Saturday, November 22, 2014

In Joy and In Sorrow

So I've debated even sharing about this. But if the outcome had been different, I definitely would have shared. So, I thought it only fair to share the not-so-pretty too. I also didn't want this to be a "woe is me" attention seeking type thing. But, this blog is a bit of a journal for me and I certainly want to log this on the timeline of life.

John and I decided a bit ago to go ahead and start trying to expand the family. We definitely want Sophia to have a sibling. Last time it took about 3 months, and we figured almost 3 years apart would be good spacing.

Well, things happened quickly and on October 16 I found out I was pregnant. I surprised John the next night by having pumpkins carved with the birth years of our current and soon-to-be family. Unfortunately one of them had gone out in the 15 minutes I had them lit, and he didn't even really notice at first. He just thought I carved pumpkins without him and was disappointed. After I spelled it out for him he was happy of course.

We decided this time around to wait to tell our families until we saw them in person, since we were planning a trip to see them on November 20. My midwife does not see patients until 8-10 weeks and my 9th week fell on the November 19. It would be good to have our first appointment and then share.

Around week 7 (3 weeks after we found out) I started to experience the normal pregnancy things. Nausea, bloating, fatigue, food aversions and all the wonderful first trimester things. (Sarcasm and loathing fully intended).

Then, early the morning of the 19th, around 2am, Sophia woke up and John went to check on her. I woke up too and knew things were not right. A trip to the restroom let me know I was bleeding a little. Not much, but no one wants to see that at all. I was much too far along for implantation spotting. Being a nurse, I knew that if indeed this was the beginning of a miscarriage, there really wasn't anything to be done. I didn't see any reason to brave the inconvenience of a middle of the night trip to the ER. They'd only be able to tell me what was happening, not stop or fix it. So after some disappointing Googling, prayer, and a Melatonin so I could hopefully sleep some, I went back to bed.

At 6am I woke again. More blood, but still not anything resembling a hemorrhage. My first appointment was that afternoon at 3:50. I called the answering service for my midwife at 6am. The only thing they could do was page the on-call MD and it was not my midwife. I knew the only thing they could do was tell me to watch and wait or, go to the ER. Instead I elected to leave a message for the staff when they got in to see if I could get an earlier appointment. Ten minutes after the office opened no one had called :( I mean, my message did say I was bleeding! By that time, the bleeding had actually stopped.

The office politely told me they did not have any openings but would talk to my midwife when she arrived. They called again at 10 to say my midwife had been in a delivery that morning, was just getting in, and they did not have any earlier appointments. At 1pm my midwife called to check on me. She had just gotten the message, unfortunately. She again said they were full but if I felt I needed to be seen earlier, please call. At that point I was fine to wait.

I arrived at my appointment, prepared to be told bad news. My blood pressure was unusually high. My exam was fine, no fresh blood, no signs indicating labor. My ultrasound, however, was not fine. This early I'm not very good at interpreting ultrasounds. I saw 2-3 black areas, in irregular circular type shapes. There was no "there's the baby, or the heartbeat is right there, see?" My midwife got her doctor to come look at the ultrasound. Apparently the ultrasound did not look typical for normal miscarriage or molar pregnancy, although they leaned towards the second option. But they were 99% sure there was not a living baby in there.

However, the tissue area was large and the doctor advised that if I waited to see if a miscarriage would occur naturally, I could experience heavy, prolonged bleeding and possibly hemorrhage. They wanted me to have labs drawn for my HCG levels, because if they were too high, that would be a good indication of molar pregnancy. So I went right away to the lab. Twenty-five nervous hours later, my midwife called to say that indeed, my levels were very high and in range for molar pregnancy. They offered a re-test to see if the levels were increasing or decreasing, but ultimately they still recommended at D&C so that I could avoid prolonged bleeding and, more importantly, tissue could be sent to pathology. I was anxious to quit feeling like I was pregnant when indeed I was not. With my HCG levels so high, I was really feeling icky.

Probably the scariest part came in pre-op, when the surgeon told me he felt almost certain it would be a molar pregnancy on the pathology report, and if so he would consult with the GYN oncologist via phone about my case to make sure he was using the best course of treatment. Because if you read the link above, you know that in some rare cases this can turn into...cancer. But more likely to him, sometimes even after the tissue is removed, the body continues to make HCG like it would for a pregnant woman, and then some. In his experience this can almost always be stopped with a one time dose of methotrexate. This is a chemo drug. But he assured me that in one dose it does not make you sterile or make all your hair fall out.

The second recommendation for molar pregnancies is that you refrain from getting pregnant again for a year. He has had patients not wait, and more than often the outcome is not good. There's a higher chance for miscarriage and recurrent molar pregnancy. And I never want to have another one of these. But it makes me sad that, at the soonest, Sophia will be 3 and 1/2 before she has a sibling.

So, my procedure was scheduled for lunch the next day, at the outpatient surgery center at the hospital. It's a fairly quick and straightforward procedure, but it does require general anesthesia. I was calm until the recovery room. Through the whole thing, John and I had been disappointed, certainly, but not devastated. With my medical background, I know these things happen, and really quite regularly. I am certainly not alone in suffering a miscarriage. My mother, mother-in-law, cousin, two friends and countless others have walked the same road. If affects everyone differently. With things being so early, we are just sad at the missed opportunity at what could have been. Other than getting choked up, that's about all that happened.

Well, anesthesia is known for releasing inhibitions anyway. So about 15 minutes after waking up, I was ugly crying. Thankfully John was there. I was mostly just mourning my place in life at the moment. I did not want to be there, recovering from surgery, losing 9 hard weeks of carrying a baby, facing putting off having another baby for a year, and possibly taking one shot of chemo. After about 30 minutes the anesthesia was wearing off more and I started to recover. I may have more crying in the future, who knows. But for now I feel reconciled to what has happened.

What is hard now, is the waiting. The report should come back sometime next week. Thankfully we are away visiting family, unfortunately not sharing happy news, but having a good time nonetheless. That occupies my mind. The best result would be that despite the odds, it was not molar. The second best would be that it was molar, but my HCG levels fall appropriately on their own and no further intervention is needed, the third option would be that is was molar, my HCG doesn't fall and one dose of methotrexate is needed. The fourth option, I'd rather not consider, and that would be that it turns cancerous. Even then the treatment rates are extremely good.

My HCG levels would be monitored no matter what, until they return to normal. But if it is molar, they will be monitored for quite a while and I think maybe even for several years in order to be cautious. I'd prefer not to live with that nagging feeling.

No matter the outcome, this is in the the Lord's hands. It did not take him by surprise. I try not to borrow worry from tomorrow, it's not scriptural :) So for now we wait. I will update again once I know the results and have a better idea of what the next steps will be.

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