Surgery Weekend

The past few days have been so full of complications, worries, and decisions; I don't know where to begin. But, they have been very significant in our lives and I need to record them.

We had last been seen in Seattle on Tuesday morning, where the specialist, Dr. Walker, determined that the babies weren't at risk enough at that point to risk immediate surgery. TTTS can be very unpredictable and there was no way to know if it would rapidly get worse and need surgery to save the babies, or if it would remain at a safe enough level to carry the babies until a reasonable delivery time without surgery. We went home to be monitored frequently for any changes that would dictate the next step.

I went to my appointment alone on Thursday while Rob was at school. I had an ultrasound tech that I hadn't had before, and she was starting to get confused by what she was finding on Baby A. She asked a doctor to come in and look with her, and they both puzzled over it, making comments like "that just doesn't make sense" and "I've never seen that happen before." They finally explained to me that the umbilical blood flow to Baby A appeared to be weak, which didn't make sense because he was the baby receiving extra blood. And when they looked at the image of his umbilical cord, it looked straight, as if it was pulled taut. The doctor's only explanation for this was that since the baby had so much extra fluid to move around in, maybe he got his umbilical cord twisted in a way that created a kink, limiting blood flow. I asked what we would be able to do about that if it turned out to be the case, and he said there wouldn't be much we could do.

The ultrasound tech couldn't find the bladder on Baby B, and as the doctor looked, he thought maybe he spotted a tiny one, but decided that it was small enough to classify me as Stage 2. Stage 3 of TTTS is where the dopplers pick up abnormalities in the babies' blood flows. Even though the umbilical abnormality they found wasn't a typical abnormality they would find in TTTS, they decided it could classify me as Stage 3. They called Doctor Walker in Seattle and scheduled me for surgery the next day.

From the time we first found out about the TTTS, one of my biggest fears has been decisions. I have never been good at making decisions, even small ones- I question myself, I stress over each option endlessly, I worry that I'm making a mistake. I've known that there are different possible treatments and that they all have risks, and I have just always hoped my situation would be black and white, and that my doctors would tell us exactly what needed to be done. Up until this point, it had been that way. Even though there has been a lot of gray uncertainty with my case, with lots of counsel and discussion with doctors, everything we have done has been what these experts have told us would give our babies the best chance.

At this appointment was when they started turning some decisions over to me. Knowing that I was planning to have surgery the next day, we discussed one of the main risks of the surgery: that it could put me into preterm labor. My doctor discussed with me that at this time (24 weeks), they would have about a 50% chance of surviving outside the womb, and of survivors, only 10% would not have lifelong problems. She told me that between 24 and 26 weeks, it is up to the parents to decide whether we would want the babies resuscitated or not, knowing the risks and suffering they could go through (and the likelihood of it being in vain). If I decided I would want them to try resuscitating them, they would give me a steroid shot for lung development in case of delivery, but if I wouldn't, the shot would be useful to get later instead. The decision was clear for me. I would do anything to give them the best chance at surviving. But, it was still a difficult thing to think about.

Then came the discussion about Baby A's possible umbilical cord problem. Though my doctor had already made the plans for me to go to Seattle, she brought up this other possibility that bugged her. If there was in fact some kind of kink in Baby A's cord, she worried that he may not even make it until surgery the next day. She gave me the option to just go and hope that things looked fine in the morning, or to come back and look one more time that afternoon. But, if I came back and Baby A was struggling, the only way to save him would be to deliver both babies immediately, at 24 weeks gestation.

This was, of course, the most horrible scenario I could think of. Having to decide whether to deliver my babies at 24 weeks -- risk Baby B's life for the chance to attempt to save Baby A, and very possibly losing both. Or whether to do nothing and give Baby B a better chance, knowing we would lose Baby A.  There would be no good option, and neither could be a choice I could live with.

We finally determined that I would go to Seattle and go right to the hospital to check on the babies to see if the umbilical cord was an urgent issue. Our minds were clouded with all these scary thoughts as we spent the day making plans for travel, plans for surgery, and plans for Collin to stay with friends for the weekend. We arrived at the hospital that night, and both heartbeats sounded good. This was relieving enough to let us sleep a little bit that night.

Early Friday morning, we headed to Dr. Walker's office for them to take a look at the ultrasound.  In a way, it was pretty disappointing. They found a good sized bladder on Baby B, meaning we weren't actually in Stage 2 at all (it was probably just small at the Portland appointment because he had peed). And Dr. Walker wasn't extremely concerned that the weak blood flow on Baby A was anything urgent yet, and it wasn't a typical abnormality that would classify us as Stage 3 either. The thing that concerned him was that Baby A's heart showed strain. It was still pumping properly, but it was tighter than it should be, showing that it was working extra hard.  He said some doctors would classify our case as a Stage 1 with an asterisk, saying Baby A's heart had abnormal blood flow, and some might categorize the abnormality as maybe a Stage 3. Our case was just very unique and hard to classify. Typically, to get the laser surgery, you'd have to be at least Stage 2, although the stages don't always have to go in order.

So, Dr. Walker told us that we had the choice. We could go through with the surgery that day as planned, or we could wait and come back on Monday to see what was happening. If we waited 3 days, he thought we would probably need the surgery at that time anyway. The difference would be if the surgery put us into preterm labor and we delivered the babies, they would have had 3 more days in the womb. And every day counts. However, that would also give them 3 more days to be affected by the TTTS, so they could potentially be less healthy by then.

When we arrived that day, we understood that urgent treatment was the only option to save our babies. But then, this gave us the tiniest bit of doubt that it could wait just a little bit longer. There was also the hope we always had that it could miraculously turn itself around and improve without the risky intervention. Our doctor said either choice would be reasonable, and there was no right or wrong answer. Of course, we were already in Seattle without Collin and coming back on Monday would mean another trip, more missed school for Rob, and figuring out what to do with Collin once again, but we had not let convenience dictate any of our actions before and we didn't want it to now.

It was extremely hard to be put in the position of making this decision.  There was no way to predict what would happen with our babies, so there was no way to know what would put them at least risk. We had a few minutes to be alone and discuss it. We prayed hard. We considered risks and possible outcomes. I wanted so badly to just have an answer and be sure about it.  Finally, Rob felt good about the decision to proceed with the surgery. And I felt good about trusting his feeling. 

We went to the pre-op room and started to get ready. About an hour and a half before the surgery was scheduled, as I was lying down with nurses taking my vitals, I started noticing contractions. They were pretty frequent so I timed them. They lasted about 40 seconds each, and soon they were happening every 2 minutes. We were so scared that I was going into labor, that we wouldn't be able to have the surgery now, that it was too late. We think it was either the huge amount of fluid in my belly that had come on so quickly and added too much pressure, or the fact that I had been dehydrated for a few days, again because of the huge amount of fluid pushing against my stomach, making it so I couldn't eat or drink much at all. The fasting before surgery couldn't have helped with the dehydration either. 

But, either way, this was how we knew we made the right decision. My body was not going to be able to handle this extra fluid much longer. If we had decided to go home, we would have been on the road in the middle of nowhere when this happened. Dr. Walker came in and I was given medication to help stop the contractions. Though frequent, the contractions were mild enough, and he felt comfortable going through with the surgery with the plan to remove fluid as well, to reduce pressure on my cervix. 

As I was wheeled into the operating room, I got really nervous seeing all the people and equipment in there. They had told me I would have spinal anesthetic, with the option to be put to sleep if I chose. As soon as I got in there, I started shaking hard, probably a combination of the cold and the fear. I immediately said that I wanted to be unconscious. I ended up being fine with just a small dose of something to help me relax though. They also gave me the option to be able to see the video of what was going on, and I said definitely not. 

The spinal block was the most amazing thing for me at that moment. As soon as it took effect, it was like every pain and stress my body had been going through for weeks immediately melted away. I literally had not been able to feel even remotely comfortable for so long, and it was so wonderful to suddenly be completely pain-free. (I'm sure the additional drugs contributed to the euphoria a little bit too). 

Rob was able to be in there with me, and he could see what was going on in the video. They made a small incision in me and sent in the tiny camera. Dr. Walker used this to examine the vessels on the placenta and determine which ones were connected between the two babies. When he found a connection, he sent in the laser energy and cauterized them. He found 11 total.  It didn't take long, maybe 30 minutes. Afterwards, he used the camera to get a little video of the babies! Rob got to see their faces through a real video rather than an ultrasound, and at that point I really wished I was able to see. But, we will get a DVD of the procedure and I can't wait!  Dr. Walker then drained over 1.5 liters of excess fluid from Baby A's sac, and they checked to make sure both babies' heartbeats were okay. 

We are so amazed at the technology that allowed this to be possible. It blows our minds that our doctor could identify exactly which vessels he was looking for. It is amazing that our two babies were able to have surgery on their placenta while still in the womb. Also, let me just add that we loved Dr. Walker. He was so knowledgeable, so thorough in looking at our case, so kind and caring, and really took the time to help us understand and answer all our questions. His British accent probably only added to his likability as well. After being sent through so many different nurses, we just felt better as soon as Dr. Walker came in, because we knew he would make sure everything was right.

Recovery wasn't bad at all. I had to wait a while for the anesthesia to wear off, but I was still basking in the feeling of painlessness. Rob and I felt so happy and relieved. I didn't go into labor during the procedure, there weren't any other scary complications, and the babies' hearts were still beating after. Our main fears did not happen! Also, even as I started to regain feeling in my body, I felt so much better with the fluid drained. I could take in a full breath, my back wasn't in extreme constant pain, and my belly was a little smaller. Also, after being dehydrated the previous days, I had IV fluids in me and I felt so great. The only concern I had was that I still felt contractions. They were mild, and I was told they were to be expected after this surgery, but it's never comforting to feel contractions when preterm labor is a real fear. I was given medication to help stop them.

We checked the babies' heartbeats throughout the evening, and even in a hospital bed, I was able to sleep more comfortably than I had in a long time because of the huge relief of fluid pressure in my belly. In the morning, Dr. Walker came to do an ultrasound. Both heartbeats were fine, and Baby B already seemed to have a little more fluid! Baby A's heart looked a little less strained as well. We weren't counting on any big changes; all the doctor was really checking for was that both hearts were beating. The idea is that hopefully in the next few weeks, things will start to even out and the effects of the TTTS will go away. They checked my cervix. I was really concerned that all the contractions I'd been having had shortened it, but it hadn't changed. We were discharged and headed home, to be monitored by my doctors here now. 

I am taking it easy, lying down as much as I can, keeping pressure off my cervix. I was also given instructions to drink about a gallon of water per day, eat as much as I can, and aim for 175 grams of protein per day.

I wish I could just say that the surgery fixed everything and the babies are healed, but it's not an immediate thing. We still have to watch. Both babies have gone through some abnormal things while in the womb- unusual amounts of blood flow, surgery on their placenta, etc.- so we still worry about their health. There is also still the likely possibility of premature delivery. I still feel contractions and my body may continue to be affected by the trauma it has been through. Early delivery is always a concern with twins, but especially with all the complications I've had. Our doctors are at least hoping for 28 weeks, which sounded so crazy and horrible before, but now that we have been faced with the possibility of 24 weeks, 28 sounds a little better. We just want to make it as long as possible! But, we feel confident now that getting this surgery has given them the best possible chance under all the circumstances.

We feel so blessed to live in this time and place where something like this could be possible. We also know that through all the decisions and stress, our prayers were answered and we were guided in the things we should do. We received guidance through the thoughts that came to us at the right times- thoughts from the temple or blessings we have received- and we know these were answers to our prayers. We also appreciate all the thoughts and prayers from friends and family and know that they have been answered as well. Every text or facebook message I got throughout the day comforted me and helped me feel a little peace through the whirlwind of stress. It was amazing how such a difficult time could have moments of such peace. Though this has been one of the most trying experiences of our lives, it is also something that has strengthened our testimonies of our Heavenly Father and brought us closer to Him.

Twins Update

**Updated Thurs, July 26: At our appointment today, our babies showed new problems and had reached Stage 2 if not Stage 3 of TTTS. So we are back in Seattle to have the laser surgery tomorrow (Friday).
*There are so many details of what is going on with our twins, and I assume most people don't need to hear the specifics, but I wanted to document a little for ourselves and those who are interested in the rare condition we are going through with our pregnancy. We haven't been very good at updating people, because there are always so many details to consider and we are usually too exhausted after long doctors visits to call people and repeat everything. So hopefully I can explain a little here.

 For the last 6 weeks, we have been going in for weekly ultrasounds to monitor the twins since they were discovered to have signs of TTTS (a condition of the shared placenta in monochorionic identical twins where the amount of blood/ nutrients they receive is unequal). Each week, we would see a change in fluid levels- the larger sac (Baby A)gained fluid and the smaller one (Baby B) lost fluid- but not enough for an official diagnosis of TTTS. To be in Stage 1, the fluid levels must be greater than 10cm in one and less than 2cm in the other.

 With TTTS, the baby who receives too much blood has the risk of overworking his heart and kidneys to process it all, to the point of potential heart or kidney failure. His body can become swollen and it produces lots of urine, which makes the high level of amniotic fluid. The other twin doesn't receive enough blood, which could cause failure of his heart and kidneys as well, and he produces a very small amount of urine and can potentially become dehydrated and anemic. Stage 2 of TTTS is marked by the smaller twin's bladder becoming too small to be identified on an ultrasound.

 At 22 weeks, baby A had reached 10.5 cm of fluid but Baby B was holding strong with just over 2cm, keeping them barely out of an official Stage 1 diagnosis. Still, week by week we watched as our Baby A kept getting more and more room to move around, and Baby B got "stuck" in his tiny amount of fluid.

 Last Thursday, at 23 weeks, Baby A was at 11 cm and Baby B was at 1.9, putting us officially in Stage 1. Our doctors had discussed our case in a meeting and the consensus was to send us to Seattle to consult with specialists who perform a surgery called Fetoscopic Laser Photocoagulation (where they put a small telescope inside my uterus to examine the placenta, identify which blood vessels are shared between the babies, and cauterize them). It is a very rare surgery and we are fortunate to live within driving distance to one of the 5 places in the nation that performs it. These doctors see more cases of TTTS than anyone here, so we were glad to get their opinions.

 We went to Seattle prepared to have the surgery if that was the decision. Our appointment was Monday morning, and in the 4 days between appointments, Baby A's fluid had gone from 11cm to 15cm. I could really feel this big change. Over the weekend, I had become so uncomfortable. My belly became even more huge and tight, tender to the touch, and it hurt all over when I coughed or sneezed. My lungs and stomach felt compressed and I could hardly walk very long or hold Collin. My back hurt all over and I couldn't get in a comfortable position at all. I was never this uncomfortable during my first pregnancy, even at the end. I still feel this discomfort and don't anticipate it going away soon. Baby B, depending on what angle his fluid was measured, was still just around 2cm, and he still had a visible bladder. Neither baby showed signs of strain of their hearts and neither showed anything that concerned the doctors about their current health. So, since immediate surgery wasn't necessary, the doctor decided not to do it at that time, but wanted me back the next day because of the concerning fact that Baby A was gaining fluid so rapidly.

 The next morning, Baby A had increased to 16 cm of fluid and Baby B still had not changed much. The decision was that since the babies' health wasn't currently failing, we should not take the risks of surgery until it was completely necessary. And, there is always the possibility to hold onto that it could reverse or at least stay the same. The excess fluid doesn't put a huge risk on the babies' health, but it can put pressure on my cervix and cause preterm labor. Fortunately, my cervix appears to be holding up well so far. We returned home, and the plan is to be seen every few days by my doctors here, being prepared to go back if certain things change.

Current belly picture- 24 weeks. I just love seeing pictures other people post at 24 weeks (. . . or full term) and comparing how much bigger I am. My belly is growing faster than even a normal twin pregnancy due to all the excess fluid. I asked my doctor to measure my uterus today and it was at 39cm, which would mean 39 weeks for a single baby! For twins, she said a normal size would be about 30cm.

With all the risks of this condition, if it becomes severe early in pregnancy, it is necessary to do some kind of intervention to save the babies. Later in pregnancy, the babies could be born before any harm starts to show, and no intervention is necessary. We are right in the middle, and have been right on the borderline of uncertainty whether intervention is necessary or not, so we have just been waiting. There is only one other option for treatment, and it has a 40-60% survival rate and a 25% brain damage rate. This laser surgery has a 90% survival rate for one twin, 70% for both, and less than 5% brain damage. We don't want to risk either unless it is absolutely necessary, but if it does become necessary, the laser surgery would be the better option. 

 The doctor we spoke with said that the laser surgery is only performed before 26 weeks. If the babies start to be in danger before then, that is what we would do. And he said that after that, our goal will just be keep them in until 28 weeks, when if their health is compromised, they would be delivered. I had known that premature birth was a possibility, but I was still a little shocked at the reality that our babies could have to be delivered in 4 weeks.

 So that leaves us back to just waiting to see what happens at each appointment. It has definitely been a stressful time and we always have the nagging thoughts in our minds of all the nightmarish possibilities. But, overall we are doing okay, and hopeful that everything will be fine. We love our babies and want them to be strong and healthy. We are thankful that our babies' bodies are still functioning properly now. We are thankful for the amazing technology that allows us to closely monitor what's going on in their bodies. We are thankful for support from family and friends and for all the fasting and prayers on our behalf.

May through July

The longer I wait to blog, the more overwhelming it seems. So I'm just going to post some pictures and briefly describe our summer so far!

We've spent a lot of time playing in parks. Collin loves going down the biggest slides he can find, and has no fear on the playground equipment.

Collin and Avery

Ice skating date

Mother's Day- the only picture we took was of the delicious trifle Rob made for me. It was so good. He also made me steaks for dinner, my most craved food at the time.

Went to the cutest "nerdy baby" birthday party! So fun.

These boys make some pretty cute nerds. 

Zoo day- drums!

Squirrel at the zoo

Kari and I both happened to go to the library story time on the same day, and our boys were randomly wearing the same shirt! 

After swimming- wearing a towel that used to be Rob's

Collin and I spent a lot of June taking turns being sick. It made for a lot of sitting around and watching TV. I think my immune system must have been really weak because the simplest colds hit me hard.

 The worst of it was the hand, foot, and mouth disease. It wasn't that bad for Collin- he just had a little rash on his arms and legs that didn't seem to bother him, and I actually didn't even know what it was until after the fact when I heard it had been spreading around here. Usually only kids get it, but I was one of the lucky adults that got it too. For me, it was horrible!! Both hands and feet were totally covered in the rash pictured below, and it itched like crazy and burned. The first night, I didn't sleep at all because all I could do was keep my hands and feet in ice water all night long. Otherwise, they were on fire. I could hardly walk on my feet or use my hands at all for the next few days. It was so painful and miserable. A few weeks after, the skin on my hands and feet started peeling off as a result, and I still have peeling skin over a month later.

At the end of June, we made our Salt Lake trip! We had lots of fun! Collin loved playing with cousins, and there were so many fun things for him to do at Grandma and Grandpa's house. He was in heaven.

Little 4-wheeler with Meagan! (Not the best picture of Collin, but he loved that thing)

Rides at the local festival! Riding with Ethan and Bryce

First carousel ride!

Side note- Collin's eyes are really sensitive to the sun and he loves wearing his sunglasses! We went to the community pool a few times, and once when Rob was holding him in the pool, he was wearing his sunglasses and his white skin and hair were exposed and a kid came up to Rob and said, "Hey, is your kid an Albino?" We thought it was pretty hilarious.

Big 4-wheeler! Rob spent a morning out 4-wheeling with my dad and had a lot of fun.

Swinging!

Lunch at the park

Taylorsville 4th of July parade! Collin and baby Tyler

Music and the Spoken Word! Meagan, Spencer, Lindsey, Katie, Justin, Rob, and I got to go. It was Spencer's first time coming to it! 

Collin has no fear. He had no problem going up this big ladder to go down the slide.

Birthday party for Kyle! Some of the kids in their party hats!

Pinata!

Cute Tyler napping in the swing

Grandma and Grandpa with the kids

City Creek mall- Collin, Kyson, and Dillon watching the fountain display

City Creek mall

Temple grounds

Salt Lake Temple

I asked Collin if he loves to see the temple, and he stood and stared at it like this for a minute.

Of course there were tons of delicious treats.

He loved this slide.

Fireworks in the street!

Sparklers

My mom and sisters threw us a little baby party and got us cute little matching outfits for our twins! (And some for Collin to match them too!) It seems so much more real holding up multiple little outfits like that. We are going to have 3 little boys to dress!

Then a few pictures from after Salt Lake

We got a membership to OMSI and Collin loves the water area.

Weekend trip to Seattle:

Pacific Science Center

We were able to visit Grandma Ness. Collin was a fan of riding on her walker.

He also loved jumping on the hotel bed.

Babies

So I know it's taken me a while to blog, but I just wanted to write a few thoughts about having twins. Finding out we are having twins was the biggest shock I have ever had. They don't run in our families, and I never really thought about the possibility.  I think I've said things in the past like "I think twins would be fun" or "Having twins would be so crazy and hard" but I never felt the need to knock on wood or anything, because I didn't think there was any chance of it happening to me. Although, in the weeks prior to our first ultrasound, the thought of twins had popped into my head quite a bit. I don't know if it was just the normal thoughts people have before seeing their first ultrasound, or if it was more than most people think about it, but it was just kind of a fantasy and not any kind of 'feeling' that I was having two. I thought about how we would announce it. I was thinking of running a race and wearing some kind of 'running for two' shirt, and then I thought that if it was twins, it would say 'running for three'. And I thought about telling our parents by mailing a card that said "Congratulations on grandchild number 16..." and in the inside, "...and number 17!" with an ultrasound picture. But it seemed like more of just my imagination coming up with pretend scenarios, and not an actual possibility. (We actually did make those cards for our parents, but since we found out on the Friday before Easter, we just showed it to them over skype so it could be an Easter surprise. . . we announced our pregnancy with Collin on Easter 2 years ago too). 

I was much more relaxed about this pregnancy at first, since I'd already done it before. I wasn't as diligently reading pregnancy books or looking for info online every day like I was the first time. I was totally planning for an easy, low-stress pregnancy where I was going to keep running til the very end (a race per trimester was the plan! haha).

So when we went in for our 8-week ultrasound, we were excited but nervous. As my doctor started the ultrasound, I had the same normal fears (what if something is wrong? what if there is no baby at all and I'm just imagining that I'm pregnant? and, since we had watched "Make Room for Multiples" on TLC the day before, my last thought was, what if there's more than one?). Rob and Collin were with me. The image quickly settled on a baby, and I could see something else in the side that looked like another baby. My doctor scanned back and forth and I kept seeing two. My mind was going crazy. Rob saw too. Ultrasounds can be confusing to read so I didn't dare say anything because I could have been wrong about what I was seeing, and I just waited for the doctor to confirm. She finally started saying something like "Oh! Well, guess what guys. . . " and we just knew. We still waited for her to say it though. The next several minutes were a blur of shock, disbelief, and feeling like the luckiest people in the world. It was one life moment I wish I could relive, because it was such a huge and life-changing surprise.

The first thing I remember thinking about was how gigantic I would get, probably realizing the immediate crazy truth that there were two growing babies inside me. Rob said he was thinking more of the realities of having two babies and how difficult it would be. My doctor told us some things about twin pregnancy afterwards and said "you guys aren't going to remember any of this, but I'll say it anyway" and she was right. We went home and I was just shaky the rest of the day. We couldn't think about anything else; Rob even completely forgot an appointment he'd had for later that day. But we were so happy and just looking at our two little babies in the ultrasound picture was the best thing ever.

8 weeks, the day we found out about our twins.

During the first trimester, I was sicker than with Collin, but still no throwing up. I just had that familiar feeling of not being able to tell if I was extremely hungry, full, sick, or what. I couldn't think of any food in the world that sounded appealing, yet I was starving. Also very tired. Mornings were fine. I could go to the gym and do all my normal things, but then I'd take a nap with Collin (I still do, every day. I need it) and wake up feeling sick the rest of the afternoon and evening.  I ate a lot of cereal, and greek yogurt cups. Interestingly, even though most of my cravings were sugary treats, I could not eat chocolate, and still have a pretty low chocolate tolerance. I could eat a little bit of sweet milk chocolate or a chocolate pudding, but anything rich (chocolate chip cookies, brownies, chocolate frosting) was repulsive to me. I'm not complaining, I wouldn't mind if that aversion is permanent. (I don't know if I'll ever eat a piece of that huge Costco chocolate cake again.) 

Though I thought I'd be more relaxed about this pregnancy, being immediately classified as a "high-risk" pregnancy put me right back into crazy worry mode. Everything about it was new again, so I started reading and searching for twin pregnancy information. And my pregnancy worries were at least doubled now. My worries have still never been focused on the difficulties of taking care of twins; my worries are just getting them here safe and healthy. People always ask if I'm scared to have twins, and when I think about it, I know it will be harder than I could ever imagine, but those worries are nothing compared to my concern that they will both be healthy. It is funny how we weren't planning to have two babies, but now that we know about them, we want both of them so badly. I felt so much anxiety before each appointment and so much relief when both were still okay.

I didn't grow very quickly at first and a lot of people commented that I hardly looked pregnant, or that it didn't look like I could be having twins. Then somehow, over the last few weeks, I suddenly grew a belly really quickly! I really noticed it when we were in Salt Lake, and I was between 20 and 21 weeks. I had lots of round ligament pain and the clothes I brought for the week-long vacation no longer fit. I'm not even going to say how much weight I gained in the 2 weeks between appointments. I grew so suddenly, and it was a little bit uncomfortable! I actually started feeling very pregnant- light headed, no energy at all, feet starting to swell, unable to walk long distances- and I have the feeling it will keep going that way :)

16 weeks

21 weeks! And this picture doesn't even do it justice.

We had our big ultrasound at 18 weeks where we found out that our babies are identical boys! I think we were both kind of expecting boys. This puts the streak at 11 boys in a row on the Grothaus side, and 10 boys in a row on the Grimmer side! We had a little gender celebration with a few friends from our complex that night. They all wore the color(s) of their prediction and came over to see that the treats were all blue!

I was debating whether to write anything about this, but I guess it has been the biggest thing on our mind lately. At our ultrasound, the babies looked great, but they discovered that they had uneven amounts of amniotic fluid, which is a warning sign for Twin to Twin Transfusion Syndrome. Basically my biggest fear for our twins since I had read about it. This is where the twins share a placenta and parts of their circulatory systems, and the amount of blood they receive is unequal. One gets too much and one gets too little: really dangerous for both. There are possible procedures to help it, but most do not solve the problem and all are high risk. My doctor transferred my care to a specialist at a different hospital and they scheduled me for a very long appointment the next week. Even though we were happy to have seen our baby boys that day, it was overshadowed by our new fears and feelings of dread.

At our appointment, they detected the inequality of fluid but said it was not enough to be diagnosed as a stage of TTTS yet. The doctor went over each stage, it all sounding pretty horrific, and basically said there's no way to tell what will happen. It could stay the same, it could progress very slowly, or it could progress very quickly, and that all we could do was monitor it closely.

We made our trip to Salt Lake City during Rob's break, and had our next appointment the morning after we got back (on Thursday, at 21 weeks). The difference in fluid levels had increased, and though it was still not enough to be diagnosed as stage 1, it was very close now. One baby had 2.4 cm of fluid and the other had 9.4.  They told us that Stage 1 starts when the levels are 2cm and 10cm. So now we are just waiting to see what happens and going in for ultrasounds every week. We are praying that it won't reach a dangerous level. The uncertainty of everything is really difficult for me. Though we have this constant dread and worry in the back of our minds, we know that we'll be able to endure whatever trials are ahead, and we have faith that everything will be okay.

Anyway, that's our baby update (finally)!