Jan 31, 2013

A Big Day in the NICU

When I got to the NICU this morning, both boys were sleeping so peacefully.
 
Pip
Pop
 
It didn't last.
 
The boys were little models for the annual Baylor nursing report and so their room had a marketing person, a photographer, a director, the nurse who was modeling for photos, a lighting person, and, of course, their nurse all bustling about. They took a number of pictures of the nurse fussing over Pop, although oddly none with both boys, to use in the NICU section of the report. Before the nurse arrived they took a few with me standing in to test the lighting and said they will email them to me. All the excitement put their 11:00 feed about 30 minutes behind schedule, but they were both so patient and cooperative!
 
They ate, laid back down, and right about the time they fell asleep the hearing screen team arrived. Both boys passed their newborn hearing screens and can check off one more box on the list of things that need done before they can go home.
 
Passed!
 
At the (slightly late) 11:00 feed we started a 24 hour breast feeding marathon to see what sort of weight they are gaining just from me. I was under the impression this 24 hours would be solely breast feeding, but they changed their minds this morning and the boys are still getting fortified bottles (breast milk mixed with formula for extra calories) after breast feeding if they want them. Realistically, I can't breast feed and then give 1/2 a breast milk bottle afterwards once we are home. I will either be able to pump or feed, but with them eating every 3 hours and the feeds taking 45-60 minutes for the two of them, I can't then pump or I'd never sleep! Sadly, this means I am gaining NO confidence in my ability to feed the boys from this experience. It's just making me nervous about how I will do this alone.
 
Pop
 
The nurses are really pushing the boys now and trying to get them home. Yesterday they started "sink or swim" and lost their gavage tubes so the boys have to work for all their feeds now. So far, they are really doing great and could be home as early as Sunday (two days earlier than we were told at our check in on Tuesday!).
 
Continued progress on feeds, vaccinations, circumcisions, and car seat tests left to go!
 
Pip
 
 

Jan 27, 2013

14 Days

The Casses
 
Two-weeks ago today, at 8:23PM and 8:24PM, two precious men changed our world forever! Our family of three became a family of five (Rory isn't allowed in the NICU so she isn't pictured!). This morning we snapped a few pictures with both boys during the 8AM feeding. It was so fun seeing them interact a bit and look at each other.
 
Brotherly love.
 
After spending some time with our boys we headed to Dallas for church at Munger Place. It was great seeing our church family and we were glad to sneak in a visit before the boys come home and we go into quarantine no germs mode.
 
After some much needed soul rejuvenation, we headed to our house (I had almost forgotten what it looked like. Kidding. Sort of.) and got some house prep done. We checked the mail and sorted through bills, cleared off the bed in the guest bedroom so when the boys come home their Nana and Nano can come help out, continued the work on operation put the house back together post new carpet, etc.
 
Later in the afternoon, Casey's parents and brother arrived with the cribs! They look absolutely amazing! They are all set up in the nursery and we couldn't possibly be happier. We forgot to take any pictures of the cribs all set up, but maybe it's for the best -- let the suspense build for the big nursery reveal in a few weeks (months?) when everything is finished.
 
Casey's parents joined us for the 8PM feeding time and it was really special to see them holding and loving on the boys. Their is something so powerful about seeing grandparents with their grandbabies. During their feeds, Pip completed his first full feed from the breast tonight! What an awesome two week birthday accomplishment!
 
Pip (left) and Pop (right) at two weeks.
 
 
Pip giving the pirate eye. Pop is having none of it.
 
Pip ignored his dinosaur decor but Pop really studied it.
 

Jan 26, 2013

NICU Progress Report

It has been a few days since I last posted and I have so much progress to share! A few things bulleted here got their own (back-dated) posts to go into more details, so check out the links for some great photos.
 
January 13: The babies are here! Pip (Baby A) was born at 8:23PM weighing 4lb3oz and 17.25in long. Pop (Baby B) entered the world at 8:24PM weighing 4lb8oz and 18in long. Both boys were healthy! They were breathing room air from birth and didn't require any respiratory interventions. They were taken to the NICU because they weren't big enough to regulate their own body temperature or feed on their own.
Pip and Pop just a few minutes old. Still in the delivery room.
The only picture we have of both boys.
January 15: Chose names for the boys. We were still "trying them out" though and didn't fill out the birth certificate information until Thursday the 17th right before discharge. Did you know you have to PAY to get the birth certificates?!?
January 16: Boys put under Phototherapy Lights. The lights will help decrease the boys billirubin levels, which means they will help eliminate the jaundice the boys are suffering from.
January 17: Casey gave Pop his first bottle. He took a few mL before getting tired. Discharged from the hospital.
January 19: First full day away from the babies for a family funeral. We asked Nano and Papa (Casey's parents) to go hang out with the boys at the NICU for a bit since we couldn't be there during the day. (I was able to make the 8:00AM feeding and Casey and I both snuck away before the family dinner was over for the funeral so we could make the 8:00PM feed.)
January 20: Billrubin levels down enough that the boys got out from under the phototherapy lights.
January 21: Bilirubin levels rechecked 24 hours later. They both have borderline results, but the neonatologist decided to keep them out from under the lights for the next week and see if they can bring the levels back down on their own. Casey's last day off.
January 22: Christened a Mom - projectile vomitted on for the first time after Pop got his stinky liquid vitamin. First Bath.
January 23: Open Air Cribs. Mom's night out - Kitchen Group in Dallas.
January 24: 35w0d. Interviewed and chose a pediatrician.
January 25: Pop took first full feed from the breast during our first successful tandem feed. Two big successes!
 

Jan 23, 2013

Open Air Cribs

Another milestone down!!
 
Two of the three NICU exit requirements have been met!
 
Pip in his big boy bed.
Today, Pip and Pop moved from the big isolettes to small open air cribs. They are regulating their own temperatures now!
Pop regulating his own body temperature.
 
 

First Baths

The boys took their first baths last night! They were both little messes from having head ultrasounds with sticky gel all in their hair and down their backs so they needed it!
 
Since the boys still have their umbilical cords, they can't sit and soak in the bathtub, so they got sponge baths inside their isolettes.
Pip getting ready for his sponge bath.
Pip went first and we got the loudest cry out of him we have ever gotten. He was not a happy man. (But my laid back guy quickly went back to his cheerful self!)
Poor Pip. He's not a fan!
It was a happy momma though. As part of bath time, they take off all of the leads so I was able to walk around holding him for the first time!
Walking and holding my baby (Pip).
Pop went next, and he didn't like bath time anymore than his brother did. We've heard how good his lungs are a number of times and got to experience them again!
Pop didn't like bath time either.
This time, I helped with the rubbing and scrubbing. He looked at me with these big sad "you too mom?" eyes.
Mommy helping with Pop's bath.
After bath time, came my favorite time: lead free snuggle time with both of my boys!
Pip all clean.
 
Pop all clean.
 
Nana and I with the freshly clean boys.
And we aren't sitting right by the isolettes!
 
Nana comforting Pip before his wires all get reattached.
After bath time, the boys were reconnected to the wires and both got put in little undershirts. They were getting ready to have their isolette temperatures slowly moved towards room air in the hopes that the next day they would be self regulating and moved into open air cribs!
After bath time, Pip in a shirt.
 

Jan 21, 2013

Bye Daddy

Casey has been off of work since Friday morning when he got an unexpected phone call to come home because my water broke. Sadly, he can't stay away from the office forever and tonight he left McKinney to head back to our house in Dallas. I don't know how many nights a week he will stay in Dallas versus commute to McKinney, but it was so sad watching him say good bye to the boys. He will be gone until at least Thursday and maybe until Friday depending on how his work week goes.
Falling asleep with Pop on his last evening in McKinney.
 
Pip and Pop will miss their daddy!
 

Jan 20, 2013

One Week

It's incredible how much can change in just one week.
Happy One-Week Birthday Baby Boys!
 

Jan 17, 2013

Breaking

My heart is breaking into a million tiny little pieces right now.
 
Today was discharge day.
 
Most people look forward to discharge day and arriving at home with their precious bundle(s). But, I can't be happy about leaving. My boys and my heart are staying behind in the NICU. I would give anything to be back in my room down the hall from Pip and Pop.
 
They were inside of me for 33w3d and we were always together. For the past 4 days my boys have been right down the hall where I can visit anytime and get constant updates on their progress. That's 34w0d of together. Now I feel empty. I feel helpless.
 
My body wasn't able to support them like it was supposed to. I know that I couldn't have done anything differently to stop this. I know I didn't do anything wrong. I know that my body did a great thing growing two miraculous and healthy little boys. I know that they are better off in the NICU than still inside of me.
 
Pip and Pop might be small, but they are mighty little fighters. I helped them become little warriors. But, I hate that they have to fight this fight already. I want to kiss it better. But, I can't. I want to fight this fight for them. But, I can't.
 
Luckily, the hospital can. We are so blessed to be leaving them with incredible NICU nurses who just dote on them and with a very capable doctor who is taking excellent care of them. These wonderful people can do so much for Pip and Pop that I can't. The staff at Baylor McKinney is exceptional. Our boys are getting one on one loving from some of the greatest nurses I have ever met. All of our nurses so far have been compassionate, competent, experienced, and, most importantly, in love with our boys.
 
I know the boys are right where they need to be.
 
I know they are receiving the best care possible.
 
I know they are going to be okay.
 
I also know that after driving away from that hospital today, I will never be the same.
 
Of course, after becoming a mom, I'll never be the same.
 
And I have to choose to let the joy of being a new mommy to two perfect sons shape me more than the heartbreak of a few weeks in the NICU.

Jan 16, 2013

72 Hours Later

Our two little men are doing incredible and already showing us what overachievers they are. We are so blessed that despite their very early arrival everything is going so so well. Our first 72 hours as parents to these two perfect little boys have been incredible. Their is no better feeling in the world than snuggling with your baby against your chest, except maybe watching your husband snuggle a baby against his!
 
Casey getting in good snuggles with Pop.
 
We are in such great hands here at Baylor McKinney and have had truly gifted nurses and doctors working with us and the Ps. We know it is just a matter of time before we are home as a family. Pip and Pop*** have to achieve three milestones before getting discharged from the NICU:
 
1. Be breathing on their own.
From day 1, Pip and Pop have been breathing room air and never required oxygen or breathing assistance. One milestone down!
2. Be able to tolerate full feeds from either the breast or the bottle.

The boys are still too young to understand latching and sucking and so have feeding tubes, but they have successfully increased their feed amounts each of the last three days of their lives! Today both boys had some "residual" (meaning they had undigested food left in their stomachs after a feed) but we have been assured that this is quite normal with preemies.

3. Be able to maintain their own body temperature.
They are still too small to maintain body temperature, but that will come with time as they get to be chubbier little fellows.
 
The biggest setback (if you can even call it that) the boys have had is a bit of jaundice, which is to be expected. They are under the lights for the next few days wearing their cool little sunglasses! Sadly, this means we get less skin-to-skin time with them as they don't want them out from under the lights too frequently.
Pip (top) and Pop (bottom) showing off their stylish frames.

Pip (top) and Pop (bottom) under the lights.
 
 
 
 

***For now, the boys will remain Pip and Pop on the blog, although they do have names. We are still weighing our comfort level with having the babies names out on a public webpage.


 

Jan 14, 2013

Babies are here!!

Last night Pip and Pop made their entrances into the world!
 
 
Pip (Baby A) weighed 4lb3oz and looks just like his Daddy. He was born at 8:23PM. Pop (Baby B) weighed 4lb8oz and was born just a minute later at 8:24PM.
 
The boys are currently in the NICU and doing really well. Hospital policy does not allow any visitors into the NICU during RSV season (particularly since it is so bad this year) so while we would love for you to meet our little men, they need just a few weeks to grow bigger and stronger first!
 
Casey has been playing the proud papa and spending time with the boys while Lexy recovers. This afternoon we hope to all be together as a family and will let y'all know names just as soon as we have them.
 

Jan 13, 2013

Baby Watch II

We made it to 48 hours! The boys little lungs have been given every chance and I am now phased off of the magnesium sulfate.
 
So now we wait. And pray.
 
Depending on how my body reacts to stopping the magnesium, they could come this afternoon or it could take another two weeks.
 
We are praying God's healing hand and Almighty strength over these two little miracles.
 
 
Trust in The Lord with all your heart,
And do not lean on your own understanding.
In all your ways acknowledge him,
And He will make straight your paths.
Proverbs 3:5-6

Jan 12, 2013

BabyWatch

On Thursday, January 10, Casey and I visited with the MFM to learn how the babies were doing and get a better idea of the risks of cholestasis, one of which is pre-term labor.
 
Little did we know that just a short 24 hours later we would be sitting in Labor and Delivery!
 
At 10:15 on Friday, I was sitting in bed reading a book and all of a sudden felt wet. I had heard of pregnant women peeing on themselves, so my first instinct was to be totally disgusted with myself. Because, I mean really who wets the bed at 28?! I ran waddled into the restroom to get myself cleaned up, but the fluid didn't stop.
 
At this point I started to realize it was something more, so I shot off a text message to my OB:
 
and I called Casey and told him to come home. Luckily, we had finished packing this week so we just needed to throw electronics and toiletries into our bag, put the carseats in cargo (because they aren't installed) and we were on our way.
 
We arrived at the hospital around noon and spent some time in L&D triage getting all of our records up to date and verifying information that had changed since our last visit (At this point, I admit defeat. I'll probably never blog about that Christmas Eve trip.) We got admitted and the first step was to hook me up on the nonstresstest to check the babies and monitor my contractions. The babies looked good but what i had thought were cramps were actually contractions. Next, they checked my cervix and ran a lab test confirming it really was my water that broke.
 
The results came back pretty quickly (20 minutes maybe?) and I recieved an IV drip, magnesium sulfate, an anti-nausea med, and an antibiotic. Once the line was in, we were taken to an L&D suite.
 
Once in the suite, steps were taken for me to stay for a while, like inserting a catheter. Umm..wow. It was uncomfortable going in and the pain got more and more unbearable. Contractions with a catheter in had me crying (Literally. Tears.) and begging them to take it out. My whole abdomen got sore to the touch, particularly in the area where the catheter was and the pain intensified dramatically with each contraction. To get it out, I had to agree to the humiliation of bedpans, because I'm not allowed to stand up. It was a great trade! Honestly, I am so past being humiliated or embarrassed at this point. (Okay. Maybe a bit embarrassed that I'm putting this out there for all you People of the Internets.) The contractions continued hard and heavy for most of the night.
 
I don't remember a lot of last night. I had awful contractions. I cried. I was terrified. I sat with my Mom and Casey. I was in and out of lucidity because of all the drugs. Casey's parents flew home from vacation in California and we were able to seem them right after they landed. Casey's brother rescued our dog and dropped her off at my Mom's. We received hundreds of texts and twitter messages and appreciate them so so much. (I'm just sorry I'm not able to respond to them all individually). I only remember one thing about last night: I knew it would take 24 hours for the dose of the steroids to get to the babies so I HAD to make it 24 hours. (And, I wanted them to get a second round, so really I had to make it 48 hours.)
 
It was a long night and there were a number of times overnight that I didn't think we'd make it (later learned, neither did my nurse or OB) but we did. Pip and Pop stayed safely on the inside.
 
Today has been rather uneventful. My contractions have slowed in both frequency and intensity. I got some sleep. Not much, but it's amazing what a little bit of sleep can do! I got the second round of the steroid at 1:30 today and now I'm on track to let this dosage gets its full 24 hours!
 
I am feeling all of the awful effects of the magnesium sulfate, but so thankful for this miracle drug slowing things down and giving my boys more time. Because my water has broken, I can only stay on the magnesium sulfate for 24 hours due to the risk of infection. Tomorrow afternoon, I will go off the magnesium and lose its magical contraction stopping and we'll see what happens!
 
Y'all have no idea how much we appreciate all of your prayers and thoughts! God has been with us through every step of this miracle pregnancy and these are two cherished little boys. I know God is great! He is the ultimate Healer has a plan for all of this.
 

Jan 10, 2013

Cholestasis and the High Risk BabyDoc

Today Casey and I met with a new MFM, Dr. E-B, to check in on the babies and learn more about cholestasis and what this means for the babies and I.

Dr. E-B was very thorough and did a complete anatomy scan of both boys. In summary:
  • Pip and Pop look healthy and all of their parts are where they need to be and doing what they need to do.
  • My cervix is no longer closed (I guessed that from the whole mucus plug experience - which I will never blog about or share because eeeew!) and is fairly short, but it's okay because I'm 33w0d with twins. She didn't tell me how open my cervix is (she had the nurse write down 15,12 but I don't know what that means).
  • Pip is sitting VERY low down in my pubic bone area and putting constant pressure on my cervix. He does not have much growth space or amniotic fluid, which that needs monitored. He is also measuring a lot smaller than Pop (and much smaller than the ultrasound tech predicted on Monday).
  • Pop has plenty of growth space and amniotic fluid and is measuring slightly big. He is spooning with his brother with his head down and taking up all the room. His gestational sac is bigger than his brothers, so he can spread out more.

Pip

(Baby A)

Pop

(Baby B)

PositionHead DownHead Down
LocationMy left,
VERY low
My right,
up high,
making an L
Weight4lb4oz
(1933g)
5lb1oz
(2307g)
Size Percentile24%64%
Size Discordance-16% (or +19%)

To watch out for:
  • Pip's amount of amniotic fluid
  • Discordant fetal growth (the differential between the babies is now at -16% (Pip is 16% smaller than Pop), which is barely above the cutoff for concern and so it just needs watched. Because math is fun, the size differential the other directions says Pop is 19% bigger than Pip, which is closer to the 25% discordance problem zone.)
  • My cervical length
Takeaways:
  • Dr. E-B believes that 37w is the latest possible delivery date for twins and as soon as a complication develops, they need to be delivered earlier. In her opinion, the boys should come out between 35 and 36 weeks at the latest. However, she also said that with cholestasis the likelihood of preterm labor increases dramatically and I probably won't make it 35 weeks. In her opinion, I could deliver at any time and the boys will be healthy and 33w0d is a great place to be with twins.
  • This fits with my gut feeling that they are coming sometime in the next week or two.
  • We need to get busy this weekend! Lots of preparation. If you are bored this weekend, drop by and we can put you to work!

Packing Hospital Bags

We are all packed and ready for the hospital - and only 9 weeks later than our Preparing for Multiples Class said we should be! Next step, we need to get these bags into the car and our carseats installed!
 
In class, we were told we should be packed by 24 weeks so we were prepared for any circumstances, including an emergency trip to L&D. We learned on Christmas Eve (I promise a full post about this is coming!) why this is important but didn't actually both finish packing until this week. In our class they said car seats should be installed between 30-32 weeks for twins, so we aren't TOO far behind on that one.
 
I am sure we have WAY too much stuff and will regret lugging it all around, but we just don't know for sure.
 
Bag One is mine. It contains two pairs of button front pajamas, a warm cozy robe, nursing tanks, nursing bras, a coming home outfit (an outfit that fit me well at 5-6 months pregnant), granny panties and socks (only one pair of each of these since the hospital does provide them), and slippers. I also have pens and a notebook for keeping track of important information and the babies. I included a green and a blue pen so I can record feeding schedules for the boys and differentiate Pip from Pop if it's necessary. I also have scrapbook paper for footprints and any other little memories I'd like to jot down. On my bathroom counter, I am living out of a packed toiletry bag so it is ready to be thrown in. The toiletry bag has nipple cream and dry shampoo in addition to my normal travel supplies.
 
Bag Two is Casey's. He packed two complete changes of clothes, tennis shoes, a swimsuit, a bag of quarters for the vending machines and has his toiletries in the bathroom ready to go. He also put a surge protector in his bag so we can charge all of our electronics at the hospital. Missing from Casey's bag are snacks for after the delivery, but he just can't seem to decide what to throw in!
 
Bag Three is for the babies. It has two sets of coming home outfits (two coordinating outfits in preemie size and two coordinating outfits in newborn size), two hats, two pairs of little gloves, two wubbanubs, and blankets. Since it might be cold when Pip and Pop arrive, I included two muslin blankets and two fleece blankets.
 
When it is time to make the hospital trip, we will also grab my My Brest Friend pillow and our electronics (2 iPads, 2 iPhones, our camera, our camera to iPad photo transfer thingy, and all five chargers). We also have old towels sitting at the ready in case our reason for rushing to the hospital is that my water broke.
 
You can see my packing spreadsheet here.
 
What do we not have packed that you couldn't live without? I'm sure we forgot something...
 

Jan 8, 2013

Week 33

Marination Time:
32w5d
 
Baby Size:
 
The Bump tells us that Pip and Pop are each the size of a durian (another fruit I've never heard of!) and gives an average weight range of 4.2-5.8lbs for this month. BabyCenter says the babies each weigh as much as a pineapple, with an average weight over 4 pounds and length over 17 inches, head to heel. At our growth scan at 32w4d both boys were over 4lbs and healthy! (More details.) His Boys Can Swim no longer says the Ps are each as big as the front tire of a kids Big Wheel. Instead, it compares their length to a 17" laptop for the next few weeks.
 
Baby Milestones:
Pip and Pop are growing and growing! They are also getting smarter and smarter as they go through more bran development. This week they started to coordinate breathing with sucking and swallowing. This is an important skill to master before they come out or they will need feeding tubes. This week their bones, except the skull, will continue to harden.
 
Symptoms:
Itching. Exhausted. Contractions. Tiny Bladder (Seriously. Every. 90. Minutes.) Trouble bending over - as in it doesn't happen. Shortness of breath and easily winded. Bruised and tender uterus. Nausea with contractions. Mild indigestion. Losing mucus plug (Eeew! Advice: don't google image search that. Ever.)
 
How I'm Changing:
I seem to be past the changing part of pregnancy. In fact, I look less round and pregnant than I did before. My belly used to go out, but now it is taller (starts lower) and wider and doesn't stick out as far.
 
What I'm Eating:
Odwalla Chocolate Protein Monsters (they stay down!). Milk. Not much. I have absolutely no appetite at all.
 
Annoyances:
Itching.
 
Sleep:
Due to the cholestasis and itching I sleep 45ish minutes at a time. Medications were changed so hopefully that changes soon!
 
Missing:
Sleep.
 
Belly Button Watch:
My flattie lives on. And since Pip fell so low, I'm not as round as I used to be so I might **fingers crossed** ever go past flattie!
 
What I'm most excited about:
I am so excited to meet Pip and Pop!! It's still a few weeks away (I hit 37w0d in 4w2d!!!) but I am eager! I'm not so eager I want them out today. I want them to be healthy and NICU free so they need to stay in a bit longer, but I know it's soon!
 
My milk doesn't expire until after they will be here! Crazy!!!
 
We have a few weeks to finishing putting the house back together post carpet install tear apart and to get the nursery done, but not long!
 
Previous Weekly Updates:
Week 32
Week 31
Week 30
Week 29
Week 28
Week 27
Week 26
Week 25
Week 24
Week 23
Week 22
Week 21
Week 20
Week 19
Week 18
Week 17
Week 16
Week 15
Week 14
Week 13
Week 12
Week 11
Week 10
Week 9
Week 8
Week 7
Week 6
 

Jan 7, 2013

Week 32 Growth Scan

I had my first BioPhysical Profile (BPP) today. Combined with the NonStress Test (NST), which I also had today, this showed that Pip and Pop are both healthy and doing well!
 
The electronic fetal monitoring in the NST uses paddle like devices (one for each baby) to record the babies heart rates and a little clicker to indicate when I feel movement so they can evaluate the heart rate elevation from movement. There is also a paddle tracking me and looking at the number of contractions I have and how the babies respond to the stress of uterine contractions. The fetal ultrasound for the BPP looks at fetal movement, the babies' muscle tone, and the volume of the amniotic fluid surrounding each baby.
 
Until delivery I will have a BPP every Monday and a NST every Monday and Thursday. We're keeping a close eye on these little boys!
 
 
 
Today I also had a growth scan.
 
The results weren't bad, and were in fact expected, but it was still hard to swallow.
 
Our last growth scan was 4w3d ago on December 6 at 28w0d and at that time, Pip and Pop were HUGE babies, each weighing over 3lbs and measuring 12 days ahead. They are now both in approximately the 50th percentile and are measuring right on track. (Look at this BabyCenter chart for more information on average fetal weights.
 
This is great and I should be thrilled. They are still growing together. They are right where they need to be.
 
But, I was shocked to see how much their growth slowed down. I knew that twins rate of growth slowed in the third trimester because they start running out of room, I just wasn't prepared for it to have slowed that much!
 
 

Pip

(Baby A)

Pop

(Baby B)

PositionHead Down
Head Down
LocationLeft of my belly buttonRight of my belly button
Placenta Anterior
(in front of baby)
Posterior
(behind baby)
Weight4lb9oz
4lb11oz
Average Ultrasound Age
(Gestational Age is 32w4d)
33w0d33w1d
Size Percentile50ish50ish
 
I don't have as much growth information as usual (like the different body part measurements, the exact weights (in grams), or the exact percentiles) because I saw a different ultrasound technician than normal and she was unwilling to print me a copy or even let me take a photo of the screen. She also didn't give me any baby pictures! Sad ultrasound!
 
With all of this new information, feel free to update your expectnet guesses, or if you haven't entered go enter your guesses now. The site says you have to register, but it only asks you for an email address and password (no personal information) so that you can go back later and change your guess and so we can contact you if you win! Click here to go over to the game site.
 
 

Jan 4, 2013

Another Diagnosis: Cholestasis

I've had a few rare diagnoses during this pregnancy. I guess I shouldn't be surprised that these miracle twins who started with only a 5% chance of IVF success have also beat the odds on rare diagnoses.
 
I've blogged a bit about my itchiness (see the annoyances subheading here and prayer request here) and now I know what's causing it.
 
I have been diagnosed with obstetric cholestasis, sometimes called intrahepatic cholestasis since it occurs inside the liver. According to Cincinnati Children’s Hospital Medical Center, Cholestasis occurs in about 1 out of 1,000 pregnancies. Yet another rare condition.
 

"Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones." Basically, all of the pregnancy hormones have affected my gallbladder function and liver function. So, the bile my liver is producing to break down fats and aid in digestion is building up in my liver and spilling into my bloodstream. This is causing the severe itchiness that isn't made better by topical creams and lotions.

Most of the risks are actually to the babies not me and include an increased risk of stillbirth, premature labor, fetal distress, maternal hemorrhaging and meconium passage in utero. I will deal with discomfort, itchiness, fatigue, and nausea but all of the symptoms should go away within a few days of delivery.

Despite all of these scary risks, with treatment almost all of the negative outcomes can be avoided. The two most important factors in treatment are reducing the bile acids in the bloodstream with the medicine Ursodeoxycholic Acid (brand name Actigall or generic name Ursodiol)** and delivering the babies as early as lung maturity will allow. Since 37 weeks was our delivery plan for the twins anyway, we are good there.

I started the ursodiol today and will hopefully get some relief from it. I will be frequently monitored (already have appointments booked for twice weekly non stress tests, weekly ultrasounds, and weekly appointments). We will take things day by day. I'm still hopeful I will make it to 37 weeks but I have accepted that I might not.

Right now, I am overwhelmed. I am angry. I am terrified. I am disappointed that my body has done yet another thing to possibly endanger the babies. I am a hormonal, emotional mess!


** From www.icpcare.org: "Ursodeoxycholic Acid - UDCA (Actigall, Ursodiol, Urso) is one of the most important treatments for ICP. It’s a natural bile acid composition that displaces the more harmful bile acids in bloodstream. It has been shown to reduce levels of bile acids in umbilical cord blood and amniotic fluid. Some studies have shown it to significantly reduce pruritus, serum bile acids, transaminases, and bilirubin. Studies have shown that it improves bile acid transport across the placenta, which may reduce the risk of stillbirth (intrauterine death of baby) associated with ICP. It also helps to relieve some of the itching symptom associated with ICP."


 

Fragments for Friday: First in 2013


 
Sometimes things happen throughout the week that are interesting and blog-worthy, but they just aren't a full post. Fragments for Friday to the rescue! All of those random thoughts collected over the week can go in one place: Fragments for Friday.
 
Not a Myrtle and I are so excited so offer you the chance to link up and share your Fragments for Friday. So jot your notes and link up with us!
  • Happy 2013!!
  • Reality check: I have been having huge discussions with Pip and Pop that they weren't allowed into the world until 2013. How short-sighted am I?! Now it's 2013!!
  • On a related note, my milk doesn't go out of date until after I hit my estimated delivery date of 37w!
  • At the beginning of December we took maternity pictures with David Tran. He did an incredible job but we were waiting to share the photos until after our Christmas cards went out. I posted them all yesterday. Swoon!!
  • Last night, Casey and I stopped at Target to buy more Odwalla protein shakes and had the oddest check-out experience. The first thing our cashier, Mary, said to us when we got the register was "Congratulations. And are you having twins?" Ummm.... I really don't look that big and I was wearing an old fleece of Casey's that makes me look fat not pregnant. Then Mary says "Is your due date February? I don't think you'll be much longer." My due date is in February! How the heck did she know?!? Her last comment: "Two big healthy babies. About 5lbs each now." On December 6 at 28w0d they weighed 3lb5oz and 3lb2oz so 5lbs is certainly possible at 32w, but that would make them BIG babies. Especially for twins. Mary thinks I'm carrying 10lb of baby already. I sure hope she's right. Growth scan and BPP on Monday so we'll know soon. Given Mary's obvious clairvoyance I don't understand why she is working as a cashier at Target!
  • The Rockabye Baby station on Pandora is the coolest thing ever! I love watching the babies dance along!
  • I mailed the first 80 of our Christmas cards but never finished addressing the rest. I feel awful! So, if you didn't get one, check out the design on the blog and I'll get you a baby announcement in a few months instead!
  • We had friends over to celebrate my 28th birthday and watch the Cowboys game on the 30th. We're still mourning the end of Cowboys season, but it was so great to see friends! I seriously feel like I live under a pregnancy rock. I worry the isolation from friends is going to be worse after the babies come :(
  • You've all seen this bullet before, but I really want more guesses! We set up an online guessing site to enter your expectations for Pip and Pop. We would LOVE for ALL of you to play along! Go to http://www.expectnet.com/games/CassBoys to enter your guesses. We are really excited to see your thoughts!
  • I've started twice weekly visits to the OB. Every Monday I will have a BioPhysical Profile (BPP) (and a growth scan some Mondays) as well as a Non Stress Test. Every Thursday I will have another Non Stress Test and meet with an OB. Lots of appointments in my future!
  • I truly believe in the power of prayer and know that God listens and responds. He is all-powerful, all-wonderful, and all-capable. He is capable of infinitely more than infinitesimally more than we can even imagine (Ephesians 3:20). On my heart:
    • My sister-in-laws mom was laid to rest the day after Christmas. Prayers of comfort and peace for Amy and for my niece and nephew who lost their grandmother. Prayers for this family which has experienced so much loss the last few months.
    • I am itching everywhere. Like crazy. I seriously want to claw my skin off. It feels like the itch is radiating from inside of me instead of being on the outside of my skin. On Wednesday, I saw my OB for it and she had blood drawn to test or cholestasis. Prayers that the itching isn't from this (or if it is, at least that it is not severe). Prayers for Pip, Pop, and I as we enter this final stretch.
    • Numerous twitter friends going through infertility treatments, pregnancy complications, bed rest, waiting for adoption or surrogacy, and the struggles of raising kids.
      • @suzschmooz had a chemical pregnancy and while excited for her first ever BFP is mourning that loss.
      • Continued prayers for @When20Meets30 whose twins, Camden and Cameron, born at 23w5d, both passed away.
      • @EndoJourney's son MB remains in the NICU but the neonatologist is optimistic that he will be released in the next 3-4 weeks near his estimated due date (EDD).
      • @RNPhotoGirl has one last snowbaby and will be trying FET again. Prayers this one is her take home baby.
      • @LeLeIsMe announced a pregnancy recently. Se has had multiple late second trimester losses so prayers for a long and healthy pregnancy with a healthy baby at the end.

Write your own Fragments for Friday and link up with us!

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December Big Idea:

God's son came into the world as a child to offer me peace.

December Memory Verse: And a little child will lead them. Isaiah 11:6
New bracelet and new verse coming Sunday!

Jan 3, 2013

Maternity Photos

 

Week 32

Marination Time:
32w0d (a bit behind - I apologize!)
 
Baby Size:
 
The Bump tells us that Pip and Pop are each as big as a squash and gives an average weight range of 2.5-3.8lbs for this month. BabyCenter says the babies are taking up more and more space inside my uterus (stating the obvious!) and each weigh as much as a large jicama, with an average weight of about 3 3/4 pounds and length of about 16 3/4 inches, head to heel. Sadly, it has been four weeks since my last growth scan and I have no idea how big they are! His Boys Can Swim still says the Ps are each as big as the front tire of a kids Big Wheel, about 16 inches.
 
Baby Milestones:
Pip and Pop at this point ready for delivery. They have toenails, fingernails, real hair (peach fuzz counts right?) and their skin is becoming baby soft as they continue to plump in preparation for birth. They continue to grow, work on breathing and lung development, and further develop their five senses, but all of the basics are done! It is recommended that a twin mom gain 1-2 pounds per week forthe rest of the pregnancy, with roughly half of that going directly to the babies! In fact, over the course of the next weeks the babies could gain as much as half of their total birth weight.
 
Symptoms:
Itching. A lot. Everywhere. Miserable Miserable Itching. Exhausted. Contractions. Tiny Bladder (Seriously. Every. 90. Minutes.) Trouble bending over - as in it doesn't happen. Shortness of breath and easily winded. Bruised and tender uterus causing make me cry levels of pain. Nausea with contractions. Mild indigestion.
 
How I'm Changing:
I seem to be past the changing part of pregnancy and now I just continue to grow!
My first nap in the nursery. I'm sure it won't be the last!
 
What I'm Eating:
Odwalla Chocolate Protein Monsters (they stay down!). Applesauce. Greek yogurt (Fage with strawberries). No more food aversions. No food cravings. I'm just trying to eat enough every day to help the boys grow big and strong!
 
Annoyances:
Itching.
 
I have had itchy feet for a few weeks but just ignored it - I slept sans socks so I could rub them together at night.
 
Then, two days ago the itching was all over and so bad I couldn't do anything but be itchy. It might have been NYE and my birthday, but I spent over an hour in a lukewarm oatmeal bath trying to feel better. I couldn't see a rash, hives, or anything like that so doused myself in lotion (cetaphil) and tried to sleep. Around 3, I woke and put Benadryl cream on some of the worst areas. Still no help.
 
I woke up on the 1st still itchy, but it wasn't overwhelming so I figured whatever it was was done. I washed all our bedding and moved on.
 
I thought.
 
Mid afternoon I started itching badly. By 5, it was bad enough I texted my doctor. She said to try a bath with pine tar soap so Casey went and bought some for me and I tried it. No relief. At that point, my OB brought up cholestasis and told me to come in the next day for bloodwork.
 
Yesterday, they did a full exam and drew blood to send off to the lab. Hopefully, results in a week. At this point I have red welts starting to form on wrists, ankles,and some of my other worst itchy places from scratching too much. I think this afternoon I will go get a manicure with my fingernails cut REALLY short so they can't leave scratch marks.
 
I'm concerned about the effect on the babies and how the heck I am going to survive without going insane from itching! Nothing is giving me any relief at all. The only time I feel at all better is when I'm physically in the bathtub, but I can't live in there! (Although, if it gets much worse I might review that opinion).
 
Sleep:
My sleep stretches have actually grown a bit longer. Instead of a maximum of 90 minutes at a time, I'm now going 2.5 hours normally!
 
Missing:
Nothing right now.
 
Belly Button Watch:
My flattie lives on.
 
What I'm most excited about:
As of today, I am 32w0d which I had set as my minimum personal goal for baby gestation. We made it!
 
Average gestation for twins is 34-35 weeks depending in which statistic you look at, so I'm going with 34.5w (34w4d) as my next goal. This means my next goal is to make it to January 21st (which is also Martin Luther King Day).
 
Previous Weekly Updates:
Week 31
Week 30
Week 29
Week 28
Week 27
Week 26
Week 25
Week 24
Week 23
Week 22
Week 21
Week 20
Week 19
Week 18
Week 17
Week 16
Week 15
Week 14
Week 13
Week 12
Week 11
Week 10
Week 9
Week 8
Week 7
Week 6
 

2013: My Resolution

I am really behind on blogging after taking a week off while Casey was home from work.  We enjoyed this last week as "the two of us" for probably the last time in a very long time!  We worked on the nursery (lots of progress to share), and the cribs (TONS of progress but probably not shared until they are finished), took a trip to L&D, enjoyed Christmas with our families, celebrated my birthday, and mourned the end of the Cowboys season.  I will hopefully post twice today and twice tomorrow to try and start catching up!

But before I catch up, I want to look forward.




Writing a New Year's Resolution felt really difficult this year.  I know my life is going to change drastically and wonderfully in ways I can't even imagine within the next few weeks.  Two little lives are going to change everything for me.  The truth is, I normally choose an "easy" resolution: lose weight, eat healthier, exercise, read the bible every day, etc.  Invariably, all of these resolutions fall off within a few months (days?).  I don't really know why, but a resolution to lose weight only ever seems to last until February or March.  By mid-year I have typically forgotten what resolution I had even made.  How can I make a resolution like that, when I don't know what my life look like a month from now, or two months from now.  All I know, is it will change.

So this year, I don't plan to make a New Year's Resolution about self-improvement.
  • I'm still gaining weight so Pip and Pop can be healthy when they make their arrival.  After they come, I hopefully won't be dieting because I will be breastfeeding.  Maybe the pounds will fall off and maybe they won't.  That won't be the priority though.  My priority will be giving them the proper nutrition.
  • I would love to eat healthier, but I've learned that isn't a New Year's resolution, but a lifestyle choice that Casey and I are both making to ensure we are able to watch our boys grow up. 
  • I do plan to exercise - lots of walks around the neighborhood pushing a huge double stroller are in my future, but at least for 2013 we've cancelled the gym membership.  It just isn't that season of my life.
  • I would love to read the bible everyday.  I cherish my quiet time with God each day and need to get better at including bible reading in that time every day instead of only some days.  But, I'm about to be a new mom.  And sometimes my soul might just need to sit with God and let His Grace wash over me.  And that's okay.


Instead, I am pulling my New Year's Resolution out of the Bible. 

Psalm 71 begins with a man seeking change.  He says "In you Lord, I have taken refuge" or in a different translation "I run for dear life to God" (Psalm 71:1).  This man is desperate for the Lord's love, grace, and help.  He3 continues his prayerful request to God and in verse 18 says:

"Even when I am old and gray, do not forsake me, O God, till I declare your power to the next generation, your might to all who are to come." -- Psalm 71:18


Psalm 71 is full of praise for God as the author declares Him a "rock of refuge", "my solid ground", "my hope.  The author says "I have leaned upon You since I came into this world; I have relied on You since You took me safely from my mother's body, so I will ever praise you" (Psalm 17:6).  One of my favorite verses in the bible follows: "But as for me, I will always have hope; I will praise you more and more" (Psalm 71:14).  After a full life time of believing in God's majesty, serving God, and praising Him, the author still wants just a little more time to pass on his knowledge of God. 

I'll admit that I want more than "a little more time" and I'm not (quite) old and gray yet (although I've heard twin boys will speed up the process!).  But, I can still think about his question.  I can still ask myself how I am passing the gospel on to the next generation.  I can still desire to raise up the next generation in the spirit of the Lord.

So, in 2013 I resolve to live a Psalm 71 life. 


Life may be hard.  I will have troubles.  But I know You will always run to my side.  I know you were by my side when I hit rock bottom in 2012.  You used your power and majesty to bring me up.  For 2013, I resolve to sing Your praises, even on the hard days.  I resolve to share Your love with others, and pass on Your wondrous deeds to others. 

One way I can do this is through discipleship to my own precious sons after they are born.  They will need your grace and your love and I resolve to raise them up in the image of Christ. 

I can do this by returning to my work at Munger Place once the boys are old enough to go without me for a few hours.  I can share You with the next generation.  I can continue to pour my heart and soul into lessons for those sweet children. 

I can continue blogging, where I have the opportunity to tell the story of your works and majesty in my own life to an infertility community that has so often lost faith in You.
 
I resolve to always have hope.
 
I resolve to praise you more and more.
 
I resolve to rely on you.
 
I resolve to declare Your power to the next generation.
 
I resolve to share Your might with all who I know.
 
I resolve to live a Psalm 71 life.