April 09, 2012 – Birthday Surprises

It turns out that my pity party couldn’t have come at a better time.  I did in fact need to be ready to face new challenges the next day.  I just had no clue what was coming. 

My doctor called me the next morning with my labs.  It turns out that when the ER ran a quant HCG (which is only produced by placenta cells) I tested over 9,000.  2 weeks post D&C I should be testing a lot closer to 0.  Wednesday my quant was over 6,000.  My doctor was worried.  He let me know we may be getting ready for some big changes to our treatment plan, but he didn’t worry me with more information.  I knew he was worried enough to call me himself (usually his nurse calls with labs) which meant he was seeing something bigger on the horizon.  I tried to stay calm, but was preparing myself for bad news.  He asked me to come in for labs again this week.  I am actually going to be there on my birthday. L

That evening he called back again to speak with Doc and me.  The test results from the tissue sample taken during the D&C had come back.  The tissue came back with a karyotype of 69 XXY.   The fetus would not have been viable; there was absolutely nothing we could have done to change the outcome of this pregnancy.  What 69 XXY means is that instead of having 46 chromosomes, like most people do (some amazing people have one more or less), our baby had 69 chromosomes.  Somehow our child had 2 copies of Doc’s chromosomes.  That can happen in 1 of 2 ways; either 2 sperm fertilize the same egg, due to an incompetent shell, or during the replication phase the father’s chromosomes are replicated twice.  That information alone wasn’t so bad… but my doctor wasn’t done. 

This type of pregnancy is called a partial-molar pregnancy.  It is characterized by a partially developed fetus and an over developing placenta.  I did not present at all as a partial-molar pregnancy.  Normally women who have this become very ill, very early in the pregnancy, and they normally experience heavy bleeding during the first trimester.  I felt great and had no bleeding during the 1^st 9 weeks of my pregnancy.  I didn’t start feeling sick until nearly 2 weeks after the D&C (what would have been 12 weeks of gestation).  The trouble with a partial-molar (or molar) pregnancy is that the over developing placenta can cause gestational trophoblastic disease and may continue to grow if left in the uterus.  Gestational trophoblastic disease may develop into a cancer (choriocarcinoma).  Because the cells are naturally occurring in the body, if left untreated it spreads easily throughout the body.  However, when diagnosed quickly it is extremely treatable.  If placenta cells from a molar pregnancy remain in the uterus they will continue to consume any new fetus that develops.  Therefore it must be treated.

You might recall that while we had most of the tissue removed during the D&C, we didn’t have it all removed because there was absolutely no sign of this disease present in me at the time and we were hoping to preserve my ability to have children.  My trip to the ER was the first clue we had that there was a problem.  My doctor explained that he wanted to speak with the OB/oncologist before proceeding to create my treatment plan.  I will most likely be undergoing another D&C which will be followed by chemotherapy, but he wanted to make sure that I would have the best care and he was seeking input on whether I should receive treatment here at our hospital or at the University hospital.  Obviously, this was difficult news to hear. 

Was there any good news?  Yes.  The good news is that we caught this.  If we hadn’t had the genetic testing done, we might still be scratching our heads trying to understand what was going on.  Most women who undergo treatment are able to have children once treatment has been completed.  My prognosis is very good.  My doctor explained that my constantly decreasing HCG levels are a very good sign.  There is also the always wonderful news that I have an amazing physician, who is working to make sure I have the very best care and that I am well taken care of.  Finally, thank God we have health insurance!

How are we handling this?  Our heads are spinning.  I mean, who tries to get pregnant and ends up with cancer?  We didn’t even see this as a possibility!  For now we are trying to keep our heads up and are ready to do whatever we need to.  We are trying to get prepared for whatever may come.  I have also instituted a household policy of joking about it.  I just couldn’t handle the reality if we take it too seriously, so we are trying to keep it light.  The running joke around here has become that most guys buy their wives jewelry or take them some place nice for dinner for their birthdays.  Mine gave me cancer.  It was the most expensive gift he could think of. J