Friday, July 22, 2011

Cured! For reals!!!

I. Am. Speechless.  Went to the high-risk OB yesterday for a follow-up on my issue.  Ultrasound tech was so nice.  (I like the tummy ultrasounds MUCH better than the vaginal ones, although my husband correctly complains that the picture quality is not as good.)  Ultrasound tech was like your baby is perfection.  It has a strong nose (unlikely to have Downs), very little fluid behind the neck (unlikely to have other diagnosable cognitive issues), fluid in the tummy (also good), two symmetrical brain halves, etc., etc.  And it's moving all around and growing ahead of schedule--two things babies with restricted oxygen / blood do not do.

AND he couldn't even find anything wrong with me.  He looked all over but could not find any abnormality at all.  What!?!  Shut the front door!  The doc came in and confirmed--my uterus / placenta is perfection.

The bleed (or whatever) appears to have resolved.  [Let's not discuss how this would never even have been diagnosed if I'd been a normal person having my first appointment this week.]  So it probably was just a simple subchorionic hematoma / hemorrhage or whatever and, as all the docs I saw hoped, eventually resolved.  (Although last week the high-risk OB I saw said he expected it would take 3-6 weeks to resolve, not 1 week!)  Not sure WHAT is up with the wonky vascular system, but who cares?!

The high-risk OB was like, there is literally nothing wrong with you, get out of here and start seeing a regular OB.  I've never been so excited to get kicked out of something in my whole life!  Although I do have ONE more appointment there next week (to do the full first trimester screen for potential issues) so they're keeping my activity light until then (no exercise, sex, etc.), although I was okay'd to walk around.  Walking?!  What a treat!

Oh, and did I mention that the ultrasound tech made a prediction on gender?  (Certainly not a sure thing at 12 weeks and 2 days, although he seemed pretty confident even though he warned me not to paint any rooms just yet.)  It's a... secret for now!

U.S.A.!  U.S.A.!

Tuesday, July 19, 2011

No news is good news!

Not much to report today... except I'm 12 weeks pregnant!  Big (arbitrary) milestone.  I'd be feeling pretty good if not for all the medical issues that continue to plague me. 

My fertility doc officially transferred my care to the high risk OB.  I think I was my fertility doc's longest running post-pregnancy patient!  But I wanted to make sure I had the screening testing that takes place between 11 and 13 weeks, so I really needed a full-time OB.  And the high risk OB's office refused to see me beyond my specific referral for a second opinion unless I was transferred to them.  So it was time.

I'm going to miss my fertility doc.  I've gotten attached to him.  And I am NOT excited to start going to a new doctor that I've only met one time.  (And I'm doubly not excited to go to an office that is impossible to make appointments at.  Oi!)  I want to switch back to my regular OB (who knows me really well, helping me with my ectopic pregnancy and miscarriage, etc.) as soon as possible.

Oh, one other good piece of news--I'm FINALLY off of the progesterone!  Not sure how long "normal" patients are on it, but I got the impression I was on it a little longer than normal.  Anyway, I am now--for the first time in MONTHS--taking no meds.  Yay!!!

So next up is check-in appointment with the high risk OB this week to check the bleed (?).  Next week I have a "new patient" appointment and genetic counseling.  Good times.

Wednesday, July 13, 2011

Maybe it's a subchorionic hematoma after all

Saw the high risk OB today.  I had my first "tummy" ultrasound today.  The ultrasound tech was super nice.  She was so excited when the ultrasound started and baby was standing on his/her head.  (Baby slid down on its side soon after the ultrasound started.)

After she was done with ultrasound, she went and talked to doc, and then he came and talked to me.  He asked me what my fertility doc thought and I told him that the fertility doc had not seen anything like it before.  He seemed surprised.  He looked at the pictures and films she took and said he thought it was a past bleed.  (He did not use the words subchorionic hematoma in our appointment, but that's what he wrote on my form.)

What?  I thought we ruled that out weeks ago, right?

Well, high risk OB said he thought I just have a wonky vascular system (which is where the strange pumping blood in my uterus is coming from) and, totally unrelated from that, I had a bleed (which is what caused the lake).  He pointed out that it had shrunk from the last time I had an ultrasound.  He said it was good that baby was measuring slightly ahead of schedule--it suggests that blood is getting to the baby.  He gave me the same diagnosis that the fertility doc gave me when he originally thought it was a subchorionic hematoma--no activity, no sex, hope it shrinks.  But he wants to see me next week just to be sure.

I was so excited I was speechless. 

When I was leaving, I overheard him talking to the ultrasound tech about me.  She asked him something and he said, "pray that it gets smaller."  She said, "what if it doesn't?"  He responded, "pray harder."

A little cryptic, but I was still excited for a diagnosis and the first good news I'd gotten in a while.  I actually allowed myself to get excited for the first time that this pregnancy might last.  I'm 11 weeks and 1 day, less than 1 week to 12 weeks!

But later I started thinking about it... and I saw what he wrote on my form... how can it be a subchorionic hematoma?  That's generally a past bleed, not an active bleed.  Over the course of almost two weeks my fertility doc monitored the bleed, and it was pulsing with my heartbeat.  That's not a past bleed.  That's connected to my vascular system.  The high risk OB did not watch the ultrasound, he just looked at the pictures and videos.  Is it possible the high risk OB just missed what the fertility doc saw--namely an active bleed?  That seems impossible, considering my fertility doc sent all of his notes along. 

Also, I'm not bleeding.  I have not had a single spot of blood.  If it was a past open bleed, wouldn't blood come out?  Again, fertility doc thought all blood was still in my vascular system.  But high risk OB thinks that the blood is leaving my vascular system, even though it's not coming out of me.

On the other hand, for the first time in two weeks it's shrinking, which IS good.

I wish I could have articulated why fertility doc ruled out subchorionic hematoma (also known as a blood clot or chorion), but I did not realize that was the actual diagnosis until I left.  (That's what doc wrote on the patient form.)  I was just so excited for good news.  Also, I'm not a f-ing doctor!!!

Let's be clear, a subchorionic hematoma is NOT a good thing to have.  It can cause a miscarriage.  It also means you're at a greater risk for placental abruption.  But I was excited for that diagnosis because the outlook is generally good--most people end up delivering healthy babies.

I'm so confused.  Which diagnosis is correct?  What the hell is wrong with me?!?

Thursday, July 7, 2011

Arteriovenous malformation? Why not!

Yet another doc appointment.  Doc doesn't think I have pseudoaneurysm like the ones terrifying me in medical articles.  Among other reasons, he pointed out those generally dealt with arteries external to the uterus (ones that could have been affected by trauma) instead of internal ones.  He said my issue is inside the uterus--outside of the placenta.  He thinks it could be congenital like an arteriovenous malformation.  (Also rare.  I've decided NOT to spend this weekend reading about them... maybe....)

We looked at it again--the blood rushing through it is definitely from me, not baby.

Doc said he did not think it appeared like it was at an immediate risk of rupture (and again suggested it might never rupture and instead be squeezed by baby), but still wants me to keep activity light.  I can go back to work (desk job), but no exercise, cleaning, etc.  He also referred me to a high risk OB for a second opinion / further consult.  Awesome!

I left the appointment about as upbeat as I've been since I started this whole process.

Oh, and baby looks fantastic.

Tuesday, July 5, 2011

Status Quo - Almost done with a week of bed rest

Back at the doctor today.  Nothing has changed.  Good news is that baby looks good, heartbeat strong, still growing, etc.  Bad news is that blood is still flowing into a contained mass in my uterus and I'm still on bed rest.

The appointment was funny because it was an epic ultrasound procedure.  We saw the mass, we saw baby, we looked for source of blood flow, etc.  At the end they could not find the mass and the doctor told me it was probably because my uterus contracted because it did not like the ultrasound and the bleed was temporarily cut off.  (Not cured, just temporarily slowed.)  I joked with a girlfriend that if it does rupture and I start bleeding, I know what to do to stop it--jam a huge dildo up there.  (Just kidding, I would not do that, nor do I own a dildo!!!)

I spent a significant part of the weekend reading medical journal articles on pseudo-aneurysms of the uterus.  I read about diagnosis (they sound like what I have--pulsating mass connected to a parent artery by a narrow neck, often diagnosed during pregnancy because of increased blood flow), treatment (potentially they close on their own, but usually need to be treated if >2 cm, preferable treatment option is to embolize the pseudoaneurysm), outcome when pregnant (depends on how far along, where it is, etc., but there are very few cases of successful treatment during pregnancy), causes (usually trauma such as c-section or, rarely, ivf egg retrieval), etc.  It's an extremely rare condition, but it happens.  Not sure if that's what I have (it could be lots of things, I also read about arteriovenous malformations, but it doesn't seem like I have that because I'm not bleeding), but I mentioned what I'd read to the doctor.  I was happy when he told me to send him the journal articles.

My next appointment is in two days.  The doctor seemed optimistic that it might resolve on its own--especially when the baby gets big and started putting pressure on it.  He also did not seem to think we were at an immediate risk of rupture.  Of course, he's concerned enough that I'm still resting (although he did suggest I could increase my activity a little bit--maybe cook, go out to dinner).

I also started reading articles about what to do in case of an extended bed rest.  I think I might go crazy if that happens.  I never realized how much I like my job until I wasn't allowed to do it!

Saturday, July 2, 2011

A uterine aneurysm?!?... Maybe....

Went back to the doctor.  Both he and the ultrasound tech seemed shocked by what they saw.

It looked almost exactly the same as yesterday.  It still appeared to be an active bleed--the blood was pulsing with my heart beat--but the "clot" had not gotten any bigger and the blood did not appear to be going anywhere.

It turns out I don't have a blood clot or an active bleed.

Instead, I have an enlarged blood vessel.  Blood goes in (like a river) expands into a large space (like a lake) then goes back out (river again).  Sounds like an aneurysm, right?  (Although the doctor never actually used the "a" word.)

My doctor has never seen something like this before.  (That's never good.)

He ordered that I remain on bed rest.  He did not seem overly worried about my health, although he said to contact the office immediately in case of any bleeding.  (Obviously if there's a lot of blood I'm going to the hospital.)  The prognosis for baby is less clear.  If this thing never ruptures or gets any bigger (it's like 3cm x 3cm now) the doc seems to think that would be okay (not ideal).  If it blows or grows, that's obviously really bad.

I have another appointment early next week.  Depending on what we see, I'm going to see about having him refer me to a high-risk OB.

Unbelievable, right?