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| Week 21 Day 4 |
We went into the ultrasound pretty quickly after getting there. The baby had been moving a lot the night before and was laying on her back this time. So the ultrasound tech could get the face, hands, feet, chest and heart. They also do 3-d scans of the face. The baby loves to have her hands by her face and suck on her thumbs, but luckily she was moving around enough to get a good shot of her close up.
After the ultrasound, we waited in the exam room for the OB and that took forever, maybe 45 minutes or an hour. We even thought they might have forgot about us. The appointments with the dr after the ultrasound are scheduled as a separate task so there was a little time between the ultrasound and the dr appointment, but also the dr was a little late. I was ok but Naomi was grumpy about being in the exam room for so long.
My sister really didn't like my ob. She thinks that she was rude. I think she was a little short, but my sister kept interrupting her explanations to ask questions. So I think they were both being a little rude. My opinion is that the labor and delivery nurses do a lot of the work and I will interact with them the most so I just like a Dr that can handle anything crazy before or after delivery.
There were a few concerning issues with the second exam. The first, was that the cord was inserted into the placenta at 1.9 cm and it should be at least 2 cm. Since 1.9 is so close it is not a big deal but something to monitor because the baby might not get as much nutrients.
The second thing, was an EIF (echogenic intracardiac focus) which is a calcium deposit on the heard and shows up as a bright spot. It is a soft marker of down syndrome because EIFs show up more in babies with down syndrome, but EIFs are also seen in typical babies. Since, I already did the genetic screening for down syndrome then there is no concern about down syndrome. I could do a more invasive and risky test to be 100% sure instead of 99% sure, but I don't think the risk is enough for 1% difference.
The final thing, which is the most concerning was that there was fluid on the heart. The doctor was concerned about this but she wouldn't speculate about what that would mean without sending me to a maternal fetal medicine doctor for a closer look. She said that she just wanted to "cross the t's and dot the i's" so I shouldn't lose sleep over it. Ha! Having less information proved is not very good for me in the coming weeks.
Other than those, I learned that because of my advanced age that the OB office I go to induces at 39 weeks even if everything looks good. I was not sure how I felt about that. I really wanted to at least get to 40 weeks May 31st even if I have to get induced at that time. I left feeling concerned about the baby's health but also contemplating switching obs if other options were available. Since my sister had a follow up the next week I asked her to talk to her doctor about what they do.
At home, I was at first ok with being patient and waiting for more information, but I decided I wanted some more information. So I requested my records from the anatomy scan appointment. On Monday I called my OB office and asked about the referral. They said that the referral wasn't marked 'stat' so they had a week to do the referral, but they would note that I called to see if they could get it done early. Hearing again that it wasn't urgent was a relief but I am glad I called because they texted me that night with the referral information.
First thing on Tuesday, I called the perinatal office to make the appointment. They hadn't even opened the email yet about the referral, but they let me schedule. I was able to schedule for the following Tuesday. I think if I had waiting for the normal turn around time it could be another week before the appointment. It was nice to know that it wasn't a rush but regardless I was still thinking about it all the time.
Alongside of making the appointment, I was looking up fluid on the heart online. This resulted in two main outcomes. The first is Fetal pleural effusion. A fetal pleural effusion is when there is fluid around the heart greater than 2 mm. It can be concerning because it can take up room where the lungs need to develop and pushes them aside. However, from a few studies even at 7 mm of fluid the outcomes look good. They might need to insert a needle in to the uterus and drain the fluid from the heart if it was really keeping the lungs from developing or they might drain the fluid after birth. However, for many cases they don't do a lot of intervention. So this seemed like ok news and it also sounded most like what was going on with me.
The second result is about hydrops. It is much more concerning with worse outcomes. However, for hydrops to occur two or more areas in the baby need to have fluid, like the heart, kidneys, abdomen or near the lungs. It can happen for several reasons one is caused by an immune response if the mother lacks an RH factor. I have an RH factor so hydrops wouldn't be caused by an immune response. There are also non-immune factors the most common cause is parvovirus. My ob did ask if I had a cat and I said no and that I do have dogs but I used a claw to pick up the poop so I don't have direct contact. Actually I didn't even pick up the poop during the first trimester just in case! I had a lot to pick up in December however. It can be caused by other viruses as well as down syndrome, turner's syndrome and other chromosome abnormalities. So, because I already did the genetic screenings, I didn't have a cat, and the fluid was only in one spot I didn't think hydrops was likely but it was still a possibility.
I also looked up inducing at 39 weeks for older mothers. I didn't find a ton of numbers for women over 35, but one UK study said that for 35-39 mothers who get induced at 39 weeks it prevents 17 stillbirths a year. There are more births in the US so I estimate maybe it would be about 100 stillbirths in the US. So there is a benefit but it is pretty low for an individual.
On Friday the 29th, my sister had her follow up. She had a great appointment. The placenta had healed and the clot was gone. Hooray! Also, the baby was bigger again so her due date was changed again to August 27th. Which matches my sister's dates so it probably won't change again. She also asked about what their policy was for induction at 39 weeks. Her Ob says that week 39 births are less risky, but what they do is they have you go in during the 39th week. They do a ripening and that may put you into labor but it may not. She said if it doesn't happen that they wouldn't move on to full on induction.
I looked up ripening on Mayo clinic, it is considered a type of induction, but it is not like they are breaking the water or giving medication to induce. So I am tempted to change OBs.
That week, I also learned that my Aunt had colon cancer. She went into get a routine check and they found the cancer. Colon cancer can be very deadly but that is because by the time symptoms show up it is already 4th stage. So everyone is hopeful that because she didn't have symptoms yet that it was an earlier stage and easier to overcome. She was lucky to get in for a surgery on Wednesday the third. They would remove the cancer and some of the nodes.
So the first week of February, was just as eventful as the last week in January. On Monday the appointment records arrived. I was able to see that the fluid was measured at 3.4 mm. That made me feel that the fluid was an effusion and not hydrops. Also, between 2 mm and 4 mm is considered a low amount of fluid (above normal). The results of low fluid gave me a lot of relief that no intervention would be needed.
On Tuesday, I was able to bring one guest to the MFM. It was pretty far from my house but because of the freeways I was able to get there in 45 minutes. I met with my mom so that we could go the rest of the way together. She offered to drive which was nice because I was nervous. The MFM office was very nice and clean. I had filled out a lot of the forms online but there was an additional questionnaire that needed to be filled out. I also had to give a urine sample.
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| Week 23 day 1 |
We went back to the ultrasound first. It was like another anatomy scan! The tech looked at everything again. Of course she took a lot of pictures of the heart and because of all the research I saw the fluid this time and saw when she measured. I also got more 3-d pictures of the face which is so clear. At the end of the ultrasound the tech told us that less than 3 mm was considered normal and that the fluid was measuring less than 3! So she was not concerned about the fluid!
I was so relieved to hear that news. It was great to know that the fluid levels were normal and everything was looking good. The tech led us to an exam room to meet with the MFM. While we were waiting a staff member came in to let us know that the appointment was booked for 10 so it might be a little bit of a wait, but as soon as the dr was done with the current patient he would be in. It was so nice that they came into the room to let us know that there would be a bit of a wait, even though it was only about 15 minutes.
It was nice to decompress a bit and my mom and I discussed what questions we had. I wanted to ask about inducing and 39 weeks and my mom wanted to know about covid vaccine especially for my sister who cannot work from home. She also thought maybe I could switch my OB to that office even if I don't need to see the MFM in the office I could see an OB at the office.
The doctor came in. He went over all the results including the placenta cord (which I hadn't even told my mom about before that opps). He was not concerned because the baby was weight 1.8 lbs and that is considered in the top 91%! So the baby is getting all she needs otherwise she wouldn't be so big. He talked about the EIF but because I have the genetic screening and no other soft markers he is not concerned. Then he said the fluid looked good. There should be some fluid around the heart because it lubricates the heart as it pumps and the level of fluid is within normal.
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| Cushions for Window Seat, Nursery |
So we asked about switching obs. I don't think he wanted to steal business from my doctor, but of course I could do that. Also I could do a hybrid approach. Their office doesn't not have admitting privilege at the hospital I was thinking of, but the hospitals they admit too are great ones too. I like the first hospital because my brother and niece were born there. So I know that it is nice and it does have an NICU. However the one he admits to is one that my friend went to. I know it is nice too and the NICU is even better. I am still not sure if I will switch or not but I did like the MFM better than the OB at my office. I have a follow up appointment with them in a month. So I have time to decide.
As far as covid vaccine, he said that if it was him, he would get it when it was available to him because the risk of hospitalization, incubation and death are high for people with covid if they are also pregnant. I don't know when it will be offered to me and since I work from home right now I think I can make it to my due date before getting the vaccine. I do want to get it after I give birth even though I plan to breastfeed.
On Wednesday, my Aunt had her surgery. They removed the cancer and also a few nodes. The dr thought they looked like the cancer had spread to a few of them, but they will biopsy them. If it did spread that is considered stage 3 but it doesn't look like stage 4. Stage 3 survival rates look much better than stage 4. She is already scheduled to do chemo.
After all the good news from earlier in the week. I woke up on Saturday and was relaxing with my coffee. I looked over at my 14 year old dog, Reggie's and I saw that the white parts of his eyes were yellow. I checked his ears and they were yellow too. I knew that was not good news.
In the last few weeks, he had been declining. It was hard to get him to eat even if it was just liquid broth. He was wheezing a lot at night. He also had lost a lot of weight, but he started out overweight so he wasn't underweight for his breed. He still wanted to eat treats, or if I had yummy chicken he wanted to eat it. He was also still active. He would get up to the couch and bed. he would still bark at me if he wanted something or at the door if he heard amazon. So while he was declining he was still happy and not in pain.
I called his vet but they were almost closed for the day and they couldn't take him until Thursday. So I thought maybe I could wait until Monday to bring him to Jojo's vet. Reggie's vet is near my parents house because he lived with them for most his life and Jojo's is near me but they allow walk ins. So I spent the afternoon painting the remaining walls of the nursery white. I probably could have spot painted but it was pretty quick with the roller and I had did the trim the Saturday before. Reggie stayed in the room with me or right by the door because he didn't like the tarp. He was annoyed that he couldn't be on the couch but he still was being active.
In evening I was concerned about waiting all the way until Monday to get him to the vet. Sunday was superbowl and I wouldn't be with him all day. So if something happened I wouldn't be able to take him to the vet. So I asked my sister where they brought their dog when she had a heartattack. She sent me back the vet and I called to ask if I could wait until Monday. They said I should bring him in.
I just knew then that it was not going to end well. So I put Jojo in my room in order to get Reggie in the car by himself. He was excited to get in the car. He was even more excited when I put the leash on him. He was very happy in the backseat, looking out the window and going for a ride. The vet was about 30 minutes from my house. I kept looking back at him and looking at him with the mirror. When I got to the doctors we waited in the car as I called from the parking lot.
The tech came out to get him and have me sign some forms. He barked at her a little bit, but was nervous when she opened the door to get him out. I told him it was ok and watched him go. I wish I had hugged him once more and snuggled him when we waited.
After about 20 minutes the vet called and said that Reggie was yellow and he wanted to blood work to
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| Reggie |
look at his liver enzymes. That would take a few hours so I was able to go back home. I really didn't want to go home but I needed to because my phone battery was low. I was finishing dinner when the vet called again. He said that his one enzyme that normally would be under 400 was at 7,000. He thought he had an obstruction in his gallbladder but he would need an ultrasound. He was so surprised that his levels were that high especially because Reggie was so active even barking at people. He couldn't believe he was so active. Usually if he was that active he would sent him home until the ultrasound the next day but with the levels so high he thought the gallbladder might erupt at any time.
Anyway after a difficult conversation, I called my parents to let them know what was going on. I had texted them a few times that day but they had not responded. I knew it was bad and I needed to get a hold of them. They didn't answer but I left a tear ridden message and they called back. I explained what was going on. My mom said that she could be the one to get the information and make the decision. So after we hung up she called the vet and he explained everything to her.
My dad called after the conversation and said that after a long conversation the vet had said that it was either liver cancer which at his age would not be treatable or gallbladder obstruction (which was the most likely) he could have gallbladder surgery but it is a hard recovery for any dog especially one so old. He said if it was his dog he would put his dog down. He said there was also a risk of eruption of the gallbladder and that would be a very painful death. So we had to decide if we should put him down that night or in the morning. We, including my sister and brother, decided that it was better to do it that night. Reggie would be scared and uncomfortable all night being at a vet office. We just didn't think it was right to make him go through that. Luckily we were able to go see him one last time.
It was bittersweet though because they had to sedate him prior to the visit. He was awake but he was very out of it. Also we could only go in two at a time. So my sister and mom went in first, then my dad and I went it. It was decided that we would be in the room when they put him down. I went into the room by myself. Reggie was laying on the table in a blanket. He was really out of it. I put my hand by his nose and when my dad came in the room I saw him look over and his eyes did light up but it was just a barely. It was so hard to see him like that. It would have been nice if he was active like he had been that evening, especially for my family who hadn't seen him that day.
I just wanted to pet Reggie for as long as I could, but I knew it was more for me than for him. I told him I was sorry and hugged and kissed him. After sometime my dad said he was ready when I was. I said I was ready. I wasn't ready, but I knew I wouldn't be ready. So I said ok. He got the vet who administered the drugs. It was very fast after that. I did see when the light left his eyes. It was a little after his breath stopped. While the drugs were being administered the baby was kicking me a lot! Maybe she knew I was upset and she was saying goodbye too. The vet checked his heart and said he passed. We were able to stay after that. We said some final goodbyes. He was still soft and warm, but it wasn't Reggie anymore.
After we went back to the car with my sister and mom. We spent some time in the car talking about Reggie. He had been in our lives for 14 years. We all had great stories about him like he brought a dead bird into my sister bed, he knew all of our names, and he was super smart. He learned to ring a bell to go outside and knew when you told him that you put leftovers in his bowl. He was young when my brother was in HS and he went to all the parties that my brother had in the yard, but when my brother went to college he was getting older. So he would just hang out with Dad and in his middle and late ages.
It was hard to let him go. I think maybe if I had just waited until Monday I would have got one more day with him, but the results would have been the same. However, his gallbladder might have erupted and I'm glad he wasn't in pain.
It is different without him in the house. He is more of a cuddler than Jojo is. Also I think Reggie and I had a strong bond. I usually could figure out what he wanted when he barked at me, and he is better at reading my body language. I woke up this morning and the blanket smelled like Reggie. It is an big feeling for sure. I know it was the right decision even though it was a hard one. I will miss and love him for the rest of my life.
I am relieved about the good news about the baby and my aunt, but I am still feeling bummed about losing Reggie too.
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| Week 23 Bump |
The last thing is that I was touching my stomach on Saturday and I felt that it got hard! I couldn't feel
anything on the inside, but I think it still counts as a Braxton hicks. My sister was the 23 weeks and 5 days when she started getting contractions. Hers were not considered Braxton hicks but they were not labor contractions. Her contractions were more consistent and often also some of them were a little painful. I also felt a hard stomach once today, Monday the 8th! So I think that is a second one.
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