We spent another day in the hospital since my last post. I was having constant contractions again and needed another shot of terbutaline. This happened almost one month ago and I have been doing very well ever since. It has been concluded that the pouchitis has been causing inflammation in my pelvic region, and as all of your arthritis sufferers know, inflammation does not discriminate. My poor uterus has become an innocent bystander in my IBD war. Thankfully, none of these contractions have caused any dilation of my cervix, meaning they are fairly harmless, but need to be stopped by medication if they do not cease on their own.
On the pouchitis topic, a 6-week course of Flagyl has seemed to do the trick. I am now finally off of the antibiotic and feeling well. The doctors still suspect the infection has not completely subsided, but because it is in a very manageable phase, we have decided to halt the medications for the interim, hopefully until at least post-birth.
Another cause of (mild) concern is the C-Section. I have been followed by my surgeon, GI, OB and hematologist on a regular basis throughout this pregnancy, and all have slightly differing viewpoints on different aspects of my impending surgery. Should my colorectal surgeon be present or just on call? Should the incision be horizontal or vertical? Will there need to be a T-Shaped incision to take care of bowel issues? At what point should I switch to heparin from Lovenox to prepare for the section? These questions, along with several others, have become points of contention. As a chronically-ill woman, I have long been aware of the importance of the agency of the patient. It is so critically important that we are self-educated and aware of our treatment courses and methods of medical care. In defense of my team of doctors, there are no simple, straightforward answers to these questions as my situation is fairly unique (natural pregnancy post-J-Pouch surgery, with blood clotting disorder and previous scar tissue trauma). We have all (yes, I have been an integral part of this decision-making process) decided that:
1. My CR surgeon will not be present, but will be called and on stand-by while I am in the OR.
2. The incision will be made horizontally for two reasons: 1. This heals much more quickly and does not cut into abdominal muscle 2. It is safer. The one cause for concern is that I have a considerable amount of scar tissue in my lower pelvic region from previous surgery/complications from those surgeries.
3. A T-Shaped incision will only be made if scar tissue or bowel issues are present. I have been warned that this is a distinct possibility, but will be avoided if possible.
4. I will switch to heparin this week. One cannot receive spinal anesthesia while on Lovenox because of risk of hematoma on the spine, which can result in paralysis. Heparin is a twice-daily injection (rather than once-daily) and is not as effective of an anticoagulant or as well-studied in pregnancy as Lovenox, which is why the switch to heparin is delayed for as long as possible. I will switch back to Lovenox post-birth.
I have been contacted by a few other J-Pouchers who are currently pregnant or who have been pregnant post-surgery. If you don't mind sharing in the comments section: how are you approaching your C-Section (or delivery)? I would love to hear from those of you again from abroad, as I find the cultural differences very interesting!
I suspect that my next post will occur after my family has grown to 3 (well, 4. We must count my darling Figgie Wigs).