Uncommon Julia

Here's to You!

I raise my glass to you, my far-flung friends.

May 2005 be a miraculous year for each and every one of us!

The Good, The Bad, and the Unknown

The Good:

Hannah Eilene will make her grand entrance on January 17, 2005, God willing.

My doctors rock.  Really, they do.

I will deliver via c-section in the regular OR of our hospital.  There will be a full phalanx on doctors, including my OB, a gynecological oncologist, a skilled anesthesiologist, the blood bank people, and quite a few people to focus on Hannah, too.

Hannah is doing great.

My cervix is still behaving nicely, meaning we're not too concerned about going into labor before this whole plan is underway.

I passed my NST today without any weird looks of concern - those get old.

I AM GONNA HAVE A BABY GIRL REALLY SOON!

The Bad:

It isn't accreta.  It's increta - the middle phase.

The increta covers anywhere from 20-40% (or more) of my uterus' surface area.

They are going to have to fanagle some way to have my husband present for the delivery, since it won't be in the maternity ward OR. (But my doctor says she'll make it happen.)

My only shot at experiencing labor was the 18-hour hellish ordeal I went through to deliver Thomas.

I may lose my uterus.  And that, in a word, would suck.

The Unknown:

The doctors will not have any clue about the odds of saving my uterus until they remove the placenta.  The best odds they can give me right now are 50/50.  Dr. Special reitterated (numerous times) that I should ready myself for a hsyterectomy, even though they will try their best to avoid one.

That's the big unknown.  There are million more corallary unknowns that spring from it, so we won't touch them for now.

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I have a ton of other thoughts to blog about, but I just need some absorption time first.

Thank you for all of the prayers - don't stop now.

We'll See

Appointment with my OB today at 9:30.  Teleconference with OB and Dr. Special at 10:00.  Answers supposedly forthcoming.

I'll post as soon as I can, but I don't know how long all of this will take.

Very nervous.  More prayers, please.

In the Meantime, There's Projectizing

While I wait for that bastard radiologist to get back to Dr. Special, there's work to be done!

First off, our house is being painted over the next few days.  A good friend owns a house painting company, and in order to keep his crew busy during the slow holiday times, he offered to do it at cost.  We jumped at the offer because our house has a very open floorplan that means you can't just paint one room at a time - there are no stopping points.  I'm hiding away in my office while the work is done.  Fortunately, the office doesn't need painting.  I've got the windows open for ventilation (can I brag to those yankees out there that it's in the 70s today?!).  When the work is done, which should be Friday, and all is back in place, I'll post pictures. 

Secondly, the nursery is damn near done.  I took what used to be my changing table, which was in good shape, and apholstered the front of each drawer with the same fabric from the crib bumpers.  I bought new pulls, too.  All in all, it was a really easy fix.  The wood color isn't an exact match to the rest of the room, but with the fronts of the drawers covered, you'd never know it.  Plus, this meant we didn't have to buy a changing table, and the cost was minimal, as we already had the fabric and it only required a staple gun.

As you can see, I also bought a rod and finnials to hang the quilt my grandmother bought.  She bought the quilt in anticipation of Thomas, before we knew he was a he, and she's held onto it this whole time.  I can't believe what a great match the colors are!

You'll also note some pink things on the walls - those are dragonfly stencils.  They provide a better effect when you're seeing the room all at once.

The other big project was my old rocking chair.  It was a nice Ethan Allen piece... back when my parents purchased it when they were first married.  But then it went with me to college and at some point I decided to strip it.  Anyway, my husband restained it to match the nursery furniture and we found a guy who reapholstered it for nearly nothing.  I LOVE the fabric I picked.  Now it looks like a brand new rocking chair.  And it is SO comfy from the years of being broken in.

Now we just lack the curtains, which are being sewn from left-over fabric by a coworker of my husbands.  They should be ready in a week or so.

I also took notes from all the advice I solicited a week ago and made a shopping trip to get the last few baby/mother care items I needed.  And I'm packing my hospital bag - slowly - in stages.  It's hard because you still need most of the stuff you pack for yourself.  And it's almost impossible to get your husband to realize that he'll need stuff, too.  And then it just doesn't seem real anyway.  But I'm trying.  And I have a check list.  So that's good.

Let me know what you think of my projects - unless you think they suck, in which case just keep it ito yourself. :)

A Hijacking of Sorts

Somewhere in Houston there is a radiologist - the sole possesor of knowledge pertaining to my accreta - and he is refusing to return Dr. Special's pages.

Fucker.

Ostriches Have Long Legs, Too

I am tired and I am grumpy.  And I've been crying.  My specialist in Houston (who I'll have to name here at some point) has the report.  He's had it since this morning, a the very least.  And yet, I know nothing.

I know he's busy.  But DAMN.  I've spent all of the holidays with this crap hanging over my head.  The Infoholic Witch has returned with a renewed sense of purpose and I'm reading everything I can about c-sections, accreta, and how not to lose one's uterus.  I need some freakin' answers so I'm not just running around like the newly-beheaded chicken I feel like.

I'm supposed to call him (how's Dr. Special sound?) at 3:15 to get the full scoop.

Man, I hope it isn't a giant scoop of crap. 

Until then, I'm fighting tooth and nail my desire to shove my head in the sand and pretend none of this is happening.

Round About This Time One Year Ago

I wrote my first blog entry.

I can't seem to think of anything overly profound to say to mark the anniversary.  Other than this:

You people have saved me.

I have no idea how I would have picked up the pieces of 2003 to forge my way through 2004 without you.  Seriously.

By way of a recap, when I began writing this blog I had just lost my third child in one year's time.  I had moved houses (without first selling the old) and started a new career.  I had learned that my grandma was suffering from a slowly debilitating terminal illness.  I had been through the horror of an 18-hour labor to deliver my first son, who we decided to save from suffering with his illness any longer.  I had scattered his ashes.  I had been through four D&Cs and a Thanksgiving hemmorhaging incident.  I was emotionally beat up and suffering from post-traumatic shock syndrome in a very classic way.

Finding this blogging community was key in getting me back to being me.  I was reminded that sometimes humor is more effective than only haunting reverence.  Sometimes you had to laugh at your own ill fate.  Even if you were only laughing to keep from losing your own effin' mind.  (Oh, and I learned that cursing was acceptible, even from mourning mothers.)

When I was diagnosed with Asherman's Syndrome, everyone rallied with much needed advice and jokes and even a few internet cock-slaps to tell me that I would be alright.  I would make it through.  We laughed at my hoo-ha balloon and hormone therapy that was enough to make me appreciate the effects my IF sisters are suffering through.  And after a few more surgeries and HSGs I was okay again.

You lifted me up on your shoulders when I went to Washington, D.C. to march for our collective rights.  You gave me the courage to tell total strangers about my first son and you made me feel like a hero for going.  Really, I was the lucky one who was able to go, when I knew how many of you longed to.

When I conceived a fourth child without so much as an attempt to have sex near the time I ovulated, you all understood that "congratulations" just didn't go over.  You understood that I thought I really would lose my tenuous grasp on sanity when I began to bleed at five weeks.  You knew that fear ruled my world for the time being and you got me through it.

You knew not to jump to the "your safe now that the first trimester is over" comments when we did make it to 13 weeks.  And when I feared the worst before each scan, you snapped me out of it.  You congratulated me on things that seemed mundane to others - like tiny footprints and elbows that bent.

Now, as I face more bad luck in the medical realm, I know that my friends will be there to help me through.  And handing that burden over will mean a better result  in the long run.

Everyday brings me some new piece of appreciation for the fine, outstanding, courageous women I've met online.  We are truly a community.  And I am so, so proud to belong.

Thank you.

And here's to a miraculous 2005 for all of us.

The Few Answers I Have

The full MRI report didn't come in on Thursday, so the earliest I'll have any detailed answers is Monday.

The good news is that my visit with my OB on Thursday went really well.  I asked a zillion questions and she had all the right answers.  By right, I mean she knew when to say "I don't know, but I will find out" and she assured me that there was no one more equipped or experienced for this case.  She then proceeded to list the other specialists she wanted to consult for my case, including an oncologist (not because of any fear of cancer, but because they are accustomed to working with invasive growth, which is what accreta is), my maternal-fetal medicine specialist in Houston, and an anesthesiologist.

She listened and took notes when I spoke of the articles I was able to find online about conservative therapies, various outcomes, etc.  She never once treated me like I was paranoid, or spoke down to me.  She also said that she would not be leaving town at all before this baby was born, and that furthermore, if anything should happen prior to our plans, she would be coming in to handle the case no matter what - on call or not.  This did a lot to calm my nerves.

The great upshot of all of this is PRIOR KNOWLEDGE.  It gives us such an advantage and skews the odds in our favor.  It's still very scary, but not nearly as scary as it would have been had they only discovered the accreta after I delivered.

There is still a great risk to my uterus, and I'm trying to be honest with myself about that risk while still staying hopeful and upbeat.  It's an interesting line to walk, but much easier since Thursday's visit.

Tertia asked some good questions in the comments of my last post.  I'm re-posting my anwers here for those that missed it:

1. do you definitely have accreta?

Yes, unless there was some collosal miscommunication between my radiologist and my specialist, I do have accreta. What I don't currently know is how much, or exactly where, other than I know it is posterior because that's where my placenta lies.

2. how did they suspect it?

The doctors have known to watch me for this condition because of my history of scarring (Asherman's Syndrome). Having had six uterine surgeries, my uterus was much more suceptible to being invaded too deeply by the placenta. My specialist said he wasn't really surprised to see I had accreta, given my history.

3. if you do have it, is there a chance that they can do something about it without future harm to your fertility? what are those chances?

There is a chance that we can save my uterus. I don't know much about the odds at all right now, since we're still in the dark about the details of my case. Of course, the less severe my accreta, the better my odds, I assume. And I am lucky that the radiologist didn't mentione increta or percreta, the worse forms of the same condition.

As I understand it, there are a few "conservative treatments" that involve manual and surgical removal of my uterus right after a c-section, and then sometimes some reconstruction of any damaged wall. There are also proceedures I've seen on TV (for once it paid off) where balloon catheters are used to cut off the blood supply to the uterus just after the baby is delivered and just before the uterine surgery to prevent so much blood loss.

(While I'm at it, yes, I imagine they will have me begin banking my own blood.)

4. will doing a c section help?

As my specialist explained it, a c-section will likely be my best option for several reasons: 1. We can be fully prepared for it, with the best doctors ready to go. 2. After a c-section the doctors can more easily manipulate my uterus to perform whatever surgery they need to to deal with the placenta. I imagine this is most important considering its posterior position. Attempts to remove the placenta vaginally would be "blind" and much more difficult.

I am okay with having a c-section, but I am scared about the prospect of everything that will happen after.

5. any risk to you or banana at this stage? ie prior birth?

There is no greater risk to Banana right now that prematurity. My placenta performs just fine and her good size is an indication that she's getting plenty of nutrients, etc. We will be 34 weeks on Monday, and she's measuring at about 37. I'm also going to ask about the use of steriods and/or an amnio to test her lung maturity prior to delivery.

As for me, I'm afraid the risks are still there. But I do want to stress how blessed we are to know about this in advance. It will give us time to prepare, which in this case is more than half the battle. Still, I am worried about the chances of going into labor spontaneously before those arrangements are complete. The average gestational age at delivery for a patient with accreta is 34-35 weeks.

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So, as soon as I know something more, you will.  Until then, I'm doing my best to look at the sunny side.  Here's what I have so far:

Benefits of a scheduled c-section:

1.  My parents will be able to be here on time for the whole show.

2.  My husband will be able to give notice (yes, he got that job I referred to months ago) with precision not allowed by spontaneous labor.  This will mean he can give his full two weeks notice, get his full two weeks vacation to spend with me and the babe, and then start up his new job right on schedule.

3.  There is just the wee slightest chance that delivering a few weeks before my due date will save me from stretch marks.  (I'm really not holding my breath on this one, though.)

4.  As I understand it, I won't have to worrly about hoo-ha physical therapy!

5.  No pooping during labor.

I'm all ears for any other upsides...

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THANK YOU as always for your positive thoughts, prayers, and intelligent questions.  Geez, I love you guys.

Oh, and I'm not bothering to spell check, so pardon my typos.

Giving Them a Run for Their Money

I was beginning to feel left out.  Everyone else has their special issues: There's Julie and Charlie keeping us in suspense and educating us about the life of a premature infant, as well as numerous other pregnancy complications; There's Tertia, describing the ins-and-outs of bearing twins through bedrest damn near to term; There's Grrl and Sarah giving us all a raging case of tennis elbow from refreshing her site and keeping tabs on her two babies; and the list goes on.

As I mentioned a few posts back, by comparison, I was looking like one plain-jane wonderbread pregnant chick.

Notice I used the past tense.

There is accreta.

I don't know anything further because the goddamned report still hasn't come in.  But my specialist spoke with the radiologist and he said there is accreta.  He will call me as soon as he has the report.  He'll be working in tandem with my OB to map out the safest course to, well, to keep me alive and if at all possible, save my uterus.

I know that sounds like melodrama - and trust me, I wish it were - but this is not a situation to be taken lightly.

"In Placenta Accreta, the abnormally firm attachment of the placenta to the uterine wall prevents the placenta from separating normally after the delivery.  The retained placenta interferes with uterine contraction that is necessary to control bleeding after delivery.  Severe bleeding and surgical attempts to control bleeding are the major sources of maternal morbidity and mortality in cases of Placenta Accreta.  Blood transfusions are required in more than 50% of patients with Placenta Accreta."

and...

"Unfortunately, most cases of Accreta are encountered without warning in women who are not prepared for the possibility of hysterectomy.  Control of potentially life-threatening haemorrhage is the first priority, however, the patients desire for future fertility must be taken into consideration.  Historically, control of bleeding has been achieved by hysterectomy.  However, 10 recent reports include 31 cases of Placenta Accreta being managed without hysterectomy, there were no maternal deaths, and subsequent fertility did not appear to be impaired.

Initial approaches to conservative management of Placenta Accreta may include curettage and/or oversewing of the placenta bed and occluding the blood vessels that supply the pelvis.  Reported success rates of these manoeuvres vary widely.

There are several case reports of Placenta Accreta in which all or part of the placenta was left inside the uterus and managed expectantly.  This is possible only in patients who are stable.  It should be considered in those who understand and accept the risks of delayed bleeding and infection.

Conservative options may provide alternatives to hysterectomy in carefully selected patients.  In the majority of cases however, hysterectomy remains the procedure of choice."

I'll most definitely be in my cave.  I'll emerge to give you any more information as I receive it... and to accept any tips you may have on keeping myself occupied and, um, sane.

I'm Not Holding Out, I Promise

After spending all day yesterday alternately jumping out of my skin when the phone rang, and picking up said phone to pester my specialist's nurse we still have no report on my MRI.

Apparently, the hospital is backed up on reports right now because everyone's being a slacker near the holidays.  But yesterday they did promise the nurse that they would have the report to her by today.  I have promised myself I won't call to prod her again until 2:00 today.  That seems reasonable, right?

The past few days has been the closest to worried I've been in a while.  I'm trying to hold onto my original belief that there is nothing wrong with my placenta.  But let's face it: after six uterine sugeries, and a history of Asherman's, I can't pretend the risk isn't real.

That, combined with the fact that I haven't really heard of any good outcomes from placenta acreta that didn't involve hysterectomy's to save the mother's life, has made me one nervous nelly.  As is my habit, I've allowed myself to forecast all of the doom that would come with such a diagnosis way before it comes to fruition.  It's my old friend, the Habituated Trauma Searcher, at it again.

I've fought so hard for this baby, it would be heartbreaking to have to give up my uterus in order to stay alive.  I know I want more children.  I'd like it if I could give birth to them. 

But any minute now, that nurse is gonna call and tell me the coast is clear.

Until then, I hear Tertia has some nice cookies and wine in a cave somewhere.  I believe I'll join her.