Sunday, December 25, 2011

Twins Background

Ann has had endometriosis since before she was pregnant with Fiona. After Teague was born, she started having pelvic pain early. Her doctor dismissed it thinking it was too early for her to have any issues. She went on the mini-pill, but continued to have a lot of discomfort. We did some research and decided to look at an IUD instead of moving to the pill Ann had been using before we started trying for number four. The IUD literature suggested that the more constant release of hormones in addition to the impossibility of ‘forgetting’ proved a better fit for most sufferers of endometriosis. Ann checked with insurance and they said they would cover it as a treatment for endometriosis, so we proceeded with it at the end of October 2009. It was problematic for a while and hard to see in ultrasounds when they checked for it.

Sometime before mid July 2010, it must have dropped out without Ann noticing it (the IUD changes frequency and intensity of cycles, I don’t want to get into it in detail). Near mid-August Ann started feeling unwell, she had a low-grade fever for weeks. She went through an antibiotic cycle and her temperature wouldn’t return to normal. She finally decided to ignore it, since it was so low-grade. During this time, we thought Teague was old enough to get rid of a lot of baby things. We made piles of stuff, took it to Deseret Industries, and gave it to people in batches. In early September, Ann started to get nauseated pretty regularly. Again, we puzzled over what was wrong with her. The nausea kept returning and it finally dawned on me that she might be pregnant. We both figured this was unlikely because of the IUD. For some reason we never have any spare pregnancy tests sitting around, so to find out for sure we needed to buy some. On 9/18, Ann took a vanload of baby things, including the expensive baby gates, to Deseret Industries right after we had a conversation about waiting due to the possibility of she might be pregnant. Later that day she bought some tests at Wal-Mart and decided to use one the following morning when it would be the most accurate.

On 9/19, a Sunday morning, she got up and took the test first thing. I was still waking up, but aware she had gotten out of bed. I woke up fully when I heard her crying in the bathroom, she showed me the test—it was positive. Ann worried about waiting until the next day to see a doctor, the Mirena website indicated that emergency care was necessary if you get pregnant while using their device. We had done the math and I figured a day more or less wouldn’t matter much when she was already 9 weeks along. The following day, she told the doctor’s office what had happened and they saw her that day. I had decided to stay home with Teague since Ann hadn’t been able to find a babysitter. She called me a little after 10:30 to tell me that they’d done an ultrasound and found that two babies had been clearly visible. Ann sounded a little weepy during this conversation and asked if I could come there to be with her. I protested that Teague would be too much trouble at a doctor’s office, but she insisted and the two of us went off to meet her there. This was the first time I had been to the new office and I had to get instruction on how to get to the right one. When I was shown to Ann’s exam room, she had apparently calmed down a lot. The nurse asked if she was doing better and her face showed signs of recent crying. Ann related to me that when she first saw the two little circles on the screen and the doctor had confirmed they were looking at twins, she had gone into a panic for a little while. The doctor and nurse decided to leave her alone to calm down for a little while, around which time she had called me to come over. There was no sign of the IUD in the uterus.

We went to a lab where a tech did more extensive scanning, still no sign. He thought the IUD must have dropped out, but the doctor was sure Ann would have noticed this and assumed instead that it had pierced the uterus and was somewhere in the body cavity. They wouldn’t be able to say for sure until after the births since x-ray scans are dangerous for the unborn babies. We were left in the following weeks to try to get used to the idea of not only another pregnancy but two more children. The idea was not very comfortable at first because Teague had been and still is very difficult in many ways. He is very stubborn and given to tantrums. He is extremely resistant to correction and the cost of property damage at his hand has been very expensive. He requires a lot of love from us and we were concerned that dividing our hearts again to allow for two more children might be difficult. We also frequently regretted having sold and donated so many things that we would need for our new babies.

Since Ann was so far along in the pregnancy, we didn’t wait at all to tell everyone. I let Ann call most of our family about it. There was a lot of surprise and excitement. Jen Richardson’s response was unintelligible since it was screamed or squealed—she was unable to speak normally for some moments. It was left to me to inform the men in my family. I received mostly derisive laughter from my brothers and friends. I feel that this propensity was partially my fault for the way I described the discovery of the pregnancy and its nature. Many of the friends and ward-members Ann told reacted in fear and agitation, because so many of them too were using IUDs and their reliability was now in question.

On December 9th, we had an ultrasound at the office of a group of specialists for high risk pregnancies. By this time we were a lot more joyful at the prospect of having more children. We were really happy to see the high quality imaging there. However, the tech went out to get the doctor after scanning and measuring for around 45 minutes. When the doctor came in he started explaining to us what TTTS was and then told us that our twins had it. Sometime during the time he was explaining possible treatments, Ann started crying. He apologized and said that he was blunt by nature, but figured most people would rather get it straight. What followed were ultrasounds twice a week until they could decide whether or not to seek treatment. We started out will an imbalance of amniotic fluid of about 8 and 3 cm (with Brigid being the donor and saran-wrapped in the dividing membrane). We kept going in twice a week with few changes until December 20th, when the doctor advised us to seek the laser ablation treatment right away. The fluid was measuring at about 10 and 2 cm. We made arrangements and left later that night. Denise and Kevin took the kids for us for the nights of the 20th and 21st; the Dave and Jamie Smith took them the nights of the 22nd and 23rd. It was pretty surreal to go straight away like that all of the sudden. We got into the airport pretty late and I think it was after midnight by the time we were checking into the motel. The hospital is in Hollywood and the motel was right across the street, not the nicest place. At least it was clean.

The next morning we had breakfast at a 50s diner that was pretty cool. Then we went into the appointment to have measurements taken and then consult with Dr. Chmait. We were very nervous; the ultrasound tech was doing measurements for about 45 minutes when the computer on the machine froze up. She ended up losing all the imaging she had taken. Dr. Chmait had to come in and take over since she had committed to help out another doctor (everyone was short staffed due to holiday week) and he could ‘diagnose’ on the fly which she couldn’t do. The measurements they took were useful for research, but the imbalance was the only relevant one for us. They confirmed what we had found at IMC. Dr. Chmait recommended that we move ahead with the surgery. We talked about it a lot and prayed together in his office. We both felt that it was the right thing to do. I recall feeling that the babies would be ok if we proceeded. The assistant took us on a sort of tour to let us know where we’d need to be and when and what people we’d be seeing. We had ‘lunch’ again at the Café 50’s where we’d eaten breakfast. In reality we shared a milkshake and a banana split. We then went on a quest to find comfortable footwear for Ann to wear around the hospital. We finally found something at a nearby Payless. We had dinner late, since Ann wasn’t supposed to eat after midnight. We bought a bunch from Pollo Loco and brought it to our room to eat.

The next morning, we checked out of the motel and went to the hospital. We were told we had problems with insurance since our carrier had misunderstood in which hospital Ann would be receiving the treatment. At first the hospital wanted us to put down $4000, but then it turned out they just wanted us to pay a down payment on it, which ended up being $1000. Soon after, Ann was taken to surgery and I was left on the way at a waiting area. I was promised news within an hour or so. The waiting was pretty awful. I prayed a lot and kept trying to distract myself by playing on my iPhone, but the time passed very slowly. At last Dr Chmait himself came out to let me know things had gone well. He showed me pictures of the babies that he’d taken during the procedure and they were pretty amazing, but I again had that surreal, distant feeling. Apparently Ann had made some comment about the babies having my feet.

During surgery, Ann had felt a little panicked so they gave her something to help her relax. Although it had made her feel a little loopy, she had been able to watch on the TV screen during the procedure and remember what had gone on fairly well. It took a while longer to finish things up after the visit from Dr Chmait, but Ann and I were together again before long. One of the nurses on his staff brought me to her. We were both happy that things had gone well. There was one vessel in particular that had been difficult to track since it went under the tissue of the placenta and then came back out again. He was glad to have performed the surgery since experience allowed him to separate this flow as well which might have been missed by someone less experienced. It was so unusual, in fact, that he intended to write a paper on it. We were somewhat nervous during the next day because the first 24 hours are so crucial. It had been raining all day and the talk started that night about the heavy rain storm causing mud slides and traffic problems that night. I went down to the cafeteria which was by far the worst I had ever seen. Everything seemed dubious to me and I thought it safe to get a pre-wrapped sandwich. I was quite wrong and spent the night with an upset stomach followed by vomiting the next morning. By morning the rain had gotten to be the prevailing news story and we heard from various staff about their difficulties making it into work. It started to worry us about our travel plans and the possibility of missing Christmas with our kids.

During the course of the morning we went to three or four different places in the hospital for follow-up tests. I remember the cardiologist spent quite a while looking at the babies’ hearts. Everything looked ok and Dr. Chmait felt confident enough to release Ann and let us head home. We left the hospital around noon, but our flight wasn’t until evening so we drove around Hollywood and then up to Malibu where we finally ate lunch at Morgan’s Café, an interesting place. The weather had cleared a lot and the danger of us missing our flight had diminished, but we were still a bit antsy and got back to the airport with a lot of time to spare. The return flight was uneventful, but we got back so late that we decided to let the kids stay another night at the Smiths since they were asleep already. We picked them up midmorning the next day (Christmas Eve) and started the festivities.

About a week later, we went in for the follow up appointment post surgery. The fluid levels had started to equalize and we were passed the initial phase of highest danger. The doctor thought Ann could pretty much return to normal activity, but not to lift anything over 20 lbs (Teague). Even so, we tried to keep up with the advice Dr Chmait gave us about taking two two-hour breaks each day where she was off her feet. That lasted about three weeks. After that she was mostly back to normal. Looking back, I wish she had continued to take it easy since she went into labor two months (almost to the day) of her surgery.

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