Tuesday, June 24, 2008

10W0d: Colorado and 1st prenatal visit

We're back! We've been back since Sunday, actually. S and I had a wonderful time in Colorado. Last Wednesday night, we flew into Denver and picked up our rental car. We had reserved a "compact," but ended up with a Hummer(!) instead. Apparently this particular car rental place has a lot of very large vehicles (for skiers, I suppose), and few compacts. With today's gas prices, the compacts and even the full-size vehicles are being snatched up immediately. So, yes, we ended up with a Hummer for only $18/day (the compact rate). Even the gas didn't end up being too bad ($70 or so) since we used only 3/4 of a tank over the course of 4 days.

Wednesday night, we stayed at a semi-sketchy airport hotel that we had reserved via hotw.ire. Hotw.ire claimed that it was 3 stars, but failed to mention that it was undergoing major construction (especially outside) and overlooked the freeway. Oh well, it certainly beat our next accomodations...

In Estes Park, we stayed at a place called the "Tin.y To.wn Cabins," part of a larger enterprise called the "Tro.ut Have.n Lodge." We knew it would be cheezy based on the website pictures, but there was really no choice since literally everything else under $250/night was booked over the weekend. Our little cabin (nestled between a miniature golf place and a bunch of brush which hid the river, and overlooking an RV park) had very dated furniture and carpet, but we can handle that. The bad parts were: 1) we returned to the cabin on Friday to find a horrible smell. At first we thought it was a dead animal. We opened all the windows and doors immediately. Next, we noticed that we had zero hot water. Well, it turned out that the bad smell was an overwhelming amount of natural gas from a two dead pilot lights (water heater and stove). Good thing we didn't light a match or something! 2) Saturday AM, we heard the scratching sounds of what seemed to be a rather large animal in our wall, and then under the bathroom floor. Don't know what it was, but creepy.

Now that I have finished with the amusing parts, I will say that Rocky Mountain National Park is really beautiful. We saw everything from meadows with aspen and elk, rushing streams and waterfalls, high mountain lakes, snow-capped peaks, and tundra above the treeline, blooming for the few weeks of summer. We hiked every day (Thursday thru Sunday). At first I was concerned about the altitude, my personal fitness or lack thereof, and potential stress on Blueberry, but everything seemed to be OK in the end. I had a slight headache on Thursday and Friday morning, but that went away with some Tylenol and acclimation to the altitude.

S and I started an open-ended discussion about baby names. We have fairly similar tastes, but he is a bit less open to uncommon names than I am. Unfortunately the names that we both like are not favorites for either one of us. This may be difficult, but luckily we have about 7 months to figure it all out.

On our way back to the airport on Sunday, we stopped by to see my old friend and former med school classmate, R, her husband J, and their 3 children, ages 5.5, 2.5, and a 6 week old newborn. It was a lot of fun to see their home and to see how they deal with parenting 3 little ones at once. They are pretty relaxed and seem to do a great job.

Yesterday, I had my first "normal" OB appointment at 10w0d. They told me to arrive "1/2 hour early to complete paperwork." I chose to get there 15 minutes early, and completed the forms within 10 minutes. The medical assistant called me in to the exam room a few minutes later. I found it a little strange that she just asked me my weight rather than measuring it, even though there was a scale 2 feet away. I wonder if it will be that way throughout pregnancy. So far, I haven't gained anything, BTW. It's amazing, because I have been eating pretty heartily, and I usually gain very easily. I had initially gained due to fluid weight from OHSS, but I lost that plus 0.4 lbs more by late May, and the scale hasn't budged since.

My appointment yesterday was with a nurse practicioner. She does the initial visit, but then sets you up for the remainder of the visits with an OB physician. They do have nurse-midwives, but they are located at a different office, and I didn't consider that option. She had read the aforementioned paperwork and therefore knew about the fact that I had IVF. She didn't really ask me anything much about it (ie whether it was my first cycle, how many eggs, how many transferred, or anything like that). I also mentioned the OHSS and she wrote that down, but didn't have any further questions.

She then did a brief heart, lungs, and breast exam. She asked if I was sore ("no") but then said, "well you definitely have pregnancy changes in your breasts." Hmmmm... She next did my annual Pap smear (I was due) and confirmed what I already could feel -- my tiny cervical polyp has returned. I think this is the 4th time it has appeared since I was 25 years old. They won't remove it until sometime after Blueberry's appearance. Luckily, it has never bled, so I don't think it will cause any problems. As she finished the Pap, she said something like, "your pelvic outlet is nice and round, a typical female shape, and it should not be a problem to deliver vaginally." Interesting...

Next, she wanted to do the ultrasound. She said, "let's try the abdominal approach first." (To me this implied that we would eventually do both the abdominal and the vaginal approach, but that was not the case.) She said that it was fine that I had an empty bladder. She placed the probe on my suprapubic area and after just a moment of searching, Blueberry popped into view. It was definitely blurrier than the pictures at the RE's office. I'm not sure if that was due to the abdominal approach or whether it was simply a poorer-quality machine. Anyway, I was thrilled to see Blueberry again at any angle, and he/she gave a few waves and kicks to say hello. I could see the flicker of the heartbeat, but the NP said, "we don't measure that anymore because it doesn't matter what the heartrate is in the first trimester." I don't really buy that explanation, but I'll just assume that it was still OK. She did give me a bunch of printouts, but most are very blobby-looking. The best one is this:

I think you'll agree that the 9w0d ultrasound is easier to make out that this one. Oh well! The important part was that Blueberry had grown from 23 to 33 mm in just 1 week, and actually measured 2 days ahead at 10w2d. She didn't measure the sac, and honestly, I don't want to know anyway.

After the ultrasound, she let me get dressed again, and returned to the room with a packet of information. She then spent about 10 minutes showing me the various materials and brochures in the folder; it contained info about contact numbers for about childbirth and breast feeding classes, pamphlets about what not to eat, and brochures about first trimester screening and other upcoming tests. She asked if I had any questions, but really, I couldn't think of any. I guess I am hoping for someone to be really interested in chatting with me and getting to know me as a person, asking me about what kind of birth I want, etc, but I'm probably being unrealistic.

After that, the appointment was over. Oh, Dr. A from the RE office was standing there in the back hallway. He works at both offices (university clinic and private RE office), apparently. He said, "Hi, Sarah." It was nice to see a familiar face and I told him that all was well. I next chose my OB/GYN for the remainder of my prenatal visits. (I chose a woman, Dr. K, who I have seen once before in 2006. It's been a while, and I can't even remember what she looks like. However, I know I prefer her to my 2007 OB/GYN, Dr. V, who was the one who didn't know to draw CD3 labs -- like FSH -- on CD3.) However, for my next visit, Dr. K is already full and I will see an NP one more time. Other than that, I was scheduled with appointments every 4 weeks until early December. After that it will be every 2 weeks, but the schedule is not yet open that far out into the future.

I want to do the first trimester screen (bloodwork and nuchal translucency test), and they have in fact already scheduled me for the bloodwork part next Monday (June 30th), with the nuchal translucency scan to be done around July 7th. However, this stresses me out because I am starting my new job on July 1st, and I will therefore be changing insurance plans in the middle of the test. Thus, I'm afraid that neither insurance plan will want to pay for a screening test that was done half during my enrollment in their plan, and half either before or after my enrollment. I tried to sort this out today, but it seems that the majority of human resources / benefits type people on our campus are out of vacation this week, or leave their desks by about 4 PM. Argh... I could wait until after July 1 to start the screen, but it is a time sensitive test and I will be pushing the limits a bit. Also, I may not have a new insurance number for a week or so. I think it will turn out OK, but I can just foresee that I will have to make a lot of phone calls to try to sort this one out...

Anyway, I've certainly blabbed enough for now. I'm thrilled to see a few new pregnancies among the women on my blogroll recently (Alison! Jen!) and I hope that those will keep coming in the next few weeks!!

Wednesday, June 18, 2008

9w1d: Graduation

Yesterday was my last visit to the RE's office. S came along for this ultrasound, and it was truly magical.

Blueberry at 9w0d:

The head is toward the right, and you can see little arms and at least one of the legs. The "ball" at 9 o'clock in the top picture is the yolk sac.

The heartbeat sounded strong and fast again. The most amazing thing, though, was that he/she was actually squirming around! So cute!! The RE (Dr W) said, "Wow, I could watch this ultrasound all day long!"

I think I can finally come back to reality and not worry about the small gestational sac issue anymore. Blueberry's crown-rump length was 22.3 mm and the mean gestational sac diameter was 32 mm. (This time, Dr W checked 2 diameters -- 40 mm and 24 mm -- and averaged them, which is apparently the correct way. I'm kinda glad she didn't do that at prior visits because my numbers would have been even worse!) Anyway, there is now more than 8 mm between the size of Blueberry and the size of the sac, which is normal. This is such a huge relief.

After I got dressed and we walked out of the ultrasound room, Dr. W and several of the nurses presented us with a rolled up paper tied with a purple bow. It turns was a "Certificate of Graduation." Below that phrase it said our names, and then "Dreams Can Come True," and was signed by the entire staff. It is cheezy, I suppose, but of course I started crying and hugging everyone there. I felt a little bad because there was one patient in that area who was getting her blood drawn. Well, hopefully she got some hope or inspiration from seeing us "graduate."

They told me to come back and visit with a big belly and/or with a baby in tow. I just might do that, but I'll be sure to do it at a slow time of day so that there won't be other patients around. In any case, I didn't say goodbye because I hope that we'll be back in a couple years for baby #2!

Next Tuesday, I go to the regular OB/GYN's office. Yay!

We are going on a short mini-trip to Colorado tonight. This is our attempt to salvage a bit of real vacation before I start my new job on July 1st (as opposed to just sitting around the house during our ill-fated May vacation when I was sick with the OHSS). We are flying into Denver, and then we'll be staying in Est.es Park and spending a few days in Rocky Mou.ntain Nat.ional Park.

I'll check in with you all when we get back!

Sunday, June 8, 2008

7w5d: Tagged!

I was tagged by Pink, and it looks kinda fun...

A - Attached or Single: Attached - Wonderful husband
B - Best Friend(s): Katie and Sumi (hi guys!), my husband S, and my mom!
C - Cake or Pie: Cake (chocolate)
D - Day of Choice: Definitely Saturday
E - Essential Item: Glasses and/or contacts... can't go further than across the room without 'em
F - Favorite Color(s): purple, berry
G - Gummy Bears or Worms: Gummy Worms (the sour kind)
H - Hometown: lived in Iowa 'til age 10, but I'd consider San Diego my hometown since I spent the rest of my growing-up years here
I - Indulgence(s): Still drinking one Diet Coke per day (RE said it was OK... but still...)
J - January or July: hmmmm... honestly I like July better, but January is my birthday and Blueberry's due date. Sorry S! (whose birthday is 7/10).
K - Kids: Love them and trying to wait patiently to have one!
L - Life was incomplete without: My husband. It's still incomplete while waiting for a baby!
M - Marriage Date: 10/1/06
N - Number of Siblings: one half-brother (age 20 now) and one sister (age 9)
O - Oranges or Apples: Oranges
P- Phobias or Fears: Cockroaches, roller coasters, can't imagine ever jumping out of a plane or bungee jumping!
Q - Quote: the Golden Rule: "Do Unto Others as you would have them do unto you"
R- Ring size: My engagement ring is a freakishly small 4.75, and actually my ring too big (spins all the time and sometimes falls off). I think I need 4.5 or 4.675 instead. I have small knuckles and fingernails, for whatever reason. However, my fingers are long, and I wear a size 7/Medium in hospital gloves. If any part of my body is long and thin, why does it have to be my fingers? Legs would be better!
S - Season: Summer
T- Tag 3 Friends: Cindy, soapchick, and Hilary...
U - Unknown fact about me: Depends on who's asking, I guess. I have been both a Democrat and a Republican (pre-Bush-era!), and I am currently unaffiliated.
V - Very favorite stores: ummm...Nordstrom Rack probably (blush!)
W - Worst Habit: Diet Coke!
X-ray or Ultrasound: Ultrasound! Of course! Get to look at follies or the Blueberry!
Y - Your Favorite Food(s): Way too many! Pizza? Chips and salsa? Thai food? Yum, yum, and yum!
Z - Zodiac: Aquarius (but I don't believe in it!)

Thursday, June 5, 2008

7w2d: Introducing.... Blueberry!

I'm sorry if my comments have been sparse lately. I'm trying to catch up with everything, mostly real-life stuff.

I haven't told you guys our nickname for the embaby: he or she is called Blueberry. I think the name came up on the day of the ET; I was looking at pictures of 5 day blastocysts online and we were trying to think of a name, and that's what stuck! Maybe we were influenced by pictures of the day 4 morulas (aka raspberries); I don't know. Anyway, I've really liked how so many of you have had nicknames (Scrappy and Doozer come to mind), and it feels really good to be able to call him/her by name without assigning a gender and still staying a tiny bit detached (see below).

My two readers with a medical background may recall that there is a scary syndrome known as a "Blueberry Muffin Baby." Which is not a good think, as it signifies congenital rubella, CMV infection, etc. I refuse to give up our cute nickname because of that!

Chicago was fun but exhausting. There were about 33,000 (or more) people attending this conference, so it was crazy. I was listening to lectures about breast cancer pretty much 8AM to 4 or 5PM every day, and I learned a lot. It is always inspiring to hear about all of the new therapies and hopefully tests that will help predict which patients will benefit from these therapies. I also realized that unless I start focusing more time on work, I'm unlikely to ever get my name on even a tiny abstract.

The fun part of the trip was that I had the chance to stay in a hotel room with my friends K (wonderful friend since 7th grade, high school, college, and residency; also a Heme/Onc fellow and the mother of an adorable 9 month old boy) and A (friend from residency, also a Heme/Onc fellow at the same institution as K, and 17 weeks pg). We enjoyed talking about everything: pregnancy stuff, career issues, and reliving the laughs, odd personalities, and horrors of our stressful Inter.nal Medicine residency program. It definitely helped the days pass quickly up until today's ultrasound:

The great news is that Dr W is thrilled about Blueberry's progress. His/her crown-rump length is 9.9 mm, right on target. The heart rate was a perfect 148 bpm, and this time we not only saw the flicker of the heartbeat, but we were actually able to hear it (via transvaginal Doppler). Absolutely amazing!

I would be lying if I didn't admit to you all that I am still incredibly nervous, though. Blueberry's gestational sac is only 17 mm in its longest dimension. The mean gestational sac diameter would certainly be even smaller. 17 mm corresponds to about 6w3d or so, ie about 6 days behind. I've spent hours googling this topic, and this pretty much summarizes my current angst:

1) I asked specifically, and Dr W is NOT concerned about the sac size. She says it is completely fine, and she assures me that if she did have any concerns, she would let me know. I don't know why this isn't enough for me.

2) most websites, scientific articles, and textbooks do not really talk much about sac size or the variation thereof, and it is most frequently mentioned referring to badness such as having a certain-sized sac without a visible yolk sac or embryo

3) there was one (and only one) study in 1992 which found that if the difference between the gestational sac size and crown-rump length was less than 5 mm, the chance of miscarriage was 90%. If it was 5-7.9 mm, it was 26%, and above 8 mm, it was 10%. In my case, the difference was 7.1 mm (17-9.9 mm).

4) The sac should increase in size by about 1 mm/day, and the average is 1.1 mm/day, I believe. An increase of under 0.6 mm/day is a poor sign. Mine did increase by 1mm/day since 6w0d, so I guess I'm on-track there.

5) I read a blog in which the author had a normal sized embaby and a small sac, raising her OB/GYN's concern. Unfortunately, the blogger's embaby stopped growing soon thereafter (at about 8.5 weeks). Other blogs described twins in which the smaller sac embaby did not make it. A few other blogs had cases in which everything seemed to turn out fine, but somehow these did not completely reassure me.

Oh please, please don't let Blueberry run out of space to grow!!

My mood varies from elation to dread, depending on if I am thinking
about the beautiful heartbeat or the petite sac. I will probably see Blueberry next on Tuesday, June 17, at 9w0d. Our other option was 8w3d, but that is Friday the 13th, and I guess I'm feeling a little superstitious. The main consideration, however, is that S will be coming to the next ultrasound, and I figure that we might as well see as developed of an embryo as possible at that visit. So, 9 weeks it is! Today's ultrasound was great, but I couldn't make out what was head/yolk sac/body/limbs, and I'm looking forward to being able to see a bit more detail.

I am truly sorry if all of my whining and worry seems frivolous to anyone out there who is still TTC. I don't know, I think I am kinda scarred from the entire IF experience, and I can't believe that this will really work for us.

Please keep growing, Blueberry!