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Pregnant and need to vent...
      #350552 - 10/03/09 12:24 PM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

Hello there the few of you who are "oldies" here and remember me. Finally after all my health issues over the past few years we felt the time was right to get pregnant. And pregnant we got straight away and I am thankful for that. I am not so thankful however that the nausea hit me straight away. I am only in the very beginning of week 5 and today I have felt sick all day apart from 4-6 hours in the middle of the day. I have thrown up once in the am and several times in a row in the late afternoon. In the am the nausea went away after I threw up but not in the afternoon.

As you may remember I have anxiety issues from all the stuff I've been through. After I had the colostomy surgery last fall and got a chronic gastritis and felt sick a lot the anxiety got worse and in the spring and late summer I've had panic attacks. The attacks aren't the worst part though. They settle down quickly. It's the increased level of tension and nervousness that lingers afterwards that's the worst part. First I was on a drug called Atarax but it's not ok during pregnancy and when getting off it gave me panic attacks I switched to Lergigan (prometazine) which is also used for morning sickness. And yet I threw up.

I really hope this is just temporary. I want to be happy now that I am pregnant and not worry and feel sick.

Another thing that I'm sad about is that my choir will be on national tv. We're supposed to record 4 tv services on Oct 17-18. Now I don't know if I'll be able to participate. I've read that the pregnancy hormones will hit you more in week 7-8 or so. I sure hope they don't when I've felt this sick today as early as maybe day 29 or something like that.

Please those of you who are religious, pray for me! And for those of you who aren't just keep your fingers crossed this will get better fast so I can enjoy the pregnancy.

I don't want to sound like I'm not grateful - I know so many people struggle to get pregnant and for us it worked on the first try (of course it's still early and you shouldn't count your chickens, but I don't want to go through this for nothing) - but it's hard to be really HAPPY when you feel miserably sick. I will start cognitive behavioral therapy a week from now and I hope I'll feel a bit better then so I can go see the therapist and go to pregnancy controls and things I like doing without being afraid. We don't have a car so I'll have to take the bus or a cab. Pushing very hard to try to see a silver lining I guess I can say that I will be forced to do some serious work on my nausea phobia! :P

Thanks for your support.

Hugs to all of you from me!

P S In case you're curious I can tell you that my colostomy works perfectly and since the stubborn post operative nausea cleared I've been able to eat pretty much everything apart from spicy hot food and really sour things - like larger amounts of balsamic vinegar et.c. So for me (remember I had (yes I don't consider myself to really suffer from IBS anymore although my upper GI tract is sensitive) IBS-D and nerve damages in the pelvic floor so I couldn't hold the BM back) the colostomy was really the right thing to do. I've been able to enjoy life so much, joined a choir for example. And I attended a yoga class before I got pregnant - we'll see if I'll feel well enough to go to any more classes.

Edited by Ulrika (10/03/09 12:29 PM)

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Urika ... there is some good news there!! new
      #350573 - 10/04/09 07:20 AM
Double J

Reged: 03/09/06
Posts: 900
Loc: High Rocky Mountains ibs-d

Congratulations!!

Good to see you posting, and you will be in our prayers. Stay well, and we hope you have the chance to sing with all your heart.

--------------------
Courage doesn’t always roar. Sometimes courage is the quiet voice at the end of the day saying, “I will try again tomorrow”. Mary Anne Radmacher

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Re: Urika ... there is some good news there!! new
      #350580 - 10/04/09 02:09 PM
glasgowgirl

Reged: 09/01/08
Posts: 413
Loc: Vancouver, Canada

Congratulations that's so wonderful about the baby and the choir.

Far as the televised choir thing goes I would say plan on being there but don't beat yourself up if you can't be.

--------------------
Stable IBS D

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Re: Urika ... there is some good news there!! new
      #350582 - 10/04/09 02:19 PM
glasgowgirl

Reged: 09/01/08
Posts: 413
Loc: Vancouver, Canada

Incidentally I don't believe there's any rule saying you have to be ecstatically happy while pregnant. Pregnancy can be rough and tough to cope with. There's is no shame or lack of gratitude in admitting that.



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Re: Urika ... there is some good news there!! new
      #350588 - 10/04/09 05:55 PM
hawkeye

Reged: 06/16/03
Posts: 705
Loc: NYC

Hi Ulrika,

Don't know if you remember my old posts, but I certainly understand the panic and anxiety. I've been helped enormously by therapy which for me was a combination of CBT and Gestalt therapy. It was not a 100% cure, but a huge difference in my life. I was able to get off of anxiety drugs and stop feeling as though the anxiety and panic could control my life. I haven't had a panic attack for over 1 year now. I was having one big one a month and almost daily lesser ones.

Even with all the difficulties, I'm so happy to hear you're pregnant! My wife really struggled with nausea and throwing up during pregnancy. I like what Glassgow girl told you - you're allowed to not be glowingly happy at all times in your pregnancy - its incredibly difficult! There are tons of websites with different advice on the "morning" sickness, from ginger lollypops, to the wrist bands that press into your acupressure points and more too I'm sure in the few years since my wife was pregnant. They're all probably worth a try. I hope you feel better very very soon!!!

--------------------
Ladies & gentlemen take my advice, pull down your pants and slide on the ice.

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Re: Pregnant and need to vent... new
      #350721 - 10/10/09 03:15 PM
Lisa Marie

Reged: 07/17/06
Posts: 1566
Loc: Lakewood, CO

Congratulations!!! that is such wonderful news!!!

Yup, I had the morning sickness all day for about 2 months. I know exactly how you feel, and it sucked. But by the second trimester (the "Honeymoon trimester"), you'll have forgotten all about it, trust me!

Have you tried acupuncture? It actually helped considerably with my nausea, and who knows, maybe it will help with your anxiety issues as well?

Congrats, and I hope you feel better soon! This is such an amazing, wonderful, exciting time in your life! You WILL be able to enjoy it, don't worry! Those first few months are definitely the hardest.

--------------------
~~~~~~~~~~~~~~~~~~~~~~~~
Lisa, IBS-C (Vegan)
Stable since July 2007!
Mommy to Rhiannon Marie (Dec. 13, 2008)

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Re: Pregnant and need to vent... new
      #350729 - 10/11/09 11:08 AM
Nelly

Reged: 08/06/04
Posts: 4381
Loc: Within stray mortar fire of DC

That's great news for you, Ulrika! And please vent all you want! You know we're here for you!

Life with an ostomy is very means constant vigilance, but you are an incredibly smart, dedicated, clever girl, so it strikes me that your life will not be slowed one bit! My friend Andy in a wheelchair from a motorcycle accident forever ago, however, just got his and doesn't take care of it at all. That thing is a, 8-cornered dirty, translucent plastic bag. Just awful. Nothing like yours, which looked to me more like a fashion accessory! Very hip! (OK, slight pun intended!)

Is this the first grandchild for the grandparents? My mother's given up on me (finally!) and my brother helped a lot by getting married and having one of his own. Yea for me! Plus, I get to be Eccentric Aunt, with the random $20 handouts and age-inappropriate gifts, Tee heee. Hey, that kid's growing my spare parts. I'm getting on his good side early!

I like the new hair in your profile pic! Very pretty, and it suits you nicely!

~nelly~

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Re: Pregnant and need to vent... new
      #350740 - 10/12/09 07:39 AM
ajtheartist

Reged: 08/02/07
Posts: 6
Loc: Lincoln, UK

First of all congratulations Ulrika. It sounds like you've come through a lot, had a wish come true and now you've got mixed feelings because of the nausea - it's perfectly understandable. The sick feelings do wear off, I had them for about 5 weeks. Keeping a steady blood sugar can help alot if you can manage it. Your body will nourish baby no matter what (I dropped a bit of weight when I had attacks but it all came back and scans show baby is growing beautifully). You can definitely believe your body will handle this pregnancy like any girl without IBS, hang in there, you can get through it!

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Update new
      #350781 - 10/14/09 04:12 AM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

Thanks for all your comments. Actually it turned out I probably just had a stomach bug. Haven't had one before since 2000 I think so the timing was certainly interesting, but then again the immune system does change a bit when you're pregnant. Anyway I started feeling a lot better after about 24 hours and after that I have been ok up until the day before yesterday. I suppose it's the "real" morning sickness that is starting to appear now. I tend to feel sick early in the morning and late at night and at the end of meals, so I need to make sure I eat more often and smaller quantities each time. I wear acupressure wristbands whenever I remember. I am now almost 6 weeks pregnant.

It looks like I will be able to participate in the tv recording with the choir this weekend which is great! (Though quite exhausting. I am pretty tired anyway, and with pregnancy I don't have more energy. :P Yesterday we had rehearsal from 6.30 p.m. - 9.50 p.m. and the recording on Saturday will be 10.30 a.m. - 8 p.m.)


I don't remember if I told you that I got married June 13th this year. I haven't posted any wedding pics here but those of you who "know me" from this forum and are on facebook can just add me and look at some wedding pics there.

Nelly: Thanks for the compliment but the picture is actually pretty old and I just have pigtails on it. We'll see if I'll get around to changing pictures to a more recent one perhaps from my wedding.

/Ulrika

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Update at 29 weeks new
      #356958 - 03/24/10 10:52 AM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

So I have today entered my 30th week of pregnancy. Things are going ok. I have the usual pregnancy issues such as pelvic pain and joint pain and swelling in general. Plus some special stuff for me, like my ostomy prolapsing due to the increased abdominal pressure and some issues with catheterisation due to swelling, changes in bladder function and anatomical changes caused by the growing uterus. Sometimes it gets a bit too much and sometimes I worry about what will happen with these issues during the remaining part of pregnancy, but for the most part I'm just happy. I will have a planned c-section late May or early June. You can find some belly pics from 28 weeks here.

/Ulrika

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Question for you about prolapse and pregnancy... new
      #356996 - 03/25/10 08:32 PM
Lisa Marie

Reged: 07/17/06
Posts: 1566
Loc: Lakewood, CO

First of all, you look amazing!!! And you are in the home stretch!!!

I haven't posted about this yet, but you are the perfect person to talk to about this, so I think it's time. I found out a few months ago that my pregnancy and delivery 15 months ago caused an unusually severe uterine and vaginal prolapse. Unusual considering my young age, and only having one (small!) baby. I realize your prolapse issues were slightly different, but I am curious how you are handling pregnancy with that. My discomfort is daily, it's absolutely horrible to feel like you're constantly "falling out", but I'm sure you're familiar with that. It's definitely starting to limit my activities somewhat, and causing some bladder issues as well. I've been told I can't really have surgery until I'm done having babies (I'd like to have a second). How was your surgery? Did they just sort of re-suspend what was prolapsing? I've been told this doesn't work as well with uterine prolapse, and that the problem usually returns 5-10 years after surgery. The only other option is hysterectomy, which isn't terribly appealing, and can cause other organs to prolapse later on. There doesn't seem to be an easy solution. Lately the discomfort is making me reconsider a hysterectomy - after baby #2 of course.

That said, I'm really nervous about getting pregnant again. My OB is fine with it, and even said I can probably have another vaginal delivery, but well, I already feel 9 months pregnant some days and there's no baby in there yet!!! So I guess I'm just curious how you're feeling and dealing with all that with your pregnancy. I don't know anyone else who's had this issue at this point in their life, so that makes it harder for me.

Anyway, just thought you might have some advice for me. Take care of yourself, and good luck with everything!

--------------------
~~~~~~~~~~~~~~~~~~~~~~~~
Lisa, IBS-C (Vegan)
Stable since July 2007!
Mommy to Rhiannon Marie (Dec. 13, 2008)

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Re: Question for you about prolapse and pregnancy... new
      #357179 - 03/31/10 09:30 AM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

I understand that you feel a bit frustrated with your issues. Any discomfort in the pelvic area is very distracting and annoying I think.

My problems are very different from yours so I am not sure how much help I can offer, but I can sure offer support. The part that is prolapsing for me is the ostomy itself, i.e. the part of the bowel that is now attached to my abdomen. When it happens the bowel sort of slips out through the ostomy making it longer. It's normally about 1 inch long max, but when it prolapses I think it can get about 4 inches. It feels very uncomfortable and as it swells it gets heavy and sort of pulls. I try to be as careful as I can to prevent that it gets worse. Most of the time I keep it inside the abdomen by wearing something tight over though this sometimes causes problems with the filter in the ostomy bag, making the bag fill with air which makes the ostomy prolapse anyway. I've had a couple of middle-of-the-night bag changes with very much frustration from that I can tell you. :P

They have told me that if the ostomy keeps doing this after pregnancy they will just shorten it, i.e. loosen the ostomy from the abdomen, cutting it a bit shorter and reattaching it.

But all this is very different from you problems. I understand about your discomfort though. I have nerve pain in the urogenital area which can cause issues sometimes with my bladder emptying since I do intermittent self catheterization. Plus this area is very swollen from the hormones which has caused issues with irritation in the urogenital area and urethra sometimes even with some bleeding during catheterization. My bladder is also a bit irritated from time to time when the baby moves around.

The most annoying problem I have though is with the disconnected rectum. They didn't remove that when they did the ostomy surgery because it can cause issues in the pelvic region such as the bladder and uterus falling backwards a bit and doing surgery in that area can also compromise fertility. The rectum produces mucus that must be emptied now and then, but normally this isn't much of an issue to me since it's usually enough to go the "regular way" about once every 1-3 weeks. But now during pregnancy it's more active and sometimes I've had to go every day, sometimes 2-3 times a day and sometimes I can try but nothing comes out only to have to rush a few minutes later. So a bit like IBS-D but miniature style. :P Very annoying though as I want to keep clean since I do the catheterization. Should this be an issue when I'm done having kids I might consider having the rectum removed but as in your case I would have to look at possible side effects too such as bladder issues. If it goes back to just emptying once every 1-3 weeks I will not hesitate to go through another pregnancy as I know the issues are temporary.

I understand you feel a bit unsure about another pregnancy. I can tell you this though. I had thought about things that might become an issue, and most of those things haven't happened. The stuff that has happened though I hadn't planned on, such as the rectal issues and the ostomy prolapse. So you never know. I suggest you talk it through with your OB/GYN and ask a bit about how your symptoms/problems might be affected by pregnancy. I know OB/GYNs can sometimes be a bit "oh you get a child for your pain so get over it" but hopefully you have one that can help you and be empathetic about it. I'm sure they can't exactly predict how you would experience pregnancy with these issues, but they should have some ideas of what may or may not happen.

I also think that our memory is pretty bad when it comes to remembering what pregnancy was like afterwards. So it may be that you hesitate now, because you don't know what it would be like, but then after having your second child - i.e. when you're out on the other side so to speak - you might think it was nothing, even if you felt frustrated at times during pregnancy.

After all my years with health issues I got problems with GAD and panic attacks and I was quite concerned before getting pregnant how everything would work out and I thought I'd be a super neurotic mother to be. But I have been a lot calmer than I thought. Lately I've had some issues with panic sensations though that I think are related to the issues I've had (like when every problem acts up at the same time and it just gets too much) plus the fact that there is a lot to organize before the baby comes and it's getting quite close now. Also I will have a planned c-section and have become a bit more scared of surgery after the ostomy surgery and I'm not looking forward to the spinal anesthesia since I've had a paralysis before. But I guess all of these things are normal to worry about. I'm fairly confident I will think it was all worth it afterwards. :P

I also think it's good if you can have an accepting attitude. I'm practising that in cognitive behavioral therapy. Sure I get upset and frustrated sometimes and it sure helps to cry when it gets too much, but most of the time the best thing you can do is to just take a deep breath and say "ok this is how things are right now - now how do I want to live my life?" Just sort of realize that letting things stop you from doing what you want doesn't make your life better, just more boring. This isn't easy to do all the time of course. But as an example I can mention that I performed a solo in the Christmas musical at my church despite not singing solo for hmmm about 15 years or so and despite having a cold and the rectal issues with hard-to-predict toilet visits. I did it and it really helped me both with anxiety and with coping with my physical issues.

Oh boy, long reply. I hope you'll find some of it helpful though. You're welcome to come back to me if there is anything else you would like to know or discuss. You can also email me. My email is in my profile info.

/Ulrika




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Update: date set for planned c-section: May 31st :) -nt- new
      #357180 - 03/31/10 09:37 AM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden



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Re: Question for you about prolapse and pregnancy... new
      #357183 - 03/31/10 01:21 PM
Gerikat

Reged: 06/21/09
Posts: 1285


I just had to respond to your post. I don't know you, and I don't believe we have ever chatted, but you are amazing. Your attitude is beyond unbelievable, after what you have been through. It really makes me appreciate the little inconvenience I have with IBS, compared to what you deal with daily. I think there are a few who you could help on the Eating board, with your attitude. God Bless you and I wish you all the happiness in the world with your new little one.

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Thank you Gerikat. :) -nt- new
      #357190 - 03/31/10 03:13 PM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden



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Re: Question for you about prolapse and pregnancy... new
      #357195 - 03/31/10 08:35 PM
Lisa Marie

Reged: 07/17/06
Posts: 1566
Loc: Lakewood, CO

Wow. Thank you SO much for taking the time to make such a thoughtful response! I've felt so isolated because I've had no other women my age to talk to that have gone through anything remotely like this, so it means a lot to me. You captured a lot of my thoughts and fears perfectly. While yes, our prolapses are quite different, it's at least comforting to know other women have done it (women's bodies are amazing things, aren't they??). My OB has been fairly sympathetic; she said she's actually had a similar prolapse for 20 years, but it doesn't bother her enough to have surgery for it. And she has definitely given me the "we do it because we want that baby" line. Yes, it's true, but that doesn't make it easier. I do agree with you that we forget the really awful parts of pregnancy after it's all over with. If we didn't, we wouldn't do it over and over again, would we?

What you said at the end really hit me: the part about accepting that this is the hand I've been dealt and I can't let it keep me from doing what I want in life. This is so true. I know damn well I'm going to have that second baby, I think it's just a matter of making sure I'm totally informed about all the risks and options before going into it.

That said, I'm going to see a urogynecologist (surgeon) in May. He's THE expert where I live, so I'm anxious to hear what he has to say. The post-baby surgical options don't sound terribly fantastic, and they all have their various risks, and I want to talk to him about the best way to go forward. I've also decided to get fitted for a pessary, which is a firm plastic "device" that's used to hold up the cervix and uterus. My OB originally had me try a diaphragm (they're more flexible and comfortable, she thought), but I was constantly having to push it and my prolapse back up every time I went to the bathroom. So that became too much of a pain. I hope the pessary will help, especially during my next pregnancy.

You're an amazing woman, Ulrika, and I'm just so happy for you that you've made it to this point!!!! You give me hope and confidence that I, too, can make it through a pregnancy with all this going on. I still can't believe all that you have to go through.

I hope you enjoy these last two months of your pregnancy!! it's such an amazing time. I'll let you know how my appointment goes next month, and keep me posted on how things progress for you.


--------------------
~~~~~~~~~~~~~~~~~~~~~~~~
Lisa, IBS-C (Vegan)
Stable since July 2007!
Mommy to Rhiannon Marie (Dec. 13, 2008)

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Congrats and Good Luck! -nt- new
      #357350 - 04/04/10 12:33 PM
Stephie

Reged: 03/10/04
Posts: 2696
Loc: Vancouver, Canada



--------------------
~~I'm not crazy, I'm just a little unwell-I know right now you can't tell~~Matchbox 20
IBS-D,pain.

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Re: Question for you about prolapse and pregnancy... new
      #357378 - 04/05/10 06:10 AM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

I'm so glad I could be of some help to you. Good luck with the appointment with the specialist. Those things can be quite nerve wrecking as you never know what they'll say but I hope things will go well and that you'll get good advice that you feel is right for you. I'll keep you posted on how things are going here.

/Ulrika

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Update: c-section moved to June 2nd. Getting pretty fed up with pregnancy issues now... new
      #358855 - 05/23/10 10:49 AM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

Quick update. My c-section was moved to June 2nd from May 31st. Not much of a difference but I would rather have had it moved closer in time since I am having pretty tiresome problems with my body now. I have bad back and pelvic joint pain making it hard to walk, my ostomy is prolapsing worse than ever due to the pressure of the belly and my disconnected rectum is also irritated from the pressure and the contractions making me visit the bathroom a lot more than I would like. I really hope this will all go back to normal once the baby is out and the pressure decreases. I have some anxiety issues and the increased problems the last few weeks have made me more worried about what would happen if these issues don't go away after the baby is born. I want to feel good and have energy to focus on the baby and be happy.

Tomorrow I will see my midwife and it will be nice to talk everything through with her.

/Ulrika

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Re: Update: c-section moved to June 2nd. Getting pretty fed up with pregnancy issues now... new
      #358861 - 05/24/10 08:30 AM
emmasmom

Reged: 09/22/06
Posts: 1710
Loc: ILL

good luck when you see that baby its all worth it! Don't worry it will all work out just relax and enjoy the rest of your pregancy before you know it you'll be a mom! Good luck!
emmasmom
ibs-c gas

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UPDATE: Our baby is here!!! :) <3 new
      #358986 - 05/31/10 10:49 PM
Ulrika

Reged: 08/20/06
Posts: 581
Loc: Uppsala, Sweden

Just wanted to tell you that our baby boy has now arrived. He wanted to get out of there a little earlier than planned which was just fine by me. My water broke on Tuesday May 25th and I was observed over night and the c-section was performed the next morning. Everything went really well. I was in quite a lot of pain afterwards and the traditional hormonal ups-and-downs but I feel a lot better now. Still some issues with the body but it's a lot better.

For those of you who know me on facebook you can find some pics there.

/Ulrika

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Re: UPDATE: Our baby is here!!! :) <3 new
      #358987 - 06/01/10 03:24 AM
Flipada

Reged: 03/02/06
Posts: 1026
Loc: West Michigan, USA

Congratulations, Ulrika! He will be your greatest love. Hugs to you.

--------------------
Flipada - IBS-C "It's a gas, gas, gas"
**Lauren**

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Re: Pregnant and need to vent... new
      #359003 - 06/01/10 01:09 PM
Nelly

Reged: 08/06/04
Posts: 4381
Loc: Within stray mortar fire of DC

Congratulations!!

~nelly~

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Re: UPDATE: Our baby is here!!! :) <3 new
      #359005 - 06/01/10 06:00 PM
Gerikat

Reged: 06/21/09
Posts: 1285


I am so happy for you and your family. You have been through so much, from reading your posts, and you really deserve that bundle of joy.

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Re: UPDATE: Our baby is here!!! :) <3 new
      #359007 - 06/01/10 06:20 PM
Toady

Reged: 04/06/06
Posts: 1299
Loc: A small city, Northwestern Ontario, Canada

Congratulations!!! I'll be checking out pics asap!!



--------------------
Cassandra

Live like there's no tomorrow. Love like you've never loved before.

IBS A 20+ years, Chronic Migraines, Chiari Malformation (decompressed June 22, 2010), Brachial Neuritis, and ??? the list just keeps growing, but I'm still shiny side up!

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Re: UPDATE: Our baby is here!!! :) <3 new
      #359018 - 06/02/10 05:57 AM
dragonfly

Reged: 05/12/08
Posts: 1088
Loc: canada

Congrats!Glad to hear things went well.Enjoy him.

--------------------
IBS-D since 1999...mostly stable..i do cheat too.Bad me.


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Re: UPDATE: Our baby is here!!! :) <3 new
      #359025 - 06/02/10 09:58 AM
glasgowgirl

Reged: 09/01/08
Posts: 413
Loc: Vancouver, Canada

Alright!! So happy for you and your new family.

--------------------
Stable IBS D

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Re: UPDATE: Our baby is here!!! :) <3 new
      #359040 - 06/02/10 08:10 PM
Lisa Marie

Reged: 07/17/06
Posts: 1566
Loc: Lakewood, CO

Congratulations!!! I am SO HAPPY for you!!! I'm not on Facebook (yeah, I know...), so I'd love to see a picture here! Good luck to you, I can't wait to hear how everything goes! And I hope everything goes back to normal for you quickly - it's amazing how childbirth just wreaks havoc on your body, isn't it???

--------------------
~~~~~~~~~~~~~~~~~~~~~~~~
Lisa, IBS-C (Vegan)
Stable since July 2007!
Mommy to Rhiannon Marie (Dec. 13, 2008)

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