Thursday- March 30, 2006 2:30pm- LUPUS ANTICOAGULANT

Today at 2:15 as I sat in my office preparing for a 2:30 meeting with some big clients, Dr. O Sitti calls. She is a blood specialist I went to see several weeks ago because Aunt Sissy had been diagnosed with a genetic blood disorder. I decided to get tested just as a precaution. Well, as I said, Dr. Sitti called me herself. She is from Thiland and speaks with an accent. She said "Stephy,I need talk you about test. First, you know you pregnant? You not tell me you pregnant!" I told her well, I didn't know I was when I came in to see you but yes I just found out. She said "well, this confusing to me but,you tested positive for Lupus Anticoagulant." Things got very quiet on the phone. I was basically like freaking out. She said "You okay? You calm down. We take care you and everything be okay." I am still sitting there in silence. I don't know what Lupus is so I am thinking the absolute worst (this is some form of cancer), I come out with... "Am I dying from this?" She says "No! Goodness you not die! We going to test you some more and we gona get to the bottom of this. We treat this and we get it taken care of." WHEWWWW... I am not dying... that is all I can think or hear at this point. She tells me she will have orders for me Friday am for more test. I need to have them done asap on Monday. I agree! My nerves are completely SHOT and I have totally missed my 2:30 appointment. Thank goodness for my assistant Chrystie who got on the phone with the clients rescheduled our appointment and called Kevin to come to my office. I am blessed to have her on my team and a saint for a husband! Talk about shock...I think I don't like surprises anymore. This surprise thing is getting to the point that it is not funny anymore. Please keep us in your prayers as we go throught this series of test and search for some answers.

I must admitt have been a little hesitant to look up these terms on the internet and I just keep hoping the test are wrong. But, I will post here some information to give you all a better understanding of what is going on. If there is anyone who is reading this who has been through this disorder while pregnant please share with me. It would really help put my mind at ease.

The term "lupus" is used when talking about many different forms of the disease. When someone says, "I have lupus," he or she could be affected in many different ways depending on the type of lupus present.

TYPES:
Cutaneous Lupus: ACLE, SCLE, CCLE, or DLE
Systemic Lupus: SLE
Drug- Induced Lupus
Overlap: RA, Myositis, Sjogren's, Scleroderma
Neonatal Lupus (rare)
Even within the same type of lupus, each case is unique, symptoms range from mild to severe and no two cases exact the same toll.

Cutaneous (skin) lupus: affects primarily the skin, but may also involve the hair and mucous membranes. It is frequently referred to as discoid lupus. Within lupus of the skin, there are types that cause different looking rashes and symptoms. These include: Acute cutaneous lupus erythematosus (ACLE)
Subacute cutaneous lupus erythematosus (SCLE), Chronic cutaneous lupus erythematosus (CCLE) or Discoid lupus erythematosus (DLE). Other terms used to describe specific forms of chronic cutaneous lupus include: verrucous DLE, lupus profundus, mucosal DLE, palmar-plantar (hands and feet) DLE, and lupus tumidus.

Systemic lupus erythematosus (SLE): can affect any system or organ in the body including the joints, skin, lungs, heart, blood, kidney, or nervous system. Symptoms of SLE can range from being a minor inconvenience to very serious and even life threatening. A person may experience no pain or they may experience extreme pain, especially in the joints. There may be no skin manifestations or rashes that are disfiguring. They may have no organ involvement or extreme organ damage. Most often when people mention "lupus," they are referring to the systemic form of the disease.

Drug-induced lupus erythematosus (DILE): is a side effect of long-term use of certain medications. Some symptoms overlap with those of SLE. Once the suspected medication is stopped, symptoms should decline within days and usually disappear within one or two weeks.

Neonatal lupus: is a rare condition acquired from the passage of maternal autoantibodies, specifically anti-Ro/SSA or anti-La/SSB, which can affect the skin, heart and blood of the fetus and newborn. It is associated with a rash that appears within the first several weeks of life and may persist for about six months before disappearing. Congenital heart block is much less common than the skin rash. Neonatal lupus is not SLE. "Lupus and Pregnancy" by T. Flint Porter, MD, MPH and D. Ware Branch, MD. Lupus News, Vol. 20, No. 5 Winter 2000.

Lupus in Overlap: The majority of people with lupus have lupus alone. Between five and thirty percent of people with lupus report having overlap symptoms characteristic of one or more connective tissue diseases. There are several well-recognized overlaps that may affect people with lupus including: lupus and rheumatoid arthritis (RA), lupus and myositis, lupus and systemic sclerosis (SSc or scleroderma), lupus and Sjogren's syndrome (SS). Blood disorders are common in lupus and can be very important. Hematologists, who are specialists in blood disorders, are often asked to be involved in the evaluation and treatment of patients with systemic lupus erythematosus (SLE). The principal hematological (blood) issues of interest are: Anemia: low hemoglobin or red blood cells ,
Thrombosis: excess blood clotting , Blood transfusion , and Bone marrow testing

Thrombosis

The body's blood is normally in a liquid state. When a person is injured or has surgery, blood thickens and plugs up the spot that is bleeding in a process called hemostasis , also known as coagulation or clotting . Hemostasis is a normal, vital function of the body. Sometimes in lupus, however, the processes of hemostasis are too strong, and a blood clot forms where it is not needed—or wanted. This condition is called thrombosis . It may be said that the difference between hemostasis and thrombosis is that the latter is too much of a good thing. If a thrombus , or clot, breaks off and travels elsewhere in the circulation, it is called embolus . Thromboembolism is fortunately not common, but it is always significant. Blood clots may affect the leg veins (sometimes with embolism going to the lungs), or the arteries to the arms, legs, or brain, as well as other places in the body. During pregnancy, blood clots can lodge in the placenta and disrupt nutrition to the fetus. A baby may be born prematurely with low birth weight, or may not survive to be delivered. Some women lose pregnancies over and over until a proper diagnosis is made and treatment given. Most thrombosis in lupus is associated with antibodies in the blood called antiphospholipid antibodies . The two blood tests most often used to detect antiphospholipids are the anticardiolipin test and the lupus anticoagulant test . (The lupus anticoagulant has a paradoxical name, since it is not really an anticoagulant in the body—it just looks like one in the laboratory.)

Diagnosis and treatment

The best treatment is anticoagulation (blood thinning) medication, such as warfarin (Coumadin and generics). Warfarin cannot safely be used during pregnancy because of a risk of birth defects in the middle of the first trimester, and a risk of fetal bleeding in the third trimester. Thus a woman who takes warfarin must switch to the injectable anticoagulant heparin or low molecular weight heparin as soon as she is pregnant. These are safe for the fetus. Aspirin and other anti-inflammatory drugs are not very effective antithrombic treatments when the problem is antiphospholipids. The best management of antiphospholipid pregnancy is not yet established, but often involves a combination of drugs. Careful, frequent monitoring of both mother and fetus by the obstetrician is an important part of overall care.

Lupus anticoagulants and Pregnancy

LA have clearly been associated with an increased risk of fetal loss due to pre-eclampsia, placental abruption, intrauterine growth retardation, and stillbirth. Some evidence suggests that this may be due to antibodies against the placental anticoagulant protein, annexin V. Placental infarction has been suggested as the cause of the failure to carry to term but pathological analysis has not definitely supported this contention. What about treatment? Well, we are looking at a thrombotic disease so we need anticoagulation, and as you would expect for acute thrombosis. You treat as you would any patient, usually with heparin followed by Coumadin. This anticoagulation should be continued for at least six months and it may be very important to continue it for a longer time depending on the status of the patient. If the lupus anticoagulant and underlying syndrome that perhaps the patient has disappears, you may not need longer anticoagulation. Now during pregnancy when this certainly occurs as well, what should one be doing? Patients who have recurrent pregnancy losses should, during their next pregnancy, receive low molecular weight heparin and again, oftentimes, low dose aspirin is added. The increase in fetal survival is about 50-80%, so this has been fairly effective treatment in these patients. I should add that there has been some debate about the level of Coumadin, Coumadin-ization that should be maintained in these patients. There is evidence in some people’s hands that they feel that higher dose or higher doses sufficient to cause the INR to be 3.5 or above is important. I think the answer isn’t entirely known.

The DRUNK Pregnant Woman-

Well, for the last five days, I have been drunk. This has been weird. Finally the doctors think they know what's causing the problems. Before we found out about our "little surprise", I was taking Effexor XR. When the docs found out I was PG, they decided they wanted me to come off of it. I was also on Effexor when I got pregnant with Mary Catherine. However, with her I stopped it cold turkey. The doctors seem to think that stopping it like that could have been what made me so sick last time. So they decide to switch me to Wellbutrin and then wean me off of that. Well, I take the wellbutrin on Saturday, stayed up all night and by Sunday Morning, I was out of it, slurred speech, numb teeth, etc. This continued until Tuesday when Kevin had enough and he called the doctor. Miller said stop it cold turkey and Clary said wean off of it. I tried everything from cutting it in 1/2 to taking it alternating days. Finally last Thursday, I decided not to take it anymore. I decided if it made me sick, it would be better than being drunk. Finally, the dizziness has ended and I am back to normal. Everyone may now get back on the roads and my staff can stop running to the back of the building when they see me drive up to the offices.

Davis

If you are a boy, your name will be Rowland Davis Rawlinson. What a big name for such a little fella. We have decided that we will call you Davis. This name has been in the Rawlinson family for many years. But, no one has ever been called Davis. It is my middle name- Kevin Davis Rawlinson. It is also your Pop Pop's middle name-Waverlyn Davis Rawlinson (however, Pop pop never liked Waverlyn so they called him Wade). It was also your Great Grandfather's middle name- Vincent Davis Rawlinson. We are not 100% sure where this name came from. We do, however, know when it started being the oldest male in the families middle name. Your great-great grand father, William James Rawlinson, was married to a very kind lady who's maiden name was Davis. This first wife passed away unexpectedly and he remarried. His second wife was the mother to Vincent Davis Rawlinson. This was the first Rawlinson with the middle name Davis. We believe in honor of his first wife, and her family heritage, William James and his second wife used the name Davis as their son's middle name. Hope this helps you understand where the name Davis came from.

Love, Daddy

The Name Game

Who will you be? That is the question. How can we name a person we haven't met yet? How do we know that your name will fit your personality? It is NAME GAME time and our family has been playing this last weekend. A fella that you unfortunately never had the opportunity to know, Dadaddy Mac, once told Mommy and Daddy to name a child something that "means something"! So we are going to name you something that means something in his honor. He was a very wise man an I hate you never got to know him.

Mary Catherine definately thinks you are a "GURL" and she already calls you- Ella. So, if she is right and you are a "gurl" you are going to be named a slight variation on one of Mommy's family names. Your name will be Eleanor Love Rawlinson. We will call you- Ella. This is a very special name because you will be named after two very special strong women in the McLaughlin family. This name origionally belonged to Mommy's Great Grandmother McLaughlin- Lenore Love McLaughlin. The origional Lenore Love McLaughlin was called Nora or Lenore. She didn't like being called Nora much. She was an orphan at Thornwell orphanage who met Great grandfather McLaughlin while he was a student at Presbyterian College. She was very close to a man that Dadaddy loved to read about named William Plumber Jacobs. We have several of his books which I will make sure are yours someday. Mr. Jacobs was a minister from the Clinton South Carolina area who preached some dynamic sermons and was the founder of Thornwell and Presbyterian College. I will make sure your Great Aunt Miriam Stribling(or as Mary Catherine calls her - Aunt Mimimm) tells you all about her and writes it down so you will know all about her and what a wonderful woman she was. The second Lenore Love is very special lady that you will know and love as much as your Mommy does. Her name is Lenore Love Stribling Whitehurst. Our family calls her "Love" but everyone else calls her "Lenore". I don't know which she prefers. You will have to ask her that question someday. She lives in Virginia and is a French teacher. Dadaddy Mac often called her his "favorite cousin". She is so beautiful and smart. I just can't wait for you to meet and love her as much as we do. So to give you family name but make it a little different we changed the Lenore to Eleanor. If you choose when you get older you can use Eleanor instead of Ella. It will be your decision as you grow up. Just know your name is special and definately "means something"!

Mommy thinks you are a boy. If it is a boy we took the middle names from both of your granddads and your name will be Rowland Davis Rawlinson and we will call you Davis. When you get older you can decide if you prefer Rowland or Davis. Mommy's daddy was named Samuel Rowland McLaughlin, Sr. He was called Rowland. This was Mommie's Grandmother Thelma's maiden name. The Rowland family was from Vicksburg, Mississippi. Many of them still live in that area. I can't wait for you to meet them. The Rowland's are good hard working people who believe in God and family. Dadaddy Mac was a special man. He was a God loving man who loved family. He loved history and geneology. He was a graduate of Presbyterian College where his specialty was history and math. By profession, he was a real estate developer. He was a very successful businessman. He also liked to think of himself as a farmer. Just between you and me, he was much better at real estate than farming. His farming experience consisted of sitting in his truck and instructing those who were doing the actual farming. Many people called him excentric, I prefer to think of him as a visionary. He could take an idea and make it happen. He knew how to get it done. He was a fighter who never gave up on anything or anyone. He was a very driven hard worker. He expected alot from his family and those around him. One quote that was his motto in life was "the true measure of a man is that which he can do for those who can do absolutely nothing for him." If you adopt this quote to your life, you will go far. The name Davis is from your Dad's side of the family. For as many generations as I know about, the oldest male's middle name has been Davis. So, besides liking the name, we didn't have much choice here. Honestly, I don't know the whole story about how the name "Davis" got started but,I hope your Dad and PopPop will post on your blog and tell you the story of your name. Maybe they will even tell you about the other people who have had this name.

Well, there were other names that were considered for you but no matter what your personality I think these names will be appropriate for you. Your name will definately "mean something". Ella or Davis, whichever you are, be proud of your name and make those you are named after proud.

5 Weeks and 1 Day- EMOTIONS AT THE SURFACE

This pregnancy has been wonderful so far. The only complaint is the very VIVID nightmares. They are strange...they go from me fighting in the revolutionary war to friends of mine having affairs to things I will never tell anyone. These dreams come one right after another. After most of the dreams, I am so disturbed that I am unable to go back to sleep. These are very weird dreams. I just wish they would stop so I could sleep! I have been getting up every morning since Friday at 6:30am. Okay, I like my sleep so this schedule has to change...I need sleep really bad.

Today, Mary Catherine brought a book into the den and wanted to know where it came from. It was called "I'll Love You Forever." It was a book given to us by the Boozer family at Mary Catherine's baby shower. As I read the note Marsha wrote in the front of the book, I started crying- that was just the beginning. I have always thought to this point that the book was a bit mature for Mary Catherine but, for some crazy reason today, I decided she was old enough to understand it. If you have never read this before, I do not recommend reading it while you are pregnant. As I began to read the book to Mary Catherine, I knew immediately I was pregnant...I was sobbing by the middle of the first page. I cried through most of the book. By the end, I was sobbing hysterically. Poor Mary Catherine was so confused, she couldn't understand why I was crying. Then the crying got mixed with hysterial laughter at myself for crying. Kevin was trying to help me finish the story. Oh my...this is going to be a long 8 months!

Besides the emotions and nightmares, I actually feel pretty good. I have slight nausea but, I just keep eating and it goes away. I am prob going to be as big as a barn when this is over but so far so good.

SURPRISE!!!!

Life's little surprises are so much fun! This surprise involves one of the most wonderful things in life. Today, Kevin and I found out we are expecting a baby on November 25th, 2006. We had planned to have another child maybe next year but God had other plans for us. He decided it was time NOW! This is definately an example that we live on Gods schedule not our own. We firmly believe God knows what is best for us, our family and our life. We are so blessed by his grace.

How did we find out? Well, it began last night when I knew I wasn't feeling very well. I had a "really bad stomach virus" last Monday-Wednesay and I honestly couldn't believe I was still having such a hard time getting over it. I had decided that I must be about to start my monthly cycle. I got the calendar down and counted...28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38....something wasn't right. Let me try that again....29, 30, 31... Okay, I best call Kevin..."Honey, how about stop by Walgreens and pick up a home pregnancy test." His response..."DO WHAT?" I told him it was just a precaution and to just get it. When he gets home, we read the directions and it says wait until morning. So, we head off to bed and don't think much about it. When I wake up at 5:30 am the next morning, I decide I am going to take the test just to prove myself wrong. I take the test and it takes all of 30 seconds...PREGNANT! I go in kiss Kev on the forehead and say "you are going to be a Daddy again!" His response "DO WHAT?" We are definately awake at this point! I think we were both in a state of SHOCK! Okay I think, I will just take another test...I go in to take the 2nd test and the machine breaks. It now reads--->ERROR! Okay I think, whewwwwww it is a faulty test! Calm and cool Kevin says "Don't you need to go schedule your first baseline mammogram? Why don't you just run in the doctors office and let them test you to just verify it was a faulty test." I think that is a "GREAT idea". When I get to the doctor's office at 8:30am, there sits AUNT SISSY (Celia) waiting for her weekly check. Celia is expecting on April 13th. She is having a boy and his name will be Wills. She knows immediately why I am there...She is grinning. I explain my situation at the front desk and also tell them I need to schedule my first mamogram. The nurse explains that they need to run the pregnancy test first. I agree and sit down and wait with Celia. When they call her back she ask me to go back with her since Brian wasn't able to be there. I was excited. While we are waiting on the doctor in the back holding area, the nurse sends me on back to take the test. As Celia gets called into the room, the nurse catches my arm and says,"before you go in with her, I am going to need to talk with you." I sit back down wondering what is going on. She takes me to the nurses station and tells me that I will not be able to do my baseline Mammogram until December. I say, "Goodness, they must be really busy around there!" She says, "Well, no, they aren't that busy but you are going to be busy until November 25th." It took a minute and I must have had a look of shock on my face because she said "YOU ARE PREGNANT!" Honestly, she kept talking but, I don't remember anything else she said after that. I AM PREGNANT! OH MY GOODNESS-->I AM HAVING A BABY! I went into the room with Celia and I do not remember anything that happened in there. I think the doctor did the thing where she checked Wills heart beat- WHO KNOWS!! I did try to call Kevin and he was in a meeting. I left a message with his secretary that just said "11-25-06!" The rest of the day is pretty much a blur! I know they sent me over to the hospital for some blood testing. Kevin did finally call back, "he was excited!" We told everyone...POP POP, GAGA, Aunt Sissy, Aunt Pam, Mrs. Marsha Boozer, Miss Chrystie Crowley (Mom's secretary), Jen Jen, and finally Mary Catherine. I went straight to her school at 11:30 to pick her up. When I got her in the car I said "Guess what God has sent us? A BABY!" She immediately wanted to know where it was? I explained it was in my tummy! Of course, she asked "How did it get in there?" Our response for now is..."God put it there!" She immediately began to kiss my belly, sing and talk to you! She is going to be such a wonderful BIG sister and can't wait for you to get here!

We are so excited about you and your pending arrival. Daddy and I already love you so much. You are definatly the best surprise I have ever received! I think you are a boy!