Sunday, April 24, 2011

My Trans Abdominal Cerclage (TAC) Experience

This is way overdue, but I felt it was still necessary to write. I wanted to share with you all as well as anyone else who may be getting an abdominal cerclage in the future, my TAC story in detail.

A Trans-Abdominal Cerclage is a cerclage or band they tie around your cervix to keep it shut. I have an incompetent cervix (IC) that caused me to go into labor at 17 weeks with my first pregnancy. The weight of the baby was too much for my weak cervix to bear, so it started to funnel, then dilate. I then started having contractions and my son was born. On the second pregnancy, we had a vaginal cerclage to keep the baby in and my cervix shut. The doctor went in vaginally to place the cerclage through my cervix, like a purse string stitch. This works for a lot of women, but it didn't work for me. The weight of the baby was again too much for my cervix to hold and it began to dilate. Only this time, my water didn't break, the amniotic sac began to bulge out of my cervix and I went into labor, delivering my second son at 16w4d. The reason this didn't work for me was because doctors can only place the cerclage so high on your cervix, when they place it vaginally. It wasn't high/tight enough on my cervix to make any difference for me. The cerclage stayed in place and didn't rip through my cervix, it just slowed labor down a bit.

The TAC is different because they go through your abdomen (surgically) to tie the cerclage right at the top of your cervix. The material they use is so strong, that an 8-inch piece can support an adults entire body weight, so holding up a uterus with a growing baby doesn't even compare. Placing the stitch that high also means that the cervix is no longer a factor and won't/can't open. It's a permanent stitch and stays in place forever. When a woman is pregnant her cervix thickens and swells, so the cerclage is nice and tight- nothing is getting through it. But when a woman goes into labor or is no longer pregnant, the cervix goes back to normal size and there is a slight opening in the cervix. This opening is enough to pass menstrual blood as well as lets semen through if you want to get pregnant again. Because there is only an opening for fluids to pass through, all births are delivered via cesarean.

Now I live in Texas, but we flew to New Jersey to get the TAC done by Dr. George Davis, because he's an expert at it. There are of course about 100 doctors all over the US that have done a TAC at least once, but I didn't want to be an experimental case. I found Dr. Davis through my friends Becky and Jessica who had a TAC done by him several months prior. They both had success stories, so that brought me hope. Also when I googled "TAC doctors" his name kept popping up. There's also another doctor in Chicago- Dr. Haney, that does them quite often and successfully, but once I spoke to Dr. Davis on the phone, I knew he was the one.

Dr. Davis and I.

I nervously called Dr. Davis and left him a message. Within 5 minutes, he called me back and we spoke for over an hour on the phone. He answered all of my questions and I never felt rushed or like I was being a bother. He wanted to help us bring a baby into this world. We communicated by phone and email, sometimes up to 10pm at night. I asked about him and he said he's been doing TAC's for over 24 years! I don't understand why this procedure isn't further practiced or why it's so rare if he's been doing it for so long. I think most doctors are scared to do it, honestly. I mean, who wants to cut open a pregnant woman's abdomen?

We spoke several times on the phone and almost immediately he was ready to schedule a surgery date. That was scary for me, but it needed to be done. He tried to verify insurance benefits but my crappy insurance decided they weren't going to pay for it. So he offered to do the procedure at cost and only charged us the bare minimum- $600 for the anesthesiologist, $550 for the doctor, and $2750 per night for the hospital fee. There were no medication fees, operating room fees, etc. Although we were billed for the total amount after we got home (for over $13,000) Dr. Davis rectified that for us. We were supposed to pay the amount in full the day of the procedure, but they didn't accept AmEx so they billed us. While there in NJ, we paid the anesthesiologist and doctor fees in full.

My surgery date was scheduled for Friday morning at 7:30am. The night we arrived we went to Dr. Davis' office in Camden, NJ to fill out paperwork, check my weight, height, blood pressure, and to do an ultrasound of the baby. We were given the directions to Kennedy Hospital in Blackwood, NJ and to our hotel in the neighboring town of Turnersville. I was told to have a nice dinner but not to take any meds, eat or drink anything past midnight. And to be at the hospital the next morning at promptly 4:45am- no earlier. No problem.

The morning of the surgery, I showered and got ready to head to the hospital. Part of the reason we had to get there so early was to pay the bill, but since we had issues there, we went straight on into the day surgery waiting room. I filled out more paperwork there, then they called me back to the prep area, while Mr. H waited to be called back with me. When I was called back, I was met with a few different nurses. They checked my blood pressure, had me change into a gown and non skid socks, take off my clothing, any jewelery (wasn't wearing any) and take out all my piercings (only my ears, you pervs :-P). Another person came in to take a couple vials of blood, asked me a ton more questions, then put in an IV in my hand. Generally, I don't have issues with needles or getting IV's, but it REALLY hurt and started to swell. The maternity ward nurse thinks the person who administered the IV, went all the way through my vein, then back in where it should have gone, which is why it bruised and hurt so much. That could explain all the puffiness. After all that was done (30 minutes) Mr. h came back in to see me. He was with me no longer than 5 minutes, we hugged, cried a little bit, he gathered my belongings and then they walked me back to the OR with a metallic hair cap on. Classy.

The OR was freezing! I was asked to sit on the end of the bed and bend over so they could give me a spinal to numb my lower half. That stings a little, but I was more concerned with my butt crack flashing the anesthesiologist. Once that was done, I laid back and "relaxed" on the table. They strapped a BP cuff to my right arm which squeezed the bejeesus out of my arm and left me with broken capillaries, that looked like stretchmarks. I was awake during the surgery so they kept testing different parts of my body to make sure I was fully numb. Once I was, Dr. Davis came in, he and a nurse inserted a catheter and they cleaned off my abdomen and belly with orange gook. By this point, my gown was pulled all the way up and just covering my boobs, while the rest of my body was exposed. To say I felt quite vulnerable was an understatement. From my rib cage down, it was numb, heavy feeling and warm. From my boobs up, I was freezing. They put this air flow thing on my arms and across my chest which pumps warm air through them to keep me warm. It worked some, but my hands were still freezing and it kept expanding and popping up in my face. I wasn't bothered by it but the nurses kept trying to tape it down, which didn't work.

Anyway, I'm laying there, Dr. Davis shaves the top part of my pubic area, just enough to clear the way. I couldn't really feel or see anything but I could hear what was going on. Once all that was done, he began to determine where he was going to make his cut. He started to cut through my skin, then the fat, then down to the muscles. He said he doesn't "cut" through the muscle, he said once he gets down to that part, he separates it and moves it out of the way. Since I couldn't exactly watch, I'm not sure how all that was done, but I take his word for it. I didn't feel pain, but there was pressure and movement and you could sense that something was happening down there. As he was cutting through the nerves I kept getting weird pulsing sensations up in my rib area. I don't know how else to describe it, but it's kind of like hitting just below your knee and your reflexes pop your leg up. It was strange, because I didn't expect to feel anything. That happened for a few minutes then stopped. Once he was all the way through to the spot he needed to be, the curtain went up and I couldn't see anything but blue paper.

Both Jessica and Becky warned me about the intense feeling of pressure. And, I suppose, if you've had a c-section before, then you know that same sensation. He pushed my bladder, intestines, the uterus, etc, whatever was in the way out of the way. Except that it felt like he was fisting me and shoving my insides up inside my chest. I felt like he was stuffing a turkey, and I was the poor bird. That, to me, hurt. They tried to convince me that it was not pain that I felt, but just pressure, but I beg to differ. It hurt, to the point that I started to cry from the intensity of it all. I began to sob uncontrollably, so they gave me pain meds through my IV. Each dose only lasted about 10 minutes, so they gave me a few doses of that. Side effect from the pain meds- itchy face. All I wanted to do was scratch. At one point, all one nurse did was sit by my head and rubbed where I asked her to. She stroked my hair and tried to keep me calm and breathing, through the hysteria. Just when the pain subsided and I got a reprieve from the pain, it started back up. I can't blame him though, because he was doing what he needed to do.

I'm now to the point where he starts stitching me up. Again, I couldn't see or really feel completely what he was doing but I could feel the tension and he tugged on the string to tighten it as he sewed along each layer. Almost like I could picture what he was doing in my mind, but was blind to it all. Strange. When it came to putting my skin back together, he used staples. My belly looked like Frankenstein. Towards the end of the procedure, which lasted an entire 2 hours from start to finish, my spinal began to wear off and I could move my feet. I felt tingling in my legs too, which freaked me out because I just wanted him to be done. When he was done, he placed an adhesive over the staples, then he and another nurse wrapped this tight elastic band around my waist. It was kind of like an ace bandage, but huge and it stuck together with velcro. It helped apply pressure so things didn't jiggle around. I wore that while in the hospital, during recovery at the hotel and for about another week once I returned home.

They wheeled me to recovery, where I was for about an hour. In between sleeping and itching my face, they gave me meds to manage my pain- the same meds they gave me in the OR through my IV. Since it didn't last very long, they kept giving it to me every 15 minutes. Then I started to feel pain and they wouldn't give me any more since they were going to wheel me up to my room. They said the nurse up on the maternity floor would give me something. I waited for about 20 minutes in pain, then went to my room, where I waited another 20 for a nurse to come in and give me something. I was pissed. Mostly because I was out of it, and exhausted and hungry and wanted to see Mr. H. The whole time I was in surgery, he checked us out of the hotel, he ate breakfast then was waiting for me in the waiting room. At some point, I think Dr. Davis met up with him to let him know how everything went.

I was now in my permanent room in the maternity ward. Mr. H stayed with me there at the hospital on the pull out chair. It was tight and cramped, but it worked. I remember sleeping quite a bit, in between the nurses coming in and out to check my temperature and blood pressure. I got pain meds every 2-4 hours as needed. Since our insurance wasn't going to pay for the procedure or the stay in the hospital, we were only going to stay one night. I was in the hospital for a full 36 hours which the doctor thought was plenty of time. I ate a full dinner that evening and my doctor was irritated by that. He came in to visit me after I was done polishing off my entire plate of bruschetta chicken, orzo and orange cake. My nurses were supposed to put me on a liquid diet so I didn't over develop gas, but they didn't. Their fault, not mine, but I'm the one who paid for it in the end. I was majorly bloated and couldn't relieve myself. I was popping gas meds every few hours, but they didn't seem to help. The gas pain was intense- it caused a big portion of my pain and discomfort. Don't dismiss the gas pain- it's real. By nighttime, on day 1, I was walking. It felt like each leg weighed a thousand pounds, but I walked from my bed to the door and back- about 20 feet. I was encouraged and praised by my nurses with each step. I did this a couple times that night, just because I wanted to progress and I knew it would help in my healing. It was tough. Believe it or not, the walking helped with the bloating in my stomach.

By the next morning on day 2, I wanted the catheter out! It was irritating me and it still felt like I had to pee even when I didn't. I'd like to say once it came out, I felt relief, but I didn't. From then on, I had to get up out of bed and walk myself to the bathroom to urinate. That was quite frequently since I was still hooked up to the IV. Later that morning I was disconnected from everything. I ate breakfast, walked a little more, this time down the hallway and back with Mr. H. A nurse came in to remove the adhesive bandage and I showered. That was interesting because the bathroom stall was tiny and I was afraid of standing. The nurse brought me a chair to sit on but it hurt to sit so I didn't use it. The water hitting my belly stung a little bit, I washed from my hair down to my waist then Mr. H did the rest for me. I couldn't bend or twist without pain. It felt good to be clean, despite the discomfort.

Nurse Betty and I.

Later that afternoon, we were wheeled up to see Dr. Davis, by my nurse Betty- she was wonderful! He performed a vaginal ultrasound where we were able to see the cerclage and the baby. I wasn't smiling and happy and giddy as Dr. Davis thought I should have been, but I was. He said "it's okay to smile" so I did. But I was focused on what I was seeing. You see, all this time, I haven't been worried about the baby, I've been concerned with what my body is doing and wondering if it's performing as it should. I worry about the cerclage failing, or my cervix funnelling, not the baby. I know the baby is okay, it's me that screwed up. We got ultrasound pics and discovered that all was well, then went to chat with Dr. Davis in his office. All I can say, is the man is quirky and funny and has a major obsession with Diet Coke, but he is brilliant and when it comes to babies and the female body, he is serious and he means business. Perfect combination if you ask me.

Shortly after that, we were released from the hospital and drove to a nearby town to stay at a Summerfield Suites in Mount Laurel, NJ. We chose that place because they had a separate bedroom from the living room, as well as a kitchen. When we checked in, Mr. H requested a handicap-accessible room, which was helpful because the bathroom was slightly bigger, but they also had grab bars by the toilet and in the shower. And the toilets were higher than traditional rooms. That may not seem like a big deal, but after you have abdominal surgery it hurts to bend down that low. Having the toilet that little bit higher made it much more comfortable to sit and get up on my own. The grab bars helped with stability while standing.

Once released from the hospital, I was given a prescription for Percocet. I was to take it every four hours as needed. At first I did take it every 4 hours, then 5, then 6 etc. It made me drowsy so I slept quite a bit. I was also taking several stool softeners a day to help things along. Mr. H would get up early, go to the free breakfast buffet, then bring me back something. I was hungry but didn't have much of an appetite, so a bagel with cream cheese, maybe some fruit and juice was all I had. All I wanted to do was sleep and I did but it wasn't very comfortable. The bed was fine, I just couldn't get comfortable or was in pain. Getting out of bed was tough too. I don't think one realizes how many abdominal muscles are used to sit yourself up and get out of bed. It was agony at some points because the bed was so low. A few times, in the middle of the night, I just rolled myself out of bed and crawled to the edge to pull myself up, because no matter how I tried I couldn't sit up on my own. And I was/am far too stubborn to wake up Mr. H and ask for help.

On day 3, I got a special visit from Jessica and her family. I'll write more about that in another post, but it was great finally getting to meet her- she's a doll. It was also a welcome distraction from thinking about the pain. Seeing her and her new daughter was also a reminder that Dr. Davis works miracles.

Day 4, I was ready to go home! I wanted to be in my own bed in my home. I wanted to see Autumn again, I wanted to be around family. Later that night, Dr. Davis came by the hotel after his ballroom dance class (I told you he was quirky!) to check on me and remove my staples. I was afraid that that would hurt, but it really didn't. The staple remover looked like a pair of scissors, with a blunt end. There was a slight clicking sound as he removed each staple (19 total). A couple of them stung a little bit but it didn't hurt any more than removing a sticky bandaid. I had Mr. H take a picture of my incision with the staples still in- it's a little freaky looking. I then saved the staples as a souvenir :-) The incision overall was about 5-6 inches long. It's healed nicely and after a week or so all the bruising went away. I can feel the raised skin on my abdomen, but it no longer hurts.

On day 5, we flew home. That morning after eating breakfast on the way to the airport, I got sick. Luckily, we had just pulled out of the parking lot and were not on the highway yet. I opened the car door and left NJ a little part of me. I was more concerned about the stomach cramping while vomiting than anything else. It wasn't too bad and once I was done, I felt much better. I'm not sure what made me sick that morning because I haven't had any morning sickness or nausea this pregnancy. The flight went on schedule. I packed a small toddler pillow that I got from BRU, to place between my incision and the seatbelt. It added the cushion I needed without any rubbing or irritation.

For the first week, I felt burning/stinging on my skin on my lower abdomen. The nurses and the doctor said it was the nerves coming back to life. What was/is strange though is that most of my lower abdomen from my belly button to my scar, was numb to the touch. I could poke, scratch, pinch it and I didn't feel it. I could lean up against a cold counter and not feel cold. Some feeling has come back to my belly button and I can feel about an inch above my incision. Hopefully over time, I'll get full feeling back. But since I'll be delivering this baby via cesarean and they'll have to cut me again, this process will probably start all over again.

Also worth mentioning, is that the pain meds make you constipated. That's why I was taking stool softeners from day 1, but they weren't really working. I took a full 7 days for me to experience relief. That was baffling to me, because I kept thinking "where is all this food going?", but the truth was, it wasn't going anywhere. I tried to go many times, to no avail. I finally called my doctor once I got home and basically begged for a remedy for relief, because my stomach was beginning to cramp. It's amazing it took a week for that to happen, but it did. The problem solver? A large swig of Milk of Magnesia. Not very tasty but it worked within 9 hours.

2 weeks post-op I was feeling much better but still sore at times, and the incision was still tender. By week 3, I was feeling a lot better. Week 4 brought a whole new person and I felt normal again. Dr. Davis told me there were two rules to follow. 1). If it hurts, don't do it. 2). No driving til I was able to jump off the bottom step of the stairs with all my weight and it didn't hurt. That scared me because I didn't want to even try that. I didn't drive for 6 weeks post op because I didn't really have a need to. Mr. H has taken me to all my appointments and most days, I'm resting and taking it easy at home. It has now been 7 weeks since the surgery and I can hardly tell I've had my belly cut open. There are times when my abdomen feels heavy and I feel pressure on my cervix but it's no longer painful. I assume that's how it will be from now til the end of the pregnancy but that's okay.

So that's my TAC story. I hope it will help someone out there that needs this information. I tried to not leave out any details- for me, knowledge is power. And knowing as much as possible about something that no one else is talking about is beneficial. Even if it only helps one other person, I've done my job.

Saturday, April 23, 2011

P17 Injections and TMI :-)

I got my first P17 shot on Wednesday. I was a bit freaked out when I read the bottle and it said "insert deep intramuscularly". It was the "deep" that terrified me, and I fully expected for Nurse Betty to come in my room with a 4-inch needle to poke me with. Because of that, my blood pressure was slightly elevated, but the last few weeks it has returned to normal. Thank goodness, because that's one less thing to worry about.

Anyway, I'm not generally fearful of needles or shots but knowing that I have to get these for the next 17 weeks, I was worried about the pain/side effects. Since I was just getting an injection and not seeing the doctor, a nurse visit was all that was scheduled for me. I didn't even see my regular nurse because they were so booked up, but the nurse that saw me was really nice, gentle and understanding. I asked her if she wouldn't mind checking the heart rate of Baby 3, just to assure me that it was still alive and well and she did. Heart rate was 160 bmp. That's all I need to know to get me through another week.

Firstly, I thought the injection was going to be given in my rear. It was actually given to me on my hip, right below my waist line. I felt the initial poke of the needle (which was only an inch long) but that was it. The medication is pretty thick so I fully expected it to burn and it didn't. It has to go in pretty slowly and it took about a full minute to push it all in, but like I said, there was no pain. A couple hours later though, the skin around the injection site burned a little and was sore. It was like that the rest of the day, but was fine the next.

I don't really know what the side effects of P17 shots are, because I didn't ask, nor did I google them, but I have been a little dizzy- not all day and mostly at night. I also feel like I'm starving. Like I woke up NEEDING to eat because my stomach hurt and felt like I hadn't eaten in days. Also, and this is totally TMI: TMI ALERT: Stop reading if you don't want to know.... but it smells a little odd "down there". Not funky, not bad or smelly, not dirty, just odd. Like it almost smells...burnt. ha ha! I tried googling that but came up with nothing. I guess I'll have to ask my doctor about that on Wednesday when I go back in. If anyone knows anything about P17 injections and their side effects or has experienced this before, let me know.

Sunday, April 17, 2011

It's Official!

I am officially more pregnant than I've ever been. Actually, I reached this milestone on Friday but I'm just now blogging about it. It feels good, but I still don't feel like I'm "safe" yet.

Thursday night was a little tough for me. I was 17w1d, which is when we lost Sam. I remember going to bed at 2am, with a back ache and cramping. I soaked in the tub and felt better so tried to get past it. I didn't realize at the time it was contractions- now I do. At promptly 4am, I woke up with the worst cramps of my life, which I thought was gas. I tried to use the bathroom to relieve myself but it didn't work. I rocked back and forth for a few minutes, then my water broke and the toilet filled with blood. That was the beginning of my worst nightmare.

That was 4 1/2 years ago and a lot has changed since then. Obviously, the transabdominal cerclage (TAC) is working and holding up well, which is why I'm still pregnant today. But I couldn't help but think back on what happened that night, this past Thursday. I didn't want to go to sleep, so I stayed up til 4 am in bed watching Sex & The City 2. It was a good distraction. A friend of mine says I should try hard and not associate all the bad things that happened with Sam. And she's right. But that night, I wasn't thinking of Sam. Yes, I missed him- I miss him all the time, but I was thinking more of my own personal trauma and all that I went through- it just happens to be on the same day Sam was born. Does that make sense?

The next day, after a good night's rest, I was able to reflect on how far I've come. And to know that I am more pregnant than I've ever been before, made me smile. It makes me feel like this baby actually has a real chance of being born ALIVE into this world. I'm hopeful and feeling good. I've been going to the OB every couple weeks and baby is growing as it should and doing well. Seeing him/her on the screen and hearing the heart beating at 170 bpm is such a relief for me.

Starting this Wednesday I'll be getting progesterone injections. I'll be 18 weeks and will take them until I reach 36 weeks gestation. I think they're called P-17 shots, but they help in preventing pre-term labor. My doctor told me that once you go into labor there isn't really any good medications that stop it and the one that works better than the others, affects the baby's heart rate so it can't be given for very long. So basically, if I go into PTL, I'm SOL. And my insurance has already said that they won't cover a loss having if I go into pre-term labor. Nice huh? So getting these weekly injections is just a precaution, it's being proactive. My OB didn't think I really needed them, but the perinatologist recommended I start them since it couldn't hurt anything. I'm willing to do whatever it takes to bring this baby safely into this world.

That's all for now, bathroom is still taken apart but the walls are getting put back up slowly but surely. Still haven't had the plumber out because 2 of them were out of town and another had car issues. Hopefully someone can come out this week to fix the damn plumbing. We picked out some really nice travertine and glass tiles and the tile setter came out today to give us an estimate. Hopefully it will all be completed within a couple weeks. I miss my shower!

Sunday, April 10, 2011

16w4d and A (Tub) Leak

I am now at the same gestation that I was when we lost Jack. This coming Thursday will mark the day when we lost Sam at 17w1d. It's a stressful week to say the least.

I went to the perinatologist on Wednesday for a follow-up appointment and they checked on the baby as well as my cervix. My cervix was measuring about 4 cm, and was closed. All that's good news but I still have doubts this thing will hold as it should. It's just a scary time for me. I go back in to my regular OB on Tuesday so I'll be able to see the baby again. In the last few days I've been feeling pressure and have a feeling of heaviness in my lower abdomen and on my cervix. This all could be completely normal but I can't help but think otherwise.

In other news, our guest bathroom has a leak in the tub. I noticed water pooling outside the tub when I showered and just thought that I wasn't closing the shower curtain correctly, but yesterday I let the water run for a few minutes before I got in and there was a puddle of water on the floor again, even though the water was facing away from the curtain. the leak was coming through the wall. Our linen closet backs up to the shower so we pulled out blankets, and towels only to find there was mold and mildew on the sheet rock and under the carpet. Then I thought that we (read: Mr. H) should check the carpet and walls in the adjoining room, which is the living room, to see if there was any damage. And there was. There was mold on the lower part of the wall behind the media cabinet. All the mold has been cleaned up and I'm not allowed to go near any of it. The carpets are dry and as I type, Mr. H is tearing down the walls on all three sides of the tub.

I've decided all of this is merely a distraction so that I'm not thinking about the baby and I can concentrate on something else. But I feel useless because I can't help and while Mr.H doesn't want me in there, I think he's a little bitter about having to do all the work himself. He is fully capable, he is a handyman after all, but his parents are on the way to assist.

I'll update when I know something else.