Chez Perky

On the Plus Side, Now I Know the Terbutaline Works...

Yesterday for hours I was having pretty uncomfortable contractions spaced exactly 5 minutes apart. Eventually they shifted to exactly 4 minutes apart. I wasn't loving this development, but having a lot of contractions wasn't the end of the world. After all, that's what I DO, right? Yes, they were more uncomfortable than usual, but they weren't alarmingly so, so I wasn't sure whether it really mattered. I decided that I'd see if I could sleep through the night to decide how alarmed I should be. And that's when the fun began. The contractions didn't get better through the night, and I never did get more than about 20 minutes of sleep at a time, but there were only 2 stretches in the night where I even got that many. I spent the whole night trying to figure out when it was appropriate to call the doctor or at least call Matria. Calling at 2:30 seemed silly, I rationalized, since I'd be getting a bolus at 3am. At about 3:15, I fell asleep for 20 minutes, which seemed to me to suggest some improvement, so I figured calling wasn't strictly necessary. By 4:30 I was in agony, so I considered calling and asking for an additional bolus, except that the auto-doses really weren't doing much good, so why would I think another bolus would? By 5:30 I was in tears from the pain (as I had been intermittently through the night), but again, only half an hour away from a bolus, so calling seemed premature.

All night the contractions themselves were not only stronger and more regular than usual, but I had cramping so severe I expected to see blood every time I went to pee and pain into my back along with the cramping so strong that I would have sworn I had a kidney stone had it not been so definitely in sync with the contractions. Once I dragged myself out of bed at 6:30ish (with less than an hour total sleep to show for myself), I couldn't quite figure out WHAT to do with myself. I still felt crappy, but at that point, I wasn't feeling any worse than I'd felt all night, so I decided to wait to call Matria until it turned over from After-hours to the local center, so that I had a higher likelihood of talking with a nurse who knew me. At 8:30 I called over there and spoke with a nurse who, as it happened, I'd never spoken with before. She suggested giving myself an extra bolus, but also said that she'd recommend contacting the doctor, since this was a change from the norm for me. So she paged the doctor for me.

Dr. P. was on call, which surprised me, since he's going to be away all this coming week, but that was good since I saw him twice this past week, so he knew what was going on with my medications, etc. He called me directly, rather than trying to relay everything through Matria, which I appreciated. He first told me to raise my basal rate on the terbutaline, and then said he could bring me into the hospital and get me onto a monitor and possibly mag sulfate if I wanted. Alternatively, this is about the last opportunity I've got to use Indocin (they won't use it after 32 weeks), so since I haven't been on it for a few weeks, and since historically it works well for me, that was my other choice. So I decided to try the Indocin again and he said if I wasn't feeling better in several hours, I can always come in to the hospital. Fine and dandy, except today is my foster son's 4th birthday party, so I'd like to avoid that if possible. Obviously, if I need to go, I need to go, and that's all there is to it. However, if there's any way to avoid it today, I'd like to. I do want at least my husband to be at the party, and I'd rather not go to the hospital alone (I'm not going to be at the party regardless).

So that's what we agreed upon. And then... shortly after I talked to Dr. P., I pulled out my pump to give myself the extra dose that my nurse had suggested and I realized that the pouch that holds the pump was a little damp, as was the area around the pump where the tubing attaches to the syringe in the pump. How odd... And I peered closely at the tubing and watched it for a good long while. And I realized that absolutely NO medicine was going through that tubing. In fact, probasbly no medicine had been going through that tubing all night. And in retrospect, when I changed the syringe last night, I vaguely remember that ther was a subtle "crack" sound as I put the tubing on, and I DID check to see if anything looked cracked but didn't see anything, so I'd sort of forgotten about it. Obviously, I didn't look closely enough. Whoops. In the two months that I've had the pump, this is a first. Still, I feel foolish.

However, at least now I know that the terbutaline really IS serving a very important purpose. Because if that was just a tiny glimpse of 12 hours without terbutaline (bearing in mind that the half-life of terbutaline is, I think, 4-5 hours, so I theoretically still had terbutaline in my system that whole time, just less and less of it through the night, then boy, do I not want to know what life woud have been like without it all together. So as many contractions as I feel with the terbutaline... at least I now know that the Terbutaline DOES work. Really well. Sheesh!

Well, I know what I'll be doing tonight...

Tonight I will be packing a hospital bag. Because, you know, it seems like there's a possibility that I might need it at some point. I probably wasn't clear enough in my last post. In fact, I was downright misleading when I said, "So I'm just going to sit around waiting to see if it's a trend." What I'd been told yesterday by my Matria nurse was that one day of high blood pressure wasn't really a good data point and that if I had two days, then they'd decide what to do. So at the time I wrote my post this morning, I was waiting for my Matria nurse to call (since I'm not doing contraction monitoring anymore, she calls me in the afternoon, rather than in the morning after morning monitoring).

Anywhozit, my nurse called me around 12:30 and told me to take my BP again around 1:30 and see if it was still high. It was (125/94), so she called my doctor's office. They promptly had me come into the office to be seen and the nurse at my doctor's office suggested that IF I already have a bag together I might want to bring it with me, but if I didn't already have it together, not to worry about it. Well, phooey. That wasn't entirely what I wanted to hear. Suffice it to say, I didn't have a bag packed anyway, so it was a moot point. And so... off to the doctor's office. Dr. P. was in the office I went to, which made me happy (he's a very calming influence). My BP was, annoyingly, elevated but not high while I was there (130/84). High for me, but not high enough to be problematic. My cervix has shortened by about half a centimeter. That's not fabulous, but Dr. P. pointed out that at this point we want to get these babies another three weeks, not another three months, so it's manageable (at its shortest, it was 1cm, it's longest was 1.6 which used to be about as short as it would get).

Anyway, Dr. P. ordered some labs and a 24-hour urine collection. He said that obviously they've been doing their best to manage me as an outpatient for as long as possible, and that now they've kind of got a choice, which he left with me. Did I feel more comfortable being admitted now so I can be monitored 24/7 or would I be more comfortable and less stressed at home? I told him that honestly if he'd asked me last week I would have told him to admit me, but I really, really wanted to go home today. Next week, I said, I'm all yours. You can take me. In fact, I said, it's probably best to admit me next week, so that I'm not trying to navigate the issues of dealing with getting to the hospital or doctor's office if I need to in the midst of the Jewish holidays. He said that was a good point, and we'll talk about it again before we get there. He wanted me to still come in for my already-scheduled appointment on Friday and we'll see how it goes. At this point we're just taking things one day at a time, and that's okay.

Right now I'm really uncomfortable. The contractions are really getting intense. I gave myself an extra dose of terbutaline, which I normally try to avoid, particularly at night, but that's the way it goes. But it's okay. Not far now, right?

Breaking News! Indocin Works! (Update at Bottom)

So while I was in the hospital I was on Indocin for 24 hours. This isn't a drug that can be taken long-term in pregnancy because it reduces the amount of amniotic fluid, which is bad (and after 31 or 32 weeks causes bigger problems), but for short term use, it works quite well as a tocolytic, as I've discovered a couple of times now. So, while I was in the hospital, my contractions went down to only a few per hour, which is great.

I didn't bother to monitor the night I got home, because I figured I'd been monitored enough all day. And the next morning (Tuesday morning) I had zero contractions. This isn't shocking, considering that I still had some Indocin in my system. (Though, honestly, I can hardly remember another time that I had zero contractions in an hour.)

Tuesday night, however, I had fifteen contractions in an hour. The Indocin, clearly, was no longer in my system. (I had my uber-husband look up the half-life of Indocin, which turns out to be 4.5 hours, so that worked out about right) So I had to give myself a demand dose of terbutaline and remonitor (shock of shocks). And I had 10 contractions. So the nurse said "Well, should I have you remonitor again, or just call the doctor?" Uh, yeah, let's think about this. It was 10:30pm. If I remonitored, by the time I heard back from her it would be close to midnight, by which point if I still had that many contractions, they'd be calling and waking up a doctor. No thank you. So I told her to call the doctor. In an ideal world, frankly, I would have called the doctor, but for whatever reason the after-hours nurses prefer to speak to the doctors directly, so whatever. I suggested that she mention that I do have Indocin at home and ask if I could take that for another 24 hours.

Dr. R. was on call again (she was the doctor on call who admitted me on Sunday), so she knew that my fetal fibronectin on Sunday had been negative, knew what my cervical length was, and knew what the orders in the hospital had been off the top of her head, so she was okay with me taking the Indocin for 24 hours, and was otherwise unconcerned. For the record, I wasn't concerned either. This is just what I do at this point. I contract. A lot. Often. But, admittedly, if it had kept up at that rate, there was no way I was going to get any sleep, because it was making me pretty darned uncomfortable. And so.... I went back on Indocin for 24 hours last night. Easy enough.

And this morning I had 3 contractions. And tonight? One contraction. Gee, do you think this stuff works? I think so. Shame I can't take it continuously.

Edit: Jennifer from Arkansas asked You've posted about the side effects of the terbutaline (sp?) as far as how it makes you feel. What is the indocin like? Any immediate sife effects to speak of? (other than the fact that it ROCKS in taking care of the contractions!!)

Well, all drugs have a side effect profile, of course, but the short answer is that Indocin doesn't really have any negative side effects for me. Indocin (or indomethacin) is a non-steroidal anti-inflammatory drug (NSAID) like Aleve or a variety of other drugs. Normally NSAIDs are contraindicated in pregnancy, but obviously there are controlled exceptions like this one, but I wouldn't recommend taking an NSAID just for fun while pregnant. Anywhozit, the main side effect for me is that it helps my headaches ever so slightly. It can also cause stomach pains or upset, so it's recommended that one take it with food or Tums, which I find is helpful, but rarely remember to do. (I never found that Aleve hurt or upset my stomach, but I do find that the Indocin does a bit... which is funny because I took a LOT of Aleve before I was pregnant and the Indocin isn't any more potent) Anywhozit, that's pretty much it. I don't think there are any other major side effects.

I'm also now taking the Nifedipine every day which has a few side effects itself, most notably it is a beta blocker, so it can lower blood pressure (which isn't a bad thing, since Terbutaline raises blood pressure). The lower blood pressure can also lead to dizziness and whatnot, but that hasn't been a problem for me. Yet.

Home Again

Many thanks to my pinch-hitter husband for posting for me this morning. As he said, I was sent to the hospital for monitoring last night after my 4:30 monitoring session had 15 contractions in an hour. Suffice it to say, it was a fun day all around.

So... off to labor and delivery triage we went. Where we quickly discovered I was still having far too many contractions. The nurses were great, the hospital was boring. My doctor called after a bit to suggest some options. We settled on trying 3 doses of Nifedipine over an hour and half and if I was still over threshold after that, she'd admit me over night for observation, get me on Indocin for 24 hours, and check my cervix in the morning and probably let me go after that.

Three doses of Nifedipine later, and just as many contractions, and there was a room with my name on it. And so, my darling husband went home to get some things for me, including (bless him) a toothbrush/toothpaste which hadn't even occurred to me, but BOY DID I LOVE HAVING THAT! And the fun began. They got me back on the monitors... three fetal monitors and a contraction monitor. Now the ironic thing about that set up is that to keep the fetal monitors in the right place, I had to be laying on my back. But that made the contractions worse. But rolling onto my side disturbed the fetal monitors too much. Finally around midnight, the nurses called my doctor and asked if they could just leave the contraction monitor only on so that I could get more comfortable and hopefully sleep. At 1:30, they came in and took off the three fetal monitors, I rolled onto my side and went to sleep. At 4am I got my second dose of Indocin. At 6am, I woke up and my day started... for the last couple hours I'd only had a couple contractions. Miracle! (Indocin works well for me...it's just that it can't be taken long term)

Anywhozit, around 8 I was brought the world's most disgusting breakfast (kosher hospital food... never a good thing... ick!). and a bit before 9 I was taken down for an ultrasound and to meet with my doctor. My cervix was, at its shortest, 1.7cm... shorter than last week, but not so much shorter than it was 5 weeks ago when this whole bed rest crap started in the first place. She recommended raising the basal rate on my terbutaline pump, adding Nifedipine XR again on top of the terbutaline, and having a fetal fibronectin test done weekly along with the already-scheduled weekly cervical measurements.

She was fully prepared to let me go home and asked if I had any questions. And I said, well, I wasn't trying to be picky or anything... but I was doing the 4x daily finger sticks for blood sugar testing because I couldn't take the three hour test, and since I hadn't had a single blood sugar reading out of the range of completely utterly normal, could I maybe cut back on the number of times I had to test...but I was willing to do whatever she wanted me to. She said I could just do it twice a day if I wanted, but forewarned me that as I got later into the pregnancy, they'd probably still make me return to four times a day anyway. No problem. She went off to type up the ultrasound report and then popped back in and said, "Hey, since you're in-house right now anyway, do you want to just DO the three-hour glucola test?" Uh, YEAH! Except I'd already eaten breakfast. No problem. I had eaten breakfast at 8, so they'd do the test at 4 and I could go home after that, unless I'd feel better staying another night (NO THANK YOU).

And so... I spent the most boring day of my life in the hospital today, internet-less, bored, with limited things to read or do. But on Friday, I should know whether I have to keep finger-sticking myself! And I was home at 8pm tonight. Safe and sound. All is well, the babies are all healthy and fine. The contractions are better for the moment. And life is good because I have my precious internet back. Gawd I'm an addict. Thanks everyone for your kind thoughts. I suspect this won't be the last time I have a visit to the hospital before this is all over, but at least this wasn't a terribly long orientation... :) I'll try to catch up on your blogs tomorrow.

Post from the spouse

If you read the last post, then you're aware that there were a lot of contractions - enough that the MD wanted to see Karen in the hospital. After several hours in triage, she was admitted for further observation, medication, etc. Things are under control, and she and the kidlets are well. She'll be discharged this evening and will likely update again when she can.

-S

We've hit a new record...(updated twice in middle)

Fifteen contractions this morning. In an hour. I'd say that's impressive, except, uh, that's not exactly how this is supposed to be working...

*shrug* I have to take my BP and pulse in a couple minutes, give myself a demand dose, and then remonitor from 10:30-11:30. Hopefully the extra dose will help calm things down. Otherwise, I imagine this will be an... interesting day.

I wonder if there's an award for hitting the record. Er.... scratch that. I'm pretty sure I don't want to find out. I have a feeling today I will not be moving much. My husband can wait on me hand and foot, right? Excellent.

Update: 8 contractions in my re-monitoring session. Got an auto-dose of terbutaline at 12pm. Remonitoring from 12:30-1:30. Not worried about it. Likely to go down again... that's three doses of terbutaline in a short timeframe. Even if it goes down, I may ask the nurse to call my doctor anyway, because that much terbutaline at once is making it hard for me to breathe comfortably. I think it's time to ask about repeating the Indocin regimen for 48 hours so that I don't have to keep doing this multi-dose stuff for the next few days. I dunno. I'm not feeling very assertive today, so I guess I'll just have to figure it out.

Update #2: Now I'm waiting for a call back from the doctor. Third monitoring session was 12 contractions. ... And while I was typing this the nurse from Matria called back to say she'd heard from the doctor on call (Dr. R.) and what she wants me to do is give *another* demand dose at 4pm, re-monitor at 4:30 and then decide whether I should come in to be checked. SO.... I'll update you later!

In other news.... I absolutely could not fall asleep last night, which is unusual for me. I mean, I usually can't STAY asleep, but most nights, my head hits the pillow and I'm OUT. Not last night. Not sure what the deal was, but I think it was close to 3am before I finally drifted off and I couldn't drag myself out of bed until about 10 'til 8 (normally I wake up around 6, even if I don't get out of bed that early). Anyway, in my supreme irritation at not sleeping, I read a couple blogs I've never read before and then got curious about something and got myself a tape measure...

Now, I've lost about 20-24 pounds this pregnancy (depending on the week... I seem to gain and lose the same 2-4 pounds week to week lately). But what wasn't making sense was that recently, many of my pre-pregnancy clothes have been fitting just fine. My skirts have fit me all along, but I grew out of my blouses pretty quickly after I started showing. (my skirts fit me primarily because I don't like things ON my belly; I prefer that they be under my belly... but recently, I've noticed that even my pre-pregnancy skirts are sometimes falling a little too low if I wear them and I realized I could actually pull them up around the largest part of my belly without any real discomfort other than my normal "I don't like things touching my belly" discomfort)

Anywhozit, I pulled out a tape measure and measured my girth. And sadly? My "waist" measurement (not that you can really call it a waist anymore) is only about an inch larger than it was last summer (the last time I measured my waist). I lost a bunch of weight (maybe 15 pounds in three months?) in my first pregnancy and only gained 3-5 pounds back after the miscarriage (some of which was attributable to the fertility drugs, I think). And I've lost about 20 in this pregnancy... but when you consider that the babies keep gaining weight and I'm not gaining weight... my total loss is probably much higher than 20 pounds. HOLY HECK! I wonder how much I'm going to weigh a few weeks after these babies are born. I mean, seriously, I'm overweight, there's no question. And I had a lot of weight to lose. But sheesh! I was JOKING after my first pregnancy when I said all I have to do to get to my idea weight is get pregnancy 3-4 times, but apparently pregnancy really IS the great weight-loss plan for me. How ridiculously odd.

(to be fair, a lot of this weight loss is probably due to the fact that I've been off of Depakote for a while now... I gained a LOT of weight taking Depakote, but had to get off of it because Depakote = EVIL in early pregnancy. And now I'm taking Topamax, which does have a weight loss side effect for some people... but when I last took it [at a significantly higher dose] I didn't have this kind of a drastic weight loss - not even close. Anywhozit, I think it's fair to say that I'm taking off that 20 pounds per year that the Depakote helped put on me... at a somewhat faster rate than I put it on)

Frustrating

First, I should note that this is my 198th post. I'm pointing this out because of the unlikelihood that I'll notice when it's my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there's the fact that I made it to 28 weeks this week. And... I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I'd had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That's not good. What is good is that he didn't make me think there was that much reason to worry until it was clear that we didn't need to worry. But anyway, in a lot of ways, I'm very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people... but stupid people) keep thinking it's okay to say stupid shit like, "Well, great, you got to 28 weeks, so it's all good now, the babies can be born any time, right?!?" WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes... 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don't survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That's too early. If my babies were born right now, they would be about 2 pounds. That's not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son's grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I'd had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

"Hello?"
"28."
"28?"
"28!" (I'm still trying to figure out who the flying fig is on the other end of the phone)
"What do you mean, 28?"
"You're at 28!"
"That's not possible!" (I knew it wasn't my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there's no WAY I could have had 28 contractions in an hour)
"What do you think it is?"
"What do you mean 28?"
"28!"
"28??"
"Yes! 28!" (this went on for about two minutes)
"28 what????"
"You're at 28 weeks!!" (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don't know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it's a milestone. NO, it's not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, "I even talked to my sister who's an OB/GYN and she said..."). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I'm begging you, stop acting like it's okay for these babies to come out right now!

I swear, it's like I almost feel like all these people who think it's "okay" now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don't want to find out the hard way. I just want these babies to have every chance possible. I don't want them to come out now. I'm not ready. They're not ready. They're too tiny. I'm too scared for them. Please don't come now. Please. I don't know how we'd bear it. I don't. I know we'd just do it, but I don't want to find out. I really don't. I can't.

I haven't been a seriously emotional wreck through this pregnancy. I'm not more snippy than I am when I'm not pregnant (I'm very snippy when I'm not pregnant, so who can tell the difference?). I rarely cry, though I'm crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I've been okay. I've had my moments of "oh my god how are we going to take care of triplets??" but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything's okay now... I just feel like ... like they're saying it's okay for all my worst fears from the beginning to come true.

And it's not helping that the contractions really are out of control. I mean, the good news is they're not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO...). I'm just lucky. Somehow, that doesn't bring any peace of mind, because it makes me worry that if there really IS a problem, we'll miss it. But then again, my doctors have been careful never to assume that my contractions are just "normal for me" when they get up to a certain level. They'll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything's different. So it's not like they're blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I'm having so many contractions that they keep changing the terbutaline dose. And I can't keep taking the Indocin (though I suspect I'll be back on it for another 48 hours next week), even though it worked. Unfortunately, I've gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they've lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren't "just" migraines... this is definitely terbutaline-induced). I'm afraid that we're to the point where even though I haven't topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we'll see. I'm trying not to be frustrated. I'm trying not to be angry at people for their good intentions. I'm trying not to be too anxious about these babies. I'm trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I'm trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn't matter. All that matters is keeping these babies in for another 6 weeks.

Doctor's Appointment

The long and the short of it (no pun intended) is that my cervix is still short (around 2.4cm), but it's stable, which is great news. Babies all look fine, good heart rates and good amount of amniotic fluid. Dr. P. was working today, which was a relief (he was the doctor on call this past weekend, so I'd been hoping to speak with him directly today, and I got my wish).

He spent a lot of time talking to me about the changes he'd made to my protocol and why and how he hoped things would progress over the next several weeks. We're on the same page with the whole, "even though the survival rates for 28 weekers are very high, it would be very bad to deliver right now." He still wants to get me to 34 weeks before delivering, and I'm all for it.

Two babies are head down and the placenta previa has finally completely resolved itself, so I told him I don't need no stinkin' c-section. He reiterated that vaginal triplet deliveries are tricky at best and not always advisable, and I said, "well, I can dream, can't I?" "Oh yes, you can can dream. And I always wanted to be 6'4"..." Anyway, he didn't say no, but did emphasize that I shouldn't get my heart set on it. He has done vaginal triplet deliveries and he's not dead set against it (for that matter, he's done a vaginal quad delivery), so it's not like he can't do it, but he wants to make sure I realize that it's a very rare occurrence that things really line up in such a way that it's remotely advisable. I understand that, but I really want to keep the door open for as long as possible, even though I know it's probably not going to happen.

He explained that I can't stay on the Indocin long term, as it tends to result in a lower amniotic fluid level, but that if we need to repeat the Indocin regimen of 48-hour treatment on a weekly basis, we can do that until about 33 weeks... after that, there are bigger problems, but then things get a little less problemmatic if I go into labor anyway. He also explained why he didn't want to do steroids yet... although steroids are good for about 4-6 weeks after they give them, they are problemmatic for a couple reasons: 1. they'll definitely raise my blood sugar (which isn't the end of the world for me, since my blood sugar is stable and normal right now, but why tempt fate if we don't have to yet?) and 2. steroids have a tendency to increase contractions both in frequency and intensity for several days to a week after administering them. I love irony. So he said steroids aren't quite as magical as everyone thinks they are. Still, he'll definitely give me steroid shots at or around 30-32 weeks to give the babies the added edge in lung development that they need, but his preference is to put it off until as late as possible.

He said one of the problems I'm facing is that my uterus is distended further than it would be if I were full-term with a singleton right now and it really does think it's done, and that's likely a huge contributing factor to the contractions. He said this is definitely aggravated by the fact that I've got a very small pelvis to rib size (read: I'm SHORT), so there isn't even much more room for things to expand, even if it wanted to. With all that pressure on my uterus and, in turn, all that pressure on my cervix, it's no surprise that sometimes my contractions get out of control, and the best they can do is try to control it with the medications they have available for the time being. Definitely, though, bed rest is doing a good job, because my cervix is hanging in there and is much improved from how short it became right before I got thrown on bed rest. So I have to keep hanging out in bed/recliner for the long haul.

Oh, he also talked about the fact that most women have more contractions at night... 4pm-4am you definitely see increased uterine activity. I definitely have noticed EXACTLY this, and thought I was losing my mind. But he said it makes sense if you want to take *any* lessons from evolution, this is one you probably could take seriously... that most mammals need to give birth under the protective cover of night. Even though this isn't so relevant to humans (at least not today), it's still a documented scientific fact that uterine activity increases between 4pm and 4am. There are also more labors that start in the middle of the night than, say, mid-morning. Interesting! This is why when all hell was breaking loose with me on Saturday night he said he wanted to raise my basal rate on the terbutaline and then let me sleep if I could and see how I was doing in the morning, because doctors are much more concerned if contractions are at a high rate during the morning hours... they tend to be much more troublesome. Since I was still over threshold in the morning, that's why he called in the Indocin.... because the morning pattern was much more indicative of a problem than the evening-into-late-night pattern had been.

The other thing he'd done Sunday morning was raise my threshold to 8 contractions per hour... and the reason he did that was because he said at this point with triplets it's a lot more realistic to expect to see 4-6 contractions per hour regularly, but 8 per hour is definitely alarming, so rather than getting up in arms about something which could be normal (and bear in mind that all weekend I was above 8 anyway, so I was still justified in being concerned), raising the threshold would allow us to focus in when there really was something that needed attention.

Anyway, that was the appointment. It was a good appointment overall. Dr. P. wasn't saying he's not concerned, because he is, but he's definitely on top of things, which gives me a lot of hope and peace of mind. Meanwhile, we'll take it one week at a time, and if necessary, one day at a time.

And now, I really, really, really must go to bed.

Quick Update

I never really finished saying how things ended up over the weekend. Sunday morning I was still over threshold (7 contractions), so the doctor raised my threshold to 8 contractions "allowed" in an hour and called in Indocin (indomethacin), which is an NSAID that is used as a tocolytic. That combined with the two increases to my terbutaline (basal and bolus rates) over the weekend have calmed down the total number of contractions I'm getting, though the intensity of the contractions continues to escalate.

I have a doctor's appointment in about an hour, so we'll see if things still look stable. If they do, I imagine I'll be allowed to stay home for a while. If not, I don't know what's in store. My guess is that everything is still stable and that my body is just screwing with me.

I'm really starting to feel nervous. I'm not really worried that anything is really going wrong. I think it's fair to say that even if something was going wrong, it's out of my hands. ButI feel so utterly out of control and that feeling isn't pleasant. I know at least part of it is that the terbutaline makes my heart pound which simulates that nervous feeling in the first place, because the nervousness is definitely worse when it's close to or during a terbutaline auto-dose. FUN!

Anywhozit, I'll try to remember to post after my doctor's appointment today.

well phooey

Yeah, so first of all... checking blood sugar four times a day? SUCKS. Worse? All of my blood sugars have been completely, utterly, astoundingly, ridiculously normal. Technically, I know, this is a good thing. It's just that it's extremely annoying to do this when there isn't even a really good reason for it!

Furthermore, the diabetes educator that came out to edumacate me was completely patronizing and annoying. She kept lecturing me on the perils of diabetes and blah blah. And yes, I get that it's something to be taken seriously... except, hello? I have not yet been diagnosed with diabetes (nor does it seem like I will be if these blood sugar readings are any indication). She emphasized that this would "obviously be a serious lifestyle change" what with the diabetic diet and all. Now, I'll use the diet as a guideline, but I'm not following the diet all that strictly at this point because, again, not so much with the diabetes diagnosis. But I wasn't going to tell her that. What I told her was that the biggest lifestyle change really was going to be that I was going to need to eat much much more and much more often according to the diet guidelines she was handing me (a 2500 calorie diet).

"Oh," she said in a sickenly sweet and patronizing voice, "I think you'll find once you start measuring portions, that you weren't eating as little as you think you were."

Okay, what part of I'm pregnant with triplets and I've lost 22 pounds in this pregnancy did you miss in this conversation? And how dare you assume that I've been overeating all this time!! I've had doctors accusing me all my life of overeating, so I'm accutely aware of the number of calories I consume in an average day. Yes, sometimes it's more, sometimes it's less. But on an average day, I'm not eating ANYWHERE NEAR 2500 calories. Yesterday and today, in the spirit of cooperation, I probably had about 1800 calories and I can't begin to describe how sick I feel from eating all that food and eating practically non-stop. Ugh. Ick. Yuck.

Enough bitching about that though. Let's talk about contractions.

Five last night. Five this morning. Not over threshold, but combined with a lot of cramping, my terbutaline dose was raised a tiny bit and I was asked to remonitor mid-day just to see how things were. My strip was a little odd, so who knows, but I was just told to make sure to monitor a little early tonight and send it in. So I did.

I monitored from 6-7ish. 10 contractions.
Demand Dose at 7:15.
Remonitor from 7:45 to 8:45. 8 contractions.
Regular dose occurred at 8:15 in the span of time I was monitoring.
Another demand dose at 9:30.
Remonitored from 9:50-10:50pm. "At least 9 contractions" but the monitor had been all wonky and kept telling me to adjust the sensor, so they're not sure they saw them all.

Thank heavens Dr. P. was on call tonight, because he's not making me come in to the hospital. Yet. He raised my basal rate by 10%. He said to sleep through the night. And if I'm over threshold again in the morning, he'll call in Indocin to my pharmacy. If, however, I top out on the terbutaline (which it sounds like I'm about to do), I get to be hospitalized. My doctor, as a general rule, does NOT hospitalize patients unless there is no other option. So, well... phooey.

So there you go. That's tonight's fun. Hopefully tomorrow will be, um, less fun.