Surgery

It has been a crazy and exhausting 48 hours, but we are home now and enjoying the Red Wings/Maple Leafs alumni hockey game while relaxing! This will be the first new years eve in a long time that we haven't done anything, but we are totally fine with that!

We arrived in Ann Arbor around 6ish on Sunday night, and we had a great experience there from the very beginning. Our doctors and the surgery team had prepared the weekend nurses to be ready for us, to draw my preop labs right away when we got there (so there would be no delays on Monday morning for surgery) and even to put us up in a nice room with a full-size bed on the labor and delivery floor for Sunday night. Once we got settled in, they told us we were welcome to go wherever we wanted, so we went downtown to grab some dinner (and a beer for Nate) before we headed back... :) We got as much sleep as we could that night, but we were pretty anxious for Monday morning.

We checked in bright and early at 6am on Monday and we were brought to our room in preop holding on the L&D floor, where we got LOTS of attention from tons of different nurses, doctors, the CNS with the fetal surgery team, and others. We also met our doctor, a maternal fetal medicine specialist, who spent tons of time with us and was just wonderful in explaining exactly what was going on through the entire morning. We really appreciated this because our nerves (or, at least mine) were a little out of control, knowing that one or both babies could pass away during the surgery. After she had a chance to do a quick ultrasound to see what was going on with her own eyes (everything looked the same as it had the week before), we rolled down to the preop area on the 4th floor (the main surgery floor for the children's hospital). These ORs are bigger than the typical L&D OR (where they normally mostly do c-sections) and have more camera capabilities. This is where I met two of my anesthesiologists and some other people like the circulating OR nurses. After my IV was placed and fluids were running, I kissed Nate goodbye and they wheeled me to the OR, which, by the way, is a much scarier place when you're the patient! Lots of people were waiting for me and they all did such a great job taking care of the babies and me before and during surgery.

This is where I admit that having an epidural placed is not nearly as scary as I had made it out to be. My doctor talked to me about running, spinning, Holland, Dutch people, and tons of other things while the anesthesiologists worked hard to place the epidural, and before I knew it, it was in. Did I mention she was great?

A couple people (nurse friends) asked me what they give you for anesthesia and sedation when you're pregnant... the answer is, some really good stuff! Lidocaine, fentanyl, and propofol made me really sleepy, really numb (such a weird feeling), and allowed me to sleep through the entire surgery. The CNS who works with the fetal surgery team had gotten Nate's cell phone number before surgery and called him 3-4 times during the case to update him on what was going on. Nate then updated our parents and sisters, which was super nice since they weren't there with us. One cool thing about the surgery was that the camera was right in there next to the babies, so they took some cool pictures for us (unfortunately, we didn't get to see much more than feet.) I don't know anyone else who has a cool picture like this before their baby's born...

Nate met us back up at the L&D prep/recovery area, and we met with the doc. She was thrilled at how the surgery had gone, and she informed us that she and the fetal surgeon had identified and cauterized 27 potentially problematic blood vessels, which is a lot! (Which probably explains why the surgery took about 3 hours as opposed to the expected 2). Once I could feel my legs, I was taken to my new room in the high risk OB area. I was monitored for contractions for probably the first 6ish hours, but I wasn't having anything more than minor contractions (irritability from the surgery).

A resident came in to do a quick ultrasound not too long after we got to our room, and we were just so thankful to be able to see two little hearts beating away on that screen! I'll spare you the incredibly boring details of the rest of our day/night yesterday; we both ended up getting about 7-8 hours of sleep last night which was more than we expected!

This morning we woke up and had another (more comprehensive) ultrasound. They looked at the babies' fluid levels, bladders, and blood flow, just like they have with our other ultrasounds. Everything looked stable, and Baby A had a normal amount of fluid around her (4.6cm) because they were able to drain some of the extra during surgery. Baby B's bladder is still invisible and she has very little fluid around her, but the doctors had all warned us that it would take some time (weeks as opposed to days) for things to normalize. Basically, we got the most positive news that we could for day 1 post-op, and we are so so so thankful! We met with the doctor again, who warned us to remain guarded, but who seemed very optimistic about the outcome of the surgery.

We will go back next week Wednesday for another ultrasound. Until then, and until further notice, I am on strict doctor's orders to restrict my activity as much as possible (she didn't call it "bedrest," but from what I gathered, it basically is.) No work, no cleaning, no shopping, minimal walking, etc. Since they made an incision in one of the amniotic membranes, it is weak and at a high risk for breaking and putting me into preterm labor.

We made it home by 2 today, and Nate has been taking care of things while I rest on the couch. I am incredibly sore (who knew a 1cm incision could hurt so much) and tired... I'm thankful we can rest together tonight and tomorrow before Nate goes back to work.

Thank you all again SO much for thinking about us and praying for us over the past 2 crazy weeks. We have made it past a major hurdle, but we are not out of the woods yet. Please continue to pray that our babies will tolerate the changes in blood flow, that I learn to take it easy over the next while, and that my water will not break.

Love,

The Vander Ploegs

Fetoscopic Laser Photocoagulation for TTTS... Wow, that is a mouthful!

Several people have asked about the surgery on Monday and what it entails. I thought I'd fill everyone in all at once...

The truth is, after hearing about how "minor" this surgery is, I would think it was no big deal if I was sending a patient down to have it. However, being the patient this time (and also having two precious lives that could be affected as well) makes it a lot more scary. This experience will definitely change how I look at patients when they are going for a procedure that seems "minor" to me. No matter how small, procedures are scary, especially when you've never been through it before. (And all the risks of the surgery that they HAVE to tell you about are extremely overwhelming, even if you know the risk is very very small.)

Anyways! The doctor we met with at U of M did a wonderful job of explaining the surgery and answering ALL of our questions, and she even gave us her phone number in case we thought of more. She will not be the one performing the surgery on Monday, but it will be another member of her team, who we will get to meet either Sunday night or Monday morning. I will be checked in at 6am on Monday morning and have an IV put in so I can receive a preop antibiotic and fluids/sedation meds during the surgery. They'll also give me some meds to prevent contractions while they're messing with my uterus and all that good stuff. I will then have an ultrasound so they can get a good picture of both babies and where their umbilical cords enter the placenta. I will then be taken down to the 4th floor (I assume this is the main OR) of the children's hospital, where I will be met  in the OR by 3 anesthesiologists, two surgeons (the maternal-fetal medicine doctor and a fetal surgeon), several nurses, and lots of people, like med students and residents, that just get to watch. The joys of a teaching hospital!

For some reason, the next part is the scariest part! The epidural or spinal (not sure which). After my last post, I got some good advice from lots of people, mostly just to try to relax and take deep breaths. I talked with a nurse yesterday who is on our case who said that there will be a nurse in the OR whose job it is just to distract me while this happens. That's encouraging! I'll be happy when that part's over. The anesthesiologist will also give me some meds through my IV to make me sleepy... the more, the better!

After the epidural is in and I'm good and numb (and hopefully sleeping), the procedure will start. They'll make about a 1cm (I'm guessing) incision through my abdominal wall, uterus, and amniotic sac of baby A (since it's bigger). They'll put in a tiny camera so they can look at all the blood vessels in the placenta. The first hour or so of the surgery will be spent just mapping out these vessels and coming up with a plan. Once they know what they're going to do, they'll use the same incision to insert a laser next to the camera. This laser will be used to cauterize the blood vessels that connect the two babies.

A little background... ALL twins that share a placenta share some blood vessels.The problem with TTTS is that they do not share equally. Normally, doctors would not have to intervene and cauterize the connecting blood vessels, but in our case, they need to stop the blood that flows unequally from Baby B to Baby A.

Once they are done cauterizing the connecting blood vessels (or at least all the ones they can see), they will drain some of the amniotic fluid from Baby A before they close me up. (Why not... they're already in there anyways, and it's not good for her to be swimming in so much fluid).

Obviously, my description of the surgery is if everything goes perfectly as planned. As you can probably imagine, there are plenty of risks to opening me up and poking a hole in the amniotic sac. We are praying that everything goes as planned and they're able to get rid of the culprit blood vessels so that our babies can grow and develop normally!

I'll have to stay in the hospital until the next day, at which point, if all goes as planned, I will have one more ultrasound and then be discharged. My care will most likely be transferred back to Grand Rapids at that point, but we are going to be very busy with appointments and ultrasounds for the next while.

Thank you again for praying, and keep it coming! I'm going to make Nate take his turn and update this thing when I get out of surgery on Monday.

Love,
Sara & the Girls (and their Daddy too)

The Plan...

First of all, thanks for thinking and praying for us this last week, and especially today.

Our appointment started with a VERY long ultrasound, which took about an hour and a half. I don't know if you know this, but pregnant people aren't supposed to lay flat on their backs, because all the extra weight in your abdomen can press down on the blood vessels, blocking blood from flowing back to your heart. If your heart can't get blood, it can't pump it out to the rest of your body, and your blood pressure drops. Pretty sure this happened to me about 10 minutes into the ultrasound. Not only did my back hurt, I was nauseated, hot, dizzy, and miserable. After multiple position changes, extra pillows, taking my top layer and my boots off, a dose of Phenergan, and a cold washcloth on my face, I felt much better and we could continue. Both babies were really active during the ultrasound, Baby A moreso than Baby B because of her large swimming pool of amniotic fluid she has to move around in. (Not good, but still kind of fun to see her flipping over again and again.)

The doctor came in before the ultrasound tech had even left the room and told us we had a lot to talk about... which was no surprise to us. She gave us more information about monochorionic (one placenta) twins than we ever knew there was. She then talked about twin-twin transfusion syndrome, which she agrees is what we have. She went through all the stages and possible interventions. Our babies are in stage III according to our ultrasounds. This means there's an unequal amount of amniotic fluid between the two -- Baby A having too much and Baby B having not enough (stage I), they are unable to identify the bladder in the donor twin because she's not making enough urine (stage II), and there is MILD abnormal blood flow through some key blood vessels in the donor twin (stage III). Thankfully, the recipient baby is not yet showing any evidence of heart failure/fluid overload, which would put us in stage IV. To put this all in perspective, the doctor today told us that if we chose not to do anything to treat the TTTS, our babies would have a 95% chance of dying. Not what any parents (even the ones who have only been parents for 3 months) want to hear. Yikes.

For stages I and II, doctors usually just watch the babies really closely and may not even perform any interventions. For stages III and IV, the best treatment is the laser surgery I referred to in one of my other posts. I didn't know this, but when the doctors in Grand Rapids and Ann Arbor talked to each other over the last week, they had penciled us in to have this surgery on Monday because they thought we'd probably be interested. They were right! We are planning to return to Ann Arbor on Sunday night, because we have to check in to the hospital at 6am on Monday morning for surgery. I'll stay one night overnight and hopefully go home on Tuesday.

Because this surgery is the only procedure that treats the underlying cause of TTTS, it was what we were hoping they would do for us. Still, nobody wants to hear that they have to have surgery. I've never had any kind of surgery before, so besides being afraid for my babies, I'm afraid for myself! I think I'm the most worried about the spinal... it just sounds painful... and I almost passed out in nursing school watching one get put in. Of course, I'm willing and ready to do anything to give my girls a chance, but that doesn't make it less scary. Please keep the prayers coming for Nate, me, and the cute little girls growing inside me. The surgery is not without risks, and it is not a guaranteed fix... but it's our best bet. 10 days ago, we thought having one baby was the most exciting thing in the world. Today, we think having just one baby seems like the most devastating thing that could happen. We have quickly surrendered to the fact that all we can do is trust in God to heal our baby girls. By the way, here they are!

Love,
The Vander Ploeg 4

Thank-You

We want to give a huge thank you to everyone who has called, texted, shared, and PRAYED for us over the last few days. We have amazing families and friends, and our work families at Cheever and Spectrum have been keeping us sane while we wait impatiently to find out what the next steps are. Keep the prayers coming! We have four days until our appointment at U of M and we are getting more and more anxious to hear what the doctors there will have to say. Of course, we are hoping that if some kind of intervention/procedure needs to be done, that it can be done as soon as possible.

Nate has been reading up a lot on TTTS, and he discovered that most moms carrying babies with TTTS have some type of nutritional deficiencies, which I'm sure I do since I had such a hard time eating for the first couple months of pregnancy. I am only up one pound from my pre-pregnancy weight, so our mission is to get me to gain some weight while eating nutritional things. (Never thought I'd say my goal was to gain weight.) Nate has been spending a ton of energy just making sure that I have what I need to eat for these babies to grow as big and strong as they can!

In his spare time (when he's not making sure I'm getting my protein), Nate draws very detailed and lifelike pictures of TTTS on the computer to explain to the kids at work what's going on...

In all seriousness though, please continue praying for us and our sweet girlies! We will, of course, update the blog if and when we hear anything new.

Sara, Nate, and the Girls

"Aren't we cute?"

Twin-Twin Transfusion

We met with the high-risk specialist today and received the news we were hoping we wouldn't hear. The doctor is pretty sure our babies have twin-twin transfusion syndrome (TTTS), which, from my understanding, means one baby (Baby A) is getting quite a bit more blood flow from the placenta than the other (Baby B). In fact, blood is somehow being shunted from Baby B to Baby A. Because of this, Baby B isn't getting enough blood flow to her kidneys, isn't making urine, doesn't have enough amniotic fluid, etc. On the other hand, Baby A has an excessive amount of amniotic fluid, which could eventually lead to problems for her if this continues.

(side note... yes... I said HER. Can we just celebrate this for a second? We found out today our babies are identical twin GIRLS. Ever since I found out we were having twins, I was secretly hoping for girls. I got my wish! Now Nate and I don't have to come up with two boy names that we agree on, which some of you know was quite the challenge for us.  I can't wait to dress them the same when they are little and for them to be the best of friends. Unfortunately, this special news kind of got lost in the shuffle today with all the not-so-great news we were hearing.)

After taking in the news, we asked some questions that we did not want to ask. Will our babies make it? To be honest, the doctor didn't seem too optimistic about the possible outcomes for either baby if nothing is done to treat the TTTS. The earlier in pregnancy this is found, the worse it is (and ours was found quite early), because the babies have to live for that much longer with the lack of blood flow or excessive fluid.

FORTUNATELY, there is a procedure that can be done to help stop (or maybe just alleviate somewhat) the shunting of blood. I don't know much about it at this time, but it looks like a relatively minor surgery. When we asked if there was a chance both of our babies would be okay, the doctor told us that, with this procedure, there is definitely a chance. We will do anything we can for that chance! This procedure is not done in Grand Rapids, so we are being referred to U of M to be evaluated. Our appointment is next week Thursday, the day after Christmas. We were told to plan on being there all day. Lots of waiting! (Our favorite.)

Nate and I have both commented how we love these sweet baby girls more than we thought we could love someone that we've never even met. 72 hours ago, I was planning on a routine checkup for my pregnancy the next morning. From Tuesday morning until now has been a whirlwind... the excitement of having twins, the fear of being referred to a specialist because of unequal amounts of amniotic fluid around the babies, LOTS more excitement of celebrating twins with friends and family, the fun of being able to see the babies again this morning and finding out that they are girls, and then the sheer terror of hearing all about TTTS. Our emotions are all over the place. Being in the medical field, I believe in the power of medicine and am so grateful for amazing procedures that can heal people and BABIES before they are even born. More importantly, we know God can heal these precious little girls, and we are begging Him to do so. We are hopeful! Please pray with us, and we will update when we have more information.

Nate, Sara, Baby A and Baby B

This Feels Like a Dream...

A little background before I go into the details of this crazy, surreal day...

The morning of September 28, 2013, I decided to take a pregnancy test, for no real reason other than curiosity. I wasn't late yet, and I wasn't having any weird symptoms, but I took it anyway. To my surprise, the second little line showed up for the first time ever, and our journey to being parents began.

I did the calculations and determined that I was about 4 weeks pregnant at the time I found out, making my due date June 7, 2014. We told our families right away, and they were as thrilled (if not more) than we expected them to be. Around 6 weeks, I started having some nausea, heartburn, headaches, etc. to the point of being pretty miserable. I tried all the different remedies that everyone suggested, but I didn't feel much better. Word got out around work that I was pregnant pretty quickly, because I was feeling so sick that a lot of people just figured it out (plus, I wasn't much good at keeping it a secret.)

My first appointment at 11 weeks went well; we got to hear the baby's heartbeat, and that was about it, since the doctor had been called away for a delivery. Between 11 and 15 weeks, I started slowly feeling a little better, although not 100% yet.

This brings us to today...

I had a normal checkup scheduled, and since the doctor wasn't available for my last appointment, I was going to get the whole shebang -- pap smear, cultures, etc. I kindly told my husband he could stay home for this one. The nurse came in first to find the baby's heartbeat. She found it right away, but told me I seemed a little big for being 15 1/2 weeks and that maybe my dates were incorrect. I found myself thinking that I must have been wrong all along and that I really was closer to 20 weeks than I thought. The doctor came in and thought the same thing -- in fact, she said "you are way bigger than 15 weeks. We'll get you in for an ultrasound today or tomorrow." She explained that either my dates were wrong or that there was more than one baby in there. For some reason, I refused to entertain the idea that maybe two or more babies were growing inside me, so again, I assumed my dates had been wrong this entire time. They were able to get me in for an ultrasound right away... so quickly, in fact, that there wasn't enough time for Nate to get there.

The ultrasound began, and within 10 seconds, I heard the tech say, "there's one baby, and there's another baby." Holy Shit. I was in shock. I don't remember a lot of it, so thank goodness she gave me a lot of pictures. According to the ultrasound, both babies are about the same size, they each have their own amniotic sac, and they share a placenta. From what I gathered, this means they are most likely identical twins! I could have found out the gender(s), but I decided to wait until the next one (yes, we'll be having a lot) when Nate could be there too.

I called Nate, and of course, he didn't believe me at first. When it finally hit him that I was serious, he said, "let the ride begin!" I waited to talk with the doctor, who is a bit concerned that one baby has quite a bit more fluid around it than the other. This could mean one baby is getting quite a bit more blood/nutrients than the other, a condition called (I think) twin to twin transfusion syndrome. It could be something, or it could be nothing. We are going to a high-risk specialist on Thursday to be evaluated and to have another ultrasound.

We called our families as soon as I got home, and they were as excited (if not more) as when we told them we were pregnant in the first place! We are overwhelmed, scared, and most of all, thrilled! We thought we had a lot to think about and get in order with one baby, and we are discovering that it will be exponentially more with two! We have great family and friends to support us and we know everything will turn out fine!

I don't know if I'll ever share this blog with anyone, but I really wanted to document this day and the rest of the pregnancy... if for no one else, then for me.