Houston, we have a plan

The meeting with Maternal-Fetal Medicine was good. Better than I expected, in fact. So, here is the plan:

- If I get knocked up on my own, which past history indicates I can do, I will immediately start taking low-dose aspirin at the first sign of a positive pregnancy test – the risks are low, and the evidence is pretty good that it can help with hypertension and preventing pre-eclampsia.

- I’ll call Dr. Twitchy’s office (the RE) and see him for initial blood draws and weekly ultrasounds until I am 10 weeks along, and start zofran as soon as possible to hopefully prevent the hyperemesis from getting as bad as last time.

- At 8-10 weeks, I will have an appt with Dr. Special (the MFM doc) to go over the plan for the coming months, draw some baseline labs (liver function, especially), and do a baseline 24 hr urine.

- Dr. Special said that she thinks that, unless things change dramatically, she’d be happy for me to be seen by the hospital-based midwives. I didn’t ask about out-of-hospital birth – seemed like it might be pushing it.

- I will stay on the Aldomet unless (or until – it is a pretty weak drug) it stops working; Then I would be switched to Labatalol and possibly a diuretic, if needed. Dr. Special said that they would have a greater tolerance for my blood pressure rising, as long as it stayed below 160/100 – if it starts creeping up, they will just adjust/change my medicine.

- I will have more frequent ultrasounds than average – weekly for the first 10 weeks, then approximately monthly, and then weekly ultrasounds/biophysical profiles for the last month or so.

Continuing to lose weight will help all of this, so in that spirit K and I bought an exercise bike yesterday… We have a really small house and it is sitting in the living room staring at me, so I think we might actually use it. My goal is to use it at least during Jeopardy – what could be more fun than sweating while answering nerdy questions?!

My current BMI is 29.8 – or, Fatty McButterpants, put down that cupcake! (mmm, cupcakes…) I would like to get to 24.7, which is in the Normal BMI range and would require me to lose 36 lbs – 6 lbs/month for the next 6 months. Do-able, but I’m not going to like the process.

Action, Anticipation

I finally got my courage up and called the Maternal Fetal Medicine service at our local hospital to schedule a preconception consultation... I was worried that I would have to justify or explain, but the receptionist calmly scheduled the appointment and said she'd send a preconception consultation packet - apparently they do these all the time. She scheduled it for May 28th (eek!), which is faster than I thought I'd be able to get in, but it will be good to get answers. Because I work at the accompanying university doing maternal and child health research, it was a bit complicated to figure out who to see without saying to a current or future boss, "So, um, I'm going to be trying to get pregnant in the next 6 months; you cool with that?" I ended up asking for the doc, let's call her Dr. Special, who backs up the hospital-based midwives who I delivered with last time - she also does preeclampsia research, so hopefully she'll be up on the latest.

Things I'd like to get answers/opinions on:
- My current risk profile for preeclampsia?

- I know I need to keep losing weight, but where should I realistically try to be to minimize risk?

- Should I continue on the Aldomet or try to get off of it? Chronic hypertension was unmasked last time I was pregnant, but I am currently well controlled on a low dose of Aldomet - an anti-hypertensive that is considered reasonably safe during pregnancy

- Right before I was pregnant with M, I was tested for abnormal clotting factors... One of them, lupus anti-coagulant was higher than the normal range. This could be important because these clotting factors are implicated in repeat pregnancy loss (ding!) and pre-eclampsia (ding! ding! we have a winner!) Usually, they test again in a month or two, because one reading can be false positive/negative... They didn't test me again b/c I got and stayed pregnant with M. My question for Dr. Special will be: Should I be tested again? If so what will we do? Low dose aspirin (see question below), low molecular weight heparin?

- Should I take low dose aspirin? - That's where the latest pre-e research is pointing...

- If so, when should I start? Some people start early in pregnancy to help with implantation... The thought is good implantation & vascularization results in lower risk of pre-e

- Can I deliver with the local free-standing birthcenter midwives with routine monitoring by Dr. Special? - The birthcenter midwives have admitting privileges at the hospital...

- If so, when/how should I be monitored by Dr. Special?

- If not, can I deliver with the hospital-based midwives? When should I be monitored by Dr. Special?

- When I had an epidural during M's delivery, I had a really bad allergic reaction to the mastisol (type of adhesive) they use to tape down the epidural catheter - it looked like a chemical burn and took 25 days of prednisone to calm down... I also got a staph infection from the hospital, so it was a huge mess... I am not planning to have an epidural again (see: freestanding birthcenter midwives), but if I am induced again for pre-e or another medical emergency, I know I may want one, especially if I am on pitocin and have to labor in bed like last time... My question to Dr. Special will be: Is there anything else they can use or do to tape the catheter down?

So, um, I guess I have a few issues to discuss... I'll let you know how it goes.

Guttersnipe

What happens when toddlers are left unsupervised on a sun porch with a large flower pot...

I'm thinking about having her audition for Oliver! or maybe take up boot-blacking. Or, if being a pirate ever comes back in style, she's certainly got the teeth and the snarl.

For Miss Kittie...

Things my 2 year old has said lately:

- When asked what she’s doing in the back seat, cheerful response: “Pickin’ nose!”

- “Mama, you’re a cracker” How true, baby, how true…

- “Where did daddy go? Potty? Did Daddy go poop in the potty? Did Daddy go peep in the potty? SUPER POTTY, DADDY!” All said at top volume in a restaurant…

Sorry for the depressing posts (and lack of posts)… hopefully I can get back to my regularly scheduled snarky-ness...

We know better

Sorry for the long time, no post... a lot has been percolating, but I just couldn't seem to get a coherent thought together. Then, today I was reading an article in the New York Times about how a mother is feeling after close calls concerning the lives of her daughters, something that, thank God, I have not had to face, and a line jumped out at me:

“Other parents worry about the worst,” she told me, “but they don’t really believe it could happen. We know better.”

As I contemplate another pregnancy, any anticipation, excitement, or potential joy is always tempered by this feeling. It is not just my education, although as a maternal and child health researcher I am acutely aware of all the potential complications of pregnancy, labor, and delivery... It is not just my own history (recurrent miscarriages, hyperemesis, preeclampsia) , or the history of my friends, my fierce mama tribe (infertility, miscarriage, stillbirth, preterm birth, developmental delays)... It is instead a growing realization of how sick I was during my pregnancy with M and how long it has taken me to recover, an overwhelming gratitude that things turned out as well as they did, and a sense of not wanting to tempt fate, knowing that it could always be worse.

The cruel catch-22 of infertility/subfertility is that you repeatedly make the conscious decision to subject yourself to mental and sometimes physical pain with the hope that it will result in the ultimate joy. I cannot deny the joy, but the equation seems more complicated now. How do I remain a good parent to the child I have, while going through all the hell that conception and pregnancy can mean for me? The impulse of those who care for me is to say not to worry, that everything will be fine... and it may be, or it could be worse than I can even imagine...

Yet, YET, I still feel a drive to try for another, to have another darling child, to give M a sibling... What is the definition of insanity? Doing the same thing over and over and expecting different results? Well, I guess I should just go ahead and punch my ticket for the crazy train.

Funniest Easter Candy Post EVAH!!!

Go on... take a look at delightfully devious Anne Nahm's latest post (not work appropriate)... I dare you not to laugh

Cootie shot

We definitely could use some cootie shots over here.... or at least a cootie catcher...

Sorry for the no blogging, but we have been S-I-C-K over here....First K got in a car accident and got a nasty concussion. He wasn't driving, a co-worker was, but still...I think I'm going to make him wear a bubble-wrap suit like in Dude, Where's My Car (Zoltan!). After spending a week waking him up every 2 hrs and staring at him in between, I was beat. Then M got sick again with a pseudo-flu, got better for a couple of days, and then has been sick all this past week. I got tonsilitis last Sat (WHO gets tonsilitis as a grown-up?!), had an allergic reaction to the first antibiotic Dr. Nice gave me, and then spent the rest of the week slowly getting better on another antibiotic (while of course taking care of M and doing everything in the house...bitter, party of one). So, boring, boring, nothing to blog about...

Future doctah?