transcended.net

So…where to begin. Well, it turned out that I didn’t need to think about how to bring up stopping work after all because that was pretty much decided for me after yesterday.

I think I definitely overdid it a bit with all the walking on Christmas Eve but Christmas Day we largely took it easy. I did spend about 40 minutes on my feet waiting for a table at dim sum in Chinatown but right after we got home, I spent the next couple hours resting in bed while Paul started cooking. I went back downstairs around 3pm and watched him cook for awhile, and then made the critical mistake of attempting to wrap BIL’s gf’s Christmas present on the floor of his parents room. After that landed me with major contractions and shooting pain in the v.ag I gave up and put it in a bag with some wrapping paper covering the part that was sticking out. Then I went back to sitting and doing nothing.

Around 5pm though I noticed that my uterus was extremely tight. It didn’t appear to be contracting though, just constant tightness that would sometimes actually hurt a bit in my abdomen and make my back feel sore. The discomfort seemed to come and go, but since the tightness was constant I thought it might be muscles stretching as I’ve read can cause a constant tightness as opposed to contractions. I’ve actually had this before sometimes when I’m walking around for awhile and it always goes away once I’m able to sit down and rest so I figured once I lied down it would be okay.

Unfortunately it wasn’t until about 9:30pm that everyone was finally on their way and Paul had deemed the kitchen sufficiently clean enough that the rest of the mess could be left for the next day (I didn’t clean, just hung out with him while he did). I went upstairs and chilled out in bed expecting the tightness to go away, which it did. Kind of. Until I realized it was no longer constantly tight but instead happening every 8 minutes or so. It wasn’t uncomfortable as long as I was lying down (although I did feel some pressure down there during each contraction) but once I got up to pee during a contraction and my back felt a bit “off” (I described it to the on call nurse as a 3 out of 10 on the pain scale, so not super painful but just noticeably uncomfortable). During this time I made sure I was constantly sipping water.

After this went on for about an hour or so I figured, okay, given my blood pressure issues, etc., it’s probably time to at least call the urgent care line and see what they wanted me to do. Of course, they wanted me to come in and I felt awful because poor Paul has been so busy getting the house ready for his parents visit and then cooking all day that he was exhausted and we both were supposed to work the next day (today). By the time we left it was about 10:30pm and I actually offered to go myself figuring that once I got there they’d probably calm down and they’d tell me it was all in my head or something but Paul just looked at me like I was crazy and of course went along.

As far as I can tell we were the only ones in L&D triage that night. The urgent care line had already called ahead and let them know I was coming so I was in a room within minutes. The nurse asked me a few questions and seemed surprised that I had made it 32 weeks with this being my first visit, she said usually first time mama’s have at least a couple visits much earlier in their pregnancies. This made me feel better that even if this turned out to be completely dumb, they were used to it anyway.

Unfortunately, they quickly confirmed that yup, the contractions were not in my head, in fact they were a lot closer together than when I was at home, I believe sometimes coming as close together as three minutes apart, although she said it looked like the range was anywhere between 3-8 minutes. She called the on-call doctor in my OB group who requested that I be checked out by the in-house OB who was on-call that night. More waiting and monitoring contractions which eventually slowed down back to where they were at home, which was once every 8 minutes. My blood pressure was, of course, very high – I think 140/90 and climbed higher before it eventually started to go down as I got sleepy and more used to being there.

The on-call OB came in and she was very nice as well. She made it sound like my contractions were slowing down but I told her they had actually increased and just slowed back to where they were when I was told to come in. She decided to do another ffn even though I just had one done about a week and a half ago and then she pulled out good ol’ Wandy to check my cervix. I was honestly expecting it to be about the same as my last ultrasound but she immediately said it looked like it was only about 1.7cm now. Then we watched it actually grow longer on the screen and she exclaimed that I have a dynamic cervix because suddenly it was 2.5cm but she was sure the 1.7cm measurement had been right at the time, she looked at the contraction monitor and it turned out to be that that was while I had been having a contraction. We watched it continue changing on the screen and measured a couple more times and it was 1.9cm and then 2.2cm. So basically even the longest, non-contracting measurement was still 0.3cm shorter than my last shortest measurement.

This result earned me a cervical check and again I was surprised when she said I was about 1cm dilated. She did however say that the cervix felt much thicker than it looked on the ultrasound and that it was still quite high and the baby appeared to be quite high – all good signs that I was not likely to deliver in the very near future. She said they would wait for the ffn results and then call the on-call OB in my group again to see what we should do.

The ffn results finally came back about an hour later and were negative. Big sigh of relief. However, my on-call OB still wanted me to get the steroid shots for lung maturity just in case (I’m thinking her rationale is that if my bp keeps climbing and they need to induce for pre-e they will have already gotten this out of the way) and then as a last minute add on they decided to give me a shot of terb since I was still having those contractions every 8 minutes and they didn’t seem to be getting further apart or stopping.

Looking back it really felt like they just didn’t want to send me home while I was actually contracting but I really did regret the shot after I got it. The nurse said it would only work for about an hour or so and the shot made me feel TERRIBLE. So jittery and my heart felt like it was beating out of my chest. I couldn’t help but wonder how it was making poor little Cheeks feel even though his heartrate still wasn’t all that high on the monitor. They watched me for about 20 minutes and let me go since I went the final 15 minutes without a contraction. The terb made me so jittery I couldn’t sleep for about an hour after we got home (we got in the door at 2:30am) which left me plenty of time to google all the scary side effects and opinions on giving it to women for preterm labor. For the record I plan to turn it down if they try to give it to me again, particularly if they offer me the oral version since the FDA has apparently banned that (not the injection though) for stopping PTL.

Interestingly and coincidentally enough, the medicine I was prescribed for my bp issues is also used to stop/slow contractions, so I guess I’ll be continuing on with that for now despite it making me feel pretty crappy. The doctor said that should stop the longer I take it so hopefully he’s right.

The in-house on-call OB and nurse at triage seemed pretty sure I would be put on bedrest for the rest of the pregnancy by my regular OB who I luckily already had an appointment scheduled with today and told me definitely not to go into work in the morning. I felt bad because I was only one of two people scheduled to be in so if I didn’t go in there would be one person alone there but after sleeping at 3:30am there was no way I’d be useful in the office anyway. My coworker was super understanding.

I spoke with Dr. MFM who I was actually supposed to call this morning anyway about my blood pressure and filled him in on what was going on with the contractions. He said to talk to Dr. OB about it but definitely no work for the rest of this week at least. He called me back later in the day after he talked to the lab about the tests I had done on Friday and said that since my C3 was low at 70 and he didn’t recall it being low previously in the pregnancy (he was at home and I’m assuming he didn’t have my chart) he thought this was likely a lupus related issue more than pre-e.

This really didn’t feel/sound right to me as I was pretty sure my complements are always low, they just get REALLY low when I flare, and I have had very minimal joint pain whereas joint pain is usually the first thing I can actually feel when I’m flaring. Luckily when I asked him about my 24hr urine result he realized the lab hadn’t given him those results so he said he was going to call them and call me right back. During that time I pulled up my app from Dr. Rheumy’s clinic that actually shows me all my lab results (ugh, I like Dr. MFM a lot but why can’t they be more tech savvy!) and sure enough my C3 was 53 in May (right before I got pregnant) and 67 in August. So as I suspected 70 was actually on the higher end of my normal range. I let Dr. MFM know this when he called back and he pondered for awhile but clearly he was rethinking his conclusion that this was a lupus flare when that clearly doesn’t make sense in light of MY normal range.

He told me that my 24hr urine result was 980, and I’ve read that the cut off for mild pre-e is 300 so I was a bit freaked out by the number but he said it wasn’t THAT high, just high-ish. I don’t really know what that means but when I saw Dr. OB later in the day he sort of gave me the same message so I guess it’s just not at a level where they freak out and hospitalize me, they just watch closely for now and pull me out of work to try and reduce all potential stress factors.

Dr. MFM did in fact say to scratch his original plan of upping my prednisone to 20mg and instead stick with my current dosage. He decided to have me rerun labs this Friday and see him on Monday to see if things are stabilizing or continuing to get worse. Also, he said I could go into his office for the second steroid shot for baby’s lungs, which I did.

Anyway, after making it through my very nervous dad driving me through the city, my mom interrogating Dr. MFM’s nurse and then Dr. OB, the two actual visits themselves and one more shot to the bum I was feeling pretty stressed out by the events of the day. Which I’m pretty sure is the exact opposite of how I’m supposed to be feeling. I emailed my group at work and my bosses and plan to call HR tomorrow. I asked Dr. OB if I can go in for a half day to tie up loose ends and he said keep it to a couple hours JUST to tie up loose ends and not to work so I’ll probably do that this week or early next week or something. I feel like I won’t be able to relax until I feel like work is at least as squared away as it can be and I’m not leaving people hanging.

I guess I’m still processing everything that happened today too and that’s also why I feel so stressed right now. The medical types all seem to think we can keep things going to 36 weeks which appears to be the new goal now. Outside of the doc and nurse in triage, my regular care providers seem much more concerned about the pre-eclampsia symptoms than the cervix/contraction thing. I think the reasoning behind that is sometimes contractions and cervical changes can start happening without anything ultimately REALLY happening for weeks but as bp and protein in the urine start to increase they generally continue doing so, the question now is will it happen gradually over weeks (which is the hope) or much quicker than that.

Anyway, that’s what’s been going on over here. Officially on home-rest, luckily not full-blown bedrest. I’m free to move around in the house as needed and even wander outside provided I take things very easy (i.e. no walking around for extended periods of time but going somewhere and sitting is probably ok). My days just need to be focused on stress reduction as much as possible and not overexerting myself physically but Dr. OB said there’s no reason I should feel confined to the bed. I can’t say I’m not glad to be done with work for the rest of this pregnancy, but I do kind of wish I had more of a heads up it was coming so I could have prepared myself for a handoff a little better. Oh well, it is what it is and I’m trying to put work out of my mind asap.

Time to focus on me and little Cheeks making it through the next four (hopefully five!). Speaking of Cheeks he was super active throughout the entire 2+ hours of monitoring. He kept kicking at the monitors and squirming away from them and the nurse kept pointing out how much he was moving (demarcated by black boxes on the readout). He looked great during the whole session, which was the real reason I had decided to go in in the first place – because I was worried the contractions could be causing him distress somehow. Then in typical mommy guilt fashion I felt bad that he seemed to hate the monitoring so much and here I was subjecting him to it.

Anyway, really hoping easing into being at home will lift me out of this stressful funk I’m feeling right now…