A night of doubts and omens

The night before the delivery, I still was in two minds to wait till at least Thursday (38 weeks complete). We were packing, getting organized. My sis was staying with us, managing home for me. My in-laws were coming on 21st (as per original date). All seemed organized. I wasn't so much convinced as resigned. My doc had done an external check and said the head seemed to be in down position, she didn't feel a transverse position, though hadn't dropped so position changes wee possible. I was toying with the idea of waiting. Letting the position correct, baby drop, maybe go for natural delivery. I was mentally prepared for 21st..not tomorrow! I wasn't ready. What if I didn't lactate. What if baby hadn't crossed 2.5kgs? What if loops were back? So many questions...so much indecision.

And then all of a sudden, I leaked milk. It was totally unexpected and shocking. Whoa....! It seemed like a sign. I took it as a sign. I still couldn't believe that I had managed it so far, and my survivor baby had held on despite all the things that had kept going wrong. It seemed destined in a way. I stopped thinking and just let it be.

Reaching fetal viability

From my last pregnancy I knew that 28 weeks was the first milestone, while 32 weeks was the absolute minimum. I stayed in bed and counted the days off. When I reached 28 weeks, I felt some confidence, but didn't let myself hope too much. At 30 weeks, my doc sent a fellow practitioner to check my progress externally. She was fine with me, but wanted me to take steroid shots to accelerate fetal lung development in case of pre-term labor. I had been feeling the baby move for a while and she told me to start keeping count. I started an excel sheet!

I asked my doc if I should get an ultrasound done, since I had no check up after week 18 and till the doc visited me at home at week 30, but she said she didn't want me moving before week 34, at which point, she would be fine even if she had to deliver then. Week 32 brought another home visit and all seemed fine. At week 34, we finally went for an ultrasound. At this point, it had been almost 4 months since we had any internal check done and we had NO idea what was going on inside, apart from the two home doc visits who just checked my belly externally for baby size and position.

At the ultrasound, it was amazing. We saw a 3-D ultrasound. We saw our baby....really developing. Everything looked great, till the sonologist hit us with a whammy....the umbilical cord was wrapped around the baby's neck...twice. It was a possible danger scenario, not so much of choking as the loops constricting nutrient supply to the baby and creating problems. Again, it was a case where the loops usually resolved themselves (though not two loops usually) and babies born with loops did survive. (My mom told us, she herself had been born with loops around her neck.) However, it was a complication, and my doc asked me to track fetal movements closely and keep check. Also, the baby was growing on track, except for her abdominal cavity which was 2 weeks behind. What more..seriously >.< We went home to wait it out. My doc had lifted my bed rest restriction, but I still followed it to some degree...what was a few weeks more anyway.

At 35-36 weeks, we had our next ultrasound. Amazingly, our baby had taken off both loops! Even our sonologist was amazed. At this point, finally I let myself start believing that this time..it might actually happen!! Unfortunately, the baby had turned and was now transverse, a position that again usually resolved itself, but in delivery, was impossible without caesarian. The doc told me to remember the head was near my right flank, not that I realized the significance of that comment at that time. We went home. It was Durga Puja. We spent it at home, only going for Navami morning puja, on the completion of my 37 weeks on Asthami Friday. The next day was Dussehra, at home, and then we had an appointment on Monday evening.

My doc was now keen to plan a C-section with the completion on 37 weeks (which completed on Friday)...the lower limit for a full term baby. I was still toying with the idea of a normal delivery though after my doc heard that the baby was transverse, that went out of the window. Transverse babies do resolve and my baby hadn't dropped yet, but with my history, my doc wasn't taking chances post 37 weeks. The baby had been 2.4kg in the 36 week ultrasound. 2.5kg is the lower limit for a normal weight range baby. We were sure baby would have crossed that.

I was tracking fetal movements on my excel sheet and it seemed to me there was a little drop in them, though still above the standard 10 kicks count. We fixed Thursday the 21st for the C-section. Booked the room, OT everything. On Monday 18th, when I went to meet my doc, I mentioned the change in fetal movement pattern. She was immediately disturbed. She sent me up for a monitoring test. The test showed within range, but when we spoke to her, she told me she wanted to deliver the next day, as soon as we got a slot in the OT. She told me the baby was probably over 2.5kg, we had made 37 weeks, at this point, it was absolutely fine to deliver. And while it was of benefit to keep the baby in as long as possible to pack on more weight, she would rather not take a risk with a precious pregnancy, with my history, and with my feeling of changed fetal movement pattern, however vague and unsubstantiated. In her terms, maternal instinct took precedence, even if I wasn't wholly sure. If I felt enough to raise the issue, it was enough. She wanted me to get admitted immediately for delivery next morning. I asked her if it was an emergency or could I go home and get admitted in the morning. She was ok with that next morning admission and we went back home.

Things start to go wrong...

I had slight bleeding the day of my appointment with my possible prospective ob-gyn. But I figured I was meeting her anyway...will get it checked too. It happened last time as well and had cleared up on its own. I had spoken to both my fertility specialist and her on phone and sorted out roles. They would do the cerclage together and then she would take over if I wanted to change my current gynae and stay on with the same hospital.

On my way to the hospital (barely a 10 min drive) I felt a gush of blood and got terrified! I told my new doc and she asked me to get an ultrasound done immediately. The ultrasound showed a large retro-placental clot and a low lying placenta. She advised me not to take chances and admitted me immediately to get the bleeding under control. With an openly bleeding unresolved clot , it was not safe to do a cerclage at this time. I had come to the hospital alone, without anything or anyone, just for a consultation and I found myself admitted! Worse, hubby was out of town, in fact had just left that morning. He had planned the business trip because after we met our specialist and she was agreeable, everything had seemed ok, and he wanted to free up the next week for my possible cerclage surgery. I called my mom, luckily she lived only an hour away or so and got my admission and home front organized. I was kept on complete bed-rest for a week or so to see if the bleeding would subside and we could do the cerclage. However, the bleeding didn't stop. The clot was still there and fairly big, but now, my placenta was coming very low, almost half placenta previa. A symptom of this condition IS bleeding and the method to control it...you guessed it cerclage! But with the clot still unresolved, the cerclage could not be done. There was nothing we could do but wait for the clot to resolve. And as long as the placenta was low, I would continue to bleed. Placenta does travel upwards in most cases and resolves itself by the end of the second trimester, but for the time being all we could do is wait and watch. Would anything ever go right!

After a week or so in the hospital, and seeing that the clot was slowly resolving itself, I spoke to my doc about going home. We would anyway have to wait for 4-5 weeks or so for the clot to completely resolve. I would have to be on strict bedrest...but then I had got used to that. The bleeding continued throughout, attributed to the low placenta now. Luckily through all this, my baby remained fine. It was already week 14. It seemed like I was destined for late emergency cerclages. I closed things with my original gynae since considering my case, I wanted to stay with the hospital close by.

At week 17, I went for another ultrasound, after spending the month on strict strict bedrest. The clot had resolved a lot, but the placenta was still low and bleeding. Plus there was a very slight but definite opening of the cervix. At this point my new doc suggested going for the cerclage which would manage both the bleeding and the opening. But my fertility specialist was out of the country! We spoke to her, decided not to wait, and went ahead with my new doc.

The cerclage went in and I was discharged in my 18th week, after my level II scan. Miraculously, the baby was still doing fine, everything with the fetus was on track. Now I only had to hold everything together.

My new doc put me on strict bed-rest, arranged for someone to come give me my progesterone shots at home and told me she was confident of me and just to stay positive, in bed, keep my digestion smooth and take things easy.

A change of doctors

At 13 weeks, we were in two minds about getting a cerclage. It hadn't helped the first time. It had led to infection and tears. This was a natural conception. If this could happen on its own, maybe it was best not to interfere. On the other hand, history of cervical incompetence has a very high probability of recurring. In fact it is the standard reasons to do cerclages! And the first time, it had been a twin pregnancy, the cervix had already started opening, and the cerclage was put in as an emergency procedure. This time we had time on our side and it was a single baby.

The other thing making us uncomfortable was my gynae herself. Though very experienced, we had only had failures with her in 4 years. Her cerclage had been unsuccessful. She lived and operated far away from our home, and during the miscarriage emergency, we had realized the need of having medical help close by. But I was uncomfortable changing her. She was vastly experience, knew my entire history and literally knew me inside out. It wasn't her fault I was turning out to be such a stubborn patient. On the other hand, in her own words...sometimes the relationship just doesn't click. And this wasn't clicking. Things like her extreme conservative approach and focus on negatives was becoming grating with each successive failure.

We went to her for my 13 week check up, actually meeting her for the first time in my pregnancy. She examined me but was iffy about the efficacy of a cerclage. It must be put of course according to her, but there was no guarantee it would hold. NOT the thing you want to hear after a failed cerclage and loss of 2 babies. She indicated extensive tearing on one side, and was not confident of having enough place to take a stitch on that side. But when we asked her if she would recommend we shouldn't go for it, she said it was chancy. The cervix may not open, but if it did, it would be emergency cerclage again. And 13 weeks is best time for a cerclage. Post that it takes time to settle, and it might be the same story all over again. She told us to think over it, and also the decision of to stay at her hospital or go to one closer to home (where we had had to go during my miscarriage emergency).

We came away feeling troubled. I felt like she had literally left me dangling off a cliff in a damned if I do, damned if I don't position. The thing that hurt me most (and pissed both of us off) was her attitude of not taking any responsibility for the cerclage. It was like I'll do it, but its your luck. I don't guarantee anything. Now I know any surgical intervention has failure rates. But to so totally distance oneself from the result really got to both of us.

We decided to take the advice of my IVF specialist, who consulted at the hospital where I had gone during my miscarriage and had taken an interest in monitoring me then, even though she doesn't practice obstetrics anymore. She actually was my gynae's reference for fertility treatments, and would manage conception to first trimester, post which you would go back to your regular gynae. I was so demoralised by my current gynae's frankly morose predictions that I needed a balancing view. I had found this specialist very technically skilled and hoped for at least a more objective if not positive view.

I made an appointment with her. She was happy to see me pregnant, attributing it to my weight loss (which she had suggested in her very consultation with me). She was confident a cerclage could be placed and was adamant in her advice that I must get one done. She did operate at my preferred hospital and was willing to do the procedure. However, neither of us wanted to slight my regular gynae and she could not help me with obstetrics and pregnancy management for the rest of my term as she no longer practiced it. At this point, I remembered another doctor, who consulted at this hospital, who had in fact done my D&C after my miscarriage. She was younger than my current gynae, but I had found her extremely nice and positive during my stay at the hospital. I decided to consult with her for taking me on as a patient post cerclage and fixed up a meeting on the next day.

The greatest shock of my life

After all the downs and even more downs of 2009, by end of Jan 2010, I just wanted to put the past behind me and get back a hold on my life. We decided to stop trying and started making plans of what to do next. Hubby quit his job and we started looking at jobs abroad, and experience we had always wanted, but didn't want to act upon given all the medical problems I was going through. However, once we decided to take a break, we were free to look at that option.

February is lovely weather in Delhi, spring flower shows and melas. And we made the most of catching as many of them as we could, almost like a mini vacation.

I had started my cycle, post miscarriage, end of Jan. When I missed the next one, I didn't really bother. After all, I had never been regular anyway, and the thought of me conceiving, without any external help, in just one cycle, after 4 years of failed medical interventions...was laughably remote. Around second week of March, my hubby suggested I should try a home test. Anyway, there were still a couple of kits left over, may as well finish them off. It barely mattered..may as well finish off a kit..or thats what I thought.

To my utter disbelief, the result was positive! No intervention, no medicines, heck barely a couple of instances on our part even! I tried the second kit...same result! Called my gynae...already 8 weeks in, she sent me for an ultrasound....and what do you know...I WAS pregnant!! It was unbelievable!!

Went back home in utter disbelief. Gynae put me on medicines specially progesterone support (ugh injections!..since my parallel blood test report had shown low prog levels) and told me to take it easy and meet her after 13 weeks were up. At 13 weeks, given my cervical history, we had to make a decision on whether to go for cerclage or not.

So till then I just took it easy and lived in utter disbelief.

Update

So I had my last visit with the surgeon on Jan 16. He said I was all fine, scars healing nicely and ready to move on! Whoopie! Of course, that didn't mean I have license to eat, eat and eat...just that there were no more real restrictions, and with some circumspect eating, I should be fine!

I felt like a racehorse let out of the box! Immediately, I wanted to eat everything! Suddenly my appetite is back too. I feel hungry almost all the time! So far I've tried mexican (chicken tortillas, nachos without cheese), chinese (dimsums, soups and chicken in oyster sauce), buttered garlic bread (2 at a time), chicken teriyaki half-sub sandwich, mayo scraped off chicken burger, assorted snacks like khatta meetha, chana dal, small samosas, boiled corn, chocolate, small cup of milk (double toned), standard indian fare - normal tadka dal, aloo-gajar subzi, etc. So far so good! No stomach aches or anything. If I overeat, I feel a bit sick...not achy sick but more gassy/acidity sick (but not enough to warrant an antaacid)..and of course gas remains a problem. Otherwise it seems ok. Makes me feel very optimistic. Maybe its all really going to be fine!

Now I need to keep a control over how much I eat. I tend to feel hungry all the time. So far I had avoided snacking, but off late I think I'm overly snacking. Small meals many times a day has kinda translated to many snacks, and lunch/dinner are not always as small as they used to be (3 rotis instead of 2, 8 dimsums instead of 2 or 4, etc. etc.) I'm giving myself a couple of weeks to get the freedom eating out of my system. I lost a lot a weight last year, so I plan to keep weighing myself to keep a note of my eating. And though I am going a bit easy on myself this week, I think I should get back to slowly introducing restrictions back...on portions and on snacks.

But I really think this may work!

On the gynae front, my lochia stopped a couple of weeks back. I've been on the watchout for it restarting, but so far so good. 6 weeks are over since the surgeries/delivery and I'm in the safe zone. Not sure how my usually irregular periods will work out. Not really looking at conception this year, so I'm more relaxed about that. I guess I'll give it a month or so before going back to the gynae for a general check up and PCO status. Otherwise, I've kind of pushed this part to the back burner for now.

Getting out of the house

On 2nd Jan, my bandages came off. Doc said I was doing fine, reduced my medicines and told me to come back after 2 weeks. With the bandages off, I felt a lot better. The cuts had scabbed over, but the doc said part of the scab was actually the glue used to seal the skin shut. The area around the cuts was dry and I was asked to apply any moisturiser (or preferably coconut oil) to the area. It itched like hell!

I was so happy to get them out, I went shopping! Earlier I was in two minds about shopping immediately after getting the bandages out. I wanted to buy jeans/pants and the 3 of the 4 cuts where in the waistband area. But apart from the itchiness, they weren't really hurting, and some retail therapy would be wonderful...so I went for it.

This was also my first foray into eating out. I went for plain grilled chicken for lunch, and the chicken teriyaki 6-inch sub for evening snack. Did I mention we shopped for 6 hours! The best part was trying on clothes, realising I'd dropped a couple of sizes. Sadly I didn't get a good pair of jeans (low waisted ones don't suit me), but I did get a lovely pair of dark blue cords and a comfy but chic pair of sweatpants. Got a full sleeved T-shirt as well. Tried tons and tons of clothes but that's all I bought. And a few books...about 7 actually. :D

Came back home exhausted. Changed and rubbed baby oil onto my cuts. While rubbing, part of one scab fell off. That immediately got me obsessively trying to remove the bigger scabs by careful levering and generous application of oil. Its amazing how obsessive scab removing can be! As long as I did it carefully, it didn't hurt...and the relief when I got the scabs out of the two big ones was amazing! I wasn't sure if it was just the healing process, or that the scabs had been pulling the skin, but as soon as they were out, the worst of the stinging while bending was over!! Hallelujah...I'm on my way to wellness at last!!

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.

Trying to conceive - TTC

My doctor started me on daily tablets of metformin and folic acid supplement. This was the first phase. First I had to get my body back into order - lose weight and reduce my blood pressure. Easier said than done! Metformin is actually an anti-diabetic drug and tackles the PCOS symptom of insulin resistance. It also helps in weight loss.

I started the pills along with trying to control diet and exercise. I did lose some weight, and after 6 months decided to start trying to conceive (TTC).

A normal cycle goes something like this (in layman's terms). The woman gets her period, about 7 days, then her ovaries start forming follicles. The endometrium (uterine lining) starts thickening in preparation of pregnancy. Follicles mature/grow to a certain size, then rupture to release the egg at around the 11th-15th day. This is the fertility period when the egg is available for fertilization by the sperm. A fertilized egg (now called embryo) implants in the uterine lining and attaches itself to the uterus for a successful pregnancy. Then comes a 10-12 day suspense phase when you may or may not be pregnant. At the end of this cycle, if you are not pregnant, the body will start shedding off the endometrium lining and this is the start of periods and a new cycle. The whole thing takes about 28 days. Any one thing going wrong will require abandoning the cycle and waiting for a month for the next one. Sometimes, if you have ended up with a surfeit of hormones, you might need an extra non contraceptive cycle to help your body get back to normal before trying again. So one messed up cycle could mean 3 months wasted!

This TTC business takes time. I couldn't adjust to that for a long time. I was used to a fast paced life - work hard, party hard, instant gratification, deadlines and results. Suddenly, I'm in a space where anything can go wrong, which you can't control; every small thing will send you back to square one and you have to wait for the next viable cycle; and even if you do everything right, results may not come and you won't even know it till your next cycle starts!

In my case, I faced everything. One cycle, I wouldn't have follicles. Another, the follicles wouldn't mature properly. In yet another, the follicles wouldn't rupture. Another time, my lining wasn't thick enough. A few times when everything was ok, we tried natural and artificial insemination, but the embryos wouldn't implant. In each stage I was variously on pills or injections, almost daily ultrasound monitoring, sometimes in the hospital for artificial insemination and giving blood tests to keep a check on hormone levels. Frustrating, maddening, time consuming and emotionally draining, without even taking into account the side effects of all the hormone stuff I was taking!!

I spent more than 3 years doing this, gave up my job, had a laproscopy surgery done (to make my ovaries more responsive to developing follicles), a hysteroscopy (to check my uterus and tubes) and spent 6 months in tuberculosis treatment (because 1 out of 3 tests came positive). My doctor wanted to cover all possible bases, and with failure after failure, we decided finally to go for the last option - IVF. I once sat down and made a chart. In 3yrs+ of trying, we had had only 5-6 cycles which had gone upto fertilization stage - 3 failed in IUI and the others in natural conception. Just 6 real chances in 3+ years. To say that I found the chart demoralizing would be a massive understatement.

I had given up everything, job, career, friends, interests; spent 3 years of my life in and out of doctors' offices & hospitals, and had nothing.

Incurable but not untreatable - the battle begins...

PCOS is incurable, but its symptoms are treatable. This means you CAN get pregnant, you can manage weight gain, hirsutism, acne etc. PCOS put you in a high risk category, but with medication, exercise, diet control and assisted reproductive techniques (ART), you can manage and control the symptoms. My body may have slammed a door on my face, but medical science still gave me options!!

Even more incredibly, lots of women go on to have perfectly successful natural pregnancies without even realizing they have PCOS, leave alone needing medical help!! No one knows why. Its just a really fickle syndrome! So there are natural success stories and medical workarounds, maybe not 100% successful, but definitely not a lost cause!

I was 28yrs old, had age, science, determination, optimism and a very very supportive hubby on my side. This was something I could do. This was something I would do. I've always believed that hard work and genuine effort will never go unrewarded.

I'm going to fight this. I'm going to put in everything I have. I'm going to take every chance I can get. I'm not going to look back on my life and regret that I could have done more. If destiny has other plans for me, we'll see...but it won't be because I didn't try and give it my best shot.

I have PCOS - Poly Cystic Ovarian Syndrome

I have PCOS - Poly Cystic Ovarian Syndrome. It has taken me a long long time to be able to say that without feelings of denial, embarrassment, resentment, self recriminations, guilt, depression and plain old fashioned self-pity. To accept that I have a condition that is a leading cause of infertility in women has been a really long journey...and one that is ongoing.

I had no prior warning of infertility, though the signs were there. I've always had irregular periods, but then loads of women do and go on to have perfectly normal pregnancies. I had put on a lot of weight, but I put that down to long work hours, stress, bad eating habits and no exercise. I didn't really have acne problems, though hirsutism (excessive unwanted hair) was something I'd learnt to live with. On my mother's side, I did have a family history of diabetes, but personally hadn't had blood sugar problems. In effect, I had never heard of PCOS, even though I displayed some of the classic symptoms. So when I visited the gynae, that was her first diagnosis, and she sent me for an ultrasound that confirmed bilateral (both ovaries) PCOS. Uh oh!!

Both my parents are doctors. I'd been raised in a family where sickness was limited to seasonal flus and the occasional childhood one time measles and mumps. All treatable with rest, chicken soup and the occasional medicine. I'd never been admitted in a hospital, was terrified of needles and of the firm belief that all illnesses are symptoms of known causes and were temporary and treatable. Then I learnt about PCOS.

First, there is no established cause. What???? A leading reason for infertility and people don't know what causes it?? It sounded incredible! But it doesn't stop there. There is no cure either. I have an incurable syndrome that makes me infertile! And there is more to come. It causes insulin resistance, obesity that after a tipping point goes on an upward spiral and diabetes. All this along with infertility, irregular periods, hirsutism, acne, hair loss, depression.....and NO CURE! Just in case my cup wasn't already full, it also increases risks of cardiovascular diseases, strokes, miscarriages, thyroid problems, lipid metabolism problems, high blood pressure, even endometrial cancer - each symptom and risk leading to its own set of medical complications!! And we don't know what causes it, we don't know what cures it...its a lifelong companion.

I'm not sure what I first felt on getting to know all this. Mostly numb I guess. To be told you have an incurable lifelong problem, which in turn will create a whole host of other problems, based on a set of what you thought were symptoms to just shrug off...numb and flabbergasted describes it best.

Nothing in my family history prepared me for this, except the diabetes on my mum's side. Still, no one else had PCOS. To say I was thoroughly unprepared to deal with my doctor's diagnosis would be an understatement. I had something with no cause and no cure - it seemed completely unfair, out of the blue and just unbelievable!! I hadn't done anything to deserve it. Why me???

To blog or not to blog

After years (since Dec 2005 to be precise) of active medical help against infertility, this June we finally had a successful IVF and conceived!! Since then, its been a roller coaster 21 weeks to realise:

- It is one thing to conceive and totally another to have a successful pregnancy

- I am more superstitious than I ever thought I would be

- Pregnancy is like christmas for many people - lots of fun, light, happy surprises and hope. I fall in the Halloween category - falling into one scare after another, more trick than treat

- My hubby is an angel, the rest of my long suffering family have angelic traits as well.

- My body knows how to keep my gynae well occupied

For a long time, I've been wondering whether to blog about my infertility. Its a sensitive topic. Very private, quite embarrassing and frequently technical about usually unmentionable parts. Not to mention feelings of denial, frustration, 'why me', depression - all not very conducive to writing eloquent or just non-bitter post. And then of course is superstition - the more you talk/think about it, the more you will jinx it. And finally, the frequent failures. Month on month hope charts rising and falling.

Well, finally, I decided to take the plunge. After all, this is my life, has been for the last few years. Others may lead infinitely more interesting lives, but this is my story, years of my life - simple, mundane, but no less real.

There's quite a lot of back history to go through. These first few posts, I've decided to write about TTC (Trying To Conceive). This itself is half the battle. Then, I plan to move on to my pregnancy. This also panders to my superstition of trying not to jinx what I have right now by talking about it!!!! Well, thats the plan anyway, lets see how it pans out!

Here is how it started. Four years ago I was a successful management executive, running the rat race with gusto, juggling work and fun, making decent money, doing good work, climbing the potential ladder, going out with friends, taking honeymoonish vacations....and generally on a fast track to a good life. Well settled personally and professionally, hubby and I decided to think about a family. It was the next logical step. We had been married a few years, were both in the second half of twenties, were just going to stop contraception and take it as it came, totally aware it may be immediate or may take some time. We had time. Life was fine. We both even managed transfers to the same city my parents lived in, so we would have a support system. Throughout, I had this vision of me getting pregnant, working throughout till the very end, having a baby, taking a couple of months of and then getting back to work, juggling work and family. Not such a far fetched idea - my mom did it with both my sister and me, uncountable colleagues were doing the same thing. It was the standard thing to do!

Then, after a few months of general trying, during a mild orthopedic check up, I decided to walk across to the gynae and get a general health check. That visit changed my life.