I was admitted to Mt. Sinai in Toronto on Saturday (yesterday) morning at 8am. Noel came and stayed with me while we waited for our first ultrasound. We saw Dr. Al-Ibrahim, who is an awesome guy by the way, who went through our history. It was a bit unusual at first because it seemed that all of our previous charts and ultrasound results had not yet been faxed to Mt. Sinai...which I thought was really annoying especially considering the urgency of the situation and how quickly they got us to get on a plane. You'd think people would make sure that my information got sent over, too. Anyway - that was sorted out eventually. And in a way, I was glad that the doctor would be taking a 'fresh' look at our babies without much previous knowledge of what was going on in there.
What he found was pretty interesting. I am not entirely certain about this yet, and am trying really hard not to put the blame on anyone, but unless all three babies have moved clock-wise in my belly and taken up residence in each other's exact same spots AND swapped weights and sizes, they have been mixing up the mono-di twins and their fraternal brother. At first this really had me upset, as the first thing I thought was that this could have been caught much sooner if they'd been keeping a closer eye on the right babies. However, the baby that is in trouble right now is one of the babies they were keeping a close eye on. It's just that I think the advancing of TTTS could have been caught a week or two sooner had they been watching the 'correct' donor twin. First, let's get these guys straight.
The new run down:
Baby A (originally called the 'recipient' twin of the ID pair, or the twin with excess fluid) is actually the fraternal triplet. He is in excess fluid of unknown origin, but doing just fine - he's always had this extra fluid, it's the only world he's known, and has never shown signs of stress and is growing normally and perfectly. He is actually the heaviest of the 3 babies, weighing in the 45th percentile for his gestational age, where as they thought the recipient ID twin was the biggest for the last almost 2 months.
Baby B (originally called the 'donor' twin of the ID pair, or the twin with low fluid) is actually the recipient twin of the two. He is the baby struggling right now. He now does have excess fluid, though if I'm correct, he doesn't have as much fluid as his fraternal brother (for whatever reason, the fraternal triplet is just fine in excess fluid, likely because it's all he's ever known). In the past they used to think this little guy was in low fluid, and it is the sudden increase in fluid that is causing his heart to struggle with the overload. He's the middle sized kid.
Baby C (originally called the 'fraternal' triplet) is actually the donor twin of the ID twin pair. Now here is where I get really confused. This baby has NO fluid around him, and he's the smallest - though not very far at all behind his twin brother. So maybe the babies really did move? I don't know - now I'm starting to think this doesn't make any sense, and maybe it would be best to just stop racking my brain about it as it doesn't matter anymore anyway. Ack, that gave me a headache!
Regardless, here's our current situation as of yesterday. Our fraternal triplet is doing just fine hanging out with his own sac and placenta. This sweet little guy is the biggest and weighs the most out of our trio. He's the one I feel move the most, likely because he's got lots of fluid to swim around in and also he has the posterior placenta (in the back to my right) so he's right up against the front of my tummy. Our donor twin has no measurable amniotic fluid around him, and you can see that he's shrink wrapped in his sac, stuck right up against his placenta, umbilical cord bunched and piled right by his head where it attaches to the placenta. Aside from this, his vitals and blood flow are normal, and he was still showing a bladder and stomach yesterday, though they were smaller than normal. He is the smallest babe of the three. Our recipient twin is struggling with the sudden onset of his extra fluid. Back home they noticed that he had tricuspid regurgitation (where one of the valves in the heart doesn't close properly, causing blood to flow backward into the wrong chamber), and this is what signalled that TTTS had progressed. Here in Toronto they notice the same, but also that he has little to no blood flow in the ductus venosus. You can see in the ultrasound that his heart is not beating like his brothers - it kind of just pulses because of the fluid overload and valves not closing, rather than squish and release. You are also able to see that the heart muscle is thickening from the work overload. His heart is not failing yet, but he is in severe cardiac distress.
After Dr. Al-Ibrahim scanned us, he went through a wonderful TTTS presentation with us. There was nothing new really that we hadn't already learned about the syndrome, but the way he presented it to us and spoke to us about it made it that much clearer in our minds just what was going on. His plan was that we were going to go forward with the laser ablation surgery Sunday morning (this morning) to separate the blood flow between the twin pair.
However, we had another scan yesterday evening with Dr. Keunen, who would have been the one performing the surgery this morning (Dr. Ryan is out of town). After having a really good look at where the twin placenta was located (anterior - so front of my belly, to the left) and where the babies' umbilical cords inserted into the placenta, he recommended that it would be best to wait for the surgery until Monday when Dr. Ryan was back in town, so that we have the best of the best working on us as this seemed to be a very complicated case, though possible. We were ok with this decision, especially given that he himself suggested that it would be best to have all of the experts at the table, all of their eyes and brains working together.
Dr. Keunen did say that we were to be scanned today just to make sure that the babies could wait another day. If it seemed that things had progressed even further they would have attempted to do the surgery today, as waiting longer could mean death for one or both twins. So...we've been waiting, and waiting, and waiting, to see Dr. Windrim today to be scanned and make sure that our babies are stable enough to wait. It's 4:30pm now, and we haven't seen him yet. I'm a little stressed and worried, but I'm pretty sure I can still feel movement from the twins so I know they're still in there.
I'm exhausted, and feel a migraine coming on. Just sitting here, waiting, is making me a bit miserable. But Noel spent the whole morning and most of the afternoon waiting with me, so it hasn't been too awful. I also got in a good nap, and am considering taking another. I have a feeling the next 24 hours are going to be exhausting.
Side note: They scanned my cervix yesterday too, to make sure that it hadn't shortened more or started dilating, as this may prevent us from getting the surgery done. Turns out it grew again (??) and as of yesterday morning I was at 2.3cm (up 1 cm from the last measurement).
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