Hi all. It's been a week since our last post because, well, there simply isn't much to report. And that's a good thing. Spencer's bladder was visible again last Thursday, and it showed up on Friday, Monday, and Tuesday, too. Encouraging!
On Sunday, we crossed the 27-week threshhold. If we can make it to 28 weeks (this Sunday), we'll have reached a very good place in terms of our kiddos' chances for life, health, and un-complication. Everything looks normal and stable as of the moment. Melissa will go in for a follow-up fetal EKG today; we're hoping to see that nothing has worsened in terms of Micah's ventricular thickening and reduced functionality. I'll write an update as soon as I hear one way or the other.
Thanks for your thoughts and prayers. They help!
Wednesday, February 28, 2007
Wednesday, February 21, 2007
Ultrasound images
Yesterday, Melissa underwent a more comprehensive ultrasound than we've had in the last couple of weeks. The main (only) order of business during her daily ultrasound experience is to analyze the twins' umbellical cord bloodflow using doppler scanning. During yesterday's exam, the doctor also checked the kiddos for growth. Here's what we learned:
MICAH
Micah is growing ahead of schedule vs. the expected growth curve for kids at his gestational age. True to Johnson form, he has a bigger-than-expected head (2 weeks ahead of schedule) and chest (about a week ahead) and average legs. On average, he's measuring out at 27 weeks (vs. his actual age of 26w 4d). He weighs in at a healthy (estimated) 2 lbs. 3 oz. This is an estimate, naturally, based on length measurements. He's probably a little heavier because his head is so large.
SPENCER
Spencer is a little behind the curve (measured age of 25w 1d), but if you exclude his femur measurement (short, like all us Johnsons at 24w 0d) and count only chest and head measurements, he's right on where he ought to be (26w 4d). Spence weighs 1 lb. 10 oz. or so (estimated).
The good news: they haven't grown apart as much as some pairs of TTTS twins do. They're anatomically normal, and their hearts are ticking away as they ought. Bloodflow through both cords looks good. The prognosis: keep on waiting! Every extra day from this point on is a tremendous blessing.
Here are some ultrasound pictures from a week ago: headshots of both boys. First Micah...
...and now Spencer...
MICAH
Micah is growing ahead of schedule vs. the expected growth curve for kids at his gestational age. True to Johnson form, he has a bigger-than-expected head (2 weeks ahead of schedule) and chest (about a week ahead) and average legs. On average, he's measuring out at 27 weeks (vs. his actual age of 26w 4d). He weighs in at a healthy (estimated) 2 lbs. 3 oz. This is an estimate, naturally, based on length measurements. He's probably a little heavier because his head is so large.
SPENCER
Spencer is a little behind the curve (measured age of 25w 1d), but if you exclude his femur measurement (short, like all us Johnsons at 24w 0d) and count only chest and head measurements, he's right on where he ought to be (26w 4d). Spence weighs 1 lb. 10 oz. or so (estimated).
The good news: they haven't grown apart as much as some pairs of TTTS twins do. They're anatomically normal, and their hearts are ticking away as they ought. Bloodflow through both cords looks good. The prognosis: keep on waiting! Every extra day from this point on is a tremendous blessing.
Here are some ultrasound pictures from a week ago: headshots of both boys. First Micah...
...and now Spencer...
Sunday, February 18, 2007
Quick Sunday update
Melissa's enjoying a long holiday weekend in the hospital. I switched places with her Mom, who's been watching the kids at our house, for a couple of days: I was fresh out of jokes Melissa hadn't heard and Mom just might have been ready for a brief break from her grandkids.
The on-call doc administered a cord doppler scan late this evening. Spencer's bladder is AWOL again, but we've gotten used to this particular disappearing act. We'll have another set of scans on Tuesday. Both kiddos cord-flow and heart-rates sound good tonight, so there's no real cause for worry.
The on-call doc administered a cord doppler scan late this evening. Spencer's bladder is AWOL again, but we've gotten used to this particular disappearing act. We'll have another set of scans on Tuesday. Both kiddos cord-flow and heart-rates sound good tonight, so there's no real cause for worry.
Sunday update
Just a few things of note have happened since our last post:
- On Friday, we visited Primary Children's Hospital via the enclosed walkway that connects it to the U of U Medical Center. Docs in their cardiology group conducted fetal echocardiograms on both twins, looking for heart problems. The short version: they didn't find any of which we weren't already aware. Micah's ventricle walls are still thicker than we'd like to see and his right ventricular function is somewhat diminished, but that's not terribly surprising considering the symptoms of TTTS that caused this to happen in the first place persist.
- Fetal EKGs are "scored" on a ten-point scale. One point is "awarded" for each worrisome feature or symptom that the doctor observes. Micah scored a "1" (the ventricular issue) and Spencer scored a "0." We'll take it!
- During Friday afternoon's cord doppler session, the doctor indicated that everything looks pretty stable. She mentioned, in fact, that she fully expects the kiddos to stay inside for at least another week. That's good news since every day inside (we've heard) counts for two in the NICU after birth. That's just a rule of thumb, but more time in is definitely better than less.
The game-plan at this point is to leave the kids inside until test results indicate that one or both would be better served to be outside. The test in question are cord doppler exams (measuring bloodflow through the twins' umbellical cords), Non-Stress Tests (NSTs) (which look for heart-rate increases following activity--a measure of the development of the kiddos' sympathetic systems), and every-four-hours ultrasound heartrate checks by Melissa's nurses.
More later...
- On Friday, we visited Primary Children's Hospital via the enclosed walkway that connects it to the U of U Medical Center. Docs in their cardiology group conducted fetal echocardiograms on both twins, looking for heart problems. The short version: they didn't find any of which we weren't already aware. Micah's ventricle walls are still thicker than we'd like to see and his right ventricular function is somewhat diminished, but that's not terribly surprising considering the symptoms of TTTS that caused this to happen in the first place persist.
- Fetal EKGs are "scored" on a ten-point scale. One point is "awarded" for each worrisome feature or symptom that the doctor observes. Micah scored a "1" (the ventricular issue) and Spencer scored a "0." We'll take it!
- During Friday afternoon's cord doppler session, the doctor indicated that everything looks pretty stable. She mentioned, in fact, that she fully expects the kiddos to stay inside for at least another week. That's good news since every day inside (we've heard) counts for two in the NICU after birth. That's just a rule of thumb, but more time in is definitely better than less.
The game-plan at this point is to leave the kids inside until test results indicate that one or both would be better served to be outside. The test in question are cord doppler exams (measuring bloodflow through the twins' umbellical cords), Non-Stress Tests (NSTs) (which look for heart-rate increases following activity--a measure of the development of the kiddos' sympathetic systems), and every-four-hours ultrasound heartrate checks by Melissa's nurses.
More later...
Thursday, February 15, 2007
Live from the hospital: Day 4
We learned a few things based on yesterday's (Wednesday's) round of tests. The ultrasound seemed to show some bleeding around Micah (the recipient). It's probably due to either his amniotic sac pulling away from the coreonic sac (the "big balloon" that holds his and Spencer's amniotic sacs) or the placenta beginning to ablate. Neither is a good thing where keeping the babies inside is concerned. On the other hand, Melissa's blood work seems to indicate that there's no significant or continued internal bleeding afoot, which is more encouraging. We spent the night over in Labor and Delivery again to enable constant heart-rate monitoring of the twins by ultrasound; they were persnickity about staying on the monitor, but when they were on, they looked good. Early this morning (5-ish), we moved back to our room in 2 East (the antepartum inpatient floor).
During our latest L&D stay, we were officially educated on the risks / implications of Cesarean section delivery. This was a "just-in-case" measure, for now: there's no immediate reason to think that C-section delivery will be necessary. It remains merely a possibility for the moment, but one that's likely enough in our doctors' minds to warrant a little legal pre-prep. The intersections of medicine and the law are many and complicated, we're learning.
On the docket for today: a thorough ultrasound (probably amounting to a complete head-to-toe for both twins), another non-stress test (NST... basically, a long period of monitoring with the intent to watch for increases in the twins' heart-rates concurrent with movement... this is a way of checking whether their sympathetic reflexes--the ones that cause your heart-rate to increase in response to exercise or exertion and to return to normal levels thereafter--have developed), and lots of laying around for Melissa. We're scheduled for a fetal echo-cardiogram at Primary Children's Medical Center tomorrow. Primary is connected to the U of U Med Center by a walkway / overpass thingy, so no excursion into the open air for Melissa is in the offing. Too bad. :-)
More news later...
During our latest L&D stay, we were officially educated on the risks / implications of Cesarean section delivery. This was a "just-in-case" measure, for now: there's no immediate reason to think that C-section delivery will be necessary. It remains merely a possibility for the moment, but one that's likely enough in our doctors' minds to warrant a little legal pre-prep. The intersections of medicine and the law are many and complicated, we're learning.
On the docket for today: a thorough ultrasound (probably amounting to a complete head-to-toe for both twins), another non-stress test (NST... basically, a long period of monitoring with the intent to watch for increases in the twins' heart-rates concurrent with movement... this is a way of checking whether their sympathetic reflexes--the ones that cause your heart-rate to increase in response to exercise or exertion and to return to normal levels thereafter--have developed), and lots of laying around for Melissa. We're scheduled for a fetal echo-cardiogram at Primary Children's Medical Center tomorrow. Primary is connected to the U of U Med Center by a walkway / overpass thingy, so no excursion into the open air for Melissa is in the offing. Too bad. :-)
More news later...
Wednesday, February 14, 2007
Long overdue update
Hi All... Lots has happened since we last updated the blog... which is why we haven't had time to update the blog. Contradictory, isn't it?
Let's back up a bit. Melissa last wrote about an encouraging appointment a week ago Friday. Our next checkup (last Friday) was as bad as the other was good. The ultrasound revealed that our kiddos have made a mess of the membranes that had hitherto separated them. Further, Spencer's bladder was invisible again.
As an aside, I learned the other day not to do as the doctors do and say that Spence "didn't have a bladder." I was talking to someone who understood it literally and asked, quite concerned, whether he was likely to grow one at some point. Awkward pause, then lightbulbs for both of us. Anyhow, I'll be more explicit in the future. The bottom line is that bladders (like all other organs) aren't visible to ultrasound unless they have fluid inside. One of our concerns about Spencer has been that he doesn't get enough nourishment and fluid and hence doesn't produce much urine. When his bladder isn't visible and his stomach is, it tells us that he at least isn't getting MORE fluid than he absolutely needs. If his stomach also disappears, it'll be time to really panic. But I digress.
The upshot is that last Friday's visit was cause for considerable concern--and a worrisome weekend. Melissa came home with instructions to return on Monday and spent the next three days on the couch in a state of uncertain worry: not fun.
On Monday, we had another ultrasound. Things looked about as before, and Melissa seemed to be having contractions. Although the cord dopplers looked good, the docs opted to admit Melissa and sent her to a room in Labor & Delivery at the U of U Medical Center. She spent several hours there Monday evening while the staff worked to stop her contractions. This feat managed by 9:00 PM, they moved her to a room on "the floor" (the antepartum inpatient wing). There she'll stay on strict bedrest, likely, until the babies come.
Yesterday's (Tuesday's) cord dopplers (measurements of bloodflow from the placenta, through the umbelical cords, to the babies) didn't look as good as Monday's. Spencer's were spotty in some ways. We're likely to have a fetal EKG conducted today.
Off to more testing! More later.
Let's back up a bit. Melissa last wrote about an encouraging appointment a week ago Friday. Our next checkup (last Friday) was as bad as the other was good. The ultrasound revealed that our kiddos have made a mess of the membranes that had hitherto separated them. Further, Spencer's bladder was invisible again.
As an aside, I learned the other day not to do as the doctors do and say that Spence "didn't have a bladder." I was talking to someone who understood it literally and asked, quite concerned, whether he was likely to grow one at some point. Awkward pause, then lightbulbs for both of us. Anyhow, I'll be more explicit in the future. The bottom line is that bladders (like all other organs) aren't visible to ultrasound unless they have fluid inside. One of our concerns about Spencer has been that he doesn't get enough nourishment and fluid and hence doesn't produce much urine. When his bladder isn't visible and his stomach is, it tells us that he at least isn't getting MORE fluid than he absolutely needs. If his stomach also disappears, it'll be time to really panic. But I digress.
The upshot is that last Friday's visit was cause for considerable concern--and a worrisome weekend. Melissa came home with instructions to return on Monday and spent the next three days on the couch in a state of uncertain worry: not fun.
On Monday, we had another ultrasound. Things looked about as before, and Melissa seemed to be having contractions. Although the cord dopplers looked good, the docs opted to admit Melissa and sent her to a room in Labor & Delivery at the U of U Medical Center. She spent several hours there Monday evening while the staff worked to stop her contractions. This feat managed by 9:00 PM, they moved her to a room on "the floor" (the antepartum inpatient wing). There she'll stay on strict bedrest, likely, until the babies come.
Yesterday's (Tuesday's) cord dopplers (measurements of bloodflow from the placenta, through the umbelical cords, to the babies) didn't look as good as Monday's. Spencer's were spotty in some ways. We're likely to have a fetal EKG conducted today.
Off to more testing! More later.
Saturday, February 3, 2007
Friday's update
hi everyone,
If you couldn't tell, Monday's exam left us a little dissappointed, and somewhat frustrated. Friday made up for it!
The boys are looking good, and showing great improvement. Spencer's (donor baby) pocket of fluid was up to 7, and Micah's pocket only increased by about 1.2, so things are leveling out. Their hearts, doppler's bladders, etc. continue to look good as well.
We actually got to meet with our doctor this time, and we will be meeting with her (yes, the same doctor) each week. We will be going back down for check-ups only once a week, on Fridays. Hurray for fewer road trips!
In about 2-3 weeks we will have another fetal echo-cardiogram done, and in another 4 weeks they will check the growth of the babies again. They will also be checking for various other things as we go along, so that when I do go into labor, they will know where the babies are at, and what they will need.
Seth and I feel very confident that we will make it to at least 28 weeks (only four weeks away-wow that is close!), and anything beyond that will be great.
The past week I have been able to tell a difference in my body on the days when I push too hard, and when I don't, so I will be trying to maintain my modified bed rest as much as possible. Luckily I am surrounded by great people who will help to make this possible.
Thanks for all of your love and support! We couldn't do it without you!
If you couldn't tell, Monday's exam left us a little dissappointed, and somewhat frustrated. Friday made up for it!
The boys are looking good, and showing great improvement. Spencer's (donor baby) pocket of fluid was up to 7, and Micah's pocket only increased by about 1.2, so things are leveling out. Their hearts, doppler's bladders, etc. continue to look good as well.
We actually got to meet with our doctor this time, and we will be meeting with her (yes, the same doctor) each week. We will be going back down for check-ups only once a week, on Fridays. Hurray for fewer road trips!
In about 2-3 weeks we will have another fetal echo-cardiogram done, and in another 4 weeks they will check the growth of the babies again. They will also be checking for various other things as we go along, so that when I do go into labor, they will know where the babies are at, and what they will need.
Seth and I feel very confident that we will make it to at least 28 weeks (only four weeks away-wow that is close!), and anything beyond that will be great.
The past week I have been able to tell a difference in my body on the days when I push too hard, and when I don't, so I will be trying to maintain my modified bed rest as much as possible. Luckily I am surrounded by great people who will help to make this possible.
Thanks for all of your love and support! We couldn't do it without you!
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