18 weeks with baby #3: This has been a hard week

This week has been…hard. Very, very hard. Emotionally. Physically.

Sunday: 18w0d

Sunday morning was day 2 of the new blood pressure medication, Procardia. I had a slight headache that started that morning. Chris, blessedly, found the small pack of adaptors I needed to get the blood pressure cuff connected.

I took my blood pressure at around 4:00 that day and it was 145/94. Fuuuuck.

So I called the on-call physician line and it was actually my doctor who answered. He told me to take another 30 mg of Procardia and recheck it in a few hours.

Later that evening, at about 9:00 I rechecked it, and was measuring 150/93. I checked again five minutes later and it was 147/96. I called him back and he said he thought I would be okay tonight, but that I needed to be worked into the schedule tomorrow to be seen. “We need to get this under control,” is what he said. 30 mg was a low dose and 60 was more of a maintenance dose, so we may have to do some adjusting.

Which was really unfortunate, because this is the best I’ve felt during this pregnancy. I’ve only had a few instances of wanting to gag when I walk by the garbage or something, but overall I feel like things have been improving so much in that department. My appetite even feels like it’s coming back and I can eat more than just cheese and carbs. That Sunday night I even made Olivia’s absolute favorite meal, shrimp fettuccine alfredo.

Monday: 18w1d

I called the office in the morning. I spent in the night in a state of, I don’t know what to call it, grimness? I wasn’t externally freaking out, but I felt really unsettled. My headache persisted the rest of the evening and overnight. I woke up in the morning and immediately my head was hurting. Headaches from high blood pressure or preeclampsia for me have always felt different than normal headaches. These are dull throbbing headaches that wrap around my head by my temples. Coupled with the fact that I was feeling the baby moving less, I couldn’t help but feel like a time bomb.

I don’t know if it was my imagination or what, but the last time this happened with Emelia when my blood pressure spiked at 34 weeks, she had stopped moving.

Now, I know I’m only 18 weeks and it’s common for babies not to be moving consistently. I know that, but try telling my brain that.

Anyway, I called in the morning and was set up for a 1:30 appointment with my doctor. It didn’t help that this was the heaviest week of work I’ve had since I found out I was pregnant. I was working on an article, wondering how I was going to get it done now that I had a sudden doctor appointment pop up, when about noon I received a call from the clinic.

Seeing the clinic’s name on my screen made my heart sink. It meant one thing and I answered and they said he was called to a birth – did I want to see one of his PAs?

“Nothing against them,” I told them, “But for this, I’d really prefer to see an MD.”

My new appointment time was 3:45. Which was good because it gave me more time to try and complete this article that was due today, but bad because that meant surely driving home in rush hour.

So I got to meet one of the other two new doctors that joined his practice. I still had the headache and my blood pressure was 154/94. She said preeclampsia at 18 weeks would be extremely rare, but she wanted to check my labs and urine anyway, even to have a baseline for future labs. She also wanted to check my TSH because while it was still in the normal range, it was on the high end and she wanted to make sure it wasn’t creeping up.

I also got up on the table and she checked the baby’s heartbeat which was in the 140s/150s and everything looked good there. She wasn’t concerned about the lack of movements and that that can still be normal this early.

Then she recheck the blood pressure and it was 129/81.

Are you kidding me?

I’ve never come close to that blood pressure since I’ve been pregnant. While I sat waiting for someone to come to do my labs, I texted Chris, telling him that I was frustrated because there’s no rhyme or reason to have blood pressure like that when literally all of them have been high. I just felt like it negated the concern about what was going on.

After getting that good blood pressure reading, she told me she didn’t want to make any changes to my protocol because she wanted to give it a few days to see if it trends down. Which I was vehemently opposed to, but what choice did I have? The data right there was showing some promise. “Maybe it’s heading in the right direction!” she said brightly.

Okay, I said, but what do I do tonight if it’s high when I check it?

She said to call if it was over 150/100. Which…still wasn’t okay with me to have that high of a number when I’M ON BLOOD PRESSURE MEDS.

That night my blood pressure came back as 159/93. I called the on-call doctor and got my doctor again. No, he said, take another dose of Procardia, that’s too high.

That evening I needed up taking some Tylenol, my first of this pregnancy and it helped my headache.

Tuesday: 18w2d

The next morning I no longer had the headache, but my blood pressure was still 146/89.

I got a call from the clinic, the PA I usually see. My thyroid level looked good. My labs were all clear except my liver enzymes were elevated. In fact, she said they were “very high,” but she didn’t want to speculate on anything, just that she was going to refer me to gastroenterology for a workup. “Because you’re pregnant, we need to figure out what’s going on.”

She too was concerned about my blood pressure readings and said to call in the morning with what they were. If it was significantly elevated again tonight, I could call again or I could just take another Procardia.

That evening was Olivia’s holiday concert and I was distracted when I got back to the dinner table with the kids discussing the upcoming concert and all I could think of was

high liver enzymes

GI referral

“Because you’re pregnant, we need to figure out what’s going on.”

I’m feeling…defeated. And overwhelmed. Work was insane. Two holiday kid concerts. Their holiday parties this Friday that I still wasn’t ready for. A baby not moving much anymore. Uncontrolled blood pressure. Was the baby reacting to that? There’s something wrong with my liver. Preeclampsia also affects your liver. My liver was also affected by some of the blood pressure medications I needed to be on postpartum last time in order to stabilize me. What’s going to happen now if the same thing happens?

I swapped out wanting to throw up 24/7 to now feeling like my life was quite literally in danger.

That night my blood pressure was 158/99 and I didn’t bother calling the on-call line. I just took another Procardia dose.

Wednesday: 18w3d

Wednesday morning, my blood pressure was 160/88 with a pulse of 120. I told Chris after I had taken it that I felt like every time I checked my pressure, I got a headache. He thought maybe my headache was always there, but I was distracted with work and trying to get articles submitted that I didn’t notice until I stopped to check my BP, and then I felt it.

I called the clinic and requested my message about my continued high blood pressure be sent to my doctor. No one else. I wanted MY doctor to review it and advise me. After all, I hadn’t seen him or anything since I was 7 weeks. Everything else has been handled by one other MD and three PAs.

My usual PA called me back a few hours later. She apologized, but he had been called to a birth. I told her I was wondering if I should just go back on the labetalol even though I didn’t like how it made me feel. But the Procardia is quite literally doing nothing. If anything, it’s making my pressures creep up. I told her I’d been searching the internet and I can’t find anything about Procardia having the opposite effect and increasing my blood pressure.

No, she agreed, it’s not typical for this to happen. She told me to go ahead and take a 200 mg tablet of labetalol now and then another pill that night. Tomorrow, I was to start 400 mg twice a day, double the dose I was originally taking. No more Procardia.

It was a rough rest of the day. I had deadlines, but also just couldn’t stop thinking about the blood pressure, the baby, and hey! this weird new liver issue.

I can’t predict the future. And my therapist is always telling me that my worrying about the future won’t actually prevent or change anything. But there are also facts that can give a sense of direction about how this is going to play out. Of course, I don’t want to get preeclampsia again or have a premature baby.

But odds are, I will get preeclampsia. I will give birth early. The question becomes, how early? And how severe?

How much can I protect this baby?

I’m still not feeling many movements. Maybe 1 or 2 times a day I’ll feel what I think is the baby. Prior to the blood pressure medication change, I was feeling lots of movements. Not consistently or strongly being that I had an anterior placenta, but they were there. They felt normal. This doesn’t feel normal.

On the flip side, what can be done? You can’t save a baby at 18 weeks. If anything was wrong, if the baby really is being affected by these pressures, there isn’t anything to be done about it. Except, of course, getting the blood pressure back under control. So requesting an ultrasound, what good could it really do?

Right after dinner, and before we started getting ready for holiday concert #2 with Emelia, I locked myself in the bathroom, sat on the toilet and sobbed until one of the kids knocked on the door and could I please put her hair in a ponytail?

Thursday: 18w4d

Thursday morning, we woke up to a snow day and I took 400 mg of labetalol. About two hours later, I started feeling that weakness and shakiness I felt the first time when I went on it. But my blood pressure was measuring 136/79 with a pulse of 106. It’s much better and I hoped my pulse would start trending down.

That night my BP was 130/76 and my pulse was 82.

Since then, on the 800 mg a day dosing, it’s been holding stable. My systolic is still higher at times than I would like, getting into the 140s, but the lower number is still good.

I feel 98% normal. No more nausea. Barely any gagging. I have my appetite back and can eat deli sandwiches (don’t worry, they’re steamed first) and carrot sticks for lunch instead of pizza. I can now make fried eggs and fruit in the morning instead of toast.

There are a few ups and downs. Saturday I took a three-hour nap in the afternoon for whatever reason and my pelvic pain can suck big time, but it’s more mental – what I’m feeling this week.

I ended up getting all the work done I needed to and was supposed to be off the rest of the year, but decided to take on two more assignments the last two weeks of the year and both of them require two interviews with doctors. I’m not even going to see payment this year for them, but I’m worried about affording three kids so that $800 can help.