Learning to breathe again after the deaths of my twins, Nicholas & Sophia, my son, Alexander, and 6 miscarriages... and finding joy on the journey with my sweet preemie twins, Bobby & Maya, and our miracle TAC singletons, Michael, Lucas, and Ana.
Wednesday, August 26, 2009
Day 35: T-3
Yesterday was not a good day, hence no update. I wasnt even in my room.
At yesterday morning's 9am HB monitoring, Bobby's HB was 212. He is normally 130s-140s. A second nurse confirmed then the Resident, Dr N, was called. (Dr P was at a different hospital after visiting me for rounds in the morning- funny stories about him, actually...) She used 2 different u/s machines to confirm the HB. It was a blur of activity as they tried to get an IV and give me oxygen. Suddenly, I was told that I was being moved to Delivery and that Dr B had been called to discuss an emergency c-section. I called Peter and tried not to cry.
They moved me from Antepartum to Delivery and continued trying to get an IV while also trying to get the babies on the monitor. 6 sticks later, I had an IV in my arm (and my other arm is now just one bruise), oxygen, and a nurse monitoring Bobby and Maya. Maya was fine, but Bobby's heartbeat stayed in the 200s then would momentarily drop to the 150s then back to the 200s. It was terrifying as they were concerned he was in distress. Dr B called Dr C, the MFM doctor that we've been seeing, and they consulted. The wanted to avoid delivery if at all possible, so Dr C came and did an ultrasound on the high resolution equipment. By this point, Peter had arrived.
As we waited for Dr C. the u/s tech pulled the babies up and the first thing he said was "There's no fluid around the heart or lungs." This was great news. This means that Bobby's heart has not started going into failure. Once Dr C arrived, it was quiet for most of the scan. But he also had some better news. Bobby was not in distress. The upper part of the heart, the atria, are not beating regularly. In a normal heartbeat, you get atria-ventricle-pause-atria-ventricle-pause, etc. The atria contracts, then the ventricle contracts and relaxes, preparing for the next round. Hence the lub-dub sound you hear on a stethoscope. Bobby's atria is contracting twice. atria-ventricle-atria. atria-ventricle-atria. The ventricle is getting the sign to contract but it cant be cause it is relaxing and by the time it contracts again, the atria has contracted a second time. This is causing the arythmia and pushed his heart into overdrive. The overdrive is called SupraVentricular Tachycardia, or SVT. The concern is that SVT leads to heart failure if not treated. Since they cannot give Bobby treatment directly, the discussion became what to give me to try and help him while not hurting Maya (whose heartbeat is stable and regular). At first, the discussion was Digoxin, a cardiac medicine that would possibly lower his heartrate but also would require cardiac monitoring for me since my heart is normal and would be impacted by the medication. This is a common first line of defense because it is an older drug that, although a class C medication, has been used enough in pregnant women that no adverse effects have been shown (there just havent been studies conducted). Dr C decided to call Dr B, a pediatric and fetal cardiologist from Dupont in DE, to consult on what he had seen and heard from the monitors. Dr B will be arriving on Monday to do a echo on Bobby's heart and, in the meantime, suggested they start me on Propranolol, a beta blocker and also class C, since it would have the greatest impact only on my blood pressure and not my heart, and he feels might lower Bobby's heartrate. The idea is to lower his heartrate and then try to figure out what is causing the arythmia. Is it a heart defect that was missed on the MFM ultrasounds (although Dr C still couldnt see a problem even yesterday) or is it an unknown arythmia that will fix itself either in utero or upon birth, which can happen. Either way, their hope is that, even if the drugs dont work (and they have a plan to add drugs if that is the case, including adding the Digoxin to the Propanolol), they can buy us time to 28w and deliver then, versus delivering now. Not that we want a 28w delivery but we will take it if that means both of them are okay. The worry is that if they cant get Bobby's hearbeat to settle back down to normal and it does go into failure, that drugs wont work. And since we arent willing to let something happen to him for the sake of going longer into pregnancy, we've already made the choice that, at whatever time they see distress, we are opting to deliver both babies.
So, last night, we were in Delivery with the idea that we would be transferred back to APU, but they decided they'd do my monitoring, etc, over there and bring us back later. That monitoring showed that he was still in tachycardia (high HB), but that in addition to going back to normal ranges, he was droppping into subnormal (80s-100s) and then back up. The residents were called and they did an ultrasound in the room. He was still moving and happy but you could see his heart going fast then normalizing and then, it appeared, taking pauses in between beats (the low beats). They felt that there was really nothing they could do except watch and wait and hopef or the best, since he was normal or high much more than he was low. Of course, I had a good cry when it was just Peter and I, terrified that Bobby's heart was stopping and that he was trying to tell us something that we just couldnt understand. "Is he saying, "Mommy, help me," and I'm not?" I sobbed. Peter just held me and rocked me and, with every little cook of our baby boy's foot, told me to take heart that our son was okay.
We got back to our room around 10pm and were so tired. I woke a few times in the night (for the bathroom, to have my BP measured, to take my new med) and each time, I prayed and willed the babies to move, just to let me know they were okay. Maya was more than happy to oblidge when I rolled onto her side and she didnt like it, but Bobby was fairly quiet. I was terrified and ended up falling back into a restless sleep with my hand glued to his side of my belly.
This morning, as we were laying in bed, Peter told me he wasnt going to work today, that he wanted to make sure that things were stable before he even thought of leaving the hospital. I am so glad that he stayed. Bobby was more than happy to make me aware of his presence with kicks and rolls, along with Maya, and I felt better about his safety, and I actually took a peaceful nap. Dr B came in during this time and talked to Peter, and then my nurse came in to do monitoring. I explained about the irregular heartbeat and SVT, but she was nervous listening to his HB because she said that what she was seeing on the monitor wasnt matching what she heard. So, she called in the Nurse Practitioner, who did an ultrasound and confirmed that his heartbeat was stable with drop offs (but not surging). Still, she was concerned and called the Resident, Dr P. Dr P had seen me this morning on rounds and told me that, while he knew I was scared, he has seen fetal arythmias a lot and they usually resolve themselves... that Dr B from DE is an expert and will find any abnormalities but that he thinks things will be just fine... To try not to worry... (and, funny story, I dont know how he found out that I had been moved from APU yesterday but apparently he called Dr N and drilled her on what happened. Last night, she laughed and told us "I had to keep telling him that you were fine.") So, Dr P came in and listened and repeated the u/s. He was able to confirm that Bobby's HB was within normal ranges and dropping off with periodic highs (190s) that only lasted seconds. So this is actually better than last night. His heartbeat is still very irregular (i.e. arythmia) but the tachycardia aspect is diminishing. This could be because of a quick response to the medication (which has lowered my blood pressure to the point that my morning dose was skipped and I felt a little off kilter) or it could be that this was just a fluke thing. I'm hoping the latter and that the arythmia as well will clear up on its own. The CRNP wanted to move me from APU to L&D; Dr P doesnt. (He wouldnt be my Resident over there... Such a nice guy.) He also told the CRNP that if he could sit and get Bobby's HB on a solid strip for 15m (meaning they can see all the highs and lows and not just points blipping up on the print out), then the nurses can do. The CRNP argued with him for a bit but after a while said "You've proved your point." He also wants them to monitor the babies seperately since they know that Maya's heart is fine right now and that way there isnt dual lines on the print out. So, a nurse will sit with me for 15m of my monitoring to get a solid, 15m strip of Bobby's HB, highs, lows, and everything inbetween.
Emotionally, I am drained and am a nervous wreck. It's bad enough to not know "why" this happened; it's worse to feel like it is a wait and see. Hopefully, come Monday, we will have some answers when the pediatric/fetal cardiologist comes, but it is the waiting until Monday that is killing me. Will Bobby be okay until then? Everyone seems to say yes, but then there is the mini-freakout when they monitor him and the nurses see/hear the arythmia. I just want to know that he is safe and okay. I dont want them to go for monitoring one day and not find him. That is my huge fear right now. I realize that delivery at this point isn't a good thing and we are desperate to get to 28w... I just want to know that he is okay until then. When he moves, I am reassured; but when he doesn't, I panic.
A note about my blood sugar... Yesterday, after breakfast and lunch, my BS came back at 120 and 127 respectively. I was really pleased. After dinner (and my first dose of the pro...), it was 166. Even though I ate the same as I had for lunch. The meds screw with your blood sugar. This morning's fast: 135. So... even though diet actually DID help, I will have to go on insulin therapy to moderate my BS as a result of the meds to help Bobby's heart. I'm a walking pharmacy!
Prayers are much appreciated. I am hoping that I will have better news to report within the next week. I'm also having a MFM u/s on Friday, which I hope will give us some peace of mind as well. Right now, both babies are kicking and I am relieved to say that we are doing okay.