OUR TRIPLET STORY
Below is a ridiculously long chronicle of the process Loren and I went through to create our triplets. Believe it or not, this is a shortened version. I cut much out, but didnít change the content that was there. So forgive me if it some of this isnít well-explained or makes no sense.
Itís an IVF story, itís a TTTS story, itís an IUGR story, itís a pregnancy story, but most of all, itís a love story. I donít expect many (if any) to read it in its entirety. I hope our story can be an inspiration to any who are experiencing similar pregnancies. For those of you who find problems with TTTS or IUGR or a triplet pregnancy in general, let this story serve as a reminder that miracles do exist.
(Ctrl + F, pressed together, will bring up a ďFindĒ box if youíd just like to search for parts pertaining to TTTS, IUGR, etc.)
CREATING Yet Another MIRACLE (or 3)
by Lesa Rhoton
I wish I could predict the future. I wish I knew if tomorrow we will begin the grueling process creating another miracle or of just going through the motions. But, I cannot. So, I will go head first into this process with all of the hopes one can have for a wonderful outcome Ė a precious baby. Creating Yet Another Miracle is the third, and probably final installment in my IVF journey. It is preceded by Creating a Miracle, and Creating Another Miracle.
This will be the second attempt at adding onto our already loving family. The first attempt, (Creating Another Miracle) with two frozen embryos, ended in a chemical pregnancy. Sad as it was, the day we found out the bad news happened to be Angusís first birthday, so we found cause to rejoice in our first miracle, and couldnít let ourselves grieve over what was not meant to be. Our final hopes rest with this attempt. We shall see.
2/7/04: Tomorrow morning is the first of many injections I will endure. I did my dry run and Iím pretty sure it will all come back to me. I feel like Iím cheating myself, and this potential life we are trying to create, because I havenít had too much time to dwell on this like I did when we were creating the embryo that would eventually become Angus. At that point, I was watching the calendar like the stock market. I had charts and graphs calculating numbers of injections, costs, days left, moods, etc. This time, I had to really find a moment to even jot down my most superficial thoughts. Donít get me wrong; Iím excited, nervous, and anxious. I just donít have time to let myself swim in my emotions. Maybe itís better this way.
2/13/04: Weíre almost a week into the Lupron and I took my last birth control pill yesterday. The Lupron is really kicking my butt this time! Hot flashes, mood swings, bones aching, fatigueÖ just feeling bad in general.
I am not as sure of the outcome this time. The first time around, I didnít know what to think. Then when we had Angus, I guess I just felt like things could never fail. I figured the frozen embryos would work. Since they didnít, I feel that maybe we arenít as untouchable as I had previously let myself believe. I really really hope weíre not doing this for nothing.
2/17/04: Getting ready to start the stimulating medications. Iím nervous. After Angusís birth and the blood I lost and the surgery that followed, I feel that my childbearing years are past me. I guess time will tell. One year from now, I could be nursing a baby, reading this, and laughing at how stupid I was.
2/22/04: Well, today is Day 2 of the Stimulating Hormones. Somehow, it feels more complicated this time, and Iím having a harder time remembering the schedule. Hard to fathom that in two weeks we will have the transfer and this whole experience will be over. Iím trying very hard not to steel myself. I want to let myself feel the joy, hope, and anxiety that comes with each step of this process. I donít want to cheat this baby (or babies) out of my complete love and devotion.
Yesterday, I had my first ultrasound. Everything was wonderful. I did, however, have a dream last night that the nurse called to say that something was strange about my bloodwork, something theyíd never seen before. Having a lot of injection dreams and baby dreams.
I was reflecting on the journal I created while trying to create Angus. I had already started thinking of names. This time, I am afraid to let myself thoughts wander to names. Itís sad. I want to be just as ďin loveĒ with this experience as before.
2/23/04: I was driving to Angusís first playgroup at the playground this morning, and I found myself thinking about my developing eggs and wondering which one or ones will potentially be my baby(ies). My experience as a mother has been such a joy, and Loren is such a wonderful daddy that I canít help thinking how incredibly lucky this baby or babies will be to be a part of our family. I really hope it works out.
Interesting thing happened at the park today. I was swinging Angus on one of the baby swings and a bird pooped on my head. Thatís very good luck if youíre living in England. I know weíre not in England, but I can certainly apply the luck to myself. I can use all of the luck I can get
2/24/04: Had my PreOp visit today. Everythingís set. It still blows my mind that weíre going to make a baby next week. It really has flown by so quickly.
So many questions and worries from here on out:
3/2/04: We did the HCG last night which will trigger a release of the eggs from my ovaries at a very specific time. (Isnít science and medicine amazing?) We stressed a little bit more it this time than last. Now, itís up to the staff. Our part is done.
3/3/04: Weíre off to do the egg aspiration in about 10 minutes. Iím hoping everything will go okay. Weíre hoping for a bakerís dozen. Iíll fill in details later.
3/3/04 Evening: Iím sitting here at the computer listening to Angus whine, Loren cook, and Bewitched playing in the living room. I, myself, am very very uncomfortable. Much more so than with Angus. Itís about 6:15, and Iím trying to recoup from this morningís activities. Everything went better than expected. They retrieved 21 eggs. Weíll find out tomorrow around noon just how many fertilized. Even as I type this, we have embryos already changing and growing. I wonder if one of them will be my future child Ė or two. We were in and out in about 3 hours. Pretty fast. Weíre now just in a holding pattern waiting for the news each day as to how many we have, what quality and when the transfer will be. Weíre really hoping for a Monday transfer.
3/4/04: We just got a call from the nurse who told us the egg results. Of the 21 we had, 14 eggs fertilized, five didn't fertilize, one fertilized improperly, and one egg was out of its shell. They said the "naked" egg was pretty unusual. Anyway, that's incredibly great news! 14! We'll get a call tomorrow with details of their quality and news of the transfer time and date. More later.
3/5/04: More good news today. I got a call about 8:45 this morning from the nurse who told me that we still have 14 embryos, so weíre going forward with the 5-day transfer. Thatís an incredible relief. Tomorrow weíll find out what time the transfer will be on Monday. Of course, Iíll be holding my breath until Monday hoping and praying that they will all survive and that weíll have 2 good ones on Transfer Day. Incidentally, Transfer Day just happens to be March 8th, 2 years to the day of Angusís aspiration. Could be a signÖ
3/6/04: Two more days until the transfer. Weíre all set for Mondayís transfer at 11:30. Weíll find out if Iím pregnant on the 19th. We wonít get a call tomorrow because the embryos will be in the morula stage where they are compacting and turning into blastocysts. I wish I could see what they look like. Itís all so fascinating. I canít put into words just how anxious I am!
3/8/04: Itís 9:35 a.m. Weíre getting ready to go do the transfer. I probably wonít write for another few days because Iíll be lying on the couch hatching and latching. Iím nervous, anxious, and excited. Ö
3/8/04: We're done and home again. At this moment Iím lying on the couch exactly the same way I did with Angus. All went as planned. Well, almost. I didn't bring my driver's license with me. I was so worried theyíd say ďSorry, Mrs. Rhoton, but we canít do the transfer today, because we donít know who you are.Ē But they found a copy of my DL from the aspiration so we were okay. It all went so quickly. We learned we have 1 early Blastocyst and 1 Grade-2 Blastocyst. We got a little souvenir dish like the one Angus was in. Loren got to see both embryos in the isolette under the microscope. True to form, he got done seeing them and said ďThey look just like me.Ē Lucky him that he got the chance to see what could be our child(ren) at this stage. He said 1 was twice as big as the other. I'm so glad he got to see them. So fast, and we were done. I am still so worried theyíre going to slide out of me. I look down at my belly and think, wow, there are 2 babies in me!
3/9/04: I'm in the same spot as yesterday as I type this. Chillin' on the couch hoping the babies are hatching and latching. I should be getting a call today about our remaining embryos. Hope it's good news. I can't help feeling like this isn't going to work. I don't know why I feel that way, but I'm really worried. I'm afraid to let myself believe that these little babies are still there. Loren's very optimistic and is certain this will work. He just kissed me on the way out and told me to tell the babies to latch on. More later.
3/10/04: Got a call yesterday shortly after I wrote this from the nurse who told me we didnít have any embryos that would be good enough for freezing. Thatís a shame, and itís not. I mean itís exactly as I wanted it to be Ė halfway. I wanted to conceive with this attempt and have none left over for freezing. Thatís the best possible outcome. Half has come true. Now, weíre waiting for the other half Ė a strong pregnancy. I almost bought a pregnancy test today. I refrained, though. Iíll buy one on Monday or Tuesday.
Side note: I woke up at around 5:00 this morning and had the faint feeling Ė gut instinct (same one I had with the other kids) that I am pregnant. I hope itís not just wishful thinking.
3/11/04: I think Iíll do a pregnancy test on Sunday, and then again on Tuesday, and then again on Thursday, and then weíll have the blood test on Friday. But who am I kidding. Iíll probably do a pregnancy test on Saturday, Sunday, Monday, Tuesday, and WednesdayÖ well, you get the picture.
3/14/04: Today is Day 6 after the transfer. This whole thing consumes my brain. I hope that in another month Iíll be thinking how silly I was to have wasted so much valuable time being worried about something that will have a happy outcome.
3/15/04: Loren and I did a pregnancy test this morning at about 5:45. It took 3 minutes for the faintest line to appear. It was so faint. But there. I am being really cautious about not jumping to conclusions about this one. I learned my lesson from the frozen embryo experience. A faint positive today could be a negative in 2 days. So, if I retest on Wednesday and the lineís even more pronounced, then Iíll jump for joy. At the moment at least I know that I have more than 20 ml/iu of HCG in my urine. Thatís promising. Weíll see. Iím so scared to let myself get excited. No big sign from God.
3/18/04: Itís 10:22 p.m. Getting ready to go to bed. Canít wait until tomorrow. Iíve done quite a few home pregnancy tests and theyíve all been positive. So, Iím hopeful. I just want to hear it from the doctorís office. I want to know what my HCG level is right now. That may give an indication of twins or singleton. We both anxiously awaitÖ
3/19/04: Just had the pregnancy test. Weíre getting ready to go to Tarpon Springs, just as we did on the day we got the pregnancy test results with Angus. The girl who drew my blood told me to call the Swann office starting at about 11:00 to get the results. Now, Iím scared. I want so badly to be pregnant. Iím so completely frightened of the results. I hopeÖ
3/19/04 Evening: Fantastic news! Weíre pregnant again! Iím thrilled. We were driving over to Tarpon Springs and found out the news on the Courtney Campbell Causeway, basically in the same place that we were when we heard the news about Angus. We spent a wonderful day at the Sponge Docks at Tarpon Springs, ate at Hellaís, drove down the coast to Cameron Cove, where we watched Angus discover the beach (loads of fun) and then we had a great dinner at Guppies on the beach. My HCG level was 419. That doesnít rule out twins, but more than likely thereís just one in there. Iíll do another pregnancy test on Monday and then another on Wednesday or Thursday. Then, at the beginning of April weíll get to see if we have one or two.
Iím so happy. Now I can talk to you, my sweet unborn child. Never believe for a moment that you werenít planned and desperately wanted.
(I have this strange feeling there are two of you in there.)
3/21/04: I have had to pee SO much today. Iím feeling slightly out of whack. This is much sooner than I felt anything with Angus. I canít wait to find out if thereís just one in there or a double dose of fun. I love you already. Itís so weird how that happens. Youíre not even the size of the O I just typed, but you are so very important already. Your dadís so elated that youíre going to be a part of our family. He really wanted at least 2 children. Iím so glad we can make his dream come true. Speaking of dreams coming true, I had said that the ultimate outcome for this would be to get pregnant this time around and have no frozen embryos to have hanging in limbo. This is definitely the ultimate outcome!
3/22/04: My HCG was 1272. The nurse said the levelís not too low for twins, but more than likely thereís just one baby growing. I canít wait to see! Either way, Iím ecstatic that weíre going to increase our incredibly happy family. How cool is it to share in the creation of a life with your best friend! Your dad is definitely that.
3/26/04: I just had my 36th birthday yesterday. Itís hard to imagine that you wonít remember what I look like in my thirties someday. Kristi, Kevin, and Kelli have had me as their mom for so much longer. Wish I were going to have more time with you on this earth, but each day is a gift, so weíll leave it at that.
Your dad has been wonderful with the progesterone shots. Up until a few days ago, that is. He stuck the needle in my butt, drew back blood and had to remove the needle to try again. THAT HURT!! Then he changed the needle and popped me in the butt on the other side only to realize that he had not taken the air out of the syringe. NOT AGAIN!! So, out with that needle. And, he stabbed me again. Three times in one night. Feeding the babies, we call it. And, you are definitely worth it.
Iím due to find out the result of this morningís HCG within a few hours. It should be over 5,000 by my calculations. If itís not, Iíll worry. If itís WAY over that, then Iíll really believe there are two of you in there.
Sweet growing offspring, I love you already and feel an intense desire to protect you and nurture you. I canít wait to see you on the ultrasound.
4/5/04: Weíve finally arrived at the day. The day of the ultrasound. Iím so excited/nervous. Iíll be happy just to see even one heartbeat. Iíve been analyzing my HCG numbers as compared to other womenís numbers, and Iíve driven myself nuts vacillating between believing Iím having twins and deciding that thereís just one of you in there. Today, weíll find out.
4/6/04: Absolutely NOTHING could have prepared me for what we saw yesterday on the ultrasound. Iím still in shock. Not one or two, but three of you! The doctor and nurse started the ultrasound without your dad, which I didnít want them to do, but I was helpless to stop myself from looking over at the screen. I said ďdo I see 2 sacs? Are there two babies in there?Ē The nurse hesitated and then said ďDoctor, thereís a split.Ē I knew exactly what that meant. OH MY GOD, weíre having triplets! I was still absorbing it when your dad came into the room. We were then both told together that there are two identicals and one singleton. Fast little flickering heartbeats. All seemed healthy. Thereís still some concern that the identicals of you are in jeopardy of Twin-to-Twin Transfusion Syndrome. Dr. Verkauf said that one of the identicals is smaller than the other and itís too early to know if theyíll all develop.
We canít get in to see a specialist fast enough. Unfortunately the specialist we wanted to see wonít see us because (and this is what I believe) I threw one of the doctors out while in labor. So weíre waiting to find another doctor. It all makes sense now, though. I knew I felt like crap for a reason. I want to throw up after even the smallest meal. And although Iím constantly hungry, I have no appetite for anything. Weíre still digesting the news. A bit shocking, to say the least. I love you all so much already. I want each one of you to be okay. Time to think of some names.
4/8/04: Morning sickness is kicking my butt right now, and the exhaustion is overwhelming. Speaking of overwhelming, itís so much to comprehend now that weíre going to need triple everything. I hope Iíll be a good mommy to all of you.
4/16/04: I started spotting and cramping a few days ago. I was so incredibly worried about it. We went to the doctor on Thursday. I basically insisted on having an ultrasound to see how the little guys are doing. I was convinced I had lost one or two of the little people. As it turned out, all is well. The identicals were one on top of the other and measuring 8w2d and 7w6d, and the other little guy (boy I feel sorry for that one Ė so lonely over there all by him/herself) measured out at 8w exactly. I was exactly 8 weeks along so all was well. Three tiny heart beats going nuts. A wave of relief came over me.
The doctor said I may have some activity restriction after 18 weeks. He says itís too early to tell if the identicals are sharing a sac (monochorionic monoamniotic). We hope not, as thereís only a 50/50 chance of survival. We have learned so many new terms throughout this experience already.
As for how I feel, Iím obscenely tired. I could sleep all day.
4/21/04: Iím 9 weeks today. I canít wait for this morning sickness to subside. I feel bad from about Ĺ hour after waking until about 9:00 or so at night. I nap everyday with Angus, but I wake up tired and with a headache. I feel like vomiting all day. I know I shouldnít complain, but itís incredibly hard to deal with morning sickness and be active enough to deal with a busy 17-month-old.
I can now feel you guys through my belly when I lie flat. Itís incredible. Iím only 9 weeks along. I can just imagine what itíll be like in another few weeks.
I spent the weekend spotting. I put myself on self-imposed bedrest the entire weekend. I felt very helpless and frustrated just lying on the couch, but the thought of losing even one of these miraculous babies is too frightening to bear. I mean, I havenít fully accepted the idea that I can handle, that my body can handle, that I have enough love, time, energy, and patience for three new babies, but on a deeper level, I feel an incredible need to protect these little guys from every possible harm.
(Names I like so far: Liam, Ruca, Holland. Loren likes Collin. Weíre really kind of holding off on thinking of names seriously until we find out all genders.)
4/25/04: We went to the doctor on Friday. My belly is measuring 15 weeks at 9w2d. Oh my lord, am I going to be huge!
5/6/04: 11 weeks alongÖ We saw you guys again today. Baby B, you were insane Ė all arms and legs wiggling everywhere. Baby C, you were sleeping with only occasional movement, and Baby A, it looked like you were dancing gracefully in your own space. All of you are on target for your ages, with Baby A being slightly bigger than B and C.
We saw the membrane that separates Babies B and C. Such a relief. Weíre going to look for it again at the next visit to confirm what we saw.
5/14/04: 12 weeks 2 days. What a week Iíve had. First I need to offer up a little background about how fate or the hand of God can play into someoneís life in such a profound and mysterious way Ė a way that sneaks up on you, and it isnít until you look back that it all seems like a well-choreographed ballet.
A few weeks ago we went to a Baby Expo in St. Pete. We stopped by a 3D Ultrasound display and entered into a drawing to win a free 3D ultrasound. How incredibly cool, I thought, to see all 3 babies in 3D. A few days later, I got a call. I had won! So we found ourselves in the office of Susan Guidi, an extremely qualified and intelligent and wonderfully enthusiastic sonographer.
Back to the storyÖ Iím a little distraught right now because we just got back from a 3D ultrasound appt. The sonographer asked me if we had any special concerns. The only one I had noted was that Baby C seemed ďstuck.Ē Upon a closer look we did find that Baby C has way too little space, Baby B is going insane in a large amount of fluid, and Baby A seems to have just the right amount. The sonographer said we should contact our doctor right away if there is any medical intervention that can prevent permanent injury or problems with the triplets. To say Iím worried and freaked out is an understatement. I instinctively felt that there was something wrong with the way Baby C never moved very much, or never moved from the same position at each ultrasound. Iím so worried.
I spent the entire day until after midnight the following day at the ER at TGH on Monday. I started bleeding on Sunday. I saw all 3 babies and they were still as usual, B going nuts, C not moving much, A gracefully dancing. All turned out well and I quit bleeding. We still donít know what that was all about.
Oh, and I guess I should mention that we found out that weíre probably having 2 girls and 1 boy. Weíll confirm it at around 14 weeks to make sure that the assessment was right. But, I pretty much saw what I needed to. Two girls and a boy.
5/17/04: Itís our anniversary today. But itís kind of the farthest thing from my mind. Iím really thinking more about this whole oligohydramnios/polyhydramnios TTTS thing. Iíve researched this a lot over the weekend and it seems like thatís what we may be looking at. I canít wait to call the doctor in an hour. I really want to get in to see what can be done, and Iím not taking ďnoĒ for an answer. Time is of the essence.
5/22/04: What incredible luck it is that we live here in Tampa. Dr. Quintero, USF Fetal Therapy Center, is one of only a few doctors in the world who is skilled in fetal surgery to separate the vascular connections between the two babies in jeopardy. And coincidentally, heís part of the group of doctors who delivered Angus. So, I spoke with Mary Allan from Dr. Quinteroís office, Dr. De Lia up in Wisconsin, a woman named Ali with triplets who survived TTTS surgery, and Dr. Parsons. Mary Allan said we have to wait until Week 16 to have fetal laser surgery and that nothing can be done until then. Dr. De Lia said as long as the babies are equal in size, to adopt the ďwait and seeĒ approach and supplement my diet with Ensure High Protein and spend a lot of time on bedrest. Ali talked at great length with me about what her surgery was like and urged me to get in touch with Dr. Quinteroís office. Dr. Parsons spoke with me yesterday. He says heís at a loss and is searching for literature that may pertain to TTTS in a triplet situation in order to see if thereís anything I can do right now to maybe halt this or make it better. He said heís never seen anything like this in his 20 years of practice, so heís pretty much going to hand me over to Dr. Quintero at 16 weeks.
The next course of action is at 16 weeks, Dr. Parsons is to do a full exam, and fill out an evaluation form to submit to Dr. Quinteroís office. Then an exam and surgery will be scheduled with Dr. Quintero, to be performed at St. Josephís Womenís Hospital.
Statistics relating to this:
I canít wait until my next appointment on Wednesday. I just want to see my babies. I want to know that theyíre still growing on target and that neither is suffering.
Baby A, Iím sorry to be neglecting you in my thoughts. Youíre just as special and important as B & C.
5/28/04: Yup, 2 girls and 1 boy. Weíre 14 weeks along now. We saw the doctor on Wednesday. Itís a good thing we were seeing Susan on Thursday, because the ultrasound technician at Dr. Parsons office said our babies are absolutely normal. As it turns out, after seeing Susan, we now know that Ruca weighs almost 20% more than Nadia, that Nadia had no visible bladder in over an hour and a half view on the ultrasound, and that Max is doing just fine. Nadia has very little fluid and Ruca is still doing somersaults in her little water world. Ruca, if you keep beating up your sister, sheís not going to be very happy with you when she comes out. The weights are .2 lb for both Ruca and Max, and Nadia weighs .17 lb. All babies are about 8 Ĺ centimeters from crown to rump.
(Susan Guidi is an angel here on earth. I canít believe how blessed we are that she was placed in our path. Sheís made calls to Dr. Parsons, Dr. Quintero, researched hours and hours trying to help us. Sheís scanning us now at no charge. What a selfless person she is! I canít even begin to think of what would be happening right now if we hadnít met her.)
Weíre going to be referred to Dr. Quinteroís office for the 16-week evaluation. I also wrote a letter to Dr. Parsons outlining some concerns over his equipment and the fact that he only works one day a week and has no one to back him up.
I feel more confident than ever that we can make it through. I love you babies so much. I will hold each one of you in my arms in about 20 weeks.
On another note, I feel pretty good. Iím trying to adhere to the bedrest/Boost regimen. I look like Iím about 6 Ĺ months pregnant. I canít walk around for too very long without getting tired out and feeling like ďsomethingís not quite right.Ē I need daily naps or Iím a walking zombie in the evening. Iím having bad dreams a lot, too. I have just hints of morning sickness, and Iím not eating all together as much as I should, but Iím trying. Kelliís watching Angus all summer so that I can take it easy. Sheís a doll. All in all, Iíd say I feel pretty okay.
6/7/04: Iím anxiously awaiting word from Mary about how to proceed. The day after tomorrow Iíll be 16 weeks along. Itís grueling waiting. I AM a time bomb. I sent Dr. Parsons a pretty detailed letter about the problems weíre having feeling comfortable with his ultrasound equipment and staff. I hope to resolve all of that this Wednesday.
I believe I have been feeling little people kicking me from inside. Itís just the flutters Iím feeling, but itís been going on for about 3 days. Mostly coming from Max.
A funny side story: As we stepped into the elevator at our last appointment with Dr. Parsons, Loren and I were trying to remember which floor to go to. A woman came in and we asked her which floor Dr. Parsons was on. She told us ď3.Ē Just as she said that, a roly-poly security guard ďRobinĒ came in and caught the tail-end of our conversation. He said a way to remember which floor is ďjust remember 3 is the number of kids you DONíT want to have at one time.Ē We just about died laughing. I told him Iím having 3 at one time, and Loren said ďNice commentĒ in a chiding, sarcastic way. We all made comments about the guy getting his foot out of his mouth. Poor guy looked mortified and so embarrassed by the comment. We couldnít help but make fun of him for it. It was way too funny.
Each night, I close my eyes and visualize myself sending down a fuzzy pink blanket to each one of the girls and a fuzzy blue blanket to Max. In my mindís eye, I tuck them in and give them each a hug and a kiss. I love you all so much.
6/9/04: Weíre at 16 weeks. We went to see Dr. Quintero today. After a 3-hour ultrasound, we learned that our little Nadia is 20% smaller than Ruca and Max. They classify her as IUGR since sheís under the 10th percentile for her gestational age. She also has absent-end diastolic arterial flow from the umbilical cord.
(Above left shows an ultrasound photo of Nadiaís cord blood flow. The peaks are systolic flow (when the heart is pumping blood away from the heart and back through the umbilical cord to the placenta) and the valleys show diastolic flow (when the heart is resting between beats while on the way through the umbilical cord to the placenta). The absent end comes into play when there is little or no flow. In other words, the peak just drops off and there are gaps in the flow leading back to the placenta. Think of turning a faucet on and then off over and over. In normal flow (see Rucaís on the right), there will always be flow even in the resting periods. Think of a faucet turning full force/soft force over and over. Absent-end diastolic flow can turn to reverse-flow in which the arterial blood actually goes in the wrong direction. Thatís a true emergency and something worth watching very regularly.)
We were told that we should hang on and have an ultrasound weekly to see what happens. If her flow remains consistently bad (as opposed to how it is now Ė intermittently bad) then weíll have the laser surgery to separate Ruca and Nadia. Dr. Quintero told us that at any minute Nadia could die and if she does, thereís a 30% chance sheíll take her sister with her. If Ruca survives, if Nadia dies, then Ruca stands a 30% chance of being profoundly brain damaged. Itís so scary right now. Not a second goes by that I donít think about this.
Options we were told we could consider were:
On a different note, Nadia had more fluid surrounding her. And, weíve been told that Max should remain unaffected by any of this.
6/20/04: Fatherís Day was quite exciting and emotional. We had the Discovery Health Channel crew taping for a special they are planning to air about our babies. They spent the day filming at our house and plan to film a few doctors appointments, and God-willing, the birth.
6/30/04: Weíre 19 weeks along. Itís been tense this past few weeks waiting for our Wednesday ultrasounds. So far, Nadiaís flow had been consistently good/bad, so that means sheís hanging on. We had all three babies weighed today. Good news. Nadiaís now almost caught up with Ruca Ė weight-wise. She weighs 9.2 oz. Ruca weighs 9.9 oz. Max weighs 11 oz. So, theyíre all pretty much on track. Weíve moved to a 2-week ultrasound schedule, which is a bit unnerving for me, but I have to trust the experts.
7/13/04: Yesterday we went to Dr. Parsons office. As usual, he wasnít there. He never is. Weíre very unsettled about that. Weíre worried that if I went into premature labor, where would he be? Who would care for us? Residents? I wrote a letter to Dr. Angel with the hope that he would take us on. I really would rather deliver at UCH, but Iím pretty sure that heíll say no. I guess we just have to let go of it and trust that our babies will be taken care of when the time comes.
Incidentally, we had an ultrasound yesterday and Nadia was the craziest of all of the babies. She was quite a busy girl. Theyíre all doing well, and itís wonderful to feel each baby moving inside of me. I know exactly whoís doing the kicking. I cherish these feelings.
8/6/04: Todayís Friday. We hit the 24-week miracle milestone on Wednesday. I honestly wondered just 8 short weeks ago if weíd ever reach this point. Iím elated.
Max, we were only able to see you in 4D on Wednesday at Dr. Qís office. Ruca, you were facing the wrong way, and Nadia, the membrane separating you and your sister shrouded you. But, I can already tell that you girls donít look too much like Max and that you, Max, look a lot like Angus.
Iím anxious to meet you guys, but I want to wait about 8 more weeks or so to see you.
Baby girls and my little boy: I canít wait to see you, to hold you in my arms, to nurse you, rock you, change you and kiss you. You will be the most loved kids in the whole world.
8/12/04: Well, Hurricane Charley is supposed to hit us tomorrow. Friday the 13th. Nobody has school and your dadís not working. Your Grandma and Grandpa Rhoton are here visiting so they can help your dad get your nursery set up and take care of Angus while I take care of you. Iím so nervous. Weíre scared to death that the hurricane is going to bear right down on Tampa and weíre going to be flooded in with no way to the hospital if anything catastrophic happens with you babies.
8/13/04: Well, after so much anxiety and preparation from your grandma, grandpa, and dad, we lucked out and the hurricane went south of us. It devastated parts of Florida and made us realize just how fortunate we have been. We hardly got rain.
8/27/04: Babies: I just want you to know just what kind of daddy you are getting. Heís the most wonderful man in the world. Your dad had a big law case in Orlando. A man was accused of shaking his 10-week-old baby to death. He was serving a life sentence. Your dad has worked on this high-profile case since before Angus was born. Many TV shows and news media have contacted your dad about this case. It proved to be a case that could make your dadís career much more successful, earn him more money, and make him famous. He was hoping to get his client a new trial so he could go on to prove his innocence and be set free. When your dad found out that you babies were in jeopardy, he immediately passed the case to another attorney. He was still a part of the case, but he didnít want potential weeks spent in Orlando to interfere with his being involved in every single aspect of your life in utero. Today, your dad went to Orlando and took a back seat in the courtroom to an attorney who got all the acclaim as the judge ruled that your dadís client was a free man. All of your dadís hard work Ė all the credit went to another attorney. But, despite my telling your dad I would support his decision to keep up with both, he chose you and you alone. His family comes first. You come first. He loves you more than you know. I feel that everyday. You are the luckiest children alive.
9/5/04: Here we go again with the stupid hurricanes. Hereís Frances, which looks like itís going to hit us after passing through the east coast. We may be flooded in. It shouldnít be too bad, but itís still unnerving. Too many what-ifs and weíre so close to having the babies. Of course, this yearís active hurricane season really mirrors what this year has been like for me Ė one massive hurricane. I donít need even one more.
9/6/04: Well, we got drenched from H. Frances. It hit us, emptied the bay for a while and then when it swung around, it brought up so much water that Bayshore Blvd. was flooded, as was a lot of downtown Tampa. Even though Iíve been on bed rest mostly, I had Loren drive me to see the flooding and devastation. Big strong trees were completely torn in half. Some of the homes near the river flooded terribly. Weíre grateful that it didnít do worse than that, and weíre glad weíll still be able to see the doctor on schedule.
9/7/04: Today we had the babies weighed. Max is a beefy boy who weighs 3lb 3oz. Ruca is almost there at 2lb 15oz. Nadiaís lagging behind at 2lb 1oz. Weíre understandably worried about her as sheís turning IUGR very quickly. Weíll up our visits to 2x a week from here on out.
9/10/04: Weíre freaking out again about yet another hurricane. This time itís Ivan and itís supposed to hit us. Itíll be one month almost to the day since Hurricane Charley hit, and with Hurricane Frances last week, I donít think my nerves can take much more. I spent hours on the phone trying to get a hotel room in Gainesville or Orlando. Finally, after 2 Ĺ hours, I found a 3-bedroom suite in Orlando for $180.00 a night. Weíll leave Monday morning if it looks like weíre going to get hit. Ivan is stronger (Category 5) and after what happened during Frances, we know that much of Tampa will be under water for quite a while if it hits. The bridges will be impassable, and power will be out for a long time. The dogs will be boarded while we seek safer ground. We need to be close to a great hospital for monitoring. Weíve come too far to lose any one of our babies.
9/15/04: Today Iím 30 weeks along. And Iím spending my second night in Bay Front Hospital. Yesterday at the doctorís appointment, after fighting over who was Baby B and who was Baby C and how to label them, the ultrasound revealed that Nadiaís cord flow is now persistently absent at the diastolic end. The sonographer measured her abdominal circumference and discovered it had actually gotten smaller than one week before. So, Dr. Montenegro decided that we should be in the hospital until delivery. Heís hoping we can hold out until 32 weeks. I am, too. At 30 weeks, these guys would require so much more care. The long term prognosis is better at 32 weeks, so weíre praying the babies can all hang in there.
Babies: This evening I looked out the window at All Childrenís Hospital and realize that if you are all born before 34 weeks, that will be your home for a while. It saddens me greatly. I love you all so much. Weíve sacrificed so much for each one of you. You may not ever realize how much. Thatís not important. The important thing is that you are a part of me and a part of your dad and we love you so completely, so profoundly, so unconditionally.
9/15/04 Part 2: I can eat only very small portions of food at a time right now, otherwise I want to throw up. I canít lie flat or I feel faint. My waist is over 50 inches in diameter. I am so out of breath from even a tiny bit of walking. I sleep in catnaps. I sleep maybe 20-30 minutes at a time. Thatís it. I worry so incredibly much about the position in which Iím lying. On my left, I worry Iím smushing Max. On my right, I worry that thereís not enough oxygen flow and that Iím smashing one of the girls. I canít sleep on my belly or back. So that leaves very little sleeping time.
9/15/04 Part 3: Last Wednesday, on top of sending Angus to daycare (as I canít care for him in my current state), which made me very very sad, Kristi left for Air Force basic training. I hadnít heard from her since and have worried tremendously. Then, when I found out I was hospital bound, I worried when Iíd get to talk with her. Well, Kristi called me tonight (a 3-way from home) here at the hospital. I just got off the phone with her about an hour ago. My poor baby was crying frantically. I could hardly understand her. Apparently she has had some physical ailments that continue to cause her a lot of pain. She said something about bed rest and something about an appointment next Monday at 7:30. She told me that basic training is really tough and that while sheís running, she imagines Iím right there beside her. It broke my heart wide open to hear her crying so painfully and emotionally. I love that girl so much. I guess Iím telling writing this because I realize that my children never ever stop being my babies. I will never ever give up my unconditional love. Sheís grown and yet, sheís still my baby and I love her with as much love as a mother has to give. And, miraculously, I still have more love to share with Kevin, Kelli, Angus, and three more. My life is so full; I feel my heart will burst.
9/17/04: The Discovery Health Channel crew came yesterday to film some tests here at the hospital yesterday. It was a bit stressful, but Iím doing this so that other women going through similar circumstances will gain a feeling of hope from our soon-to-be happily ever after.
Today, I had a biophysical profile done. Nadiaís measuring 27w4d and weíre at 30w2d. Max, itís obvious, is a gigantic baby and Rucaís just behind him. All tests came back well. Nadiaís flow looked a bit better, but not by much. Dr. Prieto was there and scanned the cord flow for Nadia. I have had to tell him several times that Ruca and Nadia are monochorionic. He canít seem to keep that in his head. I get a little uneasy when I know that he doesnít remember that, as the problems that one can have with a set of monochorionic twins are much more serious than when you have a set of fraternal babies. Ugghh!
Incidentally, Max, we saw that you have hair. What color, though, remains a mystery.
9/27/04: Well, today marks 2 weeks since Iíve been in the hospital. I woke up at 5:00 this morning, hungry. These babies suck all of the food out of me and into their little bodies. So, I need to eat several small meals round the clock. I drank a Boost High Protein and that did the trick.
Yesterday was quite a day. I spent the morning watching Hurricane Jeanne from the hospital window. I was definitely in the right place. I think I would have been panicked at home. And, we lost power in our house. I believe it wonít be on for days and days. Weíre so tired of hurricanes.
Today is such a big day. Weíre having the babies weighed. If thereís more than 40% discordance between Nadia and either Ruca or Max, then weíll deliver tomorrow. I can hardly believe that at this time tomorrow, I may be prepping for a C-section.
Last night was one of those nights where I wish I were my own doctor. Iíd been having tons of really productive intense contractions. I was monitored and the on-duty resident wanted to put me on an IV for fluids and give me a shot of morphine. MORPHINE! I graciously passed on the fluid and drugs. Then, to top it all off, they were going to put me on the NST monitor which is close to impossible to get any sense of security from what that machine reveals. They need to find each heartbeat and see how each baby reacts with movement. Well, the thing is that Ruca and Nadia are belly to belly. So itís virtually impossible to distinguish between Ruca and Nadiaís heartbeats. Two nights in a row, we determined that and I was sent for after-midnight ultrasounds just to see the babies. Well, last night Resident Dr. Idiot Gomez, an overweight dimwitted female resident, wanted me on the NST. Now, answer thisÖ how were they going to dope me up on morphine and then give me an NST which would show realistically only two doped up unreactive babies? How? I told them what we needed to do was skip the IV, skip the drugs, skip the NST and just do a quick ultrasound check of both my cervix and the babies, but NOOOOOO. Dr. Moron knew better. Well, I invited her into my room so I could really blast her with my thoughts on her approach. She was clueless.
In a way, it doesnít shock me, this lack of common sense and less-invasive approach. It also doesnít shock me that people donít aggressively try to monitor Nadia, the baby with the biggest obstacles at the moment. Each day during my ultrasound/bpp, I have to be vigilant and watch every measurement, every test. More often than not, Nadia and Ruca are mixed up and if I didnít catch it, the results would give a false sense of security. I have had to fight with residents about who was who until finally, at one point, I said, ďmeasure the femur on one of the girls, only to confirm that what I suspected was right Ė they were looking at the wrong baby. Itís very draining having to be in so much control of my tests for fear that weíd have a poor outcome. I must continue to be the voice of each one of these precious babies, or risk a tragic outcome.
My biggest fear right now is that Iím getting over a sinus infection and if we deliver the babies tomorrow, I wonít be able to touch them. Thatís going to be tough. More later. Iím so anxious to see what the babies weigh and find out whether weíll keep these babies cooking for two more weeks or not.
10/9/04: We are just shy of two weeks later than last time I wrote. Obviously we didnít deliver that week. The discordance was only 33% (40% and we would have delivered). Max weighed 3 lbs 3 oz. Ruca weighed a whopping 3 lbs 6 oz, and Nadia weighed 2 lbs 14 oz. So we wait. I was given a time limit of no later than 34 weeks. What a long wait, but Iím willing to tough it out here until itís time. Finally, we have scheduled a date for 10/14 at 12:30 p.m. At last I have a definitive goal.
Well, since that time, Iíve been successful at pissing off a resident and basically ostracizing myself from the crew down in the ultrasound department. We had an enormous fiasco one day when Pearl, an older shorthaired round little woman was scanning me. Motherís instinct told me something was just not right with the way she was scanning. I had argued with her about the dopplers, telling her that Nadia has NO diastolic flow. She argued that the cord she was measuring had flow and it was indeed Nadia. So, I let her go on. She eventually saw the error of her ways and corrected it. But, I had also noticed that Nadia seemed to be obscured on the screen, like there was no fluid around her. What an unsettling feeling.
Upon finishing and returning upstairs, I immediately told the nurse I needed a second opinion. I told Dr. Raimer as well. She had me go down for another peek, but somehow word traveled to Pearl that I had called her incompetent and told everyone I didnít want her scanning me anymore. NOT what I said at all.
Long story short, the damage was done. Now nobody down there wants to scan me, so I have Beth, the supervisor scanning me. On the weekends, itís Jo Ellen. Theyíre the best anyway.
10/10/04: Dr. Montenegro just came in to tell me heíd like to move the date of delivery up from the 14th to the 13th. I guess the doctors have a conference on Thursday and Friday. Iíd LOVE to have these babies a day ahead of schedule. The suspense is killing me. Iíll have to wait until tomorrow to find out which day. Dr. Prieto will be the surgeon, so we have to clear it with him.
After my daily biophysical profile ultrasound this morning, the sonographer checked Nadiaís weight. Sheís 3lb 11oz. About an ounce a day sheís gained. What an incredible relief!
Finally, finally Iím able to relax a bit about the babies being inside of me. Weird, because I only have 60 to 84 more hours to be pregnant Ė only 60 to 84 hours to enjoy this feeling. Though, itís tough to enjoy having an enormous belly, itchy stretch marks, difficulty walking, breathing, eating, sleeping. But, itís not that bad overall. Iíll never enjoy the kick of a baby inside of me again. So, I will try to focus on how wonderful it is to create not one, but 3 miracles inside my body.
I have so much to be thankful for as I look back over this long and arduous journey. Weíre almost there. Being here in the hospital has really made me appreciate how far weíve come. One of my nurses delivered her baby at 27 weeks and heís only 14oz. I laid relatively peaceful in my bed as I heard women screaming bringing forth babies who they knew would not survive. Itís such a wonderful, dreadful place to be, here on the antepartum unit.
I canít wait to meet my three miracles. I canít wait.
9/8/05: Here is an excerpt from an email Loren sent out dated 10/15/04:
At 8:41 a.m. yesterday, our beautiful babies arrived. All are healthy and doing well. Max, the big guy, weighed 5lbs 3oz., Ruca weighed 4lb 13oz, and Nadia , our little one weighed in at 3lbs 8oz. All are breathing room air and only Nadia needs to be in the isolette for warming. Mom is doing well and ready to get started on another set of triplets. Dad is contemplating a night job and bringing in a sister-wife. Thanks for all of your support.
9/8/2005: Yes, thatís right. 2005. Iím not even going to pretend that I continued on with this journal right after the babies came. Of course I didnít. But the chapter ended then, didnít it? So we began with the most exciting episode of our lives to date on October 14th, 2004. Truly this past nearly-a-year-already has flown by in a blur. Iíve enjoyed it as much as is humanly possible through the exhausting chaos that comes with having a toddler and multiples simultaneously.
The birth went as smoothly as any c-section can be. We had about 17 people in the delivery room, including a camera crew for the Discovery Health Channel, filming what would later become part of Twins in Peril: Twin-to-Twin-Transfusion Syndrome. As they lifted each baby out and I heard each one cry, months of stored-up tears overwhelmingly poured from my eyes Ė tears I was glad were tears of joy and not sorrow.
Ruca Holland Susan Rhoton, Nadia Opal Susan Rhoton (yes, they each share a middle name Ė a tribute to our hero, Susan Guidi) and Maximus Syrus Rhoton made their grand entrance at Bayfront Medical along with 2 other sets of triplets in less than 2 weeks time. Before they were 2 weeks old, theyíd already been the subject of a Discovery Health Channel special, 2 local TV channel segments and a full-color newspaper photo. So much hoopla! Our babies spent two-weeks feeding and growing in the NICU, were fortunate enough not too need anything invasive treatments and all came home together, Nadia not weighing even 4 pounds at the time. Sleepless nights followed. Lots of them. But somehow a family does what it needs to do out of love and instinct.
Drowning in everyday life, itís easy to forget the perilous journey we took to get these little people here intact. We faced the unknown with courage and faith, and we were rewarded with three wonderful, and very busy I might add, little miracles. When I stop to let the what-ifís enter my mind, it sends a shock of nauseau to the pit of my stomach. What if we hadnít gone to the Baby Expo and had never met Susan Guidi? We would never have known there was a problem with the girls. What if we hadnít researched TTTS and IUGR problems after that first fateful ultrasound appointment? I would never have done the bedrest and drank the high protein drinks I feel that are in great part responsible for the girlsí health and placental development. What if we had opted to have surgical cord occlusion or a fetal reduction? I donít even want to entertain those thoughts, thank you! Everything fell into place just as weíd have it Ė a testament to faith and love, research, modern medicine and most of all, miracles. And when I look at each of the triplets, and especially Nadia, I see faith personified. Theyíre here. And this is where the story really begins. After all, life is a book writing itself on a minute-by-minute basis. I intend to enjoy each page as it comes.■
Following is some advice for parents in similar circumstances as ours. I urge you to read all of it, if any of it pertains to you.
And finally, DO NOT take fetal reduction as an option for TTTS or IUGR issues. Cutting off the umbilical cord supply to Nadia (in an effort to save Ruca) wasnít an option to us, but itís being presented as an option to many other parents in similar circumstances. Have faith in yourself. Have faith in modern medicine. And, if you will, have faith in God that all will work out.