22 weeks & Post surgery report

   We are [finally] home! We were cleared for takeoff at our last meeting Monday afternoon with our surgeon Dr. Lim - yeah! On Monday we had another echo on each of the babies as well as a Doppler with an ultrasound tech before meeting with the doctor for the summary report. The tests were shorter than last week - maybe the babies were cooperating a bit more? One can hope - I personally think they are quite sick of being bugged, especially baby A! Travis has gotten to feel the babies move around! It was exciting to share the experience with him! If we stare at my belly for any length of time we can also see ripples in different parts of the belly - kind of crazy creepy, but also cool. Travis and I had a bit of a panic attack on Friday evening... the babies were on the move so I had Trav come over and feel them and watch my belly - that's when I noticed (what I thought was) swelling in my lower right abdomen. I was concerned since the twins are on the right side - but I didn't remember the doctor's saying anything about swelling. So we of course pulled out the paperwork they gave us and went through it to see what it said about swelling - which was nothing. It was accompanied by any pain or soreness so we thought we'd take a wait and see approach instead of rushing down to the hospital right then. Then lo and behold, I went to brush my teeth and the swelling was gone... that's when we realized the "swelling" was actually a baby! Needless to say, we've seen some other swells in my belly since then! I'm just thankful we didn't rush down to the hospital - how stupid would we have looked?! The girls must be getting bigger and stronger since the kicks and rolls are getting stronger each day - both reassuring and then nerve-wracking when I don't feel anything for a bit! Who knew how much time I'd spend staring at my ever-growing belly!
   Anyway, below I've summarized what the doctor's told us, as well as the 22 week progress. Our next doctor's appointment is on Friday - with our own specialist. So much has happened since we saw him that I'm kind of nervous. However, we know that he's been in close contact with our doctor's in Cincinnati so that's reassuring!
   The good news first - we heard all three babies heartbeats! While they were especially pleased that Baby B was still fighting 5 days after surgery, the road to recovery is especially long for her and the surgeon was particularly quite honest/blunt about her prognosis. Baby A's echo showed that she was a little stressed out, but well within normal limits. It's my feeling that she's still a little pissed about being disturbed last week! Though she laid out for the cardiologist, by the time we got to the ultrasound she was curled back into her little ball! The amusing thing is that she actually still has plenty of room, she just prefers to curl up, making it difficult for the techs to get all her measurements! She might be a handful - both independent and stubborn! Baby C had more fluid around her and her kidneys and bladder were quite apparent! For those of you who read up on the twin-twin transfusion syndrome (TTTS) literature, she is the 'donor' baby, so those three things are the main problems areas. The blood pumping to her brain is still not as strong (another secondary issue caused by the TTTS), but there was some improvement. Since the doctors were looking for either stabilization or any improvement since surgery - this was good news. Now for Baby B - where is where much of the focus was. Her heart is still severely sick... however, there were some minor improvements. For example, last week when they measured the flow from the left side of the heart they told us 0.4 is normal - her flow was at 3.2 (and bigger is definitely not better in this case). On Monday it was at 1.6! Our surgeon told us that while this is still way far from normal, it was good to see the improvement. The right side is still leaking and almost no blood is going to the lungs right now - which isn't a problem at the moment, but would be a huge problem should it not correct itself before she's born. There were some additional findings, but that sums it up best. The overall consensus was that she needs at least 8 weeks more of gestation to give her the best chance of complete reversal. Unfortunately, they're very worried about pre-term labor - hence the bed rest-, especially if B's condition doesn't improve (she could trigger labor). For now we're going to stay positive and be happy that there are still three little girls moving around! We understand how this still might change, but we're going to do everything in our power to keep these babies in my belly for as long as possible! 
   So, to move on to our 22-week report... Here's what Baby Center has to say: How your baby's growing: At 11 inches (the length of a spaghetti squash) and almost 1 pound, your baby is starting to look like a miniature newborn. His lips, eyelids, and eyebrows are becoming more distinct, and he's even developing tiny tooth buds beneath his gums. His eyes have formed, but his irises (the colored part of the eye) still lack pigment. If you could see inside your womb, you'd be able to spot the fine hair (lanugo) that covers his body and the deep wrinkles on his skin, which he'll sport until he adds a padding of fat to fill them in. Inside his belly, his pancreas — essential for the production of some important hormones — is developing steadily. See what your baby looks like this week.
   We'll give another report after our appointment Friday - maybe even with some pictures! Hopefully there won't be as much to report this time.... hard to believe how much we've grown to love these little girls already! As I've told a number of people - I suppose the biggest lesson we've learned is that no matter how much planning we do, kids really do tend to throw a wrinkle into things... even BEFORE they get here!

Surgery and the day after…

   Thank you all for all the thoughts and prayers you sent our way! As of this morning, we heard and saw three heartbeats – bringing tears to our eyes and some relief. While we are so thankful to get through these first 24 hours after surgery, the next few weeks are still very critical especially concerning Baby B and her heart. Below I outlined a bit of how the procedure went (for those interested) and what our plans for the upcoming weeks, but we wanted to first thank you all again for so many well wishes. It’s the most amazing feeling to realize how many people out there care and said a prayer for us and our girls… Thank You.

   SURGERY DAY: Wednesday morning we reported at Children’s Hospital at 7:00 am. They got us checked in pretty quickly and we went straight up to the Fetal Care Center. We were taken to the room we’d be staying in after the surgery and overnight where I got changed into one of those sexy hospital gowns. From there they took all my vital signs and put a TOEFL on me, which monitors contractions. Shortly thereafter someone came in to do another ultrasound to see if the babies had moved around or if they were still in the same places they were on Tuesday. Baby A was still camped out in the lower corner all bunched up as usual, and B and C were pretty much in their same spots (as I mentioned before Baby B had a bunch of area in which to move around in, which she liked to take full advantage of). After the ultrasound they put an IV line in (never have liked those things) and then we started our way down to pre-op. There we met with the anesthesiologist who asked me a bunch of questions and I was able to talk to her about how poorly I’ve reacted to anesthesia in the past. After all that paperwork was done I took a shot of some weird med (think salty sweet tart) that began relaxing me. I then received an epidural – can’t say those are too much fun, but I guess now I know what to expect in a few months! Once that was in we went into the operating room… there was a TON of set-up required, and I have to admit, I was knocked out for most of it. Unfortunately, or fortunately, I came back to when the doctors got ready to begin. It was like being in a daze where I wasn’t completely knocked out, but thankfully not completely present either. They spent a good deal of time figuring out exactly where to insert the scope, and then I felt pressure and a weird feeling as the scope traveled around inside of my tummy. They identified all the vessels they were going to sever (incorrect terminology, but I can’t remember all the terms they used)—there turned out to be 9 different places to sever. The laser was turned on and they went to work, the one “interesting” thing was that I heard a, what seemed to me, very large popping noise three different times as they were lasering (I later found out that this sometimes happens and isn’t abnormal). Can’t say I liked it too much. They then reduced the fluid on Baby B’s side – and I didn’t like that much either, both the noise and the sensation I felt were very odd. After that they were pretty much done with the procedure. They checked on each of the girls and they each were doing well… I guess all those prayers I said in the operating room were heard – as well as each of yours!

   I was taken back up to the Fetal Care Center then and they began a bunch of monitoring. The first couple hours were kind of rough as I was contracting more than they liked… they said some irritation was common, but what I was experiencing was a greater than they like to see, so the doctor was called over. After some debate they decided to give me half a dose of tributaline (an asthma treatment), which has been shown to help stop preterm labor… the other is magnesium, which they really didn’t want to give me due to the stress it might cause to Baby B. I was given the treatment and it definitely helped. The odd thing is that I am pretty sure it was Baby A that was causing all the ruckus – I think she was pissed about all the commotion that had happened since it wasn’t for her! At any rate, the contractions tapered off after several hours and things quieted down. I napped off and on the remainder of the day and Travis stayed with most of the time. My parents stopped in several times as well to check on all of us… thankfully there wasn’t much to report. Travis went back to the hotel later on in the evening for the night and came back early this morning since the ultrasound they did was at 6:45 this morning!

   The Day After: I can’t say I slept all that great… I was up about 4:00 nervous, anxious, concerned about the babies. I still am not feeling them move all that often – which seems strange considering there are three in there – but it worried me. Thankfully those fears were quickly put aside as the sonographer showed us the heartbeats in each of the babies…. After that the rest of the morning was a blur! I got to take a shower, we had breakfast, they did a few more vital checks, and then the doctor came in around 9:30 and discharged us!

   Our next appointment is Monday morning where they’ll do another echo on each of the babies, a thorough ultrasound including all the biometrics on each of the girls, and we’ll finish with a consult with the doctors. Currently we are thinking we’ll be on a plane back to Dallas on Tuesday afternoon. Once we return we’ll follow-up with our own MFM for the remainder of the pregnancy. I’m on pretty strict bed rest for the foreseeable future, which I’m not exactly looking forward to—but we’ll do whatever for our girls…

   Thanks to each of you and God bless you and your families…

21 Weeks - Surgery scheduled...

   Well, after two days of tests - which included a two-hour long MRI and a two-hour long ECHO for the babies yesterday as well as an almost 3-hour long ultrasound today - we have a plan... whether it's the "right" plan is anybody's guess - but we're praying that for once the odds are in our favor.
   We met with our team of doctors late this afternoon and they provided us with a lot of information as well as some different options. The identical twins definitely have twin-twin transfusion syndrome and - unexpectedly - we were diagnosed at stage 4 (the most severe level). This is mainly due to Baby B, whose heart has been severely affected, meaning it's enlarged, not pumping correctly, and leaking - basically close to failure. Despite this, she is otherwise 'healthy' as are the other two babies. To put it bluntly, if we do nothing, we will lose the identical twins, but that most likely wouldn't affect Baby A (who is in her own placenta). However, if we chose to do the procedure - there is a 2% chance that we could lose all the babies since my water could break, etc. On the positive side, if the surgery goes well there is a 90% chance that we'll bring 2 babies home with us and a 60% chance that we could bring 3 babies home when it's all said and done. These statistics are somewhat varied and because of Baby B's heart condition, they're not overly optimistic about her prognosis... nevertheless, we believe she's one strong girl and have decided to go ahead with the procedure. This was a big decision for us, but for us, doing "nothing" wasn't an option - though we can certainly understand that for some people this may be the "right" decision...
   Our surgery is scheduled for 9:00 Wednesday (October 20th) morning and should last about three hours. Luckily they were able to find a window/opening where they can insert the scope for the procedure. I will be staying in the hospital overnight and then if everything goes well, I'll be released Thursday morning. We will be in Cincinnati until next week, since they will do a follow-up ECHO and ultrasound to see if the babies conditions have either stabilized or begun to reverse. I will likely be on bed rest for the remainder of the pregnancy since this surgery can trigger preterm labor (which we're already at risk for).
   We thank you all for your thoughts and prayers over the last few days and hope we continue to be in your thoughts... For now, having made our decision, we're staying positive and praying that things go as well as they can. Thank you all and God bless...

20(+) Weeks...

   Well, it's been an interesting and trying week for us... On the positive side, I was able to get one interview under my belt and enjoyed a beautiful baby shower with lots of friends and family over the past week. However, things turned all upside down on Wednesday when I went for my check up in Rochester on my way to another interview... 

   As it turns out, our identical twins were diagnosed as having twin-twin-transfer or twin-to-twin transfusion... boy how things changed in just one week! Although all the babies are healthy and growing at this point, Baby B is swimming around in a gigantic ocean while Baby C doesn't have much to swim in at all (they measure the deepest pockets of amniotic fluid). Also, when the sonographer first began the dividing membrane, which has always been very visible, was nowhere to be seen... we later found it very close to Baby C. While I won't get into specifics or too many details here, for those of you interested there are some very good sites where more information can be found: the TTS Foundation as well as the Fetal Care Center of Cincinnati, which is where I am headed today. Basically, what happens is with identical twins there is a transfer of blood between babies through (in our case) a dividing membrane. Usually one twin gives 50% and gets 50% back - keeping the fluid around the babies approximately equal. However, in our case, what is happening is that one twin is receiving X amount, while the other is receiving a lot less... this is not good for either baby. For Baby B (the one receiving extra), it means her heart is having to work much, much harder which in the long term can lead to a number of problems. For Baby C, she is not getting enough and while she's okay at the moment, what will eventually happen is that she'll focus on getting the most important parts her blood while other parts (such as her kidney's) shut down. In such a situation, if nothing is done, there is a great likelihood that both babies will die. However, there are several treatment options - which is why we are headed to Cincinnati (both the doctor I met with in Rochester and my own specialist referred us there). Because we're having triplets it complicates things (something we are already quite aware of)... Depending on how the tests go and what the doctors say, we're hoping to have a laser procedure done which will basically sever the shared vessels between Babies B & C - which gives both babies the best chance for survival. The statistics on this are varied and typically based on older data - to be honest; this is a somewhat rare occurrence, which makes it hard to gather data! 

   Anyway, that's where we are today... Travis and I will arrive in Cincinnati this afternoon and our tests begin tomorrow. While I still haven't received our full schedule of what all they'll be doing, I do know that tomorrow I get to do an EKG (which they told me will take about 3 hours) and an MRI, and on Tuesday we will have a thorough (3 hour) ultrasound done. A lot of this is done to determine the best option for all of us - whether or not I can withstand the surgery, and if the babies are in a position in which the doctors can perform the necessary procedure. That's all we know for now... 

   In the meantime, we appreciate any extra prayers or thoughts sent our way. While we were aware of this potential problem, we thought we had it beat when we got through our 16 week appointment and all was well... guess that teaches us for planning too far ahead with triplets on the way. Thanks to you all... With love, Travis and Erin and all the girls...

19 Weeks and Getting Big!

  We had our appointment with our MFM (maternal fetal medicine) specialist today and the first thing he asked was how all FIVE of us were doing! Crazy to think that in a few short months there really will be five of us, not to mention the two dogs! At any rate, we're happy to report that the girls are all doing well! I was amazed to see how much they'd grown in just a few short weeks, but then again, if my weight was any indication I really shouldn't have been all that surprised!
  Baby 'A' was funny and her usual uncooperative self! If it's any indication of what she's going to be like when she arrives Travis and I are in for a real treat! The sonographer had some real fun trying to get all her measurements - she kept turning away and curling up... we're trying to figure out where the flexibility is coming from, goodness knows Travis and I sure don't rate too high on the flexibility chart! Baby 'B' was a bit more cooperative, though she like to play some games as well. Though we aren't positive, we actually thought they had Baby 'B' and 'C' mixed up! Then again, it's really hard to tell. It turns out they're stacked - not side by side as I'd thought! When did that happen?! This also means, I really am not sure which one likes the music since both 'B' and 'C' are near the top and moving around CONSTANTLY! As usual, Baby 'C' was the most cooperative - her measurements took no time at all! And today's results are...
   Baby 'A' winning at approximately 10 oz, Baby 'B' came in second at about 9 oz and Baby 'C' was close behind at approximately 8 oz. The doctor said all look healthy and are weighing in where they should. I suppose our only upsetting news was that we're going to have to be monitored a bit more closely from  now on... There was a little concern regarding the fluid differential between the twins. Baby 'C' has about half of what Baby 'B' does. We were told that while some difference is normal, they want to watch closely for the twin-to-twin transfer as we mentioned before, especially since it has changed in the last few weeks. It could be due to the way the placenta has grown/formed, or it could be an indicator of something more... I did ask if this means it will only shrink - but was told it is something that can reverse itself as well, so for now we're not going to worry too much... we'll just pray that they learn how to share a bit better very quickly! However instead of my two-week appointment, I have to go in next week to have their "fluid checked". This put a little bump into my plans since the babies and I will be up in Iowa. Luckily my doctor is going to try to find someone up there to take a quick look. This also means that I am still cleared for travel - at least for a couple more weeks! Fingers crossed that I make it through October travel-wise...
  Below are a few pictures from today's visit. We didn't get many, but I suppose we aren't really going in for a photography session! Also, here's the weekly update from BabyCenter on the growth this week... How your baby's growing: Your baby's sensory development is exploding! Her brain is designating specialized areas for smell, taste, hearing, vision, and touch. Some research suggests that she may be able to hear your voice now, so don't be shy about reading aloud, talking to her, or singing a happy tune if the mood strikes you. Your baby weighs about 8 1/2 ounces and measures 6 inches, head to bottom — about the size of a large heirloom tomato. Her arms and legs are in the right proportions to each other and the rest of her body now. Her kidneys continue to make urine and the hair on her scalp is sprouting. A waxy protective coating called the vernix caseosa is forming on her skin to prevent it from pickling in the amniotic fluid. See what your baby looks like this week.

Above: Baby 'A' loves to curl up and move around!

Below: She showed off her spine and her ability to roll over!

Below: Baby 'B' - Just checking... Still a Girl!

Tiny little baby feet!

Baby 'B' had the hiccups below! The video was much cuter...