Negatively Positive

You know you've been hospitalized too long when not only does your husband decide to graph your upwardly trending labs on an excel spreadsheet, but you both find it entertaining to try and predict the next round of numbers. Comical, yet more so pathetic. My ALT (red line labs) continues to beat itself for personal best each evening, last night Matt even guessed spot on what my number was. We're considering buying a loto ticket or betting on horses. Although the AST (blue line) hasn't been as dramatic, indicated by our handy dandy little graph, it too is on the rise.

my little liver


Matt seems to think that based on our "data collected" that we can predict with this trend what my labs will be in a week. While the evidence is clearly in front of me, I'm still hoping for a significant enough drop that they might trend downward. He's not as optimistic. With the recent spikes in my ALT, I've been expecting the attendings to be more proactive and potentially aggressive with decision making but they simply continue to monitor me as this is some odd mystery that isn't automatically medicated. Hard to medicate when you dont know what you're trying to treat or prevent, and when all other determining labs are wonderfully at their baseline.

From what I gather, it sounds like decision making about decisions will be late Wednesday or Thursday, thats not at all saying I'll be heading home on those days but maybe we'll have a plan of attack. Today, once I wake up again after my morning awake time and going back to sleep time, I'll have a BPP done with MFM. I know you guys love all the random letters, half of the time I use them, I dont know what they mean. BPP is biophysical profile and its essentially an ultrasound that collects multiple pieces of diagnostic info and gives the baby a score, out of 10, based on what has been collected. Baby will get a score based on her tone, breathing movements, body movements, reactive heart rate (whether she's having normal accelerations and decelerations within range), and measuring fluid levels. The first day here we had a BPP and I dont know what the score was but she did well. I was in my mag-coma so I didn't know that we were doing anything other than a routine ultrasound so I wasn't paying attention. I did hear them say 70% percentile and looking good though. The attending physician has once again become my favorite person and is ordering my 3rd 24-hour urine collection to test for proteins as well. It seems like the team of OBGYNs will let MFM (maternal-fetal medicine) guide them as to what to do from here based on the BPP, next 24 hour urine (results would be Wednesday), and my consistently inconsistent labs. I'm honestly not sure how long they'll keep me in the hospital for this monitoring. I agree and appreciate with the need to be cautious as this can turn bad quickly but I can still have all of this testing done outpatient and only need to do office visits 3-5 times a week for my labs, NSTs (non stress tests, essentially sitting with baby on the monitor), and a once weekly BPP, thats component is an NST so I've already killed 2 birds with one stone on that one.

Baby has continued to be solid as a rock in terms of her monitoring and activity. I haven't contracted (that I felt or was monitored) in a day or two. Relatively no physical complaints on my part either. Every now and then I get headaches that I report to my nurse and each time, my BPs been fine. I had a very sore back yesterday, and thus far, back and musculoskeletal pain has been more painful being here than anything else. I can't wait to take NSAIDs like advil again, Tylenol just doesn't do the trick. I get occasional RUQ pain as I've blogged before but its infrequent for the most part and practitioners can't quite decide if my liver is flaring, considering my enzymes are so high, or if its because baby's head has been near my liver and gallbladder causing discomfort. Particularly with today's BPP, I'm interested to see if she remains breech or if she's turned. Its very week by week with this young lady, on a lot of levels. She has 5 or so more weeks that she can turn multiple times, so whether we're looking at a c-section or normal vaginal delivery, I don't know. They both are scary to me, but for some reason I'm more "okay" with the idea of a c-section because its planned and I dont have to labor for it. People think its funny that I'm less afraid of major surgery than normal delivery, but its just how I feel about it. Clearly the baby will make the decision on that by turning or not turning. They have been impressive about convincing me that I do get to gym sooner after a normal delivery than a c-section, and get to go home sooner post partum.

I'm entirely optimistic that they will let me go home at some point, but my midwife and OBGYN and I are in total agreement that once I'm home and I'm in for one of my newly routined activities like BPP or a lab, something will be off kilter enough for readmission and delivery. No one has any idea when this might take place. Clearly we want the baby to stay in as long as she can but we've made good progress and have bought her a week since arrival so she's more equipped to handle the outside world now than she was upon admission.  I'm just not sure how long they'll allow my LFTs to escalate for my benefit. I need my liver to function, I have Uncle Dan's sangria to drink when the baby is finally born!

We'll see what today brings in terms of any potential answers! I've given up on good news which is a little sad but we're so used to hearing, you look great, you feel great, your levels are terrible but we're not going to do anything for them, baby's great, but you can't leave. Matt gets a "break" tomorrow and he'll work his 1 scheduled shift for the week. He had planned his annual guys trip to Crescent Bar so he took 3 work days off to go over to Eastern Washington, but with everything so up in the air, I can't convince him to go, although I think he needs the time away from the hospital and the monotony here. He'll work Wednesday and presumably spend half the day here anyways! Since he was scheduled to be off work for the duration of his work set, we'll be able to have some time to see what decisions are being made before he heads back next Thursday. The PD has been great about being accommodating for him, if decisions get made about when the baby will come, he'll begin is FMLA then, until that time, its a day by day experience.