Saturday, March 29, 2014

Frequent flyers

2014 has been a crazy year so far for my family. Aside from my pregnancy adventures with preeclampsia, both Joshua and Aidan have recently had medical scares involving either 911 or a visit to the emergency room.

A few weeks ago, Joshua went to get a haircut and shave at his favorite local barbershop. I had given him a gift certificate for Christmas and I was hoping it would be a chance for him to relax since the pregnancy stuff had been so stressful lately. However, he ended up passing out in the barber's chair while he was leaned back getting a (straight razor) shave (yikes!), and then because he wasn't lying completely flat when he went unconscious he started having convulsions. Scared the owner to death... afterwards she kept telling Josh, "I swear, it looked like you were being possessed!" Exactly what you want to hear after regaining consciousness. Josh was unresponsive for a few minutes after passing out so of course the good people in the shop called 911 and an ambulance came to the scene. After the EMTs took his vitals and Josh saw they were normal, he refused to go in the ambulance to the ER. He called me and I think he was planning on coming straight home, but I asked him what the heck was I going to do if he passed out again and had a seizure at home? While I could understand him not wanting to go wait for hours in the ER, I couldn't believe my medical professional husband was going to come home without being checked out by our family doctor at least. I convinced him to call and get a walk-in appointment with our PCP so that he could be given a once-over before coming home.

Thankfully, a friend from church walked into the barbershop to get a haircut right after this entire ordeal had happened to Josh. He gave Josh a ride to the doctor... which Josh later said was a really good thing because he almost passed out again on the way to the doctor's office. Our PCP ran some tests and took some blood, but told Joshua he thought he probably had just passed out due to a vagal response. Craziness! I told Josh he was just trying to show me up by having a seizure since that wasn't happening to me yet. (Bad preeclampsia joke...)

This week our Aidan Bear gave us a scare. As you might have ascertained from the story above, Joshua is not easily ruffled when it comes to medical problems. I suppose when you work in a hospital and see patients coding on a semi-regular basis, your average illnesses start to look paltry in comparison. In any case, he has a good handle on when something seems life-threatening, when something warrants medical attention, and when it's not that big of a deal. So when my husband says we need to take our child to urgent care because he hears stridor, I'm thinking, "Why aren't we just headed to the ER now? This is obviously a big deal if you think we need a doctor."

Aidan had starting losing his voice on Tuesday afternoon, and he had choked on some food that day. Josh thought he had cleared it, but that night when he laid Aidan down to put on his pajamas, Aidan started coughing and making these weird respiratory noises that Joshua thought sounded like stridor. Josh was worried that when he choked earlier that day he had ended up aspirating something and it was stuck in his trachea. So in the middle of a late-March snowstorm (not really, but it was snowing like a blizzard outside for a few hours that night), we bundled Aidan up and took him to urgent care a few blocks away. Of course, as soon as we got there, Aidan stopped showing any signs of distress and just sat there sucking on his passie like everything was fine and dandy. The NP listened to his chest and throat and said that she didn't think there was anything lodged in his airway, but because he wasn't showing any other symptoms of illness (no fever... ears, nose, and throat looked fine) and his oxygen saturation was a little low, we should keep an eye on things and if he got any worse we should take him to the ER. She told us she thought he probably just irritated his throat when he choked that day and that was probably what was causing the weird noises.

We came home and put Aidan to bed with the humidifier running, hoping to soothe his throat if it was irritated for some reason. I was up a few hours later talking with my mother-in-law when all of a sudden I hear noises coming from Aidan's room. I walked in to find him on all fours in his crib, making scary gasping/coughing noises. Joshua came in and got him up and our little champ was struggling to breathe and crying every time he coughed. "This isn't normal," I said, and off Joshua, Aidan and I went to the ER.

It was still snowing outside and very cold, and on the way to the hospital Aidan's symptoms eased. I told Josh, "I wonder if this is croup. I've read that cold air helps with croup and a lot of the time kids get better on the way to the ER because of being exposed to cool night air." By the time we got there and got Aidan registered, he seemed to be doing well again, and we were debating staying. But I told Joshua I didn't want to go home and have the same thing happen again. Thankfully a nurse pushed us through and we got into a room relatively quickly. Once we got back into the ER, I took away Aidan's passie (mean mommy) because I wanted the doctor to be able to hear the symptoms we had heard. We thought we were going to have a repeat performance of urgent care, but then I had to go to the bathroom and when I left the room Aidan got very upset. When I was walking back down the hall returning from the restroom, I heard this kid wailing and coughing and gasping and sounding generally horrible. I thought, "Surely that's not my Aidan Bear." But it surely was, and thankfully him causing a scene got a doctor in to see him stat. After about one minute of being in the room, the doctor says, "Yep, that's stridor, alright. He's got croup. We'll get you fixed up." Easier said than done, when you have a toddler who is afraid of the glowing pulse-ox they attach to his big toe (out of sight, out of mind , we learned when we covered it up with a blanket), terrified of the breathing treatment the respiratory therapist tries to give him with a nebulizer, and doesn't want to take any medicine. It's heart-wrenching to hold your kid while he screams bloody murder because he's scared... and also terribly endearing to watch him say, "all done!" to the doctors and nurses trying to treat him. He had to be monitored for an hour after the breathing treatment and the steroid they gave him, and thankfully once the medicine kicked in his breathing eased and he was in a much better mood.

So we arrived home from the ER at 2:00 a.m., a very sleepy little boy and two very tired parents. Sadly, I realized that I had made his breathing worse by having a humidifier running earlier that night, as warm air causes the airway to constrict further. The ER doctor told us when his daughter had croup he used to stick her head in the freezer when it got really bad. He told us we can manage this case of croup at home with a few days of steroids, but if it got worse again to come back for another breathing treatment.

The next day I went to the store and bought some essential oils to make a blend to help Aidan breathe and to help reduce the inflammation of his airway. I have a lot of friends who use doTERRA essential oils and there are pre-made blends available from doTERRA for different symptoms, so I looked up the ingredients for one called "Breathe" and bought a few of the oils (peppermint, lemon, and eucalyptus). I also bought frankincense which is great for reducing inflammation. When I got home I blended a few drops of each into a teaspoon of a carrier oil and we rubbed it on the bottom of Aidan's feet and on his back. We've been using this blend every day as well as finishing out the prescription for the steroid and he hasn't had any more stridor since the night we had to take him to the ER. Yay for blending traditional and homeopathic medicine.

Two days after our ER adventure I went into see my OB for one of my regular appointments and my blood pressure was too high. The NP who has seen me for the past few visits told me I was starting not to look as good (thanks...) and I told her honestly that I haven't been feeling as well. My blood pressure has been running higher and I just feel kind of bad most of the time now. She told me frankly that unless I want to have this baby next week, it's time for strict bed rest from here on out. She told me I don't have to be completely housebound, but she basically wants my feet up all the time... in the recliner, on the couch, or in the bed, she said. Thankfully we are now only 16 days away... my induction is scheduled for April 15 bright and early. Hard to believe that in just over two weeks we will be meeting our little girl. Life is never going to be the same for Aidan! Not sure he's ready to share the limelight with a little princess. :)

Our family has bent over backwards these past few weeks to help us. My mom is going to come back to Asheville next week and stay until I deliver, so that hopefully I can make it all the way to 37 weeks. I am so thankful for all of our parents who are there for us when we need help. Not everyone has that, I know. We are blessed! God has certainly been watching out for us... sending a friend to the barbershop to help Joshua at exactly the right time... letting Aidan get upset in the ER at exactly the right time so that the doctor could make an accurate diagnosis... providing time and resources for our family to come to Asheville to help us get through the end of this pregnancy. So, so thankful. The Lord is faithful, even when stuff is hard and we have to walk through it instead of having it disappear. It reminds me of that verse in Romans, "... we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope." Our family's sufferings seem so slight but I am thankful that there is not a qualifier for this verse... no matter how big or small, the adversities we face can build something good in us if we will turn our faces in the right direction. I know I need hope built in me instead of negativity, which I seem to have an ample supply of!

Please continue to pray for us... 16 more days. Joshua is still chipping away at his school work with that deadline looming... pray for him. Aidan and I are improving, but I would also appreciate continued prayer for that, especially since I'm going to be "disappearing" soon again when I go to be induced. Thanks, ya'll. Peace, love, and HOPE.

Thursday, March 20, 2014

Pregnancy update

Today I am 33 weeks and 2 days pregnant! We are so thankful for so many things...

I have not had to go back to the hospital (even to Outpatient L&D for monitoring) since I was discharged three weeks ago after the overnight stay. My mom came up from Florida for a week to help us out, and Joshua's mom ended up staying after Michelle had her baby so that she could be here to help us, too. Being able to really stay off of my feet while the grandmas run around after Aidan has been keeping my blood pressure stable. My first high BP reading at a doctor's appointment was today, and it was only 130/90. As long as it stays under 160/110 and I have no other symptoms, I get to stay at home and let baby bake a little longer. 

We are so close to the point in the pregnancy where a pre-term delivery won't necessarily mean a NICU stay! The doctor told me today that a baby born at 35-36 weeks won't automatically have to spend time in the NICU. 

At the last growth ultrasound we had, Maddy weighed approximately 4.5 lbs, which for some reason made me feel so hopeful about a pre-term delivery. Aidan was just shy of 6 lbs (and just shy of 37 weeks) when he was born (also induced because of preeclampsia) and other than battling a little jaundice, he was as healthy as can be. Never learned to breastfeed, though, which was a bummer. The suck/swallow/breathe reflex is one of the last things to develop in utero and he didn't have it down yet when he was born. I hear that girls develop faster than boys, even in the womb, so please pray that even if Miss Maddy comes early she will be able to breastfeed properly! It will make life so much easier. :) 

I have still been having the weird visual disturbances, but after a visit to an ophthalmologist to make sure my retina wasn't detaching (sigh), I was diagnosed with ocular migraines. This is basically when you get the visual aura associated with migraines but no other migraine symptoms. Since my BP has remained stable, the doctors have not been concerned. [Sidebar: After the MRI at the hospital and a follow-up appointment with an ophthalmologist-- both of which I felt were unnecessary based on a complete lack of other symptoms and the fact that it wasn't getting any worse-- I have started reading a book called When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. I have been so happy with my care since I was transferred to the OBGYN specialist group; this was the one thing that both Joshua and I felt was out of balance. Since we are the ones paying the medical bills, I'm hoping this book will give some insight on how to communicate with my doctors to avoid similar situations from happening again when I think we're going overboard. I know that the motivation of the physician is to make sure that they don't miss something significant (especially in this case since I am in a somewhat precarious position with a high-risk pregnancy)... I feel like more than anything I failed to be a strong enough advocate for myself as part of the patient-physician partnership. I think the book is going to be helpful... especially with our primary care physician as we make decisions for our regular healthcare and that of our children.]

Last week I had a little bit of a worrisome prenatal visit when my labs came back showing a decrease in my platelet count. I get bloodwork drawn every week to keep an eye on my platelet and AST enzyme counts to make sure I'm not developing HELLP syndrome. Today the doctor said my labs from this week showed my platelets at a healthy 220. Whoo hoo!

One of my MFM doctors told me at a recent visit that I am not following the "typical pattern" of a patient with early-onset preeclampsia. The "typical pattern" would be what the doctor that discharged me from the hospital three weeks ago (I've taken to calling him Dr. Doom in my head, which is a little mean) warned me about (see last blog entry). It is unusual that my condition hasn't rapidly accelerated yet. Thank you for all of your prayers. I know that God is writing his own "pattern" for this pregnancy, and I appreciate you asking Him to keep Maddy inside the womb until she's good and ready! 

Please continue to pray... of course for my health and Maddy's... but also for my family. Obviously this is a stressful situation and Joshua is trying to get the rest of the semester's work done in the next 2 weeks so that he can have it done by the time baby gets here. He has a lot of papers to write, including a big one that's worth 25% of his grade for the semester. Please pray that God will help him manage his available time well (he's also trying to wrap up clinicals for the semester) and get his work done quickly when he sits down to do it. The hardest thing for me recently has been my relationship with Aidan... he was very upset after the hospitalization and our mommy/son bond hasn't quite recovered. It's not helping that I can't be the normal mom that he is used to. It's breaking my heart... I know he will be okay... but it is still really hard for me. Please pray for both of us. Thank you again for your prayers and support... we definitely need and appreciate it! 

Also, can I just say... I can't wait for Journey Around the Sun, Part II... I recently looked at all of Aidan's pictures and it was such a great project! So glad I did it and recorded a year of his growth and a year of our lives. I'm excited to start again. :)

Sunday, March 2, 2014

The winding road

If six weeks ago I was outraged at the cost of blood glucose test strips, I bet I'll really have fun when I find out how much an MRI cost us.

Shortly after my post about my trip to the pharmacy, I was diagnosed with early-onset preeclampsia. My midwives determined me too high-risk for their care, so I was transferred to a group of OBGYN specialists, whom-- I am very happy to say-- I adore. The past month has been filled with bi-weekly doctors visits, weekly ultrasounds and lab work, a few emergent visits to outpatient labor and delivery at the hospital for blood pressure monitoring and non-stress tests, and one overnight stay on the maternal fetal medicine unit for inpatient observation. Today I am 30 weeks and 5 days pregnant. The goal is to make it to 37 weeks.

This weekend was when I got admitted to the hospital for observation. I had been complaining of visual disturbances for a few days, which can be normal in pregnancy but can also be an indicator for preeclamptic patients that the condition is worsening and needs to be assessed right away. What started as a squeezed-in Friday morning appointment at the doctor's office ended up with me in a bed on maternal fetal medicine on Friday night. It was probably the first time in this pregnancy that I was actually, truly scared.

The doctor that discharged me yesterday (the team determined that my visual symptoms were not preeclamptic and also that I'm not going to die of a thrombosis in my brain, thanks to that MRI) told me that it is not likely that I will be able to make it to 37 weeks without seeing my condition worsen into severe preeclampsia. He advised that I should prepare myself for a long inpatient hospital stay at some point and medical intervention for me and the baby. He mentioned steroids... those of you familiar with premature babies will know that he was referring to medicine they give to mature the baby's lungs quickly before a premature delivery, which indicated to me that he thought that I might not even make it to 34 or 35 weeks when the baby's lungs are considered technically developed. I'm just stating this for the record because I'm really hoping and praying that God will see us through to have this baby full-term. If she is going to have to come early, God knows that and will handle it-- He is the one that ordains these things, after all. But how I would love for Him to show His hand and sustain both me and our baby girl through 37 weeks or beyond.

Preeclampsia is a condition that is still a relative mystery in the OBGYN field-- no one knows what causes it (there are theories about endothelial dysfunction or inappropriate immune response to the placenta), there is no known treatment aside from delivery of the baby and placenta (which is not always the most favorable option in early-onset cases), and although clinical trials have taken place to see how the condition might be impacted or reduced (vitamin D sufficiency, mother having increased exposure to the father's semen, i.e. no barrier contraceptives, etc.) there is no firm evidence base. What doctors do know is that they have seen very scary things happen when preeclamptic patients develop full-blown ecclampsia (think Sybil on Downton Abbey) or HELLP syndrome. Those are conditions that I refuse to Google. I am aware that my doctors are going to do everything in their power to prevent me from progressing into ecclampsia, even if that means delivering a pre-term baby. This is really hard for Joshua to swallow... I think I find it easier to handle because I don't want anything bad to happen to me. Not that he does! I think it's just more real to me since I've felt what's going on with my body. The idea of having a seizure that could harm or kill me or the baby is not on my to-do list. I am so thankful that we are at a point in this pregnancy where the baby has a very positive  potential survival rate in the NICU if she needs to come out. There could be serious set-backs or complications, sure, but she is certainly viable. Most of all I am thankful that she is thriving in the womb and there are no signs of fetal distress or growth restriction... so far it just seems like it's my body having a problem with the pregnancy.

Many people have demonstrated their love and care to us with tangible actions in the past few weeks. I've had meals delivered and laundry done, moms with kids over to play with Aidan and more babysitters for Aidan than I can count. Thank you so much to those in our community that have really been there for us and are helping us through this. Every time I go to the hospital while Joshua is working (we decided he needs to save his limited time off work for when I actually have the baby), whether someone is accompanying me or just giving me a ride or watching Aidan while Joshua and I are both unavailable, I think of all the women out there who have to do this alone. I can't even imagine how hard that would be. I am so grateful to be surrounded by such a loving and demonstrative group of family and friends.  

Please continue to pray for our family-- that God would prepare our hearts for the winding road ahead; for our Aidan Bear, who is having a bit of a hard time with me and Joshua being gone so much and being with a babysitter a lot; and for the health of me and our baby girl. I am hoping that in another six weeks I will be announcing the arrival of a beautiful, healthy little girl and telling you all about how, despite the statistics, God carried us through to full-term and a relatively normal delivery. Maybe all of this will just be high drama that never saw any reality. :) But God will sustain us no matter what comes. Thanks for being His hands and feet!