Wednesday, August 29, 2007
Sad News
At a routine check-up and ultrasound on Monday, we found out that the baby Julia was carrying had died. After a day of consultation via the phone with doctors in Kiev and one of our insurance carriers, it was decided that Julia should go to Vienna to induce delivery in case any complications should arise. Late yesterday was full of getting all the logistics complete and now this morning we leave in about 30 minutes, 8:30 am local time. Please pray that Julia would be admitted when we arrive in Vienna, around 4 pm local time, instead of having to wait until the following morning. Thank you. We will update everyone when we return.
Monday, August 6, 2007
Pregnancy Diary: August 6, 2007
I went to see my OB/GYN today as an "official" (i.e. registered) patient. 
The line was small. I got in, and the doc walked out, telling the nurse to get my blood pressure. The nurse took it, and then she asked me for the other arm. I suppose she just wanted to make sure. Then the nurse told me to get out my sheet and get ready for the exam on the exam table. I forgot to bring a sheet today, so I just went ahead and lay down on the sheetless table. I wasn't going to take my sandals off, but I got reprimanded. The doctor came back, measured my waist and the top of my fundus. Then she produced an ancient-looking instrument, which looked like a tube with wide ends and a narrow middle. She pushed it against my uterus really hard (it hurt, and I let her know that, but she did not respond), and she listened to the baby's heartbeat. She did not time it, so I (or she, for that matter) have no idea what it was. She was done, and I gave her the papers from my blood work, the genetics counselor and the ultrasound. She studied them for a couple of minutes. Not a word. She just asked for copies, and I had them, so they took the originals and the copies. 
She asked me then how much I weighed, and I told her (There is no scale in the exam room). I bought a scale last week, so now I can keep my weight in check! It gives both kilograms and pounds, which is great, since I am so used to tracking my weight gain in pounds. She then looked at my urine analysis (I had taken it in last Friday). Turns out, I had elevated salt levels. She told me to take rosehips syrup 3 times daily for 10 days. I asked her if I had a UTI, and she said, "Not yet, but we need to get these levels down. If we can't, then you might have to be admitted to the hospital, so they can monitor your urine and diagnose the problem." I just looked at her and said, "OK." No reason to argue now. I thanked them, and they thanked me for the wafer cake (I always take something for them), and I went home. I miss my American doctors who are always so encouraging! I am still struggling with nausea and lack of energy, and I really would have appreciated something cheerful from my OB/GYN here. My next appointment is in 3 weeks.
The line was small. I got in, and the doc walked out, telling the nurse to get my blood pressure. The nurse took it, and then she asked me for the other arm. I suppose she just wanted to make sure. Then the nurse told me to get out my sheet and get ready for the exam on the exam table. I forgot to bring a sheet today, so I just went ahead and lay down on the sheetless table. I wasn't going to take my sandals off, but I got reprimanded. The doctor came back, measured my waist and the top of my fundus. Then she produced an ancient-looking instrument, which looked like a tube with wide ends and a narrow middle. She pushed it against my uterus really hard (it hurt, and I let her know that, but she did not respond), and she listened to the baby's heartbeat. She did not time it, so I (or she, for that matter) have no idea what it was. She was done, and I gave her the papers from my blood work, the genetics counselor and the ultrasound. She studied them for a couple of minutes. Not a word. She just asked for copies, and I had them, so they took the originals and the copies. 
She asked me then how much I weighed, and I told her (There is no scale in the exam room). I bought a scale last week, so now I can keep my weight in check! It gives both kilograms and pounds, which is great, since I am so used to tracking my weight gain in pounds. She then looked at my urine analysis (I had taken it in last Friday). Turns out, I had elevated salt levels. She told me to take rosehips syrup 3 times daily for 10 days. I asked her if I had a UTI, and she said, "Not yet, but we need to get these levels down. If we can't, then you might have to be admitted to the hospital, so they can monitor your urine and diagnose the problem." I just looked at her and said, "OK." No reason to argue now. I thanked them, and they thanked me for the wafer cake (I always take something for them), and I went home. I miss my American doctors who are always so encouraging! I am still struggling with nausea and lack of energy, and I really would have appreciated something cheerful from my OB/GYN here. My next appointment is in 3 weeks.Pictures: top -- a door to an OB/GYN room; bottom -- a bathroom stall at the clinic
Wednesday, August 1, 2007
Pregnancy Diary: July 31, 2007
This morning I went to see a genetics doctor. It turns out that a couple of blood tests that they had me run were for screening of chromosomal abnormalities (PAPP-A and beta-hcg). In the US they always asked us if we wanted to get these kinds of tests done, and we always declined. Here I found myself with results of something I didn't really want to know yet. We would rather deal with it when the baby is born. Anyway, when I had my first ultrasound, they told me to come back around 11-14 weeks to get a nuchal translucency scan (NT). Babies with chromosomal abnormalities will have some liquid in the back of their necks, and if coupled with results from blood tests, the diagnosis can be very accurate (about 90%).
I talked to my teammate, Cindie, and she offered me a new perspective: if something is wrong with the baby, we might reconsider our delivery choices/ treatment options beforehand. That was one good point that we hadn't thought about. So, last Saturday I called the Diagnostic Center to set up an appointment for ultrasound and the genetics doctor (GD). The ultrasound was booked through this week, so I just went ahead with the GD. No appointment was necessary (meaning: there will be a line to wait in).
Back to today. I tried to make it to the Diagnostic Center as close to 8 am as I could. There was a small line there already. Finally the nurse came out and took referrals and test results (here you pick up your test results and take them to your doctor). She mentioned that I did not have the ultrasound. Yes, the doctor can read the test results, but it will be better if you had an ultrasound, too. I told her that the next available appointment would be too late for NT. She said to go to the front desk and try to get one anyway (how am I supposed to do that?). I went and tried. They told me to go to Room 9 and see if they would take me. Recipe for trouble. The nurse from Room 9 said they were overbooked and there was no room. I had a feeling I was going to get this response. She took me to the front desk and told the lady behind the glass to make an appointment for me for later on. There were not openings till mid-next week. It would be too late. I went back to GD. The nurse was sitting at a desk with a computer, and the doctor was sitting right across from the door. She was a slender woman in her 50s, and she was wearing a green uniform. Since none of them introduces themselves or greets you, I started speaking and said that I had tried to get an ultrasound appointment, but I could not. The nurse (the one that had instructed me to try) said something to me. Suddenly the doctor turned to the nurse, "Will you keep talking or will you let the doctor speak with the patient?" Whoa! I sat down trying to avoid being caught in the cross-fire. But that was it. The nurse did not say a word till the end.
The doctor was a very reserved woman, a woman of very few words. She was very professional and seemed knowledgeable, but I wished she would just lighten up a bit. She asked me the usual questions, and I gave her my test results. She then started with the previous pregnancy questions, and I readily produced my handy print-out. There was a shadow of interest on her stoic face, and that was it. She started reading it, and I was wondering if there was a way to make her smile. After she was done dictating my info to the nurse, she asked me more questions about our relatives and family history. "Do you smoke, use drugs or drink large amounts of alcohol?" No. "Do you or your husband have hazardous jobs?" "Yes, raising of four children." Astounded look for a second, and then a smile. Gotcha! Well, at the end she said the test results looked good, but she wanted me to do an ultrasound this week, and wrote me a referral. She also wanted me to do yet another blood test later on and to come see her in early September (unless the ultrasound showed some abnormality).
Back to the front desk I went, showed them the referral, and the lady behind the glass found a free slot for today in Room 9. I hadn't stepped 10 feet from the window, when I ran into the nurse from Room 9 (the one that was not very helpful 30 minutes earlier). I told her that they sent me there because apparently there is an open window. "What, are they crazy?! We have 30 people waiting there!" I gave her the referral. "Let me go talk to the head ultrasound doctor and see what he says." The tone of her voice suggested little hope. She emerged 3 minutes later, with the same scowl on her face, "Make an appointment for today." And handed me my referral. It had a small mark, as if in initials, in the top left corner. The front desk lady printed out an appointment slip, informed me that it will cost me 30 grivnas ($6) and sent me off, grumbling something about the little dwarf (the nurse from Room 9 was about 4'9"). I laughed all the way to Room 9. I am witnessing quite a bit of personnel tension today J.
Back at Room 9, there was a line of about 6-7 women. They all had appointments, but I don't think one got in on time. There are always those who need to get in without the appointment. Since I had to be one of them last time, I decided I would patiently wait my turn at 11:55 am. A couple of "new Ukrainians" (rich people) came and jumped the line after talking to the nurse. Then there was a lady who did not look very comfortable. I heard the nurse say something about "the woman with contractions". She would take her after two other patients. I got up and offered my seat to the lady. She declined, but I insisted. She sat down. We started talking. She came all the way from the town of Skadovsk, which is about 2 hours south of Kherson and is on the Black Sea. She came here to deliver her baby, as she is having contractions and is over 38 weeks. When she got to the delivery hospital, however, the doctor sent her to the Diagnostic Center for an ultrasound. I know, it does not make sense.
I sat there till 12:35 pm. I would have been there longer, but I pleaded with the nurse, and she "moved me up". There are several reasons why I think they are so backed up. One, the nurse is constantly in and out of the room. She comes out after every patient and goes somewhere (don't they have intercom?). Fifty percent of the time she scolds the ladies who try to get in without the appointment "Are you crazy?! Look at the line!" or those who do not mention to her that they are carrying twins, having contractions, etc. She ends these tirades with "The head doctor is going to kill me!" The second reason I think they are so backed up is because the OB/GYN doctors here want pregnant women to have between 3 and 4 routine ultrasounds during their pregnancies. I can't figure out why a young healthy 24-year-old needs all that.
It was my turn. The room was semi-dark with relaxing background music. The doctor was a man in his 30s. I think he was the head ultrasound doctor. After I saw him, I thought that there might be a reason why the nurse acts the way she does. He, like the GD, was a man of very, very few words. He actually never acknowledged me, he just did his job. He barely opened his mouth when he spoke, and he spoke very softly on top of that. Add the background music, and I wondered how the nurse heard him at all. He moved his head as if to get a better look at what he saw on the screen. The head movements coincided with the wand movements. I tried to see the picture of my baby as it reflected off his glasses, but it did not work. So, I just lay there with my ears perked up trying to hear the verdict. His facial expression did not leave much hope. I was a little concerned at first, but after observing the same frown for 10 minutes, I relaxed. He seemed to know what he was doing, and he measured not only the NT, but also the nasal bone. He just gave the dimensions of the nasal bone, but I deduced the baby was probably OK since there was a nasal bone (it is absent in babies with abnormalities). Then he was done, and I got up. Not a word from either of them. I took a little time to put myself together hoping for instructions. Dead silence. I went out and waited outside (I had seen other ladies do it). The nurse appeared a couple of minutes later with a print out. "Next time make an appointment ahead of time!" I took the paper and studied it. It said things looked normal -- praise God!
It was after 1 pm, and it was time to go home.
I talked to my teammate, Cindie, and she offered me a new perspective: if something is wrong with the baby, we might reconsider our delivery choices/ treatment options beforehand. That was one good point that we hadn't thought about. So, last Saturday I called the Diagnostic Center to set up an appointment for ultrasound and the genetics doctor (GD). The ultrasound was booked through this week, so I just went ahead with the GD. No appointment was necessary (meaning: there will be a line to wait in).
Back to today. I tried to make it to the Diagnostic Center as close to 8 am as I could. There was a small line there already. Finally the nurse came out and took referrals and test results (here you pick up your test results and take them to your doctor). She mentioned that I did not have the ultrasound. Yes, the doctor can read the test results, but it will be better if you had an ultrasound, too. I told her that the next available appointment would be too late for NT. She said to go to the front desk and try to get one anyway (how am I supposed to do that?). I went and tried. They told me to go to Room 9 and see if they would take me. Recipe for trouble. The nurse from Room 9 said they were overbooked and there was no room. I had a feeling I was going to get this response. She took me to the front desk and told the lady behind the glass to make an appointment for me for later on. There were not openings till mid-next week. It would be too late. I went back to GD. The nurse was sitting at a desk with a computer, and the doctor was sitting right across from the door. She was a slender woman in her 50s, and she was wearing a green uniform. Since none of them introduces themselves or greets you, I started speaking and said that I had tried to get an ultrasound appointment, but I could not. The nurse (the one that had instructed me to try) said something to me. Suddenly the doctor turned to the nurse, "Will you keep talking or will you let the doctor speak with the patient?" Whoa! I sat down trying to avoid being caught in the cross-fire. But that was it. The nurse did not say a word till the end.
The doctor was a very reserved woman, a woman of very few words. She was very professional and seemed knowledgeable, but I wished she would just lighten up a bit. She asked me the usual questions, and I gave her my test results. She then started with the previous pregnancy questions, and I readily produced my handy print-out. There was a shadow of interest on her stoic face, and that was it. She started reading it, and I was wondering if there was a way to make her smile. After she was done dictating my info to the nurse, she asked me more questions about our relatives and family history. "Do you smoke, use drugs or drink large amounts of alcohol?" No. "Do you or your husband have hazardous jobs?" "Yes, raising of four children." Astounded look for a second, and then a smile. Gotcha! Well, at the end she said the test results looked good, but she wanted me to do an ultrasound this week, and wrote me a referral. She also wanted me to do yet another blood test later on and to come see her in early September (unless the ultrasound showed some abnormality).
Back to the front desk I went, showed them the referral, and the lady behind the glass found a free slot for today in Room 9. I hadn't stepped 10 feet from the window, when I ran into the nurse from Room 9 (the one that was not very helpful 30 minutes earlier). I told her that they sent me there because apparently there is an open window. "What, are they crazy?! We have 30 people waiting there!" I gave her the referral. "Let me go talk to the head ultrasound doctor and see what he says." The tone of her voice suggested little hope. She emerged 3 minutes later, with the same scowl on her face, "Make an appointment for today." And handed me my referral. It had a small mark, as if in initials, in the top left corner. The front desk lady printed out an appointment slip, informed me that it will cost me 30 grivnas ($6) and sent me off, grumbling something about the little dwarf (the nurse from Room 9 was about 4'9"). I laughed all the way to Room 9. I am witnessing quite a bit of personnel tension today J.
Back at Room 9, there was a line of about 6-7 women. They all had appointments, but I don't think one got in on time. There are always those who need to get in without the appointment. Since I had to be one of them last time, I decided I would patiently wait my turn at 11:55 am. A couple of "new Ukrainians" (rich people) came and jumped the line after talking to the nurse. Then there was a lady who did not look very comfortable. I heard the nurse say something about "the woman with contractions". She would take her after two other patients. I got up and offered my seat to the lady. She declined, but I insisted. She sat down. We started talking. She came all the way from the town of Skadovsk, which is about 2 hours south of Kherson and is on the Black Sea. She came here to deliver her baby, as she is having contractions and is over 38 weeks. When she got to the delivery hospital, however, the doctor sent her to the Diagnostic Center for an ultrasound. I know, it does not make sense.
I sat there till 12:35 pm. I would have been there longer, but I pleaded with the nurse, and she "moved me up". There are several reasons why I think they are so backed up. One, the nurse is constantly in and out of the room. She comes out after every patient and goes somewhere (don't they have intercom?). Fifty percent of the time she scolds the ladies who try to get in without the appointment "Are you crazy?! Look at the line!" or those who do not mention to her that they are carrying twins, having contractions, etc. She ends these tirades with "The head doctor is going to kill me!" The second reason I think they are so backed up is because the OB/GYN doctors here want pregnant women to have between 3 and 4 routine ultrasounds during their pregnancies. I can't figure out why a young healthy 24-year-old needs all that.
It was my turn. The room was semi-dark with relaxing background music. The doctor was a man in his 30s. I think he was the head ultrasound doctor. After I saw him, I thought that there might be a reason why the nurse acts the way she does. He, like the GD, was a man of very, very few words. He actually never acknowledged me, he just did his job. He barely opened his mouth when he spoke, and he spoke very softly on top of that. Add the background music, and I wondered how the nurse heard him at all. He moved his head as if to get a better look at what he saw on the screen. The head movements coincided with the wand movements. I tried to see the picture of my baby as it reflected off his glasses, but it did not work. So, I just lay there with my ears perked up trying to hear the verdict. His facial expression did not leave much hope. I was a little concerned at first, but after observing the same frown for 10 minutes, I relaxed. He seemed to know what he was doing, and he measured not only the NT, but also the nasal bone. He just gave the dimensions of the nasal bone, but I deduced the baby was probably OK since there was a nasal bone (it is absent in babies with abnormalities). Then he was done, and I got up. Not a word from either of them. I took a little time to put myself together hoping for instructions. Dead silence. I went out and waited outside (I had seen other ladies do it). The nurse appeared a couple of minutes later with a print out. "Next time make an appointment ahead of time!" I took the paper and studied it. It said things looked normal -- praise God!
It was after 1 pm, and it was time to go home.
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