Busy, Busy Bee

As Puck said in his last post, it was a long and busy week. Here are a few updates:

Sacramento Mothers of Multiples (SMoM) Biannual Sale

On April 10th, Puck and I woke early and headed to the SMoM sale. Members were able to make their purchases between 8 to 9 AM before the sale was opened to the general public. There were lots of clothing for the little ones plus toys, car seats, and many other items. Puck and I bought a few items at very reasonable prices, and we had a lot of fun picking out some outfits for the boys. Just as enjoyable as buying all sorts of loot was getting to see some of the moms we had met before. I’m looking forward to the next meeting!

State of the Union

Discomfort: This past week I have had more discomfort than before: lower back pain (especially when standing after sitting awhile), leg cramps in my calves at night, tingling numbness in my hands (mostly at night), 8-10 hours with extra weight pushing down on my pelvis, round ligament pain, plus some indigestion.

The Boys: We’ve been able to feel the tummy-monkeys doing their acrobatics in their insulated jungle-gym. At the last big ultrasound, they flipped and moved all around. They spent part of the time side-by-side and then shifted to being bunkmates. They seem to like to move around when Puck comes home and puts his hands on my belly in greeting. Sometimes, you can feel a head, bottom or foot pressing against the skin. Dominic doesn’t usually make as much of a ruckus as Alexander though. The other day Alexander seemed to be having a good time pushing out on my belly as hard as he could. It’s very reassuring to feel them moving around.

A Few Other Notes: My belly button just keeps getting shallower, and my belly continues to expand. I can’t see my toes when standing normally now, and Puck fusses at me when I try to put my pants on without bracing myself against something because I have more trouble keeping my balance. On a rainy day this past week, Puck saw me struggling to tie my shoes, and he came over to finish them for me; bending over has become more of a challenge. My Birkenstock sandals that Puck got me for my birthday are all the more treasured now for ease and comfort.

I am still taking pregnancy/allergy naps, though now that my allergies are easing a little they aren’t as long or as difficult to wake up from. My trips to the bathroom have increased as well; almost anytime I stand up to do something I have to make a pit-stop – sometimes with little time between trips. I usually wake up at least once a night for a bathroom break as well.

Overall

It’s hard to believe we’re half-way home already. Time has just been flying by. This week we’ll be finishing up week 20, and in no time our little boys will be here. I feel very fortunate to be sharing this whole adventure with Puck. He does a wonderful job of making me feel loved and beautiful, and he often has me laughing at our experiences.

From the Twin-Daddy:

We have had a very busy week getting two articles ready for publication, sending off our tax returns, birthing classes, and two doctor visits in the meantime. We have been burning the candle at both ends, and the only ones getting enough sleep in our house are the Great Dane and the two boys. We are looking at making up some of that sleep this week.

Ultrasounds by Disney

We met the perinatologist or, as the insiders call her, the Perinate. I will now call these doctors the Perinators. We went to the Land of Perinators and got an ultrasound last week from a chipper lady tech who was firm but friendly. She wouldn’t give us any advice, but she also acted as sort of a Disney safari guide for ultrasounds. She had a well-rehearsed patter about what she was doing and what we were seeing that was fairly pleasant and reassuring.

“Here we see your baby’s heart. When I look at the heart I want to see all four chambers and the blood vessels. At 19 weeks your baby’s heart is about the size of the head of a nickel. On the left of the babies heart you will see our hippopotamus, please keep your hands inside the boat.“

After the tech measured all the various bits of the boys, she told us that we were looking at two boys very close in size with good growth ahead of their due date by about 8 days. We were told we shouldn’t revise our due date, and it looks like September 8 or 9 is the day. I have to realize that as much as I wanted the due date to move up 10 days this is one of those things that we might want to believe because it makes us feel better. That being said, I can still strut because my boys are about 8 days bigger than their due date suggests. They are growing very well.

• Alex = 337 grams
• Dominic = 317 grams

For those of you who didn’t grow up with the metric system one American penny is 2.5 grams, and that means our kids are each about $1.30 in pennies.

• Alex = $1.35
• Dominic = $1.27

They are separated by about $0.08. According to this measurement their concordance = 94%.

Now those who remember the previous concordance measurement of 98% might be tempted to freak out because this number seems smaller. Take a moment and do so and then start reading again.

Twin-to-Twin Transfusion Syndrome is defined as discordance of greater than 20%, and we’re nowhere near that.

The other thing to keep in mind is that this poor lady is trying to get two rather rambunctious tummy-monkeys to hold still long enough to get her measurements. If you’re an engineer or scientist the words ‘margin of error‘ should pop into your mind immediately and you nod and then stop freaking out. If you’re not an engineer or scientist, you should just understand that a lady poking your wife’s goop-covered belly with a ultrasound wand isn’t looking for really precise measurements so much as a gist of how things are doing in there.

The gist is both boys are doing well, and their growth is ahead of schedule. Again, that is very good. TTTS is also an issue that affects the baby’s hearts, and our boys are both in the 130 range, and during our measurement their heart rates were within 3 beats of each other. Once again, this is good.

The Perinator

After the tech left, the Perinator came in, and she was all business. Not being overly talkative she grabbed the ultrasound wand and probed the goopy tummy with pursed lips occasionally frowning at the monitor. Speaking from personal experience, a frowning ultrasound tech is enough to make anyone irrational and when it is the high risk pregnancy doctor you break out in a cold sweat. You are completely certain that there is some horrible problem in there from the look on the Perinator’s face. For all you know it might be the worst case of hyper-rondel-menta-hiamitus that she’s ever seen and the only cure is to kill and eat the husband alive here in the ultrasound room with mustard , cheese slices, and at least a 15-ounce glass of water.

Fortunately, she just had her grumpy-face on that day because without batting an eye or cracking a hint of a smile she told us absolutely deadpan that, “Everything looks fine,” and, “Do you have any questions?” I promise it is more hilarious in the telling than it is when you are sitting there. We asked some questions and went home a bit bemused about it.

The OB-GYN of the Gods and the Flying-Monkey Show

Mary had made an appointment the next day with one of the OB-GYNs recommended by our general practitioner, Dr. Renwick. This turned out to be an exceptionally good idea. She also wanted a peek at the boys’ hearts with the ultrasound because it was easier with twins to get heart rates on an ultrasound. However, before we got the wand and goop out for the flying-monkey show, she sat us down, and we just had a conversation. She asked us if we had questions, and she answered all of them. What she didn’t have immediately, she went and looked up for us. Never rushed at any point, when we were done with our questions, she checked the kids, and happy with what she saw, she sent us on our way. We left feeling very confident in her and completely reassured.

A Tip for Twin-Parents

So, here is a twin tip for you. I think midwives are great, and I strongly advocate for their role as care providers. Pregnancy isn’t a medical problem to solve but rather a process that is guided which I think midwives understand very well. That being said, as a twin parent you’re sitting on top of a probability pyramid that has made you an unusual and possibly dangerous case. My advice is to respect the role of midwives but work with a doctor when you’re dealing with a high risk pregnancy. In our case, we have the best of both worlds because our doctors work hand-in-hand with midwives. Respect the midwife, but when you’re in the higher risk category, err on the side of doctor.

Wifewatch 2010

Food

She’s still eating like a champ, but we’re hitting the top end of our growth curve so we’re pulling out some starchy carbs and replacing this with leafy vegetables and protein. We’re also seeing some indigestion.

Mood

She’s a very giggly pregnant lady. I swear those kids are going to feel like they’re being deprived if they aren’t being constantly bounced around by somebody laughing.

Sleep

With our articles out of the way, we’re both looking forward to some extra sleep.

Babies Countdown – The Double Header

The due date is being pushed back to September 9, and the Twin-Daddy feels sheepish for wishful thinking.

143 days until September 9

• Today is 19 weeks and 4 days (again).
• Thursday, April 22 is week number 20 and child birthing class number 4.
• Tuesday, April 27 is the Sacramento Mothers of Multiples Meetup.
• Tuesday, May 4 is child birthing class number 5.
• Wednesday, May 5 is our next OB-GYN appointment.
• Wednesday, May 12 is our next appointment with the Perinators.
• Thursday, May 20 and the twins become viable as early as 24 weeks.
• Thursday, June 17 is Homefree Day. 90% of twins born at 28 weeks survive and that number only gets better from there on out.
• Thursday, August 12 and we hit our goal of 36 weeks minimum. From here on the twins could come at any time.
• Thursday, September 9 and we hit 40 weeks. This is our due date even if we expect the twins to possibly come sooner.
• 4 Weeks Post Delivery – Look for baby smiles.
• Sometime After the Delivery – 4.5 months of the Twinsanity Interval.

From the Twin-Daddy

Yesterday morning I put a big ‘X‘ on my calendar on the day labeled ‘Halfway Home Day‘ which represented halfway to our goal of 36 weeks.  Mary and I celebrated with an Italian lunch in which we stuffed her with Spinach, cheese pasta, garlic bread, and sweet potato fries from my plate.  The kids are growing like mad, my wife is no longer able to easily see her feet, she waddles like a pro now, and I finally built a crib this week.  With each new goal we reach another calendar day rises to take its place.

Concordance

Mary has already mentioned Twin-to-Twin Transfusion Syndrome (TTTS) in her blog post earlier.  With this in mind getting the boys through the second trimester with good growth is really key for us.  Dr. Hershey, the baby-ninja, tells us that the boys are ‘concordant’ in growth which is a good thing.

Stage I TTTS is defined as 20% or greater discordance in growth.  Because I am an engineer I tend to fall back on math and data.  I want to know exactly how concordant these guys are to each other.

• Alexander – 19.2 weeks
• Dominic – 19.0 weeks

Break that out into days of growth:

• Alexander – 134.4 days
• Dominic – 133 days

133 / 134.4 = 98.96% Concordance

That is very close to 99% when it comes to matching their growth levels.  It is so close to perfect that Twin-Mommy deserves some credit for eating well and coaching those guys on their first lessons in sharing.  For the moment anyone reading this can breathe a big sigh of relief with that 99% number being a serious comfort.

I’ll do what I can to keep this concordance number current as we move forward.  For reference’s sake that’s about 6 inches from head to bottom for each boy.  We’ll try to find an appropriate fruit for another side by side comparison.

Due Date?

Let’s assume the baby-ninja is correct and our due date is actually August 30, 2010.  You cannot doubt the baby-ninja because his powers are mysterious, and he also seems very nice (for a ninja).  If he is correct Monday, April 12 is week 20 for us.

We just want to keep that growth going strong for both boys over the next 8 weeks and 4 days when we hit our next big goal which I hereby dub Homefree Day on June 7, 2010.

On Homefree Day, our kids hit about a 90% chance of survival if born that day.  They have cleared all the major hurdles and they are beginning their last few weeks of prep work with their mom before they are introduced to a dad, a great dane, and a bunch of eager family members on both sides.  On that day the Twin-Daddy may have to have a party because he can, hopefully, relax a little bit.  (As much as any father ever gets to relax.)

Even better, every day after week 28 the boys get better odds because they become more and more ready to exit the Queen Belly.

I’m about 7 miles from the hospital, and I can get my wife there in a jiffy if the need arises.  I will not speed… I will not speed… I will not speed…

WifeWatch 2010

Food

Mary is in love with turkey-bacon lately.  So much so that we teased about adding ‘Bacon’ to Alex’s name for something like ‘Alexander Daniel Bacon Curtis’.  Her latest protein hit is 3 scrambled eggs and 4 pieces of turkey-bacon as a quick snack.  I think she is craving salt and is regularly going for fries, bacon, and anything else with a bit of Na-Cl in there.

Mood

Seeing the twins at the last ultrasound made a happy Mary and she gets a bit sniffly when she watches the DVD because they are pretty cute when they wiggle around.  It may be just me, but the latest profile images from the ultrasound really look like boys to me. They’ve definitely gone from possible tadpoles to actual babies.  She felt Alexander roll over today and literally stopped in the parking lot and said, ‘Wow! That was really weird!”

The boys should be listening now, and Mary has started singing to them when she has a moment here and there.  In one case she was singing alone in the elevator and got a very funny look from a guy when the doors opened and she was singing away.  Right now the boys are getting a good dose of Beatles, but the actual lyrics may be creatively changed depending on how much she remembers and what she wants to say at the moment.

Mother Nature’s Sun might become:

Born two little twinny-boys

Mother Mary’s sons

All day long they’re growing in my tummy… Baby buns!

Mother Mary’s sons!

Hey Jude could just as easily become:

Hey dudes

You share that food

Take a little bit but share with your brother

Remember to let him eat some too

Then you can poo

And just start over.

My Guitar Gently Weeps:

I look at my tummy and I see what it’s keeping

While my two boys gently sleep

For every new thing they must surely be learning

While my two boys gently sleep

Trust me, if she starts singing “Won’t you come out to play?” I’ll stop her until we hit week 36.  (Note: I have linked to the original Beatles versions on YouTube.com.  If you’re feeling like having a Beatles moment of your own, give them a click.)

Mary’s nesting instinct has kicked in and last Saturday I found her sitting on a chair in the garage breaking down cardboard boxes because she “wanted to.”  I don’t argue with a pregnant lady when she does weird things, and after assuring me that she didn’t want any help and that she wasn’t straining herself unduly, I left her to the boxes which she broke down and then stuffed into our recycling bin.  After that it was a session in the office-become-nursery where she sat down and sorted boxes for awhile until she pooped out.

Sleep

Her nesting instinct is directly in competition with her Twin-Mommy energy cycle and so she nests in short bursts broken up by power naps.

Babies Countdown – The Double Header

153 days until September 9

143 days until August 30

For the moment, I’m going to assume the baby-ninja is correct about our due date of August 30, 2010.

• Today is 19 weeks and 4 days.
• Saturday, April 10 is the Sacramento Mothers of Multiples Baby-Stuff Sale
• Sunday, April 11 is our next child birthing class.
• Wednesday, April 14 is our first appointment with the perinatologist.
• Thursday, April 15 is a doctor’s appointment at the Women’s Clinic, and Tax Day .
• Sunday, April 18 is child birthing class number 3.
• Thursday, April 22 is child birthing class number 4.
• Tuesday, April 27 is the Sacramento Mothers of Multiples Meetup.
• Monday, April 26 and the twins become viable as early as 22 weeks.
• Tuesday, May 4 is child birthing class number 5.
• Monday, June 7 is Homefree Day.  90% of twins born at 28 weeks survive and that number only gets better from here on out.
• Monday, August 2 and we hit our goal of 36 weeks minimum on our wedding anniversary.  From here on the twins could come at any time.
• Monday, August 30 and we hit 40 weeks.  This is our due date even if we expect the twins to possibly come sooner.
• 4 Weeks Post Delivery – Look for baby smiles.
• Sometime After the Delivery – 4.5 months of the Twinsanity Interval.

According to our adjusted dates, we are in week 19, and we will hit week 20 on Monday. (According to our former dates, last night when these photos were taken was Twin Day for week 18.) It’s been about 6 weeks since we took our last belly shots. I’ve started the gallery below with a photo from week 12.

Click on an image to see the full image. Then, click on the full image if you want to see a larger version of the same image.

Another Thursday has come and is quickly coming to an end. On our former schedule, today would mark the completion of 18 weeks and our Half-Way Home Day. You caught that I said “former”? Yes, well, we’re in the process of possibly revising our dates.

During our last high resolution ultrasound by the baby-ninja at the end of February, our boys were a week and a few days ahead of schedule. On Monday, when we returned to the baby-ninja (and found out the gender of our twins), they were surprised that our regular Ob/Gyn hadn’t updated our due date.

So what would the new due date be? August 30th.

Plus, our twin day would be moved from Thursday to Monday with this past Monday marking 19 weeks (a jump of a week and 4 days). This means that we’d already passed Half-Way Home Day without knowing it, and this next Monday would mark the momentous 20 week mark. Soon, our boys will be crossing the edge of viability. (We still need to talk to our regular Ob/Gyn to see if they also agree with moving the date up to August 30th.)

Why Did We Get an Extra Ultrasound?

We got a call around the end of March to tell us that our babies were at a higher risk for Down Syndrome based on our second round of diagnostic bloodwork, and this qualified us for a follow-up ultrasound to check for other possible physical markers. Ah, that dreaded phrase “higher risk.” It can cover such a large range of territory.

I asked specifically what the numbers were, and they told us: 1 in 49. Now, that sounds like a pretty scary number. If your brain was already frozen by the phrase “higher risk,” it might even want to illogically jump to thoughts of a 50% chance of Down Syndrome. I mean…50%, that would be a pretty high risk. However, when doctors’ give you these numbers it helps to switch them into percentages. 1 in 49 is right around a 2% chance. 2% – not something to become extremely worried about. (Why are they higher risk? A couple of the proteins [HCG and another one] in my blood that are produced by the babies were higher than expected – even for twins.)

Still, we jumped at the chance to go in for another ultrasound because our birthing center had dismissed the baby-ninja’s recommendation that we start going in for ultrasounds every 2 weeks from 17 weeks until 28 weeks to watch for Twin-to-Twin Transfusion Syndrome (TTTS). We figured this was a chance to check for TTTS and to possibly learn our babies’ gender early.

Our Current Concerns: Twin-to-Twin Transfusion Syndrome

To start, let’s review some numbers. First, around 3% of births are twins. Of twin births, only 8% are identical twins, so identical twins are less than 0.4% of all births. That’s a pretty small percentage. What does this mean for us? For one, regular Ob/Gyns do not typically deal with a large number of identical twins in their practice.

Now, Twin-to-Twin Transfusion Syndrome (TTTS) occurs in 1 out of 7 monochorionic identical twin pregnancies, but it isn’t a concern for fraternal twins or that small percentage of identical twins who have completely separate placentas. I believe one reason why our diagnostic specialist took it much more seriously than the midwife we saw at our birthing center is because the birthing center is less aware of conditions specific to identical twins.

What is TTTS? Because our boys share a chorion and placenta, some of the arteries and veins responsible for circulating their blood and nutrition can become linked in such a way that one baby receives too much and the other too little. The one who receives too much has extra strain put on his heart, and the one who receives too little eventually becomes anemic and stops excreting waste. This can develop and become serious very quickly, putting both babies at risk. However, if caught early, there is a laser surgery treatment that is pretty effective at halting the escalation of the problem. This is why regular ultrasounds are so important.

What did we learn at our last appointment? First, our appointment lasted around 2 1/2 hours. We had a short consultation with a genetic consultant who explained why the babies were considered at higher risk for Down Syndrome (the 2 proteins mentioned above), and she offered us the option of amniocentesis again. We also mentioned our own concerns about wanting to check for TTTS while there if possible.

Then, we were ready for the ultrasound. We had the same technician as before, and she took lots of measurements and especially examined the babies’ hearts and bladders. After she finished, Dr. Hershey (the baby-ninja) came in, and together they looked again at certain aspects of the babies and examined the relationship between the two amniotic sacs. I must admit that when the big guy comes in and starts discussing your babies, it is a bit stressful. We couldn’t follow the relevance of most of their conversation, but we knew we just needed to be patient, let them do their job, and wait for them to talk to us afterward.

Dr. Hershey himself came in to do the follow-up consultation with us. We barely discussed the risk of Down Syndrome. First, he told us that both boys looked good, and they are still close in size. One was the size expected for 19 weeks and the other for 19 weeks and 2 days (I forgot to ask their specific lengths).

However, he stressed the importance of monitoring for TTTS. It turns out that Dominic (our lower-left twin) has less fluid in his amniotic sac than Alexander does. This, in itself, does not mean that they have or will develop TTTS, but it does mean that they should be watched closely. He cautioned us with a tale of a couple who were not having their twins monitored for TTTS and who lost both babies, but he also emphasized that TTTS is treatable if caught early. In fact, one of the places that does the laser surgery treatment is the UC San Francisco Fetal Treatment Center (You can visit their website for more information).

Our Next Goal: Our next appointment is Wednesday with a perinatologist, and our plan is to get her on board for regular ultrasounds to monitor for TTTS. I also rescheduled our next birthing center appointment for the following day with an Ob/Gyn (instead of a midwife), and we will be working to convince her of the importance of the TTTS ultrasounds as well. If need be, we will request that they call the baby-ninja to discuss why this is so important.

Our last appointment at the birthing center we were surprised by the midwife’s decision to ignore the diagnostic specialist’s recommendation with the dismissal that “Radiologists always want to do more scans,” and we didn’t immediately question that decision. After the appointment, that dismissal started to bother us more and more. Now, we will be going to our next appointments armed with more knowledge and prepared to hold our ground and question our doctors. Hopefully, with the baby-ninja’s renewed recommendation for this monitoring, we won’t even have to be insistent. Hopefully, the perinatologist and Ob/Gyn will already be on board.

Prayers and Good Wishes Welcome

Since our last appointment, I’ve continued coaching Dominic and Alexander on sharing blood and nutrition equally, and I’ve added that they need to balance the amount of fluid in their amniotic sacs. (Hey, it can’t hurt!) We welcome prayers and good wishes for the health of our little boys. We’re at least half way home now, and they already have a crib waiting for them.