Brooke and Claire must have overheard conversations about Brooke possibly being read to go home first, because they seem to be conspiring to get more in synch so they can go home together. After a few days of finishing off her bottles under the time limit, Brooke has had a hard time staying awake to complete her feedings. Meanwhile, Claire caught up to her sister’s pace of taking every third feeding by bottle, and has done so well she might advance to nippling every other feeding before Brooke. Claire has also been the more feisty one lately, so we think Brooke may be feeling the anemia a little more than her sister. They’re still on epogen for the anemia, and we expect tomorrow’s labs to show us whether it’s working or if one or both might need a transfusion.
Mommy is having a cholecystectomy today, meaning her gall bladder will be removed. This is something we’ve been expecting for a while now, since she was first diagnosed with severe gall stones in her first trimester. Had she not been pregnant, they would have scheduled her for surgery ASAP. At the time of the diagnosis, when she was having discomfort but not severe pain, the ultrasound tech who scanned her gall bladder said it was in pretty bad shape and he was surprised she wasn’t in more pain; normally, if he saw gall stones that bad, he’d be scanning someone who came into the emergency room in severe pain. Surgeons and obstetricians prefer to avoid surgery during pregnancy unless absolutely necessary, so Kat was advised to adhere to a low-fat diet (fats aggravate gall bladder problems) and try to put off surgery until after the pregnancy.
The modified diet plan went pretty well until late in the second trimester, by which time Kat hadn’t felt any gall bladder discomfort for a while and we both got a little lazy about watching what she ate. Every other night for about a week, she started having some pretty substantial pain and discomfort, but she’s slow to complain, doesn’t want to bother anyone by “whining”, and telling the difference between what’s just the discomfort of a twin pregnancy and what could be gall stone pain is no easy thing. The night after we went out for burgers (oops), I woke up in the middle of the night and she wasn’t in bed, so I went down to check on her. She was obviously in a lot of pain and couldn’t find any position to relieve it, whether lying down, sitting up, or anything in between. She probably would have tried to ride it out yet another night, but I knew she’d had some tough nights recently and I was concerned enough to insist we go to the emergency room. I told her I’d talk her into it if she made me, but I’d rather not have to (it would have involved leveraging her concern for the babies), so she agreed to go easy.
This time around, Kat was the patient who came to the ER in severe pain due to gall stones. The first thing that happened was she got sent up to Labor and Delivery to have the babies monitored, and once they were found to be doing fine, she was released back to the ER to have her own symptoms evaluated. Sure enough, she was found to have severe gall stones and an inflamed gall bladder, so she was admitted for treatment and pain management. For the next five days, we alternated between thinking they’d have to take the gall bladder out, or thinking she could go home and try to manage it the rest of the way with diet again. The surgery option was scary because on the one hand, they (surgeon and our OB) reassured us as much as possible that they’d expect a good outcome and plenty of pregnant women have this and other surgeries without complications, but on the other, they sure were reluctant to operate unless they felt they had no other choice. Gall bladder removal is normally a pretty routine laparascopic procedure, but at this stage of a twin pregnancy, it wouldn’t be routine, and there was a good chance Kat would have needed an open procedure (i.e., bigger cuts), making for a more difficult recovery. While the surgeon was monitoring and managing Kat’s gall bladder issues, our OB was watching out for the babies, who never showed any signs of distress.
Ultimately, Kat was discharged with instructions to stay on a low-fat diet, and the OB ordered bedrest for the rest of her pregnancy, having judged her to be at increased risk of pre-term labor. (She tested positive for fetal fibronectin.) The goal was to make it through the rest of the pregnancy and once the girls were born, schedule surgery to remove the gall bladder as soon as possible - probably a few weeks later. (Yes, we asked if they could just do it at the same time as the c-section; and no, they couldn’t.) That plan worked, which brings us to today. While Mommy’s getting outpatient surgery, Daddy is in the NICU with Brooke and Claire, writing about it.
