TAC Hints and Tips

It's been four days since my surgery (which, wow...time has flown!) and I feel loads better. The eight-hour drive home yesterday wasn't the worst, although sitting in one position for a couple hours meant that each stop we made to walk started out roughly. We probably made four half hour stops or so. It might have been better to stop every hour for a shorter amount of time, but on the other hand the extended walking really helped. So it's probably a wash in terms of which is really more beneficial in the long run. There were two painful times that stuck out in my head: one was laughing, and one was coughing. Both suck donkey balls. While we were walking at a rest stop, Chris made some ridiculous comment about pooping and intestines (you know you married the right man when you can talk to him about not pooping for four days) and I started to laugh, and felt one of the worst pains I'd experienced since the first day. It left me breathless and in tears. However, it did diminish fairly quickly, so I know that the healing is going well. The second was after a drink of water went down the wrong way, and I coughed. I was sitting in the car during that one, so there was little I could do for it except press the travel pillow in harder and breathe through it. That pain lingered for a while, I think because I wasn't able to walk it off.

In terms of how I feel right this very second, I'm good. I actually feel pretty great and have experienced just a little pain today. I'm still wearing the abdominal binder, and it's made a world of difference, and I'll be able to use it again after future C-sections. It's also helped keep the swelling down. The swelling hurts worse than the incision itself, I think. It's very tender and raw, though the binder helps with that. Still, the worst is that burning sensation I've talked about.  Updated: I've since learned that it's the nerves regenerating, and it's actually a GOOD thing, since some people permanently lose sensation in areas after surgery (any surgery).

My back still hurts from holding it so stiffly. And my chest and lungs ache. Those things reaffirm to me that I made the right decision, since traditional cerclages often require bed rest, and my body just doesn't do that well. I remember it from when I was on bed rest with Caleb too - even after just a few hours of laying flat on my back, my lungs start to get congested and it gets difficult for me to breathe. I was made to be active! The trans-abdominal cerclage will allow me an almost completely normal pregnancy (knock on wood, fingers crossed, and all that).

So what tips or tricks do I have? Man, I don't know. I think this surgery is so different for everyone, but I'll tell you what helped me:

1. Get the first surgery slot in the morning!
This was the biggest difference, I think, between my fairly relaxed, on-time surgery with minimal waiting and lots of time with Dr. Haney and Trisha's crazier one that involved lots of waiting and little time with the doctor.

2. Bring your travel pillow...and lots of other pillows and blankets.
Ok, maybe not lots. But we brought the travel pillow (which is recommended up the wazoo by other ladies who have been here, for good reasons), and two full size pillows: a body pillow and a slightly firm foam pillow. Both from home, straight from our bed. First, it's comforting to have something from home. You don't even realize it, but the smell and the shape and the way you sink into it just like you do at home...all those things help you relax a bit more. Second, the hospital pillow was nothing. Maybe an inch thick. Might as well have tried to use an envelope for a pillow. Third, it helps you get into and stay in a comfortable position by offering support around your sides. I also brought a blanket - my "blankie" if you will. It's not a full-size blanket; more like a throw. Suede-ish texture on one side and faux fur in a tan zebra print on the other. I'm sure it sounds hideous, but it's a) really cute and b) really warm and c) super soft and d) super comfy and e) super comforTING. It was a Christmas present from one of my friends years ago, and while I don't go so far as to take it with me on vacations and stuff, I do use it almost every night. I had it in the hospital with me while I was on bed rest and had it with me when we delivered Caleb. So it's very special. But outside of the sappiness, hospital can be cold, so it's nice to have a good blanket.

3. Think about an abdominal binder.
Actually, don't think. Just get one. It's pricey, yes. But now having used it, I'd pay twice the amount. I have this one. There are other products out there, like the Belly Bandit, but this one was made specifically for post C-sections and abdominal surgeries. It helps support the incision, and the compression helps with post-surgery swelling. When I first used it, I thought that it was the cause of that super painful burning, like maybe it was putting too much pressure on it or causing a rash, but after talking to Trisha and taking the binder off, I realized that it wasn't related at all. I have it on pretty much all day and then take it off at night to let the incision breathe. The feeling of the surgery site with it on and with it off is night and day. Updated: Again, I've since learned that the burning is the nerves regenerating. NOTE: Some hospitals provide these. ASK before buying!

4. Keep ahead of the pain.
Use the pain meds they give you. They are there for a reason! You won't get a prize at the end for not using them.

5. Move around.
The more you move, the more it hurts...but the better it feels in the long run. It's painful. It's excruciating. You might experience a weird burning sensation that is more painful than everything else put together (Updated: the nerves again!). But it goes away, and each time you walk it will go away more quickly. I tried to get up and walk the hallways at the hotel every hour or so. Make your spouse or whoever is taking care of you make you do it. There were many times I wouldn't have done it without Chris, and I'm glad he was there. On the drive home, we stopped for about 20-30 minutes every two hours. If you’re flying, be sure to walk the aisles regularly. Don’t worry about what anyone thinks of you, limping along, walking slowly, hunched over, clutching your travel pillow. You will never see these people again, and you need to take care of youself. Just do it!

6. Don't overdo it.
You don't want you incision to open up, and you don't want the pain to become unbearable. If you overdo it, you'll be less likely to want to move around again in an hour, and in the long run that will prolong your healing time.

7. Drink lots of water and eat healthy food with lots of fiber.
Don't eat heavy, rich foods before or after the surgery. You won't poop for a few days anyway. Eating light foods - avoiding fried food or any of that food that makes you tired afterward - and drinking lots and lots of water will help you work through it. So say no to that hamburger and yes to that grilled salmon salad. Or something. I started taking Colace three days before the surgery and am continuing now. For what it's worth, I still haven't pooped...but it's not painful. Yet. UPDATE: I pooped. It was horrifically painful. I cried. I should have followed my own advice more. So to this I add: Drink MORE water. MORE. Have a water bottle with you at all times for the few days leading up to the surgery, bring a water bottle to the hospital, and have one with you when you leave. Make sure it's always full, and always be drinking from it. Also, eat lots of high-fiber foods. Raisins. Prune juice. FiberOne bars. Whatever it takes! And maybe take some of your drugs before you go for the first time. Note: If you are having your surgery at UCM, they don't give you a water bottle. You get a pitcher and paper cups. I should have brought one with me to the hospital to make drinking while laying down easier.

8. Go pee regularly once your catheter is out.
I don't know if this is universal, but for me, the pressure of a full bladder is really, really uncomfortable and actually makes standing and walking painful. So go pee right when you first feel that little tingle to avoid it. Keeping your bladder as empty as possible will keep you comfortable. And besides, you should be walking all the time anyway. ;)

9. Stretchy, comfy clothes.
I wore the hospital gown the entire time I was at the hospital. Once I got discharged, I changed into lounge pants, a tank top, and a sweater. I bought the lounge pants at Target the day before we left in a size larger than normal (they tie so I can cinch them tighter if needed). I can wear them above the incision or below and they're perfect. I have a million pairs of these Supersoft Hiphuggers from Victoria's Secret and they are the perfect post-surgery underwear. No tight elastic and they sit higher than the incision so there's no rubbing. I also brought a light summer dress (like this chemise from Anthropologie; thank you birthday gift cards!) that would have been completely perfect and I wouldn't have to worry about the waistline irritating the incision, but I never wore it. Truth be told, I barely changed. I wore one outfit on the drive down, lounge pants and a tank to the surgery, that same lounge pants and tank home to the hotel, and then stayed in same outfit for the next two days. I know, I'm dirty. I changed into different pants and a tank for the drive home, more for the sake of anyone I might run into at rest stops than my own. Looking like a dirty hobo who hasn't washed her hair in days for my husband is one thing, but for the general public I'd prefer a slightly cleaner reputation.

10. Get a Brazilian wax.
I'll give you a second to compose yourself. But seriously. It helped. Well, it didn't help, I guess, but it definitely prevented some uncomfortableness and pain. You don't have to go full Brazilian, but getting rid of the hair around where the incision was going to be definitely made life easier for both me and the surgical staff. When they pulled off the bandage, it didn't hurt at all, since there was no hair for the tape to pull out. Before the surgery, the staff didn't have to shave or clean up the area at all. I guess usually they shave it, and then use strong tape to pull up any remaining hairs, so basically a wax anyway. Might as well get it done by a pro! One of the nurses asked if I got it done just for the surgery, and said she always tells friends to do it when they're having C-sections or other surgeries in the same area. And yes, it's pretty painful if you've never had one before. But compared to the surgery itself, it's a piece of cake. Take a few ibuprofen, forcefully breathe out with each strip getting pulled off, and if you're really worried use some of this.


11. If your surgery is at UCM, use valet parking.
It's cheaper than the parking garage (for all time periods) once you get it validated from the hospital.

That's really about it. I slept most of the time in the hospital, so I didn't have to worry too much about entertaining myself. When I was awake, I watched bad TV or read a book. Chris got a new computer game just before he left so he played that pretty much the entire time and was glad for an excuse to sit around and play it. We brought a bunch of movies and TV shows and I downloaded a ton of books for the Kindle, but we ended up not really needing most of it. Your experience might be different, though, so I'd take all that you can. Better too much to do than to end up bored!

If anyone has any questions at all, please feel free to ask! Trisha is a great resource as well, especially if you're having it placed during pregnancy. Just know that you will hurt. You will be swollen. It will burn (though I still don't know exactly what is causing that). But quite literally, it gets about 50% better each day.

All in all, I think it's pretty obvious that this will be well worth it once we've got our one or two or three or four kids running around the house. Knock on wood, cross your fingers, and all that.

Superhero: The TAC Details

I now have a bionic cervix. Does that make me a superhero? A super woman who is now able to carry a child to term! Oh, wait. That's most women.

Prior to heading out to Chicago, I'd read other stories of the surgery - particularly Trisha's and Jaded's - and had very specific ideas about what to expect. None of them truly prepared me for the excruciating pain. I don't think that it's possible to really wrap your head around it unless you're actually experiencing it. I was also expecting a ton of waiting and it to be loud and busy and crazy, but since I was the first surgery of the day, it was the opposite. Yes, we had to check in at 6am, which meant waking up at 5am, but it was well worth it. We didn't have to really wait at all, and everything proceeded on time. Highly recommended to get that slot if you can swing it.

We left Omaha Wednesday afternoon to drive out to Chicago, which took about an hour and a half longer due to tons of construction. On the way there, I got a call from the hospital asking if I'd consent to having my surgery photographed for some magazine. Of course I said yes - I'm all for educating anyone I can about the TAC. I told Trisha about it and she joked that my cervix would now be bionic AND famous. Autographs, anyone?

Once we arrived in Chicago, we got some deep dish pizza (can you go to Chicago without doing that?), checked into the hotel, and grabbed a few hours of sleep. I wasn't nervous at all, surprisingly. The next morning we woke up early, around 5:30, and headed to the hospital. We found the parking garage right away, and note: you do have to pay to park. Which...am I just small town spoiled? Paying to park at a hospital? Valet is actually cheaper, so I recommend that, and obviously that has the advantage of delivering you right to the door.

Once we checked in, Chris was given some paperwork to read over and a code that he could use to check my progress on a monitor. I was called to pre-op almost immediately with three other patients who were also having various surgeries. They set me up in a little curtained-off area with a recliner where I changed into the hospital gown, was given an IV, took a pregnancy test (which I knew would be negative, sob) and answered a bunch of questions about my medical history. When she was putting in the IV, she couldn't do it in the back of my hand like she prefers, because I have "tiny" veins. She has to do it in the crook of my elbow, which meant I had to keep my arm straight...a problem since they put it in my left arm and I'm left handed. So ouch. After about 45 minutes, they brought Chris back to wait with me. Dr. Haney, a few of his staff, the anesthesiologist, and a few residents talked to us, answering any questions we had and giving the details of how the next two days would progress. I was under the impression that I'd be given the choice between general anesthesia and a spinal, but I don't remember them actually asking. I told them about my bad epidural experience, so maybe they made the choice for me based on that. The nurse then walked me back to the OR room, and Chris went back to the waiting room.

The OR room was just like in the movies - bright white, big lights, bed in the middle of the room. It was a little surreal. They strapped me onto the bed with my arms out, crucifix style...and that's the last thing I remember.

The surgery took about two hours - longer than average thanks to my severely retroverted uterus. After it was over and I was in recovery, Dr. Haney talked to Chris for about 20 minutes and let him know that the surgery went well, and they talked about the loss that we experienced. Dr. Haney told Chris that while I was going under I was chanting to the staff, "Let's do this! Yeah! Bionic Cervix! Whoo!" and got them all excited. Don't ever give me drugs. When I woke up, I was in a recovery room and Chris was next to me. I remember very little about the next few hours. I felt really shitty. My stomach didn't hurt - but my head was groggy and I felt dizzy and nauseated, like a really bad hangover. I was in recovery for about three hours, and drifted in and out of consciousness for most of it. I vaguely remember Chris taking this picture of me and asking if I looked cute. Obviously the answer is a resounding NO, but he said yes like a good husband. That black cord I'm clutching for dear life is the pain pump. I could press a button every eight minutes to dispense pain meds.

After I was deemed sufficiently awake, the transporter (sadly, not Jason Statham) wheeled us across the hospital complex to my recovery room in maternity. It shows how far I've come in my grief that it only momentarily bothered me. The last time I was in a maternity room was after delivering Caleb.

Chris brought up a body pillow, another pillow, and a blanket that we'd brought from home. Best idea EVER. I would not have been even the slightest bit comfortable without those things. We spent the day watching TV, movies, and I slept on and off. Chris played Civilization 5, and I think he was glad to have an excuse to be off work and play a computer game all day. ;) In terms of pain, there was actually very little from the incision. However, I was extremely dizzy and felt sick whenever I moved my head. I attempted to have some water and a bit of a smoothie, and immediately threw it up. Hours later I tried to eat dinner, and threw that up too. The puking is what caused my incision to hurt - without that, I would have still been fine, pain-wise. Of course, that also could have been thanks to the pain pump. Since after dinner I was still feeling dizzy and nauseous, the anesthesia resident came to check on me. I had to get my blood pressure taken laying down, sitting up, and standing. Standing, it was 90/60, which I thought was low, but apparently it was okay. The resident said I was just taking a long time to recover from the anesthesia - that is, after grilling me to make sure I wasn't suffering from drug withdrawls. "Could you be suffering from withdrawl from anything? Do you take any illegal drugs? Be honest." Yes, ma'am. The lack of heroin at the hospital is positively disgraceful! Ok, I shouldn't laugh. I know people lie about drug use all the time at hospitals. But I'm me, and I'm so not a drug user...I don't even drink caffeine. (Not because I'm some crazy health nut, but because it upsets my stomach, so you can go back to not being impressed.) That was the first time I'd sat up or stood and it hurt like a mother effer.

Shortly thereafter, around 10:30, Chris headed over to the hotel to sleep for the night. I fell asleep right after he left, but woke up off and on until about 3am, when I woke up for good. I passed the time reading and watching TV, which was difficult since I had the IV in my left arm and had to keep it straight. Every time I bent it, an alarm would go off and I had to call the nurse to turn it off. A catheter had been placed during the surgery (while I was out of it), and I hadn't even realized it until a few hours into the day. At one point I felt like I had to pee really badly, which I knew wasn't right because of the catheter (which, by the way, I couldn't feel at all and didn't hurt a bit). I had to call the nurse yet again - I think I was a "problem" patient - and it turned out the tubing had gotten tangled so it wasn't draining correctly. The relief I felt after she untangled it was amazing. I wouldn't mind having one of those all the time, you know, minus the whole having to carry around a pee bag thing.

At 4am - almost a full day after the surgery and a little over twelve hours since I'd been in recovery - the nurse came to remove the IV and catheter. Neither hurt, but since I was still feeling dizzy from the drugs, the nurse decided to keep the IV cap in just in case I couldn't keep down the pain pills and they needed to do intravenous drugs again. Luckily, I was able to keep down two Percocet. Just after that, I had to get up to pee, which was again excruciating. It was actually kind of funny (the situation, not the pain), because I couldn't go. I could feel it right there, but nothing was happening...so the nurse ran some water and put my hand in warm water. Is that funny just to me? That nurses use frat party tricks to make you pee? Okay then.

After that she had me sit in the chair for a few hours. Apparently I was supposed to have done that the day before, but due to the dizzy spells didn't want to risk it. Around seven I got back in bed and tried to get some more sleep. Dr. Haney came and talked to me for almost an hour around 8am to make sure I didn't have any more questions. We talked a bit about the sad state of treatment for second trimester losses. Chris made it back to the hospital around 9:30 (after leaving an hour earlier... Chicago traffic!), just in time to miss both Dr. Haney and a crying jag, after I'd asked twice for more pain pills and over an hour later they still hadn't arrived. That was the only real failing of the hospital, and the nurse apologized profusely when she finally showed up. I had some breakfast - about one bite of sausage and one bite of French toast - I just wasn't hungry at all. I was able to keep that down, so they decided I was okay to be discharged. They removed the IV cap, I changed into my street clothes, got one last dose of Percocet, and waited for the transporter to arrive to wheel us out to the car. I was still feeling the incision from puking, and was still dizzy and feeling slightly nauseous. However, as you can tell from the picture, I felt a lot better.

The ride to the hotel sucked for obvious reasons, as did the walk from the parking garage to the hotel room. I'm sure I looked like total hell and like someone fresh of a bender or something. Chris made me get up and walk around the room every hour or so, and oh my god. I don't know exactly what caused it, but Trish said she had it too, so it must be normal, but there was this burning sensation that was beyond excruciating. It wasn't at the site of the incision, but off to the side. I have no idea what it was, but I still feel it occasionally, and it's the most painful part. I kept taking two Percocet every few hours until I passed out for the night. [Edit: I not know that it's the nerves regenerating! So it's a good pain. Super incredibly painful and shitty, but it means everything is healing!]

The next morning (this morning) I woke up and could tell it felt a ton better already. I still have slight dizziness occasionally and the incision is still painful, but the terrible burning sensation is mostly gone. Don't get me wrong - walking around still sucks. And my back is killing me from walking around stooped over. But compared to yesterday I already feel better. I haven't had any discharge or bleeding, which I know some women experience. I bought an abdominal binder that is specifically for use after C-sections and abdominal surgery, which has helped quite a bit by supporting it and offering constant pressure. I also take a travel pillow with me to press against it when I am standing up or coughing or whatever. Each time I walk it's really painful for the first few steps, then gets progressively better. Right now, it's a toss up between what hurts worst - my back or my incision. I'm down to one Percocet every three hours. The bottle actually says one pill every four to six hours, but the hospital said one to two every three or four hours, and I called my best pharmacist friend and he told me that what the hospital said is fine, especially for just a few days. They gave me 50 pills, which means I'll have plenty left over to sell on the black market. Takers?

I keep half joking to Chris that I'd better get fucking pregnant now that I've gone through this. And I will say that I'm now scared of the C-sections that I'll be having in the future...this is painful shit! And to do this on top of having a newborn? Yikes. I don't know how people do it. Maybe the newborn cuteness acts as a numbing agent or something.

So now I just wait. Wait to feel back to normal, wait to get knocked up, wait to put this damn thing to use. Oh, and wait to shower. I am grosssssss right now.

Emotions

I don't know why, but this week has been really hard. I made it past Caleb's due date, and it was hard, but I survived. A couple weeks later our good friends had their baby girl, and I'm just thrilled for them. Insanely jealous, of course, but I think that's to be expected. I love seeing pictures of her.

But for some reason, I've just been really emotional and sad this week. I don't know exactly why. I know I'm disappointed that I'm not pregnant yet. I know I'm sad that I don't have a newborn. I know I'm sad that I never got to complain about stretch marks or swollen ankles. I know I'm so frustrated that all these sixteen-year-old girls with no jobs and no insurance and no support keep getting pregnant. I know that I'm just so stressed and mad at work and every day that I'm there reminds me that I was going to quit after the baby was born and work from home on my own business, and take care of the baby. I know that I see babies and pregnant women everywhere and while it no longer sends a knife thought my heart, I still think about how unfair it is that it's a breeze for most women, but the women who seem to want it the most have to fight for it the hardest, and some of them never achieve it. I know that I got in a fight with Chris yesterday and started crying and couldn't stop and I'm crying now and I have to suck it up and stop because I need to leave for an engagement shoot in seven minutes.

My surgery is in just a few days, and I'm so excited. Not scared, yet. Talk to me again when they're coming at me with a scalpel and I might feel differently. But not yet. I'm excited, but I'm worried. For the vast majority of women who get the TAC placed pre-pregnancy, there's absolutely no impact on their ability to concieve. But for a very few number, it does seem to make it more difficult. I should be able to relax in comfort knowing that almost everyone is able to go on and have a baby with no problem, but once you're on the losing side of statistics, you never find numbers comforting again.

God, I just want to be pregnant. I just want a baby. Sigh.

The Man with the Plan

So, like I said in my previous post, my surgery is scheduled for September 30. I have to report to the hospital at 6am (SIX. A. M. Gahhhhh.) on Thursday the 30th. I'll be there overnight and discharged Friday, then we'll come home Sunday (I mentioned this is all going on six hours away in Chicago, right?). I should be able to resume normal activities about 10 days later.

It will be similar to recovery from a C-section, only without the trauma of just having pulled an 8lb baby out of the incision. On the downside, you also don't have a cute newborn to distract you from the fact that there are staples. Staples in your stomach. Where no staples should ever be. Maybe I'll put a bib on Riley (our 100lb hound dog) and pretend that he's a baby. That's veering off into towel-baby territory, isn't it? I'll just take a step back from that statement now.

Ahem.

After all my worries that Chris wanted to wait an extra month or two before we started to try again, he DID decide that he was on the bandwagon to FWP last month (FWP = my favorite baby-making acronym: 'fucking with purpose.' Be sure not to put a typo there and type 'fucking with porpoise,' which is an entirely different animal. Literally.).

Sadly, the much-despised Aunt Flo is here, so month one of trying to conceive is a bust. That's probably a good thing since Chris spent much of the time in the week before I ovulated drinking with his buddies,* and I'd prefer a non-flipper baby...but now that I say that I'll absolutely take a flipper baby if that's what I get. Hey, he'd be a great swimmer, right?? We're not waiting until after the surgery to keep trying for a baby, however. If I get pregnant between now and then, we'll just push the surgery back until I'm 10 weeks along, which is when they prefer to perform the procedure if you're doing it during pregnancy.

T-minus 36 days. Whooo!



*Chris was actually pretty cute when he realized that we'd been trying that week - he freaked out a little that he'd gone to a bachelor party and told me that next time I needed to let him know beforehand so he can not drink. Which is a pretty generous offer considering his work has beer Fridays. My work doesn't have beer Fridays. I want my work to have beer Fridays, and then I want to NOT be able to participate because I'm knocked up.

EEEEK!

September 30. It's on!

I think I'm going to do it!

Where it stands right now is.....

I think I'm going to do it. Almost everyone I've talked to has expressed the same thought I have: "Better safe than sorry." If a (fairly) minor surgery is what it takes, then it's a small price to pay. I keep reading story after story after story about TVC (the vaginal cerclage) failing, especially when it's placed on an emergency basis. Apparently your cervix can tear right through that sucker. Who knew?

I keep thinking: if I don't get it placed and something happens, I'll never forgive myself. I'll blame ME for losing another pregnancy, or if my child has health problems from being a preemie, or anything like that. But. If I got it placed and NOTHING happens, and I have a successful pregnancy, I'll never know whether it's because the first time was a fluke or if it was because the TAC (abdominal cerclage) worked. Obviously, since the TAC was the only thing that would have changed, I'll assume it was that. Therefore, I won't be able to regret having it placed. Does that make sense? And if, God forbid, I had another loss after it was placed, I'll know that I would have done everything I could have done to prevent it. In all those scenarios, the only time I come up with any possible regret is if I DON'T do it. So I have to do it.

Granted, something could go wrong with the surgery itself. I could have a bad reaction to some part of the it, but the risk there is so minimal I can't consider it. I've gone under before, and generally they say if you've done it once without issue you'll be fine in the future. And Dr. Haney is one of the few doctors in the world who is an expert at this, so I feel 100% confident in him doing the surgery.

Dr. Haney has another Omaha patient who was cared for by the team at the other big hospital here, and I called that MFM team today and they are willing to take me on - and support the TAC decision - once I am pregnant.

So if a C-Section is what it takes to get our take home baby...well, then my husband can just thank his precious-vajayjay-not-ripped-up-from-vaginal-delivery stars.

Now all I need is to get the surgery scheduled and to get knocked up!

Conflict resolution

Hmmm.

HMMMMM.

That's all I can really say. Once again, I'm super conflicted and left to sort out the pieces on my own. I said it in one of my other posts, but I'll say it again: I hate that the lives of future children depend on me making the right choice in treatment. This is why we GO to doctors! So they can tell us what to do! I want to blindly be pointed in the right direction, please.

I had the Maternal-Fetal Medicine appointment today and it was a mixed bag. On the plus side, he agreed that the loss could very likely be the result of an incompetent cervix.

On the down side, that's about all he agreed with.

He would place me on progesterone shots, though there's no evidence that they are helpful one way or another with 2nd trimester losses like mine - they're proven to help later in pregnancy, but studies haven't shown they are helpful at 20 weeks. But then, they haven't been shown to NOT be helpful either, so there's no reason not to use them.

Where we really derail is regarding the cerclages. He believes that a TAC - or any cerclage, even - is overkill. He wouldn't place a preventative vaginal cerclage at 12 weeks, but would place an emergency one if the bi-weekly* cervical scans showed funneling or shortening of the cervix. He listed the risks of TVCs as the main argument against using one unless absolutely necessary, such as risk of rupture, infection, the cervix rejecting the stitches, etc. When I brought up TACs, he repeated the conventional wisdom: that they are only used when TVCs fail. He also said if a TVC is overkill, a TAC is beyond overkill; that it's riskier to place a TAC; that you always have to deliver via C-Section (all of which I knew).

I asked if there was a chance that your cervix could go from "okay" to "Houston, we have a problem!" in the two weeks between checks, and he said it's possibly but not likely.

Dude, it wasn't likely that my water would break and I'd lose my son. NOT LIKELY means nothing to me at this point. When you're on the losing side of statistics, numbers are never comforting again. (Ahem...a bit of frustration apparently, there.) I asked if doing weekly checks during the timeframe when my water broke would help at all, and he said it wasn't necessary but if it would make me more comfortable, he'd have no problem doing it.

I wasn't processing very well at the time, so I missed questions that I now want to ask. Like: "If you think it's IC, I don't understand the 'wait and see' approach." Like: "I thought that placing emergency cerclages were riskier than placing preventative cerclages. Is that the case?" And: "If so, why wouldn't you just do a preventative one?" And: "Please can you just give me a magic pill to fix everything?"

So now, I have a consensus on the diagnosis but two very different treatment plans.

If it happens again, would I ever be able to forgive myself for not moving forward with a TAC? Really, that's all it boils down to.

But the idea of going "behind" my doctor's back and doing something he specifically said wasn't needed makes my heart race, like I'm cheating on a test and scared of getting caught. Only this time I'd have to tell the teacher I cheated. How do I even do that, anyway? "Hey, I'm pregnant..and I'd like to be seen by your high-risk group...and, um, I had a TAC placed, despite your recommendations." For a majority of doctors out there, having a TAC placed with just one loss is...I don't know, equivalent to having chemo started with one abnormal pap smear. I'm sure they'd think I was crazy...and probably that Dr. Haney is too. I know he's on a mission to eradicate the TVCs because of the risks associated with them - namely, that they fail up to 25% of the time, and in the 75% of cases where they work, you still end up with premature babies up to 40% of the time. And the skipping the TVC to go straight to the TAC - that's an out there proposition that few doctors prescribe to today. But I get it. I'm on board with it.

Don't get me wrong - I really, really like the doctor that I saw today. I have full confidence in him. If I hadn't talked to Dr. Haney, I'd be all over this treatment plan. But he doesn't have the stake in this that I do.

I suppose the next step is a third opinion. Sigh.



*One of those confusing words with multiple meanings. Here we're looking at every two weeks, although I'm not going to lie - I'd love twice weekly. Or even daily. Hourly, perhaps. Maybe I can just permanently hook an ultrasound machine up to me?

Dr. Stitches

I just got off the phone with the Dr. Miracle I talked about in my previous post, or Dr. Stitches, as Courtney calls him. We were on the phone for about an hour and 15 minutes...and holy cow, does that man talk a lot! But in a good, "I'm-really-passionate-about-what-I'm-telling-you" way, not a condescending "I'm-the-doctor-so-you'd-better-listen-to me" way.

We went over my history in more detail and he was more convinced than ever that I have incompetent cervix, and he's certain that when I talk to the doctors they'll agree. We (well, he) also talked about the types of cerclages in details, and why he believes that the only person who should ever have a TVC (transvaginal) is one who refuses to deliver via c-section and who is willing to risk the death or extreme prematurity of another baby. His mission is to replace all TVCs with TACs (transabdominal), as he believes they are safer and more effective by miles. We talked about the risks, the procedure itself, future pregnancies, and what the next steps would be if I decided to pursue this option.

Seriously, we talked for over an hour and it would be impossible to summarize it all here, so if you have any specific questions, leave them in the comments and I'll try to answer.

But I think it's obvious that I'm in love and would drive myself to Chicago tomorrow if I could.

Dr. Miracles?

My mind is just spinning. (This is going to be a long one; I apologize in advance. But when aren't they?? I write like I talk....a LOT.)

I have a friend who lost her twin boys at around the same time I lost Caleb. She had true incompetent cervix; she was 2cm dilated and her bag of waters was bulging out before she went into labor. Recently, she found her "Dr. Miracle" and has been having consults with him. She emailed me and told me that during their consult, he mentioned that he firmly believes nearly every case of mid-trimester loss can be linked back to one cause: incompetent cervix (IC), where your cervix either funnels or opens prematurely. To treat IC, most doctors will do something called a transvagincal cerclage (TVC). This puts a stitch at the bottom of your cervix to keep it closed. The problem with it is that because it's low in your cervix, your cervix can still funnel down to the stitch, creating a V shape that puts all the pressure from the bag of waters on one small point, so the chance for pPROM occurring again is present. To prevent this, a patient with a TVC usually goes on bedrest for the remainder of her pregnancy. It has about a 80% success rate. If all goes well, the stitch is removed once you've reached full term and you can deliver normally. Another way of treating IC is by placing a transabdominal cerclage (TAC). This puts the stitch at the top of your cervix and is 99% effective, and requires no bedrest. However, it's permanent and all future pregnancies must be delivered via C-section. Most doctors and insurance companies won't approve a transabdominal cerclage unless a transvaginal one has already failed.

For several reasons, I didn't think that IC was the cause for me, but at her urging I looked up his profile and emailed him. My email to him and his reply to me are below:

MY EMAIL

Hi, Dr. Haney!

I was given your name by several different people. I'm not sure if my situation is something that can be treated, or if it was truly a "fluke". My water broke at 18.5 weeks pregnant in April of this year and I went into labor at 19.5 weeks. Obviously the baby did not survive. One of your huge advocates, Txxxxx Mxxxx, said that you mentioned during her phone consult that almost all cases where the woman went into labor mid-trimester are cases of IC. I THINK I'm one of the rare cases where that wasn't the situation, and just wanted to hear your thoughts and be sure that I and my doctors are not missing something.

According to the last ultrasound I had, on 4/9 (my water broke on 4/7), my cervix was high and closed. They didn't do a vaginal ultrasound, though, and I'm not sure how accurate abdominal ultrasounds are for cervical length. When I did go into labor, I was a fingertip dilated and they had to give my Cytotec to allow me to deliver.

I have had a full RPL panel and an HSG and thus far none of the tests have come back abnormal. My doctor suspects placental abruption, but the pathology came back clear without any signs of that. I had spotting during the pregnancy and I know that blood can act as an irritant and therefore cause your water to break.

I'm assuming that because my cervix wasn't dilated when I went into labor and the last ultrasound showed a good cervix length that I didn't have IC, but just wanted to verify and ensure that we're looking at all possible angles.

Thanks!
Lara

HIS RESPONSE EMAIL
Dear Lara,

I am sorry to hear of your loss and am sure this was devastating for you. You history is virtually conclusive of an incompetent cervix. There is virtually no way you could have preterm labor or an abruption at 18.5 weeks. That is why your pathology revealed nothing as the problem is your cervix, not placental abnormalities. If your spotting occurred in the weeks prior to your loss, this likely represented the bleeding associated with cervical changes as is common at term when cervical changes precede labor. I can explain it better over the phone but the funneling of the cervix which is seen in IC is caused by inadequate support at the top of the cervix. As the membranes descend into the top of the cervix they contain the amniotic fluid and the hydrostatic pressure from the fluid pulled by gravity widens the “incompetent” cervix. As the membranes containing amniotic fluid continue downward and shorten the length of the cervical mucus column, vaginal bacteria come into contact with the membranes and the inflammation causes the rupture of your membranes. Since the dilating force is related to the descent of your amniotic fluid-filled membranes, once your membranes rupture and the fluid is lost, your cervix no longer has this hydrostatic wedge and the cervix will temporarily appear normal by ultrasound because of its elasticity. To detect funneling, you would have to have had your ultrasound prior to the rupture of your membranes.

Quite simply, this was no fluke as membranes don’t rupture with a normal cervix. Unfortunately, my experience tells me that you have IC and will undoubtedly repeat this clinical course with subsequent pregnancies. I can appreciate that this may be a bit confusing so I would recommend that we talk on the phone so you can ask all your questions and get a clear understanding and make a decision you are comfortable with.

You can arrange that by contacting my assistant, Ms. Exxx Fxxxxxxx, at 773-xxx-xxxx. I look forward to speaking with you. Good luck.

A.F. Haney

Needless to say, this shocked me. It was absolutely not the answer I expected. My mind went a million places.

This was never even mentioned as a possibility by my OB. Is this a cutting-edge study? Is it something that most doctors have considered and dismissed? Is this one of those beliefs that have doctors split?

Could it be a scam? Honestly, one of the first thoughts I had was, "Yeah, but isn't he going to say that to everyone? Is he preying on bereaved parents who would do anything to have a living baby to get them to do this super expensive procedure?" Would a doctor really be a scam artist? I don't know enough about the medical field to know, but we're conditioned to respect doctors and trust their opinions.

His profile looks respectable, though, and his explanation makes complete logical sense to me. I don't see how it can "just happen" - doesn't there have to be a cause for everything?

I'll take this email and whatever information I get from him during my phone consult (scheduled for Friday) and present it at my MFM appointment and see what they say. If the MFMs don't agree, then do I go against their advice and look into it anyway? Do I get a third...or fourth...or fifth opinion until I find someone else who agrees with Dr. Haney? What if the MFMs are on the fence about it? What if they say it's not the cause at all? How would I even pursue Dr. Haney's ideas without offending my local team of doctors?

And I hate to say it, because I would do absolutely anything for a live baby (see: wearing diapers on my head), but I would be disappointed that I'd lose my chance for a natural, unmediated delivery if I had to have a TAC. Obviously I would come to terms with it, but it'd be yet another thing to mourn the loss of (along with Caleb, my innocence, my naivety, the excitement for another pregnancy, the ability to say "when" instead of "if" when talking about the future...). It's the least of my concerns, but since I'm being so honest here, it was another thought I had. "Oh...there goes my hippie, soothing, moving around, unmedicated, natural birth plan!"

So. many. questions!!

I hate that the world of maternal fetal medicine (and even regular OBs and RE and all that) isn't conclusive and that there are so many differing opinions. It's up to each of us to find the theory/doctor/practice that we believe is most correct, and if we choose wrong....we could end up with another dead baby.