Follow-up

I feel the need this evening to follow up my last posts with some thoughts.

I read here that, "Approximately 44% of the population is heterozygous and another approximate 12% are homozygous for the MTHFR mutation." That seems like an awfully large percentage to me, and I doubt that many women have had the problems I've had. Maybe there are other factors in this MTHFR mutation that cause pregnancy loss that we just don't understand yet.

I also read on the March of Dimes site that, "There are no good estimates on the number of affected individuals in this country." I also read here that they won't even offer to test you for thrombophilias unless you've had a past blood clot (which I did not), or, "...a history of pregnancy complications, including two or more miscarriages, stillbirth or placental abruption due to undetermined causes," (which I obviously had). It's so sad though that I had to loose even one of our babies before tests would even be ordered to make this diagnosis. I know research is being done, and I hope someday soon there can be an easy way to screen all women for these potential complications.

Also, with the more that I read I am feeling more confident that it is the thrombophilia that caused the deaths of our babies. March of Dimes says that, "The thrombophilias also may contribute to pregnancy complications including fetal loss and placental abruption," (which I had one of each). I also learned that, "Pulmonary embolus is the leading cause of maternal death in the United States," and, "studies suggest that up to 80 percent of pregnant women who develop a pulmonary embolus or other VTE (venous thromboembolism) have an underlying thrombophilia." I would do anything for my children if it means saving their lives and nothing can make up for their deaths in my opinion, but maybe their deaths weren't completely in vain. Maybe with the awareness of my diagnosis due to their demise, they may have helped prevent my death caused by a VTE or pulmonary embolism. This is a rather morbid thought, but I know that even though we have been profoundly affected by the deaths of our babies, I know that my death would have a harsher impact on more people.

I would also like to say that maybe I was hasty in being so critical of my perinatologist on her not suggesting the Folgard (super duper folic acid and B complex vitamins) initially. Maybe I should take responsibility and view it more as a partnership and be glad that I found someone who is willing to take my concerns seriously rather than just dictating treatment especially with something that appears to be a new field of study. I have always considered myself an educated consumer, but paradoxically I have always struggled with being assertive in my concerns. I am always so concerned about offending someone, but I am learning to look out for my own best interest and the interests of my family. And I feel I made a big step in that direction today by educating myself and expressing my concerns to my doctor.

Waiting for Wednesday

I called my doctor today regarding the delayed arrival of Aunt Flow. I will be going in Wednesday morning for a blood test to see if I'm pregnant. The urine test this morning came back negative again. I don't know how long it will take to get the results back, but you can be sure I will ask!

I also called my perinatologist regarding checking my homocysteine levels and a possible increase in my folic acid intake from the normal prenatal amounts. She said that it is her experience that even with normal homocysteine levels, you can still have problems, so she didn't think it was necessary to check my levels since we are already going to do the blood thinners.

She did think it was a good idea to increase my folic acid intake and called in a prescription for the super duper supplement. This is what I wanted anyway, so I didn't push the homocysteine issue. But my confidence has been lowered since I feel she should have thought of this initially. I'm not a medical professional; I can't be relied upon to think and research everything! Needless to say, I'm a little disappointed.

I also mentioned to her that we flew the day before I started bleeding and maybe that started everything in motion. She may be trying to alleviate some of my guilt, but said it probably didn't. But I'm still not going to take any chances next time!


-- Post From My iPhone

MTHFR and flying

I ran across an interesting discussion board post this weekend that gave me chills (not the good kind). It was a lady discussing a similar clotting condition to mine but hers is more severe.

Bear with me while I provide some background on this particular clotting disorder.

I had a DNS analysis performed on the MTHFR (methylenetetrahydrofolate reductase) gene a while back. When they perform the analysis, they are concerned with two different DNS sequence mutations - C677T and A1298C. It was determined that I am heterozygous for the A1298C mutation.

You receive chromosomes from both your mother and father when you are conceived, and both copies make up your genes. I received the mutation from either my mother or father, but only one faulty copy making me heterozygous as opposed to homozygous (two alike copies). You are not at increased risk for vascular diseases when you only have one of this particular copy, and I do not have the C677T mutation. Some individuals can be homozygous for both mutations, increasing their risk of vascular disease substantially.

From the research I've done online, this mutation can affect the amount of homocysteine in your body. It is the increase in homocysteine that can lead to an elevated risk for clots and vascular disease. But more applicable to pregnancy it can also interfere with B complex vitamin absorption and cause clots. Clots during pregnancy can interfere with how well the placenta works. As you may know the placenta is the baby's lifeline, and any interference can jepordize the baby's life unexpectedly and quickly.

Folic acid and the other B complex vitamins are important supplements to have before and during pregnancy to decrease risk of neural tube defects and other birth defects. Often times, women with elevated levels of homocysteine are prescribed blood thinners and special vitamins with huge amounts of the B complex vitamins to decrease homocysteine levels and increase the amount of the vitamins available in their bodies. This is to help reduce the risk of clots and birth defects.

I'm not sure why they don't screen for this with every woman who wants to be or is pregnant. It would seem like a simple way to reduce the risk of complications and fetal deaths. But I don't know enough about it to speculate on how common place or rare it may be, and it maybe a new field of study.

Another issue with clotting disorders (or thrombophilia) is that certain things can increase your risk for blood clots - birth control pills, sedentary activities, and flying in an airplane being the foremost on my mind.

The woman in the discussion board posted how she miscarried soon after flying. After I read this, my mind went back to how we had just come back from our trip to New Orleans in which we flew. We had arrived back home on Saturday, and Garrett was born the following Tuesday. I don't think this is coincidence considering I also started bleeding that Sunday following.

During my consult appointment with my perinatologist, I don't think I mentioned that we had just flew prior to the incident. I'm also thinking that my perinatologist did not check my homocysteine levels since this particular mutation is not supposed to affect that. But I am going to ask my doctor to check mine to make sure everything is kosher.

I also mentioned all this to my husband, and we were both in agreement that I will not be traveling next time I'm pregnant - no flying or road trips, period.

Results?

I feel like a little kid waiting for Christmas to arrive; well at this point hoping that it doesn't arrive if we're talking about Aunt Flow.

I woke up this morning at about 4:40am, and I swear I honestly DID have to pee (which I take as another good sign that I could be pregnant). So I went to pee into a cup and got my handy dandy dip stick out. I busied myself with some mundane task after checking the time and waited for the results.

After about 5 minutes I didn't see any indication of a positive test, and the same after 10 minutes. But after about 20 minutes (which I remind you is after the 10 minute recommended viewing period), I did see an obviously faint line. My husband would probably look at me crazy for saying there is obviously a line since to see it at all you have to kinda squint your eyes, get it at the correct angle, and don't look at it directly; but it was there!

I realize I could be imagining lines here, and it did appear after the valid timeframe, so I feel my test is still inconclusive. I did check the expiration date on the tests, and they say 7-2010, so that shouldn't be a problem, but they are older tests...

I did use up my last super duper sensitive test, but if my period is already late I should also be able to get a positive result with any OTC test, but I guess that really all depends on how much hCG I'm making. So I'm going to try to get some more sleep and wait at least until the sun comes up so people don't look at me crazy and go pick up some more tests for tomorrow. Here's hoping, and I'll keep you posted!

-- Post From My iPhone

a case of raging PMS?

I have been feeling better since my last post. It's amazing how much better things look in the morning. I think the fact that I have to keep putting one foot in front of the other helps to get me out of those ruts. I don't have the option of just pulling the covers over my head and shutting the world out no matter how much I might want to sometimes.

I also suspect the extreme moodiness and weepyness might be related to being pregnant or raging PMS. I haven't missed my period yet, but I took one of those uber sensitive pregnancy tests I ordered online that I had left over from last time. It measures 10 mlU/hCG (human chorionic gonadotropin) which is one of the hormones produced when you're pregnant. The most sensitive you can get at the drug store will usually measure about 20 mlU/hCG.

Anyway, I took a test yesterday and today, and I swear I see a very faint line. It's so faint that I'm afraid I'm imagining it. You have to look at it cross-eyed to see it even! I know that it doesn't matter how dark the line is, if it's there you're pregnant. But I wouldn't bet the farm just yet because the line was most defintely more visible after the 10 minute recommended viewing period. So my brain doesn't want to believe it yet, but my heart does! Wouldn't it be so great to get pregnant so quickly without really even trying! I could skip the whole anxiously waiting prepregnancy anxiety stage!

I really want to be able to call my doctor and just have them do a blood test to check, but I'm trapped at home with the daycare. It's the only real frustration I have with the daycare - not being able to leave without extensive planning before hand. But if Aunt Flow hasn't arrived by Saturday, I'll take another test. I only have two left!

I'll keep you posted!

Fatigued

I've been rather surprised by the intensity of the emotions I've been feeling recently. I've noticed myself becoming more emotional as Garrett's should-have-been due date draws closer. I wasn't sure how I would react as the date approached, but my emotional reaction to the reminder of how things should be and what should have been has surprised me.

In the past, similar dates with Sierra did not trigger emotions this intense so I was all the more surprised. I know that these emotions are normal, but I can't help but think that I'm not handling it as well as I should. I also know this is an irrational thought not only due to my perfectionist personality but also because I am comparing it to the previous loss. I would imagine the fact that I'm going through this again only compounds the emotional reaction.

I am also noticing myself becoming emotionally tired and cursing my stoic attitude. I am tired of being strong and handling things so well. And I don't feel as if I've been handling things so well recently. My emotional muscles are becoming fatigued, and they need a break. But how do you get a break from grief and the painful reminders?

-- Post From My iPhone

food as an art form

I've always said that even though my daughter is the oldest child in my care, she is the messiest at meal times - messier even than the infant and toddler!

It might be because she brings a whole new meaning to "food as an art form"...

Everything happens for a reason...seriously?

Today I was talking with my daycare licensing rep over the phone. She knew I was pregnant previously and at the end of the conversation asked how the baby was growing. I explained to her that I had a placental abruption, that our baby was born early, and we had allowed him to pass naturally due to severe brain bleeding.

It's the typical short response I give people when they ask, and usually people react in a similar fashion. A look of concern or pity comes across their face or in their voice, and they usually say they are sorry for our loss.

However, not everyone has this reaction, and I'm starting to find it interesting to gauge people's reaction when I tell them the news. I have a hypothesis that their reaction might be a reflection of the type of person they are. I can't be sure of this, and much more testing is needed before I can make a determination. I don't have enough data to speculate on what that reflection might mean yet either...perhaps maturity level or religious conviction?

But I digress. After I told my rep the news, I don't remember exactly what she said, but she didn't seem too concerned (maybe that's because she's a state daycare licensing rep trained to harden her heart), but I do remember her saying "blah, blah, blah, everything happens for a reason, blah, blah, blah". I didn't respond to her comment. I just told her that we will be trying again soon for another one.

I refuse to think that these things happen for a reason. The dust of my grief has settled and my spiritual views have been changed. Everyone needs to come to peace with what they believe, and I have done just that. It was not an easy path, and I still feel sorrow over the loss of my "Santa Clause", but it is now impossible for me to put my faith in a God or an existence of one. Not only would I be incredibly angry at this Being for what we have had to endure needlessly, but this anger would fester and be an incredible burden to have to bear. I've talked a little about this before, but I've also come to terms with the fact that there probably isn't an after life as well.

That doesn't mean my life or the lives of others are meaningless. On the contrary, I am learning to derive my meaning from life itself rather than through the existence of the hereafter. I am learning to be thankful for all the simple pleasures in life. I am learning to value and appreciate life so much more and see that life itself can give value to life rather than a higher being providing that value. In fact I regretted killing a fly today because of this new view! That rather surprised me. I know the fly did not feel sorrow or pain, but it's existence was snuffed out before it's time. Granted it probably only had a day or two more to go, but still!

The simple fact that we exist is a miracle. Miracle is not the right word though as it has too much religious connotation. Our existence is the winning outcome in an incredible game of chance. Why can't we value life based solely on how unlikely it could have even happened? I have become more appreciative and awed by what I see in nature as a result of my new view, and it has made me a more serene and peaceful person knowing nature is not perfect and that accidents do happen arbitrarily rather than for a reason.

Busy, Busy, Busy!

"Busy, Busy, Busy," that is my new mantra.

This may sound absurd to some of the people that know me, but I came to the realization yesterday that I am a busy person. I wield a diaper and dishrag the same way corporate executives wield Blackberries and power suits. In fact, I may have less idle time than they do!

I didn't find myself frustrated after this realization, I felt proud for being able to keep it together and run things efficiently, and I gave myself a pat on the back.

I have always been limited on idle time, and I used to blame this on my husband. I've slowly realized it's not his fault, although granted if he did help out more it would leave me a little more idle time (and he has started helping out more which I am immensely grateful for), but I would still be short on idle time if he did help with the dishes, laundry, or cleaning toilets.

Unlike most corporate executives out there, I have a higher than average intelligence, and I know I will be able to win this rat race with my brains rather than "muscle". In fact, after my post about realizing I'm operating on a time deficit, my brain started to think of ways to arrange my evenings so I can have some downtime. I say "my brain" because I wasn't actively trying to find a solution, but it was kinda processing the problem in the background, and a solution presented itself.

I've already simplified things a lot prior to this realization, but I can also rearrange things so that I have enough sleep time on any given evening. But I've noticed that once I sit down at the computer (and work on stuff like this blog which incidentally will probably decrease to just one post a week after this), I loose track of time. I usually sit down to take a break, but that also means there are things left undone. Once I realize the late time, I start procrastinating because I don't want to do the work items and it starts getting really late, hence I've squandered some of my hard earned sleep time. So I've decided that I'm going to make the most out of this iPhone my husband talked me into getting. If an item on the computer can't be done on my iPhone or when the daycare kids are napping, it won't get done until the weekend. Also, if it's not important to me or someone I care about, it won't get done either, AND those things have to be prioritized accordingly. I have to treat my time like it's a valuable commodity and stop wasting it on things that don't add value to my life or the people in it.

Clearance!

I have been very impatient over the idea of having to wait until the end of September before we can start trying again. Even though it seems so unfair to have to wait that long after being so prepared to have more children, we have been responsible. But I mentioned it to my husband this weekend, and he suggested that I give the doctor a call and find out what the risks are if we did get pregnant before our 6 months hiatus.

So...I spoke with my perinatologist today to get more information, and she gave us her blessing! She said as long as we are emotionally ready, we can start trying! I swear that's the best news I've heard all month!

My understanding is that the risk of getting pregnant too soon after a c-section is that it can cause a uterine rupture, but this is only a risk if you go into labor. We already know I will be having a scheduled c-section and have no history of pre-term labor, so I'm good to go!

We still need to get our finances in order so that we can afford an aid for the daycare; I still want to loose about 8 more postpartum pounds; and we need to schedule a preconception visit with my regular OB; but I couldn't be more excited! Woohoo!

Savannahisms

While the content of my blog is very sad, I never actually wanted the tone to be. In reality, how can you write about the tragedy we've gone through without having a depressing tone? So to help lighten the mood, I've included some funny things Savannah (our first child) has said over her short 5 years.

Savannahneese - Translation
sunshine - sunscreen
muscley pieces - chess pieces
peanuts - penis (I run a daycare, and she's been curious about the little boys anatomy when I change their diapers)
china - vagina
shortcut - haircut
Clumsy - Kenzie (the name of a little girl I used to watch)
door nog - door knob
noodle - needle
pregnant marker - permanent marker

Savannah has talked about things she's seen on commercials. My husband has tried to reverse the brainwash by telling her commercials are for "buying things you don't need". When Savannah was asked on one occasion what commercials are for, she responded, "to get you to buy stuff you don't need, but I really want them!"

When I was pregnant with Sierra, I allowed Savannah to shine a flashlight at the bottom of my stomach to help turn Sierra from the breech position. When I was newly pregnant with Garrett and we told Savannah the good news, she remembered the flashlight and wanted to do this again. I told her it was too early and the baby did not have eyeballs yet to see with. She shot up from naptime a couple days later asking, "Does my baby have eyeballs yet?!"

I can also see my child developing her negotiating skills. We were having taquitos for lunch one day which are one of her favorite foods. She will usually ask me for two more taquitos after eating the ones I gave her. I will usually only let her have one more at a time to reduce waste if she doesn't eat it all. On one occasion, she took me unawares by asking for 3 taquitos. Before I could realize what she was doing, I said, "No, only two." She then happily proceeded to skip to the counter to grab her treat. It wasn't until after the words were out of my mouth that I realized I had been manipulated! I have to admit, I was more proud than embarrased that I had been out-negotiated by my 5 year old daughter.

Up for a rat race, anyone?

This past weekend, I experienced some depression. This surprised me because I don't consider myself a doom-and-gloom type of person, and even though I didn't want to feel depressed I couldn't seem to shake it. I really think it was a combination of things related to the grieving process, lack of sleep, and stress.

The week following that weekend, I made it a priority to get to bed by 10:00 to help with the lack of sleep problem. I've noticed with myself that if I don't have the sleep I need, I feel less able to cope with stress and the emotions that result from that. Most nights I didn't make it by 10:00, but I consider it a work in progress. It wasn't from lack of trying though. I just can't seem to get everything done I need to get done within the time period allotted. Which leads me to my next point where it seems like all I do is work work work all day and night! I've often compared myself to other mothers with kids asking myself why they can seem to get some idle time in the evenings and I can't! I don't even get a chance to sit my butt down and watch anything on TV, so it's not like I'm being lazy and not making use of the time. There just aren't enough hours!

When talking about how much work I do on a nightly basis with others, I've often been asked the question, "what all do you do in the evenings?" I start listing the things that I typically do in an evening, "cook dinner, dishes, get Savannah ready for bed" and then I start drawing a blank and as I say them I realize that they don't really seem like they should add up to a lot. I ask myself, "am I just complaining to complain? Am I using my time inefficiently?" But upon discussing the problem with my husband I realized that there are only 24 hours in a day. I wake up at 6:00am and work until 5:30pm (11.5 hours - thank god I don't have a commute anymore!). If I want to get 8 hours of sleep, that leaves 4.5 hours in the evenings. Upon further investigation, I realized I do more than just cooking dinner (30 minutes), cleaning up (30 minutes), and getting Savannah ready for bed (30 minutes). Add to that the fact that we have to eat the dinner I cooked, (30 minutes), bathe myself daily (30 minutes), do laundry on various days (30 minutes), and yoga on Tuesdays and Thursdays (1.5 hrs). If you've done the math, you realize I'm left with no (nada, zero, zilch) time for other small things that seem to popup and eat into my sleeping time.

WARNING: The following paragraph makes mention to my sex life. Even though nothing explicit is mentioned, if you would rather not know about it or pretend that I don't have one, STOP READING NOW and proceed to the next paragraph!

But I've realized that I can make it a priority to trudge along at this pace wideling away at the minutes to get more sleep, but it hasn't even left me any wiggle room for sex (which has always been a topic of conflict in my marriage). I am content to ignore my urges which isn't hard considering how tired I am (yes, Kevin, believe it or not I do still have the urge!). But that isn't healthy if you want emotional and physical intimacy in your marriage. My husband feels like I'm not making him enough of a priority, and maybe he's right, but I don't know what to reprioritize. I feel like there is a solution to the problem that will make everyone happy, but I can't quite see it yet. Our most recent attempt at the problem is to agree to make time for each other on certain days of the week. If I know ahead of time then I can plan accordingly, but we've not been completely successful with this yet either. Something will come up to eat up all my time on top of already being exhausted, and I'll either forget we were supposed to be intimate that night or shamefully I'll sneak off to bed. I worry that it will only get worse as we have more children and as they get older and involved in extracurricular activities which will eat up more of the evening hours.

It is safe to return to your regularly scheduled blog...

My husband has pressured me to start my own daycare center thinking this will decrease the number of hours I work during the day leaving more hours in the evening. But I would miss the aspects that I enjoy about running the daycare in my home if I did that. Plus I'm not sure that in reality it would really increase the time I have in the evenings, especially while I am working to get the business off the ground.

He has also suggested that I just not work at all, but neither of us are comfortable with this solution especially in light of the current state of our economy. Our experiences has led us to believe that a job is never safe from layoffs, cutbacks, politics, or any other motives. If he was the only income provider, lost his job, and couldn't find another one right away, it would be disasterous for our financial outlook. I am unwilling to take that risk right now.

After all of that, I'm still left with the question, "How can I win this rat race?!"