Waiting to exhale

Each day goes by so slowly when you are in recovery. The usual recovery period is 6-8 weeks for major surgeries/ pregnancies etc and 2-3 weeks for laparoscopic surgeries. So now I'm in my 6th week post delivery and 1st week post laparoscopy. Another couple of weeks, and I should be fit as a fiddle (or so I hope). Meanwhile, various things keep going wrong. My lochia is like an unpredictable leaky tap...silent at times, then suddenly flaring up for no rhyme or reason...always uncomfortable. My lap incisions seem better, lesser twinges, but now getting really itchy. Digestive system has taken brunt of the beating. Now I'm on the same bland diet for 2 weeks...boring and unappetizing as hell. At least my last IV site didn't thrombose (thank God for small mercies) though one of the earlier sites is still painful. I'm moving from Phase I of recovery (pain and infection management) to phase II of recovery - cribbing management!

In all this hullaboo, my pregnancy loss has taken a dream-like quality. It feels so far away, like at another time and place, that it happened in the far past instead of just a month or so ago. I think back on how devastated I felt, and how I felt the pain would never go away. Today, I just feel longing for what could have been and apprehension of ever going through it again. There is some sadness, but not a deep pain. I think this is because I genuinely feel it was never meant to be and though painful for us, we spared our babies a lot of pain before an inescapable eventuality. My own pain seems to be in the past...strange considering by the end of it I was in hospital for 3 weeks, almost always in constant labor pain, fever, sickness and discomfort from complete bed-rest. Its like I've just blocked all that out...or whenever I think about it, I just fast forward the whole thing in my mind and it doesn't feel as bad as it did. This probably is the result of 'time heals', 'looking forward' and 'be positive' philosophy. But I feel guilty sometimes...that maybe I should feel more. Isn't it too soon? Its like I've moved on without any baggage. But in doing so, I've left the whole experience entirely behind...almost like it happened to another person. And the only thing I'm left with is a definite fear of going through it again...even though I would really like a child. The joy of being a parent, however briefly; the feeling that I can get pregnant, despite my PCOS; the sorrow of losing not one but two lovely babies; the effort and pain throughout in trying to carry the pregnancy through; the sacrifices both by me and my family, to give this our best shot - all lost to an overwhelming sense of self preservation for the future. Is it selfishness? or is this a natural process? I don't know. But as each day goes by, the past seems further away, and the future closer. And though I know the little things I want to do, I've lost the big picture of where I want to go from here.

GB Over and Out

Well its done. On 26th morning I checked into the hospital and got my gall bladder out. It was done laparascopically. The surgeon also checked my ovaries, tubes and uterus, and they all seem fine. I've got 4 small incisions, one near my belly button, two on the left and one above my abdomen in the middle. The surgery was sutureless, so now I'm all glued up!

The first night was a pain. I was sore all over and just getting out of bed was awful. Everytime I moved or bent, something or the other hurt, apart from the constant soreness. The only good thing was that this time, my IV held up and actually didn't hurt much. I had the cutest 2 little teddy bears on my IV (leading me to believe I might have ended up with a pediatric IV!!). In any case, the vein held up, not too much was pumped in and it didn't hurt much. Phew!

I got discharged the next day and came home. Second night too was sore but a bit better. But now my neck and shoulders have started to ache, probably delayed pain from the general anesthesia or referred pain from having the GB out. I'm on a complete Khichdi and mashed potatoes diet. Mom and Dad came over today and brought some raw peas. I'm using them as fill in snacks. I seem to get hungry very often. Last night I got so hungry in the middle of the night, I went and got some Marie biscuits to eat in bed! Still battling soreness and backaches, and pain when I bend or stretch. On the happier side, its over!!

PAC - check

My PAC (Pre anaesthetic check up) went smoothly today. All my reports are in, everything is fine. Platelets are a bit high and Hb a bit low (but on its way up). Met the surgeon and all is set for first thing Saturday morning (26th). Bumped into my gynae in the hospital lobby (now doesn't that sound like I've been spending too much time at the hospital!!) and discussed the possibility of getting my ovaries, tubes and uterus checked during the procedure. Spoke to the surgeon later, and he was fine with it.

So now, all is ready. I hope this will be the end of a truly bad run.

Preparing to lose my GB

All is in preparation to lose my Gall Bladder on Dec 26th. We met up with the surgeon on 19th, tentatively booked the admission. The ECG and X-ray reports are done. I went to the lab today for the blood work. On Wednesday, we're going for the PAC (pre-anaesthetic check). Assuming the PAC is cleared, the surgery is planned for 26th morning. I have to get admitted in the morning itself and hopefully will be out the next morning.

In the meantime, I managed to catch a slight cold/ sinusitis. I just hope it clears up soon and doesn't play havoc with the schedule. The anaesthetic will need a clear airway and that is my top concern. Plus, general anaesthesia always seems to leave me with a cough/cold later! I'm seriously hoping that doesn't happen, because coughing puts pressure on the belly, which might mess up my incisions! Maybe I'm thinking too much. At least, it keeps my mind off IV needles!!!!! I hate IV needles, and they hate me! My right arm is still thrombosed from my last visit 2 weeks back.

This had all better go well. Please God, you owe me some peace of body and mind!

Misery loves miserable company

Today I saw on the news that Katrina Kaif (Bollywood actress) has been diagnosed with Endometeriosis. Sometime back Padma Lakshmi (Top Chef host and international model) also went public with the same. Endo is another leading cause of infertility in women, and painful to boot. And like PCOS, there is no cure, just symptom management. I felt a kinship with these women. Sometimes, it just helps to know you are not alone.

On a side note, I'm now wondering whether when I go for my laparoscopy for gall bladder removal, maybe I should get checked for endo as well. Lap is apparently the best way to diagnose endo. With the disastrous pregnancy I went through, and all its various fall-outs, I think I'm now getting paranoid about everything!!

Self Pity and moving on

Yesterday I spoke to my gastro doctor and we've tentatively planned the gall-bladder-out surgery for 26th Dec. Since thats more than a week away, it made more sense to do the blood and other tests next week. Which works fine with me...I'm not to keen on needles anyway...and both arms are still suffering post IV thickened and painful veins! Logistically, this also works out coz hubby has to go out of station for 2 days, mom is taking exams at office, sis is at work and dad has a conference...so no one has to change any schedules to be with me this week.

Then this morning, after my hubby left for the airport, my maid suddenly wanted to take the night off. It seems her sister is admitted in hospital, 8 months pregnant and her (sister's) hubby is out of town. At first, I wasn't to keen, but having been through pregnancy hell the last few weeks, I could understand her need to go to her sis (who is all alone). Then, while talking with my maid about her sis, I found that her sis has already lost 3 full term babies...all within a few days of birth! Oh my god!

I've been wallowing in my sorrow and having thoughts of whether I ever want to go through the entire TTC and pregnancy again...and then here is someone who has been through so much more, and is still waiting for her first child. For the past few days, with all the medical stuff happening; self-pity, why-me and poor-me have been my dominant feelings. But after hearing her story, I felt stronger. Its not just me. Bad things happen. You grieve and move on. Good things might happen next, or more bad things. But you take what you get and try to make the best of it. That's life. And I think its time to start living again.

Fast Forward to today - Part III

Once back from hospital, luckily my in-laws had come to stay with us for a bit. So I got pampered, fed lots of protein supplements and focused on healing myself. The way was to look forward. Grief episodes were controlled and restricted to the bathroom. I had told my Gynaes about my gallstones, they both said it would have to come out before I tried again, but there was no emergency. I would need 6 weeks at least to heal after my delivery.

The edema troubled me for a couple of weeks and then got better. My haemoglobin levels rose a bit though it would take a while to get back to normal. I was having lochia bleeding but my docs said it was ok and would take a while to get better. It was gradually reducing. It seemed I was on my way to recovery. My in-laws left on 1st Dec, I was feeling much much better. Though my hubby and I hadn't discussed our loss yet, finally one night we talked about it and let the grief flow. It wouldn't go away, but we had each other. Right now, we'd focus on me getting better, and then plan a nice vacation in a few months once I was all clear. We'd see about trying again, but it was not on the cards for now...not at least for a year or so. Sadder, but closer than ever we were trying to pick up the threads of our life. His work was picking up, I was focusing doing everything to heal myself. One night we went to our favorite bookstore, my first outing not involving a medical institution in almost 8 months. Just for an hour, tiring, but fun. A symbol of life getting back on track. Our 7th anniversary was coming up on Dec 7th and my birthday was on Dec 17th. There were things to look forward to.

On the night of Dec 4th, after my nightly glass of milk and while watching tv, I suddenly doubled over with pain. I thought it was something I had eaten. I called my mom who was having dinner with some friends, one of whom happened to be a gastroenterologist. He suggested a painkiller injection for now, and a blood test and ultrasound for the next day, given my gallstone history. I wasn't keen on more injections plus the pain was lessening by then, so I just took an antacid. The pain continued till early morning while I tried to sleep on and off. I was much better in the morning, just with a dull ache and tenderness. We went for the diagnostic tests.

The ultrasound showed my gallbladder was inflamed (wonderful >.<) but other organs seemed fine. My gastro doc (mom's friend) suggested we go with the blood tests and then call him at night for further instructions. So we did that. At night, in a three way conference with my doc, mom and us; the doc told us the blood tests were out of range and I would definitely need to get admitted into hospital tomorrow. He diagnosed it as cholecystitis and pancreatitis. The best thing would be rest my pancreas, stop oral food and get onto an IV fluids as soon as possible. Since the pain had almost gone, I said I would come in the next day. Back into hospital...lovely!

The next day I got admitted, went on IV antibiotics and fluids. My blood tests showed my system was settling down, so they kept me under observation. We spent my anniversary in hospital, me on IV. Sadly, IV and I don't get along. My hands had not yet healed from my earlier hospital visits. We got an anaesthetist to look for a good site and put the needle in. My first cannula collapsed within a day. The second one lasted a day longer. By my third afternoon, my second site was swelling, they couldn't take blood samples without bruising and not getting enough blood, both IV sites were swollen and thrombofied, I was fed up. It was Tuesday. Till then, I had been hoping to all get my gallbladder removed in the same admission. I knew it was a big decision, but my gynae's had said I'd need to get it treated before I tried again, I had already had one painful gallstone attack with mild pancreatitis...I just wanted to get it done as soon as possible. I knew my lifestyle and diet would need a major overhaul. But it would have to be done, better now and give me time to adjust. Better now, when I was already on IV! My gastro doc said if my blood work was ok, we could schedule it for Wednesday, even though normally they like to wait for a 7-14 days. I was fine with doing it now. Just get me out of the hospital spiral!!!!

But tuesday, my second IV collapsed. I refused to get a third one in till we knew for sure about the surgery. My ultrasound showed that there was still some inflammation in my gallbladder. My blood reports showed a coming down to normal though not all were within normal range yet. My gynae (who consults in the same hospital) wasn't too keen on my going back into surgery so soon after delivery. 6 weeks was her prescription. Then the surgeon arrived. He too didn't want to go for the surgery immediately, but he wasn't keen on waiting more than 7-14 days post the attack. Since my IV was already out, I had lesser issues with going back home and coming back for surgery later. My biggest concern was the intervening 2 weeks, what if I got another attack? Attacks always seem to happen in the middle of the night when no one is easily accessible. What would I eat meantime? In the meantime, my lochia bleeding has increased, more than it ever was, since I have been in the hospital. At first I got worried (still am a little concerned), but my gynae said its expected upto 6 weeks post delivery. Problem is 3 weeks are over, the bleeding was going down, it was never very heavy to begin with. But now its heavier than ever, no signs of letting up...and given how everything just seems to be going wrong with me right now, I'm a bit concerned.

Anyway, under the combined advice of my gastro doc, gynae doc and lapro surgeon (and influence of IV scarred arms) we finally decided that we would postpone the surgery for now as the wisest course of action, track my enzymes till then became normal, my gallbladder inflammation till it subsided and then go for surgery. Not earlier than a week from now, not later than end of December.

So this is where I am today, on a soft, fat-free diet, antibiotics (oral thank god), nursing scarred hands/arms and researching what I can and cannot eat on the internet. Next course of action, contact my physician on Monday for instructions based on how I am feeling then, blood tests probably on Tuesday and take it from there.

And that brings me to where I am today. Its been a crazy few months. Dear God, I could really really do with a break now!

Fast Forward to today - Part II

After the first 3 months of pregnancy, we shifted to our regular Ob/Gyn. I was hoping to get off the painful progesterone injections (I'd already had an abscess on one hip and had to go on another course of antibiotics). But my doc wanted me to continue, though she reduced it to twice a week. At this point, I forgotten how my hips felt without pain!

Another month went by and all was fine. We had another ultrasound, both kids were doing fine, I had done my blood tests and they were all favourable. The kids development was fine, weight, organs, everything. By the 18th week, I realised the slight twinges in my abdomen were not gas but actually my babies moving! It took me a while to figure it out, but it was definitely them! And they seemed specially active at night when I was trying to sleep. :) By now, sleeping was a bit uncomfortable, so I was enclosed by side pillows most of the time. But we were thrilled! They were moving, developing fine, everything was going ok. We started cautiously telling people about our good news. The dusty book of baby names came off the shelf....nothing final we told ourselves, but always nice to look at options. :)

We were feeling a bit more secure. We scheduled a Level II scan on my 20th week.

20th week, where it all started going to hell.

We went for the level II ultrasound. This was a far more detailed one that any before. It was astonishing to see how developed our babies were. One was actually facing us. The doc was great. He showed us so many things - spine, head, nose, eyes, lips, arms, fingers, heart, stomach, kidneys, bladder, legs, little toes. One of them even made clapping hand movements!! One had a perfectly circular head while the other was a little more oval. Both heartbeats were normal, weight and size all normal. They were both perfect...and perfectly adorable.

At this time, I mentioned to him the slight pain I was having in my lower abdomen and he decided to do an internal scan. In this scan, it suddenly turned out that my cervix was opening!! Way way too soon. I had an incompetent cervix! Luckily we had detected it and it hadn't opened much yet. Still I would need to immediately get admitted for a surgical procedure, called cervical cerclage, which would put a stitch in my cervix and stop it from opening further. We were a little scared but the remedy was there and we felt it had been caught in time, plus the kids were fine. I got admitted the same evening and into surgery the next day. Out the day after with strict instructions to be on total bed rest in the Tredelenburg position and allowed only bathroom breaks.

I tried to follow it religiously, though the position was terrible. I was having constant digestive issues of gas and reflux now and my shoulders hurt like the devil, taking most of my weight. I had at least 17 weeks to go through, but on the happy side, I was more than half way through and my kids were doing great!!

One night, in my 22nd week, I woke up with back and abdominal pain. (Why do bad things always happen in the middle of the night???) I stayed with it for a while, tossing about the find a position were the pain would be lesser. Much much later, I would realise that what I went through was premature labor pain and it was an alarm call. I SMSed my doc in the morning and she told me to go in for a urine test. I called the Pathology guy for home collection and when he came, went to the bathroom for giving the sample. That's when I felt a smooth something trying pass out as well. I was terrified. I stopped everything, ran to my bed and lay down with the legs raised right up. Sent off the path guy without the sample, called my hubby and asked him to call for an ambulance. I also called both my gynae and my fertility doc. The latter was now also consulting at the hospital nearest to my home and she told me to go straight there and she would get someone to check me. My husband arrived, packed a few essentials. The ambulance arrived and got me stretchered from bed to hospital. My vital signs were good. I was trying very hard not to think about anything else.

At the hospital, I was transferred to a labor/private room for observation, where it came out that I was definitely getting labor pains, the earlier stitch had not held and there was some sac membrane already down all the way into my cervix. They put me on IV to stop the labor pains so that they could plan for an emergency second cerclage if possible. I was now on total bed rest (no bathroom) in my upside down Tredelenburg position. Some were gas pains, some were Braxton-Hicks, some was real labor contractins....it was all a series of pain, panic and prayer.

The next day, it seemed there was some settling down in my state, the kids seemed to be doing fine and we figured we could go for another emergency cerclage. My infertility doc was there and she did the surgery. Everything seemed to be going fine. I would have to be on total bed rest in the hospital till the end of the pregnancy, but we were ok with that. We crossed our fingers and hoped for the best.

Then came 2 weeks of chaos. Off and on contractions, I was running a low grade fever, my wbc counts were too high, digestive problems was a constant companion. Along with this, the indignity of being on total bed rest, middle of the night bathroom needs, eating while lying upside down, overall discomfort of lying upside down and IV problems. I have very thin veins that are difficult to find. The hospital had a policy of changing IV site every 3-4 days. Some of my IVs didn't last even a day. All were painful, while putting in, while they were in and after they were out. Most drips needed pre IV flushing as my veins kept clotting.

I kept getting contractions from time to time, even though I was on medication to prevent it. My low grade fever and wbc count wouldn't let up. It was around 15th November. It had been 2 weeks since my second cerclage. The medications couldn't control my contractions. I had been constantly leaking some fluid, possibly amniotic. One sac did look to carry lesser fluid on the ultrasound, but not so less to reach concern levels. On 17th November, I would complete 24 weeks (from June 02 LMP) and 22 weeks 5 days gestation (from implantation). At this point we knew I wouldn't last the normal minimum 37 weeks. We were now looking for minimum alternatives for fetus viability. My dad is a paediatrician. I hounded him to tell me everything, got both my parents (both docs) to call up everyone they knew. But all information pointed at the same thing, 32 weeks was safest, 30 weeks doable, 28 weeks minimum but not preferable. Nothing below that. I had at least a month to go and I was having painful contractions every 3-5 minutes that couldn't be controlled by medication, a low grade fever and a high wbc count despite weeks of antibiotics. I was desperately trying to hold on to anything....anything that would give my babies a chance. Their heartbeats were still regular, but that was all. Another 2-3 weeks, and my babies would have a chance. But my contractions wouldn't stop. And since the stitches were holding them in, I was in constant severe lower abdomen pain. No position helped, no medication helped. I'd been in varying degrees of pain for 2 weeks now, and now, the contractions were getting uncontrollable. The only thing holding my babies in was the stitches, and they couldn't hold in the leaking fluid from one of the sacs.

It was the most difficult decision of my life. Though I still felt huge self recrimination that I couldn't hold on for 3 more weeks, the decision in many ways was inevitable. The contractions were constant and couldn't be controlled, the leakage couldn't be stopped, the fever and wbc count wouldn't normalise (indicating some lasting infection), nothing was working. There was a chance of chorioamnionitis, and reducing fluid in one of the sacs. Even if it was only one baby who was affected, it was only a matter of time before the other did too. None of them would survive for long on delivery at this stage. Their neural, brain and blood systems were yet to develop. Holding on was postponing the inevitable.

On 18th November, we decided to let them go. That evening, my stitches were removed. The doc said she could see a foot already in the cervix post removal. No sign of a sac. It seemed one sac had already ruptured. She said it wouldn't be long. I was already upset at losing them, now I realised that I would actually have to deliver them...no caesarean, no numbing anaesthetic....the real real pain of delivering my precious babies, conceived after years of trying, nurtured through months of hope and discomfort, condemned to death on birth.

I had been in labor for days now. It was just a matter of pushing. The first baby come out in minutes. It was a girl. No sac. I couldn't even see if she was born alive. I had to work on her twin. They said it was higher up and would take some time. At this point, I just wanted it all over with. Within the next couple of hours, I delivered my baby boy. He was in his sac which I had to burst for delivery. The placenta ejection came next. And then it was all over. My two perfect babies, the prayed for completion to our family, lying in two small trays, looking perfect. The girl was already cold, but the boy was still warm. I was up immediately on delivery and walking around. I touched them, held them....bid them goodbye. No more little nudges in my abdomen, no more planning nurseries, no more hope.

I couldn't go to bury them, my husband and mother did. I couldn't believe it was over. After 6 months of anticipation, hope, anxiety, pain, discomfort, surgeries, planning...it all came down to nothing. Our little family of daddy, mommy, daughter, son and dog.....was again just daddy, mommy and dog. They were gone. I'd failed them, I'd failed my patient rock of a husband yet again, I had failed myself.

In the delivery process, I gave myself a cervical tear. The next day, I went for an ultrasound to get it checked and in the process discovered that I had gallstones!! What?? Hadn't I been through enough already!!! I went back into surgery for a D&C and repair of my cervical tear. I was still reeling from the delivery and twin loss, now I had gallstones. Perfect.

From the histopath report from the delivery (and visually from the babies themselves), it was clear that my baby girl had been infected, though my baby boy had been fine at birth. There was however, very little chance I would have carried to term, or even much longer. By the time I would have hit fetal viability, both would have been infected, and I would probably also have been in trouble. Once infected, survival of the twins was unlikely. So in retrospect, it was the correct decision for the babies and for us. I have the solace that I spared my babies a lot of pain before I would anyway have lost them. Loss sadly, is still loss.

Post surgery, I developed a dry cough that I sometimes do from the anaesthesia process. Plus, I had edema in my legs. Turned out my protein (albumen) levels and haemoglobin levels were very low. So I was given a list of medications, a high protein diet and finally sent home. I couldn't wait to get out of hospital and come back to terms with my life.

Yes, I cried while writing this post.

Fast Forward to today - Part I

So far I had been writing about my past fight. One reason was to document the process. The second (and probably more compelling one) was that I was finally pregnant and too superstitious to even write about it. Well, it didn't help. I lost my twins anyway and ended up with more complications. So I figured, I may as well get upto speed to where I am in life right now and start writing about the present instead of the past.

After years of trying, we decided to go in for IVF in March 2009. So we took a nice beach vacation early March and then settled into the IVF routine. IVF was more injection intensive than anything I had faced before. But I did form eggs, got them out in a surgical process and got 3 embryos implanted back in a IUI type process. Lots of care and progestrone for the next few days till my next period date. Sadly, no pregnancy. The implantation failed.

Next round, this time with frozen embryos. However, since ovulation was halted, I didn't take too well to a particular injection, and my lining wouldn't develop properly. So the implantation plan had to be postponed to the next cycle.

Third cycle, everything seemed to go well. Out of 5, 4 embryos thawed and 3 grade A were implanted. Another suspense period of progesterone and no activity. On the day I was to expect my period, I woke at 4am. I couldn't wait any longer and tested myself. And omigod it was positive!!! I woke my hubby and told him. It was incredible, magical, unbelievable!!!! We went to the hospital later in the day and gave in the blood tests. It was all positive! However, with my earlier chemical pregnancy experience, I remained in the hopeful but not done-deal state.

A few weeks later, we went for our first ever ultrasound, which would test for heartbeat and confirm the pregnancy. We were so keyed up, our car ran out of petrol half way!!! Not to mention, we also had a small accident earlier in the trip with a car ramming into us at the toll plaza. I had to call my dad/sis to rescue us. Since we were short on time, dad and hubby took the car to the mechanic and my sis took me for the ultrasound. They confirmed I was carrying twins!! I cannot express the feeling. Joy, relief, hope and lots of crossed fingers that let it all go well from here on. We went back home and told my hubby and parents. We had always known multiples were a possibility with IVF. It was a double bonus, but just that we were pregnant was enough in itself!

Then followed 3 months of anxiety. Most miscarriages happen in the first 12 weeks. We told only a family about the pregnancy, I stayed mostly on bed rest, daily progesterone injections (really painful) and the occasional ultrasound. Once I suddenly had unexplained bleeding and rushed to hospital for ultrasound. But it turned out okay, I took a course of antibiotics and everything seemed heading okay. The ultrasounds continued, we watched out twins develop. At first I couldn't see anything except 2 black sacs. Then we saw their bones, the spine being most prominent, slowly the arm and legs, head, nasal bone ... it was magic and it was happening inside me. Meanwhile, I got really bad morning sickness (or all day rather), lots of throwing up, gas, bloating etc. But I was really hoping everything would be okay after the first 3 months. That's what everyone said anyway.

We got through the first 12 weeks. I heaved a sigh of relief. We were shifting from our IVF specialist to our normal Ob/Gyn at this stage. I felt happier and more hopeful that this was really going to work out now.