Sunday, July 7, 2013

The Story ~ The End, Part 1 ~ Preeclampsia

... or rather the beginning. For every ending hails a new beginning and every beginning journeys to an end. It is an endless circle, seamless, constant, ongoing. Parts connect into a whole and the whole evokes each and every part.

It "ended" as abruptly as it "began." One day I was writing about bed rest, and the next day I was off of it. Just like that in a blink of an eye, or rather in the swelling of a foot, it was all over, or rather it all began. With no warning, no consent, no consultation. Just as it began on October 16th, it ended on February 20th

My pregnancy turned 36 weeks on Sunday, February 17th. I was moving around a little bit more but was still confined to our apartment. I had had my last visit to my maternal fetal medicine doctor at 33 weeks and was told I was in the “clear.” That meant that my baby’s survival chances are high should she decide to venture into the world early and that modern medicine can be employed to assist her in her early days should she need it. I was instructed to wean off Procardia, the medicine I was taking for pre-term contractions, and to stop it completely at around 34 weeks. I counted the days! When 34 weeks hit, I sighed relief; one less medicine to keep track of and chug down twice a day. Little did I know, though, that surprises lay ahead.

Procardia is the common brand name for Nifedipine, a calcium channel blocker. While it is primarily a blood pressure and heart disease medicine, it is also used to treat preterm labor in high risk pregnancies to slow uterine contractions. Since, like the heart, the uterus is a smooth muscle tissue and needs calcium to contract, Nifedipine is used to relax the uterine muscles and other smooth muscles of blood vessels throughout the body thereby slowing or stopping preterm labor.

In my case Procardia proved a success. Once off of it, though, things started moving pretty quickly. First, my contractions resumed. They were so often and so painful that many times I thought I was going into full labor. Luckily, that never occurred. Then, my weight spiked an all-time high: 160 pounds. I put on 10 pounds in one week. I was in shock and did not know what was going on. I wasn’t eating any more than previously but somehow my body managed to blow up and round up. I thought that maybe my metabolism has finally screeched to a stop and the inactivity of the bed rest has caught up with my body’s not needing any more food. At 35 weeks I started stepping on the scale before meals to check for the damage. I started eating less, too. But somehow I kept piling on the pounds.

At my 36 week appointment on Monday February 18th we got an unusual blood pressure reading ~ it was high. The doctor, however, did not seem very concerned. He dismissed it to the exercise I had just gotten walking up three flights of stairs; after all this was the most I had exerted myself in over five months. I was sent home with a follow-up appointment at 37 weeks.

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. If left untreated, it can develop into eclampsia, the life-threatening occurrence of seizures during pregnancy. While it is the most common of the dangerous pregnancy complications, apart from Caesarean section and induction of labor, there is no known cure for it. Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death.

"Severe preeclampsia" involves a BP over 160/110. That is the reading we got the morning of Wednesday, February 20th.

I didn't know anything about preeclampsia. It was something that happened to “other” women. I had already dealt with my share of challenges and of issues that happened to “other” women. A phone conversation with a nurse manager friend of mine, however, introduced me to the term “preeclampsia.” Of course, I dismissed her “diagnosis,” and filed the information away in the back of my mind. This was the afternoon of Tuesday, February 19th.

That evening when Jeff came home I told him what my friend had said about my state of being. He dismissed it as well. We thought nothing more of my rapid weight gain other than what we thought it to be: weight gain resulting from a sedentary life-style and a very pregnant belly. We continued to count up our blessings and down the number of days till this baby became full-term. But this baby never became full-term.

That night, I lay awake watching my feet blow up like a balloon. Call to mind if you can how Violet turned into a blueberry in the Willy Wonka and the Chocolate Factory and you can picture what I looked like the next morning. My eyelids were almost swollen shut and my hands were a giant round. My ankles had all but disappeared. Swelling or edema, especially in the hands and face, is considered an important sign for a diagnosis of preeclampsia. And I certainly was manifesting these signs. The transformation was remarkable and almost magical. It most certainly could have been instantaneous.

At 6:02am when Jeff stirred awake, we took photos of my swollen feet. At 6:43 when I could not bear waiting anymore, I sent the photos to my OB. At 7:15 he instructed me to call the office for an appointment. At 8:10 I was on the phone with Jeff asking him to rearrange his schedule. At 9:00 Jeff was on his way back home and at 9:15 we were on our way to see the OB. At 9:45 we were heading away from the doctor’s office. But we were not headed home.

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