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 =).

Unlikely Triumphs from unlikely follk

     There have been no major developments of late.  In the middle of this quiet waiting period times seems to crawl at times but then we look back and wonder how it all passed.  But there have been milestones and one of those milestones has been gigantic for our boys.  We have now been here in Cincinnati for three weeks and Nicole has held up remarkably well.  She has had very few bouts with self-pity and only a couple of bouts that led to a minute of bitterness (mere minutes mind you).  The hardest sting came for her on Mother's Day.  I had left Friday morning early for Chattanooga and returned late Saturday night, so she was all alone those two days preceding.  Then I did not arrive to her room till 10:30 the morning of Mother's Day, but even though she would not want me telling you, I received a couple of texts from her that hinted at anger at her state that morning.  No doubt brought about by self-pity.  By the time I got to the room, it was gone.  The entire attitude problem was something she could poke fun of, even understanding how she let herself fall into it and what she used to get out of it.  But here is why I mention it.  Why I am being candid about her short battle: because who among us would not spend entire days in the dark pits of self-pity if we were in her shoes?  Who of us would not have grown angrily impatient with our predicament?  Pelvic Rest since January.  Bed Rest since February 25th.  Back pain, discomfort, deteriorating breathing physically.  Surgery and recovery in the midst of it.  Then constant monitoring, echo and ultrasound, one after the other, often times quite painful, up to three in a week.  Then there is the loss of control, the loss of participation, the loss of the nurturer role with Eden, and all the while, in spite of all she has given up every step of the way, things grow more murky and more complicated.  We go from TTTS to a rare congenital and very compromising heart defect to the rupture of the membrane between the boys to the risks posed by their sac free floating and so on.  To have your kids 5 hours away each day and be sleeping alone in a hospital bed, hardly able to move any more.  I don't know about you, but I get a bit stir crazy after four consecutive hours in a hospital room.  I don't know what time I have spent in self-pity, but it may be more than her and I have suffered far less.  She lives in fear, every time those monitors are on and Bryce's heart dips too long she just about looses her breath, yet she does not resort to anger (a by-product of fear nod Mr. Gray).  She has tried to look charitably upon those who have attacked her heartlessly and selfishly in this time.  And she has made some hard choices and hard stands that had to be made but were difficult and painful to make all in her weakened state.  Okay, if I am painting the portrait of a superhuman, that is the partly the point.  The point is that many of us might meet despair, not just self-pity.  Many of us might live for days in contempt for our circumstance.  Some will say that she is just doing what a momma does.  And it is, the really good ones.  But for most of us, somewhere along the way selfishness would have taken hard hold and started playing games with our spiritual disposition.  This little mother is durable.  Not just in body, but in mind and spirit.  And yes I realize there are many others who have and are suffering far worse, but how often do we context and compare our suffering on the global scale when we are in the midst of it and it carries on and on and demands we give up all to the cause? 

And what is even more remarkable is that this description of this little fighting mother is nothing like the girl that lived only for self for decades, scarred by others and scarred by her own selfishness.  Her life was more like a junk yard at times than a garden worthy of gazing at.  And though she somehow always had a compassionate heart, that side of her was often lost as she ran from pain by heaping more on.  I can relate.  My story is much the same.  But I am not sure how God orchestrated this transformation, from the girl she has told me tales of to the woman I know today.  I am also sure that she could not even tell you how God did it.  It was like a good, slow bake, not so full of glorious pivotal moments, just steady daily leading in her heart to Him.  And as her heart came closer to her maker, it was reformed, reborn, and remade by His love.  I am not here to tell her story of old.  She is not as verbose nor glass wall as I am.  If she ever wants her story to be known and told she will come to that point on her own if she needs to and she will tell it, but I think only if it might serve another's good.  I don't think she would do it to bring her glory.  I honestly don't think she could be bothered by that motivation.  But I am telling a story of our journey together and her spirit today that should and could give hope to someone who has none.  I am also wanting to encourage her and lift her up and tell of something beautiful that she would not share with you.  She is not superhuman.  NIcole is not even super mom.  But she is a great human and she is a great mom and I think she would find it safe to say, that is to the glory of God and though she may not count her labors and sacrifices today as giving Glory to something far greater than herself, I think she might say she is doing it for love of our boys.  I don't know.  It's a hunch.  But how far a little light can travel and how much it can illumine and how much glory can be given from an unremarkable hospital room two states from home. 

So the milestone, again. The meat of the matter.  Today we reached 32 weeks, give or take depending upon the accuracy of our ruler.  Everyone was very clear early on, from Dr. Harnsberger to the Fetal Care Team in our initial consult pre-surgical in February that 32 weeks is the level of prematurity where most complications from prematurity disappear or very significantly diminish. The constant fear was that the boys would have to be taken early because at any moment Bryce might go into rapid decline and potentially complicate, harm, or kill his brother who is indirectly connected.  And to take Bryce early might offer little chance to save him but would certainly borrow trouble for River who was healthy and thriving.  But so is Bryce.  In spite of his severe leak through the tricuspid, his heart has not behaved as the experts expected.  It has responded with the same sort of determination and resilience that Nicole has demonstrated.   His heart has been like a ship that won't be sunk.  So now we can rest easier knowing we have crossed past many real and potential complications that could have piled on because of prematurity.  The boys could come at any time and we can find some assurance that River will be just perfect.  As for his identical brother, it could go either way, but I would have to say, he has beat the odds so much and so long and held on so strong that even those most guarded about their outlook, those who have seen it all have started to see great hope and feel that hope for us.  This journey is not over yet and we have some very major hurdles to overcome still with Bryce especially, but I hope that anyone who has followed along somewhat so far is impressed by some of the things that do not make real rational since like how could our boys be so big and strong in the womb today having fought through and still fighting some very major life-threatening obstacles?  And how could Nicole who once upon a time would not give up a Friday night out for much of anything become someone who could give up everything for someone she cannot even look in the eye?  And how did I go from alcoholic narcissist to become the sort of husband and father I have become?  And how could we have built such a beautiful family, such a close knit team that even the folks here at Ronald McDonald House talk about it with one another after seeing me here with our kids?  The things we were both best at building was brokenness, so how did we get to the point we are today where we have built what we have today in our lives and in our family?  Two words:  grace and love.  The unyielding love of God and the unmerited Grace of God.

A rather odd anniversary

Today is our anniversary, but it has by no means been a normal day.  Just the same, we are so glad that God has given us one another, that these boys are still with us, and that we are together in our greatest trials.

Last night I (Frank) took my blood pressure at the University of Cincinnati fitness gym and it came back high.  Very high. Stage two hypertension.  I took it five minutes later and it came back still alarmingly high.  Nicole's nurse told me to go to the emergency room because my numbers were stroke numbers (180/110), but I punted cause it was a machine and machines are not always calibrated right.  So this morning we have a very important Echo Cardiagram on the heart of both boys, however, most of the attention is obviously paid to Bryce in these affairs.  The results were very welcome!  There has been no meaningful change in the overall condition of his heart over the last two weeks.  He continues to defy expectation and hold so strong.  His pulmonary valve is not leaking, blood is effectively being thrust through the body in spite of the sever regurgitation in the tricuspid (coming before the PV).  His heart has not enlarged any further.  He has not developed an arrhythmia, the pressure is high, very high in his heart but that is actually good.  His walls have thickened, but that is good as well, a good reaction to a bad condition.  This was such a great relief!  All of it.

We spoke at length with the head of Fetal Cardiology at Cincinnati Children's and while he was candid about the odds, meaning, he admitted that many kids with a heart sick like this are lost after birth, our Bryce has not only tolerated it well but his heart has actually responded well and does not appear to have become alarmingly sick.  While there is absolutely no way to know which way he will go, the Dr. also said that it is possible he will require no assistance and could be released relatively quick which would mean after around 30-45 days post delivery.

The obstetric findings yesterday seemed to argue for a delivery sooner, as in at 32 weeks (this Monday) rather than 34 weeks and cardiology said they did not feel that it made much a difference either way from their position.  So all the information was turned over to the Fetal Care team, Dr. Habli, Dr. Polzine, and Dr. Lim to fashion a game plane that weighs the risks of keeping the boys in (Mono/Mono) against the risks of taking them earlier than we might otherwise.  We are still waiting on our consult with them to map out a plan of delivery.  Whatever that plan may be, it may change at any moment if the boys have different designs or if entanglement puts them in a compromising position.  And speaking of entanglement, Bryce's heart rate dipped for a prolonged time during a contraction in this afternoon's monitoring keeping the monitors on Nicole an hour extra.  While it did send off alarm bells, the rest of his chart looked great.  Finally, both boys measure over 3 lbs. now and their growth has beens steady but the rate of growth has slowed lately and is below normal.  This is not abnormal for twins but it may contribute to a decision to take the boys sooner (32 weeks) rather than latest (34 weeks).

So I did step into the ER today and started to check myself in but backed away.  I would really like to be able to wait to deal with the hypertension till we have some plan with the boys and I would like to do it with the Heart Institute at Children's. Cincy Children's has an adult heart institute focused on congenital heart disease (such as Bryce's) and Dr. Michaelfelder is writing a referral for an Echo on me.  Their fetal team all recommended I have my heart checked (it never has been) because my dad had a congenital heart defect (leaking Mitral Valve) and one of my son's has one in the form of displastic Tricuspid.  It would be my preference to look at the whole cardiac picture at one time and to plan that around the boys but I did feel very strange all day and I think the knowledge of the problem might have compounded the problem by creating more stress.  I felt deflated for a moment.  I have been the one on my feet, on the go, doing what has to be done for Nicole, the boys, the family and so on so it was discouraging to think that something might compromise my ability to perform right now.  That said, realistically, I believe it can be corrected and I am optimistically doubtful that they will discover any leakage or long standing heart defects in my own Echo.  I think I just about hit a wall for a moment when Nicole called and said that Bryce had dipped alarmingly long and I ran back from the RMH to Good Sam, but my walls tend to be only short fences that need jumping over.  Nicole did take matters in her own hands as she panicked and repositioned her body - rolled over which almost immediately relieved the Bryce's cord compression and his pulse recovered.

So, tonight we have big plans to take it easy in the room.  I grabbed her some clothes from a thrift shop so she could fancy up a touch for our anniversary, bought some flowers and a vase, and I am going to get indian take out and we are going to watch the new Les Miserables for our big night of doing nothing much.  God's presence and goodness have been blatantly obvious to us through this time.  The love of our family, friends and church family has been amazingly encouraging and even empowering.  And we know, come what may, we will be in God's perfect plan and will have been strengthened so much along the way, not only in our faith and spiritual life, but in our love for one another, our trust in one another, and even drawn closer still to our wonderful, beautiful, amazing kids who have been remarkably durable and adaptable.  I would also like to mention how very little Nicole has complained through all of this.  She has undergone some significant family of origen drama, taken from her children including her Eden and confined to a bed or sofa since February and here in a Cincy hospital heading into week three and she has not shown self-pity nor a speck of bitterness at her state.  She has submitted to whatever has been called of her for the sake of rescuing our smallest and weakest.  I have no idea how God took such as mess as she had made of herself and made such a good-hearted rock, but mysteriously, in his love, He has fashioned quite a woman and I am blessed to have her.

More kids, less stress

I am not a mom, and we dads do play a very different role no matter how engaged we are, but in this time of mom being down, I have had to play a lot of roles (with a lot of help thank God), both Dad and mom roles and I would certainly concur with this poll.  I am a bit better at letting go and enjoying the chaos than Nicole is (it can really stress her out), but I would say we both agree that having a large family is actually easier and less stressful once the family gels together as a team and learns to work with mutual support.  Also, there is really no way to spoil a child when you have so many. They simply have to pull their weight, clean their dishes, help with dinner, clean their rooms, help with house projects.  For the family to function well, the child must be trained to work some for what they have and with so many to receive, we cannot just shower them with material rubbish.  We have to concentrate on giving to them from things that do not perish or wear out, like love, support, encouragement, even discipline.  Those are the building blocks of a heart based relationship anyhow.  If you cannot connect with your child on a heart level, a new Wii is not going to do anything to create parent/child intimacy.

Nicole does stress a lot though.  Sometimes about things small enough that she might want to let it go, but sometimes about things that really matter and her concern has made a big impact.  She does deserve big kuddos in helping coach us toward real team functionality with greater interdependence and more responsible children.  Her stress and persistence have born fruit in some places like having Elise do laundry now, having the kids always do their dishes and empty the dishwasher, vacuum the floors and so on.  And honestly, the kids enjoy working for what they have on a heart level.  Kids that are given everything but require of nothing tend to have less gratitude, much more a sense of entitlement, basically, they certainly can easily drift toward becoming an unhelpful spoiled child with a sour attitude and a difficult disposition when they do not get their way.  Nicole was spoiled somewhat rotten and she raised her first, Ryon that way along with her parents.  She raised him as she was raised.  But with our littles, she had a chance to do it over and do it different and do it more right.  She was determined not to raise her kids to become what she became.  She was determined that she would not be the mother to sour, spoiled kids.  And I would have to give her 4.5 stars out of 5 for how she pulled it off.

But again, many kids makes it all but impossible to spoil the kid because the parents cannot do it all.  Not for a moment.  Nor can they afford it all.  Even if we wanted to ruin our kids by giving them everything they want or demand, we couldn't do it or afford it financially.  So we look for investments for the common good.  We look for group gifts a lot more than the smaller family.  We look for durable investments that make memories together like our lake place, our family boat, and some day a pool at our house.  Those things are enjoyed together, always, and no kid can call it their own.  It is ours.  Ours is very important for building a team mentality.  Mine is a word too common in smaller homes that can work against building an ours.  As Pam Rudd said, big families delegate.  We have to in order to operate.

And we are not arguing that everyone should have a large family.  Not at all.  Nor are we saying that all parents of smaller homes spoil their kids.  Not even close.  Just that it becomes very, very difficult to spoil a kid when you have a lot of them and you want to connect on an intimate level with each of them.

The article is here on how mom's of large families report less stress:
http://www.today.com/moms/mom-survey-says-three-most-stressful-number-kids-6C9774150

This morning's surprise

I was sleeping with the five big kids at the Ronald McDonald House, Eden was with Kelly and Peggers at the Hampton nearby when I received a text from Nicole informing me that she had been diagnosed with gestational diabetes. They immediately changed her diet and removed all sweets and treats.  For a moment she pined with the loss of this one luxury from her hospital home, but she quickly found her smile and kept it through the day even after Kelly and Peggers took our six beloveds back to Chattanooga.  For some reason that text hit me hard.  Maybe harder than the news hit her because she and our boys have endured so much that I was just: "enough already" right?  Then the kids left and my heart somewhat sank as it is prone to do when I have to tell them goodbye.

Then I stumbled upon a luxurious lunch prepped by volunteers at the House and met a man named Walter.  I have met many who have been there months, some even over a year, but his story came at the time I needed to hear it.  His three year old was sent home on hospice after a fleet of issues and surgeries in her young life finally culminated in heart failure.  He did not give up.  He contacted Cincinnati Children's and they were immediately on their way where their little girl was put on a mechanical heart to keep her alive until they could find a heart and perform a transplant.  In that time she had three massive strokes, and lost mobility on her left side ... then her new heart came through and she has regained almost all her faculties other than her voice.  We have had some challenges, some major challenges, tears, tender hearts, day to day, but God has been good every step of the way and we have seen his blessings, we have seen His care, we have seen His love shining through it all.  So, a bit of cognitive reframing and bam, we are back on the bright side.

I am so thankful for all our little kids.  They received multiple compliments at the RMH as they unloaded dishwashers, did the dishes, and had fun but showed courtesy.  They are already excited about coming back for the next visit and they are holding their spirits so high remarkably all things considered though they are quite clingy when they are with me now.  The sunshine they bring far outshines the clouds that come after their departure.

But we have a big week coming up!  Growth charting in the ultrasound tomorrow (the boys should be around 3lbs. now), then another fetal Echo Cardiagram on Tuesday which is also our anniversary, then a consult with the team to discuss a plan for delivery, then Thomas's birthday Thursday (I hope to travel home Thursday morning to spend his birthday with him Thursday and toss him a party on Friday at Peggers before running back to Ohio).  Big week.  More will become clear.  But one thing did clarify itself in the past few days:  There will be no transfer from Cincinnati though there is still a very slight chance of a transfer to Boston, and this is where our boys will be born. I think accepting that, accepting this as our two to three month home was something we needed to come to.

All the Girls together at Good Sam

Mommy happily reunited with her baby girl Eden!

Our whole family, Frank (Dad), Nicole (Mom), Elise (oldest), Sophie, Ani, Kai, Eden, and Thomas

with Bryce and River still hiding out inside.

We now have an annual membership to the fabulous Cincinnati Zoo and this was five of the kids

second visit, Eden's first.  Eden as a bit too sleepy to be all that enamored   

Hanging with Ronald at the House

May, 5 - almost 31 weeks!

For those who have been connected to us on Facebook, this will be familiar terrain, but for some who may stumble across our tale of late and find it compelling or curious, here is the overview of where we are and what this is about.

With a family of six including our Eden, less than a year old we learned we were expecting again.  Upon our first ultrasound we found two hearts, two heads, yes, we were having twins.  We were immediately considered high risk simply for having spontaneous twins, but after Nicole was was intubated a second time in the coarse of the pregancy, still early on, for a tracheal dilation (she has idiopathic subglotic stenosis), we switched doctors to one remarkable and caring Scott Harnsberger.  In his first ultrasound he told us more than we had ever known, he also determined that our babies must be identical because they shared a single placenta and that the placement of the placenta was against the cervix, or, placenta previa.  Nicole was put on pelvic rest and told to keep a slower pace because of this.  At that time he told us of potential dangers associated with monochorionic twins including a disease of the placenta called TTTS or Twin-to-Twin-Transfusion Syndrom.  About 15% of monochorionic twins are diagnosed with this disease and it is almost certainly fatal without intervention.  And so it was.

I was in Knoxville when Nicole went in for an ultrasound early February with Dr. Scott and his face turned pale and he ran out of the room to make a call.  She was headed straight over to the high risk team where she was seen by Dr. Lam who handles TTTS in Chattanooga.  He told us that we were almost there, but we could not yet be classified with TTTS because though one of our twins, Bryce, the recipient twin had 8cm of fluid, the donor was still above 2 at 2.3cm.  The signs were not good but there was no firm diagnosis.  The next week we went back to Dr. Lam who sent us into tears when he said we were certainly stage 2 TTTS (fluid imbalance greater than 2 to 8 and no visible bladder in the donor) and would require laser surgery in Cincinnati at the Cincinnati Fetal Care Center.  By that night we had received two calls from Mel, our nurse coordinator at Cincy Childrens and we were on the road by noon the next day.  The following day was 8 hours of tests and consultations and it was determined we were stage 3C.  River, the donor had only .5cm of fluid, Bryce was over 12, and there had been significant damage to Bryce's heart because of the excess fluid and pressure.  River was trapped in nothing of a sac with his face planted against the placenta and Bryce had a mansion to move around it.  We stayed in a hotel on bedrest over the weekend then she went in for surgery on the boys in Utero to ablate the offending blood vessels and hopefully more equalize the boys supply.  The procedure was a success, the boys survived, and though we stayed in Ohio for five more days till our followup, things were improving dramatically, but not everything.  It was bedrest and pelvic rest for the remainder of the pregnancy for Nicole.

The Fetal Cardiac team suspected that Bryce may have a congenital heart defect of the tricuspid valve but there was really no way to tell because often these leaks or heart issues in the recipient correct themselves over time as things remain in balance and their hearts begin to heal, however, 5 days post-op, there was no change in the severity of the leak.  So we went home to once a week visits with the high risk doctors and one with Dr. Scott.  About 30 days on, Dr. Kipikasa who is the fetal heart specialist in Chattanooga was concerned about the enlargement of Bryce's heart and the continued pace of his tricuspid leak so he sent us back to Cincinnati for another full Fetal Echo.  After than, we returned to Chattanooga for twice a week heart checks of the boys.  Because Bryce's leak was so sever, there was consistent risk of precipitous fetal demise through heart failure and because the boys are connected, there is also a risk that if one of the boys were to die in the womb, the other would as well.  So we had to watch constantly and closely for any sign of deterioration.  Then one month later Dr. Kipikassa thought it was time for us to return to Cincinnati for another full Fetal Echo and consult with the cardiac team here.  We were coming close to 29 weeks gestational age.  Dr. Kipikassa finally admitted when I pressed him that Bryce did appear to have a congenital heart defect and he thought it may be Epsteins' Anomaly  a very rare disorder with the tricuspid valve.  Before we left for Ohio again, I reached out to Boston's Children's at Harvard because of their leading work on Epsteins' and Displastic Tricuspid valves.  Dr. Rathod called me that night on his cell phone and taught me more about what we were up against than had anyone to date.  He said we would need to be in the city where we would deliver by 31 weeks and that Chattanooga was out of the question.  Dr. Scott had already surmised that and had been nudging me to prepare for an extended stay out of state.  So it was either Boston or Cincinnati.

Things became more complicated though.  Our ultrasound in Cincinnati revealed that the boys were now Mono/Mono as in monochorionic as well as monoamniotic - ie, single sac, single placenta.  The sac the boys were in had also separated from the uterine wall and there was fluid transfer from inside to outside the sac so our high risk became significantly higher risk and Nicole as admitted to Good Sam for hospitalized bedrest and we were prevented from further travel because we require very frequent monitoring. So here we are today, some two weeks later, almost to 31 weeks and I am at the Ronald McDonald House and Nicole is at Good Samaritan close to Cincinnati Children's and our plan is to deliver here and River will be kept at the NICU at Good Sam but Bryce will be transfered to Children's CICU.  And our list of complications grew a bit longer still.  Nicole was diagnosed this morning with gestational diabetes as well.  But our boys have kept growing very strong, for very long in spite of all the obstacles.  TTTS, Displastic Tricuspid Disease in Bryce's heart, monoamniotic, monochorionic, amniotic separation, diabetes and our boys are doing great.  Bryce has tolerated his condition miraculously well and though his heart is 50% of his chest cavity, significantly enlarged, it is not dangerously enlarged and his lungs are developing and functioning.  So if you are catching us here at this point, that is where we are, at almost 31 weeks on hospitalized bedrest 5 hours from home and our six kids, turtle, guinea pig, dog, and fish during a major construction project to add onto our home.  Peggers (Frank's mom) and Kelly (Frank's sister) brought our six kids up this weekend for a visit and though I brought five of the six up last weekend as well, it was Nicole's first time to see Eden, our baby girl since we left for our last fetal Echo.  Our next growth chart is tomorrow and our next Echo is Tuesday morning and after that, the MFM and Fetal Care team will arrange a consult to discuss a plan for delivery. God has been remarkably good to us in spite of these trials and we feel very blessed by His love.