The final countdown

Another long gap between posts, which I can only explain by saying that there hasn't been much to report! That is a good thing. I am now in my 37th week and feeling pretty good. Here's a rundown on the latest:

• J and I got away this weekend to the Eastern Shore of Maryland for one last kid-free weekend away, which was a lot of fun, very relaxing, and definitely needed. We stayed in a really cute B & B in Easton, did a lot of walking around the cute towns out there, had some good food, and just generally enjoyed each other's company.
• Friday was my last day in the office, and as of today I am working at home until the baby comes. It is a huge relief not to have to commute an hour each way into the office each day, and I can't even begin to describe my relief at not having to sit in an office chair. It was really doing a number on my back. The couch is much, much more comfortable!
• This morning we had an appointment with a pediatric urologist at Children's National Medical Center downtown. This has been on the calendar for about three weeks, and we were referred there because the baby's kidneys are enlarged (a condition called hydronephrosis). Basically, the inside area of her kidneys is enlarged, indicating that either fluid is not draining properly from the kidneys to the bladder, or there is a reflux problem causing the fluid to back up into the kidneys from the bladder. We liked the doctor we saw and felt good about his plan for her care after she is born. Basically, they will put her on preventive antibiotics as soon as she is born, since there is a risk of infection once she starts eating. Then, when she is three weeks old, we will take her back to CNMC for an ultrasound of her kidneys and another test where they'll use a catheter and an x-ray with contrast to get a good look at how fluid is moving around down there. We're not crazy about the idea of our baby having a procedure like that, but we know they know what they're doing and trust them to take good care of her. Best case scenario, she will grow out of all of this within the first few years of life, and they'll just have to monitor it regularly until that happens.
• Now that I've passed the 36 week mark, I am having twice weekly non-stress tests, to make sure that everything is still going as it should. Today was the first one. Basically, I go to the L & D unit at the hospital and get hooked up to two monitors: one that records the baby's heart rate, and another that records the frequency and intensity of contractions (yep, I'm having regular contractions!). They hook me up and I lay there and relax for 20-30 minutes, and then they call my OB and let him know the results, and he says either I can stay pregnant for another half a week, or they should check me in and baby's on her way. Today, the baby's heart rate was "normal and reactive," which means I can stay pregnant until Thursday, when they'll check it all again. It was actually kind of cool to lay there and listen to her heartbeat, and to be able to see on the monitors that the contractions are actually happening.
• My mom will be here in 12 days! She's coming two weeks before the due date, so it's all starting to feel really real and close. We can hardly wait to hold our baby girl!

That's it for now. Thanks for your continued support, and we'll keep you posted!

April Update

Wow, it has been a LONG time since I posted! Just another thing that has gotten a bit lost in the craziness that is our lives right now. Lots to report so I'll catch you up in bullets:

• In mid-February (at 16 weeks) we found out that baby Howie is actually a Howette -- we are having a little girl! I was completely convinced that we were having a boy, so the news came as quite a surprise for me, but we are thrilled. It was great fun sharing the news with friends and family, and starting to think about decorating the baby's room in a girly theme (we decided on coral and grey... more on that later).
• On March 5th we celebrated our two-year wedding anniversary! Since it was a Tuesday we had to play it pretty low-key, but we went out for a nice dinner and bought ourselves a shiny new car! Yep, we got rid of my 11-year-old Honda and bought a baby-friendly small SUV. We're loving it so far.
• Doctor's appointments have continued to go fairly well. I'm still getting an ultrasound every four weeks to keep a close eye on baby's growth and development, since I have the MTHFR mutation AND the immune issues to potentially mess things up. But so far, nothing major has come up. The perinatologist has been a bit concerned about her kidneys, which are dilated more than they're supposed to be (can indicate that the urinary system isn't functioning optimally), so we're watching that closely. If her kidneys don't measure in the normal range by our next appointment (4/30), then we'll have to be referred to a pediatric urologist -- doesn't that sound like fun?! Also, she's measuring a little bit on the big side (in the 76th percentile, and they like them to be between the 25th and 75th), so I'm on a strict diet (really no different from what I was doing before, basically just stay away from bread and refined sugar) and prescribed daily exercise. Having fears of a giant baby in July...
• The baby's room is finished being painted and has curtains! No furniture yet, we ordered the crib several weeks ago so it should be in any time. We also have a dresser that we just need to put together. Here is a little sneak peek of one corner of the room, with the feature stencil wall, and the curtains that match the coral in the stencil:

• This past weekend, we took a quick "babymoon" trip to southern California. We flew to San Diego, then drove up to LA to visit J's aunt E and uncle J and see his grandmother, T. J's dad also drove out from Prescott for the weekend. We enjoyed getting to see all those lovely Dubins, even if it was for just one night. Then we drove back down to San Diego and spent three days on Coronado Island. It was soooo wonderful to just relax, sleep in, not be on a schedule, etc. I could use more time like that! We enjoyed some great food, did LOTS of walking, had a close encounter with a silverback gorilla at the San Diego zoo, and got a ton of extra sleep. It was hard to come home! Here are a couple of fun photos from the trip...

Here I am, 26 weeks pregnant exactly, at Seaport Village in San Diego.

On a "Seal Tour" (like a Duck Tour) in the San Diego Bay

• We started our childbirth education class at the hospital where we'll be delivering. So far it's been pretty informative. We are lucky that our doula, Kaitlyn, is actually teaching the class. Last night was class #2 and we learned all about the process of natural birth... in GREAT detail. Nothing I didn't know on some level, but it's kind of overwhelming to hear it all at once like that and know that it's really going to happen to you in just three short months.
• Next up: J's mom is visiting us this weekend, then next weekend we'll be up in NYC to visit the Wards. Sunday marks the beginning of the third trimester -- can't believe it!

Second Trimester!

Today feels like a HUGE milestone... as of today, I am in my second trimester! Obviously, I've never gotten anywhere close to this far along before, and even for normal pregnancies, the end of the first trimester marks the end of the period in which miscarriage is a significant threat. Dr. Braverman has told us many times that immune-related loss can happen anywhere up to 12 weeks, so the fact that we've made it to 12 weeks means we're officially out of the woods! It feels so, so good to be here and to be able to relax a little bit about whether or not Howie is going to stick around.

Lots is happening this week. First, we are having our first trimester screening test on Tuesday. This is a non-invasive test that can be done anywhere from 11 to 13 weeks. It combines a maternal blood test and ultrasound to screen for chromosomal abnormalities. We should have the results from that in about a week.

Second, we are waiting on what should be our last immune blood panel from Dr. Braverman. The blood was drawn the day after Christmas, but with the New Year's holiday in there, the results are taking a bit longer than usual. Depending on how things look, I may or may not have to have another IVIG treatment.

Finally, because my regular ob/gyn doesn't deliver anymore, she refers pregnant patients after they finish their first trimesters. So, on Friday I will have my last appointment with her before I head off to my new doctor. I am really sad to leave Dr. K, but am feeling pretty good about the new guy, Dr. A. He has a special interest in high-risk pregnancies and is willing to collaborate with Dr. Braverman, which of course was one of my main requirements in a new doc. He also delivers at the Inova Loudoun Birthing Inn, which is supposed to be a super awesome place to deliver. So, fingers crossed that we continue to like him. I have my "New OB" appointment with him on Friday.

That's about it for now. We are looking forward to a 2nd Trimester celebratory dinner on Tuesday at Fogo de Chao (AMAZING Brazilian steakhouse in DC... if I'm gonna eat meat, I'm gonna eat GOOD meat!) and getting back into the groove of home and work after two weeks of visitors and travel. Thanks, as always, for your continued support!

Still hanging in!

It has been a while since my last update -- almost a month! Things are moving along nicely, I'm definitely still pregnant and we've gotten to peek at Howie two more times since my last post. Here are the details...

When we were in NY on 11/26, I had another immune blood panel drawn, and we got the results on 12/6. Unfortunately, there were a couple things that looked not-so-good, and -- long story short -- I had to have an IVIG (intravenous immunoglobulin) treatment on December 7th and 8th. The IVIG is a blood product, it's sort of a step up from the intralipid infusions in terms of its ability to calm down my overactive immune system. It wasn't too bad, just a lot of laying around because they have to pump it in really slowly. Also, before the treatment you have to take a bunch of Benadryl to prevent an allergic reaction, so it was just kind of a groggy two days for me. We'll do another immune panel on 12/26, and Dr. Braverman will determine after that whether I'll have to do another IVIG or not.

After our 11/26 appointment with Dr. Braverman, he recommended weekly ultrasounds just to make sure things were still OK. I talked it over with Dr. Kaler and we decided maybe just every 10 days or so would be enough. So I had my second sonogram on Thursday 12/6 at a high-risk maternal-fetal medicine clinic here in DC. They do a good job and have very high-tech machines, so I got a great view of Howie that day (they have a big TV hanging on the wall over the exam table so the mommy gets a good view!). That day, I was 7 weeks 4 days pregnant, and baby measured 7 weeks 5 days, was 1.47 cm long and had a heart rate of 167 beats per minute (50 beats faster than just 10 days before!). They said everything looked good, and we got this shot:

You can just begin to see the little arms and legs sticking out... I think this is looking at him from behind.

 Next up was our third -- and final! -- trip to New York to see Dr. Braverman. We were there this past Monday 12/17, and he was really pleased with everything he saw. He said that all of the blood flow looks great, Howie is developing nicely and looks healthy. Howie measured two days ahead, was 2.62cm long and had a heart rate of 178 beats per minute. Here's the pic from that day:

Howie is curled up with his head on the right and his legs on the left. It was very cool in person to see him wiggling around in there -- very reassuring. And the sound of his heartbeat -- seriously the greatest thing I have ever heard in my life.

A couple things that we did not expect also came out of that meeting with Dr. Braverman. First, he said that once I finish my first trimester, I will NOT be considered "average risk" but will still be high-risk. That was a big disappointment because we were planning on doing midwife care and a low-intervention birthing-center delivery, which Dr. Braverman said was "not happening." So, we've had to scramble a bit to figure out who our new doctor is going to be, as Dr. Kaler doesn't see patients past the first trimester (though I would LOVE to stick with her if I could). I found a doc who delivers at the birthing center who looks promising, and we are scheduled to meet with him on 12/26 for an interview. So, hopefully that will work out!

The other thing he said is that I have to stay on Prednisone and Lovenox, both of which I thought I'd be done with at the end of the first trimester. The Lovenox isn't a big deal except that it's unpleasant to give myself a shot every morning, but nothing I can't handle. Dr. Kaler told me that patients on Lovenox are usually induced at 38 weeks, which I definitely do NOT want. Then Dr. Braverman said that he'd switch me to Heparin at 36 weeks so I wouldn't have to be induced, but Dr. Kaler said that docs around here are hesitant to prescribe Heparin because of some other risks... so we shall see. The Prednisone is definitely a bigger deal, I don't feel very good on it and it has some unpleasant side effects. Of course, I will do what Dr. B says and am happy to do whatever is best for Howie.

One other interesting thing: We are planning to find out Howie's sex via sonogram when we can, but of course before then it's fun to guess and hear other people's guesses. There is a method of prediction called the Ramzi method, which suggests that there is a correlation between the baby's sex and which side the placenta is implanted on. They say if it's implanted on the left side, it's more likely to be a girl, and the right side, it's more likely to be a boy (you can read about the study here if you're interested). Well, according to Dr. Braverman, we're implanted on the left side, so -- GIRL. BUT, this morning I had an appointment with my acupuncturist and I asked her if she could tell the sex from my pulse (I had heard this could be done from my good friend L, whose acupuncturist correctly predicted the sex of her twin girls). She said yes, and explained that they get a sense of it from the strength of your pulse on your right wrist versus your left wrist -- left is boy, and right is girl. Well, guess what -- my pulse has been stronger on the left side for my last four appointments, so -- BOY. They can't both be right! I guess we'll just have to wait and see.

So, next up: meet with potential new doctor on 12/26, then we're off for vacation in California over New Years. We get back on 1/3 and then have our first trimester scan and NT screen on January 8th. Hopefully some even better pics of Howie at that point!

J and I wish you all a very happy holiday season and a joyous new year! We are grateful, as always, for your love and support.

This is Howie Dubin

Today was a fabulous day! We had our six-week appointment with Dr. Braverman and our first ultrasound. We were (and especially I was) pretty nervous going in, as our previous ultrasound experiences have not been so good and we were just so hopeful that we would see/hear a heartbeat. Sure enough, it took the ultrasound technician about 7 seconds to find our little bean and she immediately saw the tiny little heart beating. We were even able to hear it, beating at 117 beats per minute, exactly where it should be at this stage of the game. Here is Howie's first picture:

They are pretty specific about all of the measurements, and our little guy was 5.8mm long. They even gave us an updated due date of July 19, 2013 -- two days earlier than we thought. All blood flow looked good, which is a sign that the immune issues that have troubled us in the past are not having the same negative effect they've had in my previous pregnancies (the immune cells function by inhibiting proper development of the placenta, basically choking off its blood supply -- but my blood supply looked really good). We are not quite out of the woods yet, but things are looking as good as they can for where we're at right now.

Dr. Braverman wants to see us again in three weeks, so we'll head back up to Long Island on December 17th. That will probably be the last time that we see him, and soon after that I'll be released from his care on sent on my merry way to be a regular pregnant lady. In the meantime, I'll have another ultrasound here in DC in about 10 days, just to keep an eye on things.

I am feeling nauseous and SO happy to feel that way! Every pregnancy symptom feels like a little victory.

Thank you for your continued support and prayers!

Good and Pregnant

Yes, this post is about what you think it's about. I'm pregnant! We found out on Tuesday and so far things look really, really good. I went to my doctor's office on Monday to get my progesterone checked, and my doctor snuck in a pregnancy test without telling me. By the time she called me on Tuesday to tell me that my progesterone was high (yay!) and that my beta test was positive (YAY!), I had already gotten a positive home pregnancy test that morning. So it was an exciting week! I went back for a repeat blood test Wednesday morning, and my beta had gone from 10 on Monday to 62 on Wednesday. They look for a doubling time of 24-48 hours, and my doubling time was just 17.1, which is a very good sign. My progesterone was also up even higher. Both doctors are very optimistic and we're feeling great about it so far. I am convinced that the acupuncture is a huge key for me! I am also still doing the daily Lovenox injections and had my second intralipid infusion on Thursday.

Just so you have photographic evidence, here is a great looking test from today:

A very clear positive! So, if all goes well, we should welcome our little bundle in July of 2013. I'll see Dr. Braverman for a six-week check-up appointment on Monday 11/26, and then for a ten-week check right around Christmas. All prayers, good thoughts, crossed body parts, etc. are welcome, and we'll keep you posted!

Quick update

Hi all,

Here it is the day before Halloween -- can't believe how quickly October has flown by and that it's almost November! We are enjoying the cooler weather, beautiful changing leaves, and the fireplaces in our new home. We enjoyed a great weekend away in Boston this past weekend -- J's first time there -- and were lucky enough to make it back home before Sandy struck despite what I hear were over 7,000 canceled flights nationwide (and MANY flights out of Boston were canceled -- not sure how we lucked out!). We fared well in the storm, only losing power for about 40 seconds on Monday night and, sadly, a beautiful blue spruce in our backyard. All in all, not too bad.

I've been pretty silent on all of the fertility stuff for the last couple weeks because nothing much has been happening. We are back in the dreaded "two week wait" part of the cycle, which means that I've ovulated for this cycle and now we're just waiting for time to pass before I can take a pregnancy test and find out whether or not we were successful this time around. Lovenox shots started again on Saturday, so today was my fourth. So far, no bruises! A couple of things we're doing differently this time:

• I've started back to acupuncture at Dr. Braverman's recommendation. I was doing acupuncture regularly through the summer and actually think it might be pretty powerful in terms of helping us conceive -- during the months I was doing it regularly, I got pregnant in back-to-back cycles, even cycles where we really didn't think it would happen. Both times we're NOT gotten pregnant have been cycles where I wasn't doing acupuncture. So, back to the needles I go. I actually really like it and find it pretty relaxing. I have a great acupuncturist who specializes in fertility issues and I feel really confident that she knows what she's doing and is helping me.
• Since I did an intralipid infusion right after ovulation last cycle, I don't have to do it this cycle unless I get pregnant. So, while I thought I'd be on the couch with an IV one day this week, I get a reprieve. If I do get pregnant, then we'll need to do one right away, so hopefully I'll be back on that IV late next week or early the week after.

J is still taking all of his antioxidant supplements and I'm on my restricted diet, it's been a little over a month now. To be honest, it's pretty difficult -- especially when traveling -- but I'm making it work. Have found some tasty alternatives to many staple foods, and cravings for bread are getting less intense (I'm not gonna lie, I REALLY wanted to eat pasta when we were in the North End in Boston... sigh). We're hanging in! Thanks, as always, for your positive thoughts and prayers -- we really appreciate them all!!