February 2009 Archives

Hospital Stay Day 8

It is so difficult to believe that I've already been here for a week!  In one sense time has flown by but in another it almost feels like years.  Every time I see Maia it seems like she's gotten bigger or learned a new word and I don't get that sense when I'm with her every day.  This experience is teaching me not to take the little things like that for granted since you never know what can happen.

No 5:45 a.m. wake-up call this morning thank goodness.  I actually slept fairly well last night and it felt so nice to wake up to the sunshine in my new room.  I'm still so thankful to the nurses for letting me switch - I know they don't have to do that!

I had several visitors today so it was great to see people.  Ben and Maia came (of course) and Lorry and Emma, Matt and Meghan, my mom, and Ron, Kathryn and Annabelle.  It was so great to see everyone!  Maia was in such a good mood for most of the time here (even though she was a little tired) and we had some fun reading stories and blowing bubbles.  She learned how to say "bubbles" the other day so that's a lot of fun.

Dr. Wagner was the doctor today.  He said that he's been reviewing my "strips" (the heartrate monitor readouts) today and said that they looked excellent and even well beyond the gestational age that my girls are.  He also said that he was surprised with such a result considering the abnormal dopplers on Baby A but this is great news.  He told me that my 24-hour urine test came back within the normal range so at this time I don't have to worry about pre-eclampsia.  Thank goodness!

Not much else happening today.  My blood pressure readings haven't been too high (I think the highest was 129/82 and the lowest was 118/74) so I am hoping that continues.

I'm excited for tomorrow.  My friend Holli is due in a couple of weeks and I was supposed to throw a baby shower for her today but it didn't work out with me being put in the hospital.  Instead, we're doing a small, informal shower for her here in my room tomorrow evening.  I am really looking forward to an evening with the girls celebrating Holli's new baby.

Hospital Stay Day 7

This was a fairly low-key day with a few bits of excitement.  This morning someone knocked on my door at 5:45 a.m. and told me he needed to draw blood.  What a way to wake up!  I am not 100% sure what tests they did but I found out later that everything looked good.

I finished my 24 hour urine test this afternoon but am still waiting for results.  Hopefully there are no signs of protein since that is a sign of pre-eclampsia which is just not another complication that I need at the moment. 

The great news is that I got to switch rooms today!!  My previous room had a stellar view of a brick wall and it was a 2-bed room.  Now I'm in a single bed room with an actual view and SUNSHINE.  It's amazing how much a little bit of sun can affect your mood - I really appreciate that the nurses were so receptive to my request to move.  About 4 of them swooped in and took all my stuff and moved it over to the new room - bed included!  I have to hang up some of Maia's photos and artwork still but I think this is where I'll be until I leave Abbott.

Stacy came to visit today again and she loaned me a book on premature infants.  I hate to think that I'll need it but I'm pretty sure I will so I'd certainly like to be as prepared as possible.  Thanks again, Stacy!  Her son was born at 25w6d (which is tomorrow in terms of my pregnancy) and he's doing so well so it gives me a lot of hope for us.

I told Ben to take the night off tonight.  I think he's going to just relax and play some video games.  He deserves it.  My mom went over there tonight and made some dinner which will be nice to have leftovers for later. 

I think I might be expecting several visitors tomorrow so I'm excited to see people, especially since it was just me tonight!  I don't mind being alone - I have the TV and the cross-stitching but having visitors really helps break up the day.

Hospital Stay Day 6

It's been a somewhat interesting day today.  Usually I get my blood pressure taken twice a day (morning and evening) so they took it this morning and it was a nice normal 120/78 or so.  A little bit later in the day (Stacy was actually here visiting at the time) they came in and said that they needed to take it again.  I didn't get it since it was low this morning but apparently it was high once yesterday.  I told Barb (the nursing assistant) that she had me all stressed out now so of course it will be high this time and sure enough, 145/90-something.  The nurse came in and told me that I now have to do a 24-hour urine test to make sure there is no protein in my urine and I'll have to get my blood pressure done more often and now they want to get my weight every day.  Oh boy!!!  They took the pressure later and it was 135/88 then again this evening when it was 122/84 so that's a little bit more like it.

I also had a biophysical profile today (BPP) which measures each baby on a scale of 1-8.  It checks for fluid levels, movements, "practicing" breathing and muscle tone.  They used a little portable ultrasound machine to do it.  Both babies did great - they each got 8/8 so that is good news!  I'll have BPPs every Thursday and dopplers every Monday starting on 3/2.  My next growth scan will be 3/12.

Ben brought Maia to see me today!  It was so nice to see her and hug her.  The snow is bad outside so I wasn't sure if they'd be able to make it but they did.  I know it's so hard for him to get over here with her so I am so appreciative..  She was a little bit crabby because we didn't just let her run whereever she wanted but that is par for the course with a toddler.  Darek and Steph also visited at the same time so we took our wheelchair ride down to McDonald's so that they could have some dinner. It is so nice having visitors!

The "alternative medicine" lady came by today and gave me a foot massage with mandarin aromatherapy.  I'm not too into that stuff but I can never turn down a free foot massage.   Bring it on.

Ben brought a rug and an egg crate spread for my bed so hopefully that'll help me sleep better.  I can't wait to try it.  OH and he brought me our new laptop!!  It's so big and beautiful...I love it.  It has a built in webcam and everything.

OK, I'm off for the night!

Hospital Stay Day 5

I had a fairly low-key day today.  I slept a little bit better last night which is always nice and breakfast was actually fairly yummy this morning.  I really dig their fruit and yogurt parfaits!  Lorry came to see me today after I got monitored and it was good to have her here to break up the morning.  Next time I'll have to convince her to bring me coffee or something.  :-)

Dr. Wagner was on rounds today (he's the one that admitted me) and he reiterated that I'm in the right spot if something were to happen.  He seems confident in his decision to keep me here and he says that there is a world of difference between being born at 24 weeks and 28 weeks and that 28 weeks is our next goal.  I go back and forth because obviously, the earlier these kids are born the sooner I can go home but the earlier they are born the more likely they are to have problems due to prematurity and such.  It's just a crappy situation to be in because I miss Maia like crazy and I know Ben is under a lot of pressure to take care of her, take care of me and deal with other family issues out in Seattle.  We're so grateful for all of the emails, the offers to help and comments on this blog.  It keeps us going!

Not much else happening.  I'm doing some cross-stitching and Ben was able to get me access to Facebook today so that will help too with the humdrum days.  I'm borrowing a laptop right now but we just ordered our own which will get here tomorrow so it'll be great to have - especially since it comes with a webcam that we might be able to hook up so that I can see Maia more often.

Not much going on tomorrow either!  I think the "alternative medicine" people will stop by so we'll see what they'll try to do to me.  Jury's out on this free service.

Oh, and an extra special thank you to my CIT team at Target who sent me a beautiful fruit basket.  You guys rock and the chocolate covered strawberries were delicious!!

Here is an updated version of our growth chart. As you can see, based on Dr. Quintero's numbers, Baby A has "fallen off" on her progress. She's still growing, though, so she gets to stay in for a while longer. Baby B's growth looks fantastic, as usual.

Today was our first level two ultrasound at the perinatal center at Abbott. Becky isn't allowed to walk around (which I find just silly since being in bed isn't making a difference) so I wheeled her over to the appointment. The sonographer was super-efficient. She completed the whole enchilada in about 35 minutes.

There was no absent end-diastolic umbilical bloodflow. Both babies were nice and active. Baby A was still noticeably smaller. The ultrasound machine shows you the gestational age of measurements as they are taken. Baby A was reliably measuring a couple of weeks back. Baby B was always right on the money.

The sonographer took the measurements and plugged them into a special program which she said was more reliable. It came back with the same info as the ultrasound machine. Here are the results...

Baby A

Umbilical S-D ratio: 5.0 (high, as usual, but a bit better than before)
Brain S-D ratio: 4.7 (this seems a bit low to me)
Fluid Pocket: 3.8 cm (good)
Weight: 477 g / 1 lb 0 oz (itty bitty peanut!)

Baby B

Umbilical S-D ratio: 3.1 (very nice)
Brain S-D ratio: didn't do it since the umbilical was fine
Fluid Pocket: 4.18 cm (got another measurement of 5.25 cm later)
Weight: 766 g / 1 lb 11 oz (perfectly average)

We saw Dr. Gaziano. He confirmed that the babies were doing ok and wouldn't need to be delivered right away. As long as Baby A is still growing, shows no signs of distress, and has no absent flow then they "won't take them" as he put it.

He also confirmed that Becky would need to stay for continued in-hospital bed rest and monitoring. I asked him about the placenta and how it looked funny. He said its appearance may be the result of Baby A's situation and not the cause. He didn't seem overly concerned since Baby A had solid end-diastolic umbilical flow.

He mentioned that although Baby A is very small, she is not as small as some babies they see. He mentioned a little 13 ounce baby they recently delivered at 25 weeks! By comparison, our Baby A is huge! That gives us some hope.

He also brought up both babies' weights on a chart plotted against several different studies' weight percentiles. All seemed to indicate Baby B was average and that Baby A was smaller than the 10th (or even 3rd) percentile. He then brought up one study of just girl babies and it showed Baby B smack dab at 50th percentile and Baby A right at 10th percentile. He said something like "see, for girls, they're doing ok."

Becky will be going in for doppler flow studies twice a week (probably on Tuesdays and Fridays) and will continue to have the babies monitored on a fetal monitor twice a day. It will be tough for me to make it down to Abbott for all of these ultrasound appointments but I'll try to make it work.

After the peri appointment I went back up north, picked up Maia from daycare, and brought her down to visit. She was very happy to see her mommy and run around the hospital. Maia and Becky had dinner together and I think Maia liked that brief feeling of normalcy

I think we'll try to "homey up" Becky's room now that we're sure she'll will be stuck there for a while. I hope we can get her transferred to a room with some more sunlight and floor space. She's in a room with a spare bed instead of a sofa. The bed would be fantastic if I could stay over but that's not possible with Maia. We'd rather have the open space for guests and Maia's toys.

Hospital Stay Day 3

Today was moderately eventful.  Since it's Monday and business hours, various staff came through to introduce themselves and let me know what kind of services the hospital provides.  I saw someone who suggested I make a birth plan (even though it probably won't be my ideal birth at least I can still have some control of the situation), I saw someone who offers alternative medicine/healing like massage and aromatherapy, and someone who wanted me to know about the NICU and how it works with multiples.

I also had several visitors today which was really nice.  Sarah Bushnell stopped by with her kids, my parents came by (my dad just got home from Florida today), Stacy stopped in, my aunt Diane who works at Abbott came for a few minutes and then Ben came this evening.  Visitors really help break up the day!

I spoke with Dr. Fairbanks again this morning who didn't have much to say at this point until my level 2 ultrasound which they scheduled for tomorrow.  We'll know then a little bit more what the plan will be for me, whether it be staying here long term or going on home bedrest.  I'm really anxious to see how these kids have grown!  Ben is taking a half day tomorrow so he'll come by around 1 and stay for the u/s at 2.  He'll go home after that and pick Maia up and bring her over so that I can see her - I can't wait.  Today was the first day where I haven't seen her in over 24 hours.  I miss my baby girl!

I slept better last night.  I had my own pillow so that helped a ton - luckily I don't have nurses coming in in the middle of the night to take my blood pressure or anything like that.  Whew.

Ben took me on my wheelchair ride this evening and he bought me a Shamrock shake from McDonald's.  Mmmmm!!  I love that they have a McDonald's in the hospital.  Seems a bit ironic, but I still find it funny.  :)

Hospital Stay Day 2

It's been a pretty low key day today.  I slept really badly last night (woke up at 4 and was up until 5:30 or so) and got up at around 7.  Got my blood pressure taken, took a shower, had some breakfast and then pretty much just cross-stitched all day long.  Ben, Maia and my mom came to visit around 11:30ish and brought their lunch so it was good to see them.  I get 20 minutes a day of a "wheelchair trip" so we all wandered around the hospital for a little while.  It was nice to get out of the bed and see something different than my room. 

I was monitored this morning for about 20 minutes and the babies were not behaving so my nurse Karyn ended up giving up.  She said they looked good anyway but I think she was just sick of chasing them with the dopplers!  I was also monitored in the evening and the babies looked great.  My evening nurse Holly said that she had to show off the heartrate strip to the other nurses who couldn't believe they were from twins at 24w6d (yesterday's strip).  Apparently their rates looked as good as babies gestationally much older so that is great news!

The perinatologist today was Dr. Saul who was the one who told me last week to "just keep doing what you're doing" and the first thing she said was "why are you here?"  Reassuring, isn't it?  Granted, she hadn't seen the placenta degradation but she did think it was premature for me to be in the hospital at this point.  She said she puts more stock in growth ultrasounds so they are going to schedule me for one of those hopefully tomorrow or Tuesday and then we'll have a better sense of where we're at.

I got my 2nd steroid shot today (not really all that comfy) but now I'm done with those so that is great news!

Our friends Stacy and Jim stopped by today as well for a little while.  They have a son who is currently at Children's hospital and Stacy was here at Abbott in the same ward about a month and a half ago since her water broke at 24 weeks.  It was good to see them and get the scoop on what's up around here. 

There was a little altercation early afternoon today where one patient had a visitor who started yelling at her.  The girl told the nurses to "get him out of my room" and a bunch of nurses tried to get him to go away but they ended up having to call security.  Such drama!  It sounds like the guy tore the phone from the wall and was just making a big nuisance out of himself.  I can't imagine.

Anyway, I'm around so please call, e-mail or visit me.  Bedrest isn't as glamorous as it sounds!  Ok, maybe it doesn't sound glamorous.

Oh, 25 weeks today!!  Not sure what happens this week (haven't checked BabyCenter) but I'm sure the babies lungs are developing today (due to the steroids) and they're growing a bit more.  Hurray!

Wow, what a crazy couple of days.  Yesterday was rough because we had our appointment which obviously didn't go as expected.  Originally they wanted me to come into the hospital right away but we talked them into today (Saturday) because really there was no notice and I had so much stuff to do to get ready for such a change.  I ended up going to work yesterday to try to wrap things up but I still feel unprepared to be gone.  My boss wasn't even in so I had to talk to my manager and let her know instead.  Of course she was supportive and said "do what you need to do" but it's still tough leaving like that.  I had to call insurance and preauthorize our stay at Abbott and work out some logistics with my disability leave.  Ben is taking it rough because we've always had each other to rely on with Maia and now he's on his own and it's tough.  I've never been away from her before so I think it'll hit me anytime that I can't just see her whenever I want to.

Last night we stayed up late packing and then today we went out to breakfast at Perkins with some friends as a "last hurrah" before I'm stuck in the hospital.  It was nice to see everybody and to get out of the house.  My mom very generously volunteered to come with us to check into Abbott today which has been a HUGE help since she was able to take care of Maia while Ben and I talked to the doctors.

My room is fairly large but it's a 2 person room.  They only have two "shared" rooms and they try never to have more than one patient in them at a time but I'd still rather have a private room with a couch and more seating versus another bed since Ben can't stay here anyway.  I'm allowed to get up and use the bathroom and to go out into the communal circle of our ward (station 54) as long as I sit down and recline.  I can also take one wheelchair ride a day for 20 minutes.  Oh boy!

I have a lot of things to keep me busy.  I'm so thankful that Ben borrowed a laptop from work for me to use.  That will help keep me connected with my friends which will be a huge help.  Unfortunately, Facebook access is blocked here so I can only access it through my phone.

They monitored me for a couple of hours today and both babies heartrates looked great.  The plan is to monitor me twice a day going forward.  I've had my blood pressure taken, some bloodwork done, and I had a steroid shot today (which will help the babies' lungs develop at a faster rate).  I'll have another shot tomorrow then I'm done with that (thank goodness)!

We saw Dr. Lea Fairbanks today who we hadn't seen before and she's great.  She didn't have all of our charts or paperwork but she said that there's a possibility I could go home even sooner and get monitored there instead of at the hospital.  She didn't know about our placenta issues so she asked us not to quote her on that but we'll find out soon enough.  I think they'll try to schedule me for an ultrasound tomorrow or Monday.

Ron, Kathryn and Annabelle came to visit this evening which was wonderful.  We had plans with them to go over to their house for dinner but obviously that didn't work out so instead they came to us and brought us food.  Yay! 

Everyone left around 7 so it's been just me for a little over an hour.  I have access to my e-mail and this blog so please write or call (just e-mail me at beckyark-@-kduluth.com (minus the dashes) for my phone number) and I'd love to hear from you.  Visiting hours are anytime as long as it's reasonable.

I think I'll do a little reading or watch some TV. 

Here's something nice... Baby A looks just about the same but she had a foot in front of her face so the picture looks really funky. Here is a fairly nice shot of Baby B...

Oooeeee! We had our regularly scheduled doppler bloodflow study ultrasound today. Both babies were about where they were last week. We saw that Baby A's portion of the placenta didn't look healthy and that's a bit concerning. We got to see both babies in 3D which was super-awesome. Unfortunately Baby A had her big sister's foot in her face the whole time so we didn't get a great picture. We got an awesome picture of big Baby B, though, and I'll post it soon.

Shortly after the sonographer left to update the doctor she came back in, handed Becky a box of tissues, and said "don't worry, everything is ok, we're going to take good care of you," smiled nervously, and left. I overheard the doctor outside say, "call down to pre-op," he mumbled something else, and then came in... wearing scrubs. I freaked out. He introduced himself as Dr. Wagner. I stopped him and asked "did you just change into those scrubs" and he said yes. My heart raced... I swore (quietly, but not politely). I thought "oh crap, is this it?" He quickly realized what I was thinking and explained that he had to go down and perform a cerclage on another patient after meeting with us. WHEW!

Dr. Wagner is a very fun character. He gestures a lot, seems very smart, and was very likeable. He explained stuff we had heard before like the risks of losing a baby and the risk that has on the other. He also explained that monochorionic/diamniotic twins like ours have an unexpected loss rate of 25-30% without any signs of complications. Oy.. that's not something I'd heard before. Anyway, he said that he wants Becky to be "in house" and on bed rest. Ok, I thought... at home bed rest isn't that bad. He quickly clarified: "in house means in our house, in hospital."

We spent the next few minutes talking about what that means. In summary, it means Becky is going to be admitted to Abbott Northwestern tomorrow morning to be very closely monitored for 3 days. Assuming everything is ok, she'll go down to the watch-and-grow-and-see area. Dr. Wagner said Becky could go to work today, take care of things, and check in tomorrow morning when convenient for us. The perinatal clinic would take care of transferring her files and alerting Abbott. He also explained that Abbott is the only hospital in the US with 24x7 perinatal and neonatal specialists on site. Becky and the babies going to be in very good hands.

There is so much more to say. We've talked to our families and some friends and let them know. We've got so many other things going on right now and this is going to be a major bummer. Becky is being very upbeat and staying very positive which is fantastic. I'm sure she'll be adding a blog post of her own in the next day or two.

Some logistics:

• We won't be going to the hospital until late Saturday morning. Becky is trying to sort things out with work today.
• For now, please contact me if you are interested in visiting Becky so I can fill you in on visiting schedules, etc. Sending her a supportive email or posting a comment would be very welcome until we get things sorted out.
• Everyone I've talked to has been very supportive and suggested that I take any help offered. So I will. I don't need help with taking care of the house but it would be great to line up some night-time babysitting for Maia next week so I can visit Becky in the evenings. I'll probably be asking friends to help out with that but maybe I can guilt some of you into volunteering through this posting.

Well that's about all I have time to write. More to come...

Well, as we expected, Maia has 2 plugged tear ducts.  The appointment today was long but mostly only because we had to wait 30 minutes while her eyes dilated so that they could check her.  They actually assessed her vision (which is thankfully normal for her age) and then put some flourecent drops in to see if her eyes were draining properly (which they weren't).  Normally this condition corrects itself by the time the child is 13 months but if it hasn't by then there is less than a 1% chance that it ever will.

There is no medical reason that we have to do the surgery to correct this problem but if we don't it's likely to stay with her through adolecence and beyond and it's apparently a little bit more difficult to do the surgery later when the child is older.

What they'll end up doing is putting Maia under general anesthesia for under 15 minutes.  They will put a special wire down her tear duct to "clear it out" and it takes about 40 seconds per eye.  There should be no side effects and she shouldn't be in any pain afterwards but it's still scary to put our baby under!

I just wanted to reiterate what Ben said a few weeks ago about us being so completely appreciative of family and friends who have been praying for us and the girls.  Your thoughts and prayers mean so much to us and it keeps us staying positive when it's sometimes so easy to get wrapped up in the negative.  We love reading the comments on this blog and have been surprised to see some from people we didn't even know knew we were pregnant but I'm so thankful too that word gets around and that folks are coming here to give us their support.  It means the world!

Tomorrow Maia is going to a pediatric eye doctor because she has a chronic leaky eye and has been getting pink eye pretty frequently.  Hopefully they'll tell us that nothing is really wrong but there is a good chance they'll say that she has a plugged tear duct.  Usually plugged ducts resolve themselves within a year but if not, they sometimes requires surgery to correct so we're praying that's not the case.  The appointment is supposed to last for 2 hours so I'm really curious how they're going to engage a 1-year-old to cooperate with them for that amount of time!  At least we'll be prepared with snacks and toys and such.

As far as the twins go, we have no news right now other than that they are moving and shaking like crazy!  Our next doppler appointment is on Friday morning so we'll have more to say then and then next week I'll have my gestational diabetes test and the next growth scan.

Today is a milestone because we hit 24 weeks of pregnancy.  24 weeks is the accepted "point of viability" of gestation where if the bab(ies) are born the doctors will do everything in their power to save their lives.  At that age though it's pretty hit or miss and the survival chances aren't high but regardless, this is still a milestone!

Things are pretty good.  Nothing really new to report - I'm feeling mostly good, just tired a lot still and somewhat stiff.  Things like doing laundry are getting tougher and I get out of breath much easier than I used to but overall nothing much to complain about!

Maia's daycare is closed tomorrow so I'm staying home with her and we're going to take a jaunt down to Prior Lake to visit our friends Amanda and Jeremy and their new baby Jamey.  It'll be a lot of fun I think!  Their daughter Ivy is Maia's age so they always have a good time playing together.

According to babycenter.com, our babies are now about a foot long.  Their brains are growing quickly and taste buds are developing.  The lungs are developing "branches" of the respiratory tree as well as cells that produce a substance that will help air sacs inflate once they hit the outside.  Their skin is still thin and translucent but that will change soon.

I just have a few more thoughts on our appointments this week.  On Wednesday we had our OB appointment and I was curious to see what he'd say considering it was the first time we had seen him since our IUGR diagnosis.

Dr. Gosen really didn't say much!  He measured me (I measured 30 weeks), checked for heartbeats and that's about it.  My blood pressure was a nice, normal 122/73 so it must be just the stress of the peri that does it.  He did say that we might want to register at Abbott "just in case" because if we have a super early gestational delivery then we'd probably have to go there anyway since they're better equipped for extreme preemies.  He also gave me antibiotics and an inhaler for this nasty cough I've had for the last six weeks so I'm praying that they help.  I'll be seeing him every 2 weeks from now on and I have my gestational diabetes test next time.

At our doppler appointment yesterday things were looking optimistic (as Ben said).  We asked Dr. Saul about registering at Abbott and she said that it probably wasn't necessary.  If we ended up going there it would probably be because they would transfer us there and then the registration point would become moot anyway.  She also said that we should just keep doing what we're doing right now because it seems to be working so we'll still be going in weekly for dopplers and then another growth scan in 2 weeks.

We also asked her about the steroid shots since I'll be 24 weeks on Sunday and she said that they like to wait until there are signs that things are going downhill before they administer those since they benefit the baby more closer to birth.

Oh, and my blood pressure?  149/94.  Nice.  I laid on my side and it went down to 119/80-something.

Wednesday night we went to Children's hospital to visit our friend Stacy's preemie son Finnegan and it was great to get a close-up look at what it would be like if our girls ended up there.  We saw the NICU and were very impressed with the obvious care that these babies receive.  We still need to schedule a tour of Abbott though!

We had another ultrasound today to check the umbilical and brain bloodflow of both babies. It was slightly improved from last time.

Baby A's umbilical systolic-to-diastolic flow ratio average was 4.6.

Baby B's umbilical S-D flow ratio was 2.4. The ideal range is between 2 and 3.

Both babies had good heart rates and were moving around.

We also learned that Baby A's umbilical appears to velamentous--meaning that it goes through the amniotic sac and the vessels travel a bit outside the sac before implanting in the placenta. This probably explains her poor bloodflow and smaller size. There is increased risk of all sorts of complications with this situation so we'll be keeping an eye on it.

We'll continue going in for weekly doppler flow studies and have a growth ultrasound every three weeks. Dr. Saul seemed optimistic that Baby A had improved bloodflow this week which was very encouraging.

Many of you following this blog knew Colonel Mustard. He was our big tan and white cat--affectionately called "fat boy." He had been very sick and tonight I had him put to sleep.

Colonel Mustard had been struggling with constipation and dehydration for over a year. Last week he was in the vet every day except Thursday. He had not been eating since Sunday. Today he was very lethargic, out of sorts, and seemed to be in pain. He had very watery, smelly diarrhea shortly after I gave him his daily dose of subcutaneous fluids.

I talked to our regular vet around 8:30 PM to discuss and set up a visit for tomorrow morning. I went to bed early and shortly after, Colonel Mustard scooted into the bedroom (he's not allowed in the bedroom), laid on the floor, and meowed. He never meows. He squeaks. I woke Becky up and told her I was going to take him to the emergency vet. I called around and decided to take him to the University since they have access to the best doctors.

The doctor who saw him gave him a very poor prognosis. He did a preliminary ultrasound which showed fluid in his abdomen and abnormal "stuff" around his intestines. His lymph nodes were huge. His red blood count was half what it was 4 days ago (we had just done a full CBC/chem workup on Friday evening). All signs pointed to either a bowel/colon perforation and sepsis or cancer that had turned acute. An x-ray and remote radiology consult later, we were no closer to understanding what was going on. He was spiraling fast, though, and was very weak and totally disoriented.

We discussed additional diagnostic options (which would have cost a small fortune), potential treatments, and his short and long-term prognosis. The best they could do would be to get him back to the way he was on Saturday before he stopped eating--which would still leave him with a problematic colon and potentially fatal cancer. We also talked about minimal care until the morning when I could take him to my regular vet. The doctor didn't think he'd make it until the morning and if he did, he wouldn't be able to tolerate surgery or many treatment options.

I called Becky to discuss and we decided to let him go. The doctor euthanized him shortly after 2:00 AM. I held him as he passed peacefully and immediately.

He was a fantastic cat and a genuine member of the family. I am so sad for Maia. She really loved him and I know she'll be so confused. We will try to take comfort knowing that we did the best we could for him and that he isn't suffering any more.

When we go to our weekly ultrasounds the first thing they always check is my cervix and placenta.  The cervix so far has always looked good (thank goodness we don't have that problem!) but the placenta hasn't moved.  It's still a previa (which means that it's smack dab over my cervix).  This is bad news to me because if it stays that way I'll have to have a c-section.  I've known this since I found out about the previa 5 weeks ago but I also knew that it's likely to move so I wasn't too concerned.

Now with the IUGR issue however, it's a different story.  The previa hasn't moved (though it still could) but if we bring early delivery into the equation then a c-section is almost inevitable.  At our appointment last Friday I asked the tech right away if the previa was gone and she said no...then I asked her if it even mattered anymore or was I going to end up with a c-section anyway and she basically confirmed that yes, I'd need the surgery to get these babies out.

I'm really bummed about this.  I loved being able to go into spontaneous labor with Maia.  I felt like I was doing something - like I was really involved in the whole process and now this time I won't get to experience that.  All things considered I know it's a stupid thing to be sad about since our first priority is obviously healthy babies but if these are our last kids it just bums me out that I won't get to experience real labor again.  At least though I'll get 8 weeks paid at work instead of 6!

We have an OB appointment tomorrow.  I'm very interested to see what he'll say about our situation considering we haven't seen him since before we were diagnosed.  We also have our doppler on Thursday so it's a busy week. 

So I know that Ben updated on the details of our latest appointment but I had a couple of things to add.  I guess I must be getting stressed out at going to these because every time we've gone (and it's been 4 times now) my blood pressure has been high.  This time it was 138/94 which of course they got concerned about.  They usually take the BP first before the actual ultrasound and then have me lay on my side and take it again but this time they took it before the ultrasound then again afterwards.  It was 130/83 the second time they took it which is borderline but "passable".  I hope I don't continue to have these issues on top of everything else!

It was kind of frustrating getting the news we got on Friday.  Obviously I was hoping for a little bit of accelerated growth in Baby A and I know stable is the next best thing but it's still difficult to hear that we'll still be in the "watch and wait" stage.  It just feels like we're in limbo and it's not really a great feeling.  The doctor only talked with us for about 2 minutes this time and I just felt that he wanted us out of there.  I guess what else is he going to say though when nothing has changed? 

This week we have an OB appointment on Wednesday (my first since before the IUGR was diagnosed) and another doppler on Thursday.  On Thursday I'll be asking whatever peri we see about the steroid shots they give to help little lungs develop - I know they often give those at 24 weeks which I'll be next Sunday.

Speaking of which, I'm 23 weeks today!  It's flown by.  According to Babycenter.com our babies are now more than 11 inches long and weigh just over a pound.  They can hear sound from the outside and are very attuned to mom's movement.  Blood vessels in their lungs are now developing to prepare for breathing on the outside. 

Here you can see that both are growing in their respective percentiles...

Today was our second level-2 growth ultrasound with the perinatologists. Our condition is still stable and guarded. No signs of TTTS. Little baby A had grown and now measures at 20w6d (we're officially at 22w5d) and big baby B was measuring right on track. We met with Dr. Burris and he said we're still on the wait-and-see track with weekly bloodflow/doppler scans.

Here are the details...

Baby A

Umbilical Systolic-Diastolic ratio: 5.4 to 6.0 (similar to last time)
Brain S-D ratio: 4.3
Amniotic fluid pocket: 3.9 cm
Weight: 13 oz (365g)

Baby B

Umbilical S-D ratio: 2.2 (very good!!)
Brain S-D ratio: 7.2 (also good)
Amniotic fluid pocket: 4.4 cm
Weight: 1 lb 1 oz (481g)

So tomorrow is our big growth ultrasound which is essentially the same as our "big" 20 week scan.  I'm very anxious to find out the progress of these girls and to see exactly how much they've grown!  At our last appointment they were at 7 oz (202g) and 10 oz (280g) respectively.  I recall the perinatologist say that he would be surprised if Baby A (the smaller one) would reach 400g by tomorrow so I guess we're shooting for at least that.  One positive thing is that I'm feeling much more movement now.  I can even SEE my belly move if they're kicking especially hard so that is really reassuring!

I did some research to see what kind of weights are average for a 22w5d gestation (which is what I'll be tomorrow) and came up with the following chart.

Based on this information (this is a chart provided by Dr. Quintero's Fetal Therapy team) Baby A was less than 3% at 19 weeks 5 days and Baby B was just over 10%.  If Baby A is growing on the same curve we would expect her to be around 400g (14oz) tomorrow and Baby B to be almost 500g (1.1 lb, which is viability).  I'm just praying there is growth in both babies!  I hope we'll have a better idea tomorrow of what our fetal future looks like so that we can plan accordingly.

I have been completely void of energy for the last few weeks.  I am exhausted but I'm not sleeping well at night and more than one person has said "you look tired" at work and I'm sick of it.  Any suggestions?  I have a pregnancy body pillow that I'm sleeping with but I still find myself tossing and turning to get comfortable.  I also wake up with horrible cotton mouth and Ben says it's because I've started snoring now too.  Oh, the joys of pregnancy!  At least Maia is now mostly sleeping through the night so that's one less thing keeping me awake.

Ben and I have started to contemplate daycare costs a little bit.  We haven't run the numbers but for two infants and a toddler it's going to be extremely high.  We need to figure out if it's worth it based on my salary and whether the best alternate option would be for me to stay home, go part time (if that's even a possibility), switch to home daycare or hire a nanny/au pair or something.  I'm not sure I'm cut out to be a stay at home mom but I don't really know since I've never done it.  I can't imagine that I'd be able to get anything done in the house with 3 kids under 2!

I can't believe I'm 22 weeks today!  Considering that everything was hunky dory up until 4 weeks ago when we discovered the previa and SIUGR time seems to have stopped ever since.  At the same time I think about viability "only" being 2 weeks away and I get really nervous about what may happen.

At our last couple of appointments the doctors keep mentioning the possibility of monitoring me more frequently (perhaps on an in-patient basis) once I reach viability or a bit beyond.  This makes me so scared and nervous - not only because I'm afraid for the babies but I don't know how that will affect Maia.  How can I explain to a 16-month old that mommy might not be around for awhile?  I'm willing to do whatever is best to get these babies as far along as possible but all the "what ifs" keep coming into my head.  I really don't want to think about it right now since this is all speculation at this point anyway but it's getting harder and harder not to let my mind wander in that direction!

Things I'm thankful for today:

• My wonderful husband and daughter
• Active, perfect-looking twin girls
• My friends and family
• Competent, caring doctors
• My job
• Prayer
• Twinstuff Forums (there's a lot of wonderful support on those boards from people who have gone through similar situations).

Speaking of being 22 weeks, our babies are now supposedly the length of a spaghetti squash and almost 1 pound.  Lips, eyelids and eyebrows are becoming more distinct and they're even developing tiny tooth buds beneath their gums.  Wow, the human body is incredible, isn't it?