Separate...but not quite equal

This is Aunt Keka, filling in for Jenn and Kevin as they are still in the hospital in Cincinnati.

Jennifer and the twins underwent their first surgery today. A small hole was created in Jenn's stomach, about the size of a pen tip she says, and a laser was inserted into her placenta. At that point, nine connections between the little ones were severed, two of them quite large. The babies are more like fraternal twins now, as they are separate. But, they will, of course, still be identical.

The surgery went extremely well and lasted only one hour and 45 minutes. Within 20 minutes of completion, Jenn was on the phone and sounded quite well. She was amazed at how it all went, and kept repeating that there were 12, TWELVE!, doctors that helped with the surgery. I know that she and Kevin both feel very well taken care of.

The reports from the doctors were positive. Baby B looks incredibly good. He/she is growing at a great rate and appears to be healthy. Baby A, however, is still critically small. He/she only has 20% of the placenta which is not really good, but like Jenn says, "It's better than 10% or 5%!"

Oh...and Jenn had her first epidural. She says, and I quote, "Why did I never have one of those before!" Apparently, Jenn is rethinking natural childbirth.

The next 24 hours are of the utmost importance. Jennifer and Kevin will stay overnight and tomorrow they will see how the babies have adapted to the separation. If Baby A survives through the night (which we all have faith he/she will!) then there are other things to be concerned with (such as early delivery) but...Jenn and Kevin are content to worry about those things as they come. Right now, they are only concerned with the next, well I guess it's 12 hours now.

Oh...and Nina and Pawpaw Jacobs were at the hospital too. They drove down Monday evening to be there for Jenn and Kevin and their little grandbabies, of course. Nina delivered the "play by play" over text messaging. And Pawpaw just passed the phone around! Both are very relieved that, at this point, both babies and especially Mommy (Jenn) are doing well.

Jennifer and Kevin will meet with the doctors tomorrow to get a more thorough report on the condition of the twins and their outlook for the rest of her pregnancy.

I said to a friend of mine today...these little guys/girls (did you really think I was going to tell you???) have been through more before birth than I have in 29 years! Think what stories they will have to tell! They underwent surgery when they were negative years old! Crazy.

Dawson and Lane...the forgotten kids--just kidding Jenn--have been spoiled rotten over the past few days with Lori, Aunt T, Aunt Marybeth and Aunt Lola. Dawson is telling everyone that his Mommy is in the hospital...but just to make her babies feel better. And Lane is...well Lane is 11 months old. He has no clue. But he's still smiling.

A baby will make love stronger, days shorter, nights longer, bankroll
smaller, home happier, clothes shabbier, the past forgotten, and the future worth living for.-- Anonymous

TTTS Article

There was an article in the Houston Chronicle yesterday about TTTS and a couple who had the surgery. I thought I would include it in our blog so if anyone wanted to know more about TTTS it's available. http://www.chron.com/disp/story.mpl/front/5750896.html

We're are nervous, but hopeful to for our trip to Cincinnati tomorrow. We'll try to have a post up sometime on Wednesday regarding the results of the surgery. Thank you so much for your continued prayers.

Cincinnati III

Back to Cincinnati for the third time, hoping to hear some positive news.

On the way down we called Aultman to get our Amniocentesis results and they came back perfect...tears of joy. If I'm not crying for one reason, it's another these days. That was the best news we received since this rollercoaster began-we know we have two healthy babies.


After arriving in Cincinnati, it would've been best to have heard that our amnio reduction worked, but that wasn't the case. The echo cardiogram confirmed that our recipient baby (Baby B) is now showing heart complications. Although the complications are mild, they were not there on Monday.


Dr. Cromblehombe went over the details of the laser surgery which was our next option. This surgery is performed by using a scope and laser to disconnect all the vein to vein, artery to vein, artery to artery transmissions between the babies. There are some concerns with the surgery; however, not doing it causes even greater concerns. The surgery does not guarantee that the TTTS will reverse or that both babies can be saved. This all depends on the babies once they can see them and the placenta with the scope. Some of the statistics and concerns:

• There is a 92% chance that one or both babies will survive. A 65% chance that both babies will survive. And an 8% chance that neither of the babies will survive
• The placental share plays a large role. If our donor baby, Baby A, has less than a 20% share of the placenta the baby will not survive 24 hours after the surgery.
• The fate of the babies is not dependent on each other after the surgery is complete. They will be separate and if something happens to one of the babies it will not affect the other.
• Survival rate without treatment is less than 10%, if there is a survivor that baby will usually have an abnormality or birth defect.

We believe the best thing we can do for both of our babies is to go through with the surgery. We will be back in Cincinnati on Monday for pre-operation procedures. The surgery will be performed on Tuesday and we can come home on Wednesday after an ultrasound to see how the babies responded. We will have to return to Cincinnati again on Friday for one last appointment. The rest of our pregnancy will be followed by the MFM's at Aultman.

It's a concern how quickly TTTS progresses, and we feel so fortunate that all of our doctor's were on top of this situation. I cannot imagine if we would've waited any longer to go to Aultman, then to Cincinnati.

We pray that God will give the surgeons the wisdom needed to save our babies and that they will come through this surgery with great results. We are concerned about how small Baby A is and pray that the placenta will support both babies after the surgery.

Thank you so much for your continued prayers. The cards we have received have been so inspirational and supportive. We can't tell you how much this means to us.

"Life is a series of thousands of tiny miracles."- Mike Greenberg

Don't even look...

That was the motto for the day of the amnio reduction procedure...I did not want to even get a peak at the needle they were using to perform the procedure. .



I've heard all about them and knew I'd be better off not letting my curiousity get the best of me. So, as they prepared my bulging belly I turned my head the opposite direction and didn't look back until I knew it was over. There's just something about Dr. Gill praising me for doing well during the procedure, I felt like a kid again and tried not to say anything about the beads of sweat that were starting to develop on my forehead. I finally mentioned it when I seriously thought I could've passed out. Dr. Gill explained that I was having contractions from the needle and that everything was o.k. Man, did that cold washcloth ever help!



The doctor removed one liter of fluid from Baby B's sac and said both babies looked good. We are hoping to see that they evened out their amniotic fluid levels, we'd have to wait until Friday to find out if this procedure worked.





Dr. Gill provided many words of encouragement about our babies. He told us that he would do all he could to save both of them. It means so much to hear a doctor say this. We'll continue to pray and hope that this small procedure has big affects.

Cincinnati II

After the long haul south for the second time, we were hoping to find some answers.



We went through an ultrasound that showed increased signs of TTTS. The fluid level around Baby B increased from 6 cm to 9 cm in the past 10 days.



Both babies had gained an ounce, which cut down on the size difference: Baby B now weighed 9 oz. and Baby A weighed 5 oz. This is still a concern, due to how early in the pregnancy the babies started showing size differences.



The echo cardiogram that examines the hearts illustrated that our babies have had no heart damage. After our echo cardiogram was finished we had about a three and a half hour wait until we were to meet with Dr. Cromblehombe.






Our meeting did not happen with Dr. Cromblehombe, but with another MFM on his staff. This doctor explained to us that our condition has gotten a little scarier since the last time we met. The increase in amniotic fluid was one concern, but an even greater concern was what showed up on the dopplers. Baby A's doppler showed an absence of blood flow in the umbilical artery and Baby B's doppler showed an intermitent absence in blood flow in the umbilical artery. The doctor gave us some options:

• Amnio Reduction to remove the increased amount of fluid around Baby B. Amnio Reductions reverse or halt the progress of TTTS in about 20% of TTTS cases. He felt that this was the safest option for both me and our babies.




• Laser Surgery; however, he thought this was a more aggressive approach at this time. There are worries that come along with this surgery, especially if the placental share is not close to equal between the babies.

We opted for the amnio reduction and hoped that we'll fit in that 20% of patients with success. Before leaving Cincinnati we arranged to have the procedure done at Aultman the next day. We would then have to return to Cincinnati on Friday, May 2 and Tuesday, May 6 to check the progress of the babies. At this point we would discuss if the amnio reduction worked or if we would need to consider laser surgery.

We feel rather confident with our ability to locate the hospital now, I think we can return that GPS system to Pop, my grandfather.

Holding Steady

Our appointment at Aultman Hospitaly went smoothly.



Both of our babies are holding their own.



They both have strong heartbeats in the 140's, which is a great sign. The doctor's agreed that we should head back to Cincinnati on Monday, April 28 to have a second evaluation done. Our doctors at Aultman still believed that we were dealing with TTTS. We discussed our options and our MFM felt like we had time on our side and the babies were doing well, so there was no rush.



Our appointment was quite short and we headed out knowing that we would be making the three and a half hour trip south once again.