can I get some cheese with that whine?

I got a call from my doc on Thursday, saying that the pathology report was back and this time they did find fetal tissue. So that at least is good (seems like genetic analysis will happen after all). And I had a little bleeding on Monday but not much, but it picked up again on Wednesday and seemed kinda like period bleeding, so I'm thinking that's a good sign too. She said based on that, no more betas... but I ordered some internet cheapies so that I can see if in fact it does get back to undetectable at some point. Theoretically a dose of 10,000 units of hcg is out of your system in 7-10 days, so I'm thinking that my beta should be undectable probably in around 11-12, although it does seem that there are some tissue reserves that are left behind so that it can take a bit longer.

Emotionally I'm doing alright. despite the fact that I feel okay most of the time, I have a really hard time telling anyone who doesn't know already. And I also am feeling really crappy in general because I totally still look like I'm pg (I have an abdominal muscle separation from Ant and Timmy, so I pop really early) - I have never had a small waist, but it already had gone from 29.5 to 32 inches... and so now none of my clothes fit and I just feel gross. It's very different when you can rationalize it because you have a baby in there versus just looking fat. And I know that probably no-one notices but me (although I few coworkers I told about my loss told me they were beginning to wonder, so it's really not just me but I try and make myself feel better by telling myself that it is). And on top of that my skin is being really crappy now, so in general I'm just feeling really really unattractive, again not that anyone really cares, but it's just one more thing to add to the pile of crap, you know? It sucks. Also because not only had I already gained a couple of pounds while pg, but a few more since that (I am not one to quit eating when I'm sad about something, unfortunately). And of course, I'm worried that it's going to take me forever to start cycling again. Also, stupid, I know, but I can't help it. Sigh.

sorry to be so whiny about such miniscule things, but that's where I'm at right now.

D&C part deux.

Today was harder for me that last week. I went to the L&D floor in the hospital (which is where I spent yesterday afternoon) instead of the day surgery unit. Fortunately I didn't see anyone in labor, but still, being there was just a little bitter.

It was a little more private and quiet, which was nice. Last week we got to listen to a teenage boy and his anesthesiologist arguing about which form of anesthesia was best.

My right arm is still bruised from last week's IV, so I asked the nurse to put it into my left. She did not do a great job, it was probably the most painful needle stick I've ever had (and I have had a LOT, as has anyone who's gone through IF treatments). And I have *huge* veins, seriously 1/4 inch in diameter if not slightly more. So really, how tough can it be? Anyway, the pain, although it really wasn't that bad, just got to me. I found myself thinking, "I really do not want to be here again". And I just couldn't stop myself from crying. At first it was just a few tears slipping out, and I asked the nurse if she could go and get DH, by the time he came in I was full out bawling. And of course that was right when the nurses were switching over so both of them were in the room too. Very sympathetic, but sometimes you just want to cry in private.

I managed to pull myself together eventually, and then the parade of doctors started. I met interns, more nurses, residents, the anesthesia resident and attending, the OB attending and fellow - Mark was calling it the DisneyWorld approach, where every few minutes they have someone else come in to break the tedium and make you feel like you're getting somewhere, just like the videos and things to look at when you're in line in DW. I thought it was quite an apt comparison!

We did make sure to ask what they were going to do to make absolutely sure they would get everything. They were all quite apologetic that it didn't work the first time, and said they'd be using ultrasound to guide them. Mark did ask about a hysteroscopy as that was what finally got everything cleared out for a friend who also had multiple D&C's, but they said there was too much tissue and would be bleeding so an internal camera wouldn't actually be that helpful. Made sense.

They let me walk back to the OR, although I couldn't get up onto the table until the brought over a stool, it was so high! At that point they started the IV meds, and once again, next thing I knew I was coming back into the room to meet M. Once again, none of the OBs who actually did the procedure stopped by to see me (that annoyed me last time too and I will definitely be speaking to MY OB about it when I see her next), but she did at least stop by and see Mark. She told him they were cleaning me up, and that my uterus was much more upright than normal, which made for quite a difficult procedure, and explained why they didn't get everything the last time. I suppose some explanation is better than none.

I really really really do not want to do this a third time, so I hope that they really did get everything.

Nico = 0, Doctors = 14,500.

My beta today was 14,500. So much for my pretty little graph.

I was lucky in that I hardly had to wait at all for the ultrasound, they had told me it could be as long as a couple of hours. It felt weird to be wheeled down to u/s on a gurney when I'm perfectly capable of walking, but whatever.

The u/s tech started by looking at my kidneys, then bladder, then went to my uterus. I could see a little bit of what was going on on the screen, and it totally looked to me like there was still something in there. I asked, and she agreed (even though I guess they're not supposed to give you "results".) She then went to the vaginal u/s, but had the screen so I couldn't see anything. I guess probably because it might be somewhat disturbing. We chatted quite a bit about all kinds of things, and in the course of that, she mentioned that it basically looked like they D&C had done absolutely nothing. Lovely.

She went out after that to talk to the doc or one of her colleagues, and I sat up and took a peek at the screen. The first few pictures looked like a perfectly formed fetus to me, all curled up in 'fetal' position and everything. And yes, it was disturbing. Of course I couldn't resist taking another look just to make myself feel worse, and then realized, duh, that it was actually the kidney pictures I was looking at. They really did look remarkably like an embryo! The vaginal u/s pictures were actually on pages 2/3 of the pics, and I didn't want to get into trouble for scrolling to those. So I just satisfied myself with her interpretation.

went back to L&D after that to talk about what next. They scheduled me for another D&C and gave me a prescription for misoprostol as well because I wasn't sure if I wanted to give that a shot, since obviously the D&C didn't work. After talking to a few people on my ride home, including a friend who had both a natural m/c after one pg, tried the misprostol which didn't work and ended up with a D&C after another, and recalling JV's comments about her natural m/c, I did decide to try the D&C again. I will make sure not to leave the hospital until they have shown me an ultrasound picture of my uterus with nothing in it! I know that's not a guarantee, but it will certainly be better than the last attempt.

Maybe that's why I felt absolutely no side effects from that!

In which I know more than the doctors?

Spoke to the on-call OB doc this morning. He said that my beta was 19,000, which he was saying was really high compared with my previous numbers of ~300 and ~600. So they want me to come in for an u/s before Monday. I reminded him that, um, the 300 and 600 were for my previous pregnancies, at 14 and 15dpo repectively, so not really a good baseline to use. dumbass.

Anyway, because they didn't take a beta at all this pg, and he seems to think 19K is high (although Dr. Google says the range for 9-12 weeks is 25,500 to 288,000 so 19,000 doesn't seem so high to me for only 4 days past D&C. I've seen estimates from 12-36 hours for the half-life of hcg), and he said that it is quite unusual not to get any 'products' from a D&C at this stage, he seemed to fall quite firmly in the 'they did not get everything' camp.

I dunno. I just found an article that looked at hcg levels post misoprostol/mifepristone termination, with a nice pretty graph and it seems to me my numbers are right in line with the average there. I wouldn't think there would be a big difference in hcg decline post medical vs. surgical termination.

Anyhoo, more b/w and an u/s tomorrow. I think I should be happy that they're being proactive, but it seems a bit like premature proactivity to me. Guess we'll find out.

Aftermath

I really was doing okay most of this week. Physically I still felt absolutely fine (although mildly nauseous Wednesday night and I went to bed at 8pm which never happens). Emotionally I did feel a bit numb, except when I told a friend at work whom I had told about the pg the week before. I was bawling in her office. Which in a way made me feel better as I hadn't cried at all since leaving the doctor's office on Friday. It's fairly easy to tell people via the sterile medium of the internet, but actually saying it out loud was hard. Really hard.

Then my doctor's office called today to say that the pathology report had come back, and they were unable to identify any "products of conception". The docs had spoken to the OB who did the D&C and she was surprised as she was sure they had gotten everything. And they're not overly concerned about retained 'products' as I'm feeling totally normal. But, they wanted me to come in for a beta, and probably a few more over the next few weeks, to make sure that it is decreasing appropriately.

Honestly, I have almost found this news harder to take than even the initial shock of seeing that Schweffel had no heartbeat. I know so many people who have had miscarriages, from chemicals to well into the second trimester that it was not a shock to me. I wasn't expecting the baby to be dead, but I wasn't NOT expecting it either. So yeah, it sucked, but in a way I had prepared myself for it. This, though, hadn't even crossed my mind. No genetic testing, no finding out the baby's gender (did my following the chinese calendar for the girl I would love to have work?), no nothing.

I had imagined myself getting a sense of closure from the results. Now I have no evidence whatsoever that there was a baby inside me. Two positive pregnancy tests which I threw out because they were getting nasty looking (I did at least take a picture), and one ultrasound that I didn't even get a picture from. I DID see a baby there, I DID. But there's nothing left, not even a few chromosomes. Oh yeah and I have a lovely beer gut too. I had convinced myself that it was getting smaller but really that was just wishful thinking.

I'm trying really hard to avoid thinking about worst case scenarios (and based on things some of my friends have gone through like two rounds of misoprostol followed by three D&C's, I can come up with some doozies.) It's hard to be optimistic though. I guess that's what this news has taken away from me. I was lucky enough to get pregnant on our first cycle trying this time. So I was imagining that I would be pregnant again in the near enough future. Now I can't even think about that because I feel like there are too many hurdles to overcome. I know I'm being a little melodramatic but I really do feel like I've been punched in the gut after just having had surgery.

Surreality

D&C is done. And I feel the same as I did before. No cramping, no pain, really nothing to tell my mind that it's over. There is a little blood, I suppose that's something, but I still just can't wrap my mind around it. I haven't even really cried about it today.

I was planning on writing one of my usual rundowns of exactly what happened, but there really isn't much to tell. They stuck an IV in me in pre-op (we were amazed how many people were there at 6 in the morning!), asked me a bunch of questions about allergies, previous medical history, etc., discussed the anesthesia plans with me (MAC - monitor and something I forget now), and then wheeled me into the OR. We were talking about playing ice hockey and skating, and that's the last thing I remember until I woke up as they were wheeling me into recovery. I just felt like I'd had a nice nap. And that was it. I had to drink something, pee, and then could go home.

I made DH stop at TJ's on the way home to get some cinnamon buns for lunch.

More details on Schweffel's demise.

When I went into the ultrasound room the tech first looked at my uterus, and I saw flashes of something inside there, then checked my ovaries (I was thinking that the pic was so much less clear than when we were going through treatments, but realize now that's because this was an abdominal u/s).

She then moved on to the baby. I didn't notice at the time that there was no movement. What I did see was no heartbeat. She switched on the view where you can see blood flow, and I didn't realize at the time that there was no blood flow in schweffel either. Mine around the uterus was there, but nothing going inside. She did a few measurements of the crown-rump length, and I noticed that the calculation said 8w6d... then said she had to go and get the doctor.

I choked up a little and said, "I didn't see a heartbeat, did you?". She responded, "No, I'm sorry". Handed me a box of tissues, and said I should wait there a few minutes while she got the doctor. I started to text DH but then thought, what am I thinking, and just called him. It was so hard to tell him, definite waterworks. He asked if he should come in, I said I didn't know, and he said he was on his way. Such a sweetheart.

The doc came in and mentioned that I had asked the u/s tech about the h/b. I told him this was my third pregnancy so I knew what I was looking for. Poor guy, he tried so hard to be diplomatic in asking me what happened in the other two pg. He was really sensitive about it, I have heard stories from my friends about much more callous doctors and nurses, but they were both great. as can be in that situation I suppose. He did confirm no heartbeat, and that the dating was not too far off where I was supposed to be, so Schweffel probably died within the last week or so.

Which is interesting because I finally started feeling queasy through most of the day middle of last week, but that disappeared again earlier this week. Timing was probably not coincidental.

I met with my doc after that, and she talked to me about the options - waiting for a natural miscarriage, taking drugs to induce one, or a D&C. I told her I was pretty sure I was leaning towards a D&C, we were in the midst of talking about that when DH arrived. I asked if we could have a few minutes, she very quickly got up and said, "Of course!".

I needed that hug.

We talked about the options for a few minutes, then told the doc we were ready to talk to her again. She went through the D&C procedure, that we'd been scheduled for 8am Monday morning which means we have to be there at 6, and then I had to sign some consent forms, including one for either taking charge of the remains for a funeral (or I guess whatever else we wanted to do) or having the hospital dispose of them. Mark said no funeral, so we signed for hospital disposal. I think all the options stink actually. Even with a natural miscarriage, I guess the baby would just be flushed down the toilet which doesn't seem like a great ending either. I may change my mind on this I'm not sure yet.

I guess that's about it for now. I've been doing a bit of research on what to expect with the D&C. I did have one after Timmy was born because I was continuing to bleed and they wanted to make sure there wasn't any retained placenta, so I know the basics, although that was different because I was awake with a spinal block, whereas this time they're going to use IV meds for anesthesia and I think I won't remember it? I do remember thinking during that procedure how nasty it was to hear the vacuum and how awful it would be to hear that and know they were vacuuming your baby out. I guess they do it a bit differently, or I'm about to find out.

C'est fini.

I had my first OB appointment today. It was originally scheduled for 6w6d, but when I found out they wouldn't be doing an u/s I rescheduled for today, 9w3d, when hopefully I'd be able to hear the h/b with the doppler.

Only they couldn't find it. And then they did an u/s and there was no h/b there either.

So now I'm scheduled for a D&C on Monday.

Schweffel was measuring 8w6d, so it seems like it happened recently.

And now, I'm sitting here typing this and eating raw salami. I don't know what it says about me that that's the first 'forbidden' thing I'm doing. Not wine, but salami.