Counting Carbs and the Giant Baby....

The text I received at work had just two words, but meant a great deal.  Lisa had sent the message, "I'm doomed", and with that I knew that one of the last few remaining perks she had as a hospital patient was gone.  The whole ordeal began a few days earlier, when Payton's 27 week sonogram showed a healthy, growing baby.  And by growing, I mean REALLY growing.  She was nearly a full pound ahead of schedule.  I figured she just took after dad.

Lost in this sonogram was the fact that the amniotic fluid levels were on the high side, and that Payton's belly was somewhat large, two tell-tale signs of the dreaded gestational diabetes.  Although Lisa "passed" her first glucose check at 22 weeks, a second test was ordered to see if anything had changed.  "I'm doomed" meant she had a positive test, and that all candy, desserts, breads, potatoes and pastas (staples of the Nicely diet) were now on serious restriction.  Although Lisa was on bed-rest, and had spent almost 8 weeks in the hospital by this time, she could take comfort in the fact that she could wreck a piece of cake if she wanted.  No longer, it appeared.

Its been several weeks since then, and Lisa has done remarkably well on her new, modified diet.  If you're wondering at home if the restricted diet hospital food is worse than unrestricted, the answer is yes.  Restricted diet lunch lasted about two days.  Breakfast is about the only thing Lisa will eat from the hospital anymore.  But she's "taken one for the team", and done a marvelous job of counting carbs and doing what she needs to do for Payton.  Even if it means wanting to punch Guy Fieri right in the bleach-blond through the television every time he stuffs his face full of something delicious.

We're now at 31 weeks, and in a mad dash to get ready for Payton.  We've received a tremendous amount of support from everyone.  I was blown away by the "daddy-shower" my work put on for us.  While 40 weeks is full-term, there is virtuously no chance we'll see 40 weeks.  We've had the betamethasone shots to boost her lung development in the event she comes early, and her sonogram today estimated Payton weighs a whopping 4 pounds 11 ounces.  The sonogram technician said jokingly that if she keeps growing like this, she'll come out walking.  Lisa was quick to point out that she's just 31 weeks, and at this rate, Payton is gaining half of a pound each week. Walking or not, how a baby that big is going to manage to come out is a different story.

Call...don't fall.

Caution: Fall Alert

You certainly can't question Fairfax Hospital's commitment to its practices.  A couple of weeks ago, I showed up at the hospital after work and was face to face with a big red sign reading "Caution - Fall Alert" on Lisa's door.  Its pretty much universally understood that falling is not good if you're old or you're pregnant.  Lisa is looking very pregnant these days, and getting around certainly isn't as easy as it used to be.  Fearing the worst, I opened the door and asked Lisa if she had fallen during the day.  Thankfully she hadn't.

One of the medicines that Lisa is taking is a blood thinner that can cause dizziness.  The nurses on 6 East had decided to launch an aggressive "campaign" against patient falls.  As a result, the "Fall Alert" signs went up on a number of doors around the floor.  Every time a nurse came in, they reminded Lisa that they were just a phone call away.  Clever signs with phrases such as "Call, Don't Fall" were placed around the room as a subtle reminder.

Additionally, Lisa is now required to wear non-slip socks to prevent her from doing a Freddy Flintstone across the floor on her way to the bathroom.  They look like army-issue, and from across the room the top and bottom look more like tank tread than socks.  I've seen less tread on truck tires.  You could run track in these things.  She was getting a new pack every day, which was fine by me...less laundry that I had to do!

I know I poke fun at the nurses and their policies, but I am happy to know they do care and are trying to do everything they can to keep Lisa and Payton safe.  The signs are great, even if they did scare me to death the first time I saw them.  Its comforting to know that the "Fall" police are on duty, because I know my wife, and how she likes to get a running start and "Risky Business" it across the floor.

Mike Nicely, Sherpa.

If for some reason the whole teaching thing doesn't work out, all of this time in the hospital with Lisa has given me new job training.  I have no doubt that I could make it as a full-fledged sherpa.  My trip in from the car to the hospital room involves walking through a parking garage, over a bridge that crosses the entrance road, two or three elevator rides depending on the level I park on, and a stop at a security door to smile for the camera in order to be let in to Lisa's floor.  You do not want to make that trip more than once if you can avoid it.

A Nepalese Sherpa carrying his pack
on a mountain expedition

Over seven weeks, you bring and remove many things from a hospital.  Plants and flowers, bags of dirty and clean clothes, computers, homework, bags of food and drinks, and even a couple of big carpet samples are among the many things I've hauled in from the garage.  Surprisingly, for someone as clumsy as I am, I haven't spilled anything, tripped on anything, or doused anyone with a soda or two. 

You get a lot of weird looks when you are carrying a briefcase, overnight bag, carpet samples and a milkshake into a crowded hospital.  But its ok, I don't mind.  If there weren't a bunch of people on the elevator with me, I'm doubtful I would have been able to press the button for Lisa's floor.  I've been trying to come up with a solution; I wonder how funny I'd look hauling around a bunch of things in a Radio Flyer like Dennis the Menace.

Of course, I did drop a small colored square of carpet sample somewhere in the hospital.  This resulted in a scavenger hunt, retracing my steps back to the garage.  I did find it, by the way, about 20 feet from my car in the middle of the parking garage.  This couldn't have happened during a late night visit when no one was around.  The garage was packed, naturally, and lots of eyes were there to watch me walk around and randomly stop in the middle of the road to pick up a 4" piece of carpet, only return back into the hospital.  I'm undoubtedly the crazy guy who carries a bunch of crap into the hospital in some other patient's "The things you see in the hospital" blog.

Maybe I should get that wagon after all.

Status Quo...

If you've been following our blog, you know that our pregnancy has been an eventful one from conception.  Its been a little while since our last post, and I am happy to report that we have maintained the status quo.  We're over 26 weeks pregnant now, which is incredibly exciting.  A week and a half until our next big milestone at 28 weeks.  We're learning more and more about Payton; spicy food gives her hiccups, and she doesn't care much for the evening vitals.  Every night we not only hear the heartbeat, we also hear what sounds like a kickboxing match between her and the heart monitor.

Today marks 6 weeks since Lisa was admitted, and we have settled into a decent routine to make this all as manageable as possible.  Family and friends have been very supportive, making sure we are well fed, sending us things to do, and taking care of our pets, Ruby and Vegas.  Lisa is handling the days as best as she can, although I think her patience is growing thin with dining services.  We avoid them all together in the evening, and during lunch when possible.  I'm sure they mean well, but its hospital food, and we all know hospital food has been a running joke since the beginning of hospitals.  Personally, I think hospital food is the encouragement they provide to get you better (or at least get you thinking you are feeling better) and get the heck out of here.  Thank goodness for takeout and delivery...even at the hospital! 

And as for me...well I went from having one home to three.  I go from work to the hospital every day, and stay with Lisa until 10:30, travel home to my mom's because it is closer to the hospital and work and sleep there.  Once a week I make the trip back home to Spotsylvania for a whirlwind day of spending time with the cat, cutting the grass, and preparing the house and nursery for Lisa and Payton.  Some days I feel like the Tazmanian Devil cartoon, and I'm sure on most others I look like him.  I know on paper (or in this case in print) it sounds bad, and when people hear how I spend my days, they shake their heads.  But it could be worse.  True, here's never any down time, and yes, I'm always running around from place to place, but from everything I read and all the stories I hear from people with children...this isn't going to change even after Payton gets here.

The Things You Hear in a Hospital....

When you are sitting in the hospital day after day, you start really noticing all of the different sounds around you.  Obviously, the first thing you hear are the "bleeps" and "blips" of the machines that measure heartbeat, breathing and control IV fluids.  On the High Risk Pregnancy floor (HRP), you hear more "bleeps" and "blips" from contraction monitors, and even "bleeps" and "blips" that sound like they are submerged under water when they check the baby's heartbeat.  Several times a day, the nurses conduct vitals rounds.  You can hear the steady progression of "bleeps" and "blips" and baby heartbeats making their way around the floor.

But eventually, those "bleeps" and "blips" fade into the background.  I imagine its much like being in a room with a leaky faucet.  The first night, you don't sleep.  You can't concentrate on anything but the "drip, drip, drip" of the faucet.  A few days later, the sound is barely noticeable.  By now, we have to concentrate to hear the baby monitors over the wheeling of beds and scales, banging of food service carts, the "knock-knock" announcements of food service and housekeeping, the arriving helicopters and emergency vehicles, and for a short while (I kid you not) "Karaoke Hour" from a room two doors to the left.

This is how we pictured Fairfax Hospital's "Dr. Red"

Hospitals are also great for announcing things over the intercom.  Perhaps its the school teacher in me, but I when I hear announcements, I always stop what I am doing and listen.  Most people, my students included, can ignore intercom announcements like they aren't even there.  I once watched hundreds of people ignore / fail to hear fire alarms at the Flamingo in Las Vegas.  Regardless, Lisa and I noticed that one particular doctor was more in demand than others.  His name was "Dr. Red".  "Dr. Red" was needed in the pharmacy.  Two days later, "Dr. Red" was needed on the third floor, radiology.  At 11:30pm, "Dr. Red" was needed in Labor and Delivery.  I didn't know who "Dr. Red" was, but that guy was all over this hospital.  We eventually figured out that there was no way "Dr. Red" could be a real person, and that it had to be code for something.  I asked one of the nurses, and was told "Dr. Red" was a fire drill for staff.  There's no way to conduct one on an entire hospital, so at Fairfax, they rotate fire drills from floor to floor, department to department.  A few days after learning about this, "Dr. Red" was called to Lisa's floor at about 6:30 in the morning.

Lisa has also heard some other rather strange announcements.  One afternoon a few weeks ago, Lisa learned via intercom that staff was to be on the lookout for a female intruder in a flowered dress and yellow hat.  Another drill.  A real life "Where's Waldo".  There was also an escaped patient announcement for staff to be on the lookout for a 47 year old Caucasian male.  We're not sure if that was a drill or not.  Perhaps that was from the mysterious 4th floor that none of the elevators stop at.

We also hear lots of laughter from the nurses station right outside our door.  By in large, almost everyone we've encountered here at Fairfax Hospital has been friendly, caring and most importantly happy.  You'd think it would be easy for a place like a hospital to be a dismal and quiet.  But the staff here is great, and go above and beyond to make your time here, no matter how long it is, as enjoyable as possible.

A Room with a View, Please....

An AirCare Medevac, based in Manassas, arrives at the Hospital

Spending time in a hospital room for hours a day can be kind of monotonous.  I can't imagine spending 24 hours a day there, with most of that in your hospital bed.  But Lisa was fortunate when she was admitted; she got a single room (which is rare when you are first admitted), and she got a room with a decent view.  If you've never been to Fairfax Hospital, its a massive complex of towers and buildings.  I frequently hear employees tell people who have made the mistake of coming in the Women and Children's Tower instead of the Cardiac Tower that the walk ahead of them could approach 40 minutes. 

A LifeEvac Helicopter, based in Stafford, brings a patient to Fairfax

With all of these buildings, towers and parking garages, its pretty easy to imagine that most windows offer views of concrete and other buildings.  Lisa's room faces out towards Gallows Road, and the Exxon Mobile complex across the street.  We can't see the complex, just the woodland region that surrounds it, giving it the appearance of looking out into a forest.  But you really can't see much except the tops of the trees from her windows. 

A few times a day during the weekdays, and sometimes non-stop on the weekends, we watch Medevac helicopters bringing patients into and out of the hospital.  The two pictures in this blog post were actually taken about five minutes apart over the weekend.  I'm cognizant that each of these flights in and out of the hospital area a big deal, and hopefully mean more lives saved than lost.  If not seeing them meant no one was sick, injured or in danger, then of course I'd be happy to see them go.  But as long as they are going to fly into the hospital, facing their incoming flight path gives us something interesting to look at a few times a day!

Milestones...

Like all major journeys in life, pregnancies have specific milestone events.  Hearing the heartbeat, passing the first trimester, learning the sex of your baby - all very important and amazing milestones.  For us, we passed another important milestone this past weekend; we're now 24 weeks pregnant.  From the outside looking in, 24 weeks may not seem like a big deal.  Heck, we're not even out of the second trimester for another three weeks.  But when you're sitting in a hospital, with doctors monitoring you for signs of premature labor, 24 weeks is huge.

The significance of 24 weeks is that a baby is officially considered viable at this point in the pregnancy.  The baby has a reasonable chance, albeit not a great one, of surviving outside of the womb and developing like any other normal child.  The statistics are fuzzy on this, depending on your source, but it is generally accepted that any babies born at 24 weeks have about a 40% chance of survival.  They'd spend months in the NICU, and would have a hard road ahead of them, but they could make it.  Of course, now that we're here, that 40% seems downright terrifying.

For us, from now on, each passing week will be a milestone because it marks a significant increase in the chances for survival.  While we are taking it day by day and week by week, our next really positive milestone will be 28 weeks.  At this point, the baby has a 90% chance of survival, and by weeks 30-32, the odds of survival in a hospital as advanced as Fairfax aren't that much different from babies born full term.  I have no reason to believe we won't make each of those milestones, but it is comforting to know if something unexpected happened, we have increasing odds with each passing day now.

We've also started to feel the baby kick from time to time.  It started off small, with Lisa only being able to feel them from the inside, but by now, when the baby is really active, you can definitely feel them from the outside.  She's most active at night, which makes me never want to leave the hospital, and she's also most active after Lisa eats sugar, which means I'm pushing chocolate around here like a Hershey's sales rep.  Its an interesting time, in the midst of all of these milestones.  Lisa is being extremely strong, laying around on bedrest.  We're both super excited to meet our baby girl, but know that the longer the delay, the better it is for Payton. 

Just a little patience...

An image from the MFM Textbook!

It was explained to us that Lisa's cerclage was a ten minute procedure.  Of course, it took a lot longer than that, because there were complications.  If you're following this blog, that should come as no surprise to you.  After days over an hour, Dr. Frankencrocs came out into the lobby waiting room.  He told me that Lisa and the baby were fine, but that they had to perform an extra procedure because her cervix was actually beginning to dilate, instead of merely being short. 

She was expected to be in recovery a while longer, so I had nothing better to do but head on up to the room and do some research on what the "extra procedure" in the cerclage might have been.  Being the nerd that I am, I downloaded a maternal fetal medicine textbook, and began reading about the various types of cerclages and procedures.  There are actually several different types, depending on the condition of the mother, the cervix and the fetus.

I didn't find much else out about the procedure until Lisa came back from recovery and shared her story with me.  The procedure was in a regular o/r, and that it was about 5 degrees.  Lisa sat on the operating table, and leaned forward and arched her back to get the spinal.  She was really worried because her doctor wasn't even in the o/r yet, but she did walk in just as Lisa was laying down.  She had a small shot to numb her for the spinal, so the needle didn't really hurt that much.  She said it pinched and then basically everything from her naval down became slowly numb.    Dr. Frankencrocs, who apparently was beyond excited to be performing the cerclage, was ready to go before the spinal even took full effect.  Also apparently oblivious to the fact that her lower half was no longer "working" he kept asking her to move down to the end of the table.  Before the procedure had even started, Dr. Frankencrocs had been told to calm down, and also to learn patience.  I'm sure Lisa was thrilled.

If you've ever experienced a cesarean delivery, or watched one on TV, that's how Lisa described her procedure to me.  She had a sheet up, obstructing her view beneath her chest, the anesthesiologist and nurse sat by her head monitoring her vitals, while the doctors were behind the sheet.  Shortly after beginning the procedure, they changed Lisa's position, and rotated the table so that her head was down, and her feet were almost straight up in the air.  We learned later that this was necessary because her cervix was open and that they could see the baby's membranes.  They had to ensure the membranes went back up into the uterus before stitching her cervix closed.  Initially, the first stitch they tried didn't close the cervix to their satisfaction, so they put in a second cerclage, using a slightly different, more permanent stitch.  Fortunately this worked, and her cervix was closed to their satisfaction.

Before Dr. Frankencrocs left, he also let me know that because of the extra procedure, Lisa wouldn't be released from the hospital until she had the baby.  Like it or not, we were here for the duration. Lisa was going to have to learn a whole new meaning of patience.

Thankfully Dr. Nies had already informed Lisa of this by the time she got back to the room; I was nervous about having to deliver this news to Lisa, but I knew that she would happily comply with whatever the doctors prescribed to bring us a healthy baby.  She and I are convinced that if we had not come in when we did, and had the doctors not been so cautious with us and our care, its very likely we could have gone into preterm labor.  At 20 weeks, that would not have been a good thing.  So although we tease and poke fun at Dr. Frankencrocs, we are grateful for all of the doctors and nurses at the hospital who have given us a greater chance at bringing a beautiful baby girl into the world.

Dr. Frankencrocs and the Cerclage...

The first week in the hospital went very slowly.  We have a single room, and they allow me to stay with Lisa all night if I want to.  I stayed here in the hospital with Lisa for four days, and then we began preparing to figure out a plan if this transformed into something longer than a week.  There really was no news or progress for the first several days.  The doctors visited early in the morning, in two waves - first the residents, followed a few hours later by Lisa's perinatologists.  The nurses were left to handle the afternoons, evenings and overnights.

The doctors all asked the same questions: "Any pain?  Any contractions? Any bleeding?  Any leaking of fluids?"  The first few days, when I heard the word contraction, I'd cringe.  If they were talking contractions, they were concerned about preterm labor.  Thankfully, we haven't had to answer yes to any contractions.  After a week of these questions, Lisa was getting antsy.  We wanted to know their plan for us.  We didn't particularly care what the plan was as much as we wanted to know that there was one.

Dr. Frankencrocs did NOT inspire confidence!

About now, you're probably wondering who exactly Dr. Frankencrocs is.  When Lisa and I were waiting on the doctor to check her cervix, before we were admitted, a guy in scrubs caught our attention.  I've told you we're avid people-watchers right?  In an empty hallway, there was a young guy with long hair and a beard just pacing back and forth.  He probably never would have caught our eye, except that his scrubs were too short for him.  Not short if the toilet overflowed, or if the pipes in the sink burst, but too short for just walking around.  He was also wearing giant black crocs.  The rubber shoes that a lot of nurses wear at the hospital, but they usually are colorful.  Not these.  They were just functional black crocs.  They looked like Frankenstein boots, only crocs.  And they were made all the more prominent by the capri scrubs the guy was wearing.

He certainly didn't seem to be doing much, and we joked that he probably just ran files for the doctors or ran errands for them.  A few days later, he came into Lisa's room and introduced himself as a doctor from the practice.  He told Lisa that an ultrasound a few days previously showed that her cervix had gone from 2.5 to 3.0.  But that's it.  Lisa was a little confused, so she asked the nurse when she came in to check her vitals.  The nurse shook her head, and said that he didn't know anything and that he was just a student.  Lisa and I had a good laugh over that.

A few days later, we got a visit from Dr. Khoury, the head of maternal-fetal medicine at the hospital.  He checked Lisa's cervix, and after consulting with Dr. Nies, decided Lisa was an excellent candidate for a "cerclage" - basically a stitch in the cervix that prevents it from opening prematurely.  This was exciting to us because many patients who get a cerclage get to go home.  The cerclage was scheduled with Dr. Khoury for 10am the next morning.  (Can you sense the karma coming?)

The cerclage itself was described as a minor surgical procedure; Lisa would get a spinal - similar to what doctors give to patients having a cesarean delivery, and then stitch the cervix closed.  They came in early to start Lisa on an IV, and took her downstairs for the procedure.  We were talking to the nurses and anesthesiologist, and learned that Dr. Nies would be doing the procedure instead of Dr. Khoury.  We were told the doctor would come and go over the procedure with us before Lisa went back for surgery.  Instead of Dr. Khoury, or Dr. Nies...or Dr. Bronksy....or Dr. Al Kouatly....or the newest member of the practice, Dr. Shah...or even Dr. Seuss for that matter....who do you think walked in?  Yep.  Dr. Frankencrocs....capri scrubs and all.  At this point, we'd have been happier to see Dr. Phil, or even Dr. Dre.

Lisa's eyes almost popped out of her head.  She didn't even have to say anything; I knew exactly what she was thinking: "why did the nurse have to tell me that he didn't know anything"?  Lisa went from feeling confident about the procedure to terrified in a matter of seconds. It turns out Dr. Frankencrocs did perform the procedure, under the watchful eye of Dr. Nies.  The procedure was a success, but it certainly wasn't textbook.  But nothing about our pregnancy had been textbook, so it was just par for the course.  But more about the procedure later...

Let us show you to your room...

Home Sweet Home - 6 East at Fairfax INOVA

Our twenty-week "level - 2" ultrasound began with the second scare of our pregnancy.  We woke up early, too excited to find out for sure the sex of the baby to sleep in.  As has been the case all through our pregnancy, just as soon as we started to let our guard down we got a reality check.  What should have been a nice and relaxing breakfast (something two working professionals rarely get to enjoy) turned quickly into a panic-stricken morning.  The blood had reappeared.

A calm and rational person might have concluded that this was nothing to worry about; we'd seen blood before and we were okay.  But since we've started our ART journey two years ago, I've lost all rationality.  The doctors were on the phone in an instant.  I was expecting to hear some reassurance, but was instead told, "come in right now".  This did not help matters.

After a few months about 30 minutes in the waiting room, we met the ultrasound technician.  A "level - 2" ultrasound offers a much more in-depth look at the baby.  Our technician was really helpful, pointing out the features of our developing baby, including the eyes, arms and legs, hands and feet, and even all four chambers of the heart.  She spent a lot of time looking at the spine and the heart, but everything looked great.  She also confirmed that we were in fact having a girl.  We'd already decided to call her Payton.

We went into the waiting room expecting to see the doctor with information about the results, but were instead called back by the nurse.  The baby looked great, but something about Lisa was a little off.  Her cervix was "short"; meaning the "plug" holding the baby in was not as long as it should have been.  The nurse indicated we'd probably be spending more time resting and taking it easy.  The doctor wanted to check it one last time before we left. 

Let me interject here and share with you all that I am constantly studying things.  I'm a "people-watcher" at the mall, I notice that the hospital elevator goes from floor 3 to floor 5, and I am always studying and processing everything the doctor does when we're in the room.  I noticed the technician studying her cervix, and I also noticed that the cervix looked a little different from the last visit.  I wasn't smart enough to know what it was, or what the implication, but I knew it was different.

While we were waiting for the doctor, a receptionist came into the room with some paperwork.  They wanted to know if we were okay with letting anyone who called know we were at the hospital.  This was a little odd, as we were expecting to leave in a few minutes.  It got a little odder a minute later when she tried to give us a bracelet with our room number on it.  We both looked at each other, shrugged, and then I asked, "so we're not leaving we're staying here?"  It appears the cart was before the horse.  The receptionist was a little embarrassed, apologized and went to find the doctor.  Dr. Nies confirmed our suspicions.  A short cervix and a bleed that morning had earned us a week minimum in the hospital for evaluation, just to be safe.  Even though the baby was fine, we weren't going anywhere.  Hotel INOVA Fairfax, 6th floor.  Home sweet home.  At least we got a room with a view.

Some Good News and Baby Clothes...

We followed our scare up with a couple of good appointments.  The following week, we were able to get a great profile shot of the baby, and the nuchal screening was normal.  Lisa's bloodwork was a little off, but in and of itself that was nothing to be too alarmed about.  One of her hormone levels (PAPP-A) was a little lower than normal, but by itself these results just meant to doctors would continue to keep a close eye on us.  We were told to come back in a month for a routine checkup.

Since we started this process, we'd pretty much had a doctor's appointment and sonogram every two weeks.  While it was nice not having to worry about driving to the doctor's office for a month, we hadn't realized how reassuring it was to see the baby every other week.  By the fourth week, we were getting restless.  We were also excited and hopeful that at a little more than 17 weeks, we'd be able to find out if we were having a boy or a girl.

Our baby girl at 17 weeks and 3 days!

Everything looked good with the baby, and Lisa's cervix at the checkup.  We asked the ultrasound technician if she could tell if we were having a boy or a girl, and she gave a quick look.  She told us that she couldn't be 100% sure, but if she'd have to guess she'd say female.  We'd know for sure in two more weeks at our more in depth "level 2" sonogram.  We were so excited to be "most likely" having a girl.  I think I dreamed of princess dresses for a week! 

We started thinking about nursery ideas, and looking (and then buying) all kinds of baby clothes.  In just a few hours, my unborn child owned more clothes than I did.  But baby clothes are just irresistible.  We weren't even 100% sure it was a girl, but that didn't matter.  The fact that we were having a baby was more real to us than ever. 

The First Scare...

Everything seemed to be going well in our pregnancy.  We'd shared the good news with our family at Christmas, and because of our experiences in cycle one, we'd made the decision to wait until the first trimester had passed before sharing the news with the rest of the world.  Less than a week after telling everyone, we had our first scare.

Its not uncommon to have a scare or two during your pregnancy.  As the baby grows, the body stretches and makes room.  Although there is a preferred rate of growth and development, some babies have their own agenda.  There are lots of aches and pains, sometimes bleeding, and occasionally something doesn't look right on a sonogram.  All of these would be considered pregnancy "scares" and they happen more often than you'd think.

A pregnancy scare is a reality check.  For me, it was a not so subtle reminder that a pregnancy is a long and complicated process, and there are lots of things that can happen.  We'd had a pretty good few weeks,.  We were just starting to feel comfortable about things and were becoming more euphoric than nervous when our world stopped one evening.  After an hour-drive home from my parents' house, Lisa noticed something that all pregnant women fear - blood.  I'd read in "What to Expect..." (I think I've read that book cover to cover about 10 times now) that sometimes pregnant women have episodes of bleeding, and that it wasn't necessarily a problem.  But I'd also read that bleeding could mean problems with the baby, problems with Lisa or both.  I haven't had many of these moments in my life, but if you've ever felt your stomach in your throat, you know the feeling.

12 weeks and 2 days at our emergency ultrasound

I ran to the phone and called the doctor; after a few questions we were told it was most likely going to be okay, but that we should come to the hospital in the morning for an evaluation and ultrasound.  I'm not sure either one of us slept.  The baby turned out to be fine; Lisa had something called a subchroionic bleed (a small bleed in the cervix / uterus that in most cases resolves on its own) and a complete placenta previa.  This means that the placenta is resting completely on the cervix, and the baby on top of it.  Also not uncommon early in pregnancy, previas can cause delivery complications later in pregnancy and make a cesarean delivery the only option. 

We also tried to do the nuchal translucency test at this appointment.  The ultrasound technician tortured Lisa tried really hard to get a close image the baby's neck and the amount of fluid (if any) between the neck and the wall of the uterus, but she couldn't get a good enough picture.  We'd have to come back and try that again, but we weren't disappointed - the bleed was not a major problem and we'd get to see another picture of our baby a week later.  I'd take that outcome a thousand times out of a thousand.

Our Doctor...the Celebrity

Before we began the ART process, Dr. Saffan suggested we meet with Dr. Nies to discuss a pregnancy plan.  Lisa went for the consultation, and was very impressed with her.  During this time, we were DVRing every pregnancy show on TV (and there are a lot of them).  Lisa was watching an episode of "Special Delivery", a show on the now defunct Discovery Health Channel, and recognized a familiar face.  Dr. Nies had performed a life-saving delivery on an episode about Fairfax Hospital's High Risk Pregnancy Unit and NICU.  At this point, we had no idea we'd be here, but we did know that if we did find ourselves in trouble, we'd be in good hands.

When we called to schedule the appointment, we were given Dr. Bronksy.  We've since met him, and he is a very good doctor, but Lisa wanted our first appointment to be with Dr. Nies.  We had to wait an agonizing week longer to meet with her.  In the two and a half weeks since we had left Shady Grove, the baby had grown a lot!  It was no longer a "baby-shaped" blob on the screen, it now looked distinctly like a baby.  You could easily see the head, arms, legs and body!  We also heard the baby's heartbeat for the first time at this appointment.  I'd read a few of my friends' posts about the wonder and amazement of hearing the heartbeat for the first time....and they weren't kidding.  We scheduled an appointment a few weeks later for a diagnostic test called a nuchal transluceny screening, which checks for a whole host of things, amongst them Down's Syndrome.  Reality began to set in at this point; the stress and concern we had been dealing with on the quest to get pregnant wasn't about to abate.  Our first trimester was coming to a close, and we couldn't have been more happy to be where we were.

Graduation Day...

Our growing baby, complete with arm and leg buds

All fertility patients look forward to "graduation day".  I really don't know if everyone calls it that, but anyone whose gone through fertility treatment knows the concept.  Reaching "graduation day" means reaching a milestone; the multiplying cells in your body are transitioning to a fetus.  Although its really no bigger than a fingernail at this point, on a sonogram you can begin to detect the umbilical cord, head, body and even arm and leg buds. No matter how much you love and/or depend on the guidance and reassurance of your fertility doctors, you eventually have to move on.  Their job is to get you pregnant; you see someone else to stay that way.

We graduated straight to a renowned team of specialists who frequently work with patients from Shady Grove.  Most pregnant women are cared for during their pregnancy by an ob/gyn doctor, but a select few are cared for by perinatologists.  These are doctors who specialize in the practice of maternal-fetal medicine, or "high-risk" pregnancies.  There are lots of ways a pregnancy can be classified as "high-risk", including previous pregnancy complications, age, physical characteristics of either the mother or the developing fetus, and carrying multiples just to name a few.  The team of doctors that make up our practice are some of the best in the area; they run the Antenatal Diagnostic Testing Center at INOVA Fairfax Hospital, and are incredibly skilled at what they do.  Their practice is called Parinatal Associates of Northern Virginia.  Our primary doctor has been Dr. Barbara Nies, but we've see the entire team of doctors (Khoury, Bronsky, and Al Kouatly) during our pregnancy.

They are smart doctors, and I believe they've already saved our baby once.  But we'll get to that later.

Round (Cycle) 2...

After the stress of the first cycle, we decided we wanted to be emotionally ready before we began the next cycle.  Since there is no way to plan around a fertility cycle because of the monitoring appointments and blood work, we decided to enjoy our summer vacation and wait until Lisa's most stressful work time of year (summer camp) was over. 

We met with Dr. Saffan and Pam, and we decided we would increase the dosages of fertility medicine so that the cycle wouldn't take as long.  In cycle one, we took medicine to help stimulate the follicles to grow, and followed that with a medicine to prevent ovulation.  In cycle two, we took a different medicine called Lupron; this drug adjusts your hormones and turns off the brain's ability to tell your body to ovulate, giving total control of the cycle to the doctors.

Fortunately, we had no blizzards to contend with and the medicine worked really well; the cycle went surprisingly smoothly.  Lisa's eggs grew quickly, and we were scheduled for the retrieval on November 13th.  We were confident we would get a good number of eggs, and hopeful that we could get more than two of them to fertilize.  If we did have more than two make it to the blastocyst stage of development (about day 5 of growth) we could potentially freeze them for use in a later cycle if we were not successful with this round.

At the retrieval, we had eleven eggs; not as many as cycle one, but we were hopeful they were more mature.  Our first bit of bad news with cycle 2 came later that afternoon when we learned we only had two eggs mature enough for fertilization.  We crossed our fingers and hoped they would develop as well as the first two, but the odds were against that happening.  Shady Grove has great embryologists, and they were able to get two more eggs to mature and fertilized them, although eggs that mature late have less chance of developing normally.

Our embryos at 3 days old, just before the transfer!

The first two embryos did develop well, which was a good sign for us and our ability to make a baby.  We transferred them to Lisa's uterus on November 16th, and crossed our fingers that we'd have good news in two weeks.  Even though we wanted to cheat the two week blood test, we decided to wait.  Home pregnancy tests are extremely unreliable that early on, and we just didn't think we could stomach a false negative or false positive.

Lisa's first blood test was positive, and we were guardedly excited.  We had discussed asking the nurses not to give us the HCG levels from our first week tests, but we couldn't resist the curiosity.  Luckily the numbers grew as they were expected to over the three tests.  We purposely scheduled our first sonogram late because we wanted to avoid seeing a sac without a heartbeat.  At the end of week six, we crossed our fingers and went to see Dr. Saffan.  At this point in the pregnancy, we were far enough along that it was all or nothing.  We'd either see a properly developing embryo or we'd be back where we were almost a year before.  I don't know about Lisa, but I could barely handle the anticipation and nerves.  We saw that we were again pregnant with one embryo, and saw the flicker of the baby's heartbeat.  For the first time in a long time, I felt I was able to breathe.  But when you're expecting, you never stay comfortable for long.  At least cycle 2 was off to a good start.

Cycle 1...

On 495 on the road to Shady Grove, the morning after
"Blizzard #1"

Let me begin this post by warning you this is going to be highly technical and contain lots of acronyms.

Our first foray into the world of ART (assisted reproductive technology) began with a cycle of in vitro fertilization (or IVF).  Specifically the procedure we were having was IVF with ICSI, or intracytoplasmic sperm injection.  In layman's terms, Lisa was going to try and grow as many eggs as possible, they would be retrieved in a minor surgical procedure, and then these eggs would be injected with one of my sperm.  We were making a "test tube baby", as people referred to this procedure during the late 1970s - early 1980s when doctors began performing it.

We were told by our Shady Grove nurse, Pam, to expect a lot of stress during the process.  Surveys and studies on ART patients showed stress levels nearly to that of families going through cancer treatments.  I'm not sure I would go as far as that, but I can tell you that CYCLE 1 was definitely one of the most stressful times in my life (not counting our current situation).  I'll spare you the details on the cost of ART, but anyone considering such a procedure should know that it costs a lot.  I'd say an obscene amount, but the truth is, you can't put a price on having a child.  If they told me it'd cost a million dollars, I still would have done everything I could to find it.

The cycle began with Lisa taking a few different fertility hormones (shots I administered nightly), making more than the normal one or two follicles grow, and prevent the body from ovulating.  This required office visits and sonograms to monitor follicle growth every two to three days throughout the cycle.  Most cycles go from ten to fourteen days; ours went 18.  That alone wasn't a big deal, but our fertility medicine was filled by a wonderful company out of Boston, which means it was delivered via Fed Ex.  Again, alone that wasn't a big deal, but we were refilling prescriptions every few days because our cycle was so long, and we were frequently increasing the doses.

Trying to get Fed Ex deliveries through the snowiest winter in the history of the DC/MD/VA area was not easy.  On more than one occasion, I was intercepting delivery or picking packages up at the local hub because the trucks couldn't get into the neighborhoods.  We were also driving to Annandale every two days in snow, and during the morning after the first of two major blizzards, we had to drive from Fredericksburg to Shady Grove, Maryland.  Eight hours in the car for a 20 minute appointment; seems crazy, but if we skipped it, we could have lost the whole cycle.

When the follicles were finally grown to the correct size, we went to Shady Grove for the retrieval.  My Valentine's day present to my wife was the "trigger shot", the culminating shot of HCG (human chroionic gonadotropin) that signals an end of the cycle and "encourages" the eggs to mature for retrieval.  We had fourteen eggs at the retrieval, but learned later that day that only two of them were mature and were able to be fertilized.  Not good odds. 

Despite the odds, both eggs grew normally, and were transferred three days later.  Then came an agonizing two week wait to find out if the fertilized eggs attached to the uterus and began to grow.  Lisa felt some early symptoms of pregnancy, and we cheated and took about 10 home pregnancy tests before our official blood test.  I found out on my 34th birthday that we were in fact pregnant.  To ensure the pregnancy is continuing normally, Shady Grove measures a pregnant woman's HCG every two days for the first week.  The levels should double every two to three days.  Lisa's first reading was high, but her second and third did not double.  They grew, but not at the preferred rate.  Even more stress.

Two weeks later we went in for our first sonogram, and found one pregnancy sac and a developing embryo.  We didn't see a heartbeat, but it wasn't uncommon not to see one that early.  By the 5th or 6th week in normal pregnancies, you should see a heartbeat (although they aren't always detectable that early).  Unfortunately, we did not see one at the end of the 6th week, and Dr. Saffan delivered the bad news: things didn't look promising and if there was no growth by the next week we didn't have a viable pregnancy.  A week later, nothing had changed, and we were informed our embryo had stopped developing.  The day after Lisa's 36th birthday, we had a D&C.  It was an incredible roller coaster of emotions, and by this point we were both crushed but determined to try again.

Cycle 1 ended without success.  While we mourned over the loss, we grew closer together as a couple and resolved to do whatever was necessary to have our family.  It took us a few months to recover (both physically and mentally), and we received a tremendous amount of support from our friends and loved ones.   Dr. Saffan was incredibly comforting and encouraging.  He said they had learned a lot from our first cycle, and he was confident we were able to have a baby.  We did not give up, and prepared ourselves to try again in September of 2010.

Smart Doctors...

Lisa's journey with doctors began a little better than mine.  Her OB/GYN diagnosed her with endometrial hyperplasia, a scary sounding condition that carries a risk of being cancerous.  Fortunately for us, her biopsy was negative, but if we wanted to get pregnant, we were going to have to call in "the big guns".  Her doctor referred us to a friend of his, Dr. David Saffan, at Shady Grove Fertility in Annandale.  On our first visit, we met with Dr. Saffan, and his nurse Pam.  We've worked closely with them over the last two years on our journey to turn the dreams of parenthood into a reality.

I read a lot of comments about Shady Grove being nothing but an "IVF Baby Factory", and that the treatment there was impersonal.  Lisa and I were looking to have a baby, not make a new friend, so this was fine with us.  However, our treatment there from consultation through two IVF cycles was not only professional and thorough, it was also very personal.

Because we had been trying to conceive for such a long period of time, and were in our mid-thirties, Dr. Saffan saw no need to mess around.  He ordered comprehensive testing on both of us, and the results were pretty staggering.  Lisa was diagnosed with a condition called PCOS (polycystic ovarian syndrome) which pretty much rules out normal ovulation.  In addition, she also has something called MTHFR, a condition that causes her blood to clot abnormally fast, and prevents her from absorbing folic acid.  Even if we were to have gotten pregnant on our own, the odds of delivering a healthy baby were against us.

To make matters worse, the two idiots doctors who had prescribed me Androgel had inadvertently turned off my body's ability to make sperm.  My first test came back with a whopping count of zero.  Not one swimmer.  I was sent immediately to see a urologist who specializes in fertility, Dr. Paul Shin.  He ordered a battery of tests, which all ruled out physical abnormalities, so he recommended coming off of the flammable testosterone and retesting in six weeks.  By then my count had returned to normal levels, but my motility - the ability for the swimmers to actually reach the egg, was somewhat compromised.

Shady Grove laid out the treatment possibilities, and IVF assured us a greater than 60% chance of getting pregnant. As Dr. Saffan explained, none of this ruled out us conceiving naturally.  However, the odds of this happening had decreased from 30% for normal couples to basically 1 in a million.  We immediately began preparing for IVF.  Thank goodness for smart doctors.

Stupid Doctors....

There is definitive proof that we should skip the middle-man at all costs and go straight to the source.  At the beginning of this process, Lisa and I shared the same licensed moron general practitioner.  While she made both of us feel very comfortable, I should have realized that being nice and treating a patient with respect is by no means a substitute for medical know-how.  In retrospect, it really was as if all of her diagnoses were done with a dart-board, perhaps while blindfolded.

Method used by some doctors to make their diagnoses

A consultation to ask why I was unable to get my wife pregnant was immediately met with a prescription for blood-work at the local lab (translation - I don't know but maybe you'll get her knocked-up by the time your results come back).  The results were in.  I suffered from high cholesterol.  (translation - I still don't have a clue, but take some lipitor).  My blood-work also indicated borderline low testosterone, or "low - T".  This also did not explain the real source of our problem either.  But, regardless, was met with a prescription for the best thing to hit the market since Thalidomide - Androgel.  This stuff was so loaded with testosterone it practically smacked the pharmacist and hit on the cashier when I picked it up.  In addition, it was flammable.  No joke.

Being wary of any medicine that could cause you to catch fire around an open flame source, I did something I don't normally do; I read the literature on Androgel.  It was supposed to boost testosterone, and mess with the hormones in the users' body to make them feel more manly.  Perhaps my low-T was the reason I only liked football, baseball and hockey, and why I never was fond of basketball.  Additionally, several users had posted on message boards that Androgel had wreaked havoc on their ability to get their wives pregnant.  This raised the red flag, and caused me to do something else I don't normally do - seek a second opinion.

I visited another nice local quack urologist, who assured me that Androgel would not impact my ability to get Lisa pregnant.  Turns out both couldn't have been more wrong.  I realize this could be an anomaly, but I believe it serves as a valuable lesson about skipping over the middle-man.  If I have an issue with the engine in my car, I don't take it to a tire store or a Jiffy Lube and hope that just because they work on cars they might be able to fix it.  Go straight to the source - see a specialist first; don't waste your time.

Starting a Family....

Ruby, not long after bringing her home!

Like most couples, my wife Lisa and I thought about starting a family very early in our relationship.  I have a great number of aunts and uncles, and an even greater number of cousins.  My cousins have children, and even my cousin's children have children.  Almost everyone in my family has had children (and many have had multiple).  Our family reunions could be held in sports stadiums.  Simply put, my family procreates like lab rats.

Soon after marriage, our family began with the adoption of our cat Vegas, and we added an English bulldog named Ruby a few years later.  We love our pets, and we loved our "family", but we both had a strong calling for parenthood.  We love being around kids so much that we chose careers around it.  Lisa works with infants and toddlers, preschoolers and elementary school aged children in her job as a youth director.  I work with teenagers in my job as a middle school teacher.

We both shared joy in the birth of our nephews, first Vincent and then Aidan.  We also watched friends begin families of their own, all the while thinking our time was coming sooner rather than later.  Time kept marching on, however, and after months and months of discussions about possibly seeing a specialist, Lisa and I both decided to talk to our doctors about the issue.