a birth and near death story

Some folks may be wondering, since my last post over a week and a half ago was OMG ONE DAY TIL BABIES LET’S FINISH THE NURSERY, whether or not I did in fact have those babies.

I did.

And what a crazy story it is.

One last belly shot the morning of the c-section.

Things started out as planned– we didn’t sleep at all the night before from excitement, and we showed up at the hospital at 7:00 am on Wednesday, March 28 (exactly one month before my 40 week due date) for a C-section that had been moved up 5 days because I suddenly had an elevated blood pressure and had started retaining fluid. I was really nervous about the surgery, but despite a little trouble getting the spinal/epidural combo in place (apparently folks with scoliosis and an extra vertebra are a bit challenging for anesthesiologists), the whole operation went very smoothly. It’s super surreal to be lying on a table, numb from the waist down, knowing you’re being cut open and having babies pulled out, but feeling nothing but pressure and tugs and then suddenly hearing cries. I’m pretty sure I was saying “I’m afraid I’m going to feel it!” to the anesthesiologist who was standing next to me as I was already being cut open.

It turns out my girls, who had been in “bunk beds” or in the transverse position for my entire pregnancy, had turned breech somewhere between my last appointment and the surgery– so I’d have definitely needed a C-section even without my blood pressure issue or Claire having spina bifida. Jon joked afterward that there are about 5 ways I could have died in childbirth this week if not for modern medicine– breech twins are one of them. Jokes aside, there is no one more supportive and awesome than my husband, who was right by my side for the whole surgery. The surgical team kept telling him when to pull out his camera for a good photo op, but he mostly focused on supporting me and keeping me calm. He did have the anesthesiologist give me some “goofy juice” at the end when I started to freak out a bit that I might be feeling more than just pressure (pretty sure that was mental), but overall, he kept me relaxed.

Jon and the babies-- Etta in front, Claire in back.

After both girls were pulled out, Etta weighing 6.2 lbs. and Claire weighing 6 lbs. (I am SO FREAKING PROUD of those weights for 35 weeker twins, I must say), Jon went with the babies to the resuscitation area, which sounds scary, but doesn’t necessarily mean the babies are getting like, CPR or anything. They were checked out by a team of neonatologists and pediatricians, and there was a transport team standing by ready to take Claire from the university hospital where I was delivering to the nearby Children’s Hospital (where my husband works), where she would be having surgery to repair the opening on her spine caused by her spina bifida.

It turned out that Claire’s spinal defect was both higher and larger than we initially hoped. I got to see my baby girl in a plastic transport box for about 5 minutes in recovery before she was whisked away by the transport team. I’m pretty sure the “goofy juice” is what helped me not completely freak out over not getting to hold one of my babies, but we had also prepared ourselves for the fact that this is what would happen on delivery day, knowing it would be happening since week 20 of the pregnancy. I was also very thankful to have met and consulted with the team of doctors who would be taking care of her, so I knew she was in the very best of hands.

Meeting and saying goodbye to Claire.

After recovery, Etta and I were moved to the peri-partum ward, and she was allowed to share a room with me. My blood pressure and heart rate were slow to go down, and labs revealed my blood counts were very low, so on Thursday I received a blood transfusion. Everyone who came in the room and saw me afterward remarked on how much better I looked, and the color in my face, even though I was about the same shade as the beige hospital blanket that covered me. I guess I was white as the sheets before?

On Friday, Claire had her surgery, a five hour process involving neuro- and plastic surgeons to cover the 4 cm. area where you could literally see her spine. I wished so desperately that I could be there for her, but was still not in shape to be discharged from the hospital, so a social worker set up a video-conference and I got to video chat with her before the operation. She opened her eyes when she heard my voice, which made me feel so much better that she still knew her mama loved her. She came through the surgery great, and continues to recover in the NICU at Children’s. She seems to move her legs of her own accord and also to respond to stimuli, which are great signs that she may not have disability in her legs. As with everything, though, we will just have to wait and see. She may also have disability in her bladder and bowel functions, but since no babies have bladder and bowel control at this point, we won’t know until she’s older if this is the case. We certainly hope it isn’t.

On Saturday, there was talk of discharging me from the hospital as I was doing much better, but I was still feeling very very weak and not very able to get out of bed, and when my doctor suggested keeping me another day, I said I thought that was a good idea. I needed the time to continue to recuperate.

By early Sunday morning, I was feeling well enough to get out of bed and walk unassisted the 5 steps to the bathroom, as Jon was holding Etta. I remember feeling so proud as I stood up and walked unassisted, thinking this was finally the milestone I needed to get to go home. As I walked back to the bed, I felt myself getting shorter and shorter of breath. I told Jon I was having trouble breathing, and he called for the nurse. It just got worse and worse, as I struggled for breath in short gasps, and a crowd of nurses gathered around. People were telling me to take a deep breath, but short gasps were all I could manage. I began to hear crackling in my lungs (Jon later explained that this was flash pulmonary edema), and I became more and more panicked. I knew from the way I felt and the look on Jon’s face that I was crashing.

The Rapid Response team arrived and soon I was being prodded and various breathing masks were being shoved onto my face, which only increased my feeling of panic. I know enough from being raised by medical professionals and married to an emergency physician that I needed to be intubated. I was looking at Jon begging him with my eyes to get someone to sedate and intubate me so I wouldn’t have to panic and struggle to breathe any more. From the look on his face, I could tell if he’d had a cart nearby, he would have done it himself.  I truly believed I was dying, lying in that bed, surrounded by people bustling around to save me, with my husband watching and my baby girl lying next to me in a bassinet.

And then I don’t remember anything.

My next memory is vague, like a dream, where you know there is something you MUST do, and in this dream, what I had to do was pull something out of my mouth. So I just kept pulling.

It was Monday morning, and I had extubated myself. I was in the ICU, where I had spent about 24 hours on a ventilator.

After consults with cardiologists and pulmonologists and internal medicine specialists and more doctors than I can count, it seems I have developed peri-partum cardiomyopathy, which was causing congestive heart failure. My terribly lay understanding is that possibly due to the stress of the pregnancy on my body, I either developed or finally exhibited a pre-existing weakness in the muscle of my heart, specifically in the last chamber (left ventricle) that sends blood out into the body. The ability of this chamber to pump out blood effectively is measured in an “ejection fraction.” Most people’s is 50% or better, and mine was 15%.

Reunited with Etta in the peri-partum ward after getting out of the ICU. I may look yellow, but this is "good" color compared to where I was.

Putting me on the ventilator helped them pump fluid out of my body to take the load off my heart and lungs. They removed 7 liters of fluid from my body in my 24 hours in the ICU, and continued to take more off through diuretics and fluid restrictions after they got me out of the unit and back in the peri-partum ward.

Tuesday through Thursday were spent trying to fine-tune the cocktail of medicines I am now on to control my heart rate and blood pressure and allow my heart to strengthen and heal. Every day they tweaked the meds a bit, and every day I worked harder to get out of bed and walk and move. By Wednesday night, I finally was able to make half a lap around the ward, pushing Etta in a bassinet, Jon beside me to steady me, with nurses cheering– even those who hadn’t cared for me had heard about the girl who was seemingly ready to go home and had suddenly crashed and wound up in the ICU on a vent, so they were proud to see me looking better.

Etta and me.
Claire and her daddy.

At first, the medicines made me feel worse, which my cardiologist told me would happen. I’d get my meds, and then for 4 hours afterward, feel hot flashes and jitters and general exhaustion, only able to sweat and sleep. But every day that got a little better. By Thursday, Jon and me, and Etta, if I may speak for her, were just DONE being in the hospital. Convinced that I would be compliant with my meds, diligent in home blood pressure checks, and sure to come back for follow-up treatment, I was finally discharged. I have never been so glad to breathe fresh air as when baby Etta and I were wheeled out to the curb in front of the hospital on that beautiful spring day when we finally got to go home. I’m feeling better and better since then. My heart condition may never be fully cured, but it can get a LOT better, and I have high hopes of being one of the successful cases. We will not be able to have any future pregnancies, however, because it would literally mean risking my life.

Another loss that I feel very deeply is the loss of the ability to breastfeed the babies. I had really hoped to be able to nurse them, and had been working on nursing Etta and pumping and building up my supply while in the hospital, however, after the whole almost-dying thing, my doctors convinced me that breastfeeding is a major physical strain on my body, and I needed to be conserving my physical resources to give my heart the best chance to heal, so that I could become strong enough to care for my girls. I have cried many tears over this loss, but I know that we made the right choice for our family. They need my beating heart a lot more than they need breast milk.

We’re still missing 1/4 of our family, with Claire still in the NICU, and we are anxious to get her home. I’m still pretty weak, though stronger every day, and my one outing a day is to go visit her. Blessedly, Children’s has a special “twin rule” that lets us bring Etta with us to visit her sister, and it’s super special just to have the four of us together for a little bit each day– giving us a taste of how great it will be to finally have all of us home. We don’t have a specific date that she’ll be discharged, but we hope it could be soon if she keeps meeting the goals her doctors set for her. Every day that I’m wheeled out of that NICU with only one baby feels incomplete.

Seeing Claire for the first time since her birthday after I got out of the hospital. It had been over 8 days since I saw my baby.
Reunited twins!

Overall, though, I am so very thankful. I’m glad I was in the hospital where I could quickly get the care I needed when I crashed. I’m glad Claire has such awesome people taking care of her, and glad we have awesome families who would come and take care of her and Jon and Etta and me when we needed them. I’m thankful for two beautiful baby girls. I’m thankful to be alive.

The whole family.

sweating it

Before I got married, my last name was a certain word synonymous with perspiration (which is why, despite my feminist tendencies, I wasn’t so keen on keeping it).  I’ve been living up to that name this week in more ways than one.

My lovely state has been on the news lately as the HOTTEST PLACE IN THE WORLD. In case you don’t believe me, this was our forecast this week (apologies for the weird alt text in my screenshot):

Last night, at 9 pm, the heat index was still in the HIGH 90s. Just walking outside from the car into a building is enough to work up a good sweat.  My poor air conditioner has been chugging away non-stop all week in a valiant effort to keep the interior of our house a frosty 80 degrees.  It probably doesn’t help that we have furniture covering almost all the vents, to which I ask, why, God, why, are all our vents also in the most logical places to put furniture?  Our couch has now been pulled 6 inches out from the wall to expose the vent. It looks kind of silly, but damn if it isn’t cooler in here.

In addition to this heat wave, this week my husband signed me up for a membership at the gym at his work and has invited me to come work out with him.  Something to know about me: I’m basically allergic to physical activity.  As a kid, I spent one season on a softball team and spent the entirety of it making daisy chains in the outfield.  My parents signed me up for tennis lessons, where it was discovered that I had a knack for hitting myself in the head when I tossed the ball to serve.  I routinely flunked the Presidential Physical Fitness Test, but even this socialist would like to know why it’s any of the president’s business how many sit-ups I can do, anyway. Pretty much the only exercise I’ve ever loved was yoga, but classes haven’t started up at our gym yet.

And still, I know I need to get some exercise. I don’t need to lose weight, but I do need to get some cardiovascular activity in for the sake of my heart. I’m skinny but I’m not in shape.  And the gym is chock full of the one and only exercise machine I’m willing to touch: the elliptical.  I’m not sure what it is about the elliptical that makes it the least repellent form of exercise to me, but I don’t abjectly hate it, which is a big deal. It feels like walking on the moon. I can moonwalk for 30 minutes 3 times a week, right?

Well, huffing and puffing, I moonwalked for 30 minutes on Monday. I’d like to attribute some of that huffing and puffing to the fact that I made the mistake of hopping on a machine in front of a TV playing Fox News.  Yesterday, my legs felt like jelly, so I didn’t go to the gym.  Today, my sports-loving man messaged me that he was off work early, and did I want to meet him in the gym?

Something else to know about me: I’m great at guilt tripping myself. I think maybe my mother just did such a good job of it that now I just do it on autopilot. I know Jon isn’t thinking this, but I project my own guilt onto him: “What a lazyass, home in your pjs at noon on a weekday! You never work out! You should go to the gym!”  I put on my workout clothes and hopped into the car and headed to the gym. Jon had already done 20 minutes of weights when we met up at the cardio machines, him on a bike and me on the elliptical. About 15 minutes in, huffing and puffing harder than before, I told him I wasn’t sure I’d make it 30 minutes.

Something to know about Jon: he’s the most encouraging person ever, and he knows how I operate. Occasionally he tries to teach me tennis, and he’s learned that I just do not respond to negative feedback.  I need a LOT of cheerleading.  As he pedaled away on his bike set to some insane incline, he assured me that I could definitely survive 20 minutes on that machine. Then my stubbornness kicked in, and I became determined to keep moving until the time ticked down.

Now, an hour later, I think I might have finally stopped sweating.  For a minute there I thought I might puke.  Yep, 20 minutes on an elliptical machine and I’m sweating like a pig and thinking I might puke. THIS is why I need to work out.

Now I just have to decide if it’s even worth it to bother showering when it’s a million degrees outside and I’ll just be sweaty again in 10 minutes.

Are you a gym nut? Do you love to work out? Or are you like me, and frankly hate it? How do you make yourself exercise? What’s your favorite machine?

the only thing we need to lose is our obsession with thinness

Image: yoga after climbing, a Creative Commons Attribution (2.0) image from lululemonathletica's photostream

I spend a lot of time reading feministy, body-positive, Healthy at Every Size type blogs, so at first I wasn’t surprised to read a piece called Never Take Fitness Advice from the New York Times. Until I realized it was written by a man, and on Gawker to boot.  Yay for encountering body-positive messages in unlikely spaces, particularly considering the staggering number of negative messages we get about our bodies each and every day!

In this piece, Hamilton Nolan critiques a recent NYT article called “Does Working Out Really Help You Lose Weight?,” particularly its assumption that the goal of exercise, and indeed all of life, is being “thin,” a word that is used repeatedly in the NYT’s article. Hamilton writes:

Being thin is an awful goal towards which to strive. It is certainly not the goal of an exercise program. Writing an entire, ostensibly meaningful and important story on whether exercise can make you thin is analogous to wondering whether going to college can get you laid. Yes, but that’s not really the point.

The purpose of working out is get in shape. Not to get “thin.” To be in shape, for the average person, connotes being healthy, and improving on the basic elements of one’s own fitness: muscular strength, endurance, cardiovascular, flexibility, etc.

Amen! The goal of working out, and even of eating healthy foods, is to be HEALTHY, which may or may not mean being thin. In fact, for many people, it will not mean being thin. And being thin does not necessarily mean being healthy, either. I should know. I’m what the NYT might call “thin,” with a BMI* naturally in the “underweight” range of the scale, and yet I am still what you might call “out of shape.” I couldn’t run a mile if you asked me to. I have a rather high resting heart rate. But I recently started exercising regularly for the first time in my life, by taking yoga classes, and I am feeling stronger and healthier and happier the more I practice yoga.

Not to mention, thinness is a crappy way to motivate people to pursue healthy activities. I eat healthy food because it tastes good. I practice yoga because it’s fun, it helps with my back pain, and it makes me feel beautiful just to be in my body. I even hear tell that some people like to run because they think it’s fun, though I think it sounds like torture! Do what makes you feel good and healthy.  Do what’s fun. It may or may not make you thin, and who really cares anyway?

*As an aside on the BMI: a lot of those feministy body-positive Healthy at Every Size blogs I read like to talk smack on the BMI. While they have a point that having a certain BMI does not necessarily mean one is by definition unhealthy, ie, just because one falls in the “obese” or “underweight” category according to the BMI does not mean one will have all of the health complications associated with that category, the BMI is still useful as a measure of predicting risk and determining if further testing is necessary. For example, according to my BMI, I might be at risk for infertility, osteoporosis, and anemia. Because of this, my doctors might suggest testing or monitoring to see if I have developed those issues, but it doesn’t mean I have to HAVE those issues– in fact, I don’t. The same goes for people who are obese according to the BMI– they are at risk for diabetes and other complications, and may require testing or monitoring, but will not necessarily have those conditions.

the truth about high fructose corn syrup

New research confirms that consumption of high fructose corn syrup (HFCS) promotes considerably more weight gain than consumption of the same amount of calories in regular sugar (glucose).  Though the study was done on rats, there’s reason to believe they’d get similar results on human beings.  Jon happens to be on an endocrinology rotation right now and got the lowdown on why this is from an endocrinologist (they’re the ones who are experts on diabetes and stuff, so they know all about the body and sugar). I thought I’d try to explain it as simply as my simple mind understands.

Basically, when your body breaks down glucose (normal sugar) to make energy, there’s a special mechanism that tells the body to stop processing the glucose once the body has enough energy, and rather than break down the rest of the glucose, the excess just passes out of the body through urine.  However, with fructose (found in HFCS), there is no such mechanism to shut it off once you have broken it down into all the energy you need.  So the body just keeps breaking down fructose, and the excess gets converted to fat.

Our bodies just weren’t designed for consumption of high fructose corn syrup, and this research (and understanding why they got the results they got) confirms my decision to avoid high fructose corn syrup as much as possible.  HFCS is in almost every processed food, probably even in the bread you buy, so start looking at those ingredient labels!  If you’re a big soda fan (I like some soda with my whiskey or rum), see if Jones Pure Cane Cola is available in your area.  It’s the cola I use at home, and I can find it at my local Harris Teeter.  Pepsi and Dr. Pepper are also sometimes available in “throwback” form, and if you can find ’em, they’re sweetened with cane sugar.  Right now you might also be able to find “kosher for Passover” Coke, which is also sweetened with real sugar.

it’s TRICK or TREAT folks

Image via Flickr user chanchan222, licensed under Creative Commons.

WordPress has a fun little feature whereby they showcase seemingly random posts on the main page, encouraging you to click and check out new blogs. I knew I was going to be irritated the minute I saw this one: “Halloween Candy Alternatives.”

I thought, well THAT’S a post from someone hoping their house gets egged.

Seriously though, the OP writes, “Providing some alternatives to reducing the sugar glut can be very helpful and even welcome – especially considering the ongoing health problems we’re generating in this country through our passion for sugar,” and then proceeds to list several food (granola bars, nuts) and non-food (wax lips) things to give out to trick-or-treat-ers.

Ah yes, nothing sucks the fun out of Halloween like some OMGOBESITY fearmonering– it’s scarier than zombies! Instead of being ware the undead, BEWARE THE UNTHIN!

People in this country aren’t obese because of Halloween.  Kids aren’t obese from one night of candy.  Being the Scrooge of your neighborhood isn’t going to solve the problem of childhood obesity.  In fact, I’m pretty sure most health experts would say it’s fine and dandy to indulge oneself in treats once in a while, everything in moderation and whatnot.  If you’re the PARENT of trick-or-treat-ers, you can even ration the candy out over several days, like my parents always did, after they checked each piece for razor blades, of course.

If you’re really concerned about the health of children, start advocating for a healthier school lunch program which includes breakfast.  Get involved in community gardens in areas without access to fresh produce.  Make sure your local farmers’ market accepts food stamps and WIC.  Make sure kids in your local schools get P.E. every single day.  But don’t piss all over Halloween.  Unless you want to be known as the weirdo who handed out pretzels instead of Reese’s cups by all the kids in your neighborhood.