Worried and kicking

It’s been 5 days since I learned about my possible toxoplasmosis infection and I’ve just been a rollercoaster of emotion:

  • doom and gloom: worst case scenario congenital toxoplasmosis situation. How will we adjust to having a severely disabled child? Is this fair to my other children? How will our lives change?
  • denial: this MUST be a false positive. I don’t spend time around cats, I don’t eat meat, I have barely eaten raw fruits and vegetables this pregnancy and never without washing them. Then I think about the one time our cat lady neighbor picked up two packages for us while we were away. This was back when I was very early pregnant, 1-2 mo. What if one of her cats pooped on the packages and then I grabbed them? Is this enough contact to transmit toxoplasmosis? Would my IgG be positive if this were the case?
  • anger: why did my ob check this lab? There seems to be no clear guideline to doing so (for asymptomatic patients without exposure risk). I switched to this ob primarily to have the same person I saw for regular visits deliver my baby instead of a resident (to clarify: not because I didn’t think they’d do a great job, but because I would prefer for residents I work with not to see me in labor. Although, two residents did deliver my second and I can barely remember who they were) but now I’m having second thoughts. Should I have stuck with my original group, who didn’t check for toxo because it’s not standard of care? Now I’m on this wheel of test after test after test (what I’ve been trying to avoid since my first induction for suspected pre-eclampsia) and I’m mad at myself because it’s of my own doing. I also wish she had a clear algorithm in mind. If she sends off a test, then she should have a clear plan as to what to do if it’s positive or negative. Yet, I know that this is not always true in medicine, and this is how we learn.

My husband is a level-headed, pragmatic individual. He is not worried at all. He says that worrying won’t change the situation. There is literally nothing I can add to the situation by worrying, and I need to relax and wait to see what the doctors say next week. I have an ultrasound scheduled and will follow up with high-risk ob the day after (by phone at least). I wish I could be reasonable like him and not worry, but I have a tough time doing so. I worry about the need for invasive testing or treatment which could be dangerous to the baby. I worry about being in a perpetual state of worry (is this the ultimate sign of anxiety or what?) during this pregnancy. I worry that the baby will need unnecessary testing when he’s born. And I think about what it would be like to have a baby with congenital toxoplasmosis – how different from my prior newborns. How will I handle that on top of having a newborn and 2 toddlers?

In the past few days, the baby has started to kick more. He was moving early on this time around, but his movements have been much more intense and exaggerated. I like to think that he’s telling me not to worry, to calm down, that he’s alright. I hope this is true. Only 3 more days until I have my ultrasound. I pray that everything is normal.

Bad news

This month has been hectic. It started with a lovely get-away (without kids!) for my husband and I. It was lovely. We were away for a week and were able to sleep 10-12 hours per day, finish both our conversations and our meals, lounge leisurely by the pool (under an umbrella, of course), walk along the beach, read, and simply be.

As always, I returned home with a desire to incorporate some of that into my daily life: taking a few minutes per day to just be together, reading more for fun, enjoying leisurely meals, exercising. Except we came home to a 1 year old and a 3 year old and two full-time jobs so none of the above happened.

It’s also a busy time. I’ve been taking advantage of my second-trimester energy to complete a few projects, including submitting plans for a minor home renovation. I’ve also had a pesky cough since our time away and though it would go away but it didn’t, and the coughing would often rob me of my energy and cause me to feel even more tired than usual. To top things off, my oldest came down with hand foot mouth disease (HFMD) and was home the entire week prior to a flight I was taking solo with both kids. He was in pain and cranky the entire week (apologies to all of the moms I counseled on HFMD by saying it was merely viral and would blow over) and, the worst part of all was that he wouldn’t sleep through the night! So the first few nights my husband and I stayed up with him. And then my youngest got a fever (but fortunately did not erupt into HFMD) and then HE wouldn’t sleep through the night.

So I set off with both kids in recovery ALONE on a 6 hour flight and it was by far the worst flight we’ve ever had. My kids have traveled a lot because even though we don’t live close to family, I think it’s so important for them to spend time with them. They are usually shockingly well-behaved. I come prepared, keep them entertained, and they generally keep their crying and tantrums to a minimum. But last week was a different story. Both kids were on the mend, I felt like crap from a combination of not sleeping as well as fighting off this cough (oh and being pregnant), and they wouldn’t nap! So we kept things pretty together until the last 30-45 minutes. And then when the plane landed, all hell broke loose. Both kids wanted to be carried but I only had two hands and had to carry the carry-on bags (we only had travel backpacks with us but it was a lot to juggle!). Then my oldest started throwing a tantrum about everything – he didn’t want to let me into the aisle to organize our bags, he didn’t want his brother to sit by the window, and on and on and on. Meanwhile, I’m frantically trying to organize everything while his little monkey of a brother is climbing over the seats. My oldest won’t move from his spot so I tell him “I’m going to pick you up and sit you down here so that I can grab everything” and do just that. He loses his **** and starts yelling “Mommy you HURT ME!”. Meanwhile, I’m dying.  As calmly as possible, I tell him it’s time to get off of the plane. A very nice lady helps with one of our bags, I carry my youngest off the plane, and my oldest begrudgingly drags his bag and follows behind, complaining all the way.

At the gate, I have to find and unfold our stroller, which was a waste of effort because neither kid will sit in it (but at least I can pile some bags on it). The oldest is crying and blocking people as they walk off of the plane while the youngest just wants to be held. I hightail it out of there with the oldest hitting me on my backpack and throwing the world’s greatest tantrum. We are the last people off the plane and the pilots are begrudgingly walking behind us because (I learned on another trip) they can’t leave anyone behind when they leave the plane. Awesome. And then, to top it all off, I have to walk approximately 20 minutes with one kid in my arms and one kid whining the whole way because we have landed at a huge airport, at possibly the furthest airline!

It was a total disaster. I saw my parents at the exit, handed the kids off to them, and then walked off to baggage claim to burst into tears. I could tell the security guard knew I was going to lose it because he let my parents follow me to the baggage claim to help out with the bags.

Until yesterday, I thought that was the worst thing that had happened. Then, my ob called me. Before I left, I had a few third trimester labs drawn. Apparently, one of those labs was toxoplasmosis. I had already had this checked in January (at 7 weeks) and both IgM and IgG were negative. For some reason, my ob rechecked it. She admitted that this was controversial – that many people don’t recommend rechecking due to low likelihood of infection in our area and false positives. But then she told me that I had a new positive (IgM, with IgG still negative). She wasn’t sure what to make of it. She had spoken to the high-risk obstetrics group at my hospital and they would follow up with me and likely have me return for an ultrasound, as well as labs, maybe an antibiotic, etc. She told me not to freak out so I promptly did just that – freaked out.

Toxoplasmosis!? That’s one of the terrible infections we learn about in medical school that can cause a slew of problems in newborns. WTF!? But I don’t own any cats…and I’m a vegetarian! I couldn’t believe it. I did what I always tell my patients not to do – turned to Dr. Google, and PubMed, and every person I know who is an obstetrician or infectious disease expert. I received a slew of responses: it’s probably nothing/a false positive, you definitely should not ignore this, you need serial ultrasound monitoring, they need to test the baby, there’s nothing you can do anyway because you’re 24 weeks along.

I’m also a bit annoyed at my ob. Why did she check it if it’s controversial? Her exact words were “I’ll probably change my practice after this”. And I am not entirely sure she knows exactly what to do at this time. She referred me to the high-risk ob, and that person called me, but I’m traveling and can’t be seen tomorrow, and she’s going to be out of town next week. The ID expert I spoke with told me to get labs ASAP, but the ob told me it wasn’t time-sensitive. Her exactly words were “I’m going to be blunt with you because you’re a doctor: if this is a true infection, there’s not much you can do at 24 weeks”. But shouldn’t it matter if it’s a true infection?

So I’m just waiting here, anticipating the worst. And it’s made me realize that I’m done having kids. I always thought I wanted a fourth, but pregnancy is too tenuous and stressful. I think about the experiences I’ve had with my kids – my pre-eclampsia scare with my first and him being in the NICU after birth (the briefest NICU stay ever, but seemed like the longest to me), my positive first-trimester screen with my second and having to see genetics for additional screening to rule out a chromosomal abnormality, and now this with my third. I pray that he will be healthy. That this is either a huge misunderstanding (false positive) or that he does not catch this infection. I’ll have an ultrasound in one week and hopefully will have some additional information at that time – and hopefully it’s all good news.

Updates from the 1st trimester

I’ve been thinking of all of the things I want to remember from this first trimester. With my first pregnancy, I journaled all the time. With my second, I journaled less. This time around I forgot the password to access my (very sophisticated) Word doc journal and haven’t written anything since before becoming pregnant.

So first I’ll start with early pregnancy symptoms. I hate early pregnancy symptoms because they can literally be anything, so when you’re trying to get pregnant every little twinge becomes a reason to obsess over whether you could be pregnant.

I honestly didn’t feel any different than I have during my last few cycles. A bit of back pain a few days prior, but I’m pretty sure that’s more related to my 40 lb 3 year old and 25+ lb 1.5 year old. We flew for the holidays and I felt incredibly nauseous on the descent, but didn’t think much of it as I had experienced nausea with some prior cycles. What really tipped me off was this: no hormonal acne. Around the time of my menstrual cycle, I develop a few cystic acne lesions. I had zero by day 30 and this definitely piqued my interest. When I went to bed that night, I thought I felt something developing on my chin, but it was gone by the next morning. And that was it-I took a pregnancy test the next time.

During these first few weeks, I’ve felt:

-general stomach uneasiness

-nausea, usually worse in the early evening

-cravings for: carbs, juice (orange and mango), pineapple

-no desire to drink coffee (usually a staple of my diet) and no real desire to eat chocolate (another staple of my diet)

-intense moodiness

-incredible fatigue

I’ve also felt great worry, which is a staple of my pregnancies. I honestly wish women didn’t start showing until ~week 20, after the anatomy scan. With this pregnancy, I am showing EARLY. A handful of people know for a number of pragmatic reasons, and this makes me even more nervous! With my first, we didn’t even tell my family until I was almost 12 weeks pregnant. I didn’t notify my new employer until I was 14 weeks pregnant, and my colleagues at the time didn’t know until almost 16-18 weeks! With my second, I didn’t say anything until honestly around 20 weeks+ (although our families knew right away). I was negotiating a new contract at the time and didn’t want my pregnancy throwing a wrench into the plans.

I had one bit of good news at 7 weeks: baby had a heartbeat. But this is only minimally reassuring. The miscarriage rate on a population level is still 5%, and I’m sure we all know people who returned for their second check-up to find that the baby’s heartbeat was gone. So I am trying to stay sane until my 11 week appointment. And the week after I have my nuchal translucency/first trimester screen and my appointment with a genetic counselor (I’ll be 35 when this baby is born so I’m adding Harmony/Panorama/non-invasive prenatal screening test onto my routine prenatal testing). I think if I can get past the next 2 weeks (which are also riddled with work deadlines), I’ll be able to breathe a little more easily. Although then I’ll have the anatomy scan hanging over my head.

Well, I feel fortunate to be pregnant for now, and will try to keep my anxiety in check while I count down the days! The crazy thing is that in just 2 weeks I’ll be done with my first trimester, and then there are only two to go!

The first trimester

The first trimester sucks. Of all 3 trimesters, it is by far the worst (for me at least). First of all, I always feel like crap. Nauseous, tired, cranky. During my first pregnancy, I would come from work, crash on the couch, and binge on Scandal until I passed out at 9pm. Now I have two kids under 4, so I can’t just lay on the couch watching TV.

Second of all, it is fraught with worry. Once a positive pregnancy test erases the worry of “will I ever get pregnant?”, I start worrying about whether this pregnancy will stick. So there’s the worry up until the first ob appointment (will there be a heartbeat?), the worry at every subsequent appointment (is there still a heartbeat?), the first trimester screen, and on and on and on.

To top it all off, you can’t even explain to your family, friends, colleagues, etc., why you have a short fuse. They just assume you’ve turned into a bitch. And then there’s the awkward turning-down-drinks component, when everyone is dying to ask you whether you’re pregnant but of course they don’t want to because you don’t quite look pregnant, do you?

My husband took the boys out for a bit so I could finally sit down and rest today (kids woke up at 5:30a this morning and it’s 4:00p). We are both wiped, but he’s taking one for the team, and that’s why I love him.

So I’ll go back to reclining horizontally on the couch, reading my book, and trying not to worry about this trimester.

(Barely) pregnant

So this happened today, on Christmas Eve. I honestly can’t think of a more perfect present!

IMG_0410

Yes, I am barely pregnant at this point. And really just maybe pregnant. Maybe it’s a false positive, maybe I’ll miscarry, maybe the baby will have a birth defect that’s incompatible with life, and on and on and on. There are so many unknowns right now, at literally only 4 weeks pregnant, but part of me is already trying to wrap my head around what life could be like in August of 2018. Three little ones – 3, 2, and a newborn. Our house will be packed to the brim. The financial plan we created this week will need to scrapped and redone. My current baby will no longer be a baby – he’ll be a big brother. Will it be (our third) boy or a girl?

Right now, I’m just praying that this barely-there pregnancy sticks and that our baby is healthy.

Merry Christmas!