We got to the Center for Maternal and Fetal Medicine at 7:30 for our appointment. We knew it was going to be a long visit and we knew there was only a slim chance for good news, especially given the team they made sure we were able to see "if needed". Still, we tried to keep our thoughts positive and our hopes up.
We went back for the sonogram and the tech was really nice... For one very brief, glorious moment we thought Brinley was just going to be small. The tech said that she didn't see the echogenic focus on the heart and at first glance it seems like Brinley is healthy to her. She even laughed a little as I counted Boo's toes when her little foot popped up on the screen so clear. And then the tech got very quiet... very, very quiet... All I could do was reach out for Chris' hand and try to look for anything on the screen. Then she asked if anyone had talked to us about some fancy big word - about having two ventricles/vessels/v-somethings in the umbilical cord. She wouldn't look at my face when she asked so we knew that was a bad sign... we said no and then asked what that could mean. Naturally, she told us that she wasn't a doctor but that it could be a marker for a lot of things or nothing. I stopped watching the screen and started watching her, which only led me to notice every little grimace that she made when she looked at Brinley's profile, zoomed in on her heart, and took a 3D image of her hand... Then she rushed out to get the doctor telling us, again, that these could all be a lot of things or nothing at all.
Dr. Spencer came in to find me in tears and Chris being the rock that he is, and instantly apologized. Not a good sign. He looked over the pictures the tech had taken, talked to her with the fancy doctor words, tried to subtly point to his chin when the profile picture came up, and then went back to scan me some more... Dr. Spencer told us that the umbilical cord should have 3 v-things and not 2, and that could be causing the problem with Brinley's heart and her size. It could just be that - an issue with the umbilical cord that caused a VSD leading to a small, but generally healthy baby. However, the umbilical cord, the VSD, the recessed chin, the smaller limbs... they could all be because of a genetic disorder like Down Syndrome or any of the T## things. Although totally a guess, when we asked, Dr. Spencer said he would estimate Brinley's chances at 30-50% for Down Syndrome or another disorder...
We met with the genetic councilor and talked more indepth about doing an amnio and about family history. The amnio would give us almost 100% accuracy of what, if any, chromosome disorder that Brinley has... it would also tell us if she didn't have any disorder and just had this VSD and cord problems. Her and Dr. Spencer talked to us about how a VSD is simply a hole in the heart, how it's very common and often heals itself, it can be so easily treated and (again) is actually pretty common. They also told us how a heart problem combined with even the "best" of the genetic disorders can make life/survival extremely difficult. Both of them told us that even the "best" and most "popular" of the genetic disorders could greatly impair Brinley's quality of life... and that we seriously need to consider our options because of that. With some of the more severe disorders, they would all but not even let us decide because of the risks for Brinley, much less for me.
I think it was some time during this talk that Chris started crying with me.
So we did the amnio despite that it's normally avoided this late in pregnancy. We should have some preliminary results back Tuesday or Wednesday, with the full detailed report about a week after that... They are going to try and rush the results for us, but early next week we'll have a phone consult/check-in with the genetic councilor and she'll let us know what, if any, results she has from the amnio. In the mean time, they told me to take it very easy - not just because of the amnio and the risks involved there, but because of Brinley's whole condition. They did say that depending on her heart defect, the chances of it being something genetic could decrease and that the heart could be the main source for everything else wrong.
Then we waited to meet with the Hopkins doctor to look at Brinley's heart... and we cried a lot... Who would have thought that at any point in our pregnancy, we'd be pulling for a heart defect for our unborn child?!?! Yet, there we sat praying for something more than a common VSD to decrease the chances of something even more major. There we sat, crying and holding each other, praying that something be wrong with Brinley's heart... Crying about the genetic disorders and what kind of life that'd be for our baby girl, for the big sister that would have to sacrafice virtually everything because of these problems with the baby, for our family... Praying and wishing more for a heart defect that can't heal itself because that's our best option. And we cried.
Finally the Pediatric Cardio doctor finished with his normal appointments and was able to see the people who were squeezed in because of their situation. I couldn't even guess at his name since everything started seeming like such a blur of poking, prodding, pushing, twisting, turning and "shop talk" while they scanned Brinley's heart to see what's wrong with it. He was so nice though, and definitely portrayed a confidence that made me feel like he knew everything without a shadow of a doubt. If anyone could find my baby's heart defect and tell us how to fix it, this was the guy right here...
After an eternity, Dr. Hopkins went to "grab a little paperwork" real fast and then gave us our best case scenario... Brinley's heart defect is a-typical of almost all the genetic disorders, it is fixable, and as far as heart surgeries on a newborn go this one is pretty "easy". He let us know that because of the equipment here, he wasn't able to get the exact read that he'd like but when we come to Hopkins they'll be able to tell exactly and also exactly what it will entail to fix it. Oh - and he told us that we will be delivering at Johns Hopkins. There's basically no other hospital that is capable of performing the surgery that Brinley will need immediately...
So, we have two possibilities for Brinley's heart defect. Truncus Arteriosus or Double Outlet RV with Small Pulmonary Valve. (I'll have Chris scan the picture in later so this will make more sense but...) In a normal heart, you have the four chambers, the aorta and the pulmonary artery. There are two chambers on the right side of the heart, where the pulmonary artery pulls from and two on the left side where the aorta pulls from. Normally, the blood from your body (blue blood) comes in to the right side and then goes out through the pulmonary artery to the lungs; the blood from your lungs (red blood) come in on the left side and then goes out to your body through the aorta. The "good news" is that Brinley has all the pieces, the chambers look good and are doing their jobs. She has the big, main pieces of the engine as Chris put it. She does not however have the pice that separates the right and left sides. She also has the aorta and the pulmonary artery, but they aren't really in the right places basically... Without the little wall between the sides, the aorta is pulling blood from both sides and taking it to Brinley's body. But it's not all the right blood and oxygen so her limbs aren't getting what they need and are therefore small... Her pulmonary artery isn't getting the right blood either, so her lungs aren't getting the oxygen they need and she can't survive without me providing her oxygen.
The two possible diagonsis-es (diagonsi? diagnosies? IDK) are that either Brinley's pulomanary artery connects to the aorta - truncus arterious - or that it's attached to the side and very small - double outlet rv with small pulmonary valve. Either way, her limbs and lungs aren't getting what they need. The doctor said not only do both of these conditions not typically coinside with the genetic disorders, but that it is "an easy fix as far as heart surgeries go". Chris dumbed it down even more and said that this is like fixing a spark plug in an engine - it's easy to get too and doesn't involve opening the whole engine. The doctor says that (pending no genetic disorders) with the surgery Brinley will be able to be a normal kid, will keep up with her big sister and play sports, and will be able to play with her grandchildern. Of course she'll have regular check ups on her heart for the rest of her life, but a simple doctor's visit for life is almost to good to be true at this point.
We aren't totally clear yet though... It's not impossible for a genetic disorder to have any heart defect, even if it is a-typical. The Hopkins doctor and Dr. Spencer both made it very clear to us that, although it reduces the chances of a genetic disorder, this level of heart defect makes even the most "livable" genetic disorder extremely dangerous and in some cases they won't even perform the operation because the baby is... Well, you get it...
Yeah, so now we wait for the amnio results. We get everything moved to the Johns Hopkins' OB department and start seeing them as soon as possible instead of our normal OB. We will still need to go to our normal appointment on Monday for our 28 week check up and my glucose/blood test. We also need to go back to the high risk specialist in Annapolis in about 3 weeks for a scan to check on Brinley, but Dr. Spencer said Hopkins may already plan on doing this so we'd be able to cancel the appointment with them. We also have to get a Fetal Echo at Hopkins in 3-4 weeks no matter what the situation is with transferring OBs at that point. We will need to meet with at least one of the surgeons to go over the procedure for Brinley's heart surgey and plan on not being able to bring her home for a few weeks.
Again, this is all with our best case scenario... They've pretty much made it clear that if the amnio results are positive for any of the genetic disorders, we basically won't be able to... um, Brinley can't... there's just no way to have...
We're just trying to focus on the best case... and to make it more than 5 minutes without crying...
I'm sure you all know that we don't really ever ask for anything, but now we really need your prayers. Please, please, please add Brinley to your prayers. Please pray that she only has a heart defect and not any of the genetic disorders. Please pray that we get to have our baby girl. Please pray for our baby girl! We really appreciate even the smallest of positive thoughts sent Brinley's way... it's the only thing we can do.