Tuesday, February 26, 2013

A More Comfortable Ignorance

For a while I've been wanting to post the 3D ultrasound pictures of our little girl, but after our meeting at Seattle Children's I am not sure the pictures show an accurate picture of what our little girl has.  Maybe I'll change my mind later, but for right now you all get to be completely unaware as the husband and I.

First of all, let me express how wonderful Seattle Children's hospital is.  And I am not just giving high praise because we didn't have to wait in the lobby for more than three minutes. Nor did we have to pay for parking.  Everything about the experience gave us more peace--despite the fact that there are still so many unknowns about our daughter' condition.

Our appointment was with one of the cranio-facial surgeons at the hospital.  She was upbeat, positive, yet deeply concerned about our worries.  We told her about the information we had received, and we showed her the 3D images we had.  She reciprocated by showing us the images taken at the MRI.  All we had from the MRI was the radiologist's prognosis that the bump was an encephalocele, and the root of our biggest concerns.  As if looking down on her head, the surgeon showed us her brain in layers.  The varying layers confirmed what I stated in the last blog: that babygirl's brain appears to be intact with all the important parts where they should be.  This is important, because it shows that nothing important is being pushed into the mass on her nose.  If there is any sort of brain matter in there, it wouldn't be anything essential.

Additionally, the MRI pointed out that the mass was not protruding from the center of her nose; it is actually forming on the right side of her nose.  The 3D ultrasound images are confusing in that respect, because they make it seem that the bump is directly on top of her nose.  Most face-formed encephaloceles are directly in the middle of the face/nose area--like what we see in the 3D images.  The MRI is a little bit more accurate, and the bump is definitely coming from the side.  Fortunately, it doesn't seem to have affected her eye position, and hopefully her vision will not be drastically impaired because of it.  

So, we almost have a new prognosis.  I say "almost" because nothing can be confirmed until this little baby makes her appearance.  But we do know that we need not settle on the encephalocele diagnosis.  The surgeon stated that it could still be a number of things, and that--once again--we won't really know anything until she is born.  This means I may have to come up with a new blog...

I know that my husband and I would like to know officially what we are dealing with.  It is easier to plan things when one knows what to do.  Fortunately, the surgeons in the cranio-facial department at Seattle Children's do have a plan.  The doctor we spoke to is not the only one who knows about our daughter's condition.  The other cranio-facial surgeon, plastic surgeons, neurologists, and ENT surgeons ALL know about her case and have a plan.   The first issue will be her breathing.  If she can't breathe then the ENT will be first on the scene.  If she can breathe fine, then the plastic surgeons will take the lead followed by the cranio-facial, and then neurologists...  Anyway, needless to say, we have a large handful of very capable individuals prepared to help us.

There is something very comforting knowing that so many doctors know our baby and are already making plans for her before she even comes out.  It has brought so much peace to our minds.  Add to that the "knowledge" that her condition may not be as bad as we had been previously told.  While we may not have been overjoyed to the point of doing cartwheels, neither my husband nor I shed any tears of grief during our appointment.  We even felt comfortable enough to walk around the hospital for a bit afterwards.

And we are both able to once again feel the joy that comes with anticipating our own baby, but also the babies so many friend's and relatives are expecting.  Slowly but surely, we are healing.

Friday, February 22, 2013

Passing the Time

On Wednesday, my husband and I actually walked away from a doctor's appointment without a zombie-like demeanor or tears running down our faces.  This is not to say that no tears were shed on my behalf during our appointments.  The minute our ultrasound began I was wiping away tears even though it was a basic-making-sure-all-the-vitals-are-working type of ultrasound.  Maybe I'm a little shell shocked.  We did get a good look at her cute little foot though...

I next cried at our appointment with a social worker.  The social worker acts as a nice liaison between us and the myriad of doctors/specialists that we get to talk to. She also acts as a counselor, making sure that we are coping okay.  Although I feel that on the whole I am doing well, I did break down a little when asking about the NICU. One of my bigger worries is that our little baby won't be able to breathe, and that she will  get whisked away before I have a chance to see her.  The social worker assured me that the nurses will do everything they can to make sure I can see her and have her lie on my chest while I am getting all stitched up.  And when I am all done I will be wheeled directly to the NICU.  That was reassuring.  Next week we will actually get a tour of the NICU.  Besides the social worker, I am glad to know I have friends who have gone through the NICU experience, and a friend who works as a nurse in the NICU.  You will all be hearing the rest of my questions shortly. 

Today is another important doctor day for us as we will be meeting with the cranio-facial surgeon at Seattle Children's this afternoon.  We are really looking forward to meeting the doctor and getting more information about our little girl's prognosis and future.  I will be bringing tissues--not just because I am expecting the worse, but because just reading about the hospital on its own website caused a minor breakdown.  I would like to blame it all on pregnancy hormones, which may play a minor part, but the rest of the blame goes to uncertainty and worry.

Really, I don't cry all that often. Most days I pass the time tidying, looking at pinterest, eating sweets, and playing classical music for babygirl.  She really seems to respond well to Chopin.  Today we are trying out Dvorak, and she is moving around a lot to that too. 

And just a little FYI, you may start seeing Google Ads show up on the blog.  I don't really want to profit off of my daughter's misfortune's, but somehow we have to pay for all of the hospital parking fees.

Saturday, February 16, 2013

To Know or What Not to Know. That is the question

During these past few weeks, my husband and I discovered that we deal with mourning in two entirely different ways.  I tend to recover quickly by grasping on to the little things I do know, and then telling myself that everything else will be okay.  This helps me move on, but as I've discovered during this process is that it hasn't fully prepared me for more bad news.  My husband takes longer to feel at peace because he tends to focus more about things we do not know...the things that could be a lot worse than our doctors are/aren't telling us, and he worries and feels depressed about the unknowns. This is not to say that I don't feel sad or worried about things we don't know.  I tend to worry about when we can take her home or if we will be able to hold her after she is born.  He worries if she will be a vegetable (for lack of a more sensitive term that I'm sure exists, but I can't quite think of it.) However, because he has thought about all sort of terrible scenarios, he is much better at asking the doctors questions.  I can usually wait until the next appointment for news (and hang out in my happy optimistic place), but my husband will call up our doctors for answers he needs.

We were instructed not to turn to the internet for information about the Encephalocele.  I would recommend that advice to anyone diagnosed with any foreign ailment.  Instead of just doing a broad Google or Bing search, we were advised to go straight to the children's hospital websites for the most accurate information.  This is not something we did right away.  I was way to scared to leave my happy place and learn anything more horrible than the news we had just received.  But eventually we looked up those sites because my husband was having a tough time dealing with the lack of knowledge we had.  I'll put some links to the side so you can read up on our daughter's diagnosis.

So now here are some things we know, and also the things we won't know until she is born.

We know that we will have ultrasounds every two weeks until she is born.  Pretty soon we will know the date as the doctors want to due a planned C-section to make sure her nose does not get ruptured in the birth canal. We don't know if she will be able to breathe through her nose.  And if she can't do that, then she can't eat...this is leading to her spending her first days on earth in the NICU.

We do know that an encephalocele happens in one out of every 10,000 births, so it's not very common. They normally  happen if the parents have a family history of spina bifida or anencephaly--which we don't. As I mentioned in the previous post, I had an amniocentesis to determine if the encephalocele was chromosomal and if she had any other syndromes attached to this defect.  We finally have all of the results back, and we can very happily say that her defect is not chromosomal nor does she have any other syndrome.  This boosts her chance for a successful recovery, and it means we won't likely pass it on to her future siblings.  This is just a random defect. 

An encephalocele can either happen on the back of the head or in the sinus area, like the one our babygirl has.  The good news is that usually the ones around the nose have a higher chance of survival and successful recovery after surgery.  Babies born  with fluid-filled encephaloceles have less developmental issues than those whose tumors are filled with actual brain matter.  What we do not know is what our babygirl has.  We won't find out until our consult with the neurologist, or until she is born.

Our OB recently reminded us that previous ultrasounds have shown that her brain is symmetrical, so that leads him to think that the encephalocele is just fluid.  You can't imagine the world of good that reminder did for our spirits. My husband and I have felt so much lighter and calmer after hearing that.  I have tucked that news into my happy place.      

The doctor also put her nose defect into a better perspective for us as well.  If it hadn't been for her nose, we would have never have had an echocardiogram, and we would not know about her heart defect. 

We do know that we are surrounded by loving family and friends, and a supportive medical team.  It helps us to know that we do have people out there rooting for us and our babygirl.  I know she feels it too.  She has been so active lately, it makes me a very happy mama.

Tuesday, February 12, 2013

Opening the Door to a New Reality

The MRI was probably the most enjoyable test.  Mostly because I was so drugged up that I slept through most of it--waking only when I had to hold my breath.  Plus my dreams were all sci-fi--probably due the spacey nature of the tube.  Waiting for results were not as fun. At least with an ultrasound, I got to see images as they were being made.

A week after our follow up ultrasound, my husband and I headed to Seattle for a marathon day of appointments, tests, and MRI results.  At 10:30 we started with the echocardiogram--an ultrasound specifically for the heart.  I wasn't quite sure why we needed it.  Nothing abnormal with her heart showed up on past ultrasounds, so I only prepared myself for a routine echo to rule out bigger problems.  After all, I still held on to the fact that her nose defect would be an easy fix.  After looking at her heart at all angles, the cardiologist came in to show us the defect in my baby girl's heart. She has a hole in her heart that is technically referred to as a Subaortic Ventricular Septal Defect (or Double Outlet Right Ventricle).  This means that when her heart pumps, oxygen-rich blood mingles with oxygen-poor blood before the poor blood travels to the lungs.  This defect will cause her to tire out easily especially while feeding, rapid breathing, and could delay her growth.  Fortunately, it is one of the easiest defects to fix, and can be done at six months with one operation.

That last tidbit of info didn't sweeten the news that my baby has another defect.  Isn't one enough?  I wasn't prepared to hear the news.  I had no tissues, and spent most of the explanation time wiping my eyes and nose, and trying to stifle sobs.  Thanks to the nice drawings the cardiologist made I wouldn't be able to tell you a thing about it.

In stunned silence my husband and I ate our lunch.  It was a quick lunch before our 1:00 appointment, and I think we benefitted by not having time to talk.  There wasn't much to be said that wouldn't result in tears.

Our next appointment was the one that was supposed to tell me that our child's nose would be an easy fix.  One quick surgery after birth, and she would have a normal, healthy life.  And after the recent-shock I needed to hear it.  And perhaps our OB felt the same way, but instead with much gravity he explained the results of the MRI.

He began by explaining that his first opinion was that we had a simple defect.  But the MRI showed that the bump was actually made of neural matter.  And he gave us a fancy name that I could not remember or pronounce when we left the hospital.  He obviously thought that my husband and I were medical students because he threw a lot of terminology and explanations about chromosomes and syndromes that I could not repeat to you if I tried.  In more layman's terms he explained that the defect--encephalocele--was like spina bifida, where the body doesn't close around the spinal cord.  An encephalocele is found on the head where the skull doesn't close around the brain.  They can happen at the base of the head, or in the sinus area--which is where our baby's defect is.

What does that mean?  This is a very important question to ask when getting crazy medical information.   It is a question we will be asking for a long time even after our baby is born.  That day our doctor gave us two meanings depending on the chromosomal nature of the defect.  Depending on any existing chromosomal anomaly our baby could either die soon after birth or will need extensive surgeries.  After hearing about all she would need, I wasn't quite sure what the worst case scenario was.  Losing a baby sounded harsh, but subjecting her to a life of struggles and pain didn't seem all the great either.  Tears flowed easily and sobs were uncontrolled.  Everything sounded strange, new, and so foreign to the words I had programmed in my head to hear that day.

After the earth shattering news, I was prepped for an amniocentesis to find out if she would live, and to check for other possible syndromes.  This will all help in determining her care after birth.  After the news that day, I can honestly say that perhaps I was not mentally ready for the amnio.  For one who hates needles, this is the last thing I would ever volunteer to do.  In a way I did volunteer for it--all for the sake of valuable information.  If it wasn't for my fabulous husband, who encouraged and coached me through it, I probably would have demanded that the doctor stop.  For those of you who have never had the joy of an amnio, sticking in the needle isn't as bad as the pain when uterine muscle contract and pull on the needle.  In addition you have 24 hours of fearing that you could go into early labor because of it.  The doctor and nurse retrieved three vials of amniotic fluid, and when they left the room I let myself sob again.

The most relaxing part of the day was when a nurturing, grandmotherly nurse hooked me up to monitors for a Non-Stress Test.  I got to lie down and process my thoughts.  There were lots of tears from both me and my husband.  Lots of worry about the future.  But it was nice to lay down and see my daughter's healthy heartbeat (despite the defect) and her movements.  It was nice to relax, but that peaceful feeling quickly escaped as we shuffled to our car. After six hours at the hospital.

There were no good thoughts to be had.  We cried.  I felt pain every time my baby moved.  And I when I thought that I could lose her I lost all joy in her movements.  We have since learned the results of part of the amnio.  The good news is that she should live, and can have surgeries to fix her brain and nose.  However, we don't know if she has any other syndrome (we should find out in a week), and we do not know if this will happen to any of our future children.  Once again we have more information, but we still know nothing.

Let the mourning, coping, and understanding begin.


Getting off of the River of Denial

After what seemed like an eternity, I finally laid down for our second opinion ultrasound--full of hope that my husband and I were going to hear the words "I don't know what that other sonographer saw.  Your baby is fine."  Unfortunately, that was not the day's script.  The sonographer went straight to our baby's face, and said, "Oh, there it is. I see it."  Pretty simple words, and could really have been meant for anything.  But this time those words said that there is something wrong with the baby.  Due to our baby's placement, we were able to get 3D images of her face (something we couldn't get the first time), and see the bump on her nose.

And when I say bump, I mean it looks like someone put the tip of W.C. Field's nose on my baby's nose.  Maybe I'll post the pictures later.  I'd first like to edit out my name.  Bt on the images you would see a formed mouth and nostrils (ruling out a cleft palate or hairlip).  Her eyes are appropriately spaced, she has pinchable cheeks, and a pouty lower lip.  But you would also see the wide bridge of her nose that almost obscures her eyes, and you would be able to see the bump's rise.  It isn't a natural looking nose for an adult, let alone a sweet little baby. My thoughts went once again to Rudolph's parents, and I wanted to desperately keep people from staring and pointing.

After the ultrasound we met one of our new OB's.  He took a look at the images, and gave us an idea of what it could be.  He concluded that this bump was likely nothing more than a tumor that was either lymphatic or a cluster of blood vessels (as previously thought).  Harmless little defects that are easily taken care of and forgotten.  But to make sure, I was scheduled to have an MRI, Echocardiogram, and possible amniocentesis.

We felt heavy leaving the office.  We received more information, but at the same time lacked anything solid that we could focus on.  Just more worry and anxiety for upcoming tests and news.  We prayed a lot, and I felt comfort that things would be okay and that her nose would be an easy fix.  Those feelings relieved stress while waiting for our next appointments.  It is something I needed to not distress my sweet girl.  My husband struggled a little more, and looked up anything he could think of to get more information.  He needs to have it, while I need to know less in order to focus on the positive things I know: her constant movements, her healthy size, and the fact that no matter what I love her.

  


The First Alarm

It seems almost forever ago that we had our second ultrasound and started on this weird new path.  Although the second ultrasound is typically slated at 20 weeks, for insurance purposes we waited until week 27.  Due to the MaterniT 21 test we knew our baby was healthy, and that we were going to have a bouncing baby girl.  She is a bouncy one.  I've been feeling her shift around since week 16.

After what appeared to be a routine ultrasound, the sonographer mentioned that sometimes the radiologist doctor likes to come in and make sure all the images were done correctly.  Even though that didn't happen the first time, my husband and I didn't bat an eye at the thought of someone coming in and telling us more about how perfect our little baby is.  So it was indeed a crazy surprise when we were informed that our baby has a bump on her nose, and that we would need to go to a specialist for a second opinion ultrasound.  He said that best case scenario it was just a cluster of blood cells that would go away after awhile, and have a nice day.  With that we were quickly ushered into the hallway and the cold world of reality.

Having not ever heard of babies with bumps on noses, I wasn't sure what to expect. A cluster of blood cells at first sounds horrible.  For some reason my thoughts turned to that scene in Rudolph the Red Nosed Reindeer when poor Rudy's parents panic and cover their offspring's nose.  Prior to this day I thought they were kind of mean parents.  But that day I understood.  They were only trying to protect their child from mean reindeer who wouldn't let Rudolph play any in any reindeer games.  I had visions of my sweet daughter running to me crying because someone wouldn't let her play because of a thing on her nose.  Of course that made me cry.

My husband did not take the news much better.  Mostly because we were told that blood clusters were the best case scenario.  If that's the best (and in my opinion the best option would be the news that the sonographer was wrong), what is the worst, and why aren't they telling us?  It was a long, long week between appointments, and during that time we poured over the images from the ultrasound, and had no idea what we were even looking at.  So I felt pretty sure that there was nothing wrong with my baby girl. And I held on to that hope until the second ultrasound.