 76 day NICU stay - getting him to grow, worrying about his preemie lungs, devoting myself basically to helping him recover. My weight and physical fitness were secondary, and I was adjusting to being at home full-time. (I went back to working part-time after a year but from home, ie within 15 feet of the refrigerator).




Finally around October 2007 the stars aligned: a friend took me out on a trail run/walk and I was hooked instantly. She also got me to consider the crazy idea of doing my first triathlon. And another friend was just getting into running (she would go on to lose 100 pounds BTW). We started off with a mile, and tacked it on from there ever so slowly. And then the following June at exactly 3 years to the day I was hospitalized with preclampsia we completed the women's short (sprint) distance triathlon. By that October I ran my first Half Marathon and did two more in 2009 before getting pregnant last October. Attaching a photo from my first Tri and Half Marathon.


Every time I came back from a race, my darling son would see my finisher's medal or ribbon and excitedly ask me if I had won. Because to a 4 year old it's all about winning and being the fastest and nothing else matters. I try to explain to him I didn't, and I probably never will be on the award stand. I will probably never qualify for the Boston Marathon. Of course at 4 he doesn't realize what it's given me.




I don't know how to describe it. A feeling like well I can't control every aspect of my health and why my body developed this crappy syndrome, but I sure as hell can control my weight. I can control my fitness level. I can turn down the odds that say because I had pre-e that my risk of stroke and heart disease are greater. If I want to run 10 miles in one go, yes I have the power to do so if I work for it. If I want to reach the top of this 1,000 foot climb it may take me a year (it did) but each week I will run a bit farther before I stop panting. I cannot control my preemie son's growth nor how long it takes his prematurity issues to resolve but I am in control of my body. And this has given me a wonderful sense of accomplishment and a feeling of taking back what preeclampsia took from me.


I know not everyone gets the same desire, but I can only share what it did for me. Now on to this pregnancy, it has saved my sanity for close to 250 days now. Being in a high risk pregnancy and the worry over the what-ifs. All I can say is when the anxiety has gripped me, nothing has worked better than getting out with my iPod, listening to Desiree's "You Gotta Be" or another tune, getting out of the house, walking with the sun on my face. Putting one foot in front of the other and moving forward.

35 Weeks

Sometimes it's hard to believe the same body can be carrying two pregnancies so differently. As of 35.5 weeks I have yet to exhale completely but things are looking pretty darn good right now. On this date exactly 5 years ago, I was shuttling back and forth to the hospital not quite understanding what was happening and not knowing a heck of alot about preeclampsia. I hadn't a clue it would get as serious as it did and that I would be in ICU with organ failure in just 12 days with a 2 pounder in the NICU.

You can hypothesize about the many reasons why this pregnancy is (so far) preeclampsia free, and I have ideas as to what is helping, but at the end of the day it is a crapshoot and luck of the draw. Nothing, and I repeat nothing, has been proven to completely prevent preeclampsia from recurring. All you can do is reduce your risk through management of blood pressure, reduction of stress, good nutrition and being in optimal vascular health. And getting at a healthy weight if that is a risk factor for you. (Plenty of skinny people get preeclampsia but if you are obese, losing weight helps with blood pressure which is a known risk factor) I'm about to do a post on exercise later today BTW. Anyway I liken it to playing poker. You do what you can to hold the best hand and that's all you can do.

This week's labs looked great. Creatinine is at .58, platelets are back up to 180K from 170K last week.

Went in for appointment this morning and the BABY IS HEAD DOWN! Hooray for turning. Cervix is softening but no signs of effacement nor dilation. Not that surprising. VBAC would still be great if we go into labor and doc is hopeful but doesn't want a long inducement.

I also did confirm if the BP suddenly starts to rise we will indeed deliver the baby. We will not wait for full-blown preeclampsia to strike. Thank God. Pre-e can be deadliest post-partum so I'd rather play it conservative at this point.

Getting a bit better at controlling my nerves at each checkup but white coat syndrome continues to be the bane of my existence (see previous posts) Whereas I am running 110 over 65 at home I get 122 over 68 today in the office. Not bad for me as when I am really nervous it shoots MUCH higher and then we have to do a retest.

So from here on out, we have just 3 weeks and 6 days until the end point at which they will let me go. Continued home monitoring and weekly blood tests. Achy, crampy, and suffering from awful acid reflux but no swelling. Confession - sometimes I wake in the middle of the night to go pee and look down at my ankles for swelling. Hard to believe this was me exactly 5 yrs ago with preeclampsia. Couldn't get socks on, couldn't fit anything. If only we had the magic key to preventing preeclampsia every time.