Recovered

My recovery the first two weeks after surgery progressed really well.  I actually felt well enough to return to my desk job the Monday after surgery and by my post-op appointment a week post-surgery, I was no longer taking prescription painkillers and had stopped my scheduled doses of Tylenol and Ibuprofen. 

While I up and about and going about my daily routine in what seemed like a very short amount of time after surgery, the area around my incisions felt sore and tired by the evening if I'd done too much during the day. It was frustrating to realize that going for leisurely lunchtime walk was too much.  Every twinge I felt in my lower abdomen made me worry that the damage inside of me wasn't healing properly.  I quickly reached feeling 95% recovered, but I felt like I was never going to fully recover. 

I was playing with the kids yesterday when I realized that I was picking up my kids up like I did pre-surgery.  My body didn't go into its subconscious defensive mode by lifting them as gingerly as possible and I didn't feel guilty, like I was jeopardizing my health.  Instead, I tossed Soren (gently still) in the air and swung him around as he smiled and giggled.  I sat on a swing and pulled Oliver into my lap so we could swing together.  And it felt good!  My body felt good and I felt relief that I may have reached 100% recovery. 

Recovery Mode

Since my two c-sections comprise my experience with major surgery, my anxiety about surgery is rather heightened.  So I was relieved to experience that the recovery from laparoscopy really is easier than abdominal surgery.  As long as I was diligent with my schedule of painkillers, I was actually in far less pain post-surgery than I was pre-surgery.  Unlike after a c-section, it didn't taken ten minutes and a few tears just to get out of bed!  And I didn't have a newborn to nurse numerous times a night! 

I spent the three and a half days since being released from the hospital taking very seriously doctor's orders, which meant no housework, no cooking and no childcare.  I honestly spent most of the time sprawled out on my couch watching reruns of Friday Night Lights on Netflix.  I was super exhausted, whether that was a side effect of surgery, the blood loss, the cold I caught from Soren or some combination thereof, so I happily vegged out until I got bored.  Watching TV was about all I could do because I was supposed to stay off my feet and I had discovered a strange side effect of pain medications I'd never experienced before - blurry vision.  Unable to comfortably read the newspaper or anything within arm's length, I called the doctor thinking I had become far-sighted  overnight. Luckily by Sunday, my vision problems started to subside and I could happily read the People magazines my mother-in-law had dropped off for me. 

The hardest part of recovery continues to be trying to take it easy when I really am feeling so much better.  I know I pushed myself too hard after Soren's birth and I'm afraid of repeating that this time around.  When you have tons of people around you taking care of you, it sounds easy in theory to literally not do anything.  But the kids wanted to climb up on the couch and cuddle with me, sunny weather beckoned me outside and dirty dishes and toys strewn about the living room taunted me.  Even though Chris was on full-time kid-duty this weekend, it was so helpful when his parents took the kids overnight, because it took away some temptation and allowed me to do what I was supposed to do - absolutely nothing - without feeling guilty. 

I'm keeping my fingers crossed this latest round of recovery will be the last.  I'm ready to move on with my life.  I want to return to tending my garden, enjoying the summer weather and running after my two energetic little boys. 

Surgery

I've had a crazy 48 hours.  After enduring pain and discomfort over the long weekend, I called my doctor on Tuesday and got a mid-afternoon appointment.  My exam lead to a referral for an ultrasound at 7:30 p.m. that evening, where a large blood clot was found.  That discovery lead to being admitted into the hospital and a 1:00 a.m. CT scan.  My string of medical interventions finished off yesterday with a last-minute decision for a late-afternoon surgery. I'm exhausted, but feeling thankful my medical issues are on the path to being resolved.

When my doctor first broached the subject of surgery the next morning, I was scared and overwhelmed.  Until that point, I was being kept in the hospital for observation and even though the CT scan hadn't ruled out continued bleeding, my hemoglobin levels were steady and I was actually feeling the least amount of pain I had had in days.  I was bored out of my mind sitting around my hospital room and I missed my family, so I tried asking the doctor if I could leave and just come back every three hours for another blood draw.  Otherwise, I was just hanging out around and feeling like I there was no reason for being there. 

Before my doctor even determined surgery was necessary, she had insisted she felt more comfortable if I stayed in the hospital until she could be sure I was going to be okay, because it's easy for young and otherwise healthy people to tolerate a lot of bad stuff going.  Indeed, I'd put up with a lot of pain and discomfort over the past two weeks as proof of her point.   But since I was feeling pretty decent by yesterday, I thought maybe all I needed was to continue resting.  Despite how healthy I looked, my doctor impressed upon me how I could go downhill very quickly and she'd rather that happen in the hospital and not at home in the middle of the night. 

Despite how well taken care of I was at the hospital, never in my life did I want to be home with my family so badly than when I was faced with an unknown amount of time in a hospital for reasons I wasn't so sure required me to be there.  Thinking about my kids and wanting to be with them made me cry.

My case was apparently unusual enough that my doctor consulted her colleagues who've treated many patients with ectopic pregnancies and complications as a result and they determined that the state of my health was a "ticking time bomb."  Yes, if the internal bleeding had indeed stopped, I'd be fine and the blood clot would have been absorbed into my body. But if it didn't and the clot ruptured or broke up, the consequences would have been disastrous.  Although the decision to operate isn't taken lightly, being able to remove the blood clot would be an instant cure. 

I was nervous going into surgery, but was at least feeling somewhat reassured that because I was having laparoscopic surgery, the recovery would be a lot easier than when I had c-sections. More importantly, I reminded myself that I have to take care of myself for Oliver and Soren.   

For all the worrying I did about whether I even needed to be in the hospital at all, the discoveries during surgery showed exactly how serious of a situation I was in and how I truly was the ticking time bomb my doctor had referred to me as.  Surgery turned out not to be just the best option, but an absolutely necessary one. 

My doctor's original goal was to remove the blood cot, drain out blood that had gathered in the abdomen and then stop the bleeding.  As soon as she got in there though, she couldn't see past the fallopian tube, which was swollen and heavily scarred.  She immediately removed it so she could see past the "mess." Because the tube was in such rough shape, she assumed at first that the ectopic had implanted there.  Once the fallopian tube was out of her way, though, she discovered that the ectopic had actually implanted in one of my ovaries, which had split open completely in half and was still bleeding and covered in scars.  So not only did I have an ectopic pregnancy, but I had a very rare ovarian pregnancy, which occurs is less than 3% of ectopic pregnancies.

It blew me away to think that I had been walking around with internal bleeding and a ruptured ovary.  After my successful round of methotrexate, I couldn't believe that there was anything left of a sizable amount that could cause a rupture.  My doctor explained to me that ovaries are really sensitive, so even if the ectopic never grew big, it could still do more damage than if it had implanted in the fallopian tube.  Without that round of methotrexate I had a week and a half ago to break up the ectopic, my body would have been in a lot more serious trouble and a lot sooner, and I would have probably ended up in emergency surgery.  I was relieved to hear that there had still been a need for the methotrexate even though I still needed surgery in the end. 

Now that all the problems have been identified and either removed or repaired, my doctor thinks I'm well on my way to a full recovery.  I'm no longer a ticking time bomb and am humbled by the knowledge that the doctor wasn't just being overly cautious when she said how serious ectopic pregnancies and the risk of rupture are.  I'm thankful now that she consulted with her colleagues and she didn't let me go home while she tried to figure out what the heck the problem was, because in her words, it would have been a matter of time before I "crumpled" if I hadn't had surgery.

I'm now waiting to be discharged from the hospital.  I'm super tired, but at least the pain doesn't seem to be as bad as it was after c-section.  Recovery from a laparoscopic surgery is a lot easier on your body since it only requires small incisions.  I hope that remains the case. I still have recovery ahead of me and have been given the same restrictions (no heavy lifting, housework, no driving while on pain medications, etc.) that I had after Oliver's and Soren's births. 

I look forward to being back at home and with my family.  I felt so lonely at the hospital without them, so it really lifted my spirits when I had visitors.  Our nanny brought Oliver and Soren to the hospital to hang out with me the morning of surgery and then Chris took over when it was time for the kids to go home for lunch and naps.  The biggest surprise was when I was wheeled back into my room after surgery and I saw Chris sitting in my room with our two little boys in his lap.  The surgery started an hour later than expected and took a lot longer than anticipated, but there was my little family patiently waiting for me. 

Blood Clot

I was clearly ahead of the ball when I declared myself "on the mend" last week.  But I really was feeling much better by the time I met again with my doctor for a follow-up appointment at the end of last week.  I even felt well enough to take a walk.  And then another one the next day.  But during that second walk, I knew I wasn't doing so well anymore when I realized I was using Soren's stroller as support.  Once we got home, I fed him lunch and got him down for his afternoon nap as soon as I could and then collapsed on the couch for the next three hours.  I was still in enough pain the next morning that I needed to call Chris's parents for help with Soren and then called Chris at the cabin where he'd gone to help his brother with beginning-of-the-season chores and asked him to come home early. 

I saw my doctor again yesterday afternoon and although my blood tests looked great, (my hCG levels had dropped by half) she wasn't optomistic by the pain and tenderness I was experiencing in my lower abdomen and ordered an ultrasound.  The earliest appointment I could get was at 7:30 p.m. in the Radiology Department and then that got pushed back due to an emergency patient.  With my luck, the ultrasound had to be performed twice, which shouldn't have been a good sign, and by the time I talked with the doctor at 10:30 p.m., she informed me that I had a 14-centimeter-long blood clot. It could be serious, or not at all.  I have in my favor the fact that my hCG levels are dropping like they should, which means the ectopic is resolving, or else we'd have what the doctor called a "hot mess." However, until I could have a CT scan to determine whether the clot is bleeding and get a better idea of exactly what's going on, she didn't feel comfortable sending me home.  Thus I was unexpectedly admitted to the hospital.

Two and a half hours and three trys later, the third nurse was finally able to get an IV line going and sent me back down to Radiology for the CT scan.  The results of the scan weren't enough on their own to make a more detailed diagnoses and the doctor told me she really needed the results of the blood draws I'd have throughout the night.  So more waiting.  After very, very little sleep last night, I'm sitting around waiting for my doctor to round today and let me know the next course of action.   

After feeling like I was making progress towards recovery, it was so frustrating to suddenly feel like I was never going to get better.  Besides my physical discomfort, I'm feeling sad because I miss my kids and because I haven't really been able to play with them much recently and haven't been in the best mood.  And even though I have a supportive work environment and helpful nanny, I actually feel anxious imagining how Chris and I would manage if I were still a stay-at-home mom.  As difficult as it was to concentrate at work when I wasn't feeling my best, I appreciated that I have someone healthy at home to do fun stuff with the kids.  And of course, having the nanny home with the kids today is a huge help so Chris can go to work and they can follow their normal routine. 

On the Mend

I am less pregnant than I was on Monday.  That's good news! The results of my blood test on Monday showed a continued rise in my hCG level from the Friday before, but I was told that's normal even a few days after the initial methotrexate treatment.  What my doctor was hoping to see was a 15% drop in my hCG level between day four of treatment (Monday) and day seven of treatment (today) and my drop was 34%.  Never have I been so happy to be not (less) pregnant.  I'll need to have weekly blood draws until my hCG levels hit zero, but my follow-up exam indicates that I'm recovering from the ectopic pregnancy as well as my doctor was hoping. 

Today is the best I've felt in two weeks, especially compared with this last week.  My doctor warned me there would be a lot of cramping, but my gosh, I wasn't expecting flashbacks of my labor with Soren.  Remember those contractions that really started to hurt?  That's what it felt like.  I looked at my body and wanted to scream at myself, "There's not even a baby in there!"

As particularly painful and uncomfortable as that first wave of cramping was, I've never experienced being so comforted by my own child like I was by Soren.  Chris was out with Oliver and Soren had just woken up from his nap, so I pulled him out of his crib and laid in my bed with him.  I held him tightly and clasped his fists in mine as my tears fell onto the soft, wisps of curls forming on the back of his head.  I was sure he'd want to get up and play, but he contently lay there snuggled with mom and thankfully oblivious to my pain.  I was so thankful to have this sweet little boy to hug and hold.

Tylenol, the only pain-reliever I was allowed to take, was also a great comfort.  It was enough to take the edge off and allow me to be functional, but there were periods this past week where let's just say I was grumpy.   I can't wait to be back to my normal self. 

Ectopic Pregnancy Treatment

My hCG levels have continued to rise, so despite another inconclusive ultrasound, my OB was confident that I have an ectopic pregnancy and the best course of action was immediate treatment.  Surgery was not an option since she couldn't tell where the egg had even implanted.  Treating with an injection of methotrexate, which is essentially a cancer drug, is the best option, even though I'll need follow-up testing and additional doses if the first one doesn't work. 

I was hesitant to immediately pursue any sort of treatment though.  If the egg hadn't implanted where it was supposed to, how could it even survive?  It just didn't make sense to me. I felt like immediate treatment had to be unnecessary.  But that's the unfair part about an ectopic pregnancy I learned.  The egg usually continues to grow despite no chance of long-term survival and the fatal risk of eventual rupture.  Even though I wasn't in pain, "wait and see" was not the recommended approach.

So I could put my options in perspective, I asked my doctor what happened to women with ectopic pregnancies "back in the day."  Before ultrasounds, doctors had no way to detect an ectopic pregnancy early on, she explained, and they were usually diagnosed when a woman showed up in the emergency room with severe abdominal pain and then they were treated with emergency surgery.  Before the era of modern surgery - women often died.  Chris and I appreciated her bluntness. I opted for the injections of methotrexate.

Before I could start on the methotrexate, I needed another blood draw to test my liver function, so Chris and I went out for lunch while we waited for the tests to come back. It's rare Chris and I have a quiet meal together, just the two of us, and I appreciated even more having that break in between what was hours of waiting, prods and pokes and consultations with doctors and nurses.  We talked about how frustrating it is to come so close to what should have been a healthy, complication-free pregnancy and how sad Chris is about not having more biological children when he thinks about what great kids Oliver and Soren are.  I sometimes feel like I'm throwing in the towel too early, but my heart just isn't in it anymore. 

As much as I'm looking forward to moving on, I need to focus in the immediate future on getting better.  With a prescription of Zofran on hand in case I become nauseated, I'm taking it easy the next couple of days and am keeping my fingers crossed this round of treatment is successful. 

Technically Still Pregnant

Despite how upset I was to learn that I was miscarrying, once it happened, I wanted it to be over.  I've already missed spent as much time at my OB's office as I have at work and I'm ready to go back to my normal routine. Except that I'm still technically pregnant.  The physical symptoms I was experiencing indicated a miscarriage, but blood tests showed rising levels of hCG, a hormone produced during pregnancy.  My OB suspects I have an ectopic pregnancy, which means the fertilized egg implanted in my fallopian tube instead of my uterus, and thus can't survive.  I haven't decided which is worse, knowing the reason for the miscarriage or knowing that there was likely nothing wrong with what could have grown to become our baby other than that the cluster of cells missed landing in the right spot. 

An ectopic pregnancy is serious, but luckily hasn't reached the level of emergency yet and there's a chance my body will sort everything out on its own.  If not, after my next ultrasound and a blood draw to test my hCG level, my OB hopes to be able to treat me with methotrexate instead of surgery.  With either scenario, I'll have multiple OB visits over the next couple of weeks to make sure the treatment worked.  I didn't realize this process could drag on for so long. 

This experience is helping me feel more at peace with our decision to pursue adoption.  It can take longer to conceive after an ectopic pregnancy and I'm more likely to have another one, so I'm relieved not to add that to the long list of all the things I worry about.  Instead of feeling frustrated at the prospect of starting over, adoption gives me something to look forward to.