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A few notes - Karen's Musings
Random Rambling
A few notes
In this episode:
-LJ catchup
-Neurologist Update
-Ear Infections
-The Great Triplet Saga

  • I hadn't consistently read LJ in about a week and a half. I am finally caught up, but commented only sparingly. My apologies if I missed anything important; I admit to having done a fair bit of skimming.

  • I saw the neurologist on Friday. He had a fair bit to say and wasn't nearly as egotistical as I remember him being. Maybe my impression was wrong. Maybe he's mellowed. Maybe both. Anyway, he had a fair bit to say, but acknolwledged that my options were limited. The most interesting thing I found out was that apparently I do still have some lingering weakness/slowness on my left side from the TIA-thingy I had in college. My left side droops a little when I'm not paying attention (e.g. if my eyes are closed) and it's not as quick with the reflexive actions and such. Interesting. Anywhozit, pain relief options are pretty much non-existent at this point. He's not surprised that the codeine isn't doing much good as it's easy to build a quick tolerance. Triptans are contraindicated not only in pregnancy but for anyone with hemiplegic migraines or a history of stroke/TIA so I can't take them anyway. Therefore, although migraines are certainly not life-threatening, he still thinks that even in light of the pregnancy, a prophylactic option is best. What surprised me was that he did not feel that a calcium-channel blocker was a good option (I've used them before with limited success, but they do have the added benefit of having a tocolytic effect, so I thought it might not be a bad idea). He didn't think it would do me much good and felt that there were better options out there. He did ask if I'm cautious about food triggers (I am) which we discussed at length*. "Okay, so you're not going to give me the easy out on that one, are you?" Nope. Been there, done that. (Eliminating food triggers and other lifestyle triggers is the first line of defense against migraines during pregnancy, which I already knew) So he ultimately surprised me by recommending Topamax. So long as the perinatologist approved it (he did), the neurologist felt it was my best option for getting some relief during the pregnancy. He did not expect I would get complete nor even near-complete relief as he wouldn't want me getting to a truly therapeutic dose until after delivery, but at least it has the potential to make things livable. I was surprised that the perinatologist approved it, but the biggest problem with anticonvulsants in pregnancy is the possibility of neural tube defects... the neural tube is fully formed before the end of the first trimester, so that's not a concern at this point. So I'm taking 25mg of Topamax for a week, and then 50 mg of Topomax until the end of the pregnancy. The last time I took Toaomax I took 150 or 200 mg per day and it did do a fair bit of good, so I hope that I'll at least get some decrease in migraine severity through September. After that, we can re-visit higher doses for a therapeutic level.

  • The bad news is that I have a raging, horrible, painful, awful, debilitating ear infection. The good news is that it's rather keeping my mind off the state of my migraines. It's really all about perspective. It does feel like a bit of a slap in the face to have YET ANOTHER ear infection on top of everything else. Even more annoying is that it started Friday evening on the start of a long-holiday-weekend, which means no doctors to be had. The two doctors in my community that I normally turn to for weekend ear infections (because they ALWAYS seem to happen on the weekend) are both out of town, and if I call my doctor, they'll just tell me that they can't diagnose an ear infection over the phone and that I should go to the ER if it's that painful (it is), which is stupid. I have 3-4 ear infections per year. I know exactly what's going on without going to the ER. Going there will not get me any new knowledge, though it might get me better drugs. Bah.

  • There's not much else in The Great Triplet Saga, actually. At my last ultrasound, they were growing brilliantly, even though I feel like hell. I think I might actually have gained a pound, which is a miracle. That means I'm still down 16 pounds from my pre-pregnancy weight, but that's okay. I have another ultrasound scheduled on Thursday and then I have to think about scheduling the "Level II" ultrasound, which I'm told will take HOURS because it's triplets. Holy Cow. Oh, and I'm leaving my OB's office and transferring my care solely to the perinatology office. That is, when I get up the guts to make it happen. I have a fear of confrontation with doctors. It's completely irrational. I love my OB, but it seems to make the most sense to only see one set of doctors and to make sure that I see the set of doctors that has the most experience with triplets. So... yeah.

    And that's pretty much all the news from here.

    * Interesting note about food triggers... I noted that soy sauce seems to be a recentish trigger for me, but not soy products in general. He said that's because soy sauce is fermented, which had never really occurred to me, but makes sense now that he puts it that way.

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46 comments or Leave a comment
cahwyguy From: cahwyguy Date: May 27th, 2007 03:13 pm (UTC) (Link)
Keep me informed about the Topamax, especially cognative side effects. Right now I'm on the Inderal LA. I haven't seen much effect (still having my annoying but not incapacitating headaches), but no side effects either. I also found the comment on Codeine interesting -- perhaps that's why it is much less effective for me. My problem is I've gone through almost two months worth of Maxalt (11) in three weeks! So good luck -- I truly emphasize with you on this. [If you want the updates on my headaches, look here.]

Good news on the triplets, and we're keeping you in our thoughts.
estherchaya From: estherchaya Date: May 27th, 2007 03:19 pm (UTC) (Link)
It's unlikely that my input on the cognitive effects of the Topamax will be useful to you... I have serious pregnacy-brain right now and as such can't really tell right from left and upside from down. Also, in my last experience with it, I didn't find I had any cognitive effects with it at low doses... only when I got up above 100mg did I find that to be a problem (albeit a short-lived one).

I'm not surprised about the codeine remark at all... my biggest problem with pain killers for years has been my quick tendency to build a tolerance to them. But when I'm not pregnant, I can alternate with NSAIDs or other options, but don't really have that option right now. Bleh.

Thanks for keeping me in your thoughts. Definitely appreciated.
From: gingy Date: May 27th, 2007 03:13 pm (UTC) (Link)
Your ob/gyns will probably breathe a sigh of relief when you tell them. That's a pretty high risk you have goin' on there, missus.
estherchaya From: estherchaya Date: May 27th, 2007 03:21 pm (UTC) (Link)
No, I told my OB at my last appointment that I thought maybe I should transfer my care and he didn't like it one bit. To be honest, I think he doesn't want to lose the chance of following/delivering a triplet pregnancy. Not all OBs get that opportunity (he's delivered 2 or 3 sets of triplets). For him it's not so much a problem that it's high risk, because I'd be followed by the perinatologist weekly regardless of whether I continue seeing the OB. I just see no advantage to going through two sets of doctors at this point.
mrn613 From: mrn613 Date: May 27th, 2007 04:13 pm (UTC) (Link)
I'm sorry you are still in so much pain. Hopefull the Topamax can make a dent in it.

Is is possible your OB is upset about you leaving because he is going to be out $20,000 for the c/s delivery? Honestly, I don't know why you are wasting calories dragging yourself to his office in addition to the peri's. If you are afraid of confrontation, just have the receptionist at the new office contact the old office to have your records sent over. You and the babelette's should be your only concern, not his ego.
estherchaya From: estherchaya Date: May 27th, 2007 04:22 pm (UTC) (Link)
I'm sure a large part of it is being out the fee for the triplet c/s (I have no idea what a triplet c-section delivery is, to be honest, but I'll take your word for it on $20K). I think much of the rest of it is that OB's don't get a lot of opportunities to deliver triplets.

Originally I didn't want to leave my OB because I love him. I trust him. I believe he will follow my care with my best interests in mind. But now... now I have enough of a relationship with the perinatologists that I have faith in them as well. I respect them. I trust them. I like them. I believe that I will get appropriate care from them. Usually the perinatologists' office does NOT provide OB care, only the higher level monitoring that high-risk patients sometimes need. But in the case of triplets (and higher), the perinatologist WILL see me for OB care. As it stands, since I'm seeing both, every time I have a question, I have to call my OB first, then they decide whether to consult with the perinatologist or to give me advice themselves. I believe the perinatologist is better equipped to respond to triplet needs. I also believe that there is little advantage to having two sets of doctors... it seems like there are lots of opportunities for miscommunication but little actual advantages.

So anyway, my plan is to call the OB's office on Tuesday and tell the receptionist to transfer my records over, rather than trying to engage the OB in another discussion about it. I regret doing it that way because I love the OB in general and I would prefer not to alienate the practice so that I can return to them for GYN care or if I ever have a normal, low-risk, singleton pregnancy. HAH!
ichur72 From: ichur72 Date: May 27th, 2007 04:57 pm (UTC) (Link)
Very, very glad to hear that the kidlets are doing well. May it continue! Meanwhile, refuah shleimah on the ear infection ...

Walt, I know, has had good results with Topomax so far. It doesn't eliminate all of his migraines, but he says they happen less frequently, are less severe when they do happen and go away more quickly. He is taking 100 mg/day, FWIW.
estherchaya From: estherchaya Date: May 27th, 2007 05:01 pm (UTC) (Link)
I had reasonably good success with it 5 or 6 years ago, but with some side effects that weren't great. (neuropathy in my hands, for example). It took me down to maybe 5 or 6 migraines a month (down from 4-5 per week), so that part was great. But it was at a pretty high dose. I won't be allowed above 50mg while I'm pregnant, but I'm hoping that even that low dose will cut the severity a bit.
(Deleted comment)
estherchaya From: estherchaya Date: May 27th, 2007 07:39 pm (UTC) (Link)
I was told to expect it to take all morning, which surprises me, because most people I know have told me that their level II ultrasounds took about 45 minutes at most. Anyway, the perinatologists office has a couple different sonographers, but it seems like I mostly see one of them. I don't have any say over which one sees me though. Regardless, they take exemplary notes on parasitic position at every single ultrasound, so I don't think that's too big a worry. They're so used to dealing with triplets at that office that it seems pretty routine.

Yeah, I don't know yet whether it's good news on the migraines, but at least I have something to try.

I seriously doubt I can sit in a car for two-plus hours, but if you find yourself in Baltimore/Owings Mills, we could meet you there. :)
hannahsarah From: hannahsarah Date: May 27th, 2007 07:21 pm (UTC) (Link)
I love hearing that nothing "interesting" is going on with your triplets. I hope that they continue to be boring right up to and through delivery.

I can't even imagine being pregnant with triplets, in the summer, with migraines. Your strenght continues to amaze me. For today at least, I'm going to think twice before whining. :-)
estherchaya From: estherchaya Date: May 27th, 2007 07:35 pm (UTC) (Link)
Yeah, they're doing great. They are all growing exactly the way they should be, which is terrific. I'm a totally different story... I feel like crap. But the important thing is that they're still doing okay.

I think the only way to be pregnant in the summer is to be pregnant with triplets... because honestly, I won't be able to go out much, so I'll be stuck in bed in my air-conditioned house! I try to remember not to whine by remembering my friend in Texas who is 21 weeks pregnant with quadruplets and just had a cervical cerclage and is on strict 100% bedrest until they come out. It's hard not to whine with an ear infection though... :)
From: marthag8 Date: May 28th, 2007 01:02 am (UTC) (Link)
Soy sauce contains MSG, which is a known migraine trigger for lots of people.
estherchaya From: estherchaya Date: May 28th, 2007 01:05 am (UTC) (Link)
I've even used soy sauce that does not contain MSG, though, for exactly that reason, and it's still a problem. MSG is a huge trigger for me, for sure.
gishmak From: gishmak Date: May 28th, 2007 01:34 am (UTC) (Link)
good luck & feel good!
when are you due?
estherchaya From: estherchaya Date: May 28th, 2007 01:08 pm (UTC) (Link)
I'm due at the very beginning of November, but with triplets the due date sort of becomes irrelevant, because they won't let me go past 34 weeks (average for triplets is 32 weeks). They'll be born (via c-section) sometime in September.
From: lcmlc Date: May 28th, 2007 02:52 am (UTC) (Link)

error message

I just got this really neat error message when I tried to read your post to me. I think you may want to use it sometime, with some judicious editing. Use your imagination. It said, "style code didn't finish running in a timely fashion. Possible causes: infinite loop in style or layer. Database busy."

One possible scenario:"Julian didn't finish running in a timely fashion. He's still running around the living room and through the dining room into the hall, then through his and our room and back. Possible causes: infinite loop in his brain with absolutely no style. He is a runner not a layer. Database busy. Me, too.

Lots of love. lcmlc
estherchaya From: estherchaya Date: May 28th, 2007 01:09 pm (UTC) (Link)

Re: error message

but the Julian scenario describes EVERY day at the Cohen house!
cleobatya From: cleobatya Date: May 28th, 2007 02:56 pm (UTC) (Link)
despite all the secrets in your body (your migraines, ear infections, and triplets), you really looked beautiful when i saw you...you looked healthy and after things quieted down a bit, fairly relaxed.

i hope you get relief soon from all your aches and pains, and that you continue to find the strenth to deal with it while growing three babies, and raising a fourth!!!!!

it was so wonderful seeing you seth julian and your mom!!!
estherchaya From: estherchaya Date: May 28th, 2007 04:53 pm (UTC) (Link)
It was really fantastic to see you. You look fantastic and seem so much happier/at peace with yourself since last we saw you. I hope things work out well with the dinosaur so that we get to see you way more often. :)
journeytoernie From: journeytoernie Date: May 28th, 2007 04:39 pm (UTC) (Link)
yay for some relief! it's good to hear from you!

and if it makes you feel better, i haven't seen it yet, but i heard shrek and fiona had triplets.

random factoid of the day...
estherchaya From: estherchaya Date: May 28th, 2007 04:51 pm (UTC) (Link)
yes, they had triplets, though that wasn't the focal point of the movie. We saw it last week. It was cute.

Don't know yet whether the Topamax will give me any relief, but here's hoping.
From: mattclearing Date: May 29th, 2007 01:40 pm (UTC) (Link)

Sorry to hear you're not feelin so hot...

...but it could be worse. My old upstairs neighbor who was my best friend when I was living in DC got what doctors suspected was an ear infection; it was so painful he could barely sleep for weeks. It wasn't until his neck started swelling (eventually to a lump nearly the size of a tennis ball) that they diagnosed him with non-hodgkins lymphoma. He smoked for over twenty years, but was only 43.

That was a bit over a year ago...chemo killed the tumor but new ones showed up in his arm and thigh after it was done...he just finished another round to get rid of them.

As much as ear infections suck, they sure beat the alternative.

Nice to hear that the kids are doing well. I hope it's warm there, because here it's cold, wet, and extremely windy.
estherchaya From: estherchaya Date: May 29th, 2007 02:26 pm (UTC) (Link)

Re: Sorry to hear you're not feelin so hot...

certainly there are worse things (and I'm very sorry for your friend. In the grand scheme of things, ear infections (TRUE ear infections... not the kind that turns out to be non-hodgkins lymphoma) are no big deal at all. It's just annoying. Frankly, the migraines are a bigger deal.

Anywhozit, the kidlets are doing great, regardless of how shitty I feel, and that's what's important.

It is pretty warm here. In the 80's, I think, though I don't venture outside much these days, as I'm mostly house-bound. I tend to prefer the cold regardless, but Julian likes it hot, so I guess it's all good.
malkaesther From: malkaesther Date: May 29th, 2007 10:15 pm (UTC) (Link)
May the topamax help and may you also get over your ear infection. I've spent lots of time arguing with doctors about whether I need meds & which one's I need because I know exactly when I have an ear infection coming on and also know that only one therapy ever works. I miss having a doctor that knows and trusts me on this, luckily I have not had an ear infection in a few years.
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