Thank you so much for the love and care we have received thus far.
All,
We went for our routine monthly visit to the midwife today. All was fine until she put the doppler on to monitor the heartbeat. The baby's pulse was in the 215-220 range (should be 120-160). She told us to get to the hospital right away and alerted them that we were coming. They did an ultrasound to determine if there were signs of heart failure. THANKFULLY, the ultrasound showed nothing alarming. The strategy now is to try to bring his heart rate down using drugs.
Robyn has been admitted and will be there until at least Tuesday so that they can monitor the two of them closely to try and find the right dosage level. One factor not in our favour is that Robyn has a low resting heart rate and low blood pressure. So it is possible that she will not be able to tolerate the medicine that the baby needs.
Best case scenario is that the baby's heart rate stabilizes at a level of the drug that Robyn can tolerate, she comes home, and life is normal until delivery.
One other scenario is that the baby does not respond and a decision is made to deliver the baby early. He is 24.5 weeks gestation now, so we would really love to see him stay in there much longer.
Another scenario is that the baby needs a level of the drug that is borderline for Robyn. In this case, she would be kept in hospital from now until the baby is born (due date is Feb 3).
Those are the cards that we know are in the deck right now. She is being given her first dose of Digoxin (sp?) right now and will be given doses every 12 hours.
Robyn is scared and upset, but she is handling it with strength and resolve. She is in a comfortable, private room in the labour and delivery ward right now. There are a lot of unknowns at this point, so we will just be taking the forks in the road as we come to them.
I will likely take Robyn's laptop into her tomorrow, so you should be able to reach her by email. Her cell number is 919-699-5114 and her direct line in her room is 919-966-8677.
It is hard to believe we are back here (somewhat poetically, we started in the same triage room that we were in almost 18 months ago with Finley). It is a scary and serious situation, but we are very hopeful that it will have a good outcome.
We appreciate your love and prayers.
Love,
Kevin
p.s. One silver lining is that the ultrasound today revealed that the placenta previa resolved itself and is no longer a concern.
On Sat, Oct 18, 2008 at 1:46 PM, Kevin Markle <ksmarkle@gmail.com> wrote:
Finley and I are home for lunch and nap after our morning visit to see Mommy. There was lots of activity while we were there and some things to report. Synopsis: everything we have been told since last night has been good news.
Robyn's blood pressure and pulse are reacting to the drug. She looks pale and tired, but she did not sleep much last night, so that is somewhat expected. She says she is feeling okay. She gets her second dose right now then a third dose 12 hours from now. The drug usually begins to show its effect on the fetal heart rate after 3 doses.
They did an "EKG" on the baby this morning... in quotes because they obviously can't put electrodes on his chest, so it is done with ultrasound. That showed that the heart is healthy and normal. Phew.
The pediatric cardiologist came in to meet with us right before Fin and I left and was very helpful in answering our questions. His prediction at this point is that it will be diagnosed as SVT - supraventricular tachycardia. It is an electrical problem in the heart that is not completely rare. The way he explained it, the person with SVT has an extra electrical path in the heart and when the electricity flows down that path instead of the right one, the heart short-circuits and does weird things. It is treated with Digoxin for the rest of the pregnancy and through the first year of the child's life. The child is then weaned and it is determined whether the child grew out of it or not. 70% do, 30% don't. The 30% stay on the drug until they are teenagers and then decide whether or not to have a corrective surgery or control it with drugs the rest of their life.
He also said that they see in-utero babies with much higher heart rates than the 200 - 220 our little guy is pumping at (like in the 250-350 range) and there are some "normal" kids that have fetal heart rates in the 180's. All this to say that his little heart can likely take this for a while even if we don't get it solved right away. We don't know how long it has been going on. We only know it is less than a month because the heart rate was in the 140s at our previous midwife visit on Sept 16.
He implied that he thought it was a very, very remote possibility that the baby would have to be delivered in the short term. He said explicitly that they will "fight tooth and nail" to keep that from being the outcome.
He also said that he thinks that is unlikely that Robyn will have to be in hospital until she delivers. That is ultimately up to the OB people, but his expectation is that she would be home in 3 or 4 days.
All of this is great and it appears that we continue down the best-case scenario path thus far. We still don't know how Robyn's body will respond to a full load of the drug, but time will tell. She had one faint/nauseous spell while they were doing the EKG this morning, but that could have been a result of her having to be on her back for such a prolonged stretch.
The nurses have been great. She is able to eat whatever she wants. And she will be taking a shower this afternoon. She has her laptop with wireless access there, so I would venture to say that email is the best way to reach her if you are concerned about waking her. But with all the monitoring going on, she is not getting many long stretches anyway, so calling the direct line to her room is totally fine. She is weak, but she is fully coherent. I doubt she will be up to typing long emails for the next few days, but I know that receiving them would lift her spirits.
Our plan right now is for me to be single parent and adjust my schedule through Tuesday. If she comes home Wednesday and is able to function, then we will just resume normal life. If she needs much more rest and much less time in the Fin cycle, I will adjust my schedule as much as I can and then we will figure out alternatives on an as-needed basis. Thank you to all of you who have offered help. We may very likely take you up on it, but for now we are not making any radical changes to the life-as-normal plan.
I will update as there are things to report.
Much love,
Kevin
On Sun, Oct 19, 2008 at 10:02 PM, Kevin Markle <ksmarkle@gmail.com> wrote:
Not much to report. The heart rate is still in the 200s. Robyn is still doing well and her pulse and blood pressure are staying in the healthy range, which is good. If the fetal heart rate doesn't come down by tomorrow, they will likely proceed to drug #2 to see if it can do the trick. We have been told to be patient and so be it we shall.
They did another ultrasound on the baby this afternoon and saw no signs of damage again, which is great news. The worst thing that can happen now is for damage to show up and force a decision on delivering the baby early or not. Nobody is thinking that is likely at this point.
We will hope for some downward movement in the baby's heart rate tomorrow.
Lots of love,
Kevin
From: Kevin Markle <ksmarkle@gmail.com>
Date: Mon, Oct 20, 2008 at 8:55 PM
Subject: Monday mondayAll,Another day of nothing too eventful. Unfortunately, the little guy has not cardioverted yet... for you laymen, that means his heart rate is still in the 200s. We are just staying the course. Robyn's drug level is high and she is tolerating it, so that is good news. We are hopeful that it will cross the placenta and kick in soon.
There is talk of moving to the second drug, but no concrete plans as of yet.
Robyn was moved out of labour and delivery and up to ante-partum this evening. This is not necessarily a good thing, but it is what it is. There is a smaller nurse:patient ratio up there and the room is about half the size (which makes Finley's visits a bit less free). She is confined to her room because she still has a full-time monitor on her heart. She has had the other wires removed, so is free to move about her room as much as she wants. She has her computer there and would love to get emails from you... and may even have the energy to respond.
On that note... for those that have called and left phone messages for me... THANK YOU. I'm so sorry not to get back to you, but I am trying to juggle Daddy duty and some pressing stuff at school, so have few free moments right now. I will call as soon as I can. Thank you so much for your care and support. We remain optimistic that things will turn out okay and continue to have faith in the people caring for Robyn and the baby.
We will keep you posted.
Love,
Kevin
From: Kevin Markle [mailto:ksmarkle@gmail.com]
Sent: October 21, 2008 11:29 PM
Subject: Tuesday
I forgot to give you Robyn's phone number in her new room: 919-966-7403.
Today was more of the same. They did another ultrasound on the baby this morning and all reports are still positive. His heart rate is still on the bad side of 200.
They are upping Robyn's dose of digoxin. The plan appears to be to give digoxin every opportunity to work before proceeding to any other steps. There was talk of a week more of this before anything else would happen. This means Robyn's hospital stay could go on for a bit. The hope is still that the little guy's rate comes down and stays down. Our understanding is that when that happens, Robyn will be discharged 48 hours or so later and will be monitored closely as an outpatient for the remainder of the pregnancy.
The drug and the lack of exercise and the lack of good stretches of sleep are taking a toll on Robyn. She is still fighting strong and will continue to do so, but it is not a simple battle.
We are working at getting some reinforcements for the battle on the home front down from Canada. Fin had a great morning over at his friend Hunter's house (THANK YOU Christi!) this morning and he continues to do fine through all of this. He loves going to visit Mommy in the hospital, especially pushing the buttons on the elevator. And tonight he discovered the buttons on Mommy's very special bed, so I'm sure he is dreaming of his next turn on it as I type.
Thank you for your calls and emails.
We remain hopeful and optimistic and very thankful for the incredible care Robyn and the baby are receiving.
Love,
Kevin
Very sorry for the delay in updating after this rather scary email yesterday. It was a terrifying few hours yesterday afternoon as Robyn was being prepared for an emergency C-section at about 4:30, but I am so happy to say that there are some positive things to report.
Here's how it went (the abridged, I-can-barely-see-through-my-tired-eyes version): Robyn went down to labour and delivery for an ultrasound after the monitors seemed to showing that the baby's heart rate was no longer tachycardic. As soon as the ultrasound was started, the doctors and nurses became quite alarmed, scared, and frantic because the baby's heart rate appeared to be in the 80s. In L&D, that means that there is something wrong, usually with the placenta, and the baby's supply of oxygen is likely diminishing. The solution is emergency delivery. So they kicked into gear. The miracle of the day was that the OB resident had the presence of mind to check with the cardiologist before going into surgery. The cardiologist's opinion was that the heart rate was not as low as it appeared, that the baby was not in danger, and that there would be no C-section. I know my description is completely inadequate in conveying how frightening the whole thing was for us (especially Robyn), but it was awful... as scared and sick as I have felt since the day Finley was born.
We finally met with his cardiologist this morning and had some questions answered. He did another EKG (basically, a suped-up ultrasound) while we talked. The most comforting thing that he said was that we are not special... that this is "a run-of-the-mill SVT". That was actually a big relief because we were starting to think we would be written up in a textbook someday. The simple fact is that there is no standard way that SVT babies cardiovert. Some take days, some take weeks. Some flip like a switch. Some bounce back and forth. Some never cardiovert. The cardiologist said that his primary goal is to cardiovert the baby and help him find and maintain a normal heart beat, but he also said that he will continue to recommend that we just sit tight (i.e., not go to another drug or consider early delivery) for weeks even if he stays right where he is (210ish) - as long as no signs of damage or failure present.
The wonderful news of the day is that our little guy has spent some time with a heart rate in the 140s - right in the heart of the normal range. His heart rate jumped around a lot today... like a switch flipping from 210 to the disrhythmic rate, to the 140s. And when he is in the 140s, the rhythm is not perfect, but any time his little heart can get a break from the hard work of pumping in the 200s is good.
If the next few days are uneventful (except for good events, of course), then it is a very real possibility that Robyn will come home on Tuesday or Wednesday of next week. We will remain on a very intense monitoring schedule, seeing the OB every Mon, Wed, and Fri until delivery.
This will be the last mass email on this. Rather reluctantly, I will post future updates to the blog that we started 18 months ago for Finley updates and have continued to maintain with pictures. I say "reluctantly" because there is something very unsettling about becoming a blogger once again for this reason (for the Seinfeld fans... "but I don't wanna be a blogger"). But we do what we do. It is just much easier to point folks to the blog rather than filling everyone's inbox and inevitably forgetting to add someone to the list who would like to know what is going on. Here's hoping there won't be much to report for the next 15 weeks.
The address for the blog is http://finleyjmarkle.blogspot.com/
With much love,
KevinOn Thu, Oct 23, 2008 at 6:58 PM, Clark Hannah <cdbhannah@gmail.com> wrote:I (Clark) am sending an update because Kevin may not have time this evening.Late this afternoon (3:30-4:00pm) there was a definite change in the baby. They had difficulty measuring his heart beat and his activity level (kicking and moving) was greatly diminished. The doctors were very concerned and were preparing Robyn for surgery to take the baby. Then one of the doctors discovered that the baby had bradycardia dys-arrthymia (sp?), two beats at 160 and then one at 80, and he stopped the preparation for the surgery. Since that time (it is now 6:45pm) the baby's heart beat has remained the same and the baby's activity level has increased.Please be praying that the baby's heart will start beating regularly and that his immediate birth can be avoided.Clark
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