Weekly ultrasound report @ 20 1/2 weeks

Yesterday I had another ultrasound...we have so many, I have lost count! The babies were extremely active, as usual, and the tech was thrilled about it, haha. Of course, it would help if I didn't drink root beer or orange juice right before my appointment! Sorry tech. :)

They did an echocardiogram on both babies. It took over an hour to chase them around and focus in on each blood vessel on their tiny, dime size hearts. A couple of weeks ago they were concerned that maybe Baby A had a hole in her heart, but found it is not a hole, but a leaky valve. Baby B is following suit with the same leaky valve. This means the blood pumping through their hearts is being pushed through quickly and has some back flow. Sigh.... We heard the statement, "it is still so early" again...this is good though. It means there is time for their heart valves to firm up and repair themselves. This is fairly typical of at least one twin recovering from TTTS, but not in both. Of course, my babies have to be an exception to the rules....maybe this will change over time...this is my hope :) They will repeat the echocardiogram in 4 weeks to re check them.

Good news...at this point, I have not lost any amniotic fluid since last Saturday :) This means that the hole in the sack is sealing and things are settling down. If I can keep this record going, I will not have to go in the hospital at 24 weeks...this is our hope too :)

So for now, we pray for healthy hearts and no more fluid :) Can we be that specific? I'm sure Heavenly Father knows what's best :) We have certainly been blessed so far! Our next appointment is next Wednesday, June 4. Let's hope we continue with better news :)

I'm Back! :)

After spending 4 nights in the hospital, I got to come home :) Wed. I had an ultrasound at the MFM doc's at Valley and all is improving. Both babies are doing great and have plenty of amniotic fluid. They found a pocket of fluid between the outer amniotic sack and the inner chorionic sack that tracks up around the placeta a bit. The water I lost, and am still losing, is making its' way out little by little. It also looks like the blood clot I have is starting to resolve itself. In case you didn't read my previous entry, the pocket can form near the surgery site with some leakage that is trapped as the hole seals. This is both good and bad. It's very good since it means my water didn't break, but it is still a concern because it means part of the membrane wall has come loose from the inside of the uterus.

Good news first :) Since the hole where the leak was coming from was machine produced, it will heal better and faster. The hole is also very high up the side of the uterus so natural bacteria cannot enter as easily through the cervix and cause an infection. I am still on antibiotics as a precaution and have to watch my temp. and other signs of infection. If an infection occurs, it could endanger both me and the babies....we'll pray for that not to happen :) And, we were told the TTTS (twin to twin transfusion syndrome) is pretty much over with, thanks to Dr. Chmait! :)

Bad news...I'm still on bed rest. Oh well, this IS a very small price to pay to keep these kiddos, so I will try not to complain! And, hey, I DID get an awesome new couch out of the deal :) Thanks honey :) We had an appt. at Evergreen MFM today...Dr. Walker, who is the fetal surgeon that was in Nepal at the time I needed surgery, told me to take it easy and to keep the uterus as still as possible. This will help prevent the membrane not to tear away from the wall any further, which could cause my water to actually break and other not so good things we won't think about. He told me I was not allowed to have any more complications because I have pretty much had them all already! UGh...at least this is very minor compared to the babies having TTTS. At this point we are going on a day to day basis. If I am still leaking some fluid from the pocket by 24 weeks, I will have to move into the hospital and have the babies at 32 weeks. Ok, this may sound bad, but it is the original news we received when we found out there were two of these little parasites :) So, we will just have to fall back on our original plans and hope for the best possible outcome! So far, the hundreds of prayers offered in our behalf have definitely not been in vain! Thanks :)

Next Wed. my appt. at Evergreen MFM will be another long ultrasound and echo cardiograms on the babies' hearts. I got a DVD recording today of the ultrasound so will get it updated every week I am there. It is about 20 minutes long so it won't download...oh well, I will just have to post printed pics again...I'll hopefully not be updating this story until next week with more good news! Oh, and due to recent events, we have decided to name the babies Trauma and Drama, ha ha ha :)

Greetings from Valley Medical Center

Well, just when things started to look like they were getting somewhat normal (oops, I said normal!), a new scare came along. At 19 weeks pregnant, I was on bed rest for 1 and a half weeks like I was supposed to be...I was laying on the couch Sat. May 17 with my cute little daughter asleep by my side, and I suddenly felt a warm gush of fluid. I rushed to the bathroom and discovered my water had broken. Needless to say, Tom and I were scared. We thought it was all over, that the babies would be lost. We called Dr. Paek, the MFM doc at Evergreen, to see what we should do and where we should go. She told me that it didn't look good. There is an extremely high risk of infection when the membranes are ruptured early, and the babies cannot be born until at least 24 weeks. She suggested I call my OB and go to Valley Medical Center just down the street, so I did. Dr. Channel was on call for Doc Oxford...she told me not too worry too much and to come down and they would check things out. We got my friend Angie to come stay with the kids and went to the ER. Every time I stood up, I lost more fluid and I got more and more nervous. We got a wheelchair escort to the Birth Center and were sent to triage. They found both babies' heart beats, they sounded great, and then took a sample of fluid. Dr. Channel left the room to confirm that is was amniotic fluid, and I laid there, crying. As I laid there, more fluid was pouring out and we thought for sure this was the end. I have felt from the beginning that these babies are supposed to be here, and was not willling to accept what we thought was our fate.

I was admitted to the hospital and taken to my room. They started giving me antibiotics immediately to prevent any infection and I continued losing fluid. At around 9:00 they did an ultrasound. The babies were very active, as usual, and their fluid levels were completely normal. Baby A measured at 19 weeks, and Baby B measured at 20 weeks, 2 days. This was good news, but they were still concerned that I might start contracting, and go into labor. They hooked me up to constant monitoring and tried to comfort us. They told us several success stories where women carried their babies far enough, problem free, even after their water had broken. I have never known of anyone breaking their water this early, so was surprised that something could actually change for the better. The hope was to see no contraction, little or no more fluid loss, and strong heart beats on both babies.

I continued losing fluid through Sat. night, but by 6 am Sunday it had stopped. Tom was here with me and we watched a movie and tried to relax. We were still nervous...waiting always does that to me! The nurses continued pumping me full of two different antibiotics, checking my temperature and drawing blood. It was a fairly uneventful night. Tom fell asleep fairly quickly, as only he can do, and I eventually fell asleep. At about 4 AM, I woke up and coughed. Out came more fluid and my heart sank. I kind of fell asleep, I think, but nervous again, and at around 6 AM I lost some more fluid. Tom went to work and came back around 1:30 to stay with me.

Dr. Harding, from the MFM group at Valley, came in to talk to us about what was happening. He told us based on the ultrasound, lack of contractions, and state of the babies, he felt like the situation was getting better. He explained that sometimes after the laser surgery I had, some fluid can leak from the entry hole in the amniotic sack and get trapped between the outer wall of the amniotic sack and the inner wall of the chorionic sack (the outer sack that encloses both babies' sacks) and the hole will close up. This extra fluid is trapped there and when pressure is put on it, it can release and drain. He said there definitely was not a break in baby A's sack, because her levels were normal. She is also closest to the cervix and the pressure from gravity alone would have caused me to lose her fluid, go into labor and more than likely lose both babies. Another possibility was that Baby B's sack was losing fluid through the surgery hole and the hope was that it would seal itself and stop leaking. We were so relieved to here this! He scheduled us for an appt. on Wed. to recheck everything and maybe send me home. :) The rest of the day was uneventful (thank goodness!) No more fluid loss and still no contractions.

This morning at about 6 AM I lost a little more fluid. Dr. Harding checked in at around 8 AM, told me it looked like things were slowing down. I have now gone 13 hours without losing any more fluid and still no contractions! Tomorrow is my appt. with Dr. Harding's office to check fluid and baby growth. If all looks well, I will get to go home :) Wish me luck!

Twin to twin Transfusion syndrome

Well, recent events have really changed our lives, and I don't mean just the fact that we are having twins. A few scary ultrasounds and a trip to LA to see a fetal surgeon, have surgery, and back home for bedrest...It's a long story, but interesting...some cool baby pictures too...read more below...

We were referred back to the Maternal Fetal Medicine (MFM) doctors to have the babies checked on April 30th. My doctor has been noticing an inbalance in the amniotic fluid levels for both babies. One had too much and the other had too little. I wasn't too worried, and invited my mom to come with me to see the ultrasound. Tom went to work as usual and we went...we were in the ultrasound for over an hour and the tech was very quiet. She said she had to go do some report and left the room. After about 15 minutes one of the doctors came in to repeat the scan. She told me it wasn't fair to me to just let me sit there wondering what was going on and she told me what they were worried about. Baby A's sack was like saran wrap around her, with almost no fluid. They also couldn't detect her bladder. Baby B was doing laps in her indoor swimming pool and her bladder was dialated. Both babies were under stress because A was getting too little blood and oxygen and B was getting too much. The fluid levels were off because urine output changes when a body is under stress and now I have found out amiotic fluid is made up of baby urine. They told me they had Twin to twin transfusion syndrome (TTTS) http://www.eastsidemfm.com/ and we needed to act fast. There is a laser surgery that can be done to sever communicating blood vessels on the placenta and we were fortunate enough to live close to one of only 5 doctor's who could perform it. I called Tom and told him what was going on and my mom and I sat there in shock.

We were referred to Eastside MFM in Kirkland at Evergreen hospital for an appt. on Friday morning. Dr. Walker, who is the senior surgeon there, is half way across the world right now in Nepal climbing a mountain, so we saw Dr. Paek, his partner who has been training with him for two years. Complications don't seem to be a real weak point for us right now, so going with the flow was our only option! We were in the ultrasound for about two hours, getting blood drawn, filling out paperwork, etc. Dr. Paek explained that the babies were struggling and my surgery was going to be very tricky. The placenta is in the front of my uterus...when they go in with the scope through my abdomen, the scope and camera will have to be curved, which is alot tricker. She told us she has never done one like this on her own and would suggest we go to LA to see Dr. Chmait (pronounced Schmight) for the surgery. The other doctors had told us of this possibility so we had already been talking with family to make it possible if needed. We agreed to do this and were on a plane by Sunday!

Our consultation appt. was Monday morning with Dr. Chmait. We met his nurse, Terri first and she welcomed us just like family. She told us all about their mission and love for their patients. They have their office at Hollywood Presbyterian Medical Center, which is an older hospital with no frills. The office was down a long hallway of just blank doors...the only way you can tell it's a doctor's office is by the small sign next to the door. In the small front room they have a cork board with pictures from patients and their surviving babies. Terri knew the story behind each one and told us about visiting them while on vacation. They have patients from all around the world come to them...we can see why :) Dr. Chmait doesn't hang any diplomas on his wall and Terri said he gets mad at her every time she sends a newspaper clipping or video clip of his accoplishments to his mom and wife. Dr. Chmait was very friendly and genuine. We could tell he has similar family values and truly cares about the babies he saves. He confirmed by ultrasound that the babies were in need of surgery ASAP and scheduled us for the next day, Tues. May 6th.

After all the preop tests and paperwork were finally done, we thought we would try and squeeze something fun in while we were in LA, so ventured out to Universal Studios. We started out on the Universal City walk by going to luch at the Hard Rock Cafe. It was pretty cool....but our nerves were starting to get the best of us. After lunch we headed toward the theme park entrance only to find out they were closing in two hours and would charge us $65 each, ouch! We reluctantly decided not to go and headed back towards the shops. Tom talked me into seeing "Iron Man" in the most comfy theater we have been in....this was good, my stamina definitely lacks these days!

We arrived at the hospital at 8:00 the morning of March 6th, got checked in, checked out, iv put in, etc. We waited for about half an hour, filling out paperwork and waiting. Terri came in and helped wheel me to the OR and Tom kissed me goodbye and headed to the waiting room where he spent the next couple of hours listening to Spanish soap operas...he really enjoyed it, haha! :) After preppiing me some more and setting up everything in the OR, Dr. Chmait came in and started the surgery. They gave me a local anesthetic and wheeled a monitor by my head. The did yet another ultrasound to double check placenta placement and got a surprise.....they discovered a long snake like shaped blood clot (hematoma) running along the edge of the placenta right where he needed to go in. So, not only was it to be complicated because of the placenta being in the front, now he had to work around the hematoma. Ah, breathe deeply....I was getting relaxed, but still felt a little anxious listening to the doctors talking. First thing he did was make an incision about a half inch in the right side of my abdomen and inserted a long metal tube for the camera and laser to go down. OUCH, yes it hurt a little! Next came the camera....Dr. Chmait was not happy to find that the amniotic fluid was as dark as Coca Cola...I had some bleeding a few weeks ago that sent me to ER. Apparently the residual blood can discolor the fluid. He reassured me he could take care of this and everyone scrambled quickly to make it happen. They did an amniotic replacement that took what seemed like forever. They pumped out 3 liters of bad fluid and replaced some with sterile saline. What a strange sensation! I could feel my stomach getting smaller and the cool fluid going in. As soon as it was clear enough, he went in with the camera and ran right into a little hand :) Meet baby B :)

How cool is that? I got to see our babies up close and personal and Dr. Chmait gave us the photos! Since it took so long clearing the fluid, he had to work quickly, so meeting the babies was brief. He showed me her little face from the chin up...

Next, we meet baby A....hand and arm, then feet....how cute :)

The rest of the surgery Dr. Chmait would go in with the camera and find the offending vessel. The assisting doctor followed every step with the ultrasound to help guide the laser. When he found the vessel to be cut, he would remove the camera and go in with the laser. Just a couple of zaps with Terri running the foot pedal took care of it. He must have cut about 20 vessels and retraced his steps showing me from one side of the placenta to the other, connecting the dots. He was very happy to get every offending vessel and closed up. Ah, sigh of relief, now more waiting....Check out USC's website for more details and photos from Dr. Chmait's surgeries. http://www.ourbaby.org/diagnoses/twin-twin.htm I was wheeled into recovery where Terri gave me a shot to keep the contractions from coming. Now for the breakdown....a few tears of let down and panic, then I was all good again. The next 24 hours would be crucial. I spent the night in the hospital being monitored for contractions and pumped with antibiotics. The bed was horrible and my hip was aching. The nurse gave me a sleeping pill in hopes to help me sleep. It just made me dizzy resulting in barfing up my entire undigested dinner, yum....or not! I sort of slept here and there while listening to Tom snoring away in his roll away bed. Morning came and I had only had one contraction all night. Since I threw up the night before they ordered me a most delicious, blech, liquid diet consisting of chicken broth, jello, tea and coffee, which I don't drink. The nurse winked at me and suggested I steal some of Tom's breakfast, so I did. Cold oatmeal and mushy fruit never tasted so good! After a while they removed my IV and unhooked the monitors....ah, i could actually go to the bathroom without calling anyone for help :) Terri came and picked us up...my very own wheelchair chauffer :)

She took us to their office, which is attached to the hospital, for an ultrasound to check the babies. Dr. Chmait held his breath a little, put the wand on my stomach.....one heartbeat, and there's the 2nd! He smiled and said, good news! Terri congratulated us, and Dr. Chmait checked the blood flow and activity of each baby. Baby A was more active than she had been and baby B's heart was no longer struggling to beat under the pressure of all the extra blood. We had passed 2 big hurdles and he told us the babies were cured of TTTS. The next 4 weeks the babies will be measured and watched to make sure they are growing like they should. After the 4 weeks, this nightmare will be over :) As far as the hematoma goes, Dr. Chmait told me I GET to be on bedrest for possibly the rest of my pregnancy...oh, joy. Tom decided I might need a new couch to spend my days on. One thing to look forward to, I guess. Terri took us back to the hospital to be discharged and we got another wheelchair escort to the car.

We returned to our hotel room after many slow steps from the car to the elevator and I headed for the bed. Apparently I was tired or something because I fell asleep and was out cold for a couple of hours. I took a shower and we watched a movie....then back to sleep. The next morning we got up bright and early, had breakfast and headed for the airport. We got home Thurs. afternoon and entered real life. My parents had scrubbed my house and prepared my room with a TV tray and all the trimmings...now the fun begins!