I hope you’ll join me back at the other blog – but I certainly understand if you don’t.

• The inflammation around my PICC site is almost entirely cleared up. I am quite certain that it is the steroids responsible for it because when it gets close to time to take the next dose, it starts gettting puffy and itchy again and recedes within half an hour to an hour of the steroid dose.
• My headaches/migraines are much improved. Not absent, but not constant either.
• The sciatica that had left me nearly completely immobilized last week is almost gone. I have occasional twinges here and there if I step down wrong, but nothing crippling like before I started the steroids.
• My overall itchiness? Just about gone. Before starting the steroids, I was so agonizingly itchy that my skin was raw from all the scratching. Nothing had helped it. Also? I no longer seem to be getting a rash from the Phenergan – I don’t know if this is related to the steroids, or just that I have acclimated to the drug. Either way – less itchy is awesome.

But, by far, the most intriguing side effect of the steroids is that I have a ridiculous burst of energy much of the time. Even yesterday when I felt more dreadful than I’ve felt in weeks (possibly months) – I had plenty of energy. My husband was working in the afternoon/evening, so I was on my own from about 2:30 on. Just as the triplets were waking up from their nap. I expected this to spell disaster given how yucky I was feeling, but I had plenty of energy for them. I gave them a snack, played for a bit, and did a bunch of cooking. I made three large mac n’ cheese casseroles (2 for the freezer) and toffee/chocolate chip/pecan cookies. Last week I made a big pot of beef stew (frozen in 1-2 person portions, depending on the person), curry chicken, schnitzel, sweet potato pies (I had three of the most ginormous sweet potatoes I’ve ever seen in my life – and they made three pies!), and white-cholate-chip brownies (the brownie mix came in a box, so it doesn’t necessarily count – but J helped and had a ball. He also helped with the mac n’ cheeses and the cookies).

I have never been good at cooking and freezing things. If I cook something, I want to eat it now, not later! I always think I’ll take a Sunday and cook kugels and casseroles and soups for the freezer so that I’m not so slammed all the time when it comes to cooking. But it never works out that way. Recently, though, J has been super interested in cooking with me, and it gives us things to do together with relatively low stress. It also makes him SLIGHTLY more willing to try foods if he’s had a hand in making it. Though he still wouldn’t eat the mac n’ cheese casserole. Oh well.

I wonder if this is what "nesting" is like. It’s way too early for me to be nesting (I hope!), and with the triplets, I never got to really know what nesting was like – I was on bed rest forever and so sick I didn’t have any energy most of the time, but I did have a couple days here or there when I would freak out about needing to clean and so and purge. I remember one day when Seth and J were out doing yardwork and I suddenly freaked out about space and I waddled out and said, "We have to get rid of the piano. I never play it, I’m definitely not going to have time to play it with three babies in the house, and it’s taking up SPACE! We could put a whole shelf, a changing table, feeding table, something, ANYTHING in that space! It has to go!" Seth looked at me, looked over at J, and turned and said, "I think perhaps we’d better come inside to work instead of being out here. I spent the rest of the afternoon in the attic freaking out about all the stuff we needed to get rid of. And purge, I did. But that was the exception, not the rule. Technically I shouldn’t have been up there at all, but fortunately, that was before some of the scarier times in the pregnancy.

I have niggling little thoughts about all the crap in our attic often, reminiscent of that summer day with the triplets, but hopefully I’ll be able to squelch it this time. Surely the cooking is at least useful. And I do have in my mind that we need to have stuff in the freezer, because I’m petrified that I’ll get to a point where I just *can’t* cook and I’ll have this family who needs to eat. J could live all year on chicken nuggets and apple slices, but Seth hates cutting up apples. And surely, the triplets ought to have more variety than that, lest they end up with such a limited palate as J.

It’s not nesting, really, but the energy sure is welcome.

So the steroids kind of suck (side effects e.g. severe reflux and oral thrus aren’t any fun), but overall? I’d argue that my quaility of life, for the moment, is largely improved.

Except, you know, the throwing up part.

The steroids aren’t without their disadvantages – the reflux is nearly intolerable, but today I managed to keep some Zantac and Prevacid down, so hopefully tomorrow that will be better.  The thrush sucks and I’d like it to be gone now, but it’s tolerable.  Today was better than yesterday.  Yesterday I was seriously contemplating calling my doctor on Christmas to beg them to find a 24 hour pharmacy that could fill a script to FIX IT.   If you know me at all, you know that I would normally never consider interrupting a doctor’s holiday for something not life-threatening.  But … honestly, I wouldn’t have been able to pick up a script regardless – I had all four kids and my husband was working.  No way was I taking everyone out to pick up a prescription.

I admit, the wave of energy (well, it’s a trickle – but still more than I’ve had) has been helpful.  I’ve been able to get a fair bit of cooking done, so I have some things in the freezer for the days when I just can’t bring myself to cook for the family.  I’ve spent some good time with my kids.  I’ve gotten somewhat caught up at work.

I love being pregnant in so many ways.  This baby is squirming around a lot and I find it so incredible to know that I’m growing a whole human inside me.  The miracle of this pregnancy is not lost on me and I *do* appreciate it.  I love that the triplets point at my belly and say “Babies!” (though I wish they’d stick to the singular!).  I love that J keeps saying “I hope it’s a brother!  … or a sister!”  (mostly he asks for a brother, but acknowledges that a sister would be good, too).  I love that I have this baby growing.  I cherish my growing “bump” (that is ridiculously huge considering that I still have months and months to go!).  I joke that I am *never* doing this crap again on purpose, since it turns out that it’s pregnancy, not just triplet-pregnancy, that doesn’t agree with me  - but the truth is?  I’d gladly go through this all over again to have another baby if we decided that was right for our family.  But there is also, oddly, some comfort in being this sick – I know that I will be comfortable deciding that our family is complete – knowing how hard we struggled to get there.  I used to wonder if I would ever be comfortable with that notion, but now I know I can.

I feel dreadful, but nearly everyone tells me I look great.  And you know?  I feel great knowing that there’s this toy surprise at the end of all this.

I’m not really sure what my point is, but I guess, mostly, I wanted to make sure that I capture at some point the fact that pregnancy isn’t ALL misery.  Even through the throwing up, I am overjoyed to be privileged enough to carry this baby.  Even through my irrational fears and requisite infertile DBTs, I can’t wait to meet this little person – the next (probably final) addition to our family.  I am humbled to know that I have been entrusted with another little life, and to know that my successes and failures in parenting are in my control.  I know that I am not a perfect parent, but I will always strive to be the best that I can be on a given day.  Some days, of course, are better than others.

I still don’t have an OB, but I have an appointment with a new practice on Tuesday and a perinatology appointment on Wednesday.  One way or another, this obstetrician dealio is going to be resolved this week, and it feels good to assert that.  Anyway, I still have the yurt as a back up plan.

(but hey, baby?  Can you stop kicking my bladder and my cervix?  That’s not nearly as much fun as the rest of this pregnancy.  Seriously!)

Truthfully, the horrific reflux was enough to make me want to get the hell off these steroids.  But now?  Now I have thrush on my tongue/in my throat.  The last time I had oral thrush was in 2003 when I’d been on long-term heavy-duty antibiotics.   The triplets and I battled thrush for five months while I was breastfeeding them, and admittedly, thrush *there* is far more painful, but I don’t really want any kind of thrush again!    So now my tongue hurts, it hurts to swallow, and it’s excruciating to put anything on my tongue.  Fortunately, I’m not eating anyway, right?  So it’s not like I’m missing out.  Much.

Is the cure worse than the disease?  No.  If I weren’t throwing up anymore, I’d definitely think it was worth it.  But this is still like adding insult to injury.

The rest of the appointment with her was good.  She prescribed IV Steroids to see if that helped the nausea.  It did, a little (though not a lot, but I’ll take it!), until I started trying to taper the steroid.  Sigh.  The baby looks great and is growing exactly on schedule.  And Dr. M. also called the home health company to order that the dressing on my PICC line be changed stat – the tegaderm needed to come off, because my skin was so raw and painful and ick, that it posed too great a risk for infection.  Plus, hello?  It HURT!

The home health company couldn’t come out that night  to change it, plus we were expecting a big snow storm that night/the next day (we got 20 inches!).  Also the home health co. didn’t like the idea of just wrapping the PICC line in gauze – but there weren’t a lot of options because tegaderm clearly does not agree with my skin at this point.  I ended up having to go to the emergency room to have the dressing changed.  By Monday, when my nurse came to change the dressing again, the difference was astounding – it no longer hurt, the skin was healing, it was perfect.  But… the home health care company was still not going for it.  Their protocol is that if there’s gauze on the site, the dressing has to be changed every 48 hours (though my primary nurse admitted that no one has shown her this policy written anywhere – it seems to be a rumour floating around).  So they sent a new dressing out to me to try that.  And?  It’s just a different kind of tegaderm.  I’m already hurting and itching, and it was just put on yesterday.

I do have some possibly-good news, though.  Since I can’t seem to find a doctor who delivers at the hospital five minutes from my house (where I delivered my triplets), I called the birth advisor at another hospital that isn’t quite convenient, but it’s not so bad as long as we don’t have three babies in the NICU this time around.  She got me an appointment with one of the other practices that several friends had suggested.  They had previously expressed that they wouldn’t see me, but I was talking to a receptionist and the birth advisor was speaking with a clinician.  So I have that appointment on Tuesday – I don’t know if they’ll take me on directly, but at least he’s willing to talk to me directly instead of just reviewing my records.

If that fails, I’m seeing Dr. P. on Wednesday – and I’ll talk with him directly.  If he won’t take me on as a direct patient, I’ll head down to the big OB/GYN practice at a nearby University hospital – they are excellent and will take me as their practice is made up of both regular OBs and MFMs – but I was trying to avoid that.  It would mean going into the city for every appointment and delivering at a not-so-local hospital.  Having a hospital 5 minutes from home makes me really begrudge the 30 minutes (without traffic) that it would take to get downtown.  I work just four blocks from the physician’s office building, but I’ve been working a lot from home, and I only expect that to increase, so it won’t be convenient forever.

Hopefully, I won’t have to go that route.

It would be lovely to have a doctor at some point, wouldn’t it?

I was quite surprised at how quickly I popped out this time around.  I think I’ve got a more prominent pregnant belly than I did at this point with the triplets.  Go figure.  I will say this, though – shopping for maternity clothes is *much* more fun this time around.  My pre-pregnancy weight with the triplets was about 70 pounds higher than my current weight, and I’m down 4 dress sizes (literally), so the variety of comfortable, (somewhat) flattering clothes is exponentially better than the last time.   I loathe spending money on clothes that you’ll only wear for a few months, but I’ve found some good sales (plus sized maternity clothing seems to never go on sale, so I had no such luck with the triplets).  Old Navy had maternity tees for $1.50 each!!!

My little monster is definitely still hanging out  - s/he is kicking a lot, but there’s no real pattern to it yet.  Still, its reassuring… especially considering how dreadful I feel, and the fact that I still don’t have an OB.  I’m seeing the perinatologist on Friday, though, so hopefully I’ll get some more answers then.

Okay – too tired to post more, but I don’t have anything interesting to say anyway.

So the OB I met with on Monday talked with the perinatologist, reviewed his notes from our meeting, and reviewed my records…  and he definitely won’t take me on at this point in the pregnancy.  My perinatologist had recommended another practice as well – I called them today and had to leave a message with their OB coordinator because the practice has a policy that women coming into the practice past 16 weeks must have their records reviewed prior to them deciding whether to take that patient on.  I’m guessing… that’ll be a strikeout also.

I’ve left a message for the perinatologist’s nurse to find out whether they will take me on directly or if they have other recommendations.  Right now I’m just frustrated, and a little scared, about what to do next.  I have another doctor to call  - but she’s at a hospital that is just… really hard to get to from here.  It’s not far, it’s just not easy to get to.  I wish I knew what to do.  I’m really a very nice person and a good patient.  I just …  I feel awful and I’d like to know where I’m supposed to go on the bad days.

Meanwhile – I’ve still got the excellent back up plan.  I just have to build that yurt.

So I’ll admit it, my feelings are still a little hurt by having been fired by my OB last month.  Sure, I’m worried about what to do about my care.  Sure, I’d like to move on.  But let’s face it:  mostly?  My ego is bruised.  My feelings are hurt.  I feel rejected, and I *hate* that.  No one wants to be broken up with – it’s much better to be the breaker upper than the break-ee.

But, since I am currently OB-less, because the cool kids kicked me out of their practice, I need to suck up the hurt feelings and move on, which is precisely what I’ve been trying to do.  Oh, never mind that my former OB has failed to send me my medical records yet.  It’s not like I requested them two weeks ago or anything.  Oh, wait, yes I did.  See?  Another fine reason for me not to be there anymore.  Their loss, not mine, right?  RIGHT?

So I had a consult appointment with a new OB today.  Everybody loves him.  Four separate women referred me to him, independent of one another, and the perinatologist had him on the top of his list for people for me to talk to.  I couldn’t have asked for better recommendations – everyone has high praise for him, and I was particularly pleased with the fact that he is  a sole practitioner, so I wouldn’t have to worry about getting lost in the shuffle at a big practice.

I didn’t have my medical records with me to provide him, because my former OB’s office still has not sent the records to me, so I gave him a quick sketch of my medical history and brought him up to date on what’s been going on with my current pregnancy.  He asked a lot of questions, clearly didn’t love the answers, and I don’t think he cracked a smile once – well, he smiled when he introduced himself to me, but nothing after that.

And, essentially, he’s not sure he can take me on as a patient.  ”It’s a lot to take on, especially this far into your pregnancy.”  He thinks I should be on TPN, but won’t order it himself, because he hasn’t done so since he was a resident – instead he’d want me to get in with a GI doctor pronto to get them to order it and manage it from there.  That would mean juggling three doctors: the OB, my perinatologist, and a GI doctor.  (Nevermind my primary care pracitioner, and my neurologist).  He’s not opposed to a VBAC, but definitely didn’t sound thrilled about it – he said he would insist on an epidural at 4-5 centimeters, and I’d have to be in active labor (no induction) or 2-3 cm dilated by 40 weeks (I would love to GET to 40 weeks!  Right now I’m just trying to get to next week!).  He can (and does) handle a hyperemesis patient.  He can (and does) handle a patient at high risk for PTL.  He can (and does) manage a patient with underlying medical issues.  Etc.  But with me – it’s rolling all of that into one patient, and that… well, that’s a lot to take on.

Frankly, I appreciated his candor.  A lot of doctors would have said, “no problem!” instead of really thinking about the impact of taking on a patient like me.  He seemed to think I’d probably just be better off seeing only the perinatologist (I’m all for it), but he said he’d talk to Dr. P. tonight or tomorrow and he’d call me to let me know how he thinks I should proceed.  Honestly, it was both overwhelming and a bit of a relief to have a doctor look at it all down on paper and admit that it’s just a lot, and an extremely complex pregnancy.  My old OB made me feel like I was hysterical over nothing (I was never hysterical, for what it’s worth).  They made it out to be a pregnancy that was no higher risk than any other, and that I was making a bigger deal than I needed to.  At least SOMEONE is taking me seriously.

Meanwhile, I’m still OB-less.

Honestly, I’m beginning to get a little worried.  How long can I go without a primary OB to turn to?  How long can I hold off on making other decisions about my care (e.g. should I do progesterone shots to mitigate some of the risk of preterm labor?) before it’s too late?  I’m too high risk for a midwife, I can’t possibly have a home birth (not safe for me – though I totally dig the idea, and absolutely understand why other women do it).  I clearly need solid prenatal care.

I just wish I understood exactly what led to my old OB firing me, so that I could at least not do it again.  The OB I saw today has worked a lot with my old OB’s practice and he said he has NEVER heard of them sending a letter terminating care without a detailed explanation and a signature from one of the doctors taking credit/blame for the decision.  My letter was unsigned (just listed the names of the members in the practice) and did not provide sufficient explanation for the termination.  Just “we feel that you need to find a provider with whom you can have a more communicative relationship.”  So I’m left with… a whole lot of nothing.

I see the perinatologist again on the 18th.  I plan to suck it up and ask him to please just take me directly.  I don’t know how much longer I can handle uncertainty like this.

Sigh.

Once the U/S was done, I let the sonographer know I’d like to make sure to speak with the doctor (at the perinatologists’ office, patients don’t typically meet with the perinatologist at U/S appointments unless there’s a problem or the patient needs to ask the doctor any questions).   Dr. P. had stepped out to do an emergency cerclage removal – so I was given the option of waiting or talking to Dr. G. over the phone (he was at the other office).  I like and respect both doctors a lot, but I really wanted to see Dr. P. in person if possible, so I waited.  He got back to the office just before 5pm and then spent a solid hour talking with him (this is part of why I love him).

I told him that my other OB “fired” me and he laughed and said, “How the hell do you get *fired* by your physician??!!?”  So I explained what happened and he was pretty flabergasted.  The practice that fired me is a very well respected practice, Dr. P. works really well with them, and until recently, I loved them too.  Everybody loves them – I only know one person other than me that had any issues with that office – and that was a clashing of philosophies/personalities, not a concern about quality of medical care (this other person is… how shall I put this?  Kind of a witch).

He talked about possibly coming to a decision point about just moving me over to TPN.  I told him we’d sort of been dancing around the issue up until now and that I really just don’t know where the tipping point is – at what point do we decide enough is enough and just move to parenteral nutrition?  He said, “Unless you’re feeling better and think this is going to be gone in another couple of weeks, I think we’re there now.”  He wasn’t pushing to make the change immediately, but to definitely have it in mind as I’m trying to find a new OB (more on that later), and if I wanted to move to TPN before I get settled with a new OB, he’ll be happy to handle putting in the orders for it with the home health company.

He volunteered that he’s happy to cover me while I’m trying to get settled with a new OB.  And he gave me some recommendations for doctors to talk to.  The first one he mentioned was the doctor that I’d already set up a tentative appointment with for next Monday.  He said he’s a really good guy, excellent doctor, has the advantage (and disadvantage) of being a sole practitioner, and can afford to have some flexibility in terms of my care and management of my pregnancy.  He said that they work very well together, so it would be a good fit if I feel comfortable with him.  If that doesn’t seem like the right match, he gave me a couple other names to consider, and will cover me for however long it takes to find a new OB I’m comfortable with – even indefinitely.  But I think I’ll probably have a good fit with the doctor on Monday.  I just have some things I want to clarify with him, and ensure that he can work with my home health company and what his practices re: high risk pregnancies are.  Dr. P. thinks it will be a good fit, but didn’t push it.

I asked about the rash that I seem to get from the Phenergan.  He said he doesn’t find it entirely shocking, though agreed that it’s odd that it is limited to my left arm when the Phenergan’s going into a central line.  He agreed with my assertion that despite the negative side effects, I’m still better off with the Phenergan than without.  I asked if he’d ever used a steroid protocol for hyperemesis and he said he hasn’t, but he’s seen it used with some success.  He’s had the most success with a low-dose thorazine drip, as odd as that sounds.  He was certainly willing to discuss options and keep an open mind.  I told him I don’t want to make any drastic changes to my protocol before Monday when I see Dr. F., and he said that was fine, and that either I or Dr. F. could feel free to call him anytime to discuss changing the protocol if necessary.  Mostly, he’d just like to see me getting some actual nutrition at some point, though admitted that the *most* important thing is the fluid, which I’m getting already.

I noted that I’m starting to have contractions already and he said that so far, my cervix still looks good (it did at this point in the triplet pregnancy also), but reminded me that sometimes there can be a drastic change without a lot of warning.  The hope, of course, is that my issues with the last pregnancy were largely related to the triplet factor, but it’s clear that I probably just am going to have issues with contractions even in the singleton pregnancy, so they’ll monitor my cervix very closely and make sure that they’re careful about any shift.  Yes, tocolytics are likely in my future, but probably not necessary yet.

He’ll see me back in two weeks and two weeks after that.  If I need to see him in the interim, that’s fine.  Also, he’s the doctor on call this weekend, so if I need anything over the weekend, he’ll already know what’s going on and is happy to handle it for me.  I mentioned that my old OB practice probably *has* to deal with me right now if something happens and he agreed but said that unless it’s a clear emergency (like sudden, heavy bleeding), they could be difficult about it so absent a clear emergency, he recommends I just call him directly.

So all in all?  It was a good appointment.  I got most of my immediate concerns addressed, and I have a reasonable plan for the future.  Now if only I didn’t feel so cruddy – but that’s neither here nor there.