Monthly Archives: August 2010

31 weeks + 3 days, and counting…

People keep telling me that I look great for seven months pregnant. I get a lot of comments like “You’re carrying it well” , “You’re all baby” and “You don’t look that far along” but I have to admit that in this last week I’ve really started to feel pregnant – in that uncomfortable, awkward, whale-like way.

I woke up on Thursday with pelvic pain – bang, out of the blue – and it’s stayed ever since. I was hoping that I’d have a day or two of discomfort and then feel better, but unfortunately the pain seems set to stay. This means that I’m really waddling now, sleeping is more difficult, and because the pain signals pelvic instability I’ve been banned from using stairs, carrying anything, and most disappointingly… no Pilates. I’m bummed about that because I was really looking forward to getting back into Pilates now that I have the exercise all-clear from the cardiologist.

This week my feet swelled up for the first time – not massively, but it’s a sign of what’s to come. My rings started to feel a little tight too, so they’re on a chain around my neck, just in case my fingers swell. I’d be devastated if I had to get them cut off.

I’m still enjoying pregnancy – I love feeling Bert move around and some of the shapes he makes poking his limbs out of my belly are hilarious. I am so pleased to be in this position, but even so, these new discomfort do make some activities like my job and housework fairly difficult.

Aside from the pelvic instability everything looked great at my check up today. My blood pressure is staying low, Bert is still head down (good baby!) and he had a lovely heart rate of 140.

Just two months until we get to meet our little Bert – I can’t wait!

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Mini-Drama, Part Three

I have been a little tardy updating you all about my Cardiology appointment – I’ve had a busy few days.

I saw the Cardiologist on Thursday, and just like my other doctors he was lovely!

The basic conclusion he came to is that I’m probably having a reactive tachycardia – that is, my heart rate is getting high as a reaction to, well, something, but that my heart is conducting properly. Because we haven’t been able to catch an episode on ECG he can’t be sure that it’s not a true arrhythmia like SVT (supraventricular tachycardia) which occurs because the heart is conducting electricity through aberrant channels.

When I saw him I had been episode-free for almost a week, and he didn’t think I needed an echo or a 24 hour monitor, but he did want me to try to catch any further episodes on the ECG (if I was at work). On Saturday my rate went up to 150 again, but despite getting an ECG within about 6 or 7 minutes my rate had returned to (almost) normal. Today my heart rate was 120 – 125 for most of the afternoon – but I was too busy to get an ECG. I do think that being at work is a risk factor – I’m pretty frantic most of the time! – but my rate did also seem a little fast lying in bed last night. However I couldn’t be bothered getting out of bed to get my watch and check my actual rate!

I did fax the ECG from Saturday to the Cardiologist, and he called me today but I missed the call. I’ seeing my OB tomorrow so I’ll discuss it with him, but to honest I’m not too worried… the idea of being referred for more appointments or investigations is more stressful than putting up with the slight discomfort that the episodes cause!

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A Quick Weekend Recap

I’ve been doing pretty well this weekend. I had another episode of fast heart rate on Thursday but none since then, although I do get easily short of breath (which is of course common in the third trimester!). I am exhausted, exhausted, exhausted, but I guess I just have to get used to that!

This weekend was pretty eventful:

1) I hit the 30 week mark – woohoo! New picture posted on the belly page.

2) My brother and SIL flew into town for the night and it was lovely to see them

3) I had my baby shower – post and pictures to follow

I hope you all had just as much fun!

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My Morning of Medical Mayhem

After H picked me up from work I had a couple of hours at home to try to relax before heading into the hospital for my endocrinology appointment. Of course the first thing I did was wax my underarms in case I ended up scoring another ECG! Unfortunately H had a very important event on at work so he headed off early and I lay on the couch trying to stay calm and obsessively checking my heart rate.

At about 9 I headed into the city and called my obstetrician’s office on the way. They assured me that I should just come into the office whenever I had finished with my earlier appointment and my OB would see me.

I arrived at the hospital and luckily H was able to leave work to join me. There was lots of waiting… first to see my Endocrinologist, then to get my blood taken, and then to get my visual fields tested. The good news is that my endocrinologist isn’t too worried about my prolactin level. He explained that last year at a major endocrinology conference there was a session on this exact topic – how to manage pituitary microadenomas during pregnancy. Apparently there was a lot of controversy even amongst the experts but the final guidelines were that a PRL up to 4500 is acceptable (I’m only 100 above this) and that the most important investigation is visual field testing. My visual fields were normal – which effectively means that even if my adenoma has grown, it hasn’t grown enough to affect my optic nerve, which would be the sign that we needed to take further action. I’m very relieved about this because I suspect that “further action” would mean having to deliver me early and then either taking some pretty serious drugs or facing brain surgery – all things I’d quite like to avoid, thank you!

I go back this Wednesday to see him and get the results of my blood tests. Assuming all is well he probably won’t need to see me again during the pregnancy. Once the baby is born we might do another MRI just to sneak a peek at the cheeky little adenoma and obviously I’ll need to keep getting my PRL levels checked regularly but I can handle that.

I just need to say how much I appreciate having great doctors. I implicitly trust my GP and she hasn’t put a foot wrong with any of the specialists she has referred me to. My endocrinologist made a point of phoning my OB while I was there to discuss the plan and all the recent research. They also discussed my heart rate issues and agreed on what they thought would be the next best step to investigate that. After the phone call my endocrinologist commented on what a nice fellow my OB was!

And that was my next stop. After waiting in the endo clinic waiting room, pathology waiting room, and ophthalmology waiting room I headed to the adjoining hospital where my OB is based and waited in his waiting room. Thankfully we didn’t have to wait long – he saw us only about 20 minutes after we arrived, which is pretty great considering we didn’t officially have an appointment. In terms of the baby everything was great – perfect heart beat, measuring well, in the head down position, and we even got a (very brief) peek at him via ultrasound. While I was there my heart rate was fine and my BP (although a little higher than usual) was certainly within the acceptable range. We had a talk about my heart rate and discussed a few options. In the end he referred me to a cardiologist. I’ve been banned from any exercise until then, and he gave me a medical certificate because he didn’t want me working that night. I have to say I was relieved about that because after spending half the day at the hospital I wouldn’t have had much time for sleep. AND… because that shift was due to be my last for the week, I now have no more night-shifts left to work during the pregnancy! Woohoo!!!!

So, Part Three in this mini-drama will be posted at the end of next week, after I have seen the Cardiologist. Fingers crossed that all is well!

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Adding to my list of Specialists

For a (relatively) healthy and (relatively) young person, I have quite a long list of medical specialists. First there is my Endocrinologist, then my Fertility Specialist, and then my Obstetrician and Gynaecologist.

And now I can add a Cardiologist to the list.

Those of you who follow me on Twitter will have seen that I had a bit of drama on my night-shift in the early hours of Wednesday morning.

The dramas actually started during the night-shift before – which was night five of seven in a row. I think I have mentioned before that I work in an Emergency Department. I’ve recently moved back to my home base from a different hospital where I have been seconded for 6 months. My base hospital is walking distance from home and better staffed, so I was expecting this, my final week of night shift, to be easier on my mind and body than my last few sets.

Thanks to not having to drive and a slightly later start time, I was certainly getting more sleep. The pace was less frantic and there was usually time for a brief break during the shift (quite a novelty!) but I was finding myself just as exhausted, if not more so.

In the early hours of Tuesday morning I noticed that I was getting short of breath just standing up and talking. I wandered over to the nearest pulse oximeter machine and popped the probe on my finger to check the oxygen levels in my blood. My oxygen saturation were fine at 99 to 100% but I was surprised to see that my heart rate was between 120 and 130 beats per minute. I sat down to rest for a few minutes and rechecked my heart rate. It was slower but still between 105 and 110 which I thought seemed a little high but in the end I just disregarded it and went back to work – after all, heart rates do go up in pregnancy.

At about 4am the following morning a similar thing happened, but the symptoms were more pronounced. Probably since about 18 weeks of pregnancy I have occasionally been aware of a pounding heart – nothing that I would have described as palpitations, but just an awareness of my heart pounding. My heart rate always felt regular and not particularly fast so I attributed the sensation (probably quite rightly) to the fact that my heart was pumping an extra 2 litres of blood around my body compared to pre-pregnancy. However on Wednesday morning I felt decidedly off.  I had the same sensation of shortness of breath as the previous morning, to the point that I felt uncomfortable speaking in full sentences. I also felt very tight in my chest and my heart was really hammering. I put the probe on again and what do you know – my heart rate was 150! There was no way I could put that down to a normal physiological response to pregnancy. Like a nutcase, I kept on working. Within a few minutes I became very hot and started seeing spots. I went outside into the freezing air for a few minutes (which felt great) and then found a seat inside and sat down. It was 4.15 and I decided to text my dad to ask his opinion. It was 6.15 in New Zealand and I figured there was at least a 50-50 chance he was already awake.

His opinion: No this was not normal and I needed an ECG immediately and medication to slow my heart if it didn’t resolve in the next thirty minutes.

So feeling embarrassed and a little foolish I found my boss and told him what was going on. And that is how I ended up in a cubicle at work, naked from the waist up, getting an ECG. As I mentioned on Twitter, the worst part was that my underarms were due for a wax! I also had to provide a pee sample because my blood pressure was quite high (150 and I’m usually around 110). Thankfully there was only a trace of protein in my urine and my BP came back down to 130 with some rest – I’ sure it was elevated due to my anxiety. I lay on my trolley thinking about Egg and telling myself to “be Zen, be Zen”, and it did see to help my blood pressure! Thanks for the inspiration Egg!

By the time I got my ECG my heart rate was back down to 105 and looked perfectly normal (except for being slightly fast). In the end I called H to come at pick me up and take me home. I had my appointment with my Endocrinologist at 9.45 that morning and the plan was to get an emergency appointment with my Ob while I was there.

Coming up….

“My Morning of Medical Mayhem”

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The Magic Reappearing Doctor

Yesterday I was sorting through the disaster that is my bookcase looking for an item I had misplaced, when I stumbled across the business card for my endocrinologist. Of course the phone numbers were the same ones I had already tried but the card listed an email address too. I shot off an email hoping that the address was still current, and hoping to get a reply in the next few days.

What do you know? I got a phone call from my endocrinologist less than 15 minutes later!

What a relief. I had tried everything I could think of to locate him. I’d Googled him  – I mostly found him mentioned in research articles or conferences, but nothing newer than 2009 and nothing with a phone number. I’d even called the hospital where his private rooms were previously based, but the number they had for him (although different to the number I had) was also out of date.

So I was surprised – to say the least – when it turned out to be pretty easy to get in touch with him. We spoke for 10 or 15 minutes. He agreed that the rise in my PRL has been more rapid than he was comfortable with, but reassured me that the current level wasn’t so high that he was significantly concerned. While we were on the phone he looked up some very new guidelines for PRL ranges in pregnancy and my level is only very slightly higher than the upper limit. Basically, the plan is that he has booked me in to see him in the public clinic at one of the city’s main hospital next Wednesday. He decided it would be more expedient to see me at the public clinic because there would also be an ophthalmologist there who could formally assess my visual fields.

Here’s hoping I toddle along on Wednesday, get checked out, my visual fields are fine, and we just decide to keep an eye on my PRL for the rest of the pregnancy. I can handle a few extra blood tests over the next 2 months.

~~~~~

I have updated the belly pics page with my 28 week photo – showing the totally different shape of my belly button.

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The Case of the Disappearing Doctor

Well, H and I both survived our hectic weekend. Unfortunately we were both so exhausted that we did have somewhat short fuses, and there was a little bickering at times, which isn’t ideal when the MIL is visiting! Luckily we didn’t let ourselves get too carried away.

The Labour/Birth and Postnatal classes on Saturday went well – although we both found that we were having trouble concentrating by the end of the day – but I think they were worthwhile. Most of what we were learnt wasn’t new to me, but there were a couple of new things I picked up and it was good to get a refresher on the rest. Even H felt like he knew a lot of what was covered but I certainly feel more comfortable knowing that we’ve been to the classes. Now there’s just the Breastfeeding class at the end of the month, and we’ll be fully accredited parents, ha!

On Sunday we spent the whole afternoon baby shopping with H’s mum. I think this irritated H a little – he likes to be in-and-out when it comes to shopping. He’s very goal-oriented and hates to browse. He started to get a little ‘titchy’ when his mother or I made suggestions or if he didn’t think we were paying enough attention to his suggestions. He just didn’t understand that a giant baby shop is like fantasy-land to a pregnant lady and a soon-to-be-grandmother. Part of the reason we were there was to enjoy this fantasy, even if we knew that all our hypothesising and grand plans were unrealistic. I mean really, did he think I was actually going to buy the $1,900 cot? 

H’s mother was undergoing treatment for bowel cancer while we were planning our wedding, and was taking a lot of pain medications during the wedding itself and she told me that some of the evening is very vague to her. For that reason it was terribly important to her that she be able to be actively involved in planning for this baby. Once I explained that to H he loosened up a little and let us wander around ohh-ing and ahh-ing at baby clothes. The good news is that we now have our cot – still in its packaging and currently living underneath our sofa bed. This was a gift from H’s parents and I know his mother will love knowing that her grandchild is sleeping safely in a cot that she helped choose. We also bought a changing mat and a swivel changing base to go on top of the baby’s dresser. I love it so much! We’re still waiting for this to arrive but once it does I’ll set it up and take a picture for you.

Today we had our 28 week check-up. It started badly. First, H had an important event on at work. His plan was to try to be there for the appointment but he couldn’t guarantee it. This would have been fine – except that it rained today. All morning. And Melburnians do NOT know how to drive in the rain. I forgot to take this in to account and ended up running late to the appointment. If my darling H had been driving he would have got us there in time – he’s pretty impressive behind the wheel.

Unfortunately, when I did arrive at the hospital (already 15 minutes late) I was greeted by a big fat CAR PARK FULL sign and an attendant who wouldn’t let me in. I was forced to drive around and around (in heavy traffic) looking for a parking space. There were none. In the end I parked in a 15 minutes loading zone and hoped for the best, while running through the rain towards the hospital.

And what did I see when I arrived at my doctor’s office? H’s big, beautiful blue eyes looking up at me from the waiting room couch. Bliss!! It was kinda funny though… H wears a suit to work, but his job requires him to carry a gun. Because he was technically ‘at work’ he came to the appointment ‘fully loaded’, so to say! I’d never even seen a real gun until the first day I saw him all kitted out with his holster, so to be sitting 2 inches away from a gun while in my obstetrician’s office was a little odd. Good on our doc though, he didn’t even bat an eyelid!

Most of the news at the check up was good. Bert’s heartbeat sounded as perfect as ever, my fundus is measuring appropriately, and the OB could tell that Bert has his head down, his back up my left side, his bum under my left ribs (that explains the ache) and his feet under my right ribs. My blood test results are not so great. There’s nothing too serious going on, and he confirmed that I did pass my GTT (whew!). Unfortunately my iron stores are low (my Ferritin is only 6 – yikes!) and although my haemoglobin is in the acceptable range for pregnancy, it’s lower than it’s ever been for me in the past. And… my prolactin has doubled since it was last tested (at about 20 weeks). We knew that my prolactin would increase in pregnancy, but the hard part is deciding how high is too high. There are no “normal” ranges for a woman with a prolactinoma in pregnancy.

In terms of the prolactin, my OB wants me to go back to see my Endocrinologist again. He thinks that I should at least get my visual fields formally tested to make sure there hasn’t been growth of the tumour causing it to affect the optic nerve. The serious downside to this is that if my Endocrinologist does think I need to start treatment (which would happen after the baby is born) it would make it absolutely impossible to breastfeed. Sigh.

The last time I saw my Endocrinologist he mentioned that his office was moving. Yesterday when I tried to call him all the numbers were changed or disconnected. I called the hospital were he was based and they too had an old number for him. I can’t find him listed online at all. So…  how on earth do I get in touch with him?

The upshot of my iron deficiency is that I have to start eating more red meat (I’m not much of a meat eater) and if that doesn’t work I’ll need to start iron supplements. H was quite excited about the prospect of red meat every day! When I discussed this with my dad (because he likes to be kept in the loop after every OB appointment) he was quite concerned and thought that with a Ferritin of 6 I should have been starting the iron tabs straight away. Apparently a baby born low in ferritin has twice the likelihood of needing to be admitted to hospital in the first 12 months of life with infective illness than one born with adequate stores. In the end we agreed that I’ll try to improve my dietary intake, get retested at 34 weeks, and start the tablets then if I need to.

And after my appointment yesterday I came home and made myself a steak sandwich for lunch. What an obediant girl I am!

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