Geraldine Fulk

 Peripartum Cardiomyopathy Support Network

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Hello, my name is Gerie. I have a wonderful husband, Tony, whom I've been married to for almost 11 years now, and a beautiful daughter, Kyla who will be 2 years old on April 22, 2005... and a new son, Anthony due on July 22, 2005.

INFERTILITY: My husband and I struggled with infertility for 8 years due to polycystic ovarian syndrome (PCOS). On the last year of the 8 years of trying to have a baby, we were seeking professional help from the fertility specialists at the Jones Institute at EVMS. Through fate, we were referred to the wrong department- The Department of Maternal Fetal Medicine of EVMS. My husband was very upset because we had to wait almost a month for our appointment, and the Jones Institute said that we had to wait another 2 weeks. At Maternal Fetal Medicine, we met the most wonderful doctor, Dr. Dattel. She could tell that we were very upset, so she said that she was going to see us to see if she could also help with our problem. She decided to check me for diabetes- I was a little overweight at the time and she said that most of the time, even being a little overweight can cause you to have diabetes and prevent you from ovulating properly causing the PCOS. My cycles at the time were very irregular. The intervals could vary between cycles- between 1-6 months, so we went through A LOT of false alarms and false hope. After a lot of bloodwork and that nasty Glucose Tolerance Test, I was diagnosed with diabetes. I began seeing the Jones institute, and they started from square one- with Clomid which failed, then infertility injections. After 6 months of controlling my blood sugars through diet, exercise, and Glucophage, and 2 failed injection cycles, we got pregnant! We were so excited!

DIABETES: Due to the diabetes, we went back to see Dr. Dattel- a high risk OB- for the rest of my prenatal care. The pregnancy was smooth sailing... blood sugars were fine, I was feeling healthy... I wasn't even gaining very much weight due to how heavy I was when I started the pregnancy... very uneventful... until January when I started experiencing some heart palpitations. At one of the scheduled OB visits in January, Dr. Dattel was scheduled to be at a conference, so I opted to see another doctor and mentioned the palpitations. She said that it was normal during pregnancy, and it was dismissed. At the next visit, Dr. Dattel was present. I mentioned the continuing palpitations, and she scheduled me for an EKG, which was normal.

PERIPARTUM CARDIOMYOPATHY: I was diagnosed with Peripartum Cardiomyopathy in April 2003, when had my first child. I was not due until June 2, 2003, but due to my borderline high blood pressure and my borderline decreased amount of amniotic fluid, my doctor put me out of work and on bed rest on April 9, 2003. I am a pediatric registered nurse, so the fact of putting me on bed rest- and out of work, was very difficult for me. I love working with children.

The night of Easter, April 20, 2003, I tossed and turned and couldn't get any sleep. I found it difficult to lay flat on my bed. By morning, when my husband was getting ready for work, we decided to call the doctor. The doctor on call told me to come in. My blood pressure was elevated (150s/90s) and my pulse while resting was in the 120-150s. I was also a little swollen in my face and extremities. They decided to admit me with the anticipation of getting my blood pressure and pulse under control and sending me home.

I was put on strict bed rest and supplemental oxygen at the hospital for fear of a pulmonary embolus. As my blood pressure and heart rate stabilized, we all decided that it would probably be best if I was induced and deliver the baby. I was 34 weeks along. Part of my job description as a registered nurse at the time was working in the NICU Stepdown, so I knew the risks of having a preterm infant. I was nervous and scared for my new baby... were her organs going to be mature enough to live outside of my womb?

They administered a vaginal pill to help my cervix dilate and started me on Pitocin. By morning, my regular doctor came in to see me (thank goodness it was her hospital day). I was on 4 liters of O2, in painful labor, and had still had difficulty breathing. My oxygen saturations were hanging in the lower 90s while on the O2. Dr. Dattel kicked out all of my visitors except my husband (I had 4 friends in the room with me- the hospital I worked at was connected to the hospital where I was having my baby). She ordered a STAT ECHO, which showed an ejection fraction of 10%. I was told that this baby would not be delivered vaginally... that my heart wouldn't handle it. We were told that Tony would be able to attend the C-section. While waiting for the cardiologist and the delivery room to be ready, I started to go downhill. An arterial line was inserted in my wrist, and I was put on a BiPap machine which forced oxygen into my lungs. By the time I reached the delivery room, I couldn't tolerate the mask of the BiPap, and I was coughing up blood. I was coughing so much, I couldn't keep the mask on. Tony couldn't stay for the C-section because I had to be intubated.

I consciously woke up in the Critical Care Unit the following Friday- 3 days later. One of the OB doctors came in to explain what had happened to me and told me that my baby was fine in the NICU- who at birth was 4 lb 8 oz and 17 inches long. I then asked her what day it was, then became upset because I had missed Tony's and my wedding anniversary.



I looked around me and noticed that I had 2 lines in my neck and one in my upper chest- a yellow monsterous looking tube, which I found out later checked my internal blood pressure (I'm not and was not born to be a CCU nurse- LOL), and arterial lines in each wrist. Taped to my bed were 2 pictures of me holding Kyla with tubes in my nose and mouth. To this day, I don't remember having that picture taken. When my husband came in, I found out that I also had a nasogastric tube to feed me and an endotracheal tube connected to a ventilator to breathe for me- which were already discontinued the day before. He said I was "someone else" when they were trying to wean me off of the sedative medications!

On Sunday, April 27, I was transferred to the cardiac stepdown unit, where I stayed until May 1st. I was very happy with even the littlest gains I made- especially being able to take a shower. I had a telemetry monitor on 24/7 and the NICU tried to bring my baby up as often as they could because I couldn't leave the unit. The first time I saw my baby, I was in awe. Here it is 5 days later- and her feet were so long (That was the first thing I noticed)! My tired and busy Tony, would go from one unit to the next to take care of me and feed our new daughter who was still in the incubator. I planned on breastfeeding, so to get my breasts conditioned, they gave me a breast pump to use on the floor to pump my milk and toss (I was still on a lot of meds).

On Wednesday, April 30th, I was able to be taken off of my monitor briefly to visit my daughter in the NICU. What an experience it was to actually leave the unit I had been on for 3 days. I actually got to feed her, rock her, cuddle with her. What an experience it was! This was my baby, after 8 years of trying. I was really sad to leave her there when I had to go back to my own unit- but first a pit stop outside to get some fresh air. I felt like I had never breathed before. The air felt so good going into my lungs that I didn't want to leave.

The doctors saw that I was doing so well, that the next day they transferred me to the mother-baby unit. I was closer to my baby. We walked over to the NICU for each feeding time, which also consisted of cuddle time. That night, she remained in the NICU, but the following night, they brought her to stay in the room with us. By this time, she was in a bassinet. Her nurse would come in to take her back to the NICU to do her assessment and check vitals, but we would feed her when it was time. What a nerve-racking experience! Tony and I took different shifts to sleep. It is so different with your own baby! I take care of these kinds of babies all the time when I work, and now I feel like an idiot with my own baby! It's funny how life works.

On Saturday, May 3rd, both Kyla and I were discharged from the hospital. It was a long ride home. Tony was so nervous driving with me and our precious treasure in the back seat.

The doctors and both Tony and I thought it best if I stayed out of work for a year to re-coop. I learned I had been on a heart transplant list. I left the hospital with a 25% ejection fraction, and the following meds- Captopril, Aldactone, Digoxin, Toprol XL, and Glucophage. I was assured that it would be safe to breastfeed, and was told that we should not have anymore children, which broke my already broken heart. 7 months later in November, I had a follow up ECHO which again showed a 25% ejection fraction, but I was feeling good. There would be a few times when I would tire easily, but Kyla was still on a 2x a day nap schedule, so I would rest with her.

GOING BACK TO WORK: I was cleared to go back to work in April 2004. Kyla was almost a year old. I started off doing one 8 hour day a week in the office as a RN Discharge Planner, then 7 months later, increased to 16 hours a week with 8 hours working on the nursing unit, which I missed so much. December 2004, I was able to increase my hours to 20 hours a week, with 8 hours still in the office and 12 hours on the unit. I had a follow up ECHO scheduled for the beginning of January 2005. Prior to doing that, I noticed some increased heart palpitations. My heart normally palpitated occasionally, but for some reason it was palpitating up to 15x per day. Once I noticed 7 in a period of 20 minutes. My cardiologist put me on an event monitor for a month. I did my ECHO, and surprisingly my ejection fraction had gone up! It was now 55%! We were all ecstatic!



PREGNANT AGAIN: The end of January, the nursing unit I worked on had a Chili Pot Luck. It made me so sick, I had diarrhea for 5 days! By the 5th day of loose stool, I decided it was time to see my PCP. I also happened to mention that I hadn't had my cycle since Halloween, but I wasn't worried about being pregnant. The cycle I had before that was in August, and the one prior to that in April, but we both wanted to make sure, so we did a urine pregnancy test. POSITIVE! I remembered 2x Tony and I having intercourse without protection- in 21 months! We weren't worried... it took us 8 years and infertility drugs to have our last baby! We couldn't believe it! I was excited, but most of all very scared. Tony came home from work right away, and we called the Cardiology Nurse Practitioner. She took me off of the Aldactone and Lisinopril, and I was to see Dr. Herre, the cardiologist in 6 days. We also called Dr. Dattel and she scheduled an immediate US in 2 days. Everything was going so fast!

The ultrasound showed we were 16 weeks along. It was so incredible that we couldn't believe that the baby we were seeing on the screen was ours! Everything was shaped perfectly. Kyla's first ultrasound was just a round sac (7 weeks). Tony even said to the tech, "That's not our baby! That baby belongs to the woman you did before us!" But it was definitely our baby. We saw Dr. Herre the following Tuesday and got some disturbing news. He said that even though my ejection fraction was currently 55% (which he couldn't believe- he had another doctor reread it, who concurred), I most likely will have the cardiomyopathy again, and that we need to make a decision about keeping the baby soon because I was so far along. I didn't want my daughter to lose a mom, and Tony expressed that he was not going to lose me, but I also wanted to keep our new baby. GOD had blessed us with another chance to have a baby. This baby was meant to be here.

We had an appointment with Dr. Dattel the next day. She said that she has seen this before, and that she's seen other women going into the pregnancy worse off than me, and coming out great. She was going to monitor me closely throughout the pregnancy and do a scheduled C-section between 32-36 weeks, which would put me between May 27-June 24, 2005. I am 21 weeks now, and the palpitations have stopped. I can count 1 in the past 2-3 weeks.

I am so honored and blessed that GOD has given us this chance to have another child. At the last ultrasound, everything about his anatomy was where it should be. He is absolutely fine, and I am absolutely fine. I am currently on Toprol XL, Digoxin, Glucophage, and my prenatal vitamin.