So stuff is going well, I guess.
We found out at a previous appointment that my fluid levels are low normal, so I’ve been drinking water like clockwork. Seems to be helping (or rather, it seems I was probably dehydrated at my last ultrasound, since our bodies can’t really MAKE more fluid, apparently), and the fluid is back up to normal again. Hurray! It also means we’ve had a billion ultrasounds, which has been awesome. In the last one, Baby was very proud of his junk, but he kept hiding his face. I also saw lots of hair: thick and floaty and soft-looking, that stood up in spikes in the amniotic fluid. Explains my chronic heartburn. So all that is nice.
What is less than nice, is that we are now looking into stopping some of my ulcerative colitis meds, in order to give the baby the best start. Despite all the delightful – hopeful – helpful articles we found early on about the not-so-terrible effects of Imuran* on babby-forming, there are still some risks for the kid post-delivery. Low white blood cell count is one. Suppressed immune system is another. Fun!
However, no matter how much pregnancy contributes to suppression of immune system, if I go off the Imuran, I’ll have a flare up. Shockingly, bleeding guts, constant pain, and lack of proper nutrition absorption = also not good things for a fetus. So we went round and round with all my docs to come up with a plan. Two plans, really.
1. I will reduce the Imuran. Currently I take two pills a day, or 100 mg. I’ll reduce to 50 mg. If this goes well, we might consider reducing more or stopping it completely. (Please hold your skeptical snorts: remember, there is a Plan B coming.)
2. I will see a fetal/maternal specialist from the more populous part of our region, who will give us even more advice toward the best course.
However, there’s the possibility that reducing the Imuran will cause a flare. There is also the certainty that stopping it completely will result in one. So we also came up with our second plan, creatively named
1. I will reduce or stop the Imuran. If/when I flare up, I’ll call the gastro and get a prescription for …
Yes. The Devil Pred. I’m not thrilled about going back on that psycho crap, ever, when I’m the only one affected. Add a baby in the belly, or the thought of caring for a new baby, with all the attendant stresses? This course of action does not a happy Peppery make. But. BUT. There are some factors in its favor, unfortunately, just like the honeymoon crap you experience when taking prednisone for a limited period of time. ***NOTE: these factors are things I plan to verify with the fetal specialist. They might not be true in my case, in every case, or any case. Yes, right now these are just casual conversation topics with my doctor. If you’re going through something similar, talk to your doctor.***
– It’s a drug that will be less harmful to the baby than Imuran. Supposedly it doesn’t cross the placenta, or something. There’s your science for today, guys.
– We know more about its effects on pregnancy because it’s been around a while, lots of studies have been done with it.
– We know it works on me, and will control a flare up effectively, thus letting me eat healthily for the baby, absorb nutrients, and pass stool normally.
– “Less harmful to the baby” might not be true, since this depends on the dosage. My dosage to control a flare would likely be higher than the average bear’s.
– High doses of steroids can result in problems with labor, and in my body counteracting the effects of the steroids. I’m not quite clear on how this works, but the end result would be that while in labor, the docs might have to give me a monster dose of steroids. This does not sound like fun for me OR baby.
– Would need to remain on prednisone long enough after the birth for the pre-stopping levels of Imuran to kick back in. Docs usually say this can take anywhere from 1-6 months. When I first began taking Imuran back in 2003, my doc kept me on prednisone for the whole 6 months before weaning me down. Those six months? Not fun, either mentally or physically. And that was just me and A. Adding a baby to the mix worries me. Although a shitty side effect of six months of prednisone was crappy sleep/insomnia: clearly that won’t be any different from having a newborn in the house!
To sum up, because there is too much…
The bottom line is that neither option sounds great. It’s funny, though–it’s been my dream to stop taking maintenance meds, or at least stop needing things like Imuran and prednisone. Even a lower dose of Imuran, I thought, would be amazing. Here it is, and I’m a mess of anxiety. (Also good for UC, you know!) But we’re going to do something–whatever is the best choice for the baby. I presume that this will only be the first in a long line of such scary decisions. Here we go, baby.
*or azathioprine. I’m no Glaxo shill but I can type “Imuran” a lot faster. So Imuran it is.