Apothecary

Alice asked about the Lovenox and I have a soft spot for Alice. So, yes I am still taking Lovenox and have been since... I think I started the Lovenox at transfer but I might have waited until the positive pregnancy test (all of four days later). My OB said to start it at ovulation so I worked from there, allowing for IVF weirdness and the fact that when I tentatively mentioned Lovenox to my RE (man, I haven't thought about them in months - you would think I would be more grateful) he rolled his eyes so hard they would have stuck like that if I had smacked him on the back of his head. Which I considered. Anyway, it is a blood thinner and comes with its own needle and every night I try to find a new place to inject myself in the stomach. Eventually I discovered that you can pinprick around for a while until you find a spot that hurts less than the others. This has left me with a fine rash of tiny little red dots but many fewer actual blow-out bruises. For what it is worth. Lovenox, by the by, stings like an adder and comes with horrible needles. They are so weensy they should be effortless but they really suck. Oh and Alice's question was a two-parter: am I on Lovenox and why? So yes and as for why... that is harder. In theory I am a heterogeneous carrier for a single gene mutation called MTHFR. And MTHFR is linked to clotting disorders. However, half the Caucasian women in the world are carriers and yet the vast majority of women manage without blood thinners just fine. So I would be inclined to give the Lovenox a pass were it not for the fact that I am pitifully superstitious. And I noticed that the pregnancies for which I was on Lovenox (agreed to out of desperation), for the most part, progressed further than the ones for which I was not. Same unbalanced translocation ultimately was fatal but with the Lovenox the fetii developed to eleven weeks or so and without it they tended to succumb around seven or eight. This is probably a total coincidence but I could not shake the conviction that more than one thing might be contributing to the pregnancy failures. So my rationale was that if I could get a genetically normal embryo started perhaps a guaranteed clot-free environment would help. The only indication I have that this is anything other than a placebo for me is when I was in the hospital the other week I was off the Lovenox and they had to flush out my IV every time they changed it because I kept forming clots around it. Oh, and I rarely bruise despite being on it. Hardly incontrovertible evidence but there it is. Fear trumps logic.

Speaking of needles, the terbutaline pump is not bad at all, other than the part where you are attached via a tube embedded in your thigh to a vinyl clutch the size of a small evening bag. I have not sufficiently examined the apparatus but the needle bit is just used briefly to guide the little tube in and then it gets thrown away. So you have a disc with a... well, a grommet I suppose, going into your skin and then you click another disc on top of that with a tube that connects to dispenser and voila. Every three to five days you pull out the one grommet and put another one in the other leg. You would think it would be horrible to sit there and push this thing in but it isn't. My big fear was accidentally ripping it out and I did that and it wasn't as bad as I thought it would be. I spent a few nights misjudging the amount of medicine I had left in the dispenser (hint: actual math makes no sense with these things - you would think having 1.34 left with hourly doses of .066 and two bolus hits of .274 a piece would leave you plenty until morning but you would be wrong) and subsequently being woken up to change the cartridges at various ungodly hours. It took me a while but I finally learned to just abandon small amounts and put in a full cartridge every night if there is even a smidgen of doubt that it will last me. Thus ends our public service announcement.

I just took advantage of the every-three-to-five-day leg swap and had the nicest bath. I can shower in the interim but a shower always feels like work to me, what with the standing and the moving your arms around. I put a new leg grommet in but I am a little concerned about it. SOMETHING was just leaking down my leg and on to the bed and I am not sure if it was the insertion site or if my hair just dripped. It seems ok but it is rather unnerving. I have my appointment (yay! out of the house! ultrasound! glucose screening!) in two hours so I will ask someone there what they think.   

------------------ back now. I started leaking again more obviously from the insertion site so I called the nurses and they told me to swap out the needle-tube thingy with a new one and to give the needle a half-turn when I pulled it out. She mumbled something about the manufacturer. Whatever.

The doctor's appointment was quite nice, all things considered. I made a superhuman effort to pay attention when they told me what to do next this time and dithered considerably less as a result. I passed the one hour glucose, which I was expecting, and gained a pound and a half, which I was not. Doreen and I and the 13s spent a cozy forty minutes or so taking measurements. They are now big enough that I can no longer make heads or tails of any of it. Not that I could in the first place, but it is officially a jumble of bits now. 13a is head down... waaaaaaaaaaaaay down. I TOLD you I felt something in my pelvis. That would be A. The baby is so far down that it was very difficult to get a head measurement. I wondered if is is a bad thing? No one mentioned anything like, hey, watch it! that baby is about to fall out! so I guess not. 13b has turned completely upside-down in the past week and is now bottom-to-head with A, feet down. My OB airily said that as long as 13a stays head down I'll be fine to deliver vaginally. Apparently she recently delivered the latter of a set of twins by pulling the baby out feet first. I admit this sounds uncomfortable to me but I am not worrying about it yet. Right now How I deliver is the very least of my concerns falling behind a very big When and a smaller but related Where. Who/What is a matter of intense curiosity but I am content to coast on that for another X weeks. Steve is refusing to discuss names rationally (Drake? he says. Oh I know, how about Drake!) and my fear right now is that I am going to be weakened by how terrific he's being and say yes one of these days. And no offense to any Drakes out there, but it is not to my taste. And even if I succumb (which I will not) that still leaves us, oh, one two THREE names short. He's killing me.

Steve really, truly is being amazing. I know I have said this before but it bears repeating. He makes breakfast lunch and dinner, does the laundry, arranges playdates, goes to the library, fetches and carries all day long, and he even organized the pantry. Meanwhile, he put primer up in the new rooms and is planning on painting them this weekend. Oh yeah, and he is running his business, apparently making $$$ in his spare time! from home! He made me dinner and then took Patrick out for pizza tonight. I am quite touched by everything he is doing. And he isn't even all that crabby. He turns 40 on December 8th and I had planned for years to throw him a REALLY big surprise party for it. Steve loves surprises. When I did the math on the twin thing, though, I realized that I was going to have to pass on anything that involved deposits but I still planned on doing something. Now I have no idea what. Any thoughts? Maybe the surprise will be that we watch Netflix on his birthday and then I throw something in March. But if you think of anything that I can plan and execute from bed let me know.

Oh, I forgot. Yes I am still on bed rest but she did bump my threshold for contractions with the monitoring people so I will have to do less re-monitoring. Last night (was it last night? I honestly cannot remember) I was up until 2 because I kept having too many contractions and I had to take more terbutaline and then monitor again. Total drag.

And 13a is 1lb 14oz and 13b is 2lb 1oz. So, growing.

It's good. I am feeling very excited.               

Comments

[Chickenpig]

I'm glad you're feeling fine, and the babies look good. The pump sounds a little freaky, though.

I got a bit of a chuckle when you said that Baby A was in your pelvis. Of course it's Baby A, baby A is always the one closest to the exit. If they are side by side, Baby A is on the left. They can switch, a lot, I'm quite sure that mine did. Any guesses on the sexes?

[winecat]

And who said 13 was an unlucky number???? Go 13's. Go or rest or something Julia.

[Kate]

I've been reading your journal forever, but this is the first time it's struck a personal cord, because apart from one miscarriage, I've never had any (known) fertility issues. I just had a daughter, and ended up with a blood clot in my brain, so I was tested for clotting disorders and had the reasonably insignificant MTHFR as well as the more significant, but still not terrible, PAI-1. I still don't really understand it, but I know it can cause early miscarriages. I'm on blood thinners now, but have been told that Lovenox will be part of any future pregnancies.

I know it's a tiny little piece of what you've been through to have these twins, but nonetheless, I appreciate your writing about it.

[Geohde]

Breech position is actually one of the better options for vaginal delivery of a second twin. Really.

It's easier to reach up, grab legs and perform a breech extraction i.e. pull twin B out if things start to go pear after the delivery of twin A. Heads don't offer the same purchase to extract the kid quickly, and forceps that high up = Bad Idea.

[Leggy]

I also used a blood thinner (my RE was partial to frag*min) this past pregnancy when I only have one MTHFR mutation. Who knows if I needed it, but with 2 miscarriages under my belt and this being my absolute last attempt to get PG, I'm glad I did it because my 3 month old b/g twins are sleeping in the other room. Maybe it was just voodoo, but it worked, so I'm not knocking it.
How far along are you now? 26 weeks and change?

[Jenn]

It really doesn't hurt that bad when they reach in to pull out baby B if you have an epidural. My epidural was even wearing off at that point and she was in up to her elbow and it didn't hurt. Of course she couldn't grab the baby either and I ended up with a vaginal birth and a C-section, but there were unusual circumstances and I have a uterine defect.

[KLynn]

Just don't do what I did. Bob and I had calculated that Boog's due date would fall close enough to my late father's birthday, that I could schedule my c-section on my dad's birthday. Well, my body decided that wasn't happening, and Boog arrived 2 months early...the day before Bob's birthday. Poor Bob spent his 35th birthday at the hospital with me still in very guarded condition, and with Boog (all 3lbs 8oz of him) in the NICU. Now that I've told you this story, I hope I've jinxed it so that it WON'T happen to you. You're handling all this amazingly well (at least from what I can tell), so keep up the good work. Thinking good thoughts for you and your whole family.

[Yatima]

What about one of the sophisticated European variations on Drake? ...like, Dracula?

[Bea]

I'm on Lovenox (we call it clexane here) for "unexplained miscarriage and biochem pg loss". Apparently new thinking is that the blood thinning has nothing to do with why it works in pregnancy, and it may instead have some effects on the maternal immune system. Fun fact.

With a little help from my friends, I have also managed to hone a bruise-free technique! (!!!%$&@) So far one other person has tested my instructions ( http://ivfshootemup.blogspot.com/search/label/Clexane ) and confirmed they work for her, too.

Bea

[Lisa B]

OK, is it only me who thought you were joking when you wrote MTHFR? I mean, come on, M*th*r F*k*r? I nearly choked on my hot chocolate mix. ;-)

[Kate]

Lisa B - That's EXACTLY how I manage to remember the name of it.

[Alex]

Oh, this is excellent. You sound so, well, happy, which is exciting. And remarkable, considering that you are actually in a pretty difficult situation, though I realize compared what you've been through in the past, well, it's no wonder you sound giddily happy. 26 weeks! Twins!

No real pointers on the birthday party question, though I can tell you that throwing a surprise party for a DH 2 months before the actual bday (done in my case due to a trip to visit his family and with co-conspirators, it having been another one of those birthdays that ends in -0) is remarkably (surprisingly?) effective, in terms of being surprising.

All of which is to say, I guess, that late might also work, surprise-wise.

Though while it will be in some ways easier than your current situation, I'm guessing that mom-with-young-son-and-newborn-twins may also be a challenging role in its own way, perhaps not conducive to throwing parties?

[Pam L]

You could still throw a surprise party for Steve.People LOVE to help with those for things like the BIG 4-0, and I'm sure especially for you since you can't do it yourself. I would call someone you can depend on to help and do as much as you can by phone, order a cake to have someone pick up, make it pot-luck, whatever, delegate. It will still be a surprise if the doorbell rings on the 8th (and it's a Saturday!)and 20 or more people are standing there with food and cake and lovely old age gag gifts , don't you think?

[Cherith]

What a great report! Good for you and babies and Steve and Patrick.

Um...no more Drakes. Please.

I realize that in refusing to accept names of students I have taught who irritated me in the slightest I am greatly limiting my options, and those of the people I inflict my opinions on, but I currently have 2 Drakes in one of my classes and God love their little souls but they are DRIVING ME CRAZY.

Perhaps both babies are girls and therefore the Drake issue will be null and void anyway. One can only hope.

[Amber]

I had the best idea about a surprise for your husband for his birthday, that you could do from bed...but I assume sex is out, with the bedrest and all.

and that was the only idea I had.

Glad to hear the 13s are doing there thing. Hang in there!

[Lucky]

I read Drake and thought of snack cakes ... mmmm ... how about Drake and Debbie?

BTW, FWIW, 2nd twin grabbed by ankles and pulled is exactly how my neighbor delivered hers vaginally, sans pain meds (like I said, FWIW).

[Theresa]

I also want to say thanks for writing about MTHFR. I just found out a couple months ago I am compound heterozygous (2 mutations) and will need Lovenox if I ever get pg again. Unlike your dr my dr thinks it is enough to start it once I know I am pg but after 3 mc I would feel safer starting after OV. But he does have me on a baby aspirin every day and mega doses of folic acid, B6 and B12.

Best wishes with your twins!

[Karen]

Avoid Drake. Know a Drake personally and trust me Julia, your instincts are good on this one. Besides, think of all the duck jokes.

[Ann]

So glad you appear to be doing well! Oh, and "precious angel dream rabbit" at the REDBOOK site? Made me laugh out loud. Thanks.

I had a vaginal and then c-section with my twins as well - baby A being vertex and baby B being transverse. But I would do it over again, just so that I've had at least *one* vaginal birth. Weird, maybe, but if I ever get pregnant again (I have infant twins! What am I *thinking*?!?) it will be easier to argue for a VBAC.

Sorry you're feeling like an electric typewriter. If it's any consolation, they were a really cool concept, and multitudes of schoolchildren relied on them in their day...

[Aurelia]

I'm glad you are surviving bedrest, and I'm glad Steve is holding it together around the house!

And to Kate, and the other commenters who mentioned clotting disorders, PAI-1, the 4G/4G and the 4G/5G alleles have been linked definitively to endometriosis, as well as miscarriage, stillbirth, and placental disorders that can lead to things like to preeclampsia, & IUGR. Low molecular weight heparin and baby aspirin are definitely a good idea with this gene allele. I have the 4G/4G one and I'm on fragmin now and praying it works for this pregnancy.

It isn't on the normal clotting panels that are done for IF. You have to ask to be tested for it. Or have evidence of clotting issues like Julia mentioned above with her IV, or like me with clots all over my miscarried placentas.

And as my RE says, "Doctors haven't discovered all the clotting disorders yet, even if you test negative for the usual ones, it doesn't mean much. You could have a brand new one we haven't found yet."

So I guess we have to be vigilant for ourselves.

[JuliaKB]

You sound better.
Day by day and week by week. I wish you ten more weeks, bed rest and all, before the babies arrive.

You know, I just spent some time both googling the population rates on MTHFR and calculating the carrier rates from the percentage of population that is homozygous screwed for this. For what it's worth, I get about 43% of carriers, which is indeed very close to 50%, the number that originally seemed crazy high to me. And reflecting on that I think that there could be a compound effect, and there may be another small mutation in some other clotting factor you have, and the two together are enough of a problem to warrant the Lovenox. Of course I admit that I am of the "do everything you can think of to make the pg stick" school of thought. But I also clot pretty fast and no definitive genetic cause has been found.

[Allison]

I was SO about to say that Lisa B! I'm glad there are like-minded people out in the world! :D

[Kay]

Congrats on the good appointment. You seem to be doing very well. And yay, Steve. Hang in there 13s!

This is probably very lame - but you could throw him a surprise "card" party. All you have to do is email his friends (or put up a post here) of an address so that everyone can send Steve a birthday card. He's inundated with warm feelings and well-wishes - and there are no random strangers who end up sleeping in your basement. Win, win.

Good luck!

[Hetty_Fauxvert]

My DH refused to discuss names for a long time during my twin pregnancy, and I finally just made up a loooooooong list of names that **I** liked and posted them on the fridge, with an invitation to him to read and comment on them, and add his own. For some reason this got him going, and we were finally able to pick out names.

As for things you can do for your honey for his birthday -- you are such a beautiful writer and obviously appreciate him so much. It would be nice if you got that down in writing directly *to* him. (Of course, for all I know you do that every day, but ya know, most people don't.) People LOVE it when you tell them directly how much you love and appreciate them, though they may blush and "aw shucks" you to death as they receive it. :)

[Professordog]

Re: you Redbook post, I really bet there is someone around who can come to your house and do a pedicure and eyebrow waxing if you really want one. You're not hurting for money, right? Even if there's no place that advertises in-home service, if you call and explain the situation, offer to pay mileage and promise a big tip, I'd bet that you'll find someone who will do it.

Re: Steve's birthday, I guess maybe you could have a caterer come and serve a romantic dinner in your bed. Maybe some kind of Roman theme, since you'll be reclining?

Re: Baby names: Alex and Robin. Now you're covered regardless of gender. Or Alex and Max. No? I tried to get my sister to make her whole list gender-neutral names, but she wouldn't go for it either.

[maggie]

Glad things are looking good. For my one and only successful pregnancy I was on baby aspirin...as one of those "can't hurt, might help". The superstitious part of me is sure that's why everything worked out.

[Katie]

This is what I did for J's 30th birthday. His birthday is Jan 5 so I knew the weather would be an issue (in Ohio anyway) and since people were tired of traveling with the holidays I took the party to them. I created a note to all family and friends explaining it was J's 30th and could they please write him a note with good wishes on the paper provided and send it back between this and this date. I included postage and the already addressed envelopes. We received a few early in the mail but I was able to get to them before he did. So a few days before and after his birthday he was received all the notes in the mail. I created the notes in Photoshop with some of the best pictures of him from birth. The best was the grade school picture with the crazy smile I used on the return address with J's 30th Birthday then listing our address. He still has all the notes. Something that could be created on bedrest or maybe even done over email.
Katie

[Toni]

I'm excited too - for you guys of course. But I feel like we're really good friends (although we've never met and rarely converse outside of your blog) and I should start knitting something right now. But I don't knit. I'll have to come up with something.

Anyways, can't post at REDBOOK, but perhaps you could conference call into the teacher conference? I know my cell phone, along with many other features that I have no clue how to use, does have a speaker phone option. Just a suggestion.

Another random suggestion is that some places will actually come to YOU to do things like eyebrow waxes, etc. You can get everything done. Worth looking into it so you can dream about something else! :)

[Maren]

I am so glad to hear you and the 13s doing well! Thanks for your updates on the ins and outs of the pump, too. Do you have a good view from your bed? I am reminded of an Ernest Hemingway short story "The Gambler, The Nun, and the Radio" who proclaimed that "If you stay long enough in a room the view, whatever it is, acquires a great value and becomes very important and you would not change it, not even by a different angle."
Thank goodness you can shuffle around some :)

[juliag]

Just have to tell you: I read the bit about "Drake" aloud to my husband and he said "I like it. It's manly and easy to pronounce and spell. She should be glad that he's not suggesting twin boy names from The Hobbit!".

We told people we'd name our son Blortimer or Blort, for short. Also, Fahrenheit, Viper, Cobra and Zelotus (an old family name on husband's side). And then some of these joke names started to grow on us and we got scared. It's easy to be weakened over time.

[Becca]

Ok for Mr. Wonderful. Anyway your mom could come for a long weekend and you could surprise him with a weekends away with a buddy? To a golf resort or dude ranch? (or is that a little too Brokeback?) Anyway just though he might like a breather before the babies get here.

[sb]

Drake makes me think of Dr. Drake Remoray, Joey's Days of our lives character on Friends. I'm glad things are going well with A&B and I hope the whole bedrest/needles in thigh business continues to be endurable. And I second the idea for a Roman-themed reclining banquet. Togas would probably be an essential element :)

[Elena]

Hey, so Steve is doing what most wives/mothers do as a matter of course!

Do you go off the Lovenox near time of delivery to reduce excessive bleeding?

[victoria]

Yay! You sound great. I'm so happy that the worry levels seemed to have de-escalated.

[zarqa]

Hey, I turn forty this december 8 too! Although I personally hate surprises (lack of control thing), I'm certain he will enjoy a party of adoring fans. With full catering and hired clean-up of course.
Glad to hear you're on top of the ctx and the 13s are hanging in there.:)

[WendyP]

I think I know the answer to the mystery volume problem with your pump - you have to take into account what remains in the tubing. My husband has an insulin pump and his tubing has around about 10 units in it. So, if he has 20 units left he really only has around 10 to work with (time for a site change.)

Grow 13s, grow!

[nate]

I know a 16 yr old Drake who's perfectly nice--but still. All I can think is Drake Remore. And I wasn't even that big of a Friends fan--so please, stay strong! (Maybe, just maybe, he's really being this nice to you *just* so he can soften you up re: the name.)

[kari]

I didn't read all the comments, so someone might have mentioned this, but my OB said Lovenox helps increase blood flow to the baby, so they tend to be bigger. Which turned out great for me when my daughter decided to come into the world at 32 weeks. She weighed 4 pounds.
Also, I had four pregancies prior to Natalie without Lovenox ... three miscarriages and a stillbirth. So the bruises were so worth it for me!

[Tonya]

I did Lovenox/Arixtra (only ONCE a day- woo hoo!) with Tiny Boy (MTHFR homozygous for C677T), and I agree the 'tiny test poke' method helped so much to avoid bruises.

And can I give a shout out to Steve? My hubby was only gracious for about a week before he was so DONE with me being on bedrest! (Though he agrees the boy was worth it.) What a great pair of guys you have there.

Something occurred to me about your dilemma re: the teacher conference. Is it possible for the teacher to conference call you in to the meeting, so you can at least hear what's going on and participate remotely? Very glad you're still gestating and that babes are doing so well!

[Dara]

Hmmmm...it seems Steve is liking the "D" names. Draco, Drake.....how about Darcy? I happen to love that name. Very unisex, IMHO. It would honor your fave, Mr. Darcy. My other fave "D" name is Devin, also unisex. I'm not sure how you feel about twin names that begin with the same letter....

Anyhoo....you are remarkable people, you and Steve! And, of course, Patrick.

Positive thoughts, all around!

Go REDSOX!!!!!(sorry, had to slip that in...)

[Julie]

FWIW, my A baby's head was really far down as well; I remember they had trouble measuring, just like you said. I delivered about 35 weeks.

[Denise]

HATE the Drake.

(C'mon, Steve has NEVER seen that episode of Seinfeld? Nor the 41 commenters ahead of me? I can't believe I am the first to say it.)

[pk]

a 40th bday party in spring would be wildly surprising for steve. top idea.

agree with commenter who says list on fridge. we did that and it is mainly useful for whittling the ones which are unacceptable without fighting over it. then if you feel really strongly about one you can argue the case too - dp actually won the day which i still find surprising.

are you too bored to read then?

[O]

Surprise him with something to look forward to...I'm a blog newbie so I don't know what he would like. A baseball suite party next spring? A weekend with friends without you?
When are you 40? My husband and I are splitting the difference on the 13 months between our 40ths and going on a cruise right in between. We haven't been on a "real" vacation (other than borrowing time at others' beach houses, etc.) since Son 1 was born so it's a splurge but hey, when else do you hit 40?
Meanwhile, I love the idea of the catered dinner for 2 (or 4) at home. Good luck with all!

[terri c]

Am glad things are sort of stable, and am hoping along with you for more of the same. If you have b/g twins you could name them archy and mehitabel although that could screw them up when they try to learn capitalization rules later.

[TexMex]

Lovenox - check! Terb pump - check! Home monitoring - check! Wanting to weep from nightly Lovenox shots - check! Ripping out terb pump - check! God, stop copying me already!!

It's good that A is head down on your hoo-hoo. As my peri described it, its head acts as a cervical "cork" and absorbs the brunt of the contractions. Neat, huh! That's probably helping keep your cervix long and closed. And don't worry, A's head won't be all pointy and cervical shaped. My little one's head came out all round and perfect.

[FENICLE]

This indeed tugged on my heart tonight. Partially because I wrote a post on my own pregnancy issues.

Glad to hear all is well for you guys!!!

[Carrie]

Happy to hear you are all well. What about planning a trip for next Spring? You can make your plans and book hotel, etc. via the Internet and that can be the big surprise present in December. Plus the added bonus of having something to look forward to in the Spring.

[Genevieve]

Things are sounding good!
I like the idea of emailing/calling Steve's friends and asking them to do or write up something special for him. I guess any party would have to be at your place, so that would limit the numbers you could invite (and you'd have to hire someone or ask really good friends so Steve didn't end up with cleanup duty).

The Hemingway / room reference above reminded me -- have you ever read Josephine Tey's "The Daughter of Time"? It has her usual detective, but he's stuck in bed wtih a back injury, and starts doing historical investigation as a way of handling the boredom. It's very funny in parts, fascinating in parts.

[Shana]

Glad to know things are still going well for you and the 13s. Steve sounds like a real peach -- keep him. FWIW, I was head down and my sister was a footling breech so I was delivered and then the doc reached in and pulled out sis. Mom says it wasn't a big deal (no pain meds/4th pregnancy). And as for names, I know the trend now is to not rhyme but we never minded being Shana & Janna (think Anna) although people would always screw-up the spelling. I think it would be a little more annoying with boy-girl twins, though.