31 0/7

We have had a very nice Memorial Day weekend at Marika's place. We got to her place on Friday afternoon, I think that Chris and I were both a bit nervous that night. But everything has gone fine without any complications. I certainly am getting kicked all the time!

On Sat, Chris and Marika did fun housework around the house while I hung out. The weather both Sat and Sun was phenomenal- in the 80's in the sun! I'm glad that I had my sister mail me my few pairs of maternity shorts, it's hot here! We've spent much of the days on Marika's patio, soaking up the sun. We've also broken out the grill, and Chris grilled steaks and veggies on Sat, and Marika treated us to some Alaskan salmon on the grill, which her mom had caught.

I think I'm finally getting someone used to the sunlight here (today: daylight is 4:39 am until 11:18 pm). I am finally able to go to sleep in broad daylight and not wake up in the morning until it's been daylight for several hours. I haven't had a chance to see much wildlife yet, but I swear on Sat night I woke up to a clip clopping sound going down Marika's street, which was likely some moose roaming the neighborhood.

Tomorrow I have a follow up appointment with my new ob here in Alaska. While I did put in a referral to my PMD on Friday afternoon, I give it about a 75% of Blue Cross Blue Shield being annoying and sending me a bill for seeing someone out of network. Apparently with our health insurance, we're allowed to see people for emergencies out of state, but for routine things (like ob visits), I'm supposed to see someone in state. When I spoke with BCBS on Friday, they did admit that this was somewhat of an unusual situation (nice of them to concede that!), so I guess we'll wait and see.

30 4/7

The big news today is that I'm being discharged! I went for my 3 little walks yesterday without any incidents, and all the fetal heart tracings look fine, so they're springing me from the joint. When my doctor asked me this morning if I felt ready to go today vs Tues (the joys of the long weekend!), I started crying and couldn't decide, so she pow wowed with the perinatologist and reviewed my ultrasound. The residual small areas of blood are quite small (1-2 cm in size) so they feel like it's pretty low risk for me to go. My friend's house is just about 10 min from the hospital, so I can always come back over the weekend, if anything changes.

So I am very excited to get out of here, hang with Marika's dog, and sit on the patio and get some vitamin D.

Also, my sister made this webpage more fancy, so now you can subscribe to these blog postings, if you'd like. I know reading these postings is without a doubt the pinnacle of everyone's day. :-)

30 3/7

We had an uneventful night yesterday, with the exception making the mistake of watching the Celtics game. Chris and I got 2 exciting packages yesterday- we got our laptops mailed to us (yay!) and a care package from my sister, so that was a nice diversion.

I'm still struggling somewhat with the time zone change and incredible amount of sunlight, so my sleep is off. I woke up at 5 am Alaska time, but the nice thing was that I had about a million emails and facebook comments waiting for me, since most of you had been up for hours! I really do appreciate all the notes.

The covering ob came by, and it's still not clear as to whether I can leave the hospital tomorrow, possibly not until after the weekend. But I'm just trying to take it day by day. Sounds like when I do leave, I'll need to be on bed rest for several weeks. I know that there is very little evidence that bed rest actually changes outcomes, but when that's the advice I'm getting from my doctors, it's kind of hard to go against it, in case anything does go wrong.

Then the neonatologist stopped by to say hello. Apparently the NICU here is 48 beds with 7 NICU attendings, with one in house 24/7. So that was good to hear, although I'm still hoping that we can avoid using the NICU. Assuming I am able to go full term, I asked him when he thought it would be safe for me to fly home with a newborn. His feeling was that I could pretty much go home as soon as I wanted, which was nice to hear. I would like to hear from any other pediatricians out there reading this what their opinion is on this matter, as this not an issue I run into on a daily basis in Adolescent Medicine.

The best part of today was when Chris wheeled me over to the Hickel House which is for patients and familes from out of town. It seemed really nice, and might be a good option for a place to stay for the next few months to weeks, since it's looking pretty definite that I'm here until I deliver. The nice part was that I got to go outside for about 20 seconds, and it was sunny and warm! And the walk there was quite beautiful- he pushed me through the hospital's sky bridge, and I had a gorgeous view of the mountains. So it was nice to at least have that temporary change of scenery.

Also, Chris bought a connector cable for my camera to my computer (didn't bother to bring it with me to Alaska), so if you're really lucky, maybe I'll even upload the 3 pictures I took before getting hospitalized, and perhaps a nice shot of my hospital room as well. :-)

Seeing different sites of Alaska than we had anticipated...

Hi everyone,

I am starting this blog as a way to keep people updated. Not that people are so fascinated with my life, but it's hard for me to remember who I've told what, so thought this would be an easy way to do it.

First off, the important info is that I'm still pregnant (30 2/7 weeks today), the baby seems to be doing fine, and I'm doing fine.

Chris and I had planned to come visit my friend Marika in Alaska for vacation at the end of May. We made these plans before I knew I was pregnant, and once I knew I was pregnant, my ob said it should be fine anyway. We had planned a relatively tame vacation, just to be safe. Marika did a great job of putting together a fantastic itinerary, and I had actually checked to make sure that we didn't go anywhere too remote, and that there would always be a hospital nearby, in case anything did happen. But with the exception of some morning sickness and constipation, I had had an extremely uneventful pregnancy, and even had my routine ob appt 5 days before we left, and got the all clear to go.

We arrived in Anchorage on Sat. It was a beautiful sunny day, and the flights were completely uneventful. We went with Marika and her dog Dakota on a nice, non-strenuous walk through one of the beautiful parks in Anchorage, and then drove up into the Chugach Mountains (very close by!) and had an absolutely gorgeous view of downtown Anchorage and the surrounding water. Chris and I even made it up until 9 pm that night, and went to bed while it was still light.

I woke up in the middle of the night multiple times to use the bathroom, as I do these days, and at 2:30 am discovered I was bleeding. I called my ob in Boston, who told me to go to a hospital to be evaluated. Marika drove us to the Providence Alaska Medical Center, the biggest and best hospital in Anchorage. I was promptly admitted to the ob service for observation. That was probably one of the scarier mornings of my life. But the bleeding stopped quickly, and except for the annoyance of getting IVF @ 125 cc/hr so needing to get up to pee even more frequently and being hooked up to continuous fetal monitoring so not really able to move, it could have been much worse. This didn't happen while I was on a plane, this didn't happen in a remote area of Alaska, and everything seemed stable-ish. However, the big shock was the news that I might be hospitalized for weeks and then eventually be stuck in Alaska until after giving birth, which I am still hoping won't be until near my due date of Aug 2.

On Monday, I was evaluated by a perinatologist, who did a very thorough and fancy ultrasound. The good news was that I did not appear to have a partial abruption, which is what I was afraid of. The cause of the bleeding was not 100% clear. The perinatologist actually thought that the flight in might have had a role. Apparently commercial airlines do not pressurize their cabins as much as they used to- they used to pressurize to 5000 feet but some are more like 9000 feet, and that sudden change in pressure could potentially have made it more likely for me to have a small bleed. I only wish I had known that ahead of time! But at the same time, during this pregnancy, I have flown to CA, IL, FL, and Toronto, without any difficulties. The other theory as to why I might have bled is that I might have vasa previa, which is not something that you can tell on ultrasound, unfortunately. But Monday continued without any new bleeding, I was off IV fluids, and only being intermittently placed on the fetal monitor.

Tuesday more or less the same, but they did finally let me take a shower sitting down and walk out of my room, which was pretty exciting! And I was officially beta complete, as well.

Today, I was allowed to take a shower standing up and they want me to get up around the unit at least 3 times today, and see if I still don't have any further bleeding. If all continues to go well, there is a slight chance that I could be discharged home to Marika's place (not home to Boston!) on Friday, but it all depends on how the next few days go.

So that's the medical update.

Outstanding issues- will I be able to go home to Boston before I deliver? Unclear at this point. There is maybe a tiny chance that I could consider it at 34-36 weeks, if all continues to go well. I am at risk for premature rupture of membranes, due to the bleeding, but that wouldn't be quite as big of a deal at 36 weeks as it would be right now. But I think that's pretty unlikely at this point that I'll come home before I deliver. If it is vasa previa, I would not want to be on a plane if something bad started to happen.

What about Chris and my jobs? Chances are I wouldn't be able to go back to work, even if I were back in Boston. Since I'm technically on vacation this week, I've decided to not really let myself worry too much about this one until next week, when I would have gone back to work. My guess is that I'll probably have to go on disability and that my fellowship will be extended beyond July 2011 (ACGME rules are hard to get around!). But that certainly is not the worst thing in the world. Chris will likely return to Boston for a while, and then return to Anchorage when my due date approaches.

Where will I live for the next 10 weeks? Poor Marika got more than she bargained for when we decided to come and visit her! Although I could keep her dog Dakota company while Marika is at work... It sounds like my family though will play a bit of tag team and come up and visit me at various times, and try to rent an apt or something for the summer, so that way Marika doesn't have to put up with us for the whole time!

Aren't I worried about getting my healthcare in a location other than the Medical Mecca of Boston, MA?!? In a word, no. The doctors and nurses here have been absolutely wonderful. The hospital I'm at has a level 3 NICU, and they do everything except ECMO, and if we need ECMO, we're in trouble anyway... I was joking with my nurse that people in Boston would be concerned if I were getting my healthcare in NY, because clearly no place is as good as Boston! So I really have no worries about this. And it sounds like I lucked out with the ob that was on call when I came in, my friend's friend knows of her and says she's one of the best in Anchorage. But I have to say that it is a wee bit ironic, because I intentionally chose my ob in Boston because she delivers at Brigham and Women's Hospital, so much for my planning! When I was a resident, I rotated through the delivery room at Mt Auburn Hospital, which is a very nice hospital in Cambridge with a LOT of yuppie parents, most of whom have "birthing plans." We joked that having a birthing plan was a surefire way to guarantee that things would NOT go according to plan. I didn't have a birthing plan, but clearly even trying to choose with hospital/city/state I would deliver in was more than the gods were willing to let me do.

What about everything else that has to be done at home?!? I miss my kitty very much, and it makes me very sad that I might not see her until August. Fortunately, she is happily staying with Chris' mom, and probably doesn't miss me one iota! My family has been absolutely wonderful with dealing with outstanding stuff- my sister Kristin went to our place and got some things to my dad, who shipped them to us here. Kristin also went to Pottery Barn to pick up the rug for the nursery that we had ordered, and dropped off the glider rocking chair and other things that friends have loaned to us. But I'm learning to let go of some of the little details- if I don't get the pictures up on the wall before the baby is born, no big deal, because frankly he won't notice either way! And they've been helping out in a million other ways, too many to go through in this blog.

Anyway, that's the update. I am hoping that as time goes on, perhaps I'll have something interesting to say. Otherwise, it might degenerate into review of the Law and Order and Fresh Prince of Bel-Air re-runs that I've been watching on TV...

One last thing- I would just like to say how wonderfully nice everyone has been in Alaska. One of Marika's friends lent Chris their car, so he can drive to and from the hospital to visit me. The nurses and nursing aides here have all been so incredibly friendly and helpful. And even though we were beyond the cancelation policy for pretty much all our reservations here, almost everyone is giving us a full refund, once they heard our story.