Chez Perky

Quickies

No, not that kind of quickie, you sickos! Anyway, I'm so tired, and I really don't have serious energy for a real post, but I do have a couple quick points:

• I saw my neurologist yesterday and he agreed that I should probably raise my dose of Topamax, but doesn't want to maximize the dosage while I'm pregnant, so he's letting me go up another 25mg/day, which isn't much, but I'm hoping it will help. I'm down from 5-6 migraines a week to 4-5 per week, so if I could get to 3-4, that would be lovely, because they really are disabling at this point, since codeine isn't helping all that much, and my alternate pain relief options are limited.
  • I can't tell if I'm having any real side effects from it because side effects often include, e.g., changes in appetite, nausea, fuzzy headedness, lack of ability to concentrate, fatigue... which are all things I'm plagued with anyway given the whole triplet thing
• I can't sleep anymore, which is really aggravating because I'm unbelievably exhausted. That being said, I do so love my Snoogle, and highly recommend this ridiculously overpriced pillow should any of you ever find yourselves pregnant with triplets. Frankly, I kind of think I'd love this thing even if I weren't pregnant, though I'm not sure I could have justified the expense had I not been pregnant.
  
• When I say I can't sleep, I really mean it. I fall asleep the second I hit the pillow, and I stay that way for maybe as much as an hour, and then I'm up and down all night. I feel like a gigantic wimp complaining about this, but I'm so unbelievably exhausted. I'm so sick of hearing that it's good training for when I have babies, because you know... at least once the babies are here, the exhaustion will serve a purpose. I just am so tired. I can barely hold my head up at work anymore. Just. So. Tired.
  
• Heartburn? Sucks.
  
• Babies doing the Macarena? Pretty darned cool, but not without its nauseating moments
  
• J wants to know where and how the babies are coming out. I have no idea what to tell him. Suggestions are welcome. He's not quite 4 years old, so I'd rather not be too graphic, and I'd rather not scare him.
  
• Anyone know what lightning bugs eat? J wants to know that too, and I know I could google it, but I'm lazy and I'm already here typing in my blog, so it's worth a shot.
  
• I am still very grateful for how easy this pregnancy has been compared to what it could have been. There are a lot of complications I could have had that I haven't faced, and I've not lost sight of that. I'm uncomfortable. I'm exhausted. I'm in a fair bit of pain. But neither my life nor the lives of the triplets has been in jeopardy to this point. I'm at 21 weeks today, and so far, so good. I view this as an accomplishment.

Parasites are growing... and Zofran is my Friend

For weeks people have been asking me if I'm feeling the babies moving around and my answer, for the most part, has been "I think so." I mean, I knew what I was feeling was them moving, but it was pretty non-specific (except for baby A PUNCHING ME in my cervix, but that was completely different). But then on Thursday, I was driving and suddenly I was having these feelings like I was having odd little muscle twitches in my abdomen, but from the inside. But they kept happening and suddenly I was like, "What the hell is that!??" Definitely not my most maternal moment. It's pretty much been non-stop since then, which would be fine except that I've been unbelievably nauseated the last few days.

Friday I couldn't keep ANY food or water down, and every time one of these little monsters kicked me, it made me want to throw up (a couple times it did actually MAKE me throw up). So I can't say I've got the most pleasant of associations with baby kicks right now. I'd like to say it's a beautiful moment for me, but really, it's kind of weird and disgusting. Probably mostly because of the puking association. Still, I have to say that it is unbelievably cool that all three of them are kicking and that I can distinguish the three based on position. Babies A and B are the most active (or maybe their position is just most conducive to me feeling them?). It still startles me every time they do it, which is pretty much all the time. I hope I get used to it eventually! At least I know that they're thriving in there!

I'm still only keeping small amounts of food or liquid down, but at least I don't feel like I'm in danger of dehydration anymore. I'm popping Zofran like it's candy and it's helping somewhat, but not quite enough. Hopefully this too will pass. I think it is partly the result of the antibiotic I'm taking for the UTI (which doesn't seem to be getting any better, by the way), so hopefully this is temporary.

In other news, my wondermous husband got me a watercooler for my neverending thirst. One of the cats is currently investigating this scary new piece of machinery. Heh. Now if only it had goldfish in it. (Just kidding... then I couldn't drink the water!)

Update: KarenO: your mom is quite correct that the first movements feel EXACTLY
like butterflies in your stomach. That's what I'd been feeling for weeks. It was a rather non-specific feeling that almost felt like anxiety more than anything. But now there are actually distinctive kicks (maybe they're actually punches, who knows?) that are very specific and definitely not the same sort of feeling. Definitely the "I think so" stage of "do you feel the babies moving" was a sort of fluttery-butterflies-in-your-tummy kind of feeling. It's very hard to explain. That went on for a while and I definitely knew it was fetal movement, but wouldn't really have committed to "Yes! I can feel them!" Now I definitely know exactly which one is doing what and it was a very sudden transition. It's a little disconcerting, actually. I'll admit that it's neat and fascinating in its own way. It's just that the rest of me feels so gross right now that it's hard to get past the "ew-factor". I'm a total in-grate. It would be better if I weren't puking, I'm sure!

19 weeks, 6 days

In a lot of ways, this pregnancy has been a whirlwind, and in a lot of ways, time has stood still, refusing to move forward. I am very, very definitely pregnant, as every passerby seems determined to remind me, but it still doesn't feel even a little bit real, even as Baby A, the little brat, keeps punching me in my cervix. If you didn't know, that really, really, really hurts when they do that.

Pre-Natal Appointment
My ultrasound last week was also my first "prenatal" appointment with the perinatologist, which is to say, it's official. I'm OB-less. My records have all transferred over, my OB knows I won't be back until my post-partum checkup, I have only one set of doctors, and I am breathing a tremendous sigh of relief. I love my OB. I'm sad to leave his office and the comfort and safety net that I feel there, but I'm happy to have the comfort and safety net of having only one set of extraordinarily competent doctors to coordinate with. I'm very confident in the care I'll be receivig there, and that's what matters. S0 in addition to everything else, I got to meet with a nurse to fill out all the OB paperwork and background stuff... medications I'm taking, GYN history, surgical history, allergies, etc. Somehow I failed to mention that I'd had a D&C in October... whoops. But I did clear that up today. She was very nice and she gave me her card with her direct number and told me she doesn't mind if I call with dumb questions because she's always happy to tell me it's nothing to worry about... those are the easy calls.

White Coat Syndrome
I never really thought I get nervous in doctor's offices, but my blood pressure had started to worry me a bit as it's been consistently on the high side at my OB's office. While it was slightly lower at the perinatology office, it was still elevated. I have a history of low blood pressure, so I found this pretty shocking. So, we bought a sphygmomanometer for the house. My husband has very high blood pressure and needed one anyway, and he's got large arms and mine aren't tiny either, so part of my theory is that they were using the wrong sized cuff at the doctor's office. I was quite correct. My resting blood pressure at home is consistently fine, averaging about 110/65. My pulse, on the other hand, is through the roof no matter where I am, and no matter what I do to try to calm it down. I assume this is a normal side effect of pregnancy, what with the significantly increased blood volume and all, but I keep forgetting to ask my nurse about it and my google-fu is failing to completely soothe me (though a re-check with Dr. Google does seem to suggest an increase in pulse may be normal, I can't seem to find a RANGE of normal).

Ultrasound: Fetal Anatomy
The ultrasound also went well. My cervix is miraculously holding steady. The placenta previa is moving out of the way, though it's still not completely resolved. Baby A is right on top of my cervix, spending his or her spare time punching the living daylights out of my cervix. I'm not sure if I've mentioned this, but it HURTS LIKE THE DICKENS when he/she does that! They did the fetal anatomy on Baby A and Baby C (Dr. M did Baby B the previous week). I did not love the sonographer. She was pushy and was irritated that I was doing it "so early" (fetal anatomy is usually done around 20 weeks... I was 19 weeks, 1 day). She also was pissed off that the doctor had already done Baby B and only wanted Baby A done this week. The doctor had specifically NOT wanted me laying on my back for an hour and a half of torture for no good reason, when they could easily spread the appointments out. The sonographer said, "no, that's stupid. It's better to do them all at once and the moms never mind because they get to see their babies." Except, hello? I kind of minded! I was in pain. I had a pounding migraine. I was having contractions. My hips were killing me. My legs kept falling asleep. And she kept pushing down so hard I wanted to jump off the table!

That being said, she did an excellent job and showed me everything very clearly and answered all my questions and made sure I always knew exactly what she was measuring and why. Even if she DID keep referring to them as "my babies" (meaning hers, not mine, which is so not okay), she did do a great job. And she managed to not take a peak at any tell-tale signs of the babies' sexes, which is also good. So I can't entirely fault her. And besides, it might have just been pregnancy hormones, right? I continue to be astounded at the level of detail that can be seen with just a few concentrated soundwaves. Seriously, all my babies have kidneys and bladders and four chambers of their hearts and cerebellums and stomachs and how weird is that? They could tell that none have a cleft palate. They could see the blood flow through the heart. It's all just so unbelievably weird.

Movement and Pregnancy Symptoms
I do feel the babies moving, or at least Baby A. I think I might also feel Baby B, but Baby C doesn't move much, being all squished up in the corner. Baby a does so make his/her presence known though. Beyond that, I've got all the normal pregnancy symptoms. I'm still popping Zofran like candy so that I can keep food down. Except now I have a new nemesis to keeping food down: heartburn, and boy is it rotten! So now I'm also popping Tums and Zantac like they're candy. Yum! Oh and that mysterious thing called "round ligament pain"?? I always read about that in pregnancy books and thought, "yeah, right. Like I'll ever be able to distinguish that from all the other aches and pains I've got!" I admit it, I was wrong. Very, very wrong. Holy mother of um, frodo, this is very, very distinctive, unmistakeable pain! Oh, and I found out today that, shock of shocks, I have a UTI. So a week of antibiotics for me.

Uneventful is GOOD
Mostly, however, I'm having a pretty uneventful pregnancy, for which I am very grateful. I am still able to work, much to my shock. I am pretty restricted in other activity and my doctor's deal with me is that if I want to work that means that when I'm home I'm in bed or in the recliner doing nothing, which is torture, but better than being on full bedrest, as I'm sure Suzanne can attest to! I still haven't gained an ounce (I'm down somewhere between 15-17 pounds from my pre-pregnancy weight), but my doctor isn't worried. My wedding/engagement rings are loose when I'd figured that they'd be too tight to wear by now. As uncomfortable as I am, the babies are all growing exactly the way they're supposed to, they all have "textbook-perfect" anatomy scans, and I'm not in pre-term labor. What more could a girl ask for?

Some of your comments
1. Rachel Inbar noted that I haven't said much about my foster son, J, lately. I don't talk about him too much here, except in the abstract, because this blog is really about infertility and now pregnancy after infertility, but also because it is a public blog and I don't really want his mother tracking this blog down. But generically speaking, he'll be four in September and we'll have had him three years in October. He continues to astound us both with his ability to absorb the world around him and his ability to express love and compassion for the people in his life. He's very excited to be a soon-to-be-big-brother, and tells everyone who will listen "I'm going to be a big brother! My Eema* has free** babies in her belly!"

*"Eema" means mother in Hebrew. Other ways to transliterate the word include Ima, Ema, and um, probably some other ways. I personally prefer Ima, but I've found that with a non-Jewish audience, Eema is the most intuitive way, even if my Jewish readers look at it and think it looks odd.

**Free meaning three, of course.

2. I've gotten several new comments from two distinct categories of bloggers: bloggers who have just found out they are expecting triplets (all of whom are taking the news more gracefully than I did at first!), and bloggers who have their own triplets. This is exciting for me, as it seems that I now belong to TWO distinct blogging communities now... infertility bloggers and parents of triplets/multiples bloggers. I suppose this means I ought to split up my blog roll so that poor, unsuspecting infertility bloggers don't stumble upon something they didn't mean to. I'm a bit too busy at the moment to take care of that detail, but I'm TRYING to make a notation next to the blogger's name if it's a triplet/multiple blog. I hope that helps.

3. Suzanne asked where I get my google stats from. I answered her directly so I could get credit for Mel's Commentathon, but the rest of you may be interested as well. I use http://www.statcounter.com/ (there's also an icon in my sidebar that will take you there) because it's free and contains all the stats I want (primarily the keyword analysis). I got over 500 individual hits yesterday which astounds me. Seriously, I'm not that interesting, people!

4. I'm going to the DC-Metro area Get Together for Infertility Bloggers that's been arranged by LJ. Some of you may have seen some comments in my last post about this. Mel talked me into it, even though I'm an unbelievably shy person in real life with serious social anxiety about meeting up with a bunch of people I've never met. One-on-one? No problem. Eight at once? Good heavens, I wish valium weren't contraindicated in pregnancy. Mostly, I hope that no one is bothered by the pregnant chick at the table. I mean, I know I'm pregnant after infertility, so I'm not like a total leper or anything, but still. I could understand my presence making people uncomfortable. There's also the bit about the fact that I keep kosher, so I will be casually sipping a drink (nonalcoholic, bummer), which doesn't bother me a bit, but often makes others uncomfortable, but that's a whole different matter, which is just going to have to be someone else's problem and not mine. At any rate, despite all the anxiety, I'm really looking forward to it! You know, if I don't chicken out.

5. A couple people have asked me recently about my migraine status. I thought I was down to about 4 migraines a week, but when I looked back at my spreadsheet (yes, I really am that kind of anal... maybe THAT'S why I get migraines...) I'm actually at 5 per week on average. That being said, it's still an improvement over 6-7 per week. And about 2-3 per week are responding to Tylenol with Codeine, which is also an improvement. The Codeine doesn't resolve the migraine completely, but it takes the pain level down to a manageable level some of the time now, which is a huge, huge, huge improvement. I'm still definitely looking forward to the day when I'm not pregnant and I can up my Topamax dosage. Or maybe they'll let me do it sooner. That would be nice, even if it's unlikely. It's sad to say it, but 4-5 per week really IS a vast improvement, and it's good enough for me at the moment.

Um, there was a bunch of other stuff I wanted to write about, but it's all escaping me right now, and besides, this is long enough. Besides, I need to go looking for some Tums. Because they are like candy to me now. Only less satisfying.

All's Well in Perinatology Land

I have a post in draft now that's a followup to the Great Debate post, but I can't deal with finishing it now, so you'll all have to wait in eager anticipation. I know you can hardly stand it.

Anywhozit, my appointment at the perinatologist's went well. Babies are all growing, though they didn't measure anything other than the heartbeats. You can tell, though, that they're growing. They all have plenty of amniotic fluid. The previa is still a previa, but seems to have shifted slightly, so that might be a good sign... perhaps it is going to shift completely away. Or it could stay right where it is. My cervix is long and closed, which was the real key. I wasn't having any more of the maybe-contractions by the time I got to the office. But since everything else looked great, they weren't too worried, but did give me a stern talking-to about taking it easy and not overdoing it. (I'm positive that I overdid things a bit yesterday, which is probably what started the whole mess in the first place) He did confirm that with the triplets, I really should be careful about brushing off contractions as "just Braxton-Hicks" because all contractions in multiple pregnancies need to be checked out as you just never know when unproductive contractions turn out to be productive ones. I almost told him that all my friends in the blogosphere had already clued me in (thanks, Jody!), but figured it wasn't worth explaining.

The doctor was far more alarmed with the state of my migraines. It was quite a relief to have someone actually take me seriously about them, to be honest. I know that it seems like it can't be that hard to deal with bad headaches, but migraines aren't just bad headaches. They affect my vision. They affect my ability to eat. They affect my ability to stand up straight. They affect my ability to function. They affect my ability to sleep soundly. And being in constant pain puts a lot of stress on your body. It's really no good all around. And they've only been getting worse and more frequent. Honestly, I was getting 4-5 per week before I got pregnant because I'd stopped taking anything prophylactically, so I didn't think it could GET much worse, but I was very, very wrong. I kept hoping that I'd be one of the lucky ones who doesn't get migraines when I'm pregnant, but I'm one of the other kind of "lucky" ones whose migraines get worse during pregnancy. Whoopie.

Anywho, I told Dr. G. that I have an appointment with a neurologist next week but wanted to know what options I can consider discussing with the neurologist. He suggested for pain to try fioricet with codeine instead of tylenol with codeine. It could work, but fioricet hasn't worked for me for years. Then again, years ago I wasn't pregnant, so who knows what will work now. Prophylactically, however, he said taking a calcium channel blocker (like nifedipine as Jody suggested) is perfectly reasonable. He said it would have added benefits as they often use calcium channel blockers in pregnancy to treat pregnancy-induced-hypertension (which I don't have.... yet) and to calm uterine contractions. So all bonuses. He also said that if the neurologist wanted to call them to discuss things further, they'd be happy to work together to figure it out. This is all good.

I took calcium channel blockers some time ago (most of a decade ago). They weren't perfect, and didn't help enough at the time, but at this point, I'd be happy with even the tiniest bit of relief. And there are other calcium channel blockers I can try (the only one I remember taking was verapamil), so a different one may work a little better. The two drugs that I know do the best job are just not options right now... even if I got the okay from the doctor, I'm not comfortable taking them with the possible risks involved. I'm hoping the neurologist has a few good ideas for pain relief and is willing to try out nifedipine. I'm also hoping he's not scared off by the whole triplet-pregnancy thing. (My previous neurologist basically told me that so long as I'm trying to get pregnant he won't touch me... now that I'm pregnant, I'm sure his feelings won't have changed... so I'm back to a neurologist I used years ago who is geographically less convenient, but an excellent doctor, even if he is an elitist snob.)

Beyond that... there's not much to report from today's appointment. The doctor is hoping that when I get further into the second trimester I'll start feeling a bit better. So am I, but I'm not holding out that much hope. After about a week zofran-free, I'm back to being in nauseated hell. I literally threw up in the sink this morning. Lovely, I know. I have lots of weird pains and things are definitely shifting around. I'm sure most of the weird pains are the ligaments streching from the "ginormously expanding uterus" (thanks for that turn of phrase, Jody!). I'm not worried about the pains... I just didn't expect them this early.

And oh yeah... I'll start taking belly pics at some point (My husband laughs at me every time I suggest it, and I can't seem to twist around properly to get a profile shot by myself in the mirror)... though I don't guarantee I'll post them. But all of your urging has convinced me that there's the slightest possibility that I'll regret it if I don't. And that's all the news from Lake Wo-- oh, uh, wrong reference. Er. Right. That's all the news I've got for the moment.

Strange Sensation

I kept waking up last night with this tightness and pain (discomfort really, not serious pain) in my lower abdomen. It was extremely unpleasant. I feel like I'm not really far enough along for this to be contractions, but if I were a few weeks further, that's exactly what I would have thought it was. But now that I've talked to several friends who've been through several pregnancies, I'm pretty sure that it really IS Braxton-Hicks contractions. Isn't it way too early for this? (I'm 15w, 1d) It's still happening now. Bleh.

I have a perinatology appointment this afternoon, so I guess I'll find out then if I'm a crazy alarmist or just seriously in tune with my body. Hah. I'm voting for alarmist, how about you?

Anxious

Tomorrow is the re-try for the nuchal fold scan. It's been two weeks since my last try (and the babies were only a hair too small then), so there shouldn't be any problem getting the measurements this time. And I'm really anxious. Most people that I interact with on a regular basis know that I'm pregnant. There's no hiding it. I'm wearing maternity blouses nearly exclusively right now. The only reason I'm still wearing my regular skirts is that I lost 19 pounds in my last pregnancy and 15 pounds at the beginning of this pregnancy, and I've only gained back about 2 pounds so far. Anyway, the point is, everyone knows I'm pregnant at this point, for the most part. And if something happens tomorrow... I just don't want to have to go through "un-telling" anyone.

So I'm nervous. Even though I'm sure everything is fine.

Also, I feel like hell. It's already hard to breathe if I'm doing anything but lying down. My hips are killing me. I have unbelievably ridiculous cramping (which I'm still deciding not to worry about). My migraines are completely uncontrollable. And I'm a big whiner and I hate whining, so now I'm whining about the fact that I'm being a big, annoying whiner! I'm 13 weeks today and I seriously have no idea how I'm going to manage to work until 19/20 weeks, which is when I was told to expect not to be able to work anymore. I'm just not sure I'm going to make it that far. It's already so hard for me to sit, stand, walk, whatever. I'm half-considering renting a scooter to get me through a few extra weeks of work, but the rest of me thinks, you know... having another few weeks off of work wouldn't KILL me...

And, um, that's all there is to report. Hopefully there will be more after my perinatology appointment tomorrow for the nuchal fold.

Little Things

In a lot of ways, I don't really feel pregnant. It's not real yet. I'm told it will be once I can feel the babies moving, but that seems so far away. However, there are still a myriad of ways in which I am continually reminded that I'm pregnant.

• I am having incredibly vivid dreams. I'm always a vivid dreamer, but I usually forget my dreams within minutes of waking up. These days, I wake up and it takes me a while to distinguish dream from reality.
• I wake up at exactly, and I mean exactly, 5:08 every morning. There is never any good reason for it. I'm usually right in the middle of a dream and suddenly I'm looking at the clock saying 5:08, and then I fall back into a restless sleep until I drag myself out of bed around 6.
• I am both starving and utterly uninterested in food at all times. I am unbelievably thirsty ALL THE DARNED TIME. Problem is, if I drink water, I cease being hungry at all, which means I'm not eating enough. The perinatologist doesn't care if I gain weight, lose weight, or stay constant, so long as I am getting sufficient calories, but I'm pretty sure I'm not.
• I have horrific cramping that I'm just assuming is normal. Additionally, I swear my hips already feel all out of whack. I think things are already shifting much more than I would have expected at this point.
• Dog nose. Need I say more?
• I am still 15 pounds below my pre-pregnancy weight, but I can't button many of my blouses anymore.
• I haven't gotten over the ridiculous exhaustion, I expect that I won't ever.

That doesn't seem like so many symptoms now that I enumerate them, but they sure do seem to rule my life!

Because, really... why not?

Really, why wouldn't the universe take each and every opportunity to laugh at me? So I've been spotting pretty consistently for about a week. Maybe more. I'm really trying not to pay much attention. I'm wholly convinced that it's nothing, and the rest of me knows that even if it's something there's not a darned thing to be done about it. But I'm really quite tired of dealing with this. It's not heavy. It's not terribly alarming. It's just enough that I can't sit back and pretend everything's normal and fine.

Oh, and the Zofran is no longer doing a particularly good job. While my nausea no longer is a guarantee of vomitting, it is almost always painful. Yes, painful. Sounds odd, I realize, but that's what it is. A tremendous pain in my gut while I stand there praying not to throw up. Adding Fenergen to the Zofran does little to help, but does send me to sleep, so I suppose it has a bit of a bonus.

Just in case any of you thought the whole pregnancy thing was boring compared to the roller coaster of fertility treatment. Bah!

My new favorite drug of choice

My OB, bless him, called in Zofran for me on Friday. Sheesh, you mention to a nurse that you're not feeling great and you're pregnant with triplets and they move quickly! The T word worked wonders to make sure they took me seriously. :)

Anywhozit, one dose of Zofran and I felt almost human. I'm finding that the nausea is unbearable in the late afternoon through bedtime, but okay in the morning, so if I take the Zofran mid-day, life is good. Hooray for me.

Unacceptable!

My Coke tastes funny to me. I remember last time I was pregnant lots of things tasted weird to me, but certainly never Coke.

This is unacceptable. It is absolutely ridiculously unbelievably unacceptable for the nectar of the gods to taste funny. I know I shouldn't be drinking it, but I love it. And I really need a little caffeine today. I am allowed 300mg of caffeine per day. I drink one Coke per day, which is WELL below that limit. And besides, it's keeping me from feeling like I'm going to throw up imminently.

And now it tastes funny! UNACCEPTABLE!

Edited to Add: While it may, at first glance, seem perfectly reasonable to suggest Pepsi as an alternative... I must say... YECH! I am a Coke-loving Pepsi-hater! You'd think I was from Atlanta or something (I'm not). Coke is the nectar of the gods! Pepsi does not compare! And if somehow I discovered that Pepsi tasted perfectly fine during this pregnancy, I'm not sure how I'd look at myself in the mirror every morning. So I will forgive the transgression of December Baby this once, since I had obviously not made it clear how important Coke is to me! But for future reference, there is only ONE TRUE COKE! (and none of that nutrasweet crap will do, by the way)