An important lesson

Dear Emi,
I learned a very important lesson this week: never hesitate to tell your doctor everything, no matter how personal or seemingly trivial. Promise me you'll remember this, Emi, because you never know whether the smallest detail could save your life one day.

A little more than a month ago, just as I was starting my third trimester, I started to itch. All over. It wasn't what I would call severe, but it was annoying enough for me to look it up in What to Expect When You're Expecting - the handy, dandy pregnancy bible recommended to me by my general practitioner. Apparently, pregnancy can bring on all sorts of lovely skin conditions from splotchy discolorations to red, itchy, pimple-like bumps. But I didn't have a rash, or pimples - the only marks on my body were self-imposed scratches. Plus, the other skin problems were typically confined to the belly.

The only thing that seemed to apply was a rather serious liver problem called HELLP Syndrome, but itchiness was only one of the symptoms. I didn't display any of the others - vomiting, nausea and a general malaise. I did read, however, that pregnancy hormones can make your skin extremely dry, especially if you run a fan or air conditioner. So I slathered on more lotion and hoped it would go away.

But it didn't. I combed the Internet for information about itchiness and pregnancy, but couldn't find anything new. My regular appointment with Dr. Chan was coming up and I debated whether to mention the itchiness to him. The book said HELLP caused severe itching, and while the nightly scratching sessions were bothersome, it wasn't interfering in any of my normal activities. Besides, I felt fine except for the itching.

The next day at my appointment, when the nurse asked her routine, "Do you have any problems, pains or concerns?" I found myself telling her that I've been itchy all over. She took some notes, and Dr. Chan asked me about the itchiness a few minutes later while he was measuring my uterus. He examined me for telltale signs of the other pregnancy-related skin disorders, and finding nothing he ordered a blood test to check my liver function and rule out HELLP.

Otherwise, everything else was fine. My uterus was the right size and your heartbeat was strong and healthy. He wasn't worried and neither was I. By then I was far enough along in my pregnancy that he wanted to start seeing me every two weeks. Before my next appointment I stopped by a lab near my office to take the blood test.

Two weeks later, Dr. Chan told us the results showed I didn't have HELLP, but some other liver levels were slightly high. He asked whether the itching had gone away or gotten any worse, checking me for a rash or pimples. Then he asked if I was having any headaches or nausea, and if anyone in my family had any liver problems. But I was still feeling fine, and while my family had a history of heart disease, diabetes and uterine cancer, I couldn't think of anyone with liver issues. He ordered another blood test, saying he wanted to rule out hepatitis and check my gall bladder functions.

Luckily, I didn't have hepatitis, but my liver levels had gotten slightly worse. Dr. Chan told us that 5 percent of the population had levels like mine and had nothing wrong with them, but he wanted to do another test and possibly get a second opinion just to be sure I was okay. "It's something I found because we were looking for something else, but I need to follow through on it just to be cautious," he told us. "I'm not worried." He confirmed you were still moving around regularly and checked your heartbeat.

I have to say that by then I was sick of getting poked with a needle. I'd put off taking the second test until the Monday before my Thursday appointment, and knew I wouldn't be rushing off to the lab for the third time. But on Wednesday, I got a call from Dr. Chan's nurse asking if I'd taken the blood test, yet. She said Dr. Chan would like me to get it done as soon as possible, so I went in the next day after I'd fasted for the requisite eight hours.

His call triggered a panic. Once again I hit the Internet and searched for liver problems and pregnancy. The first hit was a March of Dimes reference to something called intrahepatic cholestasis of pregnancy, a disorder that leads to a build-up of bile acids in the blood, causing itchiness. I remembered seeing the words "bile acids" on my lab form, and I knew cholestasis was the culprit Dr. Chan was checking for. I tried not to dwell on the fact that cholestasis comes with a slightly increased risk of stillbirth.

Today, Dr. Chan called. It was my last day working in the suburban bureau I'd been assigned to since starting at the paper eight years ago. I'd packed up my belongings, said goodbye to the ladies in advertising and was about to start my car when my cell phone rang. "Your test results came in and your liver function hasn't improved - it's getting worse. You have something called cholestasis, so I'm going to prescribe some medication that will make you more comfortable and be better for the baby," he said. "We're also going to do fetal surveillance twice a week until you deliver."

Even though I'd been prepared for the diagnosis, the reality hit me hard. After two miscarriages, we'd manage to get you through the tricky first trimester, and except for a gestational diabetes scare in August, I'd sailed through the rest of my pregnancy without the slightest of problems. Now, as we were entering the final stretch I had to face the possibility of premature labor or worse - stillbirth. I sat in my old cubicle, crying over the phone as I relayed the news to your daddy.

I don't remember what he said. Maybe he pointed out that we were fortunate Dr. Chan caught the problem in time to do something about it. He probably said something about how you were a trooper and that he knew you were to be okay. Whatever it was calmed me enough to finally leave the office and pick up the prescription Dr. Chan phoned in.

During the drive home, I couldn't stop thinking about everything that had happened over the last month and I was profoundly grateful that I'd had the sense to mention the itchiness to Dr. Chan.