If you haven't heard yet: Pam is pregnant!  Ten weeks, now.  That's great news after trying for three and a half years with no success.  ....But, boy, is she pregnant!  She is currently carrying quadruplets.  Yes, you read right, quadruplets.  That's a tough challenge because quad pregnancies are considered very high risk.  Quads are guaranteed to deliver premature and Pam is guaranteed to have a c-section.

Multiple birth pregnancies often meet with disaster: death, blindness, deafness, cerebral palsy, and other physical and mental handicaps.  To decrease these risks, the trick is to postpone the delivery for as long as possible.  The gestation period for a single baby is 39 to 40 weeks.  The gestation period for quads is 29 weeks, on average.  Our doctor suggested selective reduction of two babies to increase the chances of the remaining two but because of our beliefs we decided not to undergo this procedure.

Due to the risks involved, we are seeking the best possible care in the country.  My research has led us to Phoenix Perinatal Associates, in Phoenix Arizona, which is known to have the most experience and highest success rates for multiple birth deliveries.  They have had about 600 successful deliveries of multiples -- 50 deliveries have been quads.  Families go there from all over the country.  But even with their highly skilled team they have had 5 deaths, 1 baby with down syndrome, 1 cerebral palsy baby.  Some of these problems were genetic, and some were developmental.  Through their experience, they have been able to develop techniques which help to prolong the delivery and maximize the outcome.  Their average gestation period for quads is 32.5 weeks (3% handicapped), compared to the 29 week (25% handicapped) average at other hospitals.  They will force the delivery at week 34 if the pregnancy goes that far.

Life for us (I use the term "us" loosely) prior to delivery will be very difficult.  Pam currently feels sick all day long.  Hopefully that will pass.  She starts bed rest at week 18.  Also at week 18 she will be on a home monitor which monitors contractions.  When contractions increase to a certain level they will use various types of drugs to eliminate them. Sometimes hospitalization is required and sometimes it takes three days for the contractions to subside.  Also, Pam needs to achieve a substantial weight gain by week 24 -- that will be hard for her.

For those of you who have had one baby at a time, you know that after delivery, it is no picnic either.  Multiply your experience by four and you might have an idea of what we will be facing after the babies are here.  With the support of family and friends (and maybe some hired help) we will get through it, I'm sure.  We are currently taking names of volunteer helpers.  Any takers? ;-)

The local management team here at Lucent has been gracious enough to allow me to temporarily work from Arizona.  This shouldn't present much of a problem since most of my work is self directed and the body of code that I develop is relatively isolated from the rest of the LUxWORKS system.  During my physical absence, I will be available via e-mail, and phone.  Pam, on the other hand, will need to transition her debugger work to one or more developers.

Here is the current plan:

With God willing, we will be blessed with four healthy babies.  Pam and I would like to convey a special thanks to the Lucent management team for the special accommodations they have granted us.  We would also like to thank each of you for your support, prayers, well wishes, and understanding during this time of difficulty and uncertainty.
 

Saturday, February 19, 2000

We landed in Phoenix a few hours ago.  The hotel is nice and so is the 70 degree weather.  Quite a contrast to the 30 degree snow and ice storm we left this morning in PA.  For those of you who've never visited here before, Phoenix is generally brown, there are cacti, palm trees, and orange trees lining the streets.  The 5 hour flight went without a hitch but it was a bit tricky getting Pam, the wheelchair, and eight pieces of luggage through the airport and car rental lot -- I'm training for when the babies are here.  All six of us are doing fine.  Pam is finally starting to feel the babies move.  Her first appointment with Dr. Elliott is on February 25.

That's all for now.  Keep in touch,

Lee, Pam, Baby A, Baby B, Baby C, and Baby D ;-)

Phoenix Scenery

Budget Suites

Saturday, February 26, 2000

We've been in Arizona a week now.  On Tuesday Pam made an unscheduled visit to the hospital for excessive contractions (which she doesn't generally feel).  They kept us in OB Triage for about 8 hours trying to get the contractions under control before they decided to admit her.  They placed her on a terbutaline pump which is the size of a beeper and which constantly administers medicine to control the contractions.  From our research we were aware of the terbutaline pump and knew it was only a matter of time before Pam would have one.  Pam has had no noticeable cervical change as a result of all of the contractions, which is very good.  Baby heart beats were taken yesterday and they all looked good.  Sam the golden retriever did his rounds yesterday to perk up Pam and the other patients.  Pam came home yesterday afternoon, pump and all.

The hospital is very well staffed and they seem to know what they are doing.  The nurses and doctors are pretty nice.  Another quad couple just arrived out here on Friday from Utah.  She is 18 weeks along while Pam is at 21 weeks.  Pam and I had a brief opportunity to speak with them and to convey a few of our experiences.  The last time the doctors delivered quadruplets was in December.  They also have quite a few triplet couples here at the moment.  In the high risk unit, Pam had a roommate whose water broke at 28 weeks.  The doctors are trying to keep the baby in and infection out.

We have a doctor's appointment once a week now.  Her next appointment is Friday where she will get another ultrasound.  Hopefully Pam will stay out of the hospital for a while.  We would like to thank all of you again for your prayers and well wishes.

Take care,

Lee, Pam, Baby A, Baby B, Baby C, and Baby D ;-)

P.S.  It's now official.  Pam's waistline measurement is now bigger than mine!  At a little over 5 months she looks about 8 months pregnant at this point.  She's gained about 35 pounds so far.  No names yet... but there's still time.
 

Friday, April 21, 2000

It's been a while (Feb. 26) since we sent a general e-mail broadcast regarding Shamu's... err, I mean Pam's... pregnancy so it's about time for another update.  The main reason we haven't sent e-mail recently was because nothing much was happening.  Life out here has been pretty routine.  No news is good news, right?

We've been in Phoenix for almost two months, now.  The weather has been great. Recently, it has been consistently sunny and about 90 degrees.

Until now, the pregnancy has been going better than expected.  Pam has been on bedrest since the beginning of February.  During this time she has been on a home contraction monitor for two hours each day.  After our arrival here in Phoenix, Pam was temporarily hospitalized for preterm labor (high contraction count) and placed on a terbutaline pump.  Contractions have been under control with an occasional small increases of the terbutaline dosage.  A few weeks ago we had a gestational diabetes scare when one test came back positive.  The second round of tests came back negative.  Whew, what a relief.  The doctors and nurses here at Phoenix Perinatal Associates have been impressed with Pam's progress.

For the statisticians:

For the mathematicians:
 

Originally, all four babies had been growing at a pace which was the same or better than that of an average single baby.  Over time, they have fallen a bit behind in size.  That is normal for quadruplets and nothing to worry about.  It's getting a bit tight in mommy's belly.  When one baby kicks it often sets off a chain reaction and they all start kicking -- good entertainment for daddy and mommy.  Daddy and mommy had better get used to the chain reaction phenomenon because it is one that will occur frequently for many years to come.

The fun is over.  No more lounging by the pool all day working on our tans (just kidding).  Pam was admitted into the hospital on Thursday, April 20 due to a condition known as Preeclampsia (Toxemia) which is pregnancy related hypertension.  We've been told that about 50% of quadruplet patients end up with this condition.  It is a major cause of preterm delivery.

Pam is almost guaranteed to remain in the hospital for the balance of the pregnancy because doctors need to closely monitor her condition.  They have placed her on Magnesium Sulfate which is expected to control seizures that can come from Preeclampsia.  Mag Sulfate is pretty nasty stuff since it can cause various discomforts, including nausea.  Pam will likely also receive steroid treatment which will help to develop the babies' lungs and hopefully extend the delivery date.  Fetal fibronectin (fFn) tests will continue to be given as an aid to help predict preterm labor.  We still hope to hold the c-section off until week 34.

Attached is a photo of Pam from a fashion shoot featuring maternity wear, compliments of Jeanne Ziobro of Lucent Technologies.  Note the sporty and stylish terbutaline pump pouch attached to what used to be Pam's waistline. The photo was taken on April 20 just before she was admitted into the hospital.

That's all for now...
Take care,

Lee, Pam, Baby A, Baby B, Baby C, and Baby D

P.S. No, we haven't decided on baby names, yet.  Any suggestions are welcome.

Thursday, April 27, 2000

At about week 6 of the pregnancy we saw four folicles on ultrasound but only three contained fetuses.  The next week we went back and saw the fourth fetus appear.  QUADRUPLETS... YIKES!!!!  At that point, my wife, Pam, and I were faced with the very important and difficult decision of selective reduction (SR).  Our doctor in Pennsylvania put a pretty good scare into us when he started talking about the risks of going through with the pregnancy and about the alternative option of selective reduction.  The perinatologists (obstetricians for high risk pregnancies) in Allentown had delivered only one set of quads in the past two years.

Due to religious convictions, we were not too keen on the prospect of selective reduction.  We immediately decided to research the subject of quadruplet pregnancies as well as the subject of selective reduction.  Our research indicated that by reducing from quads to twins the risk of a successful outcome was not reduced to the extent that one would hope.  The SR procedure introduces risks to the surviving babies.  We decided to go ahead with the quad pregnancy.  We only get one shot at this so we committed ourselves spiritually, physically, and financially to this effort.  We sought the most experienced doctors in the country in order to maximize the chances of a good outcome.

Our search quickly led us to Dr. John Elliott of Phoenix Perinatal Associates in Phoenix, Arizona.  He spent an hour and a half from his home on the phone with us answering our questions and discussing his program, techniques, and experiences.  Phoenix Perinatal Asssociates has had about 50 quad patients, over 600 deliveries of multiples, and has had an excellent track record.  Dr. Elliott is very nice and will consult with you if you call him, whether or not you decide to go there.  He will provide you with statistics regarding SR, he will provide you with statistics regarding quadruplet pregnancies, and he will provide you with information you need to know in order to increase the outcome of a quadruplet pregnancy.  The program at Phoenix Perinatal Associates uses aggressive medications and techniques and attempts to be proactive as opposed to reactive.  He is truly dedicated to helping people.

Needless to say, we are currently here in Phoenix at week 30.  Pam had severe morning (all day) sickness from about week 8 to about week 14.  It got so bad that one evening she threw up five times.  Pam went on bed rest and a home contraction monitor twice a day at week 18, we flew to Phoenix at week 20, she was hospitalized at Good Samaritan Regional Medical Center for four days at week 20 for contractions, was placed on a terbutaline pump and released.  The goal is to keep contractions down to three per hour per week in order to keep the cervix firm, high, and long.  We had a gestational diabetes scare in March when one test came back positive, but the second came back negative.  At week 29 she acquired preeclampsia which is pregnancy related hypertension.  A high percentage of quad patients (I think about 50%) develop this condition.  She reentered the hospital and will remain there until after the c-section.  Week 30 brought high levels of blood enzymes which signified liver problems.

Pam has been on a high calorie, high protein diet and the goal was to gain between 75 to 100 pounds by week 24.   Pam takes the following every day: 6 Tums, 2 iron, 1 prenatal vitamin, 1 baby aspirin, 600mg of Motrin every 6 hours, 2 Sudafed every 4-6 hours for severe congestion, 2 pepcid, 1 stool softener, and probably some other stuff that I can't recall at the moment.  Besides that, she receives terbutaline and Magnesium Sulfate I.V. to help lower contractions and to guard against seizures from the preeclampsia.  Pam is monitored an hour for contractions twice a day.  It is common to be on the monitor for more than an hour -- she has been on the contraction monitor all night long when contractions have flared up.  She was placed on steroid therapy (Dexamethasone) in order to reduce the liver enzyme levels.  If the liver gets to the point where it yields pain, then the delivery will need to be done.

Pam takes a half hour of hydro therapy twice a day which levels out body fluids.  She receives a Fetal Fibronectin test once every two weeks which helps to predict labor.  Vitals (temperature and blood pressure) are taken every two or four hours depending on her current status.  They listen to Pam's lungs and check leg and foot reflexes at least twice a day.  Blood is drawn for lab tests every one to four days depending on her current status.  The I.V. site is changed from arm to arm every four days.  The terbutaline pump site is changed from thigh to thigh every 5 days.  A weight measurement is taken every evening.  Every Tuesday a finger prick is the method used for a diabetes test to insure that the terbutaline has not raised blood sugar.

Pam has had two steroid shots for the development of babies' lungs.  Baby heart tones are monitored twice (or more) a day.  Babies receive a Biological Physical Profiles (BPP) via ultrasound every Tuesday and Friday.  The BPP checks heartbeat, fluid, movement, and "practice" breathing and provides a best possible score of 8 for each baby.

Pam currently suffers from severe congestion, blurry vision, and hot flashes from the medication.  Indigestion is also a problem, among others.  At this point it is difficult to get through the day so we continue to focus on the babies and take it day by day.  She gets a lot of support from me and from the hospital staff.  She is visited every day or so by a perinatologist from Dr. Elliott's group and is also seen by hospital residents as well as other doctors.  The nursing staff here is highly skilled at high risk pregnancies.

Ideally, a quad delivery should occur at week 34.  We might not make it to week 34 but we are trying as hard as we can.  It has been a bumpy road but we are certainly in the right place.  Some women have had more difficulty than I have described and some women have had less.  For Pam, the most severe aspects of the pregnancy have been the morning sickness and the congestion.  Pam started out at about 105 pounds and has gained about 70 pounds.  Here are the (week 29) baby weight estimates:

     Baby A (boy): 3 pounds  8 ounces
     Baby B  (girl): 2 pounds 10 ounces
     Baby C (boy): 2 pounds 11 ounces
     Baby D  (girl): 2 pounds  9 ounces

We bought a full sized high top conversion van and a used Runabout quad stroller.  We were given four cribs which are ready to go and we have some baby stuff (clothes, diapers, etc.) to start with.  The week 17 baby shower allowed us to get a bit of a head start with some of our initial needs.  We have friends and family lined up waiting to help with the babies once we get home.  If that's not enough help we will have to consider a professional.  The decision to go ahead with four babies requires a large financial, emotional, and spiritual commitment.  It requires a very large amount of hard work during the pregnancy as well as after the pregnancy, I'm sure.