Allison learned she was pregnant in June of 2015. We announced to our families over the Fourth of July holiday and made it known that John was going to be an older brother. On July 7 we had our first appointment with her obstetrician to check on the pregnancy. I can still feel my reaction when the ultrasound technician zoomed out from the embryo she was examining to announce that there was another one as well. Allison and I about fell out of our chairs with the surprise - we were going to have twins.
Sam and Charlie were identical twins, formed by the splitting of one egg and expected to be born February 16, 2016. With all twin pregnancies, Sam and Charlie's gestation was high risk and Allison underwent a treatment plan to monitor this risk. Every two weeks she went to either her obstetrician or maternal fetal doctor.
Early on her medical team determined the twins shared a placenta, a condition called monochorionic twins you can read more about here. Monochorionic twins run many risks from sharing portions of their circulatory system. Allison's medical team put a plan in place to monitor her closely for any complications that may arise.
Between Allison's 18 and 20 week checkups, she began to feel a large amount of fluid in her womb and began to have discomfort. She communicated this with her doctors and they asked her to monitor it but mentioned it would be normal to have more discomfort with twins. With that thought in mind, on October 1-4 the two of us traveled to New York City for one last trip before we became a family of five.
On October 3, Allison began to feel extreme discomfort - we cancelled the plans we had for NYC that day and got on an earlier flight home the morning of October 4. On Monday, October 5 we went to Allison's regularly scheduled appointment with her maternal fetal doctor. Our lives forever changed that day.
Allison's doctor immediately noticed a large difference in the fluid levels between Charlie and Sam's amniotic sacs. Charlie's was more than five times as much fluid than Sam's. We immediately felt the gravity of the situation as Allison's doctor informed of us that the twins were suffering from twin-to-twin transfusion syndrome (TTTS). We were told that night we needed to be on a plane to Denver within 24 hours to meet with the surgeon and team who could provide the best option to treat the problem.
Twin-to-twin transfusion syndrome is a complex issue and you can read more about it here and here. In an overly simplified version, Sam and Charlie shared blood vessels and were fighting for the same nutrient supply from their mother's placenta. Charlie was winning the battle and was known as the recipient twin - he received far too much fluid and as a result deprived Sam of what he was needed. Sam was providing most of the nutrients to Charlie and was known as the donor twin.
Even though Charlie was getting all of the fluid, he was not out of the woods. In actuality, the recipient twins in TTTS pose greater risk for heart and renal failure than donors due to the need to process extreme amounts of fluid. Sam however was becoming a stuck twin - you can read more about this issue here. He was being robbed of nutrients and had no fluids to process, causing the amniotic sac to collapse on him and essentially "shrink wrap" his little body.
The evening of October 5, Allison and I flew to Denver to have Allison treated at the Colorado Fetal Care Center (CFCC) at Children's Hospital Colorado. There we were to meet with Dr. Timothy Crombleholme and his team - Dr. Crombleholme is considered to be the preeminent surgeon for TTTS corrections. We met with the CFCC team the morning of October 6 who confirmed the Dallas medical staff's diagnosis and set up a full gamut of tests to build a treatment plan. Allison underwent an amnioreduction on October 6 to help reduce the amount of fluid and stress on her uterus which was causing preterm labor contractions.
The tests ran by the CFCC team confirmed TTTS was occurring and immediate action was required. We were given four treatment options and our choice was clear:
- Do Nothing: expected survival rate of 0%
- Amnioreductions: expected survival rate of 49%
- Selective Reduction: expected survival rate of the remaining fetus of 78%
- Selective Fetoscopic Laser Photocoagulation: expected survival rate of both twins 85%, for at least one twin 94%
On Thursday, October 8 Allison underwent surgery for a selective fetoscopic laser photocoagulation. The doctors were able to selectively ablate half of the impacted placenta area and fully ablated the second half. Allison spent the night recovering and we then had to wait in Aurora, CO for five nights to ensure the surgery was a success.
Those five nights were some of the longest of our lives - no knowledge of whether the surgery was a success or what the impact on the twins was. We spent Wednesday, October 14 conducting the same tests taken earlier and learned the ablation was successful and that both boys had survived the procedure. The news was not all positive, the procedure had ruptured the twin membrane between the boys' amniotic sacs and the twins were now in the same sac. At the time, we did not understand the seriousness of this news - little did we know it would lead to a dramatic care change in the future. Secondly, we learned Sam was showing severe signs of hydrops fetalis and would likely perish over the next few weeks. We were crushed and left for Dallas that afternoon.
The next nine days were spent in-and-out of doctors offices and the hospitals as we navigated additional effects of the TTTS and previous procedures. We also learned more about the impacts of the twins sharing one amniotic sac - Sam and Charlie were now monoamniotic-monochorionic twins. This meant the boys were at risk of cord entanglement and Allison would need to be on hospital bedrest under continuous fetal heart rate monitoring for the remainder of the pregnancy. This was to ensure if there were any cord entanglement or other problems we would be aware and able to take action to deliver immediately. Allison reported to Baylor University Medical Center for monitoring on October 23.
Allison spent 4.5 weeks on monitoring in the hospital - battling every day to keep the boys as healthy as possible and to fight the unending monotony of bedrest. Testing of all kinds was conducted during this time as well: blood draws, ultrasounds, glucose tests, etc. - and worst of all she had to endure hospital food for over a month. Two things kept her sane and enabled her to fight: family and friends constantly visiting, calling, texting and sending packages of support; and the fact that the twins continued to fight as well. It was over those 4.5 weeks that Sam fought the odds of hydrops and showed signs of recovery while Charlie continued to show signs of improvement as well.
Our story would change again on November 23. At 27 weeks, 6 days Allison began to have more and more contractions. Even with attempted intervention by her medical team it was time for the boys to be delivered. All went well with the cesarian section and Sam and Charlie came to meet us.
Samuel Bryden Logan (Sam)
Born at 9:57pm on November 23
Weighing 2 lbs 2 oz and measuring 12.2 inches long
Charles James Logan (Charlie)
Born at 9:58pm on November 23
Weighing 2 lbs 11 oz and measuring 15 inches long
Sam and Charlie went to the NICU at Baylor and were both intubated to assist them with breathing. Allison went to recovery and as expected was stronger than ever in facing the pain and uncertainty that night. Not being able to immediately hold your two babies is one of the toughest things about premature babies - the reality begins to sink in quickly.
The next three weeks saw many steps forward and many steps backward - such is the life of a NICU parent. Charlie battled a patent ductus arteriosus (PDA) which was treated with medicine and is improving. Sam battled a pneumothorax which was treated with a chest tube to help vent the air. Both boys continued to feed on Allison's milk and put on weight. We spent as much time as possible in the NICU - sometimes splitting up and taking shifts during the day (Allison) and after work (Adam). Our family continued to be the biggest support system for us - ensuring we had nothing to worry about regarding the care of our toddler, John.
We continued to become accustomed to our new normal when we had a care planning meeting with the twins' medical team on December 15. To say our world was turned upside down would be an understatement - our hearts were ripped out and anything that was left was completely numb. Sam had some extensive tests ran on him over the four weeks he was alive, the culmination of which identified with absolute certainty that he would never be able to survive outside of a hospital environment. He was fully being supported by machine. There was only one option and our decision was clear - we would have to say goodbye to Sam and let him go.
We were surrounded by family as we spent four days celebrating Sam. On Saturday, December 19 we pampered and prepped him for his final performance. Sam went peacefully in the arms of his mother and I - we continued to remain with him until the very end. We had the utmost respect and care from the staff at Baylor during this time and could not be more thankful of them for removing as much friction from the process as possible. We have a separate post on this site celebrating Sam and can view our memories here.
We continue on this journey of Sam and Charlie with all hope that Charlie will continue to grow and progress. He is set to have his continuous positive airway pressure (CPAP) device removed in the next week and all signs are pointing toward positive.
Charlie will continue to be a fighter and will succeed while his brother Sam guides him from above.