Medical Update - May 16th - almost 32.5 weeks.

Last night packed a scare.  During the last monitoring of the day (when they track both the boy's heartbeats for an hour or two), Bryce's pulse dropped, as it is inclined to do from time to time, but this drop was very far and sustained longer than any other drop by far.  The nurses literally came running in, put Nicole on oxygen and had her roll over then over again to encourage him to move (in case he was pinching his cord).  He did pull out of it and sustained a pretty good rate thereafter save one more dip that was not as dramatic.  These pulse descents seem to come right after Nicole has a contraction, last night, like clockwork.  Thankfully, they will not allow her to endure labor for Bryce may not tolerate full blown labor.  But for a moment, both Nicole and I were prepared to be rushed to delivery in an emergency C-section to remove the boys. 

So, some might ask why the team decided to keep the boys cooking considering the risks of cord entanglement in mono-mono twins.  I know our doctor back home, Dr. Harnsberger was very concerned that the pregnancy was being allowed to carry on.  So I put that question to our visiting MFM yesterday.  Cardiology said that they were fine either way, at 32 or 34 weeks and did not think it would have much an impact either way.  However, the Fetal Care team, including Dr. Lim, Dr. Habli, and Dr. Polzin were essentially responsible for the choice to carry it on.  While they typically take the twins at 32 weeks in mono-mono situations, they decided in our case to extend.  Several reasons.  One: There is no hard and fast rule about 32 weeks in mono-mono.  Some schools go to 34.  Few go to 36 if they can.  32 is more common, but the debate on when to intervene there is far from settled.  But their choice had to do with BOTH boys.  Two: She said they were prepared to handle one sick boy, Bryce, and we anticipate him being sick when he is born, but they were not excited about handling two sick boys if say River's lungs were still underdeveloped and he could not be simply stabilized.  So the extra 2 weeks was in part to help insure that there was little chance of River having complications due to prematurity.  Then there is three.  Bryce. His heart has tolerated his condition miraculously well in the womb, so, it is obvious, there is a benefit to him being in his mother's fortress.  Delivery is going to be difficult and dicey most likely and his heart could turn either way or not turn at all, but there is a significant enough chance that the dramatic change in pressure and his bodies functionality could trigger very serious problems in getting blood to the lungs to be oxygenated.  So why not keep him where he has been growing stronger safely to better prepare him for the transition as well.  Then there is the lungs in Bryce too.  His have less room to develop than River because of his enlarged heart.  So they could really do with more time.  We know we have a cardiac issue, we don't want to find a significant pulmonary issue added to the pile of complications.  All of this reasoning made sense to us and comforted us, but the dangers of keeping him in there also manifest last night when our pulses were raised as we watched that number go from 135 to 100 to 90 to 80 to 70 to 60 .... 

Nicole seemingly caught the boys turning on video the other day with dramatic footage of feet pushing hard against her body.  Presumably, that is when Bryce turned head down, head to head with his brother.  It is uncommon for twins to turn at this stage in the game because of size/space issues, but he did.  Those turns can be dangerous though because of the proximity of the boys and the lack or boundary between the two.  However, we considered this position preferable to the one Monday when River had Bryce's head locked between his knees.  They have upped the order for Ultrasounds to three a week from two a week and about 6 hours of heart monitoring a day now.  This is tricky territory.  We have our final Echo lined up for Monday morning and feel a lot more comfortable going into that because Bryce has held so steady in the womb for so long.  Every time they have come back and said, no change, that has been a miracle in and of itself. 

We are okay.  I have given up concerning myself on my blood pressure issue and it seems to be creeping down the right direction.  I will most likely have my own Echo Cardiagram in the next couple of weeks and we have already scheduled a scope for Nicole with Dr. Elluru post delivery because her breathing is becoming more strained.  I am glad that we have each other as we go through this.  It has both deepened our love and our respect for one another.  I love how God is working in us and our kids to make our great little family even stronger and tighter.  And we are eternally grateful to Peggers (and Kelly, even Martha), who have made great sacrifice of their own to keep our kids.  Eden has had more lovin' from Peggers, Kelly, Martha, and Laura (our beloved nannie) than she would have even had at home and I am encouraged to note in my short visits home that even with this distance from my last born daughter, she remains a good Daddy's girl =).