Wednesday, January 21, 2009

Some clarifications

So, as I've been talking about this situation, some people are coming in late or don't remember what is happening or have (very kindly) been offering up possible scenarios. So here is a quick overview of my recent gynecological history and explanation as to why I am a giant case of 'What the fuck?!'

Going back to October and my previous pregnancy:
10.30 - 9w appointment with no heartbeat on doppler, b/w done to reassure after spotting.
10.31 - b/w comes back far too low, sent for u/s and find development stopped around 5w.
11.3 - repeat b/w to see if levels are naturally falling in advance of taking misoprostol to induce 'natural m/c'
11.4 - Take misoprostal. Pass some tissue and clots.
11.6 - Bleeding picks up, cramps increase in severity and remaining tissue/clots are passed.
11. 27 - Negative hpt and negative OPK
12.6 - positive OPK
12.7 - ovulation, confirmed by - OPK and temp rise on 12.8
12.17/18 - Negative hpt, small temp decreases
12.19 - temp drop back to coverline, brown spotting begins (normal for me in a non-pregnancy cycle, brown spotting on 12 dpo, period on 13 dpo/cd1). Take one more test to see negative, but is + instead.
12.20 - + hpt, red spotting, finally light then medium flow
12.21 - + hpt, heavy flow all day12/22 + hpt, medium to light flow
12.23 - spotting/end of period. beta =35, mw says it was likely chemical pregnancy
12.26 - + hpt (and + everyday until next beta)
12.27 - red spotting returns and continues throughout
01.02 - beta = 87. Spotting continues, sometimes heavier like a light to medium flow. Surprised beta went up, still not viable. Expect it to drop soon.
01.08 - beta = 495 (pass large clot this day and each of the next two days) Shocked by this.
01.12 - beta = 863 (still low, ectopic suspected)
01.11 - u/s shows normal pelvic u/s, normal lining, good ovaries, clear tubes, empty ute (pass another large clot and red spotting ends)
01.19 - beta = 2106 (spotting gone - lightly tan colored cm remains)

Please note that positive tests continued throughout. Please also note (which you know if you read regularly) that I have not had sex since 12/07.

Some of the possible explanations:

-Chemical pregnancy
-Miscarriage
-Blighted Ovum
-Ectopic pregnancy
-Late implanter/slow developer
-Vanishing Twin
-An early m/c followed by a second ovulation and resulting pregnancy
-Medication making the tests inaccurate
-Molar pregnancy
-Cancer (that one is really more thanks to Dr. Google)

So, some of those can immediately be discarded. New ovulation/pregnancy is not possible unless it's the Anti-Christ or I'm the Virgin Mary (I'm not the Virgin Mary). Chemical pregnancy is now out the window. Vanishing twin might have explained the bleeding but not the abnormal beta numbers and empty u/s. Molar pregnancy is likewise unlikely, given the clear u/s and low numbers. Cancer is highly unlikely, given the recently clean bill of health and clear u/s, and while I'm due for my annual Pap, my cervix has appeared fine and cervical cancer is unlikely to cause this rise in hcg. Likewise, I am not on any type of prescribed medication of any kind, and Tylenol/Advil doesn't cause this to happen.

That leaves miscarriage (which is probably inevitable, but clearly has yet to occur), ectopic pregnancy and a blighted ovum. After the u/s the mw discussed why she did not think ectopic was a concern. Primarily, she would have expected more rapid growth and that by 7w3d (technically by ovulation) she would have expected greater symptoms or something on u/s. Additionally, though I'd had some pain on the left side, it went away and was never severe. Also, my uterine lining was completely normal, not thickened at all (as one expects in pregnancy period, but is often seen in abnormal thickness in an ectopic pregnancy). Since that time, I have had no pain at all and the spotting stopped, rather than increasing. Nevertheless, it is still a possibility, and will have to be ruled out or I will have to have methotrexate (as I understand it).

A blighted ovum remains a possibility - they are usually discovered around this time, but of course the beta numbers and bleeding throw a kink in the works.

There is a possible explanation for the u/s findings - the tech told me (and research confirmed) that it is usually impossible to see anything when the levels are under 1000 - 1500. The fact that I had a full period and an additional 3 weeks of bleeding would explain the normal size lining.

A lot of people are asking when/if I'll get a second opinion or see an OB (or why I haven't seen one already). That part is easy. The midwife is consulting with her colloboration physician as soon as possible, which is tomorrow. Up to this point, there has been no reason to see an OB or get a second opinion. The same testing and procedures would have been done. Beta draws and u/s. The results are the abnormal part, not the care or diagnoses plan I've received. I've done a lot of research and have confidence inwhat we've done so far.

I am tired of this, which I think is obvious. It's drug on and on and on. A viable pregnancy would be somewhere beyond a medical miracle and would be something worthy of Vatican consideration, imo. It's pretty old at this point. I'm tired of the bruising and the other issues. I don't want to get intimate with the dildo cam again. I just want this to end.

1 comment:

JACQUELYN said...

gosh girl, I am so sorry you are going through all of this. I hope and pray that you get the answers VERY soon. Stay strong. :)