Friday, March 30, 2012

Pictures from 29ish weeks

As promised, here are a few pictures from our ultrasound this week.  The first one I find particularly amusing.  It's a top down view of Bee's head, and that fringe-y stuff on the left side is hair.

This one is a profile shot. I love her sweet little baby nose.

Aaaaand here's the 3D shot. 

I also realized that I forgot to mention in the last post that they're estimating her weight right now (at about 29 weeks) to be 2 pounds 15 ounces.  That's almost 3 pounds o' baby!  Grow baby grow!

Just Sweet Enough

So here's the update on the past week or so.  I had my glucose tolerance test last week to check for gestational diabetes.  This involves fasting for a couple hours prior to the test, drinking a bottle of corn syrup (not literally), and then checking my blood sugar an hour later to see what happens.  Well.  Ever since I had the test with Henry about two years ago, I've been saying that I passed that one by one point.  The normal range is 74-139, and with Henry, I had a 138. Which I now realize is actually passing by 2 points, because *this* time, I had...a 139.  Thank you, pancreas, for not betraying me in my hour of need.  So as the title of this post would suggest, I am officially just sweet enough.

A couple days ago we had an appointment with the Maternal Fetal Medicine (MFM) folks.  The first thing was an ultrasound with the world's fastest sonographer. Zippy zip, measure measure, click click, and "Oh look! She's got some hair!"  She steps out and comes back in with The Doctor.  Dr. M--white hair and a mustache, probably in his 60's, and looks like he could've been a football player back in the day.  He seemed *really* tall, but that could have also been because I was lounging on an exam table about two feet off the floor at the time. He was one we hadn't met before, and I wasn't sure what to think of him at first, because he kept asking me questions that were sort of alarming, in a "why are you asking that?" sort of way.  "How old are you?  How far along are you? And have we looked at the baby's chromosomes yet? Are you diabetic?  How far along did you say you were?"  This line of questioning was going on while I was back under the ultrasound wand, so for the paranoid among us (me), one can't help wondering why all the questions.  Also amusing was Dr. M's use of the phrase "the kid" when referring to our baby.  As in, "You know, it's hard to predict the outcome with these CDH babies.  Until the kid's born, it's all kind of up in the air."  Pretty sure he referred to Bee at some point as a "he" also.  Despite the questionable first impression, I really did like this guy.

Following this second round of ultrasound viewing, Dr. M looks at me, gives me a big grin, and announces that everything looks good.  Bee's heart continues to look good, with "good ventricular output" (or some such cardiology jargon).  Basically he was saying it wasn't getting too smushed by her abdominal organs hanging out in her chest.  Also, it appears that her liver is still down below the diaphragm.  Jonathan asked if, at this point, there was much chance of the liver moving up.  Apparently the left lobe of the liver is a sneaky little thing and can find its way up there pretty much at any point.  So please keep praying that it stays down down down.

Then there's the lung to head ratio (LHR).  Here's a diagram that I stole from Abby Knoll of "It's How We Roll" fame (check out her blog over there in that list on the right--->)

First, they measure (or at least make a valiant attempt at measuring) the right lung.  (Here we have a cross-sectional area of 21mm x 10 mm, which is 210 mm squared.)  Then they measure the head circumference (200 mm).  Then you divide! (For the math geeks among us, the units don't quite match up because we're dividing an area by a distance, but just go with me here.)  In this example, it's 210/200, which gives an LHR of 1.05.

I mentioned this briefly in a previous post, but there's some controversy as to whether the number even matters.  It looks at the relationship between the baby's head size and the amount of lung tissue present.  The higher the number, the more lung tissue.  (Over about 1.4 is considered pretty darn good.  Bee had an LHR at 21 weeks of 1.8.)  This is a good thing, obviously, but the reason (I think) that the docs are hesitant to make any major predictions based on the LHR is because, you know, it's all up in the air until the kid's born.  Despite this, I asked Dr. M about an LHR, because inquiring minds want to know.  He tells me that he'd rather not give me a number because it's hard to get an accurate measurement of the lungs, it's not reproducible, etc etc.  I basically told him "Yeah that's great and all, but you seriously have got to give me *something*."   Long story short (because ol' Dr. M couldn't remember how to calculate an LHR until I told him, and also because they got about three different lung measurements), Bee's LHR is somewhere in the 2.1 to 2.3 range.  Yay lungs!

One more little piece of info is that my amniotic fluid levels are in the normal range.  That's important because sometimes the fluid levels can get too high with CDH babies, which increases the risk for preterm labor.  We don't need Bee to be a preemie on top of everything else, so she needs to stay cooking as long as possible.

So there's the update.  Lots of good news!  To recap:  1.) I'm not diabetic!  2.) Bee's heart still looks good. 3.) She's got a good amount of lung tissue.  4.) Normal amniotic fluid levels.  Many many thanks for everyone who has prayed for us or sent positive thoughts. God definitely has his hand on our little girl.

I did get some super cute pictures of Bee at this last ultrasound.  When I get a few minutes to play with the scanner, I'll post them. :)

(Also, my younger sister is due any day now with her second little girl...please keep her in your prayers as well!)

Monday, March 12, 2012

No news is, well, no news.

Apologies for the quietness of the blog over the past couple weeks.  We're still here, alive and kicking.  (Literally kicking, in Bee's case.)  Anyway, there just hasn't been much to update you on lately.  We had an appointment with the regular OB (as opposed to the *special* maternal fetal medicine folks. ha.) on March 1st, which was extremely uneventful.  I got weighed, they measured my belly and listened for Bee's heartbeat, they patted me on the head and sent me on my way.  I go to an OB practice where there are 8-10 docs, and they tend to schedule you with somebody different every time. They're all super nice, and I know them all already from when I was pregnant with Henry, so it's not really a problem.  However, it was a little unnerving/annoying/something that the guy I saw this past time seemed not to have been aware of our CDH diagnosis until I said something about it.  Then there was frantic flipping through the chart and "Ooooh yes, I see."   I guess as long as the perinatologists know what they're doing (which may or may not be the case--see previous post on Dr. Sandwich.), we're okay.

The next round of appointments starts in a couple weeks.  On March 22nd, I have another visit with the regular OB, where they'll do my glucose tolerance test.  When I was pregnant with Henry, I passed by ONE POINT. Many prayers please that I'll pass this time.  I'm sure I could handle the diet restrictions, it would just be a huge pain.  Plus I'd be obligated to whine about it for the next 3 months or so.  Nobody wants that.

The next appointment with the perinatologist is March 28th.  That's the one I'm excited about.  We'll have another detailed ultrasound and maybe get a little glimmer of a prognosis.  From what I gather, nobody likes to predict how CDH babies will do until they're born.  Still, any concrete information I can hang onto is good for my mental health.  Dr. Sandwich told me last time that they'd do another lung-to-head ratio measurement at this upcoming appointment, and we're hoping and praying for the highest number possible.  Higher numbers indicate more lung tissue, which is what we want.  They'll also check to see what organs are up above the diaphragm.  So far it's only been stomach and bowel.  Please pray that Bee's liver stays DOWN.  The liver is a big solid chunk o' organ (unlike the stomach, which is a nice squishy hollow bag, more or less), and if it's up there with the lungs, it can seriously impede lung growth.

April 10th is an appointment with the pediatric surgeon here in Greenville.  The original appointment was with He Who Shall Never Touch My Baby, but I rescheduled it with Dr. Abrams, who did a minor surgery on Henry about a year ago (a hernia repair, ironically enough).  Anyway, I still don't expect to deliver here in town, but *just in case*, we're meeting with the surgeon here so that he knows what the deal is.  If something miraculous happens between now and the next perinatologist appointment--and we pray that it does!--and the ultrasound shows the mildest, simplest case of CDH that anyone has ever seen, then we might be able to be talked into delivering here.  Maybe.  It would certainly make this about a thousand times easier in every way, logistically speaking.

April 18th Jonathan and I are heading to Charleston to visit the hospital there (MUSC) and have visits with the Charleston versions of the specialists we've been seeing here.  We'll also hopefully get to meet the lady in charge of Cross Bridge Ministries, who I've heard amazing things about (thanks for the tip, Rose!).  I spoke with her for a few minutes the other day and gave her the details of our situation and how our main need at this time is housing.  "We can help you with that."  Not sure exactly what that will look like yet, but maybe we'll be able to find out more in April.

So there's our timeline for the next few weeks.  I'm doing fine physically, and I'm holding it together emotionally (or, probably more accurately, God is holding *me* together) for the most part.  Every now and then I have moments of wondering how the heck this is all going to work out.  Those worries and wonderings mostly involve childcare, employment, and finances.  How can there be so much "real world" mess to fret over when I feel like I should be able to focus 100% on my baby?

This last bit is just a random musing.  If you don't know me in real life, then "Hi, I'm Leslie. I work as a nurse practitioner in a developmental pediatrics practice."  It's quite obvious now that I'm pregnant, and most of my patients and their parents want to "discuss" this.  Mostly it's "Oooooh, you're expecting!  When are you due? Do you know what you're having?"  (Occasionally, I get, "You're pregnant *again*?!"  That's annoying.  Please don't ever say that to anybody.)   I always smile and tell them we're due in June with a girl and that we're so excited, etc etc.  Which is all true, of course.  But I don't end it with, "..and she has this really serious birth defect and will be in the NICU for weeks, if not months. Hopefully we'll get to take her home."   That would be the full truth.  Do acquaintance-level people need/want to know that?  Maybe they do, I don't know. Feel free to weigh in.  It just seems like an awkward conversation that I'd be having about 6 times a day from now until June.