Yes Mr. High Risk OB, I am now 30.

Brynn has been into mimicking everything we do lately. When I pull out my new cordless vac she runs to grab her toy vacuum and follows along behind me. Since we no longer have a cleaning lady and since she is so gangbuster about cleaning...perhaps I should invest in an actual working vacuum for Brynn to "play with" aka be my child cleaning slave? Just kidding :-) Do you think people would frown on that? Is 20 months too young to clean? I guess so..maybe in a few years :-)

Today I woke up, packed Brynn in the car and headed south to my parents house. I dropped Brynn off so that they could watch her while I went to my 9:30 appointment with my perinatologist. This was the same peri that co-managed my pregnancy with Brynn, and he is quite the joking type. Before we discussed how future pregnancies would be managed he asked a few questions about our recent miscarriage, how many embryos we were planning on transferring on our upcoming FET, and my current age. Before I could answer, he blurted out "Well, it shows here you're 30." Yup Mr High Risk OB...as of this past Tuesday I am now officially 30. I asked him, "Does that change anything?" His response was well...not really...just that I was a little closer to "advanced maternal age." At 30? What the heck? He then of course smiled and said that was his way of saying a belated happy birthday - and that he was just kidding. I smiled back and told him that saying phrases like that is not exactly a way to get along with the ladies. He just has an odd quirky sense of old man humor so I know he truly thought he was funny :-)

But for the record....30 is not that close to advanced maternal age or AMA as they put it on the charts up in L & D. (labor and delivery). At least I say so. And while I'm on the topic I think whoever came up with that label "advanced maternal age" ought to be shot. What do you think?

My meeting with the peri went well, about what I expected it to be. He asked to see pictures of Brynn aka the "vasa previa miracle" as he refers to her. I proudly whipped out a few to show him. He discussed the following:

- progesterone taken through the first trimester
- scans to monitor for IUGR
- a cerclage to be placed around week 13 (McDonald vs Shirodkar)
- weekly cervical checks starting around week 10 via internal exam and serial ultrasounds.
- progesterone IM shots around week 16
- steroid shots around week 24 (viability)
- Zofran, Reglan and other options for nausea - vomiting if or when it occurs
- being followed by a GI doctor for hyperemisis and gastritis if those two ugly sisters rear their head again.
- the addition of possibly adding Protonix (especially IV) if IV nutrition is needed
- the possibility of a PICC line so I could spend more time at home with Brynn if IV nutrition is needed
- screening for placental problems such as a vasa previa which we had last time

We actually scheduled another appointment for next week to discuss what type of cerclage should be placed. The appointment is in conjunction with a peri from another large hospital nearby. Although the hospital that I work at and my peri that I met with is a large hospital facility, my peri wants us to get the second opinion on my care from the other large hospital facility in the area. Our hospital (the one I work at and will be treated at) does over 7000 deliveries a year and the peri group pulls in patients referred from over 17 local hospitals. I feel confident in the care I receive. But if my peri feels that a second opinion is warranted, I will certainly go to the appointment with the two peris next week. My peri said that even for a unicornuate uterus, our case is certainly not "textbook" and so they want to cover all their bases. (or asses?) Just kidding :-)

Risks discussed for both me or the potential baby with a future pregnancy...well.... I want to remain upbeat and I will not bullet point those here or now. It was nothing that I hadn't heard before or wasn't aware of. Regardless, I left the meeting excited and anxious. I want to get our transfer underway...I want to get the ball rolling.

Yesterday I started my provera in addition to the premarin I'm taking. I'll hopefully get a period in a couple of weeks and that will be the start of our transfer cycle. Next Thursday my RE wants to do a sonohystogram to take a peek inside my old uterus just to make sure things are squeeky clean. So keep your fingers crossed for me.

Tomorrow the hubby and I leave for New York City for a long weekend. It's the first time I've been away from Brynn for the night and I'm both looking forward to it and am worried of course about it. My parents are watching both her and Neela at our house so they'll be in the comfort of their own beds and familiar surroundings. Keep your fingers crossed that everyone survives the first time separation! Especially my parents :-)

Stretch uterus stretch!

Neela says "Come on people...please...what does a dog have to do to get a decent meal around here?" Neela has learned how to open our cabinet door and get out Brynn's gerber meal plates. She then drags them around and looks at us like she wants another meal too.

Yesterday I got to work a few minutes early, signed out my narcotic box from the OR pharmacy and got ready to set up my anesthesia tabletop for my first case. When I entered OR #12 I noticed that there were already endotracheal tubes and some oral airways on top of the anesthesia cart. Clearly I had a CRNA student or a RNAS (registered nurse anesthesia student) as they call themselves. I also noticed the pediatric cart next to the standard blue anesthesia cart that is in every room. Gulp. I had my mock transfer scheduled in a few hours at my RE's clinic in the medical office building, and I was hoping for an easy day! Peds cases are always a little more challenging from just the stress of doing anesthesia on kids, and having to supervise a student to make sure that they learn safely is a bit stressful at times as well. So having a student and having peds cases just means you have to keep things on a tighter leash. I quickly phoned our lead CRNA who was running the OR board for the day, to see if I could have my lunch break at 11:30 since my mock transfer was around that same time. She said staffing was tight but that it shouldn't be a problem.

Luckily we were working with one of the world's nicest ENT (ears nose and throat) surgeons who was ever so patient with my student as well. Our youngest patient was a 13 month old we placed ear tubes in, and our oldest patient was 5 year old who was having micorlayngoscopy and biopsy. After doing our preop anesthesia assessment on the five year old and talking with her parents, my student and I walked away to discuss our anesthesia plan. I asked the student if he noticed how nervous the parents of the 5 year old patient were. The student just nodded his head, but didn't look like he had given it much thought. Before I could get to miffed at the student for overlooking a huge part of anesthesia care of peds patients, mainly reassuring the parents of the kids that we were going to take good care of their child I remembered what it was like to be an anesthesia student myself.

When you're a CRNA student it's easy to get so caught up with the stress of the actual surgical procedure and what you're going to do during the case - that you forget about the patient's concerns or in the case of peds - the concerns of the parents. I told my student that as important as it was to do a good job with the anesthesia after the patient went to sleep, it was also important to do a good job in preop. It was our job to make sure that the parents knew we were going to do everything in our power to take the best care of their child. I told him that those parents were trusting in us as their CRNA or anesthesiologist the care of their most precious cargo...their child.

Honestly, while I was in school I don't think I even thought about this aspect of the job much. I was trying not to let anything happen during the case - I certainly was not concentrating as heavily on the emotional aspect of the job as well. It's kind of nice now to be to the point where you can step back and see the whole picture a little more clearly. I know I still have a long way to go but it's nice to be able to point out things to students other than the technical points of our work. A monkey can learn a skill - but it's being able to take care of our patients as whole human beings that makes us do what we do - and not be monkeys of course :-)

Long story short, I ran down to the first floor of the medical office building to my RE's office and waited to be called for my mock transfer. Once in the exam room I changed out of my scrub bottoms and into my fashionable pink paper coverup, jumped back into the stirrups once again, and my RE did his measurements with the catheter in preparation for our embryo transfer. Without much thought I remembered back to our mock transfer for our IVF cycle that resulted in our daughter Brynn. I remembered our RE saying, "deviated to the left...8cm." Meaning 8cm in was the correct catheter placement and that my uterus was deviated to the left - which was to be expected since I have a left unicornuate uterus. This time my RE said, "deviated to the left...9cm." Yay! That meant the measurements were not the same as first time, and that hopefully it was a little glimpse into the fact that my uterus might have stretched a bit from our pregnancy. A stretched uterus hopefully means more room for a future pregnancy and less preterm labor and contractions. A girl can dream right? My RE gave me a little high five (after removing his gloves of course, LOL!) and wished me good luck for my appointment with my peri next week.

I left the office with a gleeful smile on my face. Even my student mentioned that I looked happy and must have had a good lunch. Although lunch consisted of me scarfing a peanut butter and jelly sandwich and some string cheese in the waiting room - I agreed. It was a great lunch. Great news and a good lunch. And even more good news? My student took the time to talk to our last pediatric patient's parents before the case - and I could see that they were visibly calmer after he explained things to them. He was learning...and that made me feel a sense of accomplishment. My student told the parents that we were going to do everything we could to make sure we took the best care of their child. We would do everything we could so that the child had the best outcome possible.

Now if only I can keep reminding myself that my doctors are doing everything they can so that our family will have the best outcome possible. We have good doctors..we just have to have a good outcome...at least that is the mantra I keep telling myself.

Back to bearing my girly parts for all

Hope that everyone had a great fourth of July weekend. We had a nice weekend at our house. Friday and Saturday I watched Brynn while my husband did some yard work spreading the 3 yards of dirt and a couple yards of mulch we had delivered. Then Saturday night we went to the fireworks at Lincoln Golf course in Birmingham. Brynn actually liked watching them and she said her ever cute, "oohhh ahhhh" I find so freakin cute! Sunday we spent the morning together and then I had to work the afternoon and night shift on the fourth of July. I was the only anesthetist in the OR and my friend was on as the anesthetist in labor and delivery. We luckily managed to grab some dinner together before I did a couple of trauma cases that came in. One was a nine year old with a mangled arm and leg that was a result of a motor vehicle accident. Then around 10pm we tried to repair the hand of someone who was a little silly with their fireworks.

Earlier this week I traveled to my RE's office to begin prep for our frozen embryo transfer (FET). I had to have some lab work drawn, and cultures that are mandated for all FETs. The FDA mandates that anytime there is a transfer of human tissue that the recipient is screened for communicable diseases - even through they're our tissue (embryos) being transferred back to us. It was back in the stirrups again and bearing the girly parts. My RE had one of the OB residents with him that was doing their rotation through reproductive medicine with him and asked if it was okay if she remain in the room. Being a former IVFer and spending lots of good old quality time in the hospital when pregnant Brynn I thought...hey what the heck. Sure, what's one more person seeing the girly parts, right? I kind of forgot when you do infertility treatments how many times you get to either have a date with the dildo cam (transvaginal ultrasound) or get to expose it all. The first time around I think I thought about it more but now I know it just comes with the territory. Did you guys find that to be true the more cycles you went through?

In fact I had to giggle because my husband, "Gosh you've been painting your toes really nicely lately." I smiled and said, "Of course and shaving my legs as well!" Although it is nice to have one more excuse to shop at Target (extra nail polish and shave gel :-)

Last week I started on my Premarin which I'll take for four weeks. In a couple of weeks I'll start on Provera as well. After this cycle will be the cycle that we ideally will do our FET. Tomorrow I get to bear the girly parts again because we have a mock transfer. Although I work tomorrow, my RE's office is in the same hospital so I just have to arrange my lunch schedule to coincide with my mock transfer. My RE said it would be interesting to see if the measurements he takes with the catheter in prep for this transfer are the same length, or different that the measurements he took for our transfer with our first IVF. Basically he measures with the catheter to see how far in he would place the embryos for our FET. He is interested in seeing if the measurement is different due to my uterus stretching from our first pregnancy.

Thanks for your input on ways to add protein easily into my diet. I've been trying to sneak some extra in for my pregnancy marathon training. Later tonight it's off to paint the toes again for my appointment and sneak in a power walk or run with Brynn. Keep your fingers crossed that maybe our measurements from our mock transfer will show a little stretch to the old ute from last time :-)