Mary’s Pregnancies


It’s been a very long time since we last posted here. And there’s been a lot happening! The biggest news is that Mary is pregnant again, now about 23 weeks, and everything is going fine. You can see more ultrasound images here.

It’s also been exciting to be in contact once again with Dr Whitington and hear of the more recent progress in the research. See my comments on his recent paper here.

Mary’s going through the treatment again, and it’s running quite a bit smoother compared to last time. Though it’s no walk in the park. While using Intragam makes the infusion go a lot quicker, there’s still a lot of headaches and needles and time spent in hospitals. Also interestingly, for other people with NH experience, Dr Whitington’s protocol has changed somewhat since Mary underwent the treatment with Harry. Instead of starting at 18 weeks, Mary commenced at 14 weeks, and then had the second treatment at 16 weeks, before the weekly treatments started at week 18. This is based on a theory that damage to the foetus could start earlier than previously thought.

Apologies for the long break between posts. We’ll update you on our progress in the not too distant future.

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It's only eight months down the track but we got around to posting a summary of Mary's experience with the immunoglobulin treatment for neonatal hemochromatosis.  The theory behind the treatment can be found here.

My Experience
I received a product called Sandoglobulin, at a dose rate of 1g per kg of my body weight.  The high dosages and slow infusion rate combined to make a long and slow infusion (around 10 hours each week).  I am of average build and 168cm or 5'6''.  When my treatments first started in week 18 of the pregnancy I weighed approximately 68kgs or 150 lbs.  Over the pregnancy I put on about 8 kgs or 18 lbs.  This meant that my dosage increased from 11 bottles of the 6g of IVg to 12 bottles.

Over the course of the treatments the administration of the infusion caused much discussion between ourselves, our obstetrician, our haematologist and the oncology nurses.  Both the infusion rate and the infusion volume were sources of differences of opinion.  This had a large impact on the time taken to have the infusion.

For my own personal wellbeing, I found it very important to know what time the infusion would start and what time it would finish.  What I saw as unnecessary delays and setbacks were both upsetting and extremely frustrating, (eg at the end of each bottle I would wait up to five minutes for a nurse to become available to add an extra 10ml to the infusion,  failure of the solution to be dissolved in preparation for the administration causing the infusion to be paused).  Having said that, overall the staff and nurses in the oncology department were fantastic and without their support it would have been almost impossible to get through all of the treatments.

After about eight treatments I was really struggling with the treatment process.  The time was varying every week, I was suffering quite badly from dehydration caused by the treatment, this included headaches, the infusions made me feel very bloated and I could not see an end in sight for the treatments.  After the eighth treatment, I even ended up at the labour ward following the treatment as my chest was extremely tight and I was having really strong tightenings which severely impacted my ability to move.  I received some anti-inflammatory drug and was fine after a few days of discomfort.

The ninth treatment passed without incident, however my tenth treatment had to be stopped after 10 bottles.  I was very tight chested and suffered a reasonably mild asthma attack.  I had childhood asthma and so was very familiar with the sensation and able to help with diagnosis of what was happening.  The infusion was stopped; I received a diuretic to reduce fluid and received a dosage of ventalin via ventilation.  This relieved the asthma and the infusion was restarted and completed without further incident.

The asthma started after less than 7 bottles in the next treatment.  This time I received some hydrocortisone (a safe drug for use in pregnancy) and some more ventalin.  Once again this controlled the asthma and the infusion was restarted and completed without further incident.

From the eleventh treatment to the final treatment (21st) I have received pre-medication of hydra-cortisone and ventatlin.  This has enabled me to receive the treatment without incident.  It is also interesting to note that since I have been receiving the pre-medication I have not suffered headaches and the dehydration has been controllable.

Having spent so much time at the hospital I was pretty glad to have the final treatment.  The Volunteers who visited me every week were my saviours and I have to admit that if it wasn’t for them, I am not sure I would have lasted.  In fact I think that their company was even better than my own family and friends as they had no personal involvement in the situation.  They were wonderful.

Postscript
Harry is now eight months old.  I would undergo this treatment again in a flash!

As it turned out the 21 days I spent undergoing the treatment is the reason that Harry is alive today.  It was hard at the time, but I remained focussed and am so glad that we were given the opportunity to receive it. 

I thank everyone involved and think of you all very often.

Mary

I (Trent) thought I'd add a few words here on how the treatment worked from my perspective.

Sandoglobulin immunoglobulin

Immunoglobulin comes in a number of forms or brands. Mary was administered Sandoglobulin.  You can find a fair amount of information on Sandogloblulin on the net, but perhaps the more common brand is Intragam, which I think has been used by the majority of women who've been involved in Dr Whitington's program (though I'm not 100% sure).

I'm also not 100% sure on the difference in the products, but the obvious difference is that for approximately the same does Sandoglobulin will take over twice as long as Intragam!  This is pretty much based on the concentrations of IVIg in the product and the safe infusion rates.In our case, the Sandoglobulin arrived as a 6g crystal in a bottle, which was diluted to 100mL, making a 6% solution. This was then administered by drip at a rate of 150mL per hour. 

You can do the math… Mary weighed a bit over 70kg during the pregnancy – so at a dose of 1g/1kg, she required around 70g of IVIg or 11-12 bottles – i.e. approx 1100-1200mL of solution – and finally at the drip rate of 150mL – each treatment session should take about 8h!  Wrong!

One of the things Mary struggled with continuously was the length of time the treatment took, generally about 10h.  The extra 2h came about for a few reasons: extra time to ramp up to maximum dose rates, flushing the infusion lines with saline for 10min at the beginning and end of the session, sessions didn't always start on time, and finally (frustratingly) the fact that the bags of saline used to dilute the Sandoglobulin on average seemed to contain an extra 5-10mL.  Frustrating because this 5-10mL in each bottle amounted to an additional hour or so over the day.  In the end Mary was somehow able to put this behind her and decided that worrying about the time was pretty much a waste of time. 

Getting through the treatments

Apart from making sure you're relaxed Mary found a few other things that helped during the treatment:

  • Heatpacks.  The drip is often cold below room temperature and can feel really cold going up the arm. Some of the other women involved in the study mentioned that the bottles were warmed up in hands before it was administered.  Making sure the fluid or your arm isn't cold helps.
  • Blankets (as above)
  • Putting your feed up, but not necessarily reclining in the chair.  As you can imagine by the time week 36 of pregnancy rolls around it's hard to get comfortable, let alone trying to be comfortable sitting in the same place for 10h!
  • Visitors! the help break up the day.
  • Crosswords – unfortunately only when the drip is in your non writing hand.

Reactions

When you read the list of potential side effects from Sandoglobulin it sounds scary.  The doctors assured us that the risks were low, similar to any blood transfusion where the transmission of infections (unknown forms of hepatitis) is possible.  However the risks are even lower for highly processed blood products such as Sandoglobulin.  Mary did however have a few reactions (though we can't say for sure whether they were a direct result of the treatment)

  • After the 2nd session Mary developed a small rash on her hands which went away after a week and never came back.
  • Headaches.  These were pretty consistent.  The treatments were on Thursdays and generally by the Friday afternoon Mary developed a headache.
  • Tightness and asthma.  Mary had an asthma like reaction at about week 30, and then again the following week.  In both cases the treatment was stopped for about 1/2h before starting again after things settled down.  After the second week and discussing it with the doctors it was decided to give Mary a  hydrocortisone pre-med (100mL) before starting the treatment.  This made a huge difference, makingn getting through the treatments easier.

Oncology

The other interesting thing about the treatment delivery was that it was administered in the oncology department of the hospital.  In some ways Mary was a good news story for the nurses and patients, but it's not easy and at times was confronting.

The best thing about the treatment being administered in oncology was the people. The nursing staff were great and so to were the volunteers, who kept Mary's spirits up through the treatments.

Today was the last of 21 weekly immunoglobulin treatments for Mary, each of which took somewhere between 8-10h!

As you can imagine it’s a big milestone.  We’ve posted a few photos of the nurses and volunteers who helped administer the treatment in the Townsville hospital.

Actually we started to get nervous a long time ago about this process!  But we got a touch more nervy last Friday.  The visit to the Doctor was preceded by an ultrasound.  The ultrasound was fairly normal although it did seem to show that Basil’s growth rate had slowed.

On the upside, the placental blood flow was good (indicator that eclampsia shouldn’t be an issue, and also reassuring since Ellen’s placenta was not health) it was also reassuring to hear the Doctor say the liver texture from the ultrasound looked fine.

However, the slowing growth rate prompted an extra appointment and CGT for Basil’s heart.  This of course had us worried most of the weekend.  Thankfully it looks like all the worry was largely unecessary, the CGT show’s his heart is strong and well, and it also appears that slowing growth rates are probably a bit more common than we thought.

Less than a week to go now. One last scan this coming Friday and then the c-section booked for Monday 25 July!

What a relief, exitement, relief, anticipation, relief… Today was probably the last ultrasound scan. From what we understand of NH it onsets reasonably late in the pregnancy, but Ellen was born at 36 weeks, and Basil is already 34 weeks. Considering the multiple problems that Ellen had you would expect that if Basil had similar problems they would be evident in the ultrasound… wouldn’t you? It’s hard to get anything out of the doctors on this front, we just concentrate on the positives; everything looks fine, both from a NH point of view or eclampsia.

Currently Basil is about 2.7kg (already 0.5kg) heavier than Ellen. The only thing I’m not quite sure of is how good he looks. I’m pretty sure this isn’t his best angle, but here’s his latest look. Do you think he’s voguing?

The pictures from the ultrasound look a lot better earlier in the pregnancy. It’s harder to get decent views once they grow a bit and start to take up the space.

We saw our doctor afterwards and he confirmed that all looked good. The plan is still to have a cesaerian on 25 July unless things look like they’re going to happen naturally of their own accord at about the same time. Unfortunately I think those 4 weeks are going to go pretty slowly.

We attended the last of the antenatal classes this evening. The highlight included a video which really clearly set out all the potential reasons why you may want to reconsider having a baby! Sleepless nights, lack of time, crying babies… and I’m hooked.

I said to Mary over the weekend that sometime in the last week I’ve let my guard down. It’s a subconscious thing, but up until now I don’t think I’ve wanted to let myself believe that this is all happening. But now… I’m excited! When I think about it the pregnancy experience has been a bit strange. I’m normally the sort of person with a lot of questions and wanting to read all about it. But looking back I’ve pretty much avoided reading about the product of pregnancy, and when I have read up on the topic, it’s been about the neonatal haemochromatosis issues.

It is really like a blind being drawn back – sometimes there are steps in journey that I didn’t even know were there.

The problem is I’m now even more nervous about things. Mary nearly feinted at one stage today while she was at home. It’s potentially normal, but it’s hard not to worry… being alive.

Basil at 30 weeks

Mary’s just headed off down to Brisbane for a couple of days, mainly for work. Though she’ll catch up with Bob and Wendy and maybe even Mum and Dad this afternoon, which will be good. It was a bit of a downer to say goodbye. Mary’s a little nervous, hoping that nothing will happen while she’s away.

Had a good time last night at a pig on the spit, put on by Anna. There would have been around 100 people there. They’ve got a nice big property in Aligator Ck, with a few pigs, horses and chickens (1 less pig after last night). We talked with Anna’s work colleges mostly:

I think we both got a bit annoyed when someone started talking down the townsville general hospital saying that she’d never have kids there. It’s hard to get across to people how good the hospital’s been to us.

Mary’s treatment on Thursday was better than usual. It was preceded by a visit to the doctor, and a scan on the 29 April.

The scan was great to give us a bit more confidence that things are still progressing well, and they seem to be. The doctor’s visit was also good. David was unavailable at our last appointment because he had been struck down with ciguatera (fish poisoning) following a large piece of coral trout. He told us that while in hospital, he was on a drip and because of a little pain had adjusted the pump rates slightly only to be told off by the nurse. So he commented that he fully understood that if that was the way the nurses treated him, Mary might be having some issues if we’re looking for them to adjust protocols. Anyway it looks like David went and had a word with the nurses and along with the haematologist developed a written protocol for the nurses to take the 10mL out of the saline bags. The upshot… we were out of there before 5pm :))

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