December 2007 - Posts
I met with my rheumatologist this morning for my first appointment after finding out I was pregnant. Overall, a simple visit - no blood work or labs required. The labs from my last round of blood work indicate that my SSA (La) and SSB (Ro) levels have remained the same, so that's a good thing. While I haven't noticed any additional symptoms, it does appear that my knuckles are getting more inflammed (rheumatoid arthritis). I don't feel it now, but that could be what was contributing to the issues I was having earlier with hand cramps while writing.
We discussed being on Plaquenil and she's suggesting that I wait until the 12 week mark vs. 10 weeks just to be on the safe side to start the medication. She said that the 10 week timeline for development was a pretty good gauge, but in her practice she usually waits to get through the first trimester. Especially since I'm having morning sickness and upset stomache is one of the possible side effects. As is a rash. Two things I have to watch out for and call her if I notice. I raised the issue of titration with her as I seemed to recall that she wanted to start me on a lower dose and work up to a stronger one. She agreed, and after checking her notes realized that when the mail order pharmacy filled my prescription, they didn't accurately write in her directions. That's going to be something I raise with them in the next week (when I have time to write that email). I'm going to start by taking 1 pill a day for 2 weeks to see how my body reacts to the medication. Assuming everything's okay, I would then go up to 2 pills for an additional month, then back down to a maintenance dose of 1 pill a day. She'll monitor me throughout the process to see how it's going, but this should be sufficient to keep my symptoms from developing any more, and to hopefully alleviate some of the symptoms I'm already feeling (like the fatique and dryness).
She did ask if I was getting enough rest, especially considering the morning sickness bouts I've been having. I kind of chuckled and said that I was getting what I could with a toddler at home. She again reiterated it was good I wasn't working full time, and that I should lay down whenever I feel tired or naseauous. Hah. That's a good one. She commented that I looked fairly tired and my eyes were extremely dry. Two things I already knew, but felt a bit like she was pointing out the impossible. Try and rest whenever I can. I don't want my son to be a tv junkie, so I am hopeful some of the toys he received for Christmas will enable me to "lay down" when I need to, but keep him occupied while I rest. We'll have to wait and see. He does pretty well playing by himself, but wanders quite a bit in doing so. I'm also going to start using his nap time as a time for me to rest instead of cramming in housework. Something's got to give, so I guess I know what that will be.
I took a little time tonight to do some research about "swollen ovaries" and ovarian cysts...since I have one. Seems like they are common in pregnancy (about 1 in every 1,000 women will have one during pregnancy), so I'm not alone. What my doctors haven't told me is that if it ruptures or gets twisted, I will not only be in a severe amount of pain, there's the possibility that I will either miscarry or go into preterm labor. Wow, why didn't they say that?
From what I've read, cysts larger than about 6 or 8 cm usually have to be removed surgically if they haven't resolved themselves after a few weeks...and this isn't a scoped procedure. Most are open incisions, and removed around the 14 week mark when the risks are the least. That's the same time I would start the fetal heart monitoring. Let's hope in 2 weeks it hasn't grown in size and hopefully, has shrunk.
Today we received the first print out picture of our baby. How exciting! We were able to see the tiny little bubble of an "egg sac" (as they call it) two weeks ago, but today this sac now looked like a bean, and we could even see the "fluttering" inside that was the heartbeat (at about 140 BPM, so things are looking great). My ultrasound technician took a few photos of my uterus, the baby, and then my ovaries before telling me to get dressed and walk down the hall to the doctor's office to discuss the results. Throughout the entire ultrasound, my son complained because the lights were off. As he's not quite using all of his words just yet, he mainly pointed to the lights and grunted indicating that they should be on. He did take a walk over to the ultrasound technician to get a closer look at his baby brother or sister, so that was neat to see he was interested.
My meeting with the doctor was brief - long enough to review the notes in the file (most of which were inaccurate). She confirmed I have Sjogren's, and asked if I had any issues with my first pregnancy. Upon my response of "no," she said that was great news. Why isn't this in my file? She then confirmed that I would be scheduling weekly visits with her practice at the 14 week mark for the heart monitoring. I corrected her that this monitoring was going to be done at my high risk OB's office. "Oh. Okay," was her response. She asked if we had decided about the first trimester screening, to which I replied that my high risk OB's office scheduled that through her office last week. Again, why wasn't this in my file?
After clarifying (yet again in some cases) what was happening when, she indicated that things were looking great. Technically I'm 8wks1day pregnant, but I'm measuring 7wks3days. Not surprising as we know that I ovulated late these past few cycles, which could easily explain the difference. This won't change my due date, or my c-section date. The baby looks great...and yes, there's just one. My left ovary is still VERY swollen (she referred to it as my "cyst," so I have to believe that the swelling is cyst related), and reconfirmed that the same restrictions from 2 weeks ago still apply. No heavy lifting (25+ lbs), no intense exercise/activity, watch any pressure in my abdomen, etc. She even went so far to say that the next stage (since my ovary is over 7cm now) would be rupture...something I wouldn't want to have happen as I'd be in a LOT of pain. When I pushed her for more information, she basically just told me I didn't want to go there. I know I'd lose my ovary, but I'm not sure what exactly would happen (would I need a procedure, etc.?).
I have already scheduled my next appointment - 2 weeks out - and that was a bit tricky. The practice I see has 4 offices, and of course they only had an opening in the one farthest away (over an hour). I declined, asking if there wasn't something closer. After some more looking, they were able to find one at 8am downtown...yikes, heading into a major city at 8am with a toddler sounds like a death sentence. I pleaded for something later and luckily there was a 9:50 and a 10:20. I took the 10:20, and as she was filling out the card I thought to inquire which doctor I would see. As you'll recall from an earlier post, my primary OB insisted that I try and keep my rotation throughout the practice to 3 or 4 of the 9 physicians in order to concentrate the information about my case among a smaller set of doctors. This way there were a few doctors who knew a fair amount vs. many doctors who knew very little. The doctor I was going to see was the one I saw for my annual...who basically told me I shouldn't take ANY medication (under ANY circumstance) when pregnant...questioned how I knew I had Sjogren's...drilled me as to why she didn't have any physician's reports (given it was 2 days post diagnosis)...and then told me she couldn't discuss anything with me until she had all that information. I have no idea why they have you fill out a very detailed online questionnaire about your health prior to your appointment, but don't call to request information if it is needed. They knew a day ahead of time what my situation was, and could have easily had me have my rheumatologist fax over my diagnosis notes.
Needlesstosay, I asked for a different doctor, and the receptionist was very receptive (no pun intended) to this...thankfully. She found me another appointment later that day...low and behold...in the office closest to my home! Great. She also asked if I wanted a note in my file that I didn't want to see that doctor, to which I agreed. That was also nice. As I am appreciative of people going above and beyond...and not giving me a hard time in the process...I did thank her for her flexibility and thoughtfulness...pretty much in those words. Who doesn't like being thanked for going the extra mile? She could have stuck me back in the office farthest away from my house and I wouldn't have known the difference. She could have also demanded a reason why I didn't want to see that one particular physician. She didn't...and I probably wouldn't have told her anything other than personal preference as I don't like to pass judgment on people. That doctor could have been having an off day...however, I don't want to take the chance it wasn't.
On the way home this afternoon, my husband and I discussed how things were going, as I've had some pretty intense bouts of morning sickness and I've been pretty crampy on and off the past several weeks. Not that I entered into this pregnancy thinking that wasn't at all a possibility, but my first pregnancy was a complete dream (besides the weight gain). It's worth every cramp and lip biting urge to keep my stomach contents in their place, especially if the baby is healthy. We also discussed how I'm fortunate enough to not be required to work, and that I've also got a fabulous consulting arrangement that allows me to do some work on my own terms and time (usually at night when my son's in bed) without having to think about day care. I do need to remember that my health is a top priority and that encouraging my son to do more on his own (like walk down the stairs and not be carried) is going to be increasingly more important. That's a bit sad as it means he's growing up, but I can't stop that from happening.
I'm counting down the weeks until I pass the 10 week mark. Although I'm officially less than 2 weeks out, to be safe, I think I'm going to push to be past the 10 week mark as measured by an ultrasound. That's definitely something on my list to discuss with my rheumatologist this Friday, as well as call my high-risk OB about (if necessary) after my next OB appointment. Unlike the first time, I'll be going to one or both OB offices fairly frequently throughout this pregnancy, I'm I'm fortunate to have both Moms in the area and available/willing to watch our son for these weekly appointments. Family and friends are so important to us, and we're continually thankful that we're surrounded by such loving and thoughtful people.
With everything that's been going on the past few days I completely forgot about the call I received from my primary OB's office on Thursday afternoon. A very nice woman called to let me know that they had finally heard back from the high risk OB's office and that I've been scheduled for my first trimester screening. Huh? I asked her to clarify who scheduled this - my primary or high risk OB. She explained that she had notes that my high risk OB scheduled this appointment in his office for the end of January.
I explained that when I saw my primary OB last week she had asked whether we were going to have this testing, and at the time I had told her that we didn't have it with my son and we hadn't discussed whether we were planning to have it for this pregnancy. She replied that we had a few weeks before the testing needed to be done, so we had some time to discuss the topic and make a decision. Well, the woman on the phone just insisted that this had already been scheduled and that if I had any questions I should call the high risk OB's office and ask to speak with Michelle. Before thanking her, I inquired as to when my first appointment was with the high risk OB - her response, the high risk OB said another consultation wasn't necessary (which makes sense as I had already had mine back in August). I pushed to inquire when my first monitoring would be with his office, and she explained that her notes said that the first trimester screening was scheduled for the end of January and that no further appointments were necessary. Huh? She again insisted I call and talk with Michelle...on Friday as (at 2pm) she's probably already left for the day. I did thank her for the information and said I would be in touch with the high risk OB's office.
I immediately dialed the high risk OB's office - I wanted to get to the bottom of this huge misunderstanding...and things were just continuing to snowball. I figured that either I could leave a message for Michelle and she'd call me back first thing on Friday, or perhaps they could transfer me to someone else who might be able to help. Michelle was actually in the office and available. I explained that I was a bit concerned about what was going on with my care - that I had just received a call from my primary OB's office informing me that the high risk OB didn't need to see me, but had scheduled me for the first trimester screening. I continued by saying that we hadn't decided whether this was something we wanted, and thought we had some time to decide, and that I was under the impression I would need to start seeing this doctor shortly to discuss my going on Plaquinel and start the monitoring for fetal heart block. She encouraged me to leave a message for my doctor in his private voicemail and that after he listened to it, she'd be able to call me back with further instructions. This was great.
I was transferred to his voicemail, and probably ended up leaving a 3 minute message. I left my name, number, date when I first saw him, how far along I am, and then a detailed explanation of how my primary OB did get his recommendations but didn't think he'd be monitoring me throughout the course of my pregnancy, that the monitoring would be monthly at my regular appointments, and now I've been told that I don't need to see him at all. I continued by saying that I am getting close to the 10 week mark where we had mentioned I could start the Plaquinel, and that I thought I needed to see everyone (my primary OB, high risk OB, and my rheumatologist) before I could be on the medication. I concluded by just saying that there's been a misunderstanding somewhere along the line, and before we got any further I just wanted to understand what my expectations should be for my pregnancy - as things really weren't going the way I thought they would be up until this point.
Within 20 minutes, the doctor himself was on the phone talking with me. I really LOVE this guy. Not only did he have the most reassuring manner about the way he spoke, but he also didn't give me the sense that he was squeezing me into his day, or that he was in a hurry to get through our conversation. He started by telling me that I was correct in believing that his office would be monitoring me on a weekly basis, and that although it was pretty clear in his notes, my primary OB must have either glanced over the letter or just misunderstood what was going on. He said that he sees her in the hospital from time to time, and will make sure that she fully understands the series of events the next time she's there. In addition, he said I should feel totally comfortable referring any doctor in my primary practice to his letter to reconfirm what should be done...and if I am still getting the feeling that they're not reading his notes, I should call him back and he'll place a separate call to their practice to "reconfirm" my care. He explained that the weekly monitoring will start at my first trimester screening (week 12) and continue through week 28...and that this monitoring can only be done in his office, as he's the only practice in the area that has the doppler they need to do the monitoring - this isn't equipment that a regular OB practice would have.
So, I was right. I will need the first trimester screening as it's part of the monitoring his office will need to do to rule out any problems with my pregnancy. Just talking with him for 5 minutes made me feel SO much better about things, and much more confident to push back if there are any more discrepancies with the information my primary OB practice has regarding my care. I was beginning to feel like I had misinterpreted what we were told back in August and making mountains out of molehills, but now I know that I'm not crazy and that this is really what is supposed to be happening. My goal now - to keep the three doctors talking so I don't have to play patient in the middle.
Things got even worse on Friday. Although I've been crampy on and off most of the past few weeks, by Friday afternoon I couldn't even get comfortable. I was just counting the minutes until my husband was home so he could watch our son run circles around the house. Until that point we watched every Thomas the Tank episode in On Demand. He loves that show, and actually will at least stay in the same room while it is on. When anything else is on, it's like background noise for him.
When my husband finally got home, he helped me stretch out on the couch with my legs propped up a bit. Laying out was probably the least uncomfortable position. However, by about 9pm I was standing up just trying to find any position I was comfortable in. The cramps started just under my ribs and would shoot down to the top of my thigh...and at some points down to the top of my knee. It's almost like I'm having back issues now.
I am starting to show...and just under 2 months. Not like most people would pick up on it just yet, but we had a wake Thursday night and a funeral on Friday morning. Although the pants I wore fit, my tummy was definitely protruding more than usual. Since I haven't really told anyone just yet (we're waiting for our second ultrasound on the 26th) I did feel a bit self conscious. I also downed a good plate full of food at the luncheon after the funeral...and I'm sure I surprised a few people. They had lots of hot foods like meatballs and pasta and chicken, as well as salad (which I piled on my plate) and cold cuts. The ham sandwich would have tasted great, but knowing deli meats are off the menu I stayed away. I did have room for half of a very chocolate chip brownie and a Christmas decorated cookie. Although I don't always feel hungry, when the foods there my appetite shows up too.
As I haven't been feeling totally up to par these past few days, I've only managed to finish wrapping any gift in the house (I have a feeling I'll have a few IOUs...), but haven't started the cookie baking. I was supposed to do that last week, but with making meals for my parents and son to have while we were at the wake and funeral, I didn't have the time to start the cookie process. I was planning to start that yesterday, but after 2 more hours of wrapping gifts and then the need to vacuum and wash the kitchen floor (my son broke his dinner plate by throwing it off his high chair last night), I instead spent my evening vacuuming and washing the entire downstairs (needed to be done, maybe just not last night...but everything was out so I just got it done).
We'll see how far I get today. Instead of my normal 12-14 batches of cookies, I've scaled back (at my husband's suggestion) so that I don't "overdo" it. I also have to make a pie. I'm hoping by dinner it will all be done and the kitchen will be cleaned. I better get going or it will be lunchtime and I'll still have nothing out of the oven.
Yes, I've been crampy the last few weeks, but today was more so than usual. Every time I bent over, like to tie my boots before heading outside with my son, I would feel an annoying pressure in my lower abdomen. I also woke up this morning not terribly hungry, but my stomach was rumbling. I ate a bowl of shredded mini wheats and headed for a drive to the mall with my son to meet up with my husband for a picture with Santa. The whole way there, the tour through the packed mall, and the whole way home I felt sick to my stomach. Great feeling. I can't even imagine those women who go their whole pregnancy feeling this way...or the ones who actually run to the bathroom. Fun is.
I'm continuing to stick to everything I own, from pulling on underwear in the morning to trying to get the keys out of my winter coat (and getting stuck in the fleece pockets). Think the only thing I'm not sticking to right now is food, except the washing of my hands throughout the cooking process make them burn. I made some butternut squash soup tonight that was very yummy (not to mention a great source of vitamins and veggies for me and baby), and between washing the celery, carrots, the squash, potatoes and then the pots and pans my hands feel like they've been dunked in acid. Good news is my thumb is just about healed, so at least I'm not bleeding on the food. My lips are now cracked and peeling, so I am bleeding onto my forks and spoons...and napkins. My son seems to have the same problem - split lower lip that keeps cracking and bleeding. I've been using Aqaufor on his lips, maybe I should start using it on mine.
Mustered all of the energy I could tonight to make the soup and a baked mac and cheese then fold 2 baskets of laundry and pull out the vaccuum to clean out the pretzels and other food in the cushions of my couch (my son likes to bury things these days) and vaccuum the family room, kitchen and mud room. Amazing how much dust accumulates in a few days. Not to mention the trail of crumbs leading everywhere. These little bursts of energy make me feel like I've accomplished something each day, but I wish it didn't come down to me seeing the bunnies rolling across the floor to convince myself I really should pull out the vaccuum. I remember the days when I was working and just never was home long enough to vaccuum (nor make much of a mess), now I'm making more of a mess and home to actually clean it up...but I just don't feel up to it. I clean now when I'm expecting company or I'm feeling way out of control. Tonight was a mix of both. My parents are coming tomorrow evening to sit with my son while we head out to a wake for a few hours, so I can just imainge them sitting on the floor seeing nests of hair (I have long hair that gets everywhere) or crumbs from something my son ate yesterday and dropped all over the floor...or just forgot about...and we walked over...not seeing it buried beneath his mountain of cars and train parts.
I feel like I need a schedule and just need to find something that will occupy my son long enough for me to tackle a little bit each day. If I can keep up with the mess, I don't wind up stressing about the house "falling apart" or trying to cram a bunch of chores into the 15 minutes my husband has my son in the bath every other night. My husband has been a saint about trying to alleviate any water activities when he's home. He does the baths and changes the diapers to reduce the number of times my hands are in water each day. It helps...and it's nice to have some uninterrupted time to make some headway in the house. I'm sure he wonders why I only clean (or so it seems) when he's home.
In the mail today I received a copy of the letter the high risk OB sent to my primary OB back in August. After digesting the two pages and all of the medical terms and abbreviations (like CHB = congenital heart block...or fetal heart block)...and I have SSA (La) and SSB (Ro) antibodies...I got to the part where VERY CLEARLY he outlined how with "weekly monitoring from weeks 14 to 26" they should be able to determine whether or not the baby has CHB. Weekly monitoring. Did my primary OB glance over the letter or just make up what she'd like to do for the course of my pregnancy. She was under some misguided assumption that I would have regular monthly monitoring of the heart beat in her office, and maybe a level 2 ultrasound (or two) with the high risk OB. HUH? Not what he recommended. Going to have to bring that up with him once I get that appointment. Good to know I'm not out of my mind, but disturbing to say the least that they aren't all on the same page...even when they have all of the same information.
I did get the appointment with my rheumatologist for the last week in December. Will definitely be nice to talk with her about going on the meds and about my non-healing, ever splitting skin. They two slits on my thumb and middle finger still haven't healed, and just about everything cracks them open again. I've used neosporin and wrapped them up with butterflies, bandaids, and that great medical tape. No luck. My thumb's a little better, but there's nothing like wrapping Christmas presents only to look down and see your finger bleeding...and then panic thinking you've smeared it all over the gift. I've been lucky this far.
The past 2 days I've had some mild cramping. Can't quite tell if it was the swollen ovaries or gas. Hate that it could be either. I've also had no appetite. Unusual as I'm usually good to eat at most any time. I've gotten used to eating 5 or 6 small meals a day between my first pregnancy and now. Just kept it up, and it seems to work better from a feeling full perspective. We were out running errands this morning, and while I was bent over in a bookstore looking at some books, my stomach started growling. Not just a rumble and done. This was like a cat...an angry cat that was loud enough the gentleman in the aisle with me chuckled a little. No appetite, but my body is obviously still looking for nourishment. Have to think it's a girl (we're kind of hoping...and we kind of planned) as so far I've felt a good deal different with this pregnancy. We'll have to just wait and see. Healthy is all I'm hoping for right now. For both of us.
I had my first visit with my primary OB this afternoon. Definitely exciting, and as my husband, my son in his winter suit packed into his stroller like that kid from A Christmas Story, and I huddled in a room with the sterile table, a bunch of rolling carts, chairs, and a large ultrasound machine we crossed our fingers that the news would all be positive.
When I first arrived I think they stuck me with a nurse-in-training. She had no clue. Thought I had already had all of my bloodwork. Failed to realize that the bloodwork was 2 months ago to confirm I was not pregnant...and wouldn't I be coming in for more than my first visit by the time I was 3 months pregnant? She weighed me (why do they do this then ask you to pee in a cup?). Good news was I wasn't as heavy as I was with my first pregnancy (yeah, I followed their instructions!). Bad news, I was about 12 lbs up from where I was in July at my annual for my pre-pregnancy check up. Oh well.
My blood pressure was normal for me (112/70), and everything else checked out. The nurse-in-training had me sign a bunch of forms and couldn't really explain them to me. With a fussy son and anxious husband, I scanned them - one was an HIV test which I checked "decline" on as I know I'm not. Not unless my husband's stepping out and if he has the time to do that he's a magician. I agreed to the first trimester screening...as the nurse-in-training told me that it was just through bloodwork. We'll come back to this conversation.
So here we are crammed into a rather spacious room chock full of equipment, tables, and all kinds of things you'd think they would be able to find a better way to store. My primary OB walked in and greeted all of us, and began to explain that she knew I was very insistent I be seen, and understood a bit as I had Lupus. Red Flag. Lupus? Well, it's an autoimmune disease with similar antibodies that cause similar complications, but the symptoms are different. So I politely corrected her, and she inquired how I was diagnosed and what I'd done in the meantime (who my rheumatologist is, etc.). Then she explained that it was early for me to be in for a visit - I'm 6 weeks 1 day. I explained that my high risk OB wouldn't see me until they confirmed my pregnancy. She couldn't understand why it was so important that I get in to see them so quickly as she would be doing all of the monitoring during the pregnancy. Second Red Flag. I explained what the high risk OB had shared with my husband and I back in July - that his practice would do fetal heart monitoring on a weekly basis from week 10 to 28 (at which point we would know whether the baby had any heart issues). She corrected me and explained that the monitoring was less frequent and would be done in her office. Huh? I acknowledged we had different information and it was important that we were both on the same page, so she copied me the notes she had received and I'm going to give the high risk OB a call tomorrow to discuss.
Either way, she went on to explain it was too early to hear heartbeat just yet, and too early to see anything with an ultrasound, so today's visit would be to get a Pap (baseline), my tests for all of the wonderful disease I don't have (see above regarding my husband), and then do an internal to check my uterus. At this point, my son got fussy, and my husband obliged and took him for a wheel around the office while the doctor swabbed me and did the internal. She commented that I have a tipped uterus (knew that, she actually told me that a few years ago) and noted that my uterus felt large enough that we might be able to see something on the ultrasound...so she gave it a whirl and invited my husband and son back in for the show. My son didn't really like it that the lights were off, nor was he thrilled there weren't cars or trucks on the "tv" screen, but it was fun to see the little black sack containing the baby...attached to the uterus where it should be. The interesting thing is that my ovaries are very swollen. Supposedly, the ovaries swell during the early weeks as they produce the progesterone that allows the body to maintain the pregnancy. After a few weeks, the swelling subsides. However, my ovaries were VERY swollen, so much that it explains the cramping I've had the past two weeks. I can feel it now as I sit here and type. It's kind of like menstral cramps. My ovaries are what she had felt while doing the internal exam, which is why she thought my uterus was so large. She explained that I need to take it easy until the swelling goes down - no strenuous activity (no running, lifting, etc.) as it may cause them to rupture, which would not be good. I'm going back in on the 26th to have my second ultrasound, so they'll take a look at them again and let me know what, if anything, needs to be done. Hopefully the swelling will be down and I'll be fine.
The doctor did ask me about my Sjogren's symptoms, and I had explained that I had attributed the cramping to not drinking enough. Here I am again in a situation where I dismiss symptoms of something because I think they're normal. You'd have thought by now I would have known better. At least the cramps were on my list of things to discuss with her! We talked about the thirst and dry eyes, as well as about the dry cracking skin. I've got sterile butterflies on my thumb covered by a bandaid as it keeps splitting open. Two weeks now and it's still not healing. I use so much hand lotion it's crazy. She did have a good suggestion - go see a dermatologist, so I'll ask my rheumatologist if she knows someone who works with Sjogren's patients (I have to set up my first pregnancy visit with her tomorrow as well).
The doctor reaffirmed that the primary thing I would be monitored for was fetal heartblock. However, I learned something new today - there's two ways to pick up on potential problems. The first we knew about - a drop in the heart beat from a normal beats per minute of about 120 to somewhere under 70. The second is a "static" heartbeat. What she described was that the beat would be within the normal range, but wouldn't vary much which would mean that the baby's heart wouldn't respond appropriately to activity or required changes in blood volume. Didn't know this, but at least they are both monitored non-invasively through a fetal heart monitor. She mentioned that the high risk OB would most likely do a level 2 ultrasound every few weeks to check on the baby's growth as well. Autoimmune patients tend to have lower birthweight babies...which she acknowledged would probably be nice for me considering my first was 10lbs 7oz. Additionally, I will periodically have non-stress tests to ensure that I'm still providing the appropriate environment for the baby's development. Depending on the results they may decide to put more restrictions on my activities in the future.
As long as there wasn't any problem, they would schedule my c-section at 39 weeks (a week before my due date). If the baby was a high birthweight or if I had any other complications (like gestational diabetes, pre-eclampsia, etc.) I would be scheduled earlier and would need an amnio the day before the section to confirm that the baby's lungs were properly developed. Wonderful. Let's continue to hope for the best.
Back to the bloodwork. So I had agreed that I wanted a flu shot (covering the bases), and that I would have the first trimester screening...which wasn't bloodwork. Huh? That wasn't explained. The nurse-in-training also didn't mention to me that if I decline the HIV testing, the baby would need to be prior to leaving the hospital. Nope, I'll take one for the team. I was supposed to jump out of my appointment and across the hall to have my bloodwork done, but the lab closed at 3:45pm. Who has those hours? I'll have to go out in the morning after breakfast with a bundled son and pray that he doesn't scream his head off as they draw my blood, or heaven forbid, make us wait 3 days in the waiting room in order to draw a few vials of blood.
For now my marching orders include not only to limit my exertion and prevent my ovaries from ruptering, but I also need to not lift anything over 25 lbs. Did I mention my son weighs about 32? Not so easy. He gets around just fine, and can do the stairs by himself with some assistance, but what about when he fights me to go up and change his diaper or take a nap? How about lifting him in and out of the car, carraige, and other places I need to get him into as I don't have the luxury of full time assistance (nor am I the type of person who can't fend for herself). This is going to be a fun ride. At least things look good right now, and there's just some miscommunication somewhere along the line that I need to work through. The doctor did agree that everyone needs to have the same information in front of them, so I'm going to call the rheumatologist tomorrow and forward my latest blood work to the high risk OB and my primary OB, then I'll call the high risk OB and ask that the summary that was sent to my primary OB be sent to my rheumatologist and me. Oh boy, coorindation. It was also good to know that the primary OB has a weekly meeting with all of the doctors where they discuss all of the high risk cases. This way all doctors are aware of what's going on, so if I see one of them, it's not a huge learning curve (or requires a great deal of time to read through my chart). Additionally, she recommended that I try and schedule my visits with just a handful of doctors in the practice so that there are several doctors familiar with my situation rather than a bunch of doctors who know just a little bit. I thought that was a good idea. We're excited, but just want to get through the first high risk appointment to make sure that everything's in place and we're doing all that we can to ensure a safe and healthy pregnancy and delivery.
Our medical insurance company must have some pretty keen eyes, as I received a mailing the other week for a mom-to-be program that they're offering. Having worked in health care, I understand that these programs help to manage costs and ensure that patients receive the treatment they need. The insurance company must have noticed I had some labs run a month or so ago and it triggered this outreach. Nice that they're paying attention.
So I decided to call and talk with them and find out what the program was all about. I spoke with a nice lady who asked me a bunch of expected questions - how do I know I'm pregnant, have I seen my doctor, what was my pre-pregnancy weight/height, and what is my weight now. She shared information that helped to refresh my memory (like no deli meats, no unpasturized cheese, watch the amount and kinds of fish, etc.), as well as encouraged me to have 3-4 servings of dairy each day, as well as fruits, veggies, and protein. Then she explained that I should be taking in about 2200 calories a day. Okay, 4 servings of dairy is about 600 to 800 calories alone...and that's without eating ice cream. Four yogurts would be 600 calories. Take that off the 2200, then take off the 3 servings of fruits, 4 servings of veggies, and the protein...and don't forget limit the sweet intake. Yikers. Kind of deep for an early pregnancy talk.
We also talked about limiting the amout of stress in my life (was I working outside of the home, how would I describe my stress level in the home, etc.), as well as the heavy lifting I was doing. Reasonable. Then she asked if I had any other "little ones" at home, and I explained that I had a 19 month old, to which she made some type of comment about how they were close in age. A comment I thought could have been left out of the conversation as it's none of her business how close our kids are in age...and just because they're not the traditional 3 years apart doesn't mean that the second one wasn't planned (and I mean highly planned). She asked if he was active, and how much he weighed. Her response to his solid 32 lbs was that perhaps the "limiting heavy lifting" wasn't going to be that easy...but I should try and force him to be as independent as possible, and lift him only when necessary.
The kicker to the conversation was that she and I discussed how I had Sjogren's (and she asked me what it was and how to spell it...wish they were a little more trained), and in the part of the conversation where she explained what the next steps were, she fumbled over how to tell me that because of my "disease" I would be monitored more frequently...most likely...as she didn't really know what it was that I actually had. She was polite, and tried to be tactful, but I think it fell apart somewhere along the way.
The nice part about this program is that I received a book (your pregnancy week by week...which is nice, because I read the other book...what to expect when you're expecting for my first pregnancy) in the mail to help me recall what I'd be going through each step of the way. I also received a letter explaining the program and the mention that there was a survey I needed to complete and have my doctor complete. The postage paid envelope was there, but not the survey. Nice, as my doctor's appointment is this Wednesday!
Other than being tired just from trying to do all of the normal household Christmas preparations, the only other thing I've noticed is some "fluttering." I know it's WAY too early to feel movement, but this is more like a concentrated pulse in my lower left abdomen. It happened once prior to taking the test and I thought that it was just a very strange sensation. Then it happened again this afternoon while I was driving. Feels like there's a pulse of blood through a vein down there or something. Neat, but something to monitor. I also had some mild cramping on and off over the past week...think it's probably because I'm not drinking enough (or wasn't as I'm constantly thirsty now). Something to watch. Something to happily watch.
Have you ever read Dr. Suess' Sleep Book? You'll know where the title of this blog post comes from if you have.
Well, we were going to wait until this past Tuesday for me to take a pregnancy test as at that point it would have been 5 weeks from the start of my last period. However, Saturday morning as we lay in bed just barely awake talking...and watching our son scramble around in the down comforter (we bring him into bed sometimes on Saturday or Sunday morning if we want to have a lazy wake up)...my husband surprised me and said, "take the test." We quickly discussed how we had planned to wait...as pregnancy tests aren't cheap and it was completely possible I wasn't pregnant again this month. He still urged me to go take one, so I did.
Just about immediately the wonderful cross appeared confirming I was pregnant, but being skeptical, I walked away and waited the 2 minutes before checking again...and getting myself all worked up. Yes indeed, I'm pregnant! What fabulous news for December 1st. The next challenge was trying to get that first OB appointment. As we waited until after my OB confirmed I was pregnant the first time around, we figured to be safe we should do the same thing this time. I'm pretty sure that within about a weeks' time I was able to get an appointment the last time around, so when I called the office on Monday morning to schedule my first pregnancy visit I was a bit shocked that they said, "our first opening is on December 24th."
My response was something to the effect of a stutter, followed by the proclaimation that I was a high risk pregnancy and needed to be on medication by the end of the month...was there ANYTHING sooner? She said she'd check all of their offices and give me a call back. In the meantime I placed my next call - to the high risk OB. The receptionist said to just forward my files from my OB's office and then we could schedule an appointment. I explained that the doctor already had my files from before I was pregnant, and she countered that they needed the notes on this pregnancy before scheduling my appointment. I went on to explain how they couldn't see me until the end of the month and how the doctor wanted me on medication by that time. She asked that I leave the doctor a message in his personal voice mail explaining the situation and proceeded to transfer me. I kind of like how that all went - rather than have her take a note and call me back, she brought me directly to the source. I did leave a detailed, but concise message for the doctor explaining my concerns and he had his assistant relay a message just a little while later that waiting until the end of the month would be okay, but hopefully my primary OB would be able to see me sooner.
Later in the afternoon my OB's office called back - they're able to see me on the 12th. Funny how appointments can just appear like that. That's one thing I've never understood - how one needs to call nearly a year in advance to schedule their annual physical (and hopefully it won't be changed before you get there), but that when there's a need, they can find slots. It's a good thing when you're pregnant, not such a good thing when you're not.
As we won't have the official confirmation until the 12th, we debated telling everyone...and decided that telling our immediate family and friends who knew about what has been going on (and are reading this blog) would be the best thing right now. Once I met with my OB and the high risk OB we would let everyone know, as the first questions we'll get include how's the baby, what's going to happen with you, when can you go on the medication, etc. I want to have answers to these questions before we make a formal announcement. However, we also want to share the happy news with those closest to our family.
I've been feeling pretty good, only thing I've noticed in the past week or so is that I can't fall asleep at night. I lay awake tossing and turning...and moving that giant pregnancy pillow because it's easier to use that when you're not supposed to sleep on your back or tummy. I haven't quite figured out if it's from all of the excitement, if it's because my husband's been burning the midnight oil and doesn't come to bed until well after I'm asleep, or if it's something else. Time will tell. Now I'm just trying to maintain my 10 lb weight loss from where I started with my first pregnancy to prevent the OB from saying anything about my weight. Wish me luck...Thanksgiving and then a week of being sick didn't help things. Comfort foods are definitely not good for your figure!
I'm starting to notice just how dry my eyes are. My husband surprised me with tickets to Wicked last night - what a fabulous musical! I've read the book (actually back in college a friend of mine recommended it, so that was over 12 years ago...), and although it wasn't very true to the story, it was very entertaining, had an amazing set, and the costumes were unbelieveable. What artistry.
However, I've been going and going and going for weeks, and was looking forward to an early bedtime last night instead of a rush to pick up the house, make dinner, get showered, and out the door to make the 8pm show. Although I had a wonderful time and enjoyed the entertainment, during the middle of the second half I was fighting to stay awake...and as such, I began to notice just how dry my eyes were. Focusing and trying to pay attention was difficult, as was trying to ignore the sand paper feeling I got with each blink. I can fight off the yawns, but what can you do when it hurts to actually blink? It's not like you can fight off the urge to blink. It just happens. And happens. And keeps happening.
So, after about 30 minutes of mild discomfort, the musical was over and we took our brisk walk to the car. I mentioned to my husband that I was tired and my eyes were dry. His reaction? Rub them a little to get the tears going. Ah, yeah, hadn't thought of that. Oh, that's right, I have Sjogren's...and a symptom is dry eyes. Wonderful. As I sit here typing, I've got that dry eye feeling again...like my lids are glued to the top and the exposed part of my eye is coated with dust. Irritated. At least that is how it feels.
I realize that there are products out there that will help, and I'm sure I'll break down and look into them. At this point in time, I don't want to let this run my life. However, I did receive a very nice gift from my MIL, one of those U shaped pens that arthritis sufferers use to alleviate some of the discomfort and cramping they experience when writing. My SIL had shared a few websites that offered these types of "aides," but I just hadn't gotten around to doing much more than complaining. I have to say it does make a world of difference. That, and my 19 month old son like chewing on it. I guess serving two purposes is a good thing. Should probably put another one of these on my Christmas wish list as it would be a good idea to carry one in my purse too.
To answer the question, yes, I have been wearing the wrist brace and although it does seem to help, the pen helps too. I have noticed that prolonged use of the mouse definitely irritates it, but as I can't really do to much wearing the brace, I grin and bear it and try and recover in the evenings. Little by little I'm learning how everything I do impacts my life now, and what I can do to prevent some of these irritations...or lessen their impact.
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