Blood Pressure

So, my normal, non-pregnant blood pressure is about 110/65 or lower. During the first, oh, 29-30 weeks of this pregnancy, my blood pressure ran about 120/70-80. Totally fine and normal. I don't remember exactly when my blood pressure shot up last week, but for the last week or so, my blood pressure readings have been, um, not so great. I take my blood pressure every morning (and now, often several times throughout the day as well, but I'm not typing out every single BP I've taken in the last week). Here's what it's looked like (do note that often I get a lower reading later in the day and I ALWAYS get a lower reading at the doctor's office which makes NO SENSE):

9/5: 125/94 (In doctor's office later, it was 120/84, I think)
9/6: 136/111
9/7: 128/90 (at doctor's office it was 110/63... WTF??)
9/8: 106/85 (with Procardia in AM)
9/9: 121/103 (later 118/92)
9/10: 132/105 (later 146/90)
9/11: 123/105 (later 126/98)

I thought it was maybe my BP cuff that wasn't working properly, but I've got two, and they come out with just about the same readings. (they are both electronic, one is fully-automatic, one is semi-automatic) Apparently, I'm just nice and calm in the doctor's office. Normally, my BP shoots up in the doctor's office. Go figure.

Anyway, my nurse at Matria, the traitor, called my doctor yesterday and again today with my BP readings. Sure enough, I got a call back this morning saying that there's a pretty good possibility that they'll decide at my appointment today to just admit me to the hospital for observation. Careful what you wish for, I suppose. I was JUST coming to believe that maybe it WOULD be better for me to just be at home during Rosh Hashana, since I could always just go to the hospital if I needed to (there's absolutely nothing wrong with going to the hospital in a medical emergency on a Jewish holiday... it's going for something routine and/or not necessarily emergency-status that's a problem). So anyway, I was warned to pack a bag (it's mostly packed anyway) and bring it with me. At least they warned me.

I'm 32 weeks tomorrow. Just 2 weeks to go. I said that to the sonographer/medical assistant person who called me with the news of possible hospitalization and she said, "2 more weeks? Well, we can hope..." UGH. But it's all good. I'm seeing Dr. G. today. I totally trust his judgment. I have absolutely no reason to believe he would lead me astray. I do sort of wish Dr. P weren't out of the office all this week. I find Dr. G. just as comforting as Dr. P., but there's something in the back of my head wishing Dr. P. would be around, just in case. I'm not sure why. And it's not like delivering triplets at 32 weeks is a bad thing. That's the national average. It's just sooner than I'd hoped. And anyway, I still really do believe that I'm going to hang in there until 34 weeks. I'm not sure WHY I believe that, but I really do.

So, yeah. I wouldn't have been updating September 13-15 anyway, because of the holiday and Shabbos. So don't be alarmed if I drop off the planet. If I do end up admitted, I'll have either Jess or my husband update tonight. Okay? But even if I'm admitted, it's likely just so they can keep a closer eye on me, which is fine. So don't freak out if I disappear.

We've hit a new record...(updated twice in middle)

Fifteen contractions this morning. In an hour. I'd say that's impressive, except, uh, that's not exactly how this is supposed to be working...

*shrug* I have to take my BP and pulse in a couple minutes, give myself a demand dose, and then remonitor from 10:30-11:30. Hopefully the extra dose will help calm things down. Otherwise, I imagine this will be an... interesting day.

I wonder if there's an award for hitting the record. Er.... scratch that. I'm pretty sure I don't want to find out. I have a feeling today I will not be moving much. My husband can wait on me hand and foot, right? Excellent.

Update: 8 contractions in my re-monitoring session. Got an auto-dose of terbutaline at 12pm. Remonitoring from 12:30-1:30. Not worried about it. Likely to go down again... that's three doses of terbutaline in a short timeframe. Even if it goes down, I may ask the nurse to call my doctor anyway, because that much terbutaline at once is making it hard for me to breathe comfortably. I think it's time to ask about repeating the Indocin regimen for 48 hours so that I don't have to keep doing this multi-dose stuff for the next few days. I dunno. I'm not feeling very assertive today, so I guess I'll just have to figure it out.

Update #2: Now I'm waiting for a call back from the doctor. Third monitoring session was 12 contractions. ... And while I was typing this the nurse from Matria called back to say she'd heard from the doctor on call (Dr. R.) and what she wants me to do is give *another* demand dose at 4pm, re-monitor at 4:30 and then decide whether I should come in to be checked. SO.... I'll update you later!

In other news.... I absolutely could not fall asleep last night, which is unusual for me. I mean, I usually can't STAY asleep, but most nights, my head hits the pillow and I'm OUT. Not last night. Not sure what the deal was, but I think it was close to 3am before I finally drifted off and I couldn't drag myself out of bed until about 10 'til 8 (normally I wake up around 6, even if I don't get out of bed that early). Anyway, in my supreme irritation at not sleeping, I read a couple blogs I've never read before and then got curious about something and got myself a tape measure...

Now, I've lost about 20-24 pounds this pregnancy (depending on the week... I seem to gain and lose the same 2-4 pounds week to week lately). But what wasn't making sense was that recently, many of my pre-pregnancy clothes have been fitting just fine. My skirts have fit me all along, but I grew out of my blouses pretty quickly after I started showing. (my skirts fit me primarily because I don't like things ON my belly; I prefer that they be under my belly... but recently, I've noticed that even my pre-pregnancy skirts are sometimes falling a little too low if I wear them and I realized I could actually pull them up around the largest part of my belly without any real discomfort other than my normal "I don't like things touching my belly" discomfort)

Anywhozit, I pulled out a tape measure and measured my girth. And sadly? My "waist" measurement (not that you can really call it a waist anymore) is only about an inch larger than it was last summer (the last time I measured my waist). I lost a bunch of weight (maybe 15 pounds in three months?) in my first pregnancy and only gained 3-5 pounds back after the miscarriage (some of which was attributable to the fertility drugs, I think). And I've lost about 20 in this pregnancy... but when you consider that the babies keep gaining weight and I'm not gaining weight... my total loss is probably much higher than 20 pounds. HOLY HECK! I wonder how much I'm going to weigh a few weeks after these babies are born. I mean, seriously, I'm overweight, there's no question. And I had a lot of weight to lose. But sheesh! I was JOKING after my first pregnancy when I said all I have to do to get to my idea weight is get pregnancy 3-4 times, but apparently pregnancy really IS the great weight-loss plan for me. How ridiculously odd.

(to be fair, a lot of this weight loss is probably due to the fact that I've been off of Depakote for a while now... I gained a LOT of weight taking Depakote, but had to get off of it because Depakote = EVIL in early pregnancy. And now I'm taking Topamax, which does have a weight loss side effect for some people... but when I last took it [at a significantly higher dose] I didn't have this kind of a drastic weight loss - not even close. Anywhozit, I think it's fair to say that I'm taking off that 20 pounds per year that the Depakote helped put on me... at a somewhat faster rate than I put it on)

Frustrating

First, I should note that this is my 198th post. I'm pointing this out because of the unlikelihood that I'll notice when it's my 200th post, so there you go. This is fair warning that apparently, I am verbose.

Then there's the fact that I made it to 28 weeks this week. And... I have mixed feeling about this. On the one hand, this is definitely a milestone. Babies born at 28 weeks do much better than babies born at, say, 25 weeks. But it would still be utterly devastating to me if they were born right now. Apparently I'd had my doctor worried over the weekend that he was going to be delivering me at 27+ weeks. That's not good. What is good is that he didn't make me think there was that much reason to worry until it was clear that we didn't need to worry. But anyway, in a lot of ways, I'm very sorry that I ever, ever, ever told anyone that 28 weeks was a milestone. It IS a milestone, but it is NOT the goal. The goal is 34 weeks. The first milestone along the way was 28 weeks, and here we are. But now people (not YOU people... but stupid people) keep thinking it's okay to say stupid shit like, "Well, great, you got to 28 weeks, so it's all good now, the babies can be born any time, right?!?" WRONG. And when I try to explain to these people that I appreciate their optimism and enthusiasm, but 28 weeks would still be horrifying, they tell me to stop being such a pessimist and proceed to tell me all these statistics about babies born at 28 weeks.

Yes... 90ish percent of babies born at 28 weeks survive. And most of them do not have long-term issues. But 10% don't survive. And 28 weeks, need I remind anyone, is twelve weeks early. Twelve. That's too early. If my babies were born right now, they would be about 2 pounds. That's not enough. Not when they should have the opportunity to grow to be close to 4 pounds. If my babies were born today, they would probably do just fine. But that is not what I want. And that is not what is best for them or for me. And I am so sick and tired of people accusing me of being a pessimist for not thinking it would be so great for these babies to be born this week. Case en pointe: My foster-son's grandmother called me on Wednesday (GAWD, why did I EVER acknowledge that Wednesdays are the days that I hit the new-week-milestones? WHY WHY WHY?). I was waiting for my Matria nurse to call me with my morning monitoring numbers and I'd had a terrible night the night before (10 contractions in an hour, two hours in a row), so I was a bit on edge when I picked up the phone.

"Hello?"
"28."
"28?"
"28!" (I'm still trying to figure out who the flying fig is on the other end of the phone)
"What do you mean, 28?"
"You're at 28!"
"That's not possible!" (I knew it wasn't my nurse from Matria, because she always identifies herself, but I was still in that contraction-counting-mode, and I was doing the math and there's no WAY I could have had 28 contractions in an hour)
"What do you think it is?"
"What do you mean 28?"
"28!"
"28??"
"Yes! 28!" (this went on for about two minutes)
"28 what????"
"You're at 28 weeks!!" (I finally at this point figured out who it was who was calling because this is the one person in the world who cannot seem to get the point that I need her to stop harping on the 28 week thing, plus I finally recognized her voice)

I was livid, really. I told her flat out that I don't know any other nice way of telling her that I need her to stop dwelling on this 28 week bullshit. YES, it's a milestone. NO, it's not the goal. YES, babies do very well at 28 weeks (at which point she broke in and said, "I even talked to my sister who's an OB/GYN and she said..."). But NO, it would NOT be good if these babies were born at 28 weeks. They will have so many disadvantages already. We really want to get into the thirties. Thirty-four weeks is absolutely ideal. And please, please, please, I'm begging you, stop acting like it's okay for these babies to come out right now!

I swear, it's like I almost feel like all these people who think it's "okay" now for these babies to come out are almost willing it to happen and it terrifies me. Yes, they really probably would be okay, but I don't want to find out the hard way. I just want these babies to have every chance possible. I don't want them to come out now. I'm not ready. They're not ready. They're too tiny. I'm too scared for them. Please don't come now. Please. I don't know how we'd bear it. I don't. I know we'd just do it, but I don't want to find out. I really don't. I can't.

I haven't been a seriously emotional wreck through this pregnancy. I'm not more snippy than I am when I'm not pregnant (I'm very snippy when I'm not pregnant, so who can tell the difference?). I rarely cry, though I'm crying now just thinking about these babies coming out now. I keep it together. After the first few weeks of the triplet-shock, I've been okay. I've had my moments of "oh my god how are we going to take care of triplets??" but nothing too horrifying since those early weeks. And now, with people continually acting like 28 weeks was such a huge milestone and that everything's okay now... I just feel like ... like they're saying it's okay for all my worst fears from the beginning to come true.

And it's not helping that the contractions really are out of control. I mean, the good news is they're not seriously affecting my cervix. Contracting is, apparently, just what I DO (sort of like how we discovered that bleeding in early pregnancy is just something I DO...). I'm just lucky. Somehow, that doesn't bring any peace of mind, because it makes me worry that if there really IS a problem, we'll miss it. But then again, my doctors have been careful never to assume that my contractions are just "normal for me" when they get up to a certain level. They'll bring me in any time I feel uncomfortable with the pattern or feel like I should be seen. Or if anything's different. So it's not like they're blowing it off, thankfully. And they are awesome. I love my doctors. All of them.

But I'm having so many contractions that they keep changing the terbutaline dose. And I can't keep taking the Indocin (though I suspect I'll be back on it for another 48 hours next week), even though it worked. Unfortunately, I've gotten to a point where the terbutaline side effects may be outweighing the benefits. I was having difficulty breathing, so they've lowered the dose a little, but my contractions are going up even though breathing is a little easier. I can barely keep any food down. My head hurts constantly (and these aren't "just" migraines... this is definitely terbutaline-induced). I'm afraid that we're to the point where even though I haven't topped out pharmacologically on the terbutaline, I may have topped out on how much terbutaline my body can handle.

So we'll see. I'm trying not to be frustrated. I'm trying not to be angry at people for their good intentions. I'm trying not to be too anxious about these babies. I'm trying to remember that I chose my doctors because I trust them and have nothing but faith in the care I receive from them. I'm trying to remember that there are more options after the terbutaline and even if those options require that I go into the hospital temporarily or permanently, it doesn't matter. All that matters is keeping these babies in for another 6 weeks.

Doctor's Appointment

The long and the short of it (no pun intended) is that my cervix is still short (around 2.4cm), but it's stable, which is great news. Babies all look fine, good heart rates and good amount of amniotic fluid. Dr. P. was working today, which was a relief (he was the doctor on call this past weekend, so I'd been hoping to speak with him directly today, and I got my wish).

He spent a lot of time talking to me about the changes he'd made to my protocol and why and how he hoped things would progress over the next several weeks. We're on the same page with the whole, "even though the survival rates for 28 weekers are very high, it would be very bad to deliver right now." He still wants to get me to 34 weeks before delivering, and I'm all for it.

Two babies are head down and the placenta previa has finally completely resolved itself, so I told him I don't need no stinkin' c-section. He reiterated that vaginal triplet deliveries are tricky at best and not always advisable, and I said, "well, I can dream, can't I?" "Oh yes, you can can dream. And I always wanted to be 6'4"..." Anyway, he didn't say no, but did emphasize that I shouldn't get my heart set on it. He has done vaginal triplet deliveries and he's not dead set against it (for that matter, he's done a vaginal quad delivery), so it's not like he can't do it, but he wants to make sure I realize that it's a very rare occurrence that things really line up in such a way that it's remotely advisable. I understand that, but I really want to keep the door open for as long as possible, even though I know it's probably not going to happen.

He explained that I can't stay on the Indocin long term, as it tends to result in a lower amniotic fluid level, but that if we need to repeat the Indocin regimen of 48-hour treatment on a weekly basis, we can do that until about 33 weeks... after that, there are bigger problems, but then things get a little less problemmatic if I go into labor anyway. He also explained why he didn't want to do steroids yet... although steroids are good for about 4-6 weeks after they give them, they are problemmatic for a couple reasons: 1. they'll definitely raise my blood sugar (which isn't the end of the world for me, since my blood sugar is stable and normal right now, but why tempt fate if we don't have to yet?) and 2. steroids have a tendency to increase contractions both in frequency and intensity for several days to a week after administering them. I love irony. So he said steroids aren't quite as magical as everyone thinks they are. Still, he'll definitely give me steroid shots at or around 30-32 weeks to give the babies the added edge in lung development that they need, but his preference is to put it off until as late as possible.

He said one of the problems I'm facing is that my uterus is distended further than it would be if I were full-term with a singleton right now and it really does think it's done, and that's likely a huge contributing factor to the contractions. He said this is definitely aggravated by the fact that I've got a very small pelvis to rib size (read: I'm SHORT), so there isn't even much more room for things to expand, even if it wanted to. With all that pressure on my uterus and, in turn, all that pressure on my cervix, it's no surprise that sometimes my contractions get out of control, and the best they can do is try to control it with the medications they have available for the time being. Definitely, though, bed rest is doing a good job, because my cervix is hanging in there and is much improved from how short it became right before I got thrown on bed rest. So I have to keep hanging out in bed/recliner for the long haul.

Oh, he also talked about the fact that most women have more contractions at night... 4pm-4am you definitely see increased uterine activity. I definitely have noticed EXACTLY this, and thought I was losing my mind. But he said it makes sense if you want to take *any* lessons from evolution, this is one you probably could take seriously... that most mammals need to give birth under the protective cover of night. Even though this isn't so relevant to humans (at least not today), it's still a documented scientific fact that uterine activity increases between 4pm and 4am. There are also more labors that start in the middle of the night than, say, mid-morning. Interesting! This is why when all hell was breaking loose with me on Saturday night he said he wanted to raise my basal rate on the terbutaline and then let me sleep if I could and see how I was doing in the morning, because doctors are much more concerned if contractions are at a high rate during the morning hours... they tend to be much more troublesome. Since I was still over threshold in the morning, that's why he called in the Indocin.... because the morning pattern was much more indicative of a problem than the evening-into-late-night pattern had been.

The other thing he'd done Sunday morning was raise my threshold to 8 contractions per hour... and the reason he did that was because he said at this point with triplets it's a lot more realistic to expect to see 4-6 contractions per hour regularly, but 8 per hour is definitely alarming, so rather than getting up in arms about something which could be normal (and bear in mind that all weekend I was above 8 anyway, so I was still justified in being concerned), raising the threshold would allow us to focus in when there really was something that needed attention.

Anyway, that was the appointment. It was a good appointment overall. Dr. P. wasn't saying he's not concerned, because he is, but he's definitely on top of things, which gives me a lot of hope and peace of mind. Meanwhile, we'll take it one week at a time, and if necessary, one day at a time.

And now, I really, really, really must go to bed.

Quick Update

I never really finished saying how things ended up over the weekend. Sunday morning I was still over threshold (7 contractions), so the doctor raised my threshold to 8 contractions "allowed" in an hour and called in Indocin (indomethacin), which is an NSAID that is used as a tocolytic. That combined with the two increases to my terbutaline (basal and bolus rates) over the weekend have calmed down the total number of contractions I'm getting, though the intensity of the contractions continues to escalate.

I have a doctor's appointment in about an hour, so we'll see if things still look stable. If they do, I imagine I'll be allowed to stay home for a while. If not, I don't know what's in store. My guess is that everything is still stable and that my body is just screwing with me.

I'm really starting to feel nervous. I'm not really worried that anything is really going wrong. I think it's fair to say that even if something was going wrong, it's out of my hands. ButI feel so utterly out of control and that feeling isn't pleasant. I know at least part of it is that the terbutaline makes my heart pound which simulates that nervous feeling in the first place, because the nervousness is definitely worse when it's close to or during a terbutaline auto-dose. FUN!

Anywhozit, I'll try to remember to post after my doctor's appointment today.

well phooey

Yeah, so first of all... checking blood sugar four times a day? SUCKS. Worse? All of my blood sugars have been completely, utterly, astoundingly, ridiculously normal. Technically, I know, this is a good thing. It's just that it's extremely annoying to do this when there isn't even a really good reason for it!

Furthermore, the diabetes educator that came out to edumacate me was completely patronizing and annoying. She kept lecturing me on the perils of diabetes and blah blah. And yes, I get that it's something to be taken seriously... except, hello? I have not yet been diagnosed with diabetes (nor does it seem like I will be if these blood sugar readings are any indication). She emphasized that this would "obviously be a serious lifestyle change" what with the diabetic diet and all. Now, I'll use the diet as a guideline, but I'm not following the diet all that strictly at this point because, again, not so much with the diabetes diagnosis. But I wasn't going to tell her that. What I told her was that the biggest lifestyle change really was going to be that I was going to need to eat much much more and much more often according to the diet guidelines she was handing me (a 2500 calorie diet).

"Oh," she said in a sickenly sweet and patronizing voice, "I think you'll find once you start measuring portions, that you weren't eating as little as you think you were."

Okay, what part of I'm pregnant with triplets and I've lost 22 pounds in this pregnancy did you miss in this conversation? And how dare you assume that I've been overeating all this time!! I've had doctors accusing me all my life of overeating, so I'm accutely aware of the number of calories I consume in an average day. Yes, sometimes it's more, sometimes it's less. But on an average day, I'm not eating ANYWHERE NEAR 2500 calories. Yesterday and today, in the spirit of cooperation, I probably had about 1800 calories and I can't begin to describe how sick I feel from eating all that food and eating practically non-stop. Ugh. Ick. Yuck.

Enough bitching about that though. Let's talk about contractions.

Five last night. Five this morning. Not over threshold, but combined with a lot of cramping, my terbutaline dose was raised a tiny bit and I was asked to remonitor mid-day just to see how things were. My strip was a little odd, so who knows, but I was just told to make sure to monitor a little early tonight and send it in. So I did.

I monitored from 6-7ish. 10 contractions.
Demand Dose at 7:15.
Remonitor from 7:45 to 8:45. 8 contractions.
Regular dose occurred at 8:15 in the span of time I was monitoring.
Another demand dose at 9:30.
Remonitored from 9:50-10:50pm. "At least 9 contractions" but the monitor had been all wonky and kept telling me to adjust the sensor, so they're not sure they saw them all.

Thank heavens Dr. P. was on call tonight, because he's not making me come in to the hospital. Yet. He raised my basal rate by 10%. He said to sleep through the night. And if I'm over threshold again in the morning, he'll call in Indocin to my pharmacy. If, however, I top out on the terbutaline (which it sounds like I'm about to do), I get to be hospitalized. My doctor, as a general rule, does NOT hospitalize patients unless there is no other option. So, well... phooey.

So there you go. That's tonight's fun. Hopefully tomorrow will be, um, less fun.

I Certainly Can't Be Accused of Underachievement

So, since I always do what I'm told, I monitored from 7-8pm tonight and sent it in. And AGAIN, I had eleven contractions. I'm sensing a trend here, and betting that tomorrow morning I won't have very many. And I'm betting that we're moving toward having auto doses increase again or move to every three hours instead of every four hours. Because, really, WHY NOT?

Ahem.

We now return you to your regularly scheduled programming.

Update: Per protocol, I gave myself an additional demand dose at 9pm and re-monitored from 9:30-10:30 and re-sent in the data. I had 5 contractions. The good news is that on Monday I got my doctor to raise my threshold from 4 contractions to 6, so I made it in just under the wire. If I'd had 6, they would have had to call the doctor and who knows what would have happened from there. Suffice it to say, I was just as happy to have avoided that, since I was quite tired.

Almost 27 Weeks- can you believe it??

I had a ridiculously long appointment yesterday. It's really sad when the biggest excitement of my week is going to the doctor. But it's also the most exhausting part. Whew, it takes a WHOLE lot of energy for me to get up and out of my house these days! It's pathetic. Anywhozit, yesterday was a long appointment because it was more than just my normal weekly cervix check. It was:

1. 1 hour glucose screening
2. Normal prenatal BP/Urine/Weight Check
3. Fetal Fibronectin culture
4. Cervix check
5. Growth scan for the kiddos

A long appointment. Should get the glucose and fetal fibronectin results today or tomorrow. I expect that the glucose test will not be pretty and that the fetal fibronectin will be fine. Blood pressure was fine, as usual. I've lost another 2 pounds, but I didn't get yelled at this time. My doctor isn't concerned as long as the babies are growing and I'm not anemic (they drew extra blood along with the glucose screening to make sure that I'm not anemic). My cervix was slightly shorter than last week, but still relatively stable. And the kiddos are growing nicely.

Baby A is estimated at 2 pounds 2 ounces (50th percentile)
Baby B is estimated at 1 pound 14 ounces (38th percentile)
Baby C is estimated at 1 pound 13 ounces (37th percentile)

Heartbeats were all lovely in the 150s and 160s. Baby A has listened to my complaints and turned back around and is head down. Whew. Baby B also has sort of turned back around and is somewhere between head down and transverse. Baby C is mostly transverse, slightly breach. They're kind of in this weird little circle... Baby A's head down in my cervix, feet up against Baby B's head who's feet wrap around to Baby C's head and baby C's feet wrap back down and around toward Baby A. Kind of weird.

Contractions have been weird. I'm usually okay in the morning with a few or no contractions. But check out this pattern:

Friday night: 5 contractions, gave demand dose, remonitored, 3 contractions, still really crampy, slept through it.
Saturday morning: 4 contractions (threshold), gave demand dose, remonitored, no contractions, cramping, raised basal rate.
Saturday night: 7 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Sunday morning: 3 contractions, no big deal.
Sunday night: 5 contractions, but hadn't sent strip in until the next morning, so no remonitoring involved.
Monday morning: 2 contractions
Monday night: ELEVEN contractions, but hadn't sent strip in, so no remonitoring involved.
Tuesday morning: no contractions.

So now I get to start sending in my evening strips as well as my morning strips. Which means I have to monitor earlier in the evening (I usually monitor around 9pm or 10pm, but if I'm going to send them in, they prefer to receive them by 9pm. I don't like to monitor right at 8pm because that's when I receive an auto dose, so I don't think that gives an accurate picture, so this means I have to monitor at 7pm tonight. Yippee.

Oh, and while I was writing this entry, I got a call from my nurse... Yep, I failed my 1 hour glucose screening, apparently not by very much. But here's the kicker... normally this would mean taking the three hour glucose tolerance test, except I'm not allowed. Because that would mean sitting in the lab for four hours. And I'm not allowed to sit for that long. So instead, I get to have Matria (the company that does my contraction monitoring and terbutaline pump stuff) come out and edumacate me on gestational diabetes and using a glucometer and blah blah blah. And then I get to check my blood sugar four times a day for a couple weeks while they decide if I have gestational diabetes. And if I don't, I still get to keep checking my blood sugar just for fun, because I can! And if I do, well, the fun's just beginning!

The bitch of it is that they suspect that the terbutaline plus the whole triplet thing is what's likely caused the elevated blood sugar. I've been losing weight throughout the pregnancy, and have no family history of diabetes nor gestational diabetes. I don't eat sugary sweets or really many excess carbs in the first place. So let's say it's the terbutaline's fault. What would I rather have: high blood sugar and relatively controlled contractions, or low blood sugar and completely UNcontrollable contractions? Yeah, that's what I thought. Not a difficult choice to make. And anyway, I needed something else to do with my day, right? Wouldn't want to get bored!

I knew it was a high likelihood that I'd blow this here 1 hour test, but I was so hoping I was just being a negative nelly. Because seriously... have I mentioned that one of the problems with gestational diabetes is delayed lung development?? And have I mentioned that AT BEST these babies are going to be 6 weeks premature? Yeah. Aside from that, at this point, I have weekly cervix measurements, weekly urine protein checks, daily blood pressure monitoring, twice (sometimes more) daily contraction monitoring, and now I'll have 4x daily blood sugar monitoring. Seriously... is there ANYTHING they're NOT going to know about me by the time this pregnancy is over with?

Right. Well, you know, it's all good. It'll just give me more toys to play with. :)

Enough of the Self-Pity (Updated at Bottom)

Right. Well, that's quite enough of the self-pity. Or at least, that particular variety. I will now move on to an entirely different kind of whining. Pregnancy whining. Okay, I get it, there are lots of you out there who would give nearly anything to have the opportunity to whine about pregnancy, and I get that. So I'm sorry if it offends you that I don't find all of pregnancy all sunshine and light. Maybe I would if I had a singleton pregnancy, maybe I wouldn't. What I do know is that we infertiles HAVE to give ourselves permission to accept that there's nothing wrong with us for finding out that sometimes pregnancy isn't glamorous and sometimes parenting isn't perfect and sometimes we aren't always gracious about either one. Therefore, disclaimers aside, here are some of the good and the bad of late:

Good: I had a pretty decent week last week in terms of contractions and other such things. My appointment went well, my cervix had stablized and in fact lengthened somewhat, I even got a little cocky about it ("I don't need no stinkin' bedrest!") but not to the point that I violated doctor's orders. Contractions weren't done and over with, but I was generally having a good week, and they were definitely under better control than they had been.

The Less Good: The operative word in that last sentence, of course, is that they were under better control. Until Friday. I monitor contractions twice a day. I'm required to send them in every morning, but not in the evening unless I'm feeling symptomatic. I can also monitor any other time of day if I'm feeling off or feeling contractions or just feel like it or whatever. Friday around 5pm I felt a few contractions, but I sort of ignored them, because that's not terribly uncommon and I didn't think much of it. But then a little before 6, I had a few more and I thought, well, that's 4-6 contractions within the same hour, so I probably should call about getting a demand dose of terbutaline. After any demand dose, I have to monitor and send in the data, so that meant my evening data WOULD get sent in, which was fine.

So I called, asked if I could give myself a demand dose, was told yes, and then told to monitor from 6:30-7:30 and send it in. Fine. Except I couldn't get the pump to GIVE me a demand dose. It's a different button than the rest of the buttons and that button stopped working. So they had a work around for it, but that took some time, which put off my monitoring time until about 7ish to 8ish. Which is fine, but Shabbos (the Sabbath) was starting at 8, so the timing wasn't fabulous. I am allowed to do all the medical stuff I need to do on Shabbos, even though a lot of it isn't stuff I'd normally be allowed to do (e.g. using the phone). It's just that there are a couple things I had to do right at 8 (like light candles to bring in Shabbos), so it wasn't terribly convenient. Still, I made it work.

I expected that the monitoring session would yieled nothing interesting since I'd just given myself a demand dose and usually that takes care of the contractions immediately, but the nurse called back and said I had 5 contractions, which is above my "allowed" threshhold. Which meant I was going to have to re-monitor. Great. Except it's Friday night, late, I have a cranky 4 year old, my husband is at shul (synagogue), and I have to deal with remonitoring and once my husband gets home in theory we're supposed to eat a "festive meal" in honor of the Sabbath. (Someday maybe I'll explain the whole sabbath thing to my non-Jewish readers, but really, if you're wondering if I'm completely nutso, yes I am, but if you want more details, just email me... there's a link to my email address in my sidebar) Since 8pm is when one of my automatic doses happens anyway, the nurse wanted me to wait until about 8:30 to monitor again to give the dose some time to work its magic. And so, at 8:30, I strapped the monitor back on while attempting to appease J with some tortellini and some books and a couple cars (yes, he should have been in bed, but it's not like I can struggle with him alone these days).

And at 9:30 I sent in the data again. And while waiting for the phone call back, we started to sit down to dinner, and then, of course, the phone rang. The contractions had gotten much better..3 short contractions, which is under the "allowed" amount (thank heavens, because otherwise, doctor's orders would have mandated a phone call to the doctor on call and I REALLY didn't want to deal with that!), but the nurse didn't love that I'd been having a lot of cramping and it wasn't getting a lot better. So she waffled for a bit about calling the doctor anyway, but I talked her out of it (my doctor didn't seem OVERLY concerned when I'd mentioned it before, plus I promised to call if I couldn't sleep through it which is always my gauge of whether I should be waking up a doctor). She had me give myself another demand dose and encouraged me to call if it got any worse through the night. Fine.

And the next morning was more of the same. Too many contractions, demand dose (which they still had to use the awkward work-around to do, because the demand-button wasn't working) remonitor, better but not perfect, still a lot of cramping, so they changed my basal rate on the pump and got to work on getting a new pump programmed and couriered out to me. The increased basal rate did seem to help a bit throughout the day (it had also been increased the day before, so it had cumulatively been increased about 30% from two days prior). I didn't do an evening monitoring until quite late because I had people here visiting on and off throughout the day. I felt a little funny, but decided not to send in the data until morning since I wasn't required to and since it was so late. I figured I'd send it in the next morning. Turned out it was both a good and a bad choice not to send it in, because I'd had SEVEN contractions (nearly double my "allowed" threshhold) and a lot of irritability. So if I'd sent it in, I would have ended up having to do a demand dose and remonitor at midnight risking calling the doctor at 1 in the morning and blah blah blah. On the other hand, I'm lucky it didn't become a huge deal, since I didn't send it in... Anyway, this morning, all was clear, so life is good. I think I'll do this evening's monitoring somewhat early and go ahead and send it in just for the fun of it.

More Good: I did get the replacement pump around noon yesterday and it's working just fine. I've haven't been alarmingly uncomfortable today. I've got all the usual "hey I'm pregnant with triplets" discomforts, but nothing that's making me go "hey that's not good!" Also the babies have been kicking like mad and I'm pretty sure at least one of them has turned back around, so I'm hoping the others follow suit and SOON!

The Slightly Less Good: Baby A has discovered that JUMPING on my cervix is much more fun than punching it. I'm fairly certain that Baby A is still breech and is remaining that way simply to torture me. Youch!

Good: J is absolutely fascinated by my ever-expanding belly. "Oh Eema, your belly is getting bigger! It's a giant belly now! Why is it getting so much bigger??" Yeah, uh, now that I think about it, I'm less convinced this belongs in the "Good" category! ;) Anywhozit, I said, "Well, what's IN Eema's belly?" He giggled... "Bigger Babies!" "That's right, so Eema's belly has to get bigger so they can keep growing, right?" "Of course, Eema! You need a bigger belly so the babies can grow," he said as if it had been all his idea and he was telling me how the world works. He's really cute.

The Less Good: I absolutely cannot shake this cold. I feel disgusting, and it's making it even harder than usual to keep food down, and worse, it's making it difficult even to keep fluids down, which is bad, because the best thing I could possibly do for a cold is drink a lot of fluids. Sigh. So now in addition to waking up a lot with cramping and full bladder and general discomfort and leg cramps, I also wake up because I can't breathe, I'm parched, and my throat hurts. It's lovely. I'm not sure why I even bother trying to sleep anymore.

The Really Good: I haven't been admitted to the hospital and I'm 26 1/2 weeks. That so rocks.

More Good: I'm no longer completey nauseated every time the babies move. This is a good thing, since they do it ALL THE FREAKING TIME, especially at night. Actually, I kind of love it now, and I think I might miss it some day. I mean, I could still do without the cervix stomping, because honestly, I'm not kidding when I say that really hurts. I mean REALLY hurts. But at least I know the kiddos are still moving around, right?

The Somewhat Annoying: Heartburn really sucks. Definitely in Stretch-Mark Land. I have a weird little hematoma right above my ever-shrinking (but not yet popping-out) belly button and I have no idea why or where it came from. Pregnancy has made my belly embarrassingly furry. I wish there were something I could do about this, but I figure my doctor has probably seen scarier bellies. Right? RIGHT? I'm still getting about 3 migraines a week and tylenol with codeine isn't touching them but I don't have a lot of other pain-relief options. I'm also getting lower-grade headaches from the terbutaline, but those are easier to knock out. The terbutaline also gives me a very annoying side effect of making it uncomfortable to breathe... as if I'd been breathing heavily after running a long distance or something for a while. It's like my throat or lungs HURT when I breathe. It's not like I can't breathe, it's just an unpleasant sensation that I keep hoping will go away and it hasn't. The other terbutaline side effects have at least gotten less annoying even if they haven't subsided completely, but this one is just as annoying as ever.

The Good: My husband? Completely rocks.

On a Completely Unrelated Note:
An anonymous poster has asked me twice now why there are 4-hour auto-doses in addition to a lower basal rate on the pump, rather than having just a higher basal rate that incorporates the auto doses over a longer period of time. I'm not ignoring the question, I'm actually trying to find a real answer rather than just having my own random guesses. My husband is a pharmacist, so you'd think this would be an easy one to get an answer to, right? Not so much. Never mind that he was sitting shiva for a week, so he couldn't do any looking up for me, even now that he can he's super-busy and the bit of research he's done hasn't turned up a lot of clear-cut answers.

What he has found is that generally the auto-doses are recommended to be timed with the peak periods of uterine activity if it is possible to predict that pattern (it often IS possible to do so, apparently). This makes a bit of sense to me as one suggestion that was made by my nurse at some point was to change the interval of the auto doses for more effective treatment.

He also found that taking 5mg pills every 4 hours is effective about 30% of the time for uterine contractions. But that terbutaline pump protocols are effective closer to 90% of the time, so for whatever reason, it works.

What he hasn't found yet (and admittedly, he hasn't had time while at work to wander over to the Health Sciences Library) is a clear cut answer about why it wouldn't work to just have a high basal rate given out 24-7 with only denmand-doses as needed for breakthrough contractions. But if he DOES find an answer, I'll let you know. Also, Erin has a PhD in Pharmacology, I believe, so maybe she can shed some light on this. Or maybe not. I don't know. But if anyone else does happen to know, please let me know, because at this point, I'm intensely curious. Inquiring minds want to know.

(I also just reminded my husband, so he's going to do some more digging around now to see what he can find... I'll update this entry if he finds anything really interesting)

And that's enough for now.

Update per Anonymous' Comment:
Comment left last night: Hey, that's great that you are looking into the auto-dose/basal issue. If there are other options that could serve you better, it would be good to know! Now, are there any at-home IVs you can use for when you can't keep fluids down?

I'm looking into the basal vs. auto dose issue purely as a curiosity. I'm assuming this is a long tested issue at this point as this is very standard protocol that is used regularly for a large number of patients and has been for al ong time, so I'm not guessing that it would make more sense to raise the basal rate and eliminate auto-doses. It seems clear that the protocol of auto-doses combined with a low basal rate does work for most patients. It may be that it lowers the side effect profile to do it this way, and since the side effects aren't real pleasant, that's a good thing. At any rate, I've got my husband on it this week. He's still playing a bit of catch up at work from being out after his father died, but I'm sure he'll find some time to walk over to the library if I nudge him a little.

As for at-home IVs... the short answer is, yes, there are at-home IVs, but I don't warrant one. If my nausea were so extreme that I were never keeping fluids down and I were severely dehydrated and had an electrolyte imbalance, they could do an at-home IV-line for Zofran (which I currently take orally). If that didn't work, they'd admit me. However, my periods of not being able to keep fluids down are generally short-lived and haven't resulted in real dehydration/electrolyte imbalances, so an IV line would be a bit on the extreme side (nor do I want one! I'm already the bionic woman!!). At any rate, yes, it's an option, but not a likely one for me. Good idea though!

Followup to "Envy"

Some commenters say that my fertility envy will fade with time. Other commenters say it will never go away. Some say when I get to my ideal family size I'll feel better. Funny, I always wanted four children, which I'll have after this, but I never considered that it would be only one pregnancy. I suspect that it varies from person to person... there's no right answer here. And I definitely don't begrudge most people their pregnancies. Not even fertile myrtles. Not even, heaven help me, Michelle Duggar. But I grieve my inability to just BE pregnant. I grieve the freedom to say, as the Duggars say, that I'll have chilren until God tells me not to. I don't want 17 children per se. I want the freedom to make that choice. And I grieve the loss of that choice.

One anonymous commenter wrote:

It will fade, you will feel better over time.
For me pregnancy was almost the time to rehash and process all my infertility feelings. And of course, you're not a mother yet. Sure you wanted pregnancy, but what you REALLY wnated is the small head in the hollow of your neck, a baby nuzzling at your breast, a toddler shouting MUMMY and running over to hug you.
Those are the things that will heal you, not a terbutaline pump in the leg and bedrest.

The thing that struck me the most was : And of course, you're not a mother yet.

Oh but I am. If you're newish to my blog you may have missed it, but I have a beautiful almost-four year old foster son. He's not really a foster son, exactly, because he was a private placement, but I'm his legal guardian. I may not be his biological mother, but I've been his mother for almost 3 years. He knows no other mother. I could not love him one teeney bit more if I had given birth to him. I have no doubt that I could adopt a dozen children and love them just as much. I also know that I still would have grieved the loss of this pregnancy experience had I never gotten this far. Even though it makes no difference in how much I love my beautiful boy. J will probably be with us forever. He is my son in every sense except the legal sense. He knows no parents but us. There is no greater joy in this world than being a parent, and still, the pain of infertility is as raw as it ever was.

It's rare that it is someone else's pregnancy that brings out the pain for me. It's usually something far more personal, something intrinsic in myself. This time it happened to be someone else's pregnancy. Someone who got pregnant within six weeks of getting married. She certainly didn't do it to upset me. And it's certainly not her fault that it did. And most people in the community don't even realize that I COULD be feeling left behind in the child-bearing department. After all, we've been parents for three years. And now we're having triplets. So how could we possibly feel remotely out of place amongst those having their their third, fourth, fifth...?

It's true though... it's these babies that will ultimately heal me, not the terbutaline pump and the bed rest. The terbutaline pump and the bedrest do nothing but remind me that this is NOT a normal pregnancy and that I'm STILL set apart from most pregnant women. But I'll love these babies. Of that there is little doubt.

26 Weeks - How it's Going

Sorry for the delay in actual pregnancy updates... several of you have asked. With my husband sitting shiva, it's been hard to get real time to post anything significant. Things have mostly been okay, but have been a bit up and down. It seems like every time I want to post "Yesterday was a really good day" I end up having a really crappy day, so then I need to post "Yesterday was a really crappy day" except then things turn back around, so I just can't keep it all straight. ;) This is not an entirely bad thing.

The good news is that the up and down is largely confined to the contraction side of things. This is good news primarily because of the terbutaline pump. There's a lot of leeway in how I can deal with dosages on the pump (or rather, how the nurses at Matria, the monitoring company, can deal with dosages). They have a lot of leeway in the doctors' orders in terms of giving additional "demand doses" or changing basal rates or auto-dose rates. So we've been playing around a lot with that. We've increased my basal rate twice and yesterday increased my auto-dose rate by 10%, but there's more wiggle room still if that doesn't work.

What's been tending to happen is that I go a day or a day and a half with no, or only one, contraction during each of my two daily monitoring sessions (which doesn't mean I'm having zero throughout the day, but that's another story), which is great. But then I'll go a day or two with 5-6 during each monitoring session, which is when we start moving doses around. Most of the contractions aren't painful, but they are fairly uncomfortable. What's more painful is that I have a lot of cramping all of the time, which wakes me up a lot too, but even the increases in basal rate have helped that, so it's likely that the cramping is low-level contractions that don't really register as contractions themselves on the monitor (if they're less than 40-seconds, they don't call them contractions). See, and here I thought I got pregnant to avoid being plagued by painful menstrual-like cramps. Sigh.

The really astoundingly good news is that bed rest certainly seems to be doing its job, which is good because I really, really don't want to be admitted to the hospital just now. Each appointment that I've had since that first alarming appointment where my cervix had gone down to 1.5cm has shown definite improvement in cervical length. I didn't even know that could really happen. My last appointment, on Monday, it was, at its shortest, 2.8cm. Go me! This has also enabled me to return to weekly appointments instead of twice-weekly appointments, which is good, because with S dealing with shiva, I wouldn't have wanted to abandon him too often.

What really astounds me is that I remember my first appointment with the perinatologist was at 8 weeks, 5 days, and this week's appointment was 25 weeks, 5 days. 17 weeks have passed, but it feels like a lifetime ago. 17 weeks ago, I didn't even have a clear idea whether all three were going to make it. 17 weeks ago I didn't even know if it made more sense to consider a reduction and I was getting tremendous pressure in all directions to reduce. 17 weeks ago, I finally walked into an office that didn't say my only option was to reduce the triplets. 17 weeks ago I had no idea if I was making the right choice, but today I have no question that I made the right choice. I didn't know then if these little monsters had any chance of making it, but now, I have little doubt they will, though I have no idea what issues they'll be facing on the other side. 17 weeks ago, I was in despair... yesterday, I was conspiring with Jess to create a baby registry, something I couldn't possibly have contemplated even a month ago, let alone 17 weeks ago.

I remember clearly the day that it became obvious that I was attached to these little monsters. I blogged about it, even. April 19th. That's when I realized it was okay to be attached to these little parasites... the little parasites I was still too terrified to refer to as babies. Now I often refer to them as babies, but I can't remember when that shift took place. What I do know is that shift wasn't insignificant. I never thought I'd call a baby a baby until it was born. I never thought I could bear having that level of attachment before it was a "sure thing". But here I am, with three babies kicking me regularly, and that's what they are to me... alternately babies and monsters (in the most endearing way possible, of course).

But I digress. Back to how I'm doing.

Contractions... today not bad, tomorrow, we'll see. Check.
Cervical length... getting better, apparently bed rest works. Check.

Babies (!)... They are terrific. I haven't had a growth ultrasound since the 11th, but will have another on Monday, so I'll know more then, but they've all got perfect heartbeats, plenty of amniotic fluid, and they're all quite active, so there don't appear to be any serious concerns in that regard. Or minor concerns, for that matter. The one seriously annoying thing is that as of Monday, they had all turned breach. Even Baby A who has been head down for MONTHS! I know they all have PLENTY of time to turn right back around, but I'm bitter. Bit-ter, I tell you! They'd better move back around and fast. One good thing about it, though, is that Dr. M. thinks that it's possible that part of the reason my cervix lengthened again this week was because the pressure had been taken off of it with the baby's head not constantly pushing down on it, so I guess I can't entirely complain. At first with them all turning around I couldn't feel them moving much, but I think they must have shifted somewhat again, because now Baby A is most decidedly kicking me directly in the cervix on a regular basis, which is more painful than head-butting and honestly, more painful (and more persistent) than punching. So I'm not loving that. But the other two must also have shifted somewhat, because I can feel them fighting with each other again. I doubt that they've turned all the way around again already, but they've definitely moved somewhat since Monday.

Next Monday, they'll do another fetal fibronectin test, talk to me more about steroid shots (though they're still trying to put those off until at least 30 weeks if possible), and they'll do the 1-hour glucose tolerance test. Yum. I wish I could just skip to the 3 hour, since I'm at such a high risk for gestational diabetes in the first place (triplet pregnancy, PCOS, overweight to begin with...), but it's all good. Hopefully it won't be an issue and I'll only have to do this once. They will also, as I said, do the growth ultrasound on the babies, so it will be a long appointment, which is fine with me, because it's the one excursion out of the house that I'm allowed.

The current bane of my existence is that I have a nasty cold, which I think is just adding insult to injury, and I'm quite bitter about it, but hoping that it will be short-lived. I hate colds because they are utterly miserable, but they are "just colds" so you can't really complain about them without being a big whiner. Unless you're pregnant with triplets, in which case, I think you're perfectly justified in whining about basically anything. At least, that's MY excuse!

And that's where things are right now. I'm slowly catching up on blogs. I haven't been purposely ignoring anyone, it's just that things have been a bit crazy with everything going on between my dramarama and my husband's father's death. So hopefully things will calm down soon A girl can dream, right? Today my big plans are to be able to take a nap at some point.

Don't Freak Out!

Apparently I freaked out Jess today by not being as available on IM as I usually am, or at any of the usual times. And I hadn't posted or emailed her. And you know, things haven't all been going swimmingly with me recently, so this led her to the natural conclusion that there was the vague possibility that I'd ended up back in the hospital and frankly, she'd had a shitty enough day that this was news she simply could not and would not tolerate. So there. She sent me an email around 9:30 saying "Where in All of heck are you?" among other things.

So here I am. I'm okay. I'm very slow to respond to email these days in part because emailing and lying down are sometimes mutually exclusive. I wasn't on IM most of the day because I wasn't feeling great but also because my computer was being super-finicky and ticking me off and because I had a doctor's appointment. I solemnly promise that tomorrow when things have calmed down a bit, I'll give Jess my password for my blogger account and I will call her if I have to be admitted to the hospital and can't post. She will post for me, if she's willing (and I'm assuming she will be), okay?

One bit of warning... my husband will be sitting Shiva for a week starting this Thursday. My guess is that my online presence during that week will be somewhat diminished. SO DON'T FREAK OUT. I made my doctor promise me that there would be no disasters while my husband is sitting shiva. He's a trustworthy doc, so I can't imagine he was just humoring me, right? Er...

Anywhozit, I saw the doctor today, and the good news is that my cervix is still stable, so no cerclage. The less good news is that I'm still having contractions between auto-doses of the terbutaline pump... not so many that anyone's super concerned, but enough that it seems like the baseline dose probably needs to be increased, but I'm not so much looking forward to the increased side effects. But whatever it takes to keep these babies cooking a little longer!! The not good news was that I lost 6 pounds in a week. While on bed rest for crying out loud! Now, normally a girl of my girth would be jumping for joy at a 6 pound loss. Except, well, I'm not allowed to jump. And um, while my doctor wasn't fretting about me not gaining any weight... they don't love seeing a 6 pound loss in a week either. So I have to shape up, darnit! And take an extra prenatal vitamin, apparently. And, you know, not lose another 6 pounds this week. Since I have no idea how I lost that weight, I also don't know how to avoid doing it again, so this ought to be fun.

I'm slowly catching up on blogs... but I'm not commenting nearly enough. Very sorry!!

what, me? bored?

I know you were all worried that I was sitting around being bored. You were all concerned that what with the Procardia and the renewed sense of cervical stability from Tuesday's visit, I'd be sitting around complacent and just pulling my hair out for lack of anything more interesting to do. So if that was your greatest concern, fear not. There is no boredom to be had in the perky household today. I mean that bed rest thing? God it sucks. But it's anything but boring. Let's back up.

First, my husband was out of town Wednesday through Friday afternoon. That was fun, really. I mean, fun like nailing my hand to the wall would be fun. I had some help with our four year old, but not enough, because certain people who were supposed to give more help than they did, well, didn't. The monitor equipment I had gotten Wednesday night broke Thursday morning and had to be replaced (they got me a replacement by mid-day). The good news was that the two monitoring sessions I had on Thursday had no contractions. I did have some contractions between monitoring sessions, but I took the immediate-release nifedipine and whipped them right into shape. Friday, same thing, no problem.

Friday night I couldn't sleep. I had cramps all night. Everything felt funny. I just didn't feel right. I got up around 7ish Saturday and strapped on the monitor shortly thereafter and curled up with Harry Potter which a friend had lovingly picked up from Borders at midnight and left on my table for me. She rocks. But I was so uncomfortable and weird feeling that it was a lost cause. So I just put the book down and tried hard not to think. When the nurse called back she said that I'd had three contractions which wouldn't have been alarming except that it was a change. My BP was fine, but high for me (110/74... not high by any stretch of the imagination, but it's a 10 point diastolic jump), but I was still having pretty significant cramping. The nurse suggested taking the immediate-relaease nifedipine and calling back in 30-60 minutes. So an hour later, I called back and wasn't feeling any better, so the nurse said I could either call the doctor or monitor for another hour first, but she didn't recommend just ignoring it. I opted to monitor for another hour, figuring that the nifedipine surely would leave me contraction-free. Right? RIGHT? Wrong. Three contractions, and I still felt weird. And the cramping wasn't any better. So the nurse thought the best thing to do would be to call the doctor even though I wasn't over my threshold for contractions. So that's what I did.

I'll pause here to note that, as I've mentioned before but rarely emphasize because that's not what this blog is about, I'm an Orthodox Jew. A few of you know what that entails, and many of you probably have some idea, but the greatest impact to THIS particular tale of woe is that it was Saturday, which is the Sabbath (which you'll often hear me refer to as "Shabbos"). Now, normally all this futzing around with phone calls and electrical devices on Shabbos would not be permissible, but obviously, in this case Judaism is very prctical and I am permitted to monitor and to make and receive the necessary phone calls to ensure the health and well being of myself and the babies. But it was about to become even more complicated, because when the doctor called back he asked if I would mind coming in to the hospital to be checked out. He wanted to make sure my cervix hadn't shortened more, essentially, and honestly, the last time I felt this weird, my cervix HAD shortened significantly. So I said we'd go in if that's what he wanted.

However, we actually didn't entirely know where our four year old was. That sounds worse than it is. My husband had dropped him off at the children's program during regular services (he had gone to super-early morning services himself) and a friend was to walk him back to us. But she had misunderstood and had thought we wanted her to bring him a different friend's house (which is often the plan, so not unusual), so it took a while to track him down. This would not normally be disturbing, except that we needed to make this happen so that we could find a permanent location for him for the afternoon. Plus, we needed to find a way to get me to the hospital, which in this case meant my husband COULD drive me, but it would be preferably to have a non-Jew drive us, which meant finding someone or calling for a taxi. So that got taken care of too. But by the time all that happened, it was quite late and I was quite ticked off that it had taken this long, and now we have some lessons learned. Hopefully there won't be a next time, but if there is, we now have a neighbor who knows how to track down our four year old if necessary (he knows and loves her and won't be freaked out by suddenly going to her house as he does so often). She'll simply be told to find him and we'll go.

And so, three hours after talking to the doctor, I finally made it to the hospital. And, thankfully, my cervix had not significantly shortened. Slightly shorter than Tuesday, but still in the 2.x range. Still having contractions, though, so Dr. P's feeling was that the nifedipine wasn't doing a particularly good job. He felt that in his experience a terbutaline pump does a better job and is fairly well tolerated even though oral terbutaline tends not to be. He gave me a shot of terbutaline to see if that calmed the cramping, which it did, but boy did it make me feel crappy. Shaky and jittery, oh my! He said the pump is better tolerated because you're getting a constant dose over time and even the automatic doses which are bigger are given over a period of 12 minutes, so that seemed reasonable. He told me if I felt more comfortable being admitted, he would absolutely do so, but we all agreed I would more likely be comfortable at home. I frankly didn't care WHERE I was at that point, I was just so damn uncomfortable and tired at that point I wanted to have SOME sort of plan. So they set up getting me discharged and getting me a terb pump set up at home that evening. This was made easier by the fact that I was already receiving home monitoring from the company that would set up the pump and do 24/7 support for that. So the nurse called someone to come get us, and off we were.

When we got home, I asked the friend who had driven us home to please check the voicemail for me in case I'd missed a call about getting the pump set up while en route home. Long story short we had not missed any calls about the pump, but my husband's father passed away yesterday. And that's when the fun began. My husband was off trying to pick up the four year old monster, so I sent my friend out to get him to come home. He was, in fact, at a Rabbi's house, so I asked her to send home both my husband and the Rabbi. She had the good sense to suggest that J still stay put, which was brilliant and I'm sorry I didn't think of it, but by this point I wasn't thinking. My heart was still racing from the terbutaline shot and from everything else that had been happening. So my husband came home wondering what the hell could have happened to me in the fifteen minutes that he'd been gone, let alone anything that would require the Rabbi's presence (this is a friend of ours who IS a Rabbi, not the Rabbi of our community). And I stupidly didn't have him sit down next to me when I told him so he took a stop back in shock and just said, "How could you KNOW that?" It was, after all, still Shabbos, and his father lived in New Hampshire. How COULD I know that? Yeah. Lucy had some 'splainin' to do.

Now, you may think the rules about what I can and cannot do on Shabbos are weird and restritive (no phone, no affecting electricity, no cooking, no driving, no writing...), but when a close relative (parent, sibling, spouse or child) dies, the rules are quite limiting. In my husband's case, they are less so until after the funeral for a variety of complicated reasons, but we needed to clear this up PRONTO. So off he went to talk to the Rabbi of the community. Neither of us, thankfully, is personally well-versed in the mourning rituals of Judaism. But after the funeral, my husband will sit shiva (google it, for more information, I'm so exhausted I can't get into it right now). For Orthodox Jews, this is a complex and regimented process. And worse, I really can't help AT ALL. So it's going to be fun, let me tell you.

So my husband went off to talk to the Rabbi, and while he was gone my mother-in-law (LONG divorced from my father-in-law) and brother-in-law came to the house knowing that we wouldn't have otherwise heard the news under normal circumstances. Except, of course, we had, and S wasn't around and meanwhile I was expecting a nurse to show up at any time to deal with the pump and it was nearly time for me to monitor again and would this day NEVER END? An hour later, S got home with J in tow, the supplies for the pump and all the drugs showed up via courier, and shortly thereafter the nurse came at which point I begged my husband to get his brother to disappear because I really didn't want to do this in front of him. The nurse had a billion forms and a bunch of things to go over, which was fine and then she started to go over how to deal with the pump, but we ran into a snag. What, you expected this to go smoothly?

See, as I've mentioned before, my husband is a pharmacist and he was pretty burnt out, but fortunately the nurse noticed and asked for his professional opinion... but none of the syringes filled with terbutaline were labeled properly. They had my name on them, and then said Dr. Tincture which is incorrect. My doctor's name is Dr. P. and I'm allergic to Tincture of Benzoine. And nowhere on the label did it say the drug inside the syringe is terbutaline. My husband is in charge of the IV Lab at a major hospital. This is one area of protocol with which is he is intimately familiar and he said, "I'm really sorry, but this is a clear liquid in a poorly labeled syringe which gives me no indication that it was checked by a pharmacist. It could be anything. I can't let you take it." He was right, of course, but for crying out loud! Could one thing PLEASE go right? The nurse called back to the center and got them working on calling the drug company that they subcontract to that had made the mistake in the first place to get them working on replacing the drug ASAP. Meanwhile, she showed us how to deal with getting the pump primed and ready to go, and she showed me how to get the catheter in place in my leg. And she took away the bad drug and told me that once the new one showed up I could call Matria to have them walk me through getting the cartridge refilled if I couldn't remember how to do it. It was then about 9:30pm. I had received my last dose of terbutaline at about 3:15. I didn't want to take the oral terbutaline that I had on hadn because I didn't want the sudden jittery-ness again if I could help it and I didn't know how long it would be. At 10:20, the center called me to tell me that the pharmacist was going back in to remake the drug and would courier it over to me as soon as it was ready. Stat orders have a maximum 4 hour turnaround time. Yeah, I should have taken that oral dose. Sigh. Finally, it arrived at about 12:30am.

Too tired to figure it out myself, I called to have them walk me through it, which the nurse happily did, and I got it all set up, gave myself a demand dose and the jittery-ness began. Also, even more unpleaseant, I discovered that the side effect I thought I'd been imagining in the hospital was not imagined, it was real... the terbutaline makes me REALLY HOT. UGH. I have managed to avoid that symptom of pregnancy thus far. And now it is drug induced and MISERABLE.n I was able to fall asleep despite the jitters, but I woke up about 4:15 feeling panicky, but quickly realized it was the jitters from the automatic 4am dose that had just finished pumping into me. Gosh this is going to be fun!

It's now almost 6am, and I would really like for today to be less eventful, please. My husband is going in to work, and my mother is taking J for most of the day (the rest of the day I'll have several extra pairs of hands in the house to help. I will not be left alone with J... not to worry!). So I'm really, really, really hoping for a quiet, somewhat restful day. Is it so much to ask for?

Details and Followup

Okay, so my last entry was rather abrupt and seriously lacking in detail. It was a rather visceral reaction to a not-very-good appointment which frankly captured my mood, but not so much of the specifics. So let me esplain! No! There is too much. Lemme sum up... wait. This is my blog, I can take all the time I want. So here it all is... or at least as much of it as has remained in my brain since then:

Sunday
Sunday evening, as you'll recall, I was having about 4 contractions per hour and I paged the doctor on call. Dr. M called me back pretty quickly and she told me that if it continued, I should definitely come in to L&D to be monitored, but agreed that if I could sleep through them that coming in to my already-scheduled appointment at 10am was probably fine. She said that if I could sleep through them, the contractions were probably not so worrisome, but that if they were keeping me awake, I should definitely come in, get monitored, get IV fluids and probably terbutaline. She told me that I'd be seeing Dr. R in the office if I was able to hold off until morning. I wasn't thrilled to hear that. I'd never met Dr. R and I love the other three doctors and I just didn't want to meet another doctor. I couldn't, after all, possibly like a fourth doctor, could I? I don't deal well with change. At all. I get very set in my ways, so adding a new variable was definitely not something I was loving. Still, I definitely didn't want to spend all night in L&D and laying down for a few hours did slow my contractions back down to about 2-3 per hour, even if I didn't really sleep through them (Seriously... who was I kidding? I don't sleep through the best of nights!)

Monday
Monday morning I got up, took J to camp, hung out in my recliner for a bit and then headed over to my 10am appointment. I was of two minds about this appointment. On the one hand, I was a bit worried about the fact that my cervix had started to act a little wonky last Wednesday, but on the other hand, I really didn't expect that there would be any significant change, either. Other than taking J to school, I'd been pretty much continually sitting/laying down on my tush since Thursday afternoon. I hadn't done any moving around to speak of, everything had been going really well. I expected, really, to hear from the doctor "gosh, I don't know what Dr. G. was so worried about, everything's looking great." Or at least to hear, "Well, I see why he was concerned about the change, but there's not been any additional progress since Wednesday, so you're still doing fine."

Instead, one look at the ultrasound, before a single measurement was taken, and even I could tell that it wasn't good. Wednesday's measurement had been around 3cm. There was no way that it was still that long. Worse, as we were watching, we saw it start to funnel and shorten even more. The doctor froze the image and measured. 1.5cm. A few more measurements revealed that it shifted between 1.5 and 2.3 cm. This is called a "dynamic cervix". I never google this stuff, but if you DO happen to google the term "dynamic cervix" you'll see it referred to often as a precursor to an incompetent cervix. However, the doctor said that she sees a dynamic cerix a lot with high order multiples in general.

I told her that I'd been having 4+ contractions per hour the night before but they had slowed to 2-3 per hour through the night. I asked what my guideline ought to be...how long I should put up with them occurring 4 per hour before I call, etc. She said that if I'm getting 3-4 per hour for 2 hours or more after laying down, drinking water, etc. I should absolutely call. She said also that in light of my noticeably shortened cervix, I needed to "limit my activity" as much as possible. It wasn't until later that I realized I didn't know what the hell that meant. I did ask whether I could still drive J to and from day care and she said she would get someone else to do it.

She said that we could consider doing a Fetal Fibronectin test which might be one indicator of my risk of going into labor due to a cervical issue in the next two weeks. But, we couldn't do it then, because you can't do the test if you've had any sort of vaginal exam in the last 24 hours, including vaginal ultrasound. She also wanted to research whether the test was valid with triplets. She knew it was with twins, but wanted to check with triplets.

So we left things at: 1. Limit activity as much as possible; 2. No driving J. to and from day care; 3. Call if contractions increase to 3-4 per hour persistently; 4. Return for a re-check in a week - and we could consider doing the fetal fibronectin test then before the ultrasound. I waddled off to get my weight and blood pressure checked (down a pound, but didn't hear what my BP was). The doctor wandered back in to let me know that she found an article written by John Elliot about fetal fibronectin tests with triplets and quadruplets, which seemed to indicate that test results are valid even with HOMs, so she was comfortable recommending that we go ahead and do the test before my next ultrasound. Fair enough. She made a bit of friendly chatter and as I was leaving asked if the triplets were the result of IVF or IUI. Interesting that it didn't occur to her that they could have been spontaneous, but regardless. I told her that they were from a last-ditch IUI and that in fact, I'd been pushing for IVF for some time specifically to avoid the triplet scenario if possible, but here we are. I mean, I am now very excited about my triplets, don't get me wrong. But I'll tell you what, all the excitement this week was excitement I could have lived without. So she said, "Yeah, if I had needed fertility treatment, which I didn't, I'm quite fertile with three children and no need for more, thankfully, I would have done IVF because I wouldn't have wanted to risk it with IUI."

What. The. Heck? Did she seriously just say that? Yeah. She really did.

Basically I left the appointment in a haze. I made a couple calls to make sure I could arrange to have J picked up from camp that afternoon. I let my husband know what was going on. And I IM'd Jess and FREAKED THE HECK OUT. And she, good calm friend that she is, listened. And told me I really needed clarification on what "limit my activity" really means, which was true. I'm a girl who follows directions very well, if they're very specific. You tell me I may never get out of my chair ever again and I won't do it. You tell me to "use my judgment" and that's where we've got a problem. I'm not objective enough. I fully admit this character flaw. So I called my nurse to clarify. She gave me more specifics, which didn't sound terribly restrictive to me, considering that I'd already been pretty restricted in the first place. Outside of going to and from work, up until this point, my activity level has boiled mostly down to sitting my tush in my recliner and staying there, with only occasional trips into the kitchen and whatnot. So the only real difference seemed to be that I shouldn't take J to and from daycare/camp and that I shouldn't go to work anymore. I was told I needed to use my judgment about working from home, but I decided I didn't want to risk the stress of it. I was given permission to go into my office for an hour on Thursday because my coworkers were planning a "surprise" party for me (I've since cancelled that). But otherwise, trips out should be pretty much restricted to doctor's appointments.

"What we really need," the nurse said, "is to keep these babies in at least a few more weeks."
"I'm rather hoping for another 8 or 10 weeks!" I said.
"Well, I don't know about 10 weeks. Right now, we need to get you to at least 28 weeks, and we'll take every week after that as a bonus."

I. Freaked. Out. This was the first time I'd ever heard anyone from the practice ever say anything about 28 weeks being even remotely in the picture. They get most of their triplet patients to 34 weeks. It never occurred to me that I could or would be the exception to that rule. I didn't know whether she was speaking from her own experience with the practice. Or if she was speaking from specific knowledge of my case and details. Or if she was speaking based on her discussion with another doctor (she'd had another doctor review the notes from the visit before calling me back). I didn't know where it was coming from, all I knew was that I'd never, ever, ever wanted to hear those words. The whole reason I never wanted triplets was because I never wanted to hear the words, "We're hoping to get you to at least 28 weeks" or anything of the kind. I spent the rest of the day completely freaked out. How was I supposed to go an entire week without knowing what was going on? Why was waiting a week prudent? What was I waiting for? To lose another cm? I couldn't afford to lose another cm on my cervix! Ack, the stress!

I exchanged several emails with several triplet mamas who gave me some good advice, recommended I look for more agressive advice from the doctors in the practice that I know better (I did NOT come out of that appointment liking the new-to-me doctor one bit). I worried a lot. I spent a LOT of time thinking about that 28 week remark. I could not get that out of my head. That's only 4 weeks away. It can't be. There's no way that could be real. She couldn't have meant it. Could she? Eventually, I wrote my blog entry here, spent some time with S and J, and then went to bed. I was exhausted, anxious, and frankly, tired of thinking about this anymore. I would just see how I was feeling in the morning and take it one day at a time.

Tuesday
Things were going less well in the morning. I was in a blind panic most of the morning, not made any easier by the fact that the contractions had increased a lot, both in intensity and frequency. I kept thinking about that 28 week remark. I kept wondering what would happen if I waited a week. I continued to wonder when I should call the office about the contractions. I didn't want to be alarmist, but I didn't want to miss anything either. I have a tendency to second-guess myself when it comes to calling doctors because I spent a number of years getting called a hypochondriac as a kid (when all along, it turned out that, in fact, I really was sick all the time). The contractions did me the courtesy, though, of striking on the hour, every hour. Which made it easier to notice that they were every fifteen minutes. At first I thought that was crazy; it seemed a bit too coincidental. The next hour, I realized that they were closer together; almost exactly 10 minutes apart. And so I called and left a message for my nurse. And waited. And I emailed Jess and apparently freaked her out, because she immediately jumped on IM and told me that I shouldn't wait too long, I should just go straight to L&D if I didn't hear back soon. At 11:58, I called back, figuring I'd better try to catch them before they closed for lunch. My nurse said she'd talk to the doctor and call me back. Tick tock. Tick tock. Jess IM'd a list of items I should pack in a bag to take with me in case they sent me to L&D. She reminded me to call my husband (I had remembered to call him, but admittedly, it wasn't that long before Jess told me to call him that I'd realized that it hadn't occurred to me up until that point!).

My nurse called back and told me to go in to the office where they were waiting for me, so they could reevaluate me. This meant I had to see Dr. R. again, which wasn't really what I wanted given how uneasy I'd been with her the day before. But, in I went. I am nothing if not compliant. And I'm really glad I did, and very glad I saw Dr. R. in particular, because it gave me a chance to revise my first impression of her completely. She was thorough. She took a lot of time with me. She clarified a number of things. She talked me through what was going on, what the plan was, why they were going to do what they were going to do that, and this was all during her lunch break.

She went ahead and did the fetal fibronectin test before she did anything else, since it had been more than 24 hours since my last ultrasound. Then she did an ultrasound to check my cervix, and miraculously, it had lengthened since Monday! It was, at its shortest 1.7cm and at its longest it was 2.5, but it spent MOST of its time in the 2.x range, whereas on Monday it spent most of its time in the 1.x range, so this was quite the improvement. You could SEE the relief cross over the doctor's face immediately. This obviously still means that it's significantly shorter than it was last week, and even moreso than two weeks ago, so I'm not saying that I'm out of the woods or anything, but it is AWESOME. Unfortunately, this didn't get around the problem of the contractions which were coming one on top of another. "Contractions by themselves are not the enemy necessarily," she said. But when you put it all together you have to start thinking about the impact they have. So the first goal is to calm down the bulk of the contractions with a tocolytic. So I'm now on Procardia (Nifedipine) extended release tablets. That should calm most of the "background contractions" which will allow them to concentrate on the breakthrough contractions which are more likely the ones that they need to worry about. And for those, I've got immediate-release Procardia.

I will also be using a Home Uterine Activity Monitoring Service (HUAM). There are mixed reviews on whether HUAM does any good. The possible benefit that comes from HUAM is debated... some researchers believe the benefit actually comes from the close contact that patients have with a medical professional on a daily basis. Some researchers, in fact, believe that there may be a possible negative effect on patients because it could cause additional anxiety. Dr. R. said that this practice does frequently use HUAM, but that she came from a background of practices in which they did not frequently use HUAM. She wanted to make sure that I understood that I should not allow the monitoring to cause any additional anxiety. I told her that as far as I'm concerned it's nothing more than a datapoint to help piece the puzzle together. She agreed that this is precisely how it should be viewed.

She then took some time to really talk about what I can and cannot do. She said that whenever possible, I should do nothing, but recognized that I have a four year old in the house and sometimes that's not 100% possible. However, I should avoid anything that involves prolonged standing, excess stairs, I should do no lifting, no reaching, no cooking. I can get up to go to the bathroom, I can get up to get a sandwich. Combining trips would be good. I can stay in the recliner instead of bed if I am sufficiently reclined. Sitting upright is bad. Doing nothing is good. "You need to understand, however, that if you get up for a sandwich and your membranes rupture, you did not cause it to happen. It did not happen because you stood up, it did not happen because you wanted a sandwich. It will not be your fault." She said the truth is they don't know how much, if at all, bed rest helps, but that that it certainly seems that bed rest does a lot more to prolong pregnancy with higher order multiples than it does with singletons. (I realize as I'm writing this that I failed to ask about showers...)

She said that the next ten weeks were going to be a very long and tedious ten weeks for me and I said, "do I have another 10 weeks in me?" I told her about the 28 week remark that had so freaked me out the day before and she explained that a bit to me. First of all, on Monday they really had been worried. But more significantly, the nurse who said it comes from a NICU background and with preemies, the 28 week mark is a SIGNIFICANT milestone. The difference between a 24 weeker and a 28 weeker is astounding, she said. (A pediatrician friend of mine explained even more explicitly... she said with a 24 weeker, you spent the first week in electrolyte hell, and the next 6 months worrying about whether electrolyte hell caused brain issues, but when you get to or at least closer to 28 weeks, more of the prematurity issues you're dealing with are growth and development issues, rather than brain issues) She emphasized that it is absolutely still the goal to get me to 34 weeks, but that definitely the first milestone they want to get me to between now and then is 28 weeks. Then they'll be looking to 30 weeks, 32, and if I get to 34, she'll bring me a cupcake (which actually, she won't because she's moving back to Boston before I get to 34 weeks, but the thought is there). I felt a LOT better about the 28 week remark after that.

She also talked a little bit about the possibility of bringing me in-house for hospital bed rest. This isn't something they normally like to do for triplet patients if they can help it, but it's definitely under consideration for me. I bought myself some time, though, since my cervix lengthened a bit. They're going to keep a pretty close watch on me, but will continue to keep the idea under consideration and we'll just have to see how it goes. I continue to be astounded at just how quickly things change in this pregnancy. I am very grateful to have a team of truly excellent doctors. Yesterday it became clear that a lot had gone on behind the scenes within the practice that I didn't know about. Clearly my case had been discussed more than once among the practice members between my two visits (which were only about 26 hours apart). It's good to know I'm more than just a name and Patient ID number.

More good news... she called me at 6:30pm to let me know she'd gotten the fetal fibronectin result and it was negative, which is great. It means I've got a low likelihood of going into labor in the next two weeks due to a cervical issue. We can repeat the test in two weeks and continue to do so. They'll try to use the test as one way to help determine when to give me steroids to mature the babies' lungs. They don't want to give them too early, because they don't want to have to repeat treatments too many times before the babies are born. They'll give the steroids to me at 30 and 32 weeks regardless, but they'll give them to me sooner, if they need to.

Anyway, all in all, I feel a lot calmer. It was a much better visit. Although I don't love that I was having that many contractions, I feel like a lot of good came of having to go into the office, so I'm not sorry about the result. And in our next episode, I'll describe Wednesday's antics of getting the home monitoring set up. All I have to say is that this bed rest thing is seriously harder work and more stress than just going to the office!

Sorry for the novel, but a lot has happened in a short period!

Fuck

I don't curse a lot in my blog, if you haven't noticed. In real life I curse like a sailor's daughter (appropriate, since my dad was a submariner), but in the blogosphere, not so much. But honestly, I don't know what else to title this post. I've been trying to write it all day, but I just can't. So instead of really writing the full-blown story of what transpired, here are the basic important details:

July 5 cervix length: 4+ centimeters
July 11 cervix length: 3+ centimeters
July 16 cervix length: 1.5-2.3 centimeters (variable... apparently I have a "dynamic" cervix, which isn't quite the compliment that it sounds like)

Today, for the first time, I didn't hear about the fact that I would have a scheduled c-section at 34 weeks. Today I heard a new, and extremely frightening phrase: "We are hoping to get you to 28 weeks. Every week beyond that is bonus."

So I'm sorry if I'm offending anyone with my foul language, but I truly don't know WHAT to say other than FUCKITY FUCK FUCK FUCK.

Math is Hard

So on Wednesday Dr. G told me if I started having contractions any more frequently I should call immediately. I was then having contractions about 2-3 times per hour for several hours at a time. On Saturday, I was having a steady 3 contractions per hour for several hours at a time, but I wasn't sure if that counted as more frequent or not, so I didn't call. Today, on my way home from Baltimore, where I'd gone out for dinner with S, J, and a friend, figuring it's probably the last time I'm going to be allowed out for a LONG TIME, I had at least four contractions on the 45 minute drive home. I came home, drank some water and laid down on my left side for 45 minutes, during which time I had another 3 contractions. And so I paged the doctor on call.

She agreed that 3-4 contractions per hour was worth paying attention to and said that if it persisted I should head over to L&D, but agreed that if I can sleep through them, they probably aren't that worrisome. So, since I have a 10am appointment at the office tomorrow for a cervix check anyway, and since I really don't want to be in L&D all night, I asked if it's a rotten strategy to just try and sleep. She said no, and recommended benadryl. But, she cautioned, if the contractions are strong enough and frequent enough to wake me through the benadryl, I should go in, and I should also be sure to push fluids as much as possible.

This is creating quite the catch-22. The fluids, I mean. Because at one of my early appointments, Dr. P. warned me that a really full bladder can trigger contractions, and I'm pretty sure he's right. So I'm peeing a lot, which is keeping me awake, but I'm also thirsty as hell, because, well, I'm peeing a lot, which is creating a vicious cycle. And I'm having a few contractions, but I don't think it's quite 4 per hour, but I couldn't really tell you because I'm so tired and loopy I can hardly keep track. I'm guessing I should think about writing them down. They're not comfortable, but I wouldn't call them painful either. Suffice it to say, I'm guessing the next 10 weeks or so are going to be oh-so-fun-filled. If I make it that far. I hope I do.

Anywhozit, I do think the contractions have slowed down and I've decided not to worry about this until morning when I go see the doctor anyway. The one doctor I haven't met and am not particularly interested in meeting, but I suppose it can't hurt. I wish I were seeing Dr. G. Or Dr. P. Or Dr. M. Le Sigh. I guess a girl can't have everything.

*Screeeeech*

Yeah, so, um... I finally did it. I set an end date at work. I thought it was reasonable. I set it for the 20th. I'll be 24 weeks, 2 days. In fact, I thought maybe it was being slightly alarmist and silly. But I had gotten that lecture from my doctor two weeks ago about cutting back at work, and I thought it made sense to start thinking about an end date. Cutting back my hours was clearly only going to go so far. But two weeks ago, it still seemed a little silly, particularly with a 4cm, tightly closed cervix. Nevertheless, I DID set that end date, with the caveat to my client that the date could always change to an earlier date if my doctor slammed on the brakes. But that was never going to happen, you know. Because, seriously, did I mention that beautiful 4cm tightly closed cervix?

Yeah.

So I happen to know that the people that read my blog are smart and sophisticated as evidenced by your reactions to my informal froggy poll. See, I liked the froggies, Jess didn't. Jess's readers didn't love the frogs. MY readers? You mostly loved the froggies. Therefore, I know you are smart, sophisticated, and highly evolved. So I have this sneaking suspicion that you know where I'm going with this story. Because, as I said, you are smart.

I went to the doctor today, and accused him of putting a Mayan curse on me. See, just a couple days after the lecture I got about not working so much, I felt like I'd been hit by a truck. All of a sudden, I was dragging. Walking became a zillion times more tedious. Breathing became a chore. Contractions started happening more often (but still not SO often that I was worried). Dragging myself to the office was questionably sane. Cutting back my hours suddenly seemed very wise. So my theory is that the doctor KNEW I wasn't going to follow the strict letter of the law on the lecture I'd gotten, so he put a Mayan curse on me. So when he came in, he said, "How are you feeling?"

"I think you put a Mayan curse on me."
"Oh? Why would you think that?" (Please note the distinct LACK of a specific DENIAL here)
"Because immediately after you lecturing me about cutting back on working or stopping work, I suddenly felt like I'd been hit by a truck. Did you just know I wouldn't otherwise listen?"
"Pretty much. So does that mean you've stopped working?"
"Uh... no, but I'm going to soon?"
"Yeah, you're going to REAL soon."
"Can I squeeze out one more week?"
"Not so much."
"Really?"

Yeah, so my cervix has shortened to 3cm, which is still astoundingly fabulous for a chick who is 23 weeks pregnant with triplets. Still, that's a bit of a jump and he doesn't love it. What he loves even less is that he's starting to see some slight evidence of funneling, which is decidedly not good. He did say that many other doctors would look at these pictures and say there's nothing wrong here at all. "BUT," he cautioned, "With a triplet pregnancy, there's a lot at stake and we try to look for any early sign of any possible problem so that it doesn't become a big problem. It's possible I'm being overly cautious where another doctor would choose not to be, and if you were pregnant with a singleton, I wouldn't think twice about this." Yup, and that's why I'm seeing THIS practice and not another. They handle a LOT of triplets, but they take NO risks. I will do what they say. So what he's saying today is that I may go to work tomorrow, and I may take my foster-son to his developmental evaluation on Friday as planned, but only on the condition that I return to the office on Monday for a cervical check. If nothing has changed, he will clear me to work from home for the week so that I can wrap up my final projects. If things have progressed, he will tell me I'm done, regardless of how my projects stand.

Oh, and he's not so happy that I didn't call about the contractions. But the last time I called about the contractions (when I was 17 1/2 weeks pregnant), I got "ho hum, could be normal" from the doctor on call...not a doctor I've ever seen in real life, and not a doctor it appears I'll EVER see in real life as it sounds like she's actually leaving the practice. Furthermore, the guidance I'd been told all along was to call if I get more than four contractions per hour. I don't get more than four, I get 2-3 per hour. However, I now have strict instructions that if this increases even to a steady 3 per hour or more, I should call immediately. "We could do at home monitoring for you, but that's really a pain in the ass, so we'd really rather not if we can avoid it," he said. Anyway, he doesn't think the contractions are too big a concern by themselves, but combined with the slight funneling, he's not thrilled and wants to know if there is any change at all. Got it. I'm okay with that.

In other news, these little guys (or gals) are doing great... they are all measuring at 1 pound, 2 ounces each. They are all growing perfectly. They are fighting each other a lot, which is good. Apparently the constant stimulation in utero is good, because it's part of what helps their lungs develop. I think that's pretty cool. My blood pressure is still good and I asked about my high pulse and he's not worried because it's completely attributable to my increased blood volume. He said if it gets into the 120s that he'll be worried, but in the low 100's (where it's been) he's not worried at all (though I gotta tell you, it's not real pleasant for ME!).

I'll write more about how and what I'm feeling (physically) and what the kiddos looked like at the ultrasound in a separate post. Right now I'm tired and need to lay down for a bit. I might get motivated enough to scan todays ultrasound pictures eventually. We'll see.