In Memoriam: Carter Edward Hurtado (Feb. 24 – 26, 2009)

Words cannot express how deeply saddened we are by the passing of our son, who despite his strong will to live left us a few hours shy of 2 days old. He had a Stage 4 blood clot (the worst stage) in his brain, which eventually caused all his systems to shut down. He is survived by his twin brother Tyler, who other than being a preemie has been doing very well.

I apologize that many of you are finding out via blog (especially those who live far away), but we were too crushed to make many phone calls and have a very hard time talking about all the details. We initially just called one family member on each side and a friend to spread the word locally. The past few days have been the most emotional and heartbreaking days that either Michael or I have ever experienced.

I have journaled the events of this week, but we do not want to post them on this public blog due to their very emotional nature. Family and friends who wish to read this journal are welcome to e-mail me and I will be happy to send you a copy of the journal.

Tyler has been doing really well in the NICU. He just needs time to continue growing under the care of the doctors and nurses until he is closer to his original due date before he can come home. I will try to update you on his progress as I have time.

Week 31- Day 7

The babies came close to needing to be delivered last night around 9 pm. Twin A had a few heart decelerations within a short time period. Essentially this means he was either playing with or getting tangled in his umbilical cord and reducing his oxygen supply. But he figured it out and recovered and looked pretty good, except for a few sporadic decelerations, the rest of the night. It has been the same throughout today. His decelerations typically occur when I have a Braxton-Hicks contraction and thankfully I have been having less contractions since I went on medication. Of course Twin B is a show-off and hasn’t had any problems. According to the doctor as long as Twin A keeps recovering and doesn’t have long or frequent decelerations it could be another week or two until we deliver. I can’t wait to see how much the babies have grown during tomorrow’s ultrasound as it will have been almost 3 weeks since the last growth measurement.

Week 31- Day 6

Twin A had a few minor heart decelerations during the night, but otherwise is looking really good. Twin B continues to show off and always looks good on the monitors. My mom flew back to Houston today, but will be back when the babies are born when we are really going to need the most help. She did finish painting the nursery yesterday and we are so grateful! It was also nice to have her keep me company at the hospital!

Michael and I think our childbirth class must be jinxed. We started our weekly 6-session childbirth preparation class in January and it runs through March 2. Including us there were 6 couples. We only made it to the first 2 classes. Earlier this week Michael ran into one of the guys from our class whose wife (32 weeks along) is also here at St. V. on bedrest because her placenta started to detach. Today Michael ran into another guy from our class whose wife (33 weeks along) gave birth on Thursday after her water broke early. What are the odds?

Week 31- Day 5 (Friday)

The medication is working stop my Braxton-Hicks contractions. Both babies' heart rates have been looking so good that they did a quick ultrasound just to verify. Twin A didn't have any heart decelerations, which is very hopeful.

They started having me use "pressure booties" yesterday. They alternately apply pressure to each of my feet to improve my circulation and prevent blood clots. They never thought I would be on bed rest this long or they would have started me using them sooner.

Week 31- Day 4

Today's ultrasound showed that the reverse diastolic blood flow to Twin A is back, which explains why he was having a few heart decelerations yesterday. According to the monitors, the heart decelerations typically occur when I have a Braxton-Hicks contraction, which I don't even feel. The doctors are now giving me medication to relax my uterus and hopefully stop the contractions and the associated heart decelerations. In the meantime they are going to keep monitoring continuously to see how things go. If they keep going well the next ultrasound will be Monday and they will check the placenta blood flow and check the growth of the twins.

The ultrasound tech said that Twin B currently looks like he is resting his head on Twin A's butt. The nurse joked that this should earn Twin A the right to the top bunk when they are older.

Week 31- Day 3

They put the babies back on continuous heart rate monitoring today to be on the safe side. During the afternoon monitoring Twin A had a few small heart decelerations where his heart beat rate dipped lower than normal a few times (e.g. 40 seconds, 10 seconds). While this is not totally abnormal, it is something then nurses and doctors want to keep watching for. I am hoping he was just having an off day. I am also hoping he has my stubborness and keeps hanging in there as long as possible.

Week 31- Day 2

Not much new to report... both babies' heart rates continue to look great. One of the doctors told me she is amazed how well they have been doing considering the blood flow issue to Twin A's placenta.

I have actually been doing some work for the office during the day while my mom works on painting the nursery. It sounds like she is getting close to finishing. Moms rock!

31 Weeks

We made it another week! I had a biophysical profile (BPP) ultrasound today that showed that the twins' movement, heart rates, and amniotic fluid levels look great. It turns out that the next ultrasound to measure the blood flow to the placentas isn't scheduled until Thursday. Those crazy twins are all criss-crossed in my belly now. Twin A is diagonal across the bottom of my belly and Twin B, who is head down again, is diagonal in the opposite direction across the top of my belly. That Twin B is such a womb hog!

It turns out that in the detailed list of nursery prep and painting instructions I gave Michael and my mom I left out the step to paint the walls blue! They aren't going to let me live that one down!

Week 30- Day 7

Things are status quo at the hospital. Meanwhile, Michael and my mom have been painting the nursery this weekend and are going to look at/pick up some of the furniture today. I can't wait to see how it all comes together. They are painting the walls a sea blue with cream trim and then we are going to use lime green as the accent color (e.g. curtains, decorations).

My dad is working on an invoice for me to "reimburse" him for my mom's time away from him (and his laundry and meals). These are the "standard union rates for Dad/Daughter relationships" according to my dad:

1 voucher per day - travel days (half rate)
2 vouchers per day - weekday rates
3 vouchers (time and a half) on Saturdays
4 vouchers (double time) on Sundays and holidays (Lincoln's birthday, Dad's birthday, and Valentines days are recognized holidays)

He did offer a 12-voucher discount if I disclose the names we have picked out for the boys, but my lips are still sealed! We did finally narrow it down to 3 names though. ; )

Week 30- Day 6

Happy Valentine's Day! The twins' heart rates are still looking good. Since I may be in the hospital for a while a physical therapist came by today to go through exercises I can do while on bed rest. Woo hoo- ankle rotations and shoulder rolls! : )

Week 30- Day 5

Both of the twins' heart rates are looking great and so they no longer need to be on the fetal heart rate monitor 24 hours a day. Woo hoo! It is nice to be unstrapped and I am sure the boys are breathing (well, practice breathing) a lot better too. The current plan is to monitor the twins' heart rates three times a day (morning, afternoon, and evening) for an hour each time and to do an ultrasound every few days to check the placental blood flow. The next ultrasound will be Monday.

In the meantime I have been semi-productive at the hospital. My mom and I have put boxes of family photos from 1986 thru 2000 into photo albums! I have also been doing some online shopping. : ) Don't worry- I am still getting plenty of rest.

Week 30- Day 4

Great news- the blood flow to Twin A is looking better! : ) This morning's ultrasound showed that the reverse diastolic blood flow is now absent. My doctor is going to keep the fetal heart rate monitors on for another continuous 24 hours to keep an eye on things and then tomorrow we may go back to monitoring just 3 times/day until the next ultrasound on Monday.

Both babies are definitely active in the womb and I swear they were having a party in my belly around 2 am this morning!

Week 30- Day 2

The babies' heart rates continue to look good, which is a positive sign. The days are actually going by relatively fast despite being refined to bed. It looks like our next ultrasound to measure the blood flow to Twin A will be on Thursday, so cross your fingers.

Week 30 Update

I posted to the blog too early this morning. Around lunch time my doctor came by and said that after he reviewed the ultrasound that the blood flow to Twin A's placenta is actually worse. (Technically it's called diastolic reverse blood flow for all you medical folks.) So now they have me hooked up to the fetal heart rate monitors 24 hours/day so they will know immediately if Twin A starts to experience any kind of distress. I panicked at first but my mom was able to calm me down and distract me today and then Michael joined us after work.

I am quite a site with the monitor bands velcroed around my belly and carting all the wires along with me to the bathroom every hour. At one point I said I felt like a beached whale and Michael couldn't help but chuckle and remind me of the beached whale on the Oregon coast (circa 1980s?) that ODOT exploded. It's on U-Tube if you haven't seen it.

I am staying positive and every day the babies stay in the womb is another day towards a healthier delivery.

Week 30

It looks like I will be in the hospital for the duration of my pregnancy, but the good news is that as long as I stay on bed rest and the monitoring of the babies looks okay we can keep holding off on delivery as long as possible. This morning's ultrasound showed that the blood flow to Twin A's placenta is still the same, but both of their heart rates look good, they are taking practice breaths, and their movements are normal. We could even see Twin A sucking his thumb. Twin B flipped to breech position since his heart rate monitoring last night, but he still has plenty of time to flip back to head down. It turns out we can't really accurately check the growth of the twins via ultrasound for another week or two, but the doctors and nurses will continue to check the heart rates (3 times a day) and the blood flow via the placentas (twice/week).

Week 29- Day 7

The babies' heart rates continue to look great and even though my blood pressure is still high it is holding stable, which is a good sign.

My mom flew in from Houston today to help out and keep me company. My dad said he was disappointed that airport security wouldn't let her check in the burnt-orange paint he claims he purchased for the nursery. Not to worry- Michael will make sure that longhorn colors do not make their way into the nursery!

Week 29- Day 6

There is not much new to report today. Both of the twins' heart rates are still looking good. Twin B is elusive and tries to hide from the heart rate monitor. They both know they are being monitored and like to kick up a storm.

Week 29- Day 5 (Feb. 6)

I had normal blood pressure readings last night and at 6 am. Woo hoo!

We did learn this morning that I will definitely be in the hospital for monitoring through Monday, which is when the next ultrasound will take place. It takes a while for the steroids to kick in so they want to wait to measure the babies’ growth until then. Keep your fingers crossed! Grow little Twin A!

I must say that I have been enjoying bed rest at the hospital and am in very good spirits. I have not had a headache since Sunday. Most of my swelling has gone down. My fingers are still tingly, but my hands are not in pain. And best of all I have been getting good sleep (thank you Ambien!). I am reading, watching TV, playing on my laptop, chatting with visitors and friends and family on the phone, and most importantly getting rest! So all in all maybe it is a mixed blessing that I am in the hospital. I’ll do anything to make sure the boys are born healthy!

We appreciate all the warm wishes, words of encouragement, and offers for help we have been receiving. My mom is looking at flights and is likely going to fly in from Houston on Sunday and stay for a few weeks to help us out. ; ) Gotta love Moms!

Week 29- Day 4 (Feb. 5)

I had an ultrasound this morning and you could see that both boys already have hair growing on their heads! And Twin B flipped over and is now head down again. It was too soon to measure their growth again, but they did look at the Doppler blood flow to the placentas. Unfortunately the blood flow to Twin A was slightly worse than on Tuesday, but it is too soon to tell if that is significant. If Twin A is growing enough the doctor said we could go days or even weeks until we need to deliver. Right now the doctor’s first goal for us is to make it to Monday (Week 30).

My blood pressure has been varied (as is typical for anyone throughout the day) but still high and I even had a normal blood pressure reading at 4:15 this morning.

Week 29- Day 3 (Feb. 4)

I received the second steroid shot this afternoon and the babies’ heart rates have continued to look really good. They gave me Ambien before bed last night and I slept for over 6 hours straight! That is the best sleep I have had since Thanksgiving!

The doctors did rule out today that I do not have preeclampsia, which was a concern because the high blood pressure, headaches, and swelling are all symptoms. They are also normal pregnancy symptoms. After collecting my urine for 24 hours they confirmed there is no protein in my urine, which would have meant preeclampsia. That was a huge relief!

Week 29- Day 2 (Feb. 3)

We went to our regularly scheduled ultrasound this morning. It is always exciting to see the little guys moving around on the big screen. While Twin A was still situated with his head down, Twin B had flipped into breech position with his head up. (There is still time for him to flip again). They also observed that my blood pressure was still high. After measuring the twins, they discovered a 24% difference in the size of the twins this time with Twin A weighing approximately 2 lb- 6 oz. and Twin B weighing approximately 3 lb- 1 oz. A size difference greater than 15 – 20% is when doctors start to get concerned. This is more frightening for identical twins that share a placenta, but it is still concerning for our twins who are fraternal and each have their own placenta. They should both be receiving the same amount of nutrients through their individual placentas. The Doppler portion of the ultrasound also showed that the blood flow to Twin A’s placenta was lower than what the doctors would like it to be , which is likely related to my higher blood pressure.

After the ultrasound the doctors hooked me up to a fetal monitor to observe the baby’s heartbeats as well as contractions. The heart rates looked great and it turns out I have been having Braxton-Hicks contractions (harmless), but have never felt them.

At this point the doctor told us he wanted to admit me to the hospital for treatment and monitoring. Michael and I had not expected for a routine ultrasound appointment to turn into a hospital stay and were a bit alarmed and surprised to be heading in this new direction. The ultrasound appointment at Perinatology was already at the hospital so it wasn’t a far walk to check in to the labor and delivery department.

The plan of action:
* Steroid shots 24 hours apart (one Tuesday afternoon and one Wednesday afternoon) to help the twins’ lungs develop sooner in case we have to deliver early. This reduces the risk they will need respirators after birth.
* Blood pressure monitoring every 6 hours
* Fetal heart monitoring 3 times a day
* Ultrasounds at key points

Week 29 (Feb. 2)

Michael and I attended my regularly scheduled pre-natal visit this afternoon, during which they discovered my blood pressure was high. They measured 3 different times just to make sure. High blood pressure is not a good thing during pregnancy. The doctor ordered some bloodwork, which came back normal the next day.

January 2009

By January I started telling Michael that I will never be pregnant again as I was growing increasingly uncomfortable! However, the babies were doing well. During our January ultrasound (you get lots of these with twins), the boys looked good but Twin B was 16% larger than Twin A. Measurements showed Twin weighed approximately 1 lb- 11 oz and Twin B weighed approximately 2 lb. This was the first sign there might be a growth discrepancy between the two but was not yet cause for alarm. My vital statistics continued to check out at all my prenatal visits.

But oh the miserable side effects of pregnancy! I had been living with pregnancy-induced carpal tunnel since mid-November due to all the extra fluids in my body. But in January my hands started to swell and only compounded the problem. My fingertips were perpetually tingly/numb and my hands, particularly the right one, were frequently in pain or they fell asleep. The pain was only worse at night when all the fluids in my body redistributed. When I woke up in the morning I was not even able to close my hands into a fist due to the swelling and I struggled just to take a shower. The last week of January I started waking up due to the pain in my right hand.

Although my feet and ankles were also swelling quite a bit (hello, club foot!), they did not cause me any pain and the swelling typically went down after sitting with my feet up or after sleeping.

Speaking of sleeping, I started having trouble around Thanksgiving, but really struggled to get a good night’s sleep over the Christmas holidays. While I was generally able to drift off at the beginning of the night, I frequently woke up due to discomfort, being hot, or to go the bathroom yet again! (Not to mention the snoring machine, er I mean Michael, that sleeps next to me.) Once awake, it was very hard to fall back asleep and I tossed and turned for what seemed like hours. I always seemed to be getting the best sleep right when the alarm went off for work. And of course when the weekend rolled around and I wasn’t on any kind of timeline I had the hardest time of all sleeping. Go figure!

The last two weeks of January I started having persistent headaches. I was essentially having one headache per day, but they went away with Tylenol, which was a good sign according to my doctor. I also had a migraine one evening (a first for me). The second week the headaches were less frequent, but still there.

I will stop the whining and groaning there because I don’t want to scare off all of you still planning to have kids. As Michael keeps reminding me, pregnancy will all be worth it when our beautiful baby boys arrive in our lives. I just wanted to give everyone a snapshot of the events leading up to February.