Buckle Your Seat Belts; Turbulence Ahead

Picking up where I left off, we were solidly into Fall with littles getting excited about Halloween costumes and Trick-or-Treat adventures. In the last week of October, the bean was at 22 weeks, measuring just a little bigger on fundal height, and generally, growing like a weed. I had been feeling movement for several weeks, but around that point, he was getting much more forceful in his kicks and rolls, enough that Scott and the kids could feel it on the outside of my belly too. Everything was progressing nicely... until is wasn't.

I woke up on November 5 with that annoying pressure/pain feeling indicating that a UTI was setting in. It wasn't extremely painful, but I wanted to get on top of it before it got out of hand. I'd had a UTI get out of hand in my first pregnancy that landed me in the hospital on IV antibiotics due to the bacteria not growing on the culture medium and leaving the doctors working blindly to try to treat it. They weren't able to tell which antibiotics to use until we tried them and they didn't work, switch to a different one, lather, rinse, repeat. After a week of no relief, it had spread to a kidney and required IV antibiotics. It was a scary situation, and not one that I wanted to repeat. So at the first sign, I headed off to the office of Lovely Outgoing OB and Partner OB. I was in an awkward position, in that Lovely Outgoing OB had left 5 days prior, and I hadn't ever had an appointment with Partner OB. Regardless, I peed in the obligatory cup, which was very cloudy with an abundance of white blood cells, Partner OB called in an antibiotic and we went on with our day. I was swamped with procedures and meetings over the next 2 days, so I gave little attention to the fact that the pain was not subsiding. By the middle of the day on the 7th, however, I was startled to see blood in my urine to add to the pain/pressure. I called the after hours line for Partner OB (it was Saturday by this time) and she quickly called me back. She told me that she was out in the wilderness with her family, so she couldn't look up the culture results, but that I should go somewhere to be seen that day given that it wasn't getting any better with the current antibiotic. So Scott chauffeured me to a great little stand-alone ER that we have close to our house. More obligatory peeing in a cup. Urine looked clear, as it should after 2 days on an antibiotic, but presumably, the infectious bacteria was resistant because symptoms were getting worse. That meant that this poor ER doc was going to be working blindly to treat, much like the first pregnancy UTI debacle. ER Doc #1 was great though; very thorough, attentive and conscientious. He gave me some Azo to alleviate the urethral pain that was increasing, then tried a new antibiotic IV. I headed out the door, hopeful that we had tackled it with the new antibiotic and ready to watch my favorite college football team domina.... er... take it in the shorts.

By Sunday morning, the pain was increasing and Scott felt that we needed to take a more direct approach. We talked about it at great length and decided that we needed to go to an ER that had a vast network of specialists because we may need a urologist at this point. We decided on the hospital that Partner OB is affiliated with so that we could ensure some continuity of care and information sharing. Admittedly, I was aware that Partner OB was still out in the wilderness with her family, but hoping that this strategy would allow the other professionals ease of access to my history, notes and results. ER Doc #2 was a stark contrast to ER Doc #1 in that she was much more direct and a bit brash, but she was very intellectual and her approach to solving the problem was very outside-the-box. Yet another cup of urine was collected, and again, it was as clear as one would expect after 3 days on antibiotics. This made ER Doc #2 think that the problem wasn't an infection, but rather a bladder spasm. Interesting... At that point, I was open to any thoughts/suggestions/treatments, because the pain was getting too intense to handle on my own. ER Doc #2 called Partner OB who said "As long as she's not having contractions, it's pretty much out of my field." So ER Doc #2 called the on-call urologist who said "Not really anything we can do for it. Just give her some pain meds and send her home." On that note, we left with bed rest instructions and an order to see Partner OB two days later to follow up.

Throughout the day on Monday was more of the same, but the pain meds took the edge off, so I was just trying to make it to the follow-up appointment on Tuesday at 1:00 pm. Instead, I woke up at 3:30 am with contractions that were regular and 5-10 minutes apart. In addition to managing the pain, I was lying in bed thinking that we really needed to *not* have a 24 week 2 day baby! I called the OB's office, drank a ton of water, laid down on my left side and thankfully, the contractions subsided within an hour. Partner OB's nurse called me and told me to come in at 11:00 am which was as soon as she would be out of surgery. Going in, I was so eager to finally get some relief and find an effective treatment after 5 solid days of this. Unfortunately, I didn't get anything like that. This was my first time ever meeting Partner OB in person, and I was shocked to see a twenty-something walk through the door. This made her accomplishments and awards all the more impressive, given that she's obviously only been working in her field a short time. She quickly ordered a fetal fibronectin test and ultrasound view of my cervix to rule out preterm labor. Both looked perfect (cervix length was a solid 4 cm), so she was pleased and told me I was good to go. I was caught a bit off guard when I asked about the pain and she shrugged her shoulders and told me she was baffled by it. She suggested I see the urologist, with the first available appointment being Wednesday at 10:00 am. Ok. On to day 6, again, eager for this physician to finally help resolve this situation.

I arrived at the urologist's office well ahead of the scheduled appointment time (did I mention I was eager??), with my best friend, Jamie, in tow. Scott was at work and I didn't think that he needed to keep taking half days off just to chauffeur me around. The medical assistant that called me back was very soft-spoken and sweet. She directed me to empty my bladder then took me to a patient room where she started to do a bladder ultrasound to determine how effective my emptying was. As she approached me, she said "Have you had an hysterectomy?" I said "No, in fact, there's currently a fetus taking up residence in my uterus." Clearly thrown for a loop (apparently didn't read the referral notes from Partner OB??), she quickly excused herself from the room without doing the ultrasound. At this point, Jamie started to question why we've been struggling with this issue for 6 days and no one, neither ER Doc #2 nor Partner OB, thought to visualize the bladder via ultrasound. Who knows, as she noted, maybe there's a stone in there irritating it or something. Certainly taking a look could be worth the time and effort. But that was definitely not in Uro Doc's plan either.

Uro Doc charges into the exam room 30 minutes past appointment time and says "You know, there's not a whole lot we can do with you while you're pregnant. You should really come see me after you have the baby." I'm sitting there silently, a bit confused. Is she saying that this pain is going to outlast the pregnancy?! Because I am absolutely certain at this point that I *cannot* do this for another 15.5 weeks! I told her that my goals for this appointment were to identify a cause of the pain and to discuss what options we have for treating it. She scoffed "Yeah, that's not going to happen." I literally laughed out loud when she said it. Sometimes I have a nervous laugh when I'm so stunned by how brazen someone is with what comes out of their mouth. This was one of those moments. She then tells me to drop my pants and proceeds to give me the most awkward, jabbing, pinching examination of my lady parts that I have ever experienced. At the conclusion, she says "Well, there's nothing that I can do for you surgically, so although you're experiencing some discomfort, it looks like you're going to have to just ride it out." Did she just use the term "discomfort" to characterize the hell that I'd been living for 6 straight days?! Here's the moment where the pregnant lady can no longer hold in the tears of frustration. What, exactly, do you do when you have been battling pain strong enough to cause contractions for 6 days, and every doctor that you see says "I'm not sure what it is, but it's not my problem." I couldn't even look this abrasive woman in the eyes anymore. Instead I fixated on the cabinets in the corner of the room while she continued to tell me that maybe the pain wasn't even real, just a figment of my imagination. She briefly stepped out to call Partner OB, then came back to say that they had decided it was bladder spasms and they would prescribe a muscle relaxer.

I went home feeling completely defeated, miserable, and somewhat out of options. I took the muscle relaxers as directed, and promptly slept through the entire day on Thursday; a side-effect of the medication that I simultaneously loathed and appreciated. Waking up on Friday morning (day 8), things had taken a serious turn overnight and I now had excruciating back pain on the left side. There was no relief and I told Scott that we had to do something, go somewhere, find someone that would actually *do* something. After a bit of tense back and forth on what to do, he buckled me in to head to a different, full-service hospital ER  close to our house. By the time I got there, it was difficult to walk and I was a blubbering mess trying to relay to the ER nurse what was going on. Once I mentioned the pregnancy, they wheeled me on up to L&D for monitoring and for the OB on call to handle the case. There was yet another round of pee-in-a-cup, but this time, this lab did something none of the previous ones had: They actually assessed the bacteria load in the sample. They didn't just look for white blood cells, blood, color, clarity, etc.. They came back and told me that there was a very heavy bacteria load, which they would not expect to see after a week on antibiotics. They were also monitoring the baby's heart rate and contractions while they ran a few more tests. While the contractions weren't strong enough for me to time them, they noted that my uterus was very irritable. I couldn't blame it... pretty much all of me was getting to the point of 'very irritable' by day 8! In the meantime, Sensible OB thought it would be a good idea to review some of my records to see what antibiotics had worked in the past. She picked one (again, working blind to what bacteria it actually was), and within 4 hours the pain was nearly gone. I seriously could have kissed her! She sent me home with a prescription to continue that antibiotic, and by the next morning, I felt like a brand new woman. I jumped out of bed feeling like I could do anything!

Throughout the 8 days of UTI hell, I was very careful in how much I relayed to Mandy and Wes about my pain. Without them being there, I knew that they would be very concerned, and I didn't want them to get worried when there wasn't anything that they could do about the situation. I made sure to let them know with each passing day that little belly buddy was doing great and that the doctors were still working on finding a treatment that would work. Mandy was so sweet and checked each day to see if I was feeling better, but I just couldn't lay the weight of my daily struggle and frustration on them. Still, we all shared the immense sense of relief when it was finally resolved. Mandy then broached the subject of questioning the treatment choices of the previous physicians, including Partner OB. I had been thinking the same thing, so it was nice to see that we were on the same page. We agreed to find a different OB for the remainder of the pregnancy, and who better than Sensible OB that looked at the situation and thought "If it walks like an infection and talks like an infection, chances are, it's an infection." She saved us from being admitted for IV antibiotic treatment by catching it as we were on the brink of a serious kidney infection due to the spread. So it was a logical choice to schedule our next appointment with her and cancel the end of November appointment with Partner OB. As the scheduling gods would have it, our first appointment with Sensible OB would fall on the same morning as the 3D/4D ultrasound in the first week of December.