U of M, Here We Come!

The results of today's ultrasound where at the same time both expected and surprising. It looks like we are going to transfer to the U of M. We weren't going to make the official call until next week, but a couple of things are making it clear that that is where we need to deliver. That is the short story; now here is the long story with some details that I've probably explained before, but for clarity's sake, I'll reiterate:

The CVR (the increment that is used to measure the mass) is still holding steady, which is what we have come to expect. The length of time that the mass has remained a consistent size indicates that it is mostly bronchopulmonary sequestration (BPS). If the majority of it was CCAM, the doctors would have expected it to continue shrinking. Also on this week's ultrasound, they were able to get a good look at what they call a "feeder vessel." They've seen what they suspected was the feeder vessel before, but haven't confirmed that that is what it is until now. What that means is this: a BPS has a dedicated vessel that feeds it; a CCAM does not. So seeing this vessel is further confirmation that the baby does indeed have a BPS and it's not going to shrink any more. This means that we will deliver at the U of M.


Our doctor also told us that based on the size that the BPS is now and will likely be at birth that we should mentally prepare ourselves for Baby to have surgery sooner (within a few days of birth) rather than later. She said it is likely that he will need help breathing, but how much help is (and probably will remain) a big mystery. I guess that's not new news, but I think I'm just wrapping my mind around the idea that this is really going to happen.

Another thing that we were not expecting today was the news that we are going to go ahead with an MRI in utero. I'm not sure about this; the surgeon said he didn't think that would be helpful. But the doctor thinks it will be for various reasons, so we have it set up for two weeks from today.

We've actually been wanting to just make a decision to switch to the U of M for a while now. Regardless of the size of the BPS at birth, the U of M just seems like the safer choice and we've been tempted to make the call even before the doctors did, just so that we'd have the decision out of the way. But we also didn't want to be paranoid and impatient. So we've been waiting for this decision. Even though it's what we expected and it's a relief to finally know, I find myself processing it as if it were a surprise.

I'm also processing the idea that Baby will likely have surgery early in life. This is starting to feel more real.

I don't know if I've talked about it before, but another concern of mine is that Baby might come early and fast. Carter was nine days early and his delivery was normal. Logan came sixteen days early after a 2.5-hour labor. With a record like that, I'm afraid of going into labor early and fast and ending up not making it to the hospital. I know that a fast labor for #2 doesn't necessarily mean fast labor for #3, but I'm worried about it anyway.

So, prayer requests this week: Continue to pray that Baby stays healthy and the doctors will know what needs to be done and when. Pray that as we near the end of this pregnancy that I will not be anxious about getting to the hospital. (And while you're at it, pray that we do get to the hospital in plenty of time!)

30 Weeks

We've made it to thirty weeks! I feel that's significant, even though it's not. There's just something about being out of the twenties and into the thirties that makes me feel like we are on the home stretch. My mom helped me to rearrange car seats (not to mention cleaning out a pretty messy car) and three car seats DO fit! We don't have to buy a new car...at least for now. I also found a cute cradle on Craig's List and picked it up today, so now we have a place for Baby to sleep. We are making some exciting progress on the kitchen this week, too, and an end seems to be in sight. Not only that, but The Great Name Debate seems to be winding down to a conclusion. I'm starting to feel ready for this kid.

Again, our ultrasound this week showed very little change. The CVR is just above .9. This is further evidence that the mass is a BPS/CCAM hybrid. BPSs don't shrink away as much as CCAMs tend to do. I don't know why I'm obsessed with knowing what exactly the mass is since treatment is the same for both, but I tend to latch on to any little bit of information that we get that indicates one way or the other.

The heart is more in the center now than to the right and the doctor says it's looking less compressed. We can also see the baby "practice breathing," which is good, but it doesn't tell us much. While amniotic fluid is getting in and out the lungs, that doesn't really tell us how well air will get in and out when the time comes. Our doctor is still waiting to make a decision about where we'll deliver--if we continue to see the numbers stay the same in the next couple weeks, we'll be transferred to the U of M.

Also, this week I was able to get connected to anther mom who had a CCAM baby (who is now in elementary school). I'm excited to be able to ask questions and hear about someone else's experience.

Week 29 Ultrasound and Broomball Report

It looks like things are holding steady for another week. There is no major change in the numbers, but we can see that the heart is closer to where it should be than when we began.

Jeff was unable to attend this ultrasound (first one he's missed) due to a very important broomball game. Since we have come to expect nothing earth-shattering to be revealed by the ultrasounds at this stage, I gave him my blessing and wished him luck. That, however, did not stop me from allowing everyone I saw that day to laugh a bit at his priorities. :) For the last two weeks, Jeff's been involved in a company-wide broomball tournament. His team had made it down to the final four. Unfortunately, they lost in overtime, but they had a lot of fun.

After four appointments this week we now know...

that we have to wait and see.

Grrrrr. I don't like that phrase. It's a good thing, really; it's just becoming hard to live with week after week. Deciding on one course of action or another at this point would means that things aren't going well. But things are going well--the CVR, depending on how they measure it, has either dropped to .5 or stayed the same at .8. Maybe I've mentioned it before, but the mass is a tricky thing to measure; there are two different ways to do it; and it's not an exact science.

Besides our ultrasound, we have also done a consultation with the pediatric surgeon, a NICU consultation and tour, and a midwife visit with my one-hour glucose test. We didn't lean much, but a few things we did learn:
- Baby is up to 2 lb. 13 oz, which is in the 60th percentile, so he is growing well.
- The heart appears to be starting to shift back towards the left where it belongs.
- There is no magic number that determines where and how we deliver--it depends on the opinions of a variety of doctors. (This shouldn't come as a surprise to us by now, but we are both people that like to think of things in terms of numbers and facts.)
- We probably won't have to do an MRI in utero. Baby will probably have to do one on his own sometime after birth.
- The surgery to remove the Sequestration/CCAM will probably happen at around 3 months.
- Baby will likely spend some time in the NICU after birth even if he isn't having problems so they can observe him and make sure he's doing ok. The amount of time could vary from a few hours if he's fine to several days if he's having trouble.
- It's sounding more and more likely that we will not have to do a C-section.

That's all for this week's appointments. Next week we get to go back to doing just one--the ultrasound is scheduled for Wednesday. Until then...

Echocardiogram

Today, the baby had an echocardiogram (a fancy word  for an ultrasound that focuses on the heart). This was our first trek to the U of M hospital, which is where we'll deliver if there is a chance Baby will need surgery right away. The results were pretty much what we expected. They confirmed that the heart is being stressed by the mass, but not beyond what it can handle. It's functioning well right now. Baby will have to have another echocardiogram within 24 hours after birth, but that is about the only conclusion that came out of our appointment.

Jeff's aunt, Carol, came over to watch the boys, so Carter and Logan got to stay home while we did our appointment. It turned out to be a really good thing because Logan came down with another fever last night and has had a rough day. This is the third time in three or four weeks, I think. Even though his fevers get a bit high, I think it's teething. Teething is really rough for this kid and a new tooth seems to appear shortly after every episode. So it was great that the boys could stay home and Logan could nap in his own bed. Carol even brought supper for us, which was a wonderful blessing for a mom with a clingy, sick toddler and no kitchen. (Have I mentioned that our kitchen is being remodeled?) So we had tasty taco soup for supper.

Another encouraging thing today was that our contractor started installing kitchen cabinets. It's so fun to see the space starting to take shape.

So it's been a long day, but good in many ways. Still...I can't wait to be in bed!

Holding Steady

This week's ultrasound showed that the CVR is at .8. The doctor told us that the difference between last week and this week is so minor that it could be accounted for simply by the fact the CCAM is hard to measure and there is bound to be a little variation. Not only that, but just when we thought Baby couldn't be more uncooperative for his ultrasounds, he proved us wrong. He was in a head-up, face-towards-my-back position today, which didn't allow the ultrasound tech to get a good angle for getting measurements. This trend of uncooperativeness during ultrasounds does not bode well for the future. :)

So for now, things are holding steady.

We also confirmed what we suspected last week--going from a CVR of 1.4 to .7 did not mean that the mass had shrunk to half it's size. It's still a very good thing, but the numbers just aren't that simple.

The doctor thinks that in the next month we should be able to get a much better idea of where we'll deliver Baby. We'll need to see more shrinkage to be able to deliver with my midwife as originally planned, but that is very possible. So we just keep waiting, watching and praying.

An Answered Prayer

I didn't realize it until I was talking with my small group at ladies' Bible study the other night, but God is already answering one of my prayers for this process. I was telling everyone that the boys are doing great and everything at home is very normal. It almost feels too normal, in fact. Shouldn't we be doing something more than running to the grocery store, cleaning up after lunch, and deciding who has first dibs on the one toy they both want to play with?

But that normalcy is what we need right now. I am very concerned that Carter and Logan don't bear the brunt of the stress we feel over Baby's condition. And so far we haven't been stressed too much. We've been able to be very much at peace with what we're dealing with and what's in store. And that's a blessing.

There will come times when we are stressed. We'll be dealing with insurance questions. Baby will come home and need all the attention that babies need--and possibly more. When these times come, I'll renew my request that you pray for our other boys and that we manage to stay patient and give them the attention that they need.

But for now, God has given us a calm before the storm. A storm which could be very mild or severe. Sometimes it's hard to wait for the storm (that's another post for another time), but I will do my best to recognize this calm as the blessing that it is and to focus on the two boys that are clamoring for my attention as I blog. :)