Friday, April 24, 2015

32 Weeks

What a happy week!  Transfusion #1 finally happened and it couldn't have gone better! I want to remember as many details as possible so I apologize in advance for this post being quite wordy.  Hopefully it's not too hard to follow! 

Once again our week began on Monday with an MCA scan and NST.  I felt so much better going into this appointment than I did going into last week's appointments.  Rather than making assumptions about what his level would be on Monday, I just prayed that the Sonographer would be able to get an accurate measurement so we could make the best decision for Austin's health.  I was confident going into our appointment and felt we would know exactly how to proceed depending on what number we saw.

We learned pretty quickly that Austin was in need of a transfusion and there would be no more putting it off. The level came back at 66 which clearly put him in "A".
Logan and I weren't too surprised or worried about where things stood at this point because we just felt blessed to have avoided it this long and we had been prepared for a transfusion for awhile so we were ready to move ahead.  The doctor on service on Monday was great and helped us feel extra confident about the transfusion as well.  When she walked in and said: "Well, I think it's time."  Logan and I both knew she was right and didn't hesitate at all.  She explained that Austin's pericardial effusion (fluid around this heart) was a bit more pronounced so that also confirmed that he needed the blood.  He passed his NST on Monday with flying colors so it was nice knowing he was still doing well from that standpoint.  

We were asked to be at the hospital at 9:00am on Tuesday in order to prepare for a 10:00am transfusion.  We were taken back right away and over the next hour and fifteen minutes we had a lot of nurses and doctors coming in and out prepping for the procedure.  I changed into my lovely hospital garb, had an IV placed, was given an antibiotic (in case of infection from the needle), and then we did our best to patiently wait as they got everything set up.  In the room were three doctors, two nurses, a medical assistant, two lab techs, and Logan.  One doctor was responsible for monitoring Austin's heart rate and guiding the other doctor into the correct place by watching on the u/s machine, the second doctor was responsible for actually infusing the blood and the third doctor had the main job of getting the needle into the artery that connects the placenta to the umbilical cord.  They started by telling me to choose a position for my arms and then to leave them there for the rest of the time.  That was hard for me!  I also wasn't allowed to lift my head off the pillow, take deep breaths, or do anything else really.  I prayed with all my might I wouldn't have to sneeze!  Haha.  Putting the needle in didn't pinch too much because they gave me a local anesthetic but once they got it in my skin, penetrating the uterus was painful!  Rather than a sharp pain it was more of a dull, throbbing ache.  There was quite a bit of resistance getting into the uterus so I could feel the jerking as she pushed it further in and Logan said he could see her getting stopped and then pushing harder.  As soon as she got the needle in I didn't feel much the rest of the time.  Sometimes getting the needle into the artery can be difficult but fortunately she was able to get right in within a couple of minutes.  This is when having my placenta on the front side of my uterus is a HUGE blessing.  Austin's elbow and knee were on either side of the cord so she had to get the needle right between them and she did a great job!  They warned us before that the needle can accidentally poke the baby so if that happened it wouldn't cause any problems but he would feel it and move away.  How sad is that?!  Thankfully Austin wasn't poked.  In order to make sure Austin didn't kick the needle and knock it out they had to give him a paralytic which was my least favorite part.  I know it was necessary but I still don't like the thought of it.  We were assured that it would wear off after a couple hours and he would be just fine.  

As soon as the needle was in the artery, a blood sample was drawn and taken to the lab right away so they would know exactly what his blood count was so they could give him the correct amount of blood.  As they waited for the lab to call with the results, they began the infusion at a slow rate and were constantly checking Austin's heart rate to make sure he was handling it okay.  They said it's a good thing I was 31 weeks at the time because smaller babies (around 25 weeks) can't handle very much blood at once.  The lab called within a few minutes with the results.  **Quick background info: Babies are typically given a blood transfusion for anything below a hemoglobin of 8, which is roughly a hematocrit of 24.  The doctors expected his hemoglobin to be right around that or slightly higher.** When they hung up the phone and said he had a hematocrit of 15.4 (hemoglobin of 4.9) I couldn't contain myself and loudly said: "15.4?!" One of the doctors was like: "Yeah, we heard." I don't think he liked that I was so alarmed but I couldn't help myself.  Our poor baby needed blood in a bad way!  A different doctor even confirmed with me afterwards that they were very surprised he was so anemic.  There's no worry about his low blood levels causing damage or anything but we're all just very glad we did the transfusion when we did.  Because of how low Austin's hemoglobin was, he needed 90 CCs of blood so they would infuse 10 or 15 CCs and then check his heart rate before continuing. Fortunately they were able to get all 90 in and he handled it beautifully.  As soon as they finished the infusion, they took another small sample in order to get his hemoglobin once the blood was in and it came back MUCH better at 14.8 (hematocrit of 44).  At this point they pulled the needles out and we were finished! The doctors told us multiple times that everything went extremely well and we could tell they were pleased with the results. 
After the transfusion we were taken down to Labor and Delivery where they monitored Austin for the next few hours.  His paralytic started wearing off pretty quick and it was such a relief to feel him kick again!  His heart rate was strong the entire time so after a few hours we were free to go home!

They wanted me to go back on Thursday (yesterday) for another NST to make sure he was still doing well but we didn't have to do an MCA.  Austin's heart rate typically hangs out around 130 during most of the NSTs so in order to "pass", he has to raise his heart rate up into the 150s at least two times for ten seconds each time during a 30 minute period.  If he seems to be sleeping and his heart rate never raises, they'll put a little buzzer/noise maker thing on my stomach in order to get his heart rate to go up.  So much for non-stress test, right?  Haha.  During yesterday's NST he was nice and comfy and his heart rate wasn't going up like they wanted so they buzzed him and he was NOT happy.  For about 10 minutes he hung out in the mid 160s and was moving a bunch, clearly trying to get comfortable again.  Once he settled back down to his baseline of 130 they gave him a "pass" and all was well!

We've been told to anticipate the next transfusion happening on or around Monday, May 4th.  We feel incredibly blessed that the transfusion went so well and it brings us such peace knowing Austin now has the blood he needs.  Isn't it amazing what they are able to do these days?  We always talk about what a miracle it is that this is even possible!  Austin hadn't stopped moving the last couple weeks but I'm amazed at how much stronger his movements have been the last few days since his transfusion! I'm sure he feels SO much better and has tons more energy now.  I vividly remember how tired Eli looked when his blood level got too low and Austin's was way lower than Eli's ever was.  We have felt such relief the last few days knowing he probably feels so much better!

The majority of my posts lately have been about Austin, as they should be, but I don't want to forget how I'm feeling through all of this.  Physically I have no complaints at all.  I'm able to eat anything I want, I have a decent amount of energy, I'm not too uncomfortable, and aside from using the bathroom one time each night, I sleep great!  Emotionally I'm doing pretty well but I do worry about Austin so that can stress me out a bit.  Knowing we've made it this far brings me a lot of comfort because I know he would be okay if he was born today but I still hope we can make it another month or so!  The next transfusion, which will happen around 33.5 weeks, will be our last one and then we'll start discussing an induction date for a few weeks after that.  I can't believe it's getting so close!
Weight: 144.2 (This week: -.4 | Total: +23.4)

32 weeks down, 5 (hopefully!) to go!

Friday, April 17, 2015

31 Weeks

This was a roller coaster of a week (mostly in terms of my emotions) so I'm glad it's over!  I felt like I was 30 weeks FOREVER so it feels great to be 31.  I couldn't help but laugh out loud the other day when I read that Michelle Duggar, who has 19 kids(!), has had 25 ultra sounds in her life.  I've probably had 25 ultra sounds during this pregnancy alone.  Don't get me wrong, I am beyond grateful for the technology available to us that helps us keep Austin safe, I just got a little worn out from all of it this week.  And to think I used to feel that it was such a hassle to drive out to Riverton once a month!  Our week looked something like this...  

We went back for another MCA scan and NST on Monday morning and received encouraging news yet again! Little Austin's MCA level was at 54, which is right near the middle of "B".
The fluid around Austin's heart was even less noticeable on Monday and he wasn't showing signs of fluid anywhere else so that was great to hear.  My amniotic fluid level was right where it should be and my cervix is still long and closed so all great news!  They attempted to do a growth scan but she wasn't able to get great angles so the only accurate measurement she was able to get was of his head which was right on track so we feel great about that as well.

Monday's NST was also a success and Austin continued to show us that he is nice and comfortable in there. We will likely have NSTs after each appointment to help give us an even better idea of how he's doing and so far they've shown us great things!  At our appointment on Monday they asked us to come back for the same tests on Thursday and said that we would either a) Plan for a Friday transfusion if his MCA level had gone up or b) Come back again in a few days if his level was still in a safe range.  We were very happy on Monday that at the very least we seemed to have pushed the transfusion back a week!

Tuesday came around and I couldn't seem to get my mind off our appointment from the day before.  Austin's level was fine so I wasn't too stressed about him but the information we were given last Friday was quite different from what they told us on Monday so I was bugged and confused by that.  Logan and I could tell that the doctors from Friday hadn't talked to the doctors we saw on Monday and it was very frustrating.  On Monday one of the nurses also stressed to us the importance of making sure Austin was moving enough by counting his kicks (something I had never done before) so that also added extra worry.  I'm typically a "chill", "go-with-the-flow" type of person but my mind was racing all day Tuesday so I decided to call the hospital and talk to a nurse.  The nurse suggested I come in for an NST to ease my mind and said that I could also talk to an MFM doctor.  I hate making situations more dramatic than they are but I am so glad I followed my gut and had the NST done.  Austin looked great and eased all of my worries and talking to the doctor helped even more.  The details of what I was concerned about are pretty confusing so I won't get into them now but she was able to put everything straight and explain a few things I was confused about.  I can't stand it if I don't understand every little thing going on with me and Austin from a medical stand point so I was very grateful it all made much more sense when I left the hospital on Tuesday.

We didn't have to see any doctors on Wednesday and I was grateful for the break.  My mind was at ease and I felt confident that everything would be fine moving forward.  We were back at IMC yesterday for our next MCA scan and we were pretty sure Austin would be in the "A" range meaning he would need a transfusion today. Sure enough, our little guy proved us (and the doctors) wrong again and actually held his level stable at 53! What a champ!
I'm running out of room so my writing is cramped and hard to read but 53 is just below the middle of "B".  We are so pleased with his progress!  The doctor on service yesterday also told us about a calculator that he plugs the MCA level into and it gives him a different type of number that can be used to measure anemia.  He did that with Austin's level on Thursday and got a "safe" result back from that one as well so that was really great to hear.  

Austin also looked great during the entire NST so that was a success as well!  They will occasionally put a buzzer/noise maker thing on my stomach so they can see how he reacts to it and boy does he hate it!  He'll be nice and comfortable and then they'll buzz him and he moves all around and his heart rate shoots up.  It's kinda sad but we're glad he reacts like he's supposed to!  We left our appointment on Thursday feeling great about Austin's health and so pleased with how well everyone's prayers are working.  We are blessed!

I'm really looking forward to this weekend and not having to go to any doctor appointments!  I've been having a hard time sleeping the night before each appointment because I have so many thoughts and "what ifs" racing through my mind.  Hopefully we can start spacing our appointments out a little bit so I can catch up on some sleep.  I have a feeling this next week is going to be a good one!

Weight: 144.6 (This week: +1.6 | Total: + 23.8)

31 weeks down, 6 (hopefully!) to go! **It's hard to believe this baby will be here no more than 6 weeks from now!  Sometimes that feels like forever but I know the time will fly!**

I'm finally ready to post pictures of the nursery!  When I look back at these "progress" pictures it's hard to believe how much we've done.  I'm as in love with it as much as I hoped/thought I would be!
 The panos give a good perspective from start to finish but here are some closer shots:

You may have recognized the rocking chair and night stand from Eli's Festival of Trees display :)
Don't worry, we will write "Welcome Home, Austin" on the pig when he's born :)
I fall more in love with this little room every single day and can't wait to see Austin in here!  90% of this nursery has a sentimental meaning to Eli in some way or another so it is extra special for us to sit in here and remember all of the happy memories.  This room never would have become a reality without the help of both of our families so we are extra grateful to them for all of the love and hard work they put into making this happen.  It won't be too much longer before we're actually using it! :)

Friday, April 10, 2015

30 Weeks

It is such a relief to be in the 30s!  Austin is showing more signs of being affected by the Rh disease so we feel better and better as each week passes and 30 weeks feels great.  It has been a busy week so let's get to it.

On Monday we saw my OB for my regular (3 week) appointment.  This appointment went well and our doctor is very pleased with how things are going.  I had my glucose test last time, which came back totally normal, but naturally everything can't be completely right.  My blood work showed that the shape of my red blood cells is just barely above the "normal" range.  I genuinely laughed out loud when he told me.  Seriously?  I don't think I'll ever have blood work that looks like it should.  They measure the shape of your red blood cells by a number and the high end of normal is 36.0 and mine was 36.1.  My doctor said that it's so close to the normal range that he's not even going to re-draw my blood.  We just laughed at the situation more than anything and I'm not worried at all.  Apparently if the shape of your red blood cells gets too abnormal then they start checking for things like Sickle Cell Anemia.  We're not concerned about that being an issue one bit!  Aside from that "slightly off" blood work, everything else looked great.  Austin's heart rate was strong and I was measuring right where I should.  Only one more 3 week appointment and then we'll switch to every 2 weeks! Little things like that are starting to make this feel real!

Wednesday was MCA scan #6 and we had a goal of his level being somewhere between 40 and 46 because that would mean he's still in "C".  When the nurse said "57" that was definitely not what we expected or wanted to hear.  You can see from the chart below that 57 is right below "A" which means a transfusion is near.
On top of his MCA level rising quite a bit, he is also developing fluid around his heart which is another sign of anemia.  If fluid starts developing around two or more areas (like his heart and stomach) it is called Hydrops Fetalis, which is more dangerous.  Fortunately he currently only has fluid around his heart so it's not as severe.  Because of the combination of his high MCA level and the fluid around his heart, they told us to come back on Friday (today) to be re-scanned but had us prepare as if he would be receiving his first blood transfusion this afternoon.  In the beginning we were hoping we would be able to avoid a transfusion but it seems inevitable at this point.  We are just grateful it's an option!

At our appointment on Wednesday they gave me the first of two Betamethasone (steroid) shots.  They describe IUTs (Intrauterine Transfusions) as not being high-risk but also not being risk-free so they like to give the steroids for his lungs in the event something happens during the procedure and he has to be delivered. The second steroid shot came 24 hours later on Thursday afternoon.  **Side note about the steroids.  The injections themselves didn't bother me too much (probably because I'm so used to those awful IVF shots) but they warned me that many women complain about not being able to sleep after getting them.  Boy were they telling the truth!  I was up ALL night that first night but luckily the second night was better.  It doesn't matter though, I would do it again in a heartbeat for out little guy.**

After hearing that we should plan on Austin receiving a transfusion today, we spent the last 48 hours preparing ourselves physically, emotionally, mentally, and in every other way possible.  We felt a bit nervous at times but truly confident in the doctors and peaceful that everything would be okay.  We got to our appointment at 8:00am this morning and the tech was quickly able to get a great MCA reading.  "45" she said.  "Um seriously?" We were all perplexed.  Here's the graph updated with today's number:
We were so prepared for his number to rise or at least stay the same so to hear that it dropped that much was a big surprise.  She ran the scan several times and even got a number in the lower 40s once so we knew it wasn't a fluke.  This kid was definitely throwing us a curve ball!  We were thrilled that his numbers were lower but we were so prepared for a transfusion we didn't know what to think.  Two doctors (an attending and a fellow) came in to talk to us about the new findings from today and we naturally had a million questions. What does this all mean?  The unfortunate thing about a situation like ours is it's not always black and white. There is definitely a gray area where you just have to use your best judgement.  The doctors explained that he still only has fluid around his heart (and no other areas) and that it's a very small amount of fluid.  We have no reason to be worried that the fluid will cause damage to his heart and they even said that if they didn't have a reason to look specifically for the fluid, they likely wouldn't have even noticed it on a non-sensitized baby.  This brought us a lot of comfort.

In the end, Logan and I were given three options and they truly did leave it up to us.  

1. Proceed with the transfusion because he will likely need one soon anyway and we were already planning on it. 
2. Get a non-stress test and make sure he's doing well and then come back every two days to be scanned and wait on the transfusion until his numbers show he truly needs it.
3. Do an amnio today because it is much lower risk than a transfusion but it gives a very good picture of whether or not a baby is anemic. 

We were initially intrigued with the idea of an amnio until they discovered that my placenta is blocking the entire front side of my uterus so they would have to stick the needle through the placenta to even do one. We quickly threw that option out.  As for the first two options, we were truly torn and so were the doctors. There are many pros and cons to both choices that I won't get into here but in the end we decided to do the non-stress test and if all was well, wait for a couple days.  Austin passed the non-stress test with flying colors so we decided to call it a day and go back on Monday morning.

It was difficult coming to a decision we felt was best for Austin but as soon as we made the call we knew it was the right one and the doctors said they would have made that decision for themselves as well.  We will now begin a fun trend of going to the doctor every couple of days, doing an MCA scan and non-stress test, and making a decision at that time whether or not to do a transfusion.  We may go in on Monday and need to do the transfusion but we may also be able to push it back a week even.  Only time will tell!

Despite being a bit surprised at the sudden turn of events this week, Logan and I have felt great peace since the moment we learned a transfusion is likely in the near future.  We are so grateful for the comfort of the many prayers that have been said for our little family and we know they are working miracles!

Fingers crossed that next week is a bit quieter!

Weight: 143.0 (This week: Even | Total: +22.2)

30 weeks down, 7 (hopefully!) to go!

Friday, April 3, 2015

29 Weeks

It has been another great week!  Logan and I made it to our appointment on Monday a few minutes early and the weather was super nice that day so we took advantage and walked around the hospital grounds.  Being outside and seeing/feeling Spring all around made me so excited for the fun things we have to look forward to over the next several months!  This picture of one of Logan's very favorite trees perfectly captures how we felt about our little walk--it was beautiful!
MCA scan #5 was definitely the eventful part of our week!  Aside from checking his blood levels, they also checked Austin's growth and my fluid/cervix so that's always comforting.  I was 28 weeks and 3 days at the time of the scan and he was measuring 28 weeks and 2 days and roughly 2lbs 9oz.  He's growing very well!   My fluid level, which they want between 8 and 23, was 13 so that was perfect as well and my cervix is long and closed which is fantastic.  We'll take it!  Now for Austin's blood levels.  The little stinker is no longer in "D" like we were hoping but instead has moved up to the middle part of "C".  Here's the graph for the visual readers:

They did the scan several times and each level was all over the place so rather than give us one number, they gave us a range this time and officially put him down at 38-42.  The mark on the graph is right in the middle at 40.  So basically all this means is that Austin is still doing really well and is growing just like he should but rather than go back in 2-3 weeks, we will go back for our next scan 7-10 days from our last appointment which is actually this coming Wednesday.  As much as we'd love him to stay in "D" the whole time, we are very grateful that everything else (his growth, my fluid, etc.) is looking so good.  We're still holding out hope that he'll be able to stay in until I'm at least 37 weeks!

As each week passes we get closer and closer to being completely ready to welcome little Austin!  All of the sheets/blankets/clothes/etc. are washed and ready for him to use so that's a great feeling.  I have a few more decor items to purchase and then I'll finally post more pictures of the cute little nursery. I know I'm getting things ready way quicker than most people would but I'm not crazy enough to pack our bags...yet...but I'm sure that will happen sooner rather than later!  I'll feel okay doing that as soon as I hit the 30s ;).

We're looking forward to both of our appointments next week and couldn't ask for more at this point!  We definitely feel blessed!

Weight: 143.0 (This week: +.8 | Total: + 22.2)

29 weeks down, 9 (hopefully!) to go!