Wednesday, March 26, 2008

Happy day!

We had the Nuchal Translucency ultrasound today. We went to Obstetrix Medical Group for it, since Kaiser doesn't have the technology in-house to do this high-end ultrasound. The ultrasound was still covered by my insurance.

We had a list of questions we wanted answered and the doctor there didn't seem to feel the need to discuss those issues. He was most interested in the main purpose of the ultrasound, which was to assess the chances of the babies having a chromosomal abnormality. I have to say that while that was a concern of ours, it was among the least of our concerns at the time.

The ultrasound technician said he believes that the babies are dichorionic and diamniotic based on the membrane thickness between the babies' amniotic sacs. The doctor confirmed that and said they are 80-90% sure that the babies are di-di (dichorionic/diamniotic). That is a relief! I wish they were 100% sure, but we'll try to get that assurance in future appointments. If they are dichorionic, that means that they cannot have Twin-twin transfusion syndrome (TTTS). They can still be identical, but finding out if they are identical or fraternal becomes more difficult to determine (I guess it depends on how they look as they are growing up, or to be sure it would require DNA testing). Identical or fraternal - not important as long as they don't have TTTS.

The TTTS scare was still beneficial. We all learned so much due to this. The biggest benefit to come from that scare was the advice I received from Dr. De Lia and from the TTTS Foundation. As it turns out, the severe cramping I was experiencing, along with some other issues and concerns I had, were somewhat caused by malnutrition and dehydration. Dr. De Lia and Mary at the TTTS Foundation recommended that I drink 3-4 Boost or Ensure High Protein drinks per day. I started doing this a little over a week ago and I'm feeling so much better! Further, Dr. De Lia recommended that I do some bed rest on my left side. While it was difficult to do full bed rest, I got my stuff done in the mornings and spent the rest of the day lying on my left side as much as possible. I also got a pregnancy wedge pillow - the kind with 2 wedges, one for the tummy and one for the back to keep me from rolling on to my back. This helped me stay on my left side when I slept.

After trying this therapy for a few days I already felt much better and was having a lot less difficulty processing my fluids. Until doing this I was retaining water way too much! The biggest benefit of this therapy is that the amniotic sac differences are evening out! The ultrasound report said that the amniotic sacs were "normal" size. I wish they could have given me measurements, though.

Both babies are anterior positioned - in my back. I guess this explains why I started getting backaches a few weeks ago. Happy to know the reason and happy to have them. :)

Both babies measure at 12w2d even though LMP they are 11w5d.

This kind of screening (First Trimester Screening) tends to get elevated results when twins are involved. Even so, our results are excellent. Before screening, just based on age, the chance either baby would have Down Syndrome is 1 in 163. After screening, the chances of either baby having Down Syndrome is 1 in 1,793. Before screening based on my age the chances of either baby having Trisomy 13/18 is 1 in 290. After screening the chances are 1 in 5,781. These results are comparable to 20-year-old women. Woohooo! Let's hear it for my old eggs.

So, in summary, the babies are probably not monochorionic, which means TTTS is not likely. It's still possible, but we are a lot less worried. The amniotic sacs are balancing out so I'll continue to do the drinks and the rest at least until week 14, which is when we were told is a pretty safe spot for the twin issue. We probably don't have to worry about chromosomal abnormalities. We still have to push for some answers from Kaiser, and perhaps see about being seen by a high-risk OB, but so far, at least for today, all is well.

Sunday, March 23, 2008

The fun stuff!

I think I felt them tonight. I can't be sure, though. I've heard that the babies can be felt this early, and with twins it very might well have been them I felt, or one of them anyway. I was just sitting, watching the Alfred Hitchcock Hour (I love these old shows) and felt a little flutter in my lower belly. It was really low and it was like a tickle. It happened once, and I adjusted my shorts thinking that's what it was, then I felt it again when my mind was still on the area. The second one wasn't my shorts. It was definitely coming from inside.

Oh how neat! :)

So, I had to tell Dave right away. He thought it was really fun, too. I wish he could feel it. A little while later it happened again, and more than just a little bit. I put my hand there, but I couldn't feel anything from the outside, just the inside.

No, it was not gas.

My belly is starting to look to Dave and me like a real bump, too! Dave took some photos and in the photos it's not so obvious to me. It's most obvious to me when I sit down and look down at my belly, which now pokes out and gets rounded when I'm sitting. In some of my clothes you can see a definite bump, but Dave says that nobody could tell it was a pregnancy bump unless they already knew me. So, I made the mistake of asking him if they would just assume I was fat, then. Yes, my mistake. I'll post the photos when Dave gives them to me... in a month or two? hehe, probably sooner.

We are telling more people about the news, good news and bad. This isn't the kind of secret you can keep for long, especially if you are writing everything into a blog for posterity. I told my grandpa today and Dave told his dad about the twin issue. I told my dad about the possibility of Twin to Twin Transfusion Syndrome and he didn't quite understand what it was. To explain better, I said that one baby is sucking from the other, like a vampire. My dad suggested that in the next ultrasound we ask them to look for fangs and vestigial wings. So now you see where I got my sense of humor.

My OB has arranged to see me as soon as possible, which is Tuesday. I have the Nuchal Translucency ultrasound on Wednesday. I sure hope they'll be able to tell me the chorionicity on Wednesday (whether or not the babies share the same placenta). If they are dichorionic (2 placentas) then we don't have to worry about TTTS, but we'd still have to worry about the difference in the amniotic sac sizes.

I met with a genetics counselor at Kaiser last week. I'm so glad I did. She reviewed the blood tests I had already done (not the triple screen but other blood work) as well as my family history. She said we had very little chance of having a child born with a chromosomal abnormality. She said that given our circumstances with the twins that CVS or amniocentesis is not recommended in my case since the twin issues more than doubles our risks of miscarriage from either test, which would make the risk of miscarriage a lot higher than our risks of having a chromosomal abnormality. The problem is, that the triple screen or the AFP blood tests often show a false "screen positive" when there are multiples involved, so we can't rely on any of these tests to have a good idea of what we may be dealing with upon birth. I will try not to let the results panic me - probably easier said than done.

If the babies do have TTTS then if the babies need the laser surgery that can repair the connection to the placenta it can be done at week 16. This is why I'm concerned that they diagnose or rule out the issue right away. We have less than 5 weeks right now to work this out if I need the surgery for optimal timing. Also, the longer the pregnancy goes without knowing whether or not the twins share the placenta, the more difficult it is to tell and we may not know until birth. TTTS can pose extreme risks at birth if the first baby's cord is cut before the 2nd baby's, that is if the surgery is not done. Basically, if one baby dies, or loses connection to the placenta, the other baby gets too much from the placenta and could also die.

If they do have TTTS, we can have therapeutic amniocentesis at any point in the pregnancy, which at that point can give us a better idea of chromosomal abnormalities and diagnose gender (if they are of 2 genders then they are not identical and not monochorionic so they could not have TTTS) as well as help solve the problem of the polyhydramnios and olighydramnios (one baby has too much, the other too little).

It's all very complicated.

In all this research I found some great resources. I e-mailed Dr. Julian De Lia, the doctor who pioneered the laser surgery that helps correct this issue and I told him what has happened so far and asked if he thought TTTS sounded possible. He wrote back asking for my phone number. I gave it to him with hopes he'll call. He's always looking for more cases for his research on this issue since it's very rare. I also wrote to the TTTS Foundation asking for more information. They replied and told me what I can do now to help the babies whether they are with TTTS or not (based on Dr. De Lia's findings) - this should help get better blood flow and nutrients to both babies and hopefully help get Baby B more fluid in his/her sac. I can drink 3 Boost or Ensure drinks a day and I can spend as much time as possible lying on my left side. The drinks are easy, the lying on my left side not so easy. I'm doing as much as I can, though, hoping that they'll tell me in the next ultrasound that Baby B is doing much better.

I feel so much more empowered!!

Tuesday, March 18, 2008

Good news and bad news - get used to it.

When I was a kid, my friends and I (including relatives) used to play a silly game called "Good News/Bad News." It didn't have much point other than to expand the imagination. Essentially, you would tell your friend something like, "My uncle was driving the the store the other day and got into an accident!" The friend would say, "Oh no! What happened?" So you would say, well, the good news is that he's okay but there is bad news..." and the friend would say "and what's the bad news?" You'd say, "the car was totalled, but there is good news!" Your friend would play along, "what's the good news?" "He was able to still get some money for it selling it for scrap. But there is some bad news..." "What's the bad news?" "Well, when he sold it for scrap they found a dead body in the trunk. But there is good news!"

You can see where I'm going with this.

I feel like I'm in the middle of one of those stories. It all started with the IVF cycle when I was told I had no response to the medication... but the good news was that I had some antral follicles that might catch up, the bad news was that they wanted to cancel a monitoring appointment, then the good news was I had 7 follicles, shortly followed by the bad news that my blood work showed I ovulated early and the IVF was canceled, followed by good news that it was a lab error and the IVF was back on, and so on and so forth, until I got pregnant, then I lost a twin, then the twin was found again...

So as of yesterday the good news is that we still have twins! The bad news is that Baby B (we call them Baby A and Baby B for now - Dave won't let me call them Flotsam and Jetsam just yet, hehe) is still in a very small amniotic sac and the prognosis doesn't look too hopeful. I'm still hopeful, though.

After the ultrasound Dr. E suggested that we shouldn't tell anyone about the twins just yet. While it's difficult to discuss, we don't mind telling people, as long as they understand that the situation is very fragile. In fact, I'm happy for people to know because at least by their knowing, they can send us positive thoughts, offer support, and if they pray then they can pray for our situation. Prayers are always welcome and I truly believe they help!

However, I ask all of you that I know in real life to please not mention this to others we know in real life, but if you do, please mention the truth that this is not certain and that only time will tell. Dave and I are pretty open about the situation if we are asked, but it is difficult for us when someone asks us "so, how many are you having? Are you having twins?" or other similar questions as they look at us with a big optimistic smile. It's also difficult for us to talk about twins as if that will be the end result of this pregnancy. Mainly this is an issue we prefer to tell people ourselves, rather than have it passed along.

Dr. E left the room for a little while to make a phone call to the OB department at my HMO to tell them she wanted me monitored more closely. Dave wondered what was taking so long and I told him that I think I just got upgraded to high risk. When Dr. E came back, she said she suspected the possibility that the babies have Twin to Twin Transfusion Syndrome. I had actually heard of this before, but only because I watched a cheesy Lifetime movie a few weeks ago where a woman lost a baby to this. The movie was in error, though, because this woman's twins were fraternal (boy/girl - sort of obvious) and apparently Twin-Twin Transfusion (TTTS) only occurs in identical twins.

Now this is only speculation so far but it looks like a definite possibility. I have many symptoms of it already and this would explain the cramping. If this is the case, it's a frightening prospect, especially since it's happening so early in the pregnancy. We still have a lot of hope that the amniotic sacs will balance themselves out and give Baby B more room so he/she can swim around happily like Baby A. Baby A was sure putting on an acrobatic show for us yesterday in the ultrasound.

Now for the waiting game. The next appointment is the Nuchal Translucency ultrasound, which I booked weeks ago just in case I needed it. This ultrasound is mainly to determine risk factors for having Down Syndrome and since Dave and I would not terminate the pregnancy for anything, we were considering not having the testing done. We have no interest in doing a risky invasive procedure like CVS or amniocentesis so we were considering not getting the screening done, since all it could do is give us more reasons to worry over the next 6 months. As it turns out, this ultrasound is now going to be a crucial step in determining whether or not Baby A has too much amniotic fluid (polyhydramnios) and if Baby B truly has too little (oligohydramnios). Hopefully, they may also be able to tell us whether or not the babies are identical twins sharing the same placenta. I wonder if they will have a difficult time sharing when they are toddlers.

Dr. E told us that they will monitor the situation carefully through ultrasound and if necessary, they may perform therapeutic amniocentesis - so there we go probably getting the amnio we also didn't want, but now it's looking like it may also be crucial. What they may be able to do is to remove some amniotic fluid from Baby A and give it to Baby B.

As a sign of my hope, I continue to have the twin ticker here and on my myspace page. I will continue to refer to them as "the babies" and "the twins" when discussing the pregnancy. Other than that, it's tough to get all excited and talk about actually having twins as in giving birth to twins just yet. What will be will be and we are in the middle of one big "Good News/Bad News" waiting game.

Friday, March 7, 2008

Twins

So, I remember back in high school I read about this guy that had a twin in-utero, but that twin died early on. Typically when it happens in the 1st trimester this is called Vanishing Twin Syndrome (VTS). It's estimated that 1 in 8 pregnancies may actually have a twin, but statistically only 1 in 70 births are twin births. Basically, what happens is that the lost twin is absorbed by the mother and the surviving twin. We wouldn't know much about VTS if it weren't for early ultrasound.

Anyway, so this guy was the surviving twin. He was getting a lot of headaches and the doctors discovered a tertoma tumor on his brain. A tertoma tumor is a tumor made up of the parts of the lost twin. Pretty freaky, huh? Well, this tumor was making him do really bad things and the docs thought it was affecting his brain because of the location of it. So, they removed the tumor and the guy was able to live a pretty normal life without the headaches... for awhile anyway.

With the tumor removed this "vanished" twin was able to come to life and somehow came back as a full grown man looking just like the surviving twin. He was really bitter about losing his life up to this point and decided to take over the life of the surviving twin, but that meant killing the survivor. Not only was he trying to kill his surviving twin, he also brutally murdered other people in the surviving twin's life. This tumor definitely turned into the infamous "evil twin." Anyway, in the end, good twin killed bad twin and while it was a horrific experience, he was able to move on with his life. It was really difficult, however, to explain the murders of those around him, since his evil twin left behind fingerprints, dna, and other evidence that pointed to him. Still, everything was resolved. No, this story wasn't in a newspaper. It was "The Dark Half" by Stephen King. Still, these stories have to come from somewhere, right? ;)

Anyway, I was wondering, do you think that may happen to my twins if I lose the one? And if I (hopefully) keep both babies, would CVS or amnio be able to detect which one is the evil one?

Just wondering.

Thursday, March 6, 2008

No complaints!

I dunno, maybe it's different when you try to conceive for years as opposed to months, or when you have to resort to expensive fertility treatments to get pregnant, but I just can't seem to relate to pregnancy complaints.

Sure, I have morning sickness, I want to sleep all day, food disgusts me, I have been struggling to not lose weight, to eat enough, drink enough, and move enough. I'm on "rest" orders and pelvic rest orders, and I'm really bored, but I am so happy to be in this position.

I'm delighted to finally know what morning sickness feels like. My Nurse Practitioner actually had to tell me what I had actually was morning sickness - I was blaming it all on "something I ate," "too much sleep," "too little sleep," "too hot," "too cold," "ate too much," "ate too little," "dehydrated," "drank too much water," etc. It's still difficult to actually acknowledge a lot of these things for what they are - real symptoms! Even the headaches I've been getting daily, it was my neighbor that told me my headaches were pregnancy related, I had no idea.

I know these feelings are not pleasant, but they are signs of pregnancy!

I go between bouts of insomnia at night and feeling so tired I can't move in the early afternoons. And with it all, I'm loving every minute of it!

I love that I have babies in my belly even though very soon that might become just one baby in my belly. I love that I can actually hold on to some hope of actually becoming a mother! I love that some day my house will be filled with the pitter-patter of little feet. I love the thought of growing old while watching my child(ren) grow. I love the possibility of having grandchildren.

I can't wait to outgrow all my clothes and have to wear maternity clothes even though I can't find anything I like, at least not yet. I love that Dave and I will have to budget more wisely and save $$ so we an afford children and afford to do our best by them.

I love that I can finally go to the baby sections of department stores and look at things I like and don't like instead of avoiding those areas with tears in my eyes. I love that I can look at other women with pregnant bellies and babies and feel a pure happiness for them without feeling sorry for myself.

I love that my doctor visits have gone from $120 for an ultrasound to check follicles in an effort to get pregnant to $0 for an ultrasound to see my babies! There is such joy in those ultrasounds now! I love that my health care provider loves pregnant women and offers excellent coverage for people having babies even though it means lots of appointments, classes, and tests. I love that my doctor wants me to get regular blood tests and urinalysis. I love that I am in the "pregnant" category and get to experience all these tests, even those that aren't so pleasant.

I love that people will no longer ask me when I'm having children and/or if I am considering it and/or why I don't have children.

I love that I'll have a big belly in the summer heat, though I do worry that the heat might be a little dangerous so I'm planning methods now for cooling off when I'll need it. Still, I love that I'll get to wear summer (icky-spot-friendly) maternity clothes!

I am just so very grateful to be in this position, I wouldn't dream of spoiling a minute of it by wishing I wouldn't have this symptom or that symptom. I feel bad seeing that so many others aren't so empassioned by their pregnancies. I guess it's all relative.

Tuesday, March 4, 2008

Another miracle! (and another 2ww)

So, the word of today is WOW!!!

We went to the 2nd ultrasound today. I saw NP Engracia at the REI clinic. The REI clinic keeps success cases around until about week 10 before graduating their patients off to their OB. Today is 8 weeks and 4 days and was supposed to be my last visit to the REI, for this baby at least. After this appointment I was to "graduate" from their care and into the care of my OB. Well, that didn't happen and that's good news because...

The lost twin survives! After Engracia showed us many views of our little "gummy bear" I asked her to take a look at the lost twin. I had a small idea or maybe a hope that there was going to be a heartbeat there. It was just a slight inkling that I was trying to push out of my mind, because my greater senses told me I was expecting a singleton.

Engracia said, "well look at this - there is a heartbeat!" I have to admit that a part of me was really hoping for this, but certainly not expecting it. I was really shocked, amazed, scared, and delighted all at the same time! The look on Dave's face was unforgettable.

So that's the good news! Baby #2 measures right on target, just like baby#1! The bad news, well, it could be bad news, is that baby #2 has a very small and squished gestational sac and we might still lose him/her. Engracia wants to see me back in 2 weeks and she said that if things look good then, I can "graduate" and that it will be very likely that we will graduate with twins. She said the real test will be making it to 14 weeks - that's 5.5 weeks from now.

All we can do is hope and pray at this point and I'll continue doing my best to eat well, stay hydrated, rest, avoid running/jumping/etc. and continue the supplements.

So, enough about me, on to something and someone else. My cousin little Cohen is in surgery today having his tumor removed. Please join me in praying for him and his family.