Saturday, June 5, 2010

Emergency Room, Take 2

I won't bother to give anyone a blow-by-blow like I did last time--and it wasn't nearly as bad this time, anyway, since we chose a different emergency room to go to--but I will confirm that if you choose to go the ER, they are not interested in diagnosing what is wrong with you...they are only interested in proving that what you (or your doctor) thought might be wrong with you when you landed there, is not actually what's wrong with you. Then they're happy to send you home to "follow up with your primary care physician." You've usually spent lots of hours and dollars in this process, and I guess whether you consider that time and money wasted depends on your eventual diagnosis...

At any rate, yesterday was no exception... lots of time, lots of money, no diagnosis...

I am writing this update here so that those of you who saw my Facebook status about thinking I was passing a kidney stone, those who got the prayer request through Kathy, or those of you who just got word through the grapevine, can know what's going on at this point. Many thanks to those of you who have called to check on me today, but I am sending an update to keep the rest of you from having to do so. Fee free to skip to the "cut to the chase" section (below) if you just want the bottom line news.

The background: I was kind of "crampy" in my lower abdomen and lower back on Tuesday, Wednesday, and Thursday of this past week. Since Friday was to be 4 weeks exactly after the start of my last menstrual period, I assumed it was PMS and that I was going to have a pretty yucky period. Not much concerned...

The ramp up: Thursday evening, as I was reading to my family at the dinner table, my three-days-old-now cramping became terribly uncomfortable, and I excused myself to my bedroom to lie down, asking the kids to go get ready for bed. The pain rapidly intensified to excruciating, and I called iivo in to talk about what might be wrong.

Once again, while one of us writhed and moaned in excruciating pain, the other one perused the internet for answers as to what could cause such pain. After dismissing appendicitis (usually involves fever and chills, which I did not have) and ectopic pregnancy (pain doesn't usually arrive in this case until at least six weeks into a pregnancy, and is usually accompanied by bleeding), we settled on assuming I had a kidney stone to pass. All accounts indicate it to be pain on par with labor (it is worse) which causes nausea (check), inability to stay still (check), and a situation in which no position will alleviate or relieve it (check).

Not wanting to repeat our nightmare experience at the ER just three short months ago, we opted for overnight pain relief and a trip to the regular doctor the next day. 800 mg of ibuprofen didn't touch the pain, so an hour later I took a vicodin tablet which was in the house from a previous surgery. I was finally able to go to sleep.

The next day: PT was scheduled for a CLEP test on Friday morning, so iivo stayed home from work and took him so that I didn't have to drive while on narcotic drugs. Afterward, he drove me to the doctor's office.

I explained to the nurse practitioner that I was there because I was pretty sure I had a kidney stone, and I wanted to make sure it wasn't too big to pass. I mentioned that the pain had begun the evening before, but that I had taken pain medication and avoided the emergency room because I was relatively sure it wasn't appendicitis or ectopic pregnancy, the other two things the internet indicated might cause this kind of pain, and because a kidney stone, though extremely painful, was not potentially life-threatening.

I had to pee in a cup, and she poked around on my belly while we waited for the results. Apparently the results came back indicating that (1) I have a urinary tract infection, and (2) I have HCG in my urine. (For those of you who don't know, HCG--human chorionic gonadotropin, one of the only terms besides "Krebbs cycle" that I remember from all my years of studying biology--is a substance produced during human pregnancy. She had apparently chosen to test for it when I mentioned ectopic pregnancy, assuming--correctly--that this must mean that we were not using birth control and that there was therefore a possibility of pregnancy.)

Since she wasn't prepared to be medically responsible for severe abdominal pain in a pregnant woman, she dismissed what she feared was a possible ectopic pregnancy scenario to the ER.

There wasn't a chance I was heading next door to the same nightmare ER which had handled iivo's situation last February, so I called my ob/gyn's office and told them what was happening. I asked if I could please come there instead of going to the ER for the ultrasound, but they indicated that if my doctor had recommended I go to the ER, I should go, since ectopic pregnancy can be dangerous and life-threatening. We chose to head to the ER associated with their office, however, which is another town over.

Incidental en route news: The nausea decided to get serious at this point, and I threw up twice on the way to the hospital, once over the guardrail of the highway, and once in a barf bag we carry in our car. If you saw someone throwing up on the side of the highway around 2:00 in the afternoon Friday, that was me!

The ER: Their marching orders in hand (you know: prove this is not an ectopic pregnancy emergency, but diagnose nothing else that it might be), the hospital staff took blood, gave me an iv, gave me anti-nausea medicine to handle the vomiting, made me pee in a cup again, and generally watched me writhe in pain all afternoon as the vicodin wore off. Eventually I made it to ultrasound, where they found no evidence of any pregnancy anywhere. (Who didn't know that, when you're only a few days pregnant and haven't even realized your period is late yet!)

What could be causing this excruciating pain? They don't diagnose, remember; they only speculate:

* It could be appendicitis--yet one doctor who examined me said, "Does this hurt?" at which point I said, "I'm on vicodin, so I'm not sure," to which he responded, "I don't care how much vicodin you're on. If you had an inflamed appendix, when I did that, you'd climb off this table." Okay, so I guess we're safe assuming it isn't appendicitis.

* It could be an ectopic pregnancy--yet both the ultrasound tech and the first doctor who read the ultrasound didn't see anything that would make them conclude that there was a pregnancy in the fallopian tube that could be causing this kind of pain.

* Could it be kidney stones? (This was our original diagnosis ourselves, remember, and still what we were pretty sure it was... but we are the ones who had to even suggest this as a diagnostic possibility... we had to suggest that they bring us a sieve for me to pee through... we had to require that they keep the iv's flowing so I could keep urinating despite the fact that they wouldn't let me drink anything because of the vomiting... and no, they didn't look for possible kidney stones when they were doing the ultrasound, because their job was to rule out ectopic pregnancy only, remember?!)

This took all day?! Yep. Unbelievable, but yes. In the end, they sent me home last night after a dose of morphine--I was offered a choice of going back on pain meds, which I had refused all day since I found out about the pregnancy and so they could accurately assess the situation--or staying there overnight. You better believe I chose heading home. They instructed me to take vicodin when I got home, and to continue to take it all weekend to control the pain, until I could get to my ob/gyn on Monday morning. She would check HCG levels again then, to find out if they were progressing normally. (Apparently they double every 48 hours in a normal pregnancy, so knowing what mine were on Friday and then on Monday would help them determine if I had a uterine pregnancy or an ectopic one.)

Cut to the chase already! Okay, okay. I said I wasn't going to go blow-by-blow. Sorry!

I came home, took the vicodin, and went to bed. That was about 10:15. I woke up at around 3:00; stumbled into the bathroom in a sleepy, druggy stupor; forgot to pee in the sieve; then stumbled back into bed. I felt no pain, but the vicodin was only about four hours old then, so I decided to wait until morning to take any more. I woke up again around 6:30, peed through the sieve, and staggered back to my bed again. I still felt no pain, and realized this was in spite of the fact that all of the vicodin had to be out of my system after 8 hours.

So, that's where we are. No pain, all day! I was elatedly assuming this meant I had passed my kidney stone during the one accidentally-non-sieved urination of the night, but I talked to my sister today about her son's experience with kidney stones. (He was writhing around on the floor, moaning in pain, and throwing up all one day, then perfectly fine the next. She thought he had had a weird stomach virus. Three weeks later, same thing. Three weeks later again, same thing. At that point, she decided it had to be something besides a weird stomach bug and took him to the doctor. They diagnosed a kidney stone, and had to blast it for him to be able to pass it.)

So, I guess I either passed the kidney stone last night, or it stopped moving, causing a break in the pain until it starts moving again. I will hope it is the former, but the ob/gyn confirmed by phone today that the total absence of pain today confirms that this pain was related to a kidney stone--whether it has been passed yet or not--and not to an ectopic pregnancy.

I still have an appointment to see her Monday morning, when she will check HCG levels to find out what's going on with this very, very early pregnancy.

Since iivo and I have had four miscarriages since EL was born, we are not quick to assume that this pregnancy is normal and fine. But we do know for certain at this point that there is a fertilized embryo growing somewhere in my body, and that it does not have anything to do with the excruciating pain I was experiencing for the past two days.

There is certainly a chance I could have an ectopic pregnancy, but it is the same rare chance that any woman has of having an ectopic pregnancy. There is also a very good chance of this pregnancy ending is miscarriage, since there is increased chance of miscarriage with each one a woman has, and I've had at least four.

I am also 43 years old, and advanced age is another risk factor for miscarriage. Old eggs often produce fetal abnormalities, resulting in miscarriage. There is also increased possibility for Down's syndrome and other non-fatal fetal abnormalities at my age. iivo and I are aware of these risks, and have chosen not to use birth control in spite of them.

So, at this point we await news of this pregnancy. I am refraining from interaction with any emotions about any of it at this point, as there is no point in engaging with all of the possibilities. If I have an ectopic pregnancy (the one doctor's voice, who said he thought he saw irregular bulging in the fallopian tube, still lingers in my mind), I will have one particular set of ethical dilemmas and questions to wrestle with and a particular set of painful emotions to traverse. If I have a uterine pregnancy, I will face a very high chance of miscarriage and will face a whole different host of emotions accompanying that. If I have a uterine pregnancy that makes it, I will face a high chance of fetal abnormalities; this will bring its own set of thoughts and feelings and plans. And even if all is normal with the pregnancy and the baby, our lives will change drastically in relation to this reality. We will be thrilled, but we will have a whole new set of emotions to experience, decisions to make, and plans to execute. I do not need to engage all of those emotions and possibilities, since a good percentage of them will never come to pass. I will wait and engage only the ones the Lord actually brings my way.

I do not know God's plan for our lives, or for this baby, but I do know that He is good in all things. I trust Him in this. And I thank Him for this baby, however long and in whatever state he or she survives.

Please join me in praying. I'm not even sure what to ask you to ask for. Please pray for my health: I am currently on antibiotics for the urinary tract infection, I may or may not have passed the kidney stone that was causing such pain these past few days, and I am pregnant.

Please also pray for this pregnancy and this baby. Of course, our desire would be that the baby live and be healthy and whole and fine. Please join us in praying to this end.

It would not normally be our practice to share news of a pregnancy of this nature so early in the pregnancy. We know that the "odds" are against our giving birth sometime near next Valentine's Day--the baby's due date--but we also know that we serve a mighty God who is "able to do exceedingly above what we could ever ask or imagine." We trust Him with our lives, and we trust Him with this baby's life. If He lets us parent this child, we will gratefully receive that blessing. If He takes this child from us before we have that opportunity, we will praise Him even in that pain.

Thanks for praying. We will keep you posted.

1 comment:

Danielle Miller said...

Thanks for keeping us all posted and we will be saying a prayer for you and your family. Please know that you can call us anytime should you need anything...we are right down the road!