Cholestasis, Incompetent Cervix – How it Changed My World

The Beginning Was So Easy

The beginning of my pregnancy with Jacob was easy – no, it was. I loved it. There wasn’t any morning sickness (thank goodness). Most days I woke up feeling pretty darn normal. I commuted to work from the ‘burbs to the city (about a 45-minute express commute in the morning). Then I had a 10-minute walk from the train to the office. My job was stressful, but I had managed it already for five years, no big deal. The fateful diagnosis of Cholestasis and Incompetent Cervix was yet to rear its head. Yep, there was nothing out of the ordinary.

At least, not in the beginning…

Incompetent Cervix

Did you ever wonder, before you got pregnant, what it was that kept the baby in place? You know, so your amniotic sac doesn’t just fall out? (LOL!) I’ll tell you. It’s your cervix – that muscle that separates the vagina from the uterus. This muscle is what keeps the amniotic sac and placenta from straight up falling out of your vagina. (Pretty graphic image there, thanks, Luma.) Clearly, it plays a HUGE role. During your pregnancy, your obstetrician will check your cervix at least twice. If this is your second pregnancy, but you didn’t have any complications during the first pregnancy, it may be fewer checks. Let me tell you something, my previous pregnancy was pretty damn near normal (except the killer morning sickness that didn’t seem normal, but I digress).

So, herein lies the problem: I have an incompetent cervix. My cervix is a bitch. I hate it. (Strong words, I know.)

First, let me explain what an incompetent cervix is. An incompetent cervix is a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. Your cervix is supposed to be nice and tight and protective during pregnancy. It’s supposed to be like the sentinels that protect the tomb of the unknown soldier – unwavering, resilient, proud. Mine was more like – I quit. After eight months of holding it down, it just quit. That would be like the sentinels holding their post until the last few hours before deciding they didn’t want to “walk” anymore. Um, they’re not supposed to do that, and neither is your cervix.

Cholestasis of Pregnancy

If you ever wanted to torture somebody, for whatever reason, I suggest making them somehow intensely itchy. Seriously, it will drive them INSANE! How do I know? Been there, done that (as in, I, personally, was itchy not that I tortured another person – because I didn’t).

So, WTF is “Cholestasis of Pregnancy”? You already know one of the most critical parts – it makes you EXTREMELY itchy.

It started with itching on the bottoms of my feet. I thought at first it was an allergic reaction or that the faux fur lined snow boots I was wearing were the culprit. The problem with both those things was that the itching never stopped (this itching is evil). Imagine trying to figure out how you can walk but also scratch your feet simultaneously ALL DAY. Then imagine rubbing the palms of your hands together CONSTANTLY. So much so that you don’t get much work done because you can’t even type. You itch so much that you can’t eat properly either. Know what, you can’t think, because all you think about is how much you want the itching to stop.YOU KNOW WHAT? YOU CAN’T SLEEP EITHER! (Caps were necessary, very necessary.) So, yep, pretty bad. Also, you’re pregnant – already hard – but MOST importantly it’s bad for the baby.

The End

So at the recommendation of my husband after almost a week of itchiness, I made an appointment with my obstetrician. (I think the nurse thought I was crazy for making an appointment because my feet were itchy.) The day of the appointment, as soon as I mentioned the symptoms to my doctor, I was immediately sent to do blood work. Mind you my appointment was at 5:30 PM and the lab closed at 6 pm. Luckily, the lab was on the same floor; however, the nurse had to rush me out the door and call the receptionist at the lab so they wouldn’t lock the doors. The whole rushing scenario made me extremely nervous. The doctor wanted the results first thing in the morning, and she said she would call me immediately after she got them. I went home freaking out (internally anyway).

So, the next morning I got a phone call with the diagnosis. I had to book an appointment immediately with a maternal-fetal medicine specialist because I needed to be on special medication and I needed to start NSTs (nonstress tests) to monitor Jacob for distress (shit). This diagnosis was a big deal. My husband and I were worried. I started medication; I had to have bi-weekly NSTs (while somehow also working downtown – my doc is in the ‘burbs). Also, did I mention this was right before Christmas week? Crazy. Anyway, I went through almost three weeks of testing and regular appointments with the obstetrician and MFM. Three weeks of constant research trying to figure out what I could do to keep me, and my son, relatively healthy. So, here comes the other half of the shit show. My own body was betraying me even more!

At 4 am on January 8 at 35 weeks pregnant I was having contractions. Just boom! Out of nowhere. At first, I thought Braxton Hicks. Then they became pretty evenly timed. I emailed work that I wasn’t coming in. We called my mom immediately too she had to drive from the city to my house at 6 am, and had to hurry! Denise had to get to school, and I couldn’t leave her alone! By 7 am I was panicking, and my contractions were so intense! As soon as my mom was in the driveway we rushed out, bags packed and everything! Finally, 9:24 am January 8 Jacob was born at 5lbs 6oz, 19in long. My baby was here! Except for one giant problem: he was premature. (I’ll have a separate blog post where I talk about having preemie babies.)

So, why TF did, I just start having contractions out of nowhere and so strongly? It was IC – incompetent cervix. I did not have any issues with Denise, so it was never checked (other than what the routine checkups are for a healthy pregnancy). At the time it had been about eight years since I had been pregnant with her. The obstetrician never thought it was an issue, and neither did I, obviously.

To this day I constantly think this could have happened on the train to work – that I could have gotten ready and hopped on my train and been halfway there, and then BOOM contractions! Stop the train! Pregnant lady here trying to birth a child on the nasty, dirty, grimy, floor of the train. Then I would have been on the news! How embarrassing! Anyway… not important. It didn’t happen, and I am grateful.

The Beginning, Again…

So, why am I telling you this? Honestly? I want you to know I want to help. In my research, during the three weeks of constant testing, I learned a few things.

The first being that current research doesn’t understand why Cholestasis happens. The second being that the occurrence of it varies from country to country (weird). The third, and in my opinion most important, some doctors don’t even test for it when patients complain of having the same symptoms as Cholestasis.

I don’t even know how many forums, blogs, pregnancy sites, comments, and whatnot, I read through where women commented they had to switch doctors (because their current one didn’t believe there was anything wrong). Or even bring the door down on their current doctors (fucking take my blood, dammit!). Some resorted to going to the emergency room and lie to say their baby was in distress to get tested.

Why? I didn’t understand. All it took was a blood test (maybe two, I don’t remember). Especially when Cholestasis, if left untreated can be fatal to your baby. Especially, when it is treated doctors have to induce you at 37 weeks because waiting any longer can be fatal for your baby. Like, holy shit, why wouldn’t they test?

Then comes having an incompetent cervix. This one is a wholly different wormhole. I didn’t do much research into this one when I was pregnant with Jacob. I didn’t find out I had IC until I was pregnant with the twins, but once I knew, it clicked. I couldn’t understand how I could have gone through birthing Jacob so quickly (not that there aren’t women out there who are perfect birthers) when I had such a hard birth with Denise. It didn’t make sense. Regardless, this part didn’t affect me as much until I had to deal with my pregnancy with the twins. It was during that pregnancy that I started to hate my cervix so much. We’re still not on good terms, but it’s not like I can get rid of it.

Anyway…

If you are currently pregnant and feel like something isn’t right, then get checked. I don’t care if the nurses look at you funny – just do it. Also, I know a significant amount of people say “don’t google it!” or “if you google it you’ll feel worse!” But be a rebel and google away. Do your research. Be informed. BE YOUR OWN ADVOCATE. LEARN. It’s crucial for you and for your baby. HOWEVER, try your best to look at it from a third party’s perspective. Don’t go on an emotional roller coaster (even though I know it’s hard).

Lastly, find a good doctor and work with him/her. Ask lots of questions. My last MFM (Maternal Fetal Medicine) loved to send us the medical journals that he based his decisions on so we could read them. It comforted us to know that he was on top of his medical research constantly. Also, we’re weird and love to read and research things. I think we were his favorite patients.

So there it is. I’m happy I’m able to share this here. I hope someone out there finds it useful. Jacob is now a happy, healthy, almost three-year-old. Time flies.

P.S., I know there is an issue around having cervical checkups for some women due to privacy, female body empowerment, and too much medical outreach among other things. Everyone’s opinion is different; you guide your daily life based on what you think is best for YOU. I’m not trying to say here that you should have more cervical checkups but only that there is a condition that is hard to diagnose until the perfect conditions are met. So, what I am saying is you should do your research, listen to your body, and TALK to your doctor – and even if the dude (or dudette) doesn’t want to hear your side of the story then find someone else. Period.

Disclaimer: I am not a medical professional. The information contained in this blog post is not meant to assist in diagnosing any medical condition. Diagnosing medical conditions is the job of a medical professional; I am not a medical professional. The sole purpose of this blog post is to inform the reader of my personal experiences.

November 26, 2016April 25, 2018

Hypothyroidism – My Journey With An Autoimmune Disease

The Beginning

Hypothyroidism – this one is hard for me. This autoimmune condition always hits me with all its got. It likes to make itself known in the weirdest ways – always. That, exactly, is what makes it one of those disorders that are very hard to diagnose. I was fortunate though. I’m sorry if you weren’t. I’m sorry if you were one of those people that had a hard time getting answers. I know the toll it takes. I know.

Symptoms

Raise your hand if you’ve experienced that pesky feeling named “stress.” That emotional response that causes your heart to beat a million miles a minute – that makes your palms and your forehead shiny with sweat. It makes you anxious, and it makes your stomach loop around itself, endlessly. Nowadays, you hear it all over the place that you should do what you can to reduce stress levels. However, it’s one of those things that’s harder said than done.

Stress… I swear it’s what triggered my thyroid issues.

So, I had just switched jobs. I went from supporting 100 people to supporting over 1,500. The phone was always ringing. The emails were always coming. The people I supported were executives and their assistants. It was hard. These people were not nice. They didn’t care about me or my well being. They only cared that their shit worked so they could make the company money. I don’t blame them though. They were probably stressed too.

Needless to say, my first year there was hard, but I also had other stressors: I was a single mom at the time, and I still lived with my parents. When you love your family, but you have a child, everything changes. My happiness was dwindling, and I needed so much to prove to myself that I could be self-reliant. There was a goal for me to move out, as part of this self-reliance, but I also wanted the nagging (Mexican remember?) from my parents about how I needed to raise Denise (my now 11 year old), to stop.

Then, within that same year, I started experiencing panic attacks. If you haven’t had them before, then you can not empathize. I don’t wish them on anybody. It felt like I was experiencing a heart attack. I wanted to scream and cry at the same time. My heart hurt with each beat. My breath stopped with each beat. My heart leaped up to my throat with each beat. I was drenched in sweat. My arm felt numb. I made my first ER visit for a panic attack. It was a long night.

Thankfully, the ER doctor that treated me didn’t disregard me for having one. So many times I hear stories of people who were mistreated or belittled. It’s devastating to have a panic attack and emotionally painful to be treated like you’re bringing something so debilitating “onto yourself.” News flash people! We aren’t! The ER doctor gave me some “calming” medications and told me to get a hold of my stress. I took those damn “medications” once. I felt another panic attack coming on one night, so I grabbed a pill. It knocked me into the weirdest state I’ve ever been in – somewhere between a dream and the real world. I was drifting, sinking. The feeling stayed with me for a few hours. After I got out of it, I couldn’t function. I was drowsy and irritable. Never again. I didn’t care if I had to get myself through the next one (somehow), I would figure it out.

Then it was the constant fatigue. You know how sometimes you feel so exhausted that you pass out instantaneously? Or how sometimes you’re so exhausted that you want to sleep and sleep and sleep? Of course, once you’ve gotten enough rest, you’re ready to do what you gotta do. You just needed to catch up on some z’s. Wouldn’t it be so hard if you never actually caught up though? If you always needed five more minutes? That was me. I would wake up in the morning exhausted, every day – even if I had gone to sleep at 6 pm the day before and opened my eyes at 7 am the next morning. You know what’s even better? Needing a nap after having slept 12+ hours and then not being able to wake up from that nap either. I would joke that I was a modern sleeping beauty, but it wouldn’t be funny. Being constantly tired and continuously sleeping (especially when it’s not restful sleep) is its own kind of torture. It leads to more stress and even depression. On top of that, I still had Denise to take care of. My family helped so much, but she was still mine. She wanted her mommy. I couldn’t be present with her when I was always so tired.

Finally, I had a scheduled appointment with my family doctor for a follow-up to my panic attack incidents. There were two things I remembered explicitly: she asked me how heavy my periods were and then she told me she would do blood tests. It had never even occurred to me that my period could be “heavy.” I just thought I had needed to change a few extra pads lately. No big deal. Our bodies change all the time, but when she put it into perspective it turned out to be something to think about. When my test results came in, she wanted to see me to talk about them. I thought for sure she would say I had cancer or something (fuck me… more stress). As it turns out, she said she was looking for one test specifically. She was looking at my T4 levels (if you are hypo/er you know what that means) and mine were not right. She said I would need to talk to an endocrinologist and that I was possibly “hypothyroid.” It’s incredible how out of whack our bodies can get that something so regular as getting your period every month can also be used to determine your health.

Hypo-WTF?

So, my first question, what is a thyroid? Second question, what is an endocrinologist? Third question, what is hypo-thyroid? Fourth question, am I going to die? (This seems so funny now that I know the answers.) This was my first meeting with the endocrinologist. I was freaked out (naturally), but also hoping that this would be the prognosis that would help me deal with my high levels of stress, my panic attacks, my fatigue and weirdly, my heavy period. As it turns out, it was, and it wasn’t.

What the hell is a thyroid anyway? It’s a butterfly, he he he. No, not really. It’s shaped like one though. If you put your hand in the middle of your throat, right in front of your esophagus, that’s where it lives. It’s not very big. It causes BIG issues though.

So, what’s an endocrinologist? A doctor that specializes in diseases that are caused by problems with your hormones. They treat people with things such as thyroid diseases (me), diabetes, even menopause! Lastly, what is hypothyroid? It means my thyroid produces low levels of thyroid hormones. Here’s the general definition of hypothyroidism: an under-active thyroid; a condition in which your thyroid doesn’t provide enough of certain hormones. Here’s the kicker, these “certain” hormones, control SO SO SO many of your bodily functions that symptoms of hypothyroidism vary. They can also be confused with other things, like, depression – which has the same symptoms. The cure for all of my craziness? More hormones! Yay! (LOL.) It seems so simple, but it isn’t. Um, so am I going to die? Not likely. I could get thyroid cancer, or develop tumors (which is possible), but the likelihood is not very high.

Now What?

The next steps are the “it is, but it isn’t”, and the “it was and it wasn’t” simple part of my journey to treating hypothyroid. The easy part was taking my daily thyroid pill. It’s just one itty bitty tiny pill that I take every morning an hour before breakfast. See? That’s the “it is” part. Here’s the “it isn’t” part: it can take weeks or months for the hormones to have any effect on helping your thyroid regulate itself. Also, your first dose may not be the correct dose. It’s complicated. You could be on a dose your doctor thought to be right for you according to your blood tests, but yet you still feel the same. Or you could be on a dose too high and also experience one or even more symptoms than before. Your prescription is something that has to be fine-tuned, with time. Also, if you plan on getting pregnant, you need to elevate your hormone levels to have enough for a developing fetus. Then you need to find your correct dose during your pregnancy (more blood tests, yay). Finally, you need to find your exact dose AGAIN after birth – as if shit isn’t crazy enough already with normal pregnancy hormones. *SIGH*

So, seems simple, and it is, but it isn’t.

Current Events

Hypothyroidism is one of those autoimmune disorders that stays with you for life. I find that after almost nine years of having it I am still in the throes of battle. Every few months I ask myself if maybe I’m more tired than usual? If perhaps my period is too heavy again? If maybe I’m gaining weight because my thyroid levels are off again? Oh, weight! What a burden is thee! Here’s another tidbit, in case you didn’t know, people with hypothyroidism gain weight quickly and have a much harder time shedding it than any healthy person (and it’s already hard for some!). Anyway… that’s a whole ‘nother topic that maybe I’ll discuss separately.

What I want to say is that I’m continually trying to stay on top of it. I have appointments once to twice a year to catch up with my doctor and talk about any recurring issues. I have blood tests done every 6-8 weeks to make sure my levels are perfect. Lately, they haven’t been. After the ordeal of pregnancy with my twins, even over a year later, I’m still not finding my “normal” thyroid levels. It’s hard.

So, if you have hypothyroidism (or any thyroid issue really), I feel for you. I know. My family doctor was able to identify very quickly that I had a possible thyroid problem. Once I was on medication, I felt like my normal self again. I got a promotion. Somewhere during that time I also found an apartment and a boyfriend! I was happy. My high energy levels came back – I could exercise! I lost a tiny bit of weight gain. I WASN’T FATIGUED! Do you know what it’s like, after being so tired for so long, to be awake?? It’s exhilarating! I was a new person. I loved myself, and that meant I could also fully love my daughter.

So, if you find yourself fighting to figure out why you feel so terrible after trying to find answers to your symptoms, try checking for thyroid problems. You never know.

Disclaimer: I am not a medical professional. The point of this blog post is merely to detail my experience and share my symptoms with others who are interested in hypothyroidism. If you feel that you have similar symptoms, please consult your doctor.