Quick Update on Previous Blog

Dear Friends,

I asserted a little influence and was able to get them to start the IV again. Apparently the perinatologist doesn't want to "artificially" inflate the Amniotic Fluid Index (AFI). On the face of it that is transparently foolish and dangerous. After our insistence the on call doctor agreed to order the IV even though the specialist decided against it.

They will keep the IV going at least until Wednesday when we meet with the perinatologist and come up with a plan of action from there. I'll keep you posted on the AFI's and the situation with the doctors.

Dave

Medical Update #5 on Jennifer and our unborn baby Sophia

Dear Friends,

Well, the roller coaster continues. We thought that things were great and we were hoping that Jennifer might even be going home today but that is not going to be the case. Since being taken off of the IV yesterday the AFI has dropped from 10 back down to 4.2-4.5.

What is even more disconcerting is that the doctors want to wait until tomorrow to put Jennifer back on an IV to “see what happens.” To me it is the height of negligence to play a wait and see attitude when a child’s life is in the balance. It would seem wise and prudent to me to put her back on an IV until they can figure out what is causing the fluid to drop so dramatically or why the being on the IV seems to bring up the amniotic fluid so quickly.

Part of the problem is that they are treating this based on what most pregnancies do even though we have a clear history that has demonstrated that hydration and an IV was effective in bringing up the AFI when this almost identical circumstance occurred with our first child. One of the things that I appreciated with our old doctor in San Diego was that he was not willing to play the odds and instead took every precaution to make sure that the baby was safe.

Needless to say, this cavalier approach is very disconcerting to Jennifer and me. The textbooks may say that an IV won’t make that dramatic of a difference but our previous case history and the effectiveness of bringing up the AFI should be enough to have them put Jennifer on an IV just to be on the safe side.

I’ll let you know more at things progress. Hopefully it doesn’t turn into a medical difficulty merely because the attending physicians are not willing to look at the evidence that flies in the face of conventional wisdom.

Sincerely,

Dave

Medical Update #4 on Jennifer and our Baby Girl Sophia

Dear Friends,

I wanted to give you a brief update of where we are at the moment and for the most part it is very good news.

The Amniotic Fluid Index (AFI) was at 10 cc today, which is ideal. It is a dramatic improvement from the 3.9 cc that we were on Wednesday and it looked like if things continued in that direction that an extremely early delivery was inevitable. As I mentioned previously the p-r interval tested yesterday at 113 (110-140 is the range we want so this is great).

The one thing that is a bit concerning but not earth shattering is that Jennifer’s blood sugar level was on the borderline for having gestational diabetes. They are monitoring it and we’ll know more when we talk to the doctors in the morning.

Since the AFI was at 10 the on call doctor decided to take Jennifer off of the IV to see if the level will stay up on its own. That will be a huge determining factor if Jennifer is able to come home on Monday. One thing we don’t know which I suspect is that Jennifer will be on home bed rest for the rest of the pregnancy. That was the route we had to take when we were expecting with Grace, our first child.

With Grace Jennifer yo-yoed in and out of the hospital for several weeks with the fluid continuing to drop once she was home to the point that the doctor decided the only way to keep the AFI up was to have Jenn admitted for complete hospital bed rest. The problem was that Jennifer couldn’t keep her AFI up at home with no children under foot! But, of course, each pregnancy is different even though we do have a track record we can refer back to. All of this is only for a short time in relation to having a healthy, thriving child so whatever we need to do is worth it!

Thanks again for praying. Also, feel free to forward the link to this webpage to anyone that you know that might be interested.

With Love and Gratitude to our Great God and Savior through Jesus Christ our Lord,

Dave

Medical Update #3 on Jennifer and our Baby Girl Sophia

Dear Friends,

Things are starting to turn around for Jennifer and our unborn baby Sophia!

First of all, we have results back that Jennifer did NOT have H1N1 (swine) flu. In fact, it tested negative for influenza A and B so it must have been some other virus that was affecting her.

Secondly, the Amniotic Fluid Index (AFI) was measured at 8.9-9.0 cc this afternoon! Ideal is 10-11 cc so this is amazingly good news and a dramatic increase since Wednesday when it was at 3.9 cc. Hospital bed rest, a lot of liquids and a continuous IV have made a dramatic difference. I would also add that God has been gracious and merciful in intervening because even doing all those things doesn't guarantee it will go up and the doctor told us on Wednesday that it might increase it 10%. I think he meant to say 150%.

Finally, the other good news is that the p-r interval was back down around 113. Usually they like to take it three or four times to get the range since it is difficult to be absolutely precise every reading; they were only able to get one good reading today.

So, does this mean that Jennifer is coming home? I'd like to say yes, and that is my hunch, but we won't know for sure until Monday at the earliest. The on-call doctor was in today and told Jenn that if she were his patient he would keep her in until at least Wednesday. But the perinatologist (OB specialist) will make that determination after a full growth study and AFI on Monday.

We had this same problem with low amniotic fluid with Grace. Jennifer bounced in and out of the hospital repeatedly from weeks 28-31 before the doctor decided that the only way they could keep the AFI up was for Jenn to be on hospital bed rest for the rest of the pregnancy. This doesn't have to be the case but it would entail that Jenn stay off her feet completely if she is going to complete this pregnancy at home.

I would say that unless something drastically changes before Monday that we are at least temporarily out of the woods but we aren't home yet. Once again I cannot say enough about my church family here who have been so loving, encouraging and supportive throughout this ordeal. I have to admit that it was heart rending to hear the doctor even hint that the baby might fall into duress and not make it.

It also reminds me how much we take precious things for granted until things change. With Jennifer gone I immediately realize how much I rely on her to take care of the kids and do so much around the house. More than that, I realize what a precious gift her love and companionship are on a daily basis. Putting the kids to bed and finding how depressingly quiet the house is without her laughter and conversation. Even knowing that the separation is only temporary doesn't make that longing any less strong.

I pray that this situation is quickly over and I also pray that I have a lasting reminder of how amazingly special my helpmate truly is.

Dave

Medical Update #2 on Jennifer and our Baby Girl Sophia

Dear Friends,

I am heading back down to Fargo for the day but I wanted to give a quick update on what's been happening and where we are at the moment.

There is good news and not so good news to report.

On the positive front the amniotic fluid level continues to rise with Jenn being on complete bed rest, lots of liquids and an IV. We are back up to 5.7cc (Ideal is 10cc and under 8cc causes concerns). On the not so positive front the p-r interval is again climbing and is back up to 129-137 range which is up from Wednesday of 113-117. It ought to be between 110 and 140 so we aren't in a danger zone yet but it also shouldn't fluctuate much at all throughout the entire pregnancy so the fact that it is, in itself is cause for concern.

What we don't know is the why question. Is it because Jenn is on Tamiflu© that is causing the fluid to drop? Is the massive dose of dexamethasone to help the baby's lungs develop causing the p-r interval to rise? Are there other factors involved that we don't know of yet? Perhaps the flu itself is part of the issue? The other thing we don't know is how long Jenn will be in the hospital.

We had this happen with Grace and they were able to get the Amniotic Fluid Index (AFI) back up with an IV. But they put her on complete bed rest. Even with that it still increased over time and she had to be in the hospital for the duration of the pregnancy. It seems like the IV might work for the time being but we'll have to adjust so that Jenn actually does get complete bed rest at home.

But I'm jumping the gun a bit. We still need to get over these issues before they will release her to go home.

Keep praying!

Sincerely,

David Monreal

Medical Update #1 on Jennifer and our Baby Girl Sophia

Dear Friends,

This blog originally was started to give one place for updates when we were pregnant with our daughter Grace. People could come here any time and find the most up to date information and leave comments and I could access it anywhere and share with you the exact situation at it developed. It has rambled on since then but it is time to go back to its original purpose.

We are currently at 25 weeks and 1 day in our pregnancy with our daughter. After experiencing complications with our daughter Grace (see June-December, 2005 for all the details) we have high-risk pregnancies with two beautiful children and no miscarriages. Grace developed 3rd degree heart block in the womb and received a pacemaker 6 weeks after she was born.

Since that time they have learned more about this particular antibody that causes heart block and have developed a test to see if it is developing before it actually becomes irreversible. More than that, they have learned that 4mg of dexamethasone taken daily before it moves to 2nd or 3rd degree heart block on only stops the progression of heart block but reverses it back to absolute normal with no heart block later in pregnancy or after the baby is born.

Things were going fine for us and we were monitoring the situation aggressively. However, on August 10th the markers that we were monitoring started to go past the danger point and we decided on August 12th to begin the steroid treatment. By our appointment on August 17th the heart rate (p-r interval) was back within totally normal range. For those who are interested it has been consistently at 113-117 and had been as high as 146 (with a few over 150). Normal range is 110-140.

Shortly after this the entire family became ill, starting with the children and then me. It seemed to spare Jennifer at first and we were hopeful that it would miss her. We all had flu type symptoms that seemed to possibly by N1H1. The kids and I recovered quickly from the most severe symptoms. However, around August 17 or 18 Jennifer started showing minor symptoms and by the 19th was seriously ill. Even before testing (which we have yet to receive the results!) she went on a 10 day regimen of Tamiflu © and has only started to feel better this past Monday.

We went in to see the specialist for our twice weekly visit to Fargo and the heart situation is still completely stable and we are hopeful that it will stay that way. However, they now noticed that the amniotic fluid level is dangerously low. I’ve learned that 10cc is a good range to have and they get concerned if they cannot measure 4 pockets of fluid less than 8cc. We had this problem with Grace and if it dropped below 5cc, Jenn had to go to the hospital for inpatient bed rest.

The fluid level was 4.7 on Tuesday.

Strangely the doctor sent us home and told us to return on Wednesday. On Wednesday the fluid level had dropped to 3.9cc and Jennifer was admitted to MeritCare Hospital in Fargo. They have her on oral fluids and an IV in hopes of raising the level of amniotic fluid as a consequence. Initial tests today show an improvement as the fluid level was at 4.8cc.

We don’t know what caused the low fluid level. With our daughter Grace the doctors just assumed it was a byproduct off the heart block. But with this baby not having heart block we are starting to wonder if it is because of the dexamethasone. There is an off chance that it Jennifer could have gestational diabetes so we are going to ask the doctor to have her tested for that because that is on the list of other possible causes. We have been told that this drug does sometimes cause that or it could be that Jennifer is dehydrated and doesn’t know it.

They are also giving Jennifer several rounds of high dose steroids to help the baby’s lungs mature quicker in case we have to deliver before full term. They did this with Grace and Alexander as well and both of them prove daily that they have fully developed lungs!

Please continue to pray for Jennifer’s health as well as the baby’s. Specifically, pray that the fluid level increases, that Jenn can come home from the hospital, that there are no further complications in the pregnancy and that the baby will come to full term.

If you have any other questions feel free to email me through this blog or directly. I will try to post answers and give further updates on this blog page.

One further thing, I would be remiss if I did not mention the absolute love and support that I have felt from the church family here in Grand Forks. At the moment it is difficult to think clearly enough to even know what we need but people have been wonderful in showing love and support and creatively trying to think for us on what we might need down the pike. I have often commented that the church should be a foretaste of heaven and these last few weeks I have had a little glimpse of it here in this quiet Midwestern town.

Thanks!

With much love and appreciation,

David Monreal

An Open Letter to the Members of the ELCA

“Here I stand. I can do no other.” Martin Luther - 1521

“I shall delight in Your statutes; I shall not forget Your word.” (Psalm 119:16)

The Reformation dispute between Martin Luther and the Catholic Church came to a head at the Diet of Worms in 1521 when Luther was called in to renounce his teachings and the 95 Theses he tacked on the church door of Wittenberg on October 31, 1517. As Luther saw it there were two interrelated issues at stake. First, was the authority of Scripture alone (Sola Scriptura) as the sole source for doctrine and practice as opposed to the twin authorities of both Scripture and the tradition of the church. Second, was the issue of faith alone (Sola Fide); that a person is justified by grace alone through faith alone. Following Aristotelian from-matter schema, the formal issue was Scripture alone and the material issue was faith alone.

In other words, the underlying issue was the question if God’s Word alone was the only rule for faith and practice or if tradition came alongside and carried equal weight. How this worked out was that the Catholic Church came to a different understanding of salvation because they based it on the twin authorities of Scripture and church tradition. Since both carried equal weight it was Scripture that ultimately was reinterpreted to line up with tradition. Any interpretation of the Bible that ran counter to tradition was disallowed.

Luther’s core conviction was that God’s Word alone binds the conscience and is the sole authority in doctrinal matters. When called to recant he spoke plainly, “Unless I am convinced by proofs from Scriptures or by plain and clear reasons and arguments, I can and will not retract, for it is neither safe nor wise to do anything against conscience. Here I stand. I can do no other. God help me. Amen.”

Thus began the Reformation that is our history and heritage as Christians. There are interesting parallels between the discussion in Luther’s day and the debate within the Evangelical Lutheran Church of America. The material issue has to do with the acceptance of the practice of homosexuality among the laity and clergy. But underlying the issue is a question of the authority and clarity of the Word of God. Is God’s Word the sole authority in doctrinal matters and do we accept the clear and plain teaching in the Bible or do we allow the changing mores and cultural climate of our day to reject these teachings? Like those in Luther’s day, we are allowing the sentiments of men to reinterpret and redefine what God has clearly said in the Bible.

It is both sad and ironic that the very church that bares Luther’s name would abandon the clear teaching of God’s Word in order to be more in line with the sentiment and spirit of the age. Unwittingly many have overturned the very foundation of the Protestant Reformation and the core convictions of the very reformer they view as their founder.

Many in the Lutheran Church are saying that this issue should not divide the church but rather people should focus on what unites them. If one cannot agree on the very source of authority for faith what is left that unites them? This was the very reason Luther left the Catholic Church and took his stand. I believe those within the Lutheran Church who know Jesus as their Savior must once again have the courage to take a stand and do what is right before God.