Chez Perky

Blood Pressure

So, my normal, non-pregnant blood pressure is about 110/65 or lower. During the first, oh, 29-30 weeks of this pregnancy, my blood pressure ran about 120/70-80. Totally fine and normal. I don't remember exactly when my blood pressure shot up last week, but for the last week or so, my blood pressure readings have been, um, not so great. I take my blood pressure every morning (and now, often several times throughout the day as well, but I'm not typing out every single BP I've taken in the last week). Here's what it's looked like (do note that often I get a lower reading later in the day and I ALWAYS get a lower reading at the doctor's office which makes NO SENSE):

9/5: 125/94 (In doctor's office later, it was 120/84, I think)
9/6: 136/111
9/7: 128/90 (at doctor's office it was 110/63... WTF??)
9/8: 106/85 (with Procardia in AM)
9/9: 121/103 (later 118/92)
9/10: 132/105 (later 146/90)
9/11: 123/105 (later 126/98)

I thought it was maybe my BP cuff that wasn't working properly, but I've got two, and they come out with just about the same readings. (they are both electronic, one is fully-automatic, one is semi-automatic) Apparently, I'm just nice and calm in the doctor's office. Normally, my BP shoots up in the doctor's office. Go figure.

Anyway, my nurse at Matria, the traitor, called my doctor yesterday and again today with my BP readings. Sure enough, I got a call back this morning saying that there's a pretty good possibility that they'll decide at my appointment today to just admit me to the hospital for observation. Careful what you wish for, I suppose. I was JUST coming to believe that maybe it WOULD be better for me to just be at home during Rosh Hashana, since I could always just go to the hospital if I needed to (there's absolutely nothing wrong with going to the hospital in a medical emergency on a Jewish holiday... it's going for something routine and/or not necessarily emergency-status that's a problem). So anyway, I was warned to pack a bag (it's mostly packed anyway) and bring it with me. At least they warned me.

I'm 32 weeks tomorrow. Just 2 weeks to go. I said that to the sonographer/medical assistant person who called me with the news of possible hospitalization and she said, "2 more weeks? Well, we can hope..." UGH. But it's all good. I'm seeing Dr. G. today. I totally trust his judgment. I have absolutely no reason to believe he would lead me astray. I do sort of wish Dr. P weren't out of the office all this week. I find Dr. G. just as comforting as Dr. P., but there's something in the back of my head wishing Dr. P. would be around, just in case. I'm not sure why. And it's not like delivering triplets at 32 weeks is a bad thing. That's the national average. It's just sooner than I'd hoped. And anyway, I still really do believe that I'm going to hang in there until 34 weeks. I'm not sure WHY I believe that, but I really do.

So, yeah. I wouldn't have been updating September 13-15 anyway, because of the holiday and Shabbos. So don't be alarmed if I drop off the planet. If I do end up admitted, I'll have either Jess or my husband update tonight. Okay? But even if I'm admitted, it's likely just so they can keep a closer eye on me, which is fine. So don't freak out if I disappear.

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.

Almost 27 Weeks- can you believe it??

I had a ridiculously long appointment yesterday. It's really sad when the biggest excitement of my week is going to the doctor. But it's also the most exhausting part. Whew, it takes a WHOLE lot of energy for me to get up and out of my house these days! It's pathetic. Anywhozit, yesterday was a long appointment because it was more than just my normal weekly cervix check. It was:

1. 1 hour glucose screening
2. Normal prenatal BP/Urine/Weight Check
3. Fetal Fibronectin culture
4. Cervix check
5. Growth scan for the kiddos

A long appointment. Should get the glucose and fetal fibronectin results today or tomorrow. I expect that the glucose test will not be pretty and that the fetal fibronectin will be fine. Blood pressure was fine, as usual. I've lost another 2 pounds, but I didn't get yelled at this time. My doctor isn't concerned as long as the babies are growing and I'm not anemic (they drew extra blood along with the glucose screening to make sure that I'm not anemic). My cervix was slightly shorter than last week, but still relatively stable. And the kiddos are growing nicely.

Baby A is estimated at 2 pounds 2 ounces (50th percentile)
Baby B is estimated at 1 pound 14 ounces (38th percentile)
Baby C is estimated at 1 pound 13 ounces (37th percentile)

Heartbeats were all lovely in the 150s and 160s. Baby A has listened to my complaints and turned back around and is head down. Whew. Baby B also has sort of turned back around and is somewhere between head down and transverse. Baby C is mostly transverse, slightly breach. They're kind of in this weird little circle... Baby A's head down in my cervix, feet up against Baby B's head who's feet wrap around to Baby C's head and baby C's feet wrap back down and around toward Baby A. Kind of weird.

Contractions have been weird. I'm usually okay in the morning with a few or no contractions. But check out this pattern:

Friday night: 5 contractions, gave demand dose, remonitored, 3 contractions, still really crampy, slept through it.
Saturday morning: 4 contractions (threshold), gave demand dose, remonitored, no contractions, cramping, raised basal rate.
Saturday night: 7 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Sunday morning: 3 contractions, no big deal.
Sunday night: 5 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Monday morning: 2 contractions
Monday night: ELEVEN contractions, but hadn't sent strip in, so no remonitoring involved.
Tuesday morning: no contractions.

So now I get to start sending in my evening strips as well as my morning strips. Which means I have to monitor earlier in the evening (I usually monitor around 9pm or 10pm, but if I'm going to send them in, they prefer to receive them by 9pm. I don't like to monitor right at 8pm because that's when I receive an auto dose, so I don't think that gives an accurate picture, so this means I have to monitor at 7pm tonight. Yippee.

Oh, and while I was writing this entry, I got a call from my nurse... Yep, I failed my 1 hour glucose screening, apparently not by very much. But here's the kicker... normally this would mean taking the three hour glucose tolerance test, except I'm not allowed. Because that would mean sitting in the lab for four hours. And I'm not allowed to sit for that long. So instead, I get to have Matria (the company that does my contraction monitoring and terbutaline pump stuff) come out and edumacate me on gestational diabetes and using a glucometer and blah blah blah. And then I get to check my blood sugar four times a day for a couple weeks while they decide if I have gestational diabetes. And if I don't, I still get to keep checking my blood sugar just for fun, because I can! And if I do, well, the fun's just beginning!

The bitch of it is that they suspect that the terbutaline plus the whole triplet thing is what's likely caused the elevated blood sugar. I've been losing weight throughout the pregnancy, and have no family history of diabetes nor gestational diabetes. I don't eat sugary sweets or really many excess carbs in the first place. So let's say it's the terbutaline's fault. What would I rather have: high blood sugar and relatively controlled contractions, or low blood sugar and completely UNcontrollable contractions? Yeah, that's what I thought. Not a difficult choice to make. And anyway, I needed something else to do with my day, right? Wouldn't want to get bored!

I knew it was a high likelihood that I'd blow this here 1 hour test, but I was so hoping I was just being a negative nelly. Because seriously... have I mentioned that one of the problems with gestational diabetes is delayed lung development?? And have I mentioned that AT BEST these babies are going to be 6 weeks premature? Yeah. Aside from that, at this point, I have weekly cervix measurements, weekly urine protein checks, daily blood pressure monitoring, twice (sometimes more) daily contraction monitoring, and now I'll have 4x daily blood sugar monitoring. Seriously... is there ANYTHING they're NOT going to know about me by the time this pregnancy is over with?

Right. Well, you know, it's all good. It'll just give me more toys to play with. :)

Enough of the Self-Pity (Updated at Bottom)

Right. Well, that's quite enough of the self-pity. Or at least, that particular variety. I will now move on to an entirely different kind of whining. Pregnancy whining. Okay, I get it, there are lots of you out there who would give nearly anything to have the opportunity to whine about pregnancy, and I get that. So I'm sorry if it offends you that I don't find all of pregnancy all sunshine and light. Maybe I would if I had a singleton pregnancy, maybe I wouldn't. What I do know is that we infertiles HAVE to give ourselves permission to accept that there's nothing wrong with us for finding out that sometimes pregnancy isn't glamorous and sometimes parenting isn't perfect and sometimes we aren't always gracious about either one. Therefore, disclaimers aside, here are some of the good and the bad of late:

Good: I had a pretty decent week last week in terms of contractions and other such things. My appointment went well, my cervix had stablized and in fact lengthened somewhat, I even got a little cocky about it ("I don't need no stinkin' bedrest!") but not to the point that I violated doctor's orders. Contractions weren't done and over with, but I was generally having a good week, and they were definitely under better control than they had been.

The Less Good: The operative word in that last sentence, of course, is that they were under better control. Until Friday. I monitor contractions twice a day. I'm required to send them in every morning, but not in the evening unless I'm feeling symptomatic. I can also monitor any other time of day if I'm feeling off or feeling contractions or just feel like it or whatever. Friday around 5pm I felt a few contractions, but I sort of ignored them, because that's not terribly uncommon and I didn't think much of it. But then a little before 6, I had a few more and I thought, well, that's 4-6 contractions within the same hour, so I probably should call about getting a demand dose of terbutaline. After any demand dose, I have to monitor and send in the data, so that meant my evening data WOULD get sent in, which was fine.

So I called, asked if I could give myself a demand dose, was told yes, and then told to monitor from 6:30-7:30 and send it in. Fine. Except I couldn't get the pump to GIVE me a demand dose. It's a different button than the rest of the buttons and that button stopped working. So they had a work around for it, but that took some time, which put off my monitoring time until about 7ish to 8ish. Which is fine, but Shabbos (the Sabbath) was starting at 8, so the timing wasn't fabulous. I am allowed to do all the medical stuff I need to do on Shabbos, even though a lot of it isn't stuff I'd normally be allowed to do (e.g. using the phone). It's just that there are a couple things I had to do right at 8 (like light candles to bring in Shabbos), so it wasn't terribly convenient. Still, I made it work.

I expected that the monitoring session would yieled nothing interesting since I'd just given myself a demand dose and usually that takes care of the contractions immediately, but the nurse called back and said I had 5 contractions, which is above my "allowed" threshhold. Which meant I was going to have to re-monitor. Great. Except it's Friday night, late, I have a cranky 4 year old, my husband is at shul (synagogue), and I have to deal with remonitoring and once my husband gets home in theory we're supposed to eat a "festive meal" in honor of the Sabbath. (Someday maybe I'll explain the whole sabbath thing to my non-Jewish readers, but really, if you're wondering if I'm completely nutso, yes I am, but if you want more details, just email me... there's a link to my email address in my sidebar) Since 8pm is when one of my automatic doses happens anyway, the nurse wanted me to wait until about 8:30 to monitor again to give the dose some time to work its magic. And so, at 8:30, I strapped the monitor back on while attempting to appease J with some tortellini and some books and a couple cars (yes, he should have been in bed, but it's not like I can struggle with him alone these days).

And at 9:30 I sent in the data again. And while waiting for the phone call back, we started to sit down to dinner, and then, of course, the phone rang. The contractions had gotten much better..3 short contractions, which is under the "allowed" amount (thank heavens, because otherwise, doctor's orders would have mandated a phone call to the doctor on call and I REALLY didn't want to deal with that!), but the nurse didn't love that I'd been having a lot of cramping and it wasn't getting a lot better. So she waffled for a bit about calling the doctor anyway, but I talked her out of it (my doctor didn't seem OVERLY concerned when I'd mentioned it before, plus I promised to call if I couldn't sleep through it which is always my gauge of whether I should be waking up a doctor). She had me give myself another demand dose and encouraged me to call if it got any worse through the night. Fine.

And the next morning was more of the same. Too many contractions, demand dose (which they still had to use the awkward work-around to do, because the demand-button wasn't working) remonitor, better but not perfect, still a lot of cramping, so they changed my basal rate on the pump and got to work on getting a new pump programmed and couriered out to me. The increased basal rate did seem to help a bit throughout the day (it had also been increased the day before, so it had cumulatively been increased about 30% from two days prior). I didn't do an evening monitoring until quite late because I had people here visiting on and off throughout the day. I felt a little funny, but decided not to send in the data until morning since I wasn't required to and since it was so late. I figured I'd send it in the next morning. Turned out it was both a good and a bad choice not to send it in, because I'd had SEVEN contractions (nearly double my "allowed" threshhold) and a lot of irritability. So if I'd sent it in, I would have ended up having to do a demand dose and remonitor at midnight risking calling the doctor at 1 in the morning and blah blah blah. On the other hand, I'm lucky it didn't become a huge deal, since I didn't send it in... Anyway, this morning, all was clear, so life is good. I think I'll do this evening's monitoring somewhat early and go ahead and send it in just for the fun of it.

More Good: I did get the replacement pump around noon yesterday and it's working just fine. I've haven't been alarmingly uncomfortable today. I've got all the usual "hey I'm pregnant with triplets" discomforts, but nothing that's making me go "hey that's not good!" Also the babies have been kicking like mad and I'm pretty sure at least one of them has turned back around, so I'm hoping the others follow suit and SOON!

The Slightly Less Good: Baby A has discovered that JUMPING on my cervix is much more fun than punching it. I'm fairly certain that Baby A is still breech and is remaining that way simply to torture me. Youch!

Good: J is absolutely fascinated by my ever-expanding belly. "Oh Eema, your belly is getting bigger! It's a giant belly now! Why is it getting so much bigger??" Yeah, uh, now that I think about it, I'm less convinced this belongs in the "Good" category! ;) Anywhozit, I said, "Well, what's IN Eema's belly?" He giggled... "Bigger Babies!" "That's right, so Eema's belly has to get bigger so they can keep growing, right?" "Of course, Eema! You need a bigger belly so the babies can grow," he said as if it had been all his idea and he was telling me how the world works. He's really cute.

The Less Good: I absolutely cannot shake this cold. I feel disgusting, and it's making it even harder than usual to keep food down, and worse, it's making it difficult even to keep fluids down, which is bad, because the best thing I could possibly do for a cold is drink a lot of fluids. Sigh. So now in addition to waking up a lot with cramping and full bladder and general discomfort and leg cramps, I also wake up because I can't breathe, I'm parched, and my throat hurts. It's lovely. I'm not sure why I even bother trying to sleep anymore.

The Really Good: I haven't been admitted to the hospital and I'm 26 1/2 weeks. That so rocks.

More Good: I'm no longer completey nauseated every time the babies move. This is a good thing, since they do it ALL THE FREAKING TIME, especially at night. Actually, I kind of love it now, and I think I might miss it some day. I mean, I could still do without the cervix stomping, because honestly, I'm not kidding when I say that really hurts. I mean REALLY hurts. But at least I know the kiddos are still moving around, right?

The Somewhat Annoying: Heartburn really sucks. Definitely in Stretch-Mark Land. I have a weird little hematoma right above my ever-shrinking (but not yet popping-out) belly button and I have no idea why or where it came from. Pregnancy has made my belly embarrassingly furry. I wish there were something I could do about this, but I figure my doctor has probably seen scarier bellies. Right? RIGHT? I'm still getting about 3 migraines a week and tylenol with codeine isn't touching them but I don't have a lot of other pain-relief options. I'm also getting lower-grade headaches from the terbutaline, but those are easier to knock out. The terbutaline also gives me a very annoying side effect of making it uncomfortable to breathe... as if I'd been breathing heavily after running a long distance or something for a while. It's like my throat or lungs HURT when I breathe. It's not like I can't breathe, it's just an unpleasant sensation that I keep hoping will go away and it hasn't. The other terbutaline side effects have at least gotten less annoying even if they haven't subsided completely, but this one is just as annoying as ever.

The Good: My husband? Completely rocks.

On a Completely Unrelated Note:
An anonymous poster has asked me twice now why there are 4-hour auto-doses in addition to a lower basal rate on the pump, rather than having just a higher basal rate that incorporates the auto doses over a longer period of time. I'm not ignoring the question, I'm actually trying to find a real answer rather than just having my own random guesses. My husband is a pharmacist, so you'd think this would be an easy one to get an answer to, right? Not so much. Never mind that he was sitting shiva for a week, so he couldn't do any looking up for me, even now that he can he's super-busy and the bit of research he's done hasn't turned up a lot of clear-cut answers.

What he has found is that generally the auto-doses are recommended to be timed with the peak periods of uterine activity if it is possible to predict that pattern (it often IS possible to do so, apparently). This makes a bit of sense to me as one suggestion that was made by my nurse at some point was to change the interval of the auto doses for more effective treatment.

He also found that taking 5mg pills every 4 hours is effective about 30% of the time for uterine contractions. But that terbutaline pump protocols are effective closer to 90% of the time, so for whatever reason, it works.

What he hasn't found yet (and admittedly, he hasn't had time while at work to wander over to the Health Sciences Library) is a clear cut answer about why it wouldn't work to just have a high basal rate given out 24-7 with only denmand-doses as needed for breakthrough contractions. But if he DOES find an answer, I'll let you know. Also, Erin has a PhD in Pharmacology, I believe, so maybe she can shed some light on this. Or maybe not. I don't know. But if anyone else does happen to know, please let me know, because at this point, I'm intensely curious. Inquiring minds want to know.

(I also just reminded my husband, so he's going to do some more digging around now to see what he can find... I'll update this entry if he finds anything really interesting)

And that's enough for now.

Update per Anonymous' Comment:
Comment left last night: Hey, that's great that you are looking into the auto-dose/basal issue. If there are other options that could serve you better, it would be good to know! Now, are there any at-home IVs you can use for when you can't keep fluids down?

I'm looking into the basal vs. auto dose issue purely as a curiosity. I'm assuming this is a long tested issue at this point as this is very standard protocol that is used regularly for a large number of patients and has been for al ong time, so I'm not guessing that it would make more sense to raise the basal rate and eliminate auto-doses. It seems clear that the protocol of auto-doses combined with a low basal rate does work for most patients. It may be that it lowers the side effect profile to do it this way, and since the side effects aren't real pleasant, that's a good thing. At any rate, I've got my husband on it this week. He's still playing a bit of catch up at work from being out after his father died, but I'm sure he'll find some time to walk over to the library if I nudge him a little.

As for at-home IVs... the short answer is, yes, there are at-home IVs, but I don't warrant one. If my nausea were so extreme that I were never keeping fluids down and I were severely dehydrated and had an electrolyte imbalance, they could do an at-home IV-line for Zofran (which I currently take orally). If that didn't work, they'd admit me. However, my periods of not being able to keep fluids down are generally short-lived and haven't resulted in real dehydration/electrolyte imbalances, so an IV line would be a bit on the extreme side (nor do I want one! I'm already the bionic woman!!). At any rate, yes, it's an option, but not a likely one for me. Good idea though!

Followup to " Envy "

Some commenters say that my fertility envy will fade with time. Other commenters say it will never go away. Some say when I get to my ideal family size I'll feel better. Funny, I always wanted four children, which I'll have after this, but I never considered that it would be only one pregnancy. I suspect that it varies from person to person... there's no right answer here. And I definitely don't begrudge most people their pregnancies. Not even fertile myrtles. Not even, heaven help me, Michelle Duggar. But I grieve my inability to just BE pregnant. I grieve the freedom to say, as the Duggars say, that I'll have chilren until God tells me not to. I don't want 17 children per se. I want the freedom to make that choice. And I grieve the loss of that choice.

One anonymous commenter wrote:

It will fade, you will feel better over time.
For me pregnancy was almost the time to rehash and process all my infertility feelings. And of course, you're not a mother yet. Sure you wanted pregnancy, but what you REALLY wnated is the small head in the hollow of your neck, a baby nuzzling at your breast, a toddler shouting MUMMY and running over to hug you.
Those are the things that will heal you, not a terbutaline pump in the leg and bedrest.

The thing that struck me the most was : And of course, you're not a mother yet.

Oh but I am. If you're newish to my blog you may have missed it, but I have a beautiful almost-four year old foster son. He's not really a foster son, exactly, because he was a private placement, but I'm his legal guardian. I may not be his biological mother, but I've been his mother for almost 3 years. He knows no other mother. I could not love him one teeney bit more if I had given birth to him. I have no doubt that I could adopt a dozen children and love them just as much. I also know that I still would have grieved the loss of this pregnancy experience had I never gotten this far. Even though it makes no difference in how much I love my beautiful boy. J will probably be with us forever. He is my son in every sense except the legal sense. He knows no parents but us. There is no greater joy in this world than being a parent, and still, the pain of infertility is as raw as it ever was.

It's rare that it is someone else's pregnancy that brings out the pain for me. It's usually something far more personal, something intrinsic in myself. This time it happened to be someone else's pregnancy. Someone who got pregnant within six weeks of getting married. She certainly didn't do it to upset me. And it's certainly not her fault that it did. And most people in the community don't even realize that I COULD be feeling left behind in the child-bearing department. After all, we've been parents for three years. And now we're having triplets. So how could we possibly feel remotely out of place amongst those having their their third, fourth, fifth...?

It's true though... it's these babies that will ultimately heal me, not the terbutaline pump and the bed rest. The terbutaline pump and the bedrest do nothing but remind me that this is NOT a normal pregnancy and that I'm STILL set apart from most pregnant women. But I'll love these babies. Of that there is little doubt.

26 Weeks - How it's Going

Sorry for the delay in actual pregnancy updates... several of you have asked. With my husband sitting shiva, it's been hard to get real time to post anything significant. Things have mostly been okay, but have been a bit up and down. It seems like every time I want to post "Yesterday was a really good day" I end up having a really crappy day, so then I need to post "Yesterday was a really crappy day" except then things turn back around, so I just can't keep it all straight. ;) This is not an entirely bad thing.

The good news is that the up and down is largely confined to the contraction side of things. This is good news primarily because of the terbutaline pump. There's a lot of leeway in how I can deal with dosages on the pump (or rather, how the nurses at Matria, the monitoring company, can deal with dosages). They have a lot of leeway in the doctors' orders in terms of giving additional "demand doses" or changing basal rates or auto-dose rates. So we've been playing around a lot with that. We've increased my basal rate twice and yesterday increased my auto-dose rate by 10%, but there's more wiggle room still if that doesn't work.

What's been tending to happen is that I go a day or a day and a half with no, or only one, contraction during each of my two daily monitoring sessions (which doesn't mean I'm having zero throughout the day, but that's another story), which is great. But then I'll go a day or two with 5-6 during each monitoring session, which is when we start moving doses around. Most of the contractions aren't painful, but they are fairly uncomfortable. What's more painful is that I have a lot of cramping all of the time, which wakes me up a lot too, but even the increases in basal rate have helped that, so it's likely that the cramping is low-level contractions that don't really register as contractions themselves on the monitor (if they're less than 40-seconds, they don't call them contractions). See, and here I thought I got pregnant to avoid being plagued by painful menstrual-like cramps. Sigh.

The really astoundingly good news is that bed rest certainly seems to be doing its job, which is good because I really, really don't want to be admitted to the hospital just now. Each appointment that I've had since that first alarming appointment where my cervix had gone down to 1.5cm has shown definite improvement in cervical length. I didn't even know that could really happen. My last appointment, on Monday, it was, at its shortest, 2.8cm. Go me! This has also enabled me to return to weekly appointments instead of twice-weekly appointments, which is good, because with S dealing with shiva, I wouldn't have wanted to abandon him too often.

What really astounds me is that I remember my first appointment with the perinatologist was at 8 weeks, 5 days, and this week's appointment was 25 weeks, 5 days. 17 weeks have passed, but it feels like a lifetime ago. 17 weeks ago, I didn't even have a clear idea whether all three were going to make it. 17 weeks ago I didn't even know if it made more sense to consider a reduction and I was getting tremendous pressure in all directions to reduce. 17 weeks ago, I finally walked into an office that didn't say my only option was to reduce the triplets. 17 weeks ago I had no idea if I was making the right choice, but today I have no question that I made the right choice. I didn't know then if these little monsters had any chance of making it, but now, I have little doubt they will, though I have no idea what issues they'll be facing on the other side. 17 weeks ago, I was in despair... yesterday, I was conspiring with Jess to create a baby registry, something I couldn't possibly have contemplated even a month ago, let alone 17 weeks ago.

I remember clearly the day that it became obvious that I was attached to these little monsters. I blogged about it, even. April 19th. That's when I realized it was okay to be attached to these little parasites... the little parasites I was still too terrified to refer to as babies. Now I often refer to them as babies, but I can't remember when that shift took place. What I do know is that shift wasn't insignificant. I never thought I'd call a baby a baby until it was born. I never thought I could bear having that level of attachment before it was a "sure thing". But here I am, with three babies kicking me regularly, and that's what they are to me... alternately babies and monsters (in the most endearing way possible, of course).

But I digress. Back to how I'm doing.

Contractions... today not bad, tomorrow, we'll see. Check.
Cervical length... getting better, apparently bed rest works. Check.

Babies (!)... They are terrific. I haven't had a growth ultrasound since the 11th, but will have another on Monday, so I'll know more then, but they've all got perfect heartbeats, plenty of amniotic fluid, and they're all quite active, so there don't appear to be any serious concerns in that regard. Or minor concerns, for that matter. The one seriously annoying thing is that as of Monday, they had all turned breach. Even Baby A who has been head down for MONTHS! I know they all have PLENTY of time to turn right back around, but I'm bitter. Bit-ter, I tell you! They'd better move back around and fast. One good thing about it, though, is that Dr. M. thinks that it's possible that part of the reason my cervix lengthened again this week was because the pressure had been taken off of it with the baby's head not constantly pushing down on it, so I guess I can't entirely complain. At first with them all turning around I couldn't feel them moving much, but I think they must have shifted somewhat again, because now Baby A is most decidedly kicking me directly in the cervix on a regular basis, which is more painful than head-butting and honestly, more painful (and more persistent) than punching. So I'm not loving that. But the other two must also have shifted somewhat, because I can feel them fighting with each other again. I doubt that they've turned all the way around again already, but they've definitely moved somewhat since Monday.

Next Monday, they'll do another fetal fibronectin test, talk to me more about steroid shots (though they're still trying to put those off until at least 30 weeks if possible), and they'll do the 1-hour glucose tolerance test. Yum. I wish I could just skip to the 3 hour, since I'm at such a high risk for gestational diabetes in the first place (triplet pregnancy, PCOS, overweight to begin with...), but it's all good. Hopefully it won't be an issue and I'll only have to do this once. They will also, as I said, do the growth ultrasound on the babies, so it will be a long appointment, which is fine with me, because it's the one excursion out of the house that I'm allowed.

The current bane of my existence is that I have a nasty cold, which I think is just adding insult to injury, and I'm quite bitter about it, but hoping that it will be short-lived. I hate colds because they are utterly miserable, but they are "just colds" so you can't really complain about them without being a big whiner. Unless you're pregnant with triplets, in which case, I think you're perfectly justified in whining about basically anything. At least, that's MY excuse!

And that's where things are right now. I'm slowly catching up on blogs. I haven't been purposely ignoring anyone, it's just that things have been a bit crazy with everything going on between my dramarama and my husband's father's death. So hopefully things will calm down soon A girl can dream, right? Today my big plans are to be able to take a nap at some point.