Monday, December 17, 2007
after all the job of a good mother is to shamelessly show off her children- so here are so my cute pics of my 3 sons. smart son 3 at 2 weeks old. smart son 2- braving the elements-- if you live in new england you know fashion is not high on the winter priority list- its all about keeping warm. He calls his hat "a snow helmet"smart son #1 (sporting winter hood hair) building 9 foot towers in the studio roomsmart son #1 crawling his way to the bus across the yard-- because the snow is totally iced over and if you walk you slide- even all shovelled areas were covered with sheets of ice-- don't you wish you lived in new england too- but as you can see- life goes on as usual despite the snow, ice and -3 windchill.my dad with my boys a few weeks ago
Sunday, December 09, 2007
I spent one day- so completely happy- so glad to have my baby born this incredible weight off me. By all accounts he was perfect. I decided to go down with him for his ultrasound. It took 2 hrs. and at the end the radiologist said she didn't really know what to make of the findings and she was headed off to call my pedi and one of the neonatalogists. I returned to the room with him unsure of what to think - and within na 1/2 an hour a neonatlogist was knocking on our door. Basically he explained the finding was portal vein thrombosis. The left portal vein was completely occluded. It was a again a quite rare and unusual finding and treating was again a difficult call. Best case scenario was the clot will clear, worst case scenarios- lobular atrophy, portal venous hypertension, and potential need for liver transplant. Well as you can imagine this was the last thing I wanted to hear after all I had been through. He said he was going to go contact a peds hematologist and a peds GI and come back later in the day and we would try to come up with a plan. We immediately called one of our friends for a blessing for each of us and especially for our new baby. About 2 hrs later the neonatalogist returned with the peds GI and hematologists- basically they told us that the literature doesn't show that anticoagulation therapy generally makes a difference but given my history of thrombophilia and some consulatation with some experts who have researched this a lot at Toronto sick children's hospital they felt treating with lovenox was probably better than wait and see (the other option) So within the hour he was taken to the NICU- where they began full assessments- following his platelets to be sure his levels were acceptable given how clots can shred through them. They wanted to do a repeat abdominal u/s the next day and a head ultrasound to be sure things were clear before starting lovenox. I was still inpatient and would go up to the nicu to feed him every 2 hrs through the night and the next day. Then on discharge I got a boarding room in the back of the NICU where I stayed for the next 8 days- leaving the hospital 1 x for 1.5 hrs to go home and basically pack up for my stay and bring some family pictures and a name tag for his crib. I would try to be up and showered each day and by his bedside for morning rounds. Where I would stay all day. We began the lovenox (2x a day injections). We did daily labs and serial ultrasounds, and he was spending some time under the bili lights for jaundice. At his ultrasound the following monday the radiologist reported there was now "some flow" in the left portal vein -- which was very exciting-- everyone had prepared us that we should not expect to see any improvement after 3 days ( i had read the studies and knew time to resolution generally ranged from months to years) and really all they were hoping for was that the clot hadn't become worse and was appearing stable. I was so excited to hear the news-- knowing any flow is better than no flow. They again slated a repeat for later in the week-- again the radiologist said you can't really see much in a 3 days interval and so we were pleased to hear the official word in his report was-- at least the same if not better flow. WE know there is still a ways to go until normal but we are happy to have seen any progress especially so early in the game. We finally reached the right therapeutic (antifactor xa) level with his lovenox dosing and so they felt he could come home and be followed outpatient. So smart daddy-o and I were trained in the mixing of his meds- quite a process given lovenox is not dosed for someone weighing 7 lbs). So we don't know what the final outcome and prognosis will be-- these next few weeks and months will be critical as we see what happens to the clot. They do feel the left portal vein issue is related to the umbilical vein varix and the big question that remains for everyone is whether the clot is related to the heritable thrombophilia that I have? does he have it? Trouble is it can't be tested for in a baby. So from here out in the immediate future it will be weeks of us giving him 2x daily injections, testing his antifactor xa levels, repeat ultrasounds and follow up with the GI and hem. and of course the emotional roller coaster continues- not knowing what the outcome or long term results will be but we are taking it day by day. I think when you have worked in medicine you have seen too much (esp as I worked with liver and transplant patients at UCSF) you sometime wish you were one of those parents who didn't really understand all the things the doctors said or you read in the articles. But we just have to keeping praying for the best and we know many prayers have been answered so far and we are grateful for so mnay of you who have been praying for him. As you can see he is the sweetest most darling baby! Here he is at 10 days old! we're excited to finally have him home! we'll trry to keep you updated.
I know I kind of left you hanging- when we did the lung maturity amnio at 35 wks- his level was 16 (45 is considered mature) so of course no one wanted to induce. we scheduled another amnio for the following week- this time the result was 22 (again no where close to maturity) at this point though I was ready to jump off a cliff- we were in a hard spot trying to balance the risks of the umbilical vein varix (and it's risk of thrombosis or intrauterine death) and the risk of respiratory distress (which for as late in the game as i was) was far preferable. SO the day before thanksgiving i went to meet with Dr. Weisberger one of the neonatalogists (basically to inform me of the risks if we chose to pursue induction w/out lung maturity). We ended up having a really good discussion about my history, this unusual cord anomaly, and the risks for the baby. At the end of our discussion he suggested we do an xray and abdominal ultrasound after birth to ensure everything was okay. I decided 37 weeks was my limit and although statistically his risks for RDS was still just over 10%- that is generally treatable and the risk on the other side was unacceptable in my book. So I went in and told my perinatalogist I was done- I felt we had pushed things far enough and I would accept responsibility for the outcome- She was in agreement and so was the neonatalogist. I just wanted to have him because I knew i couldn't handle another loss. So we scheduled induction for Tuesday the 27th--the day I turned 37 weeks- unfortunately I was the least dilated and effaced of any of my pregnancies- so my induction would require a little more assistance this time so after 4 rounds of cytotek, numerous rounds of doctors, and residents and 21 hours my little boy was finally born! I was so happy to finally have him here safely-- after so many weeks of such incredible stress I was glad to be done.