NT Scan and The Longest Appointment Ever!

First of all, I have to say once again that I adore Dr. Hamersley. Seriously.  You want a doctor DETERMINED to do whatever it takes to help a woman have a healthy baby? She is the one to see!

My appointment was scheduled for 8am and I was very uncertain of traffic.  Turns out things were a little thick, but moved at the speed limit or above the entire way so we had plenty of time to kill.

I will take being early over late ANY day when it comes to appointments.

We weren't called back to talk to the geneticist until about 8:15 and our discussion with her lasted almost half an hour.  She drew out a full family tree with circles and squares for the various genders of our siblings and their children then went through a list of who had pregnancy issues, developmental/cognitive problems, and any known chromosomal issues.

I must say it was really nice to identify the gender of two of my pregnancy losses and she didn't look at me like I had three heads for knowing the gender of my children. They matter, and she understands that (probably from a chromosomal standpoint, but I'll take it!)

There is only one baby in the family that has had known chromosomal issues that we are aware of and that is my husband's only cousin, who passed away at the age of 11 months. We couldn't remember if there was a name to the genetic anomaly Jeremy experienced, but we shared what we did know.

My husband and I agreed to have ALL of the genetic testing run that could be done through bloodwork, including a test is not covered by insurance.  Not only will this give us a good look at the chromosomes of our baby, but will also tell us with >90% accuracy the gender of our baby.

So we will know for certain in roughly two weeks whether Dash is the girl I think she is or a big surprise boy.

One of the tests also required a rather interesting combination of blood pressures. I can't remember which test it was.  I had cuffs put on both arms and pressure was taken simultaneously on both arms.  After, 4 vials of blood were drawn, and then both arms were checked again.

The values were very close to one another on the first set: right around 102/65. After my blood was drawn, my left arm was about 98/62 and my right arm (where the blood was drawn) was 96/56.  My diastolic dropped more than the other arm, but I don't know if that is related to the fact that I'd just had blood drawn from that arm or not.  The nurse was pleased to see that the values between the two arms were very close.

The ultrasound went well, too! I am 12 weeks + 0 days based on the ultrasound they ran almost 4 weeks ago and that actually matches up with my LMP, too. Dash is measuring 12w+3d, so almost a half a week ahead!  This is really fabulous news!

Crown to Rump is 5.86cm. And that is a hand with fingers by the face!

Both my girls measured ahead starting around this point, with the measurements getting progressively larger with my first and staggering off with my second (I suspect there may have been some minor placenta issues with my second).

There were two main objectives for this ultrasound. The first was the check blood flow and the second was to measure nuchal translucency. This is a measurement of the space behind the neck as a first hand way of seeing if the baby is at risk for Down Syndrome and should be 1mm-2mm wide. Although Dash didn't want to cooperate, the tech was able to get three measurements and they all measured 1.7mm, so right within range. This picture, which she just took for us to have, was actually the one that showed the NT space the best.

The only thing "abnormal" that popped up in the ultrasound was that I have resistance in my left uterine artery. During the scan I could see that the pattern of blood flow on the screen was different on one side, but didn't know that had any significance until Dr. H brought it up.

The significance of the resistance can be found here in the last paragraph. Dr. Hamersley confirmed that I'm on baby aspirin and wants me to be diligent about taking it an hour before bedtime.  I have been taking about 2 hours prior to falling asleep, so I will adjust that.

Our discussion then turned to lovenox. I mentioned that at my preconception appointment in May she had said that when I hit 12 weeks, we'd likely move to twice daily injections.  She double checked my current dose and as the wheels in her head turned, first suggested doing 40mg twice a day, which would still be an increase over my current dose.  But then you could see her rethink that and she said, "Tell you what: We're going to have you do a split dose. I want you to take 40mg in the morning and 60mg in the evening."

This is a sort of compromise that I had been mulling over in my head a few days ago, when I learned that my anti-Xa levels had been so amazing earlier this month.  I wondered if doing 60mg twice daily would be too much.

With the arterial resistance and having lost my son on the 40mg dose, I feel very comfortable moving to the 40/60 split. I will have my anti-Xa levels checked again on either Saturday or Monday, depending on when I can get in to LabCorp to get the test done. Dr. H wants me on the new dose for 3 days prior to having the test run, so Saturday would be my earliest.

My next appointment is three weeks from today for a growth scan and to review, if needed, the results of the genetic screening.  My results will likely be in the mail before then, but if I have questions, I can ask at that appointment.

By the time we walked out, it was 10:15.  Long appointment!

As a side note, when I mentioned that I could feel the baby moving the tech asked if I knew why.  My response was, "Because this is my 8th pregnancy." She said, "You're smarter than most. It's also because you have a posterior placenta so there isn't anything to muffle the babies movements."

I suspected posterior before, but now I know for sure. Hallelujah!!

Anti-Xa Testing in Pregnancy

As I get closer and closer to the point in my pregnancy where things started to go wrong with Jackson, I have been continuing my research on the use of Lovenox in pregnancy. 

This is not really an emotional post, but more along the lines of "informative" for those who read my stuff by have no idea what medicine I'm on or why.

For those who aren't familiar with Lovenox, it is a low molecular weight heparin that is injected into your fat--in my case the belly.  It is considered an anticoagulant (reduces the ability of blood to clot), but with a unique factor: it doesn't pass the placenta so it considered very safe for a developing baby since the medicine doesn't reach the baby.

The biggest problem I have run across as I've tried to research is that so many of these studies are incredibly small! When you have a study that only includes 30 people, it wouldn't seem that you can make very many conclusions, especially when there are thousands of women in the US who are on this medication at any given time.

As an example, just a couple of days ago a medical study on the use of a specific LMWH known as dalteparin (similar to Lovenox, and I have a friend who is on this because she is allergic to Lovenox) was printed in the Lancet. The study concludes that "dalteparin does not reduce the occurrence of venous thromboembolism (blood clots), pregnancy loss, or placenta-mediated pregnancy complications in pregnant women with thrombophilia at high risk of these complications and is associated with an increased risk of minor bleeding."

The problem? The study took over 12 years to perform but only had 292 participants.  Wait, What?!?  How in the world do you conclude ANYTHING with a study that took over a decade and still had fewer than 300 participants and each participant would have been in the study for less than a year?!? In addition, when you consider how many women take LMWHs through pregnancy and the postpartum period, why weren’t more women included in the study?

The is pure speculation, but since the study was open-label and randomized, the women who agreed to participate were assigned to either a group that would receive the medication or one that wouldn't. Each of these women would have known prior to the study that they were at risk for developing blood clots during pregnancy or having a placenta problem because that was a requirement of the study.  I can't imagine any woman who has experienced pregnancy loss would agree to this kind of study, so in that sense I guess 292 subjects is large . . . and of those in the study, 2 patients were moved from the control group to the medicated group. I would speculate that something happened during the pregnancy, such as a blood clot, to require them to be on the medication but the study doesn't say.

I would love to take a look at the records of three of the MFM practices I'm familiar with locally to compare the pregnancy outcomes of patients on various doses of Lovenox and their anti-Xa test results, if those were tested.  I am quite certain that a simple computer program that could scour the medical records for key words would make this very easy.  Just search for Lovenox, anti-Xa, the result, and then how the pregnancy ended (pre-term, IUGR, stillbirth, live birth, etc).

What this boils down to is that I believe it is important for any pregnant woman to have their anti-Xa levels tested during pregnancy, and I'm not the only one who thinks that.

Consider this study: Anti-factor Xa plasma levels in pregnant women receiving low molecular weight heparin thromboprophylaxis

The conclusion has what sounds like a dire warning: 

Serial anti-factor Xa assessment for dose adjustment should be considered for all pregnant women receiving low molecular weight heparin. (emphasis mine)

Never one to research just one side of an argument, here is another article: Is the monitoring of anti-Xa activity necessary in pregnant women undergoing thromboprophylaxis?

Consider for a moment that even this abstract says that the patient needs to have their anti-Xa levels in a specific range before frequent monitoring "may not be required".  I translate that to mean that the test needs to be run until the anti-Xa levels are within a specific range and then consider backing off on the monitoring.

Last Thursday I met with my OB.  I asked her a question about the Vitamin K shot that newborn receive, usually right after birth, and how those that have inherited clotting diseases may be affected, since Vitamin K is a key element in clotting. She didn’t know the answer, so I will ask my MFM tomorrow when I see her.

My first ever anti-Xa test results had also been faxed over to my OB, so she had those.  The listed range was 0.3-0.7 and my result was 0.83.  I was out of the range, but my score was circled with a great big “GOOD!!” by it.

At first I was really nervous, because I’m OUT OF RANGE!  But I’ve done further research and found this: Nobody tells you what the range means!

Yeah, so I went to my Lovenox support group on facebook and asked them.  Based on what their doctors told them, a value of 0 means that there is no Lovenox in your system at all and your blood will clot just as it should.

Not good for someone who is trying to prevent that.

The acceptable range seems to vary based on what website Google pulls up but there is something consistent: someone on a prophylactic dose (generally 40mg/once a day) has an acceptable range closer to 0 than someone who is on a therapeutic dose (used to treat active clots or in women where the prophylactic dose is insufficient based on history). 

The range for therapeutic seems to be roughly 0.5-1.0, with a variation of ±0.2, depending on the source.  In other words, the larger the number, the less your blood is clotting.

So for me to be on the outside range is actually a very good thing.  I am not so far beyond the range that I need to worry about excessive bleeding, but nor am I on the end of the spectrum where I would worry that my dose was insufficient.

Or at least, that was the case a little over 3 weeks ago when I had the test run.

I hope that when I see Dr. H tomorrow (MFM), that she will write another lab request so that I can get tested again.  At my preconception appointment she had indicated that somewhere around 11-12 weeks, I would move to doing the shots twice a day.

I am 12 weeks today, so it is likely time to make the change.  It was at 17 weeks that I had my last “All is going great” ultrasound with Jackson, so I’m getting a little antsy!!

First OB Appointment

Today I finally met with my obstetrician for my initial exam. I've been through this same exam 5 other times, so there weren't really any surprises.

Until the end.

I thought that since I was 11 weeks, she'd just listen to the heartbeat with the doppler.  NOPE! The ultrasound machine was wheeled in and she looked around really quickly. Dash was moving around a LOT, and I could feel some of the movements at the same time, which was pretty neat.

I've had ultrasound from 5 weeks to 8 weeks, and then from 13 weeks and beyond.  This was my first "late first trimester" ultrasound and I was really surprised at how much she's grown since the beginning of the month.  The legs were the biggest surprise: they were so much longer than I would have expected! They appeared to be as long as the rest of the body and most of the head combined.

It was a really sweet treat for me to see and I really look forward to seeing Dash again on Wednesday when I see Dr. Hamersley again.

On the more medical side, my Anti-Xa levels came back at 0.83.  The recommended range is listed as 0.3-0.7, so I'm technically out of the range.  However, the value was circled and and arrow drawn with the words GOOD! in female handwriting was there.

I will absolutely be taking my vegan DHA supplements daily until my dose becomes twice daily, which I suspect will be at my next appointment.

A couple days ago some questions came up about vitamin K and lovenox, which nobody I have asked has known the answer to.  Mainly, does an increased dose of Vitamin K have any impact on Lovenox, clotting, or an impact on placental health?  The second question is that if a baby has inherited a clotting disorder from its mother, can the Vitamin K shot, generally administered within a few hours of birth, cause clots in the baby?

Next week, the Vitamin K question will be at the top of my list of questions.

There is one test I have the option of doing next week.  It would tell me, with 99% accuracy, the gender of our baby as well as if s/he has any genetic problems. It is, essentially, a full genetic screen.

I am trying to decide if I want to do the test or not.  We have had no known genetic issues with our other pregnancies, but at the same time, it would be wonderful to know in advance and prepare if something isn't entirely "normal".

Would you run the test?

Sweetest Sound

Monday, after 3 days of not being entirely sure if I was feeling the baby or just imagining things, I caved in and purchased a Sonoline B fetal doppler.  Friends all claimed their standard shipping was fast, but I really didn't expect it to be sitting on my doorstep less than 48 hours later.

Before I could open the package, I had three children I needed to get down for naps.  Today was one of those days where each of the Nappers went down easily.

I appreciate those days.

My hands shook as I sat down to open the package, read through the first few pages of instructions because that's just what I DO . . . and I might have been too nervous to just open the darn box and have at it, and then opened the batteries.

My previous doppler required headphones but this one has a speaker.  After going into my daughters' room, I layed on the floor with my back propped up against their bed with some of their gazillion pillows and went to work.

By 11 weeks with previous pregnancies, I knew exactly where to stick the probe to find the heartbeat, with only the occasional wiggle to get the clearest sound.  Because I was starting from scratch, with only my past to guide me, it took a few moments.

That "few moments" was probably less than a minute, but it always feels longer when you're on edge.  The sonoline has a digital read-out that shows what heartbeat it is detecting.  Several times I saw it detecting a rate above 120, so I knew something was going on in there, but I couldn't quite catch it.

And then I found the spot.  With that whoosha whoosha so distinct only a woman who craves it above all else can understand.  It's different than the sound of the placenta and umbilical cord . . . there is a more distinct slap that I think might be the sound of the heart valves slamming shut. It is more distinct and clear than any other sound.

I called my husband, wanting him to hear it before any others.  He didn't answer the phone, so I put my phone on speaker and turned the volume on the doppler up.  I hope he could hear it; I still haven't heard from him which means it is a very busy day at work for him.

Before shutting it off, I made a short recording.

My girls have heard the recording and I intend to let them listen live tonight before they go to bed and after Dash's daddy has a chance to listen.

I could also hear the baby kicking, and the sound matched the movement.  So I am not imagining things and those small sensations are definitely the baby swimming around and bumping the edges of her pool.

I'll need more than Divine Help if we lose this baby.

As my dear sweet sister-in-law said this afternoon, "Keep growing big and strong, Rainbow Dash and make mommy as big as a house by January!"

Yes . . . Big as a House.  That is EXACTLY what I want!!

11 Weeks

I have reached the 11 week mark. So here is a selfie for anyone who wants to know what 11 weeks on an 8th pregnancy looks like for someone who never quite lost the baby weight from losing her son.
I caved in and ordered a fetal doppler. It should be here in a few days. My first OB appointment is Thursday. It feels like forever since I saw a doctor and I have yet to hear Rainbow Dash's heartbeat. I am anxious.

Overjoyed

This morning a friend I have never met, who was an inspiration to me after the loss of my son, gave birth to her rainbow baby.
I am so overjoyed that he arrived safe and sound and that his mommy can hold him, smile at him, and share him with his daddy and big sister.
Her rainbow baby arrived exactly 2 1/2 years after the tragic death of her first son during childbirth.
Congratulations to my friend and her family! I love you and am so very very happy for you!

Cancelled

My appointment for this morning was cancelled.  The doctor was called in for a delivery.

I know it happens, but this was a first for me.  My schedule is always super tight because of the business I run so I'm a little disappointed.  They wanted to reschedule for noon.  Sorry, but I already have plans with my Dad and children for the rest of the day.

So I guess I go in next Friday instead.  I was really looking forward to hearing Dash's heartbeat!!

#100HappyDays

Today marks 100 days since I gave birth to our stillborn son, Jackson. My girls still talk about him, and I hope that as time continues to pass, they remember him and the joy he brought to each of us for such a short period of time.

The day after his birth, David and I continued with a tradition we started long ago and went to Wendy's for lunch with the girls.  Any time I have given birth, had surgery, or any other medical procedure, we have gone to Wendy's for our "first meal". It seemed fitting to continue, even though the birth wasn't what we'd wanted.

It was there, sitting at the table that I began my #100HappyDays posts, determined to find some small speck of joy in each day. After losing our daughter in 2012, I had spiraled into depression that only worsened with time and I didn't want that to happen again.

For the first few weeks, many of my posts centered on food.  I really do love food, even in some of its simplest forms.  Other posts were about my two living daughters, as each loss has emphasized just how miraculous their presence in our lives really is.

So for each of the last 100 days, I have found something to find happiness in and tried as often as I could to document that with a picture.

I do think that my absolute favorite post was the one where I found my mother's missing ring.  Talk about sheer happiness!! There was no fear, no guilt about calories, no sadness attached to the gratitude . . . nothing but delight in its purest form.

Now that 100 days is over, I'm embarking on a new journey with my family.  Those who have been following my blog know what I'm talking about.

For those that don't know, David and I are currently expecting again. I'm around 9 weeks along, with a single baby that has a strong heartbeat and whose arms and legs are already developing nicely.

The bright halo above the baby is her yolk sac (I think this baby is another Super-Hero-Loving-Princess I sometimes refer to as Rainbow Dash). The baby is head up, with arms and legs forming. Rainbow Dash looks an awful lot like a gummy bear here.  This is from July 3rd, so as long as she's growing well, she should actually have almost doubled in size this week.
 
For the majority of women, this is the point where they get to breathe a sigh of relief and start planning, whether that planning is talking about names, nursery themes, how to rearrange the furniture, what car to buy if a bigger one is needed, etc.

Our situation is different.  I've lost the last 4 consecutive pregnancies, even after I was assured this last time that Lovenox would get me to full term.

I may have those same "assurances" from different doctors now, but I'm not holding my breath until I have a pregnancy that has reached viability and even then the "baby room" will remain my sewing room.

So how is this a happy post?  Well, I'm thrilled to have discovered what I believe is the clue to our infertility: inflammation.  20% of couples diagnosed with infertility have unexplained infertility. This is the diagnosis we were given just over a year ago.

The reproductive endocrinologists in my area can kiss my big white booty because now I know what the problem is and none of them even brought up inflammation as a potential cause.

I feel rather smart, actually.  I can't take credit for all of it, there are two people who helped me out with this: my chiropractor and my maternal-fetal-medicine doctor.  Both mentioned inflammation as causes and when an anti-inflammatory diet was suggested, I jumped on board immediately.

And got pregnant on the first try!!

We had conceived Jackson the month I did a candida cleanse, which also involves an anti-inflammatory diet, I just didn't know that at the time.  So of course when we got cleared to ttc again, I was already following parts of the diet fairly closely. I just removed a few more foods and added the lovenox shots.

I have a very long ways to go and after losing my son so late, I am working with the reality that the deck is stacked against me, but we're off to a much quicker start than I could ever have imagined.

Me, 9 weeks pregnant, just 100 days after losing our son!

I've known for over 5 weeks and it still doesn't seem real.

#100HappyDays, You have kept me happy, so Thank You.