Sunday, December 30, 2012

2 miles down, 22 lbs to go

I CANNOT TAKE IT ANY MORE.

I made it four, almost five, weeks without exercising, but waiting another two will drive me absolutely mad.  Between the beckoning my running shoes are incessantly doing, the taunting the scale does each morning and my mental stream of expletives each time I have to put on maternity pants rather than normal jeans I'm just about at the end of my post-bed rest couch potato rope.  So, to quote Rafiki, "it is time."

Godiva exercise fuel...
 quick carbs or extra calories?
After a much needed trip to the local Target to pick up running pants that fit (ug, how mortifying!), HB and I laced up our dusty sneakers, packed the kids into our new Bob Dullie (thank you CraigsList) and hit up one of our old running loops for a "test run."  Between his ACL reconstruction this past August and my involuntary pregnancy induced running hiatus, it's been months since either of us have put one foot after the other for more than a gimpy shuffle or waddle.  Clearly we weren't going for much in the way of distance or speed and, considering this was only day one, I must admit that our one goal was to prove to ourselves that neither of us are either too old, too out of shape or too broken to do it... which I am tickled pink (maybe it's just my asthma?) to report we accomplished! Granted tomorrow we might be a bit sore, but by jove, such mental exercise was well worth it. 

With my starting blood sugar reading at 177 mg/dL, we ran five minutes on one minute off for four sets around the local YMCA sports fields.  The high wind was an additional challenge and I over bundled myself for the weather something fierce, but we kept it mutually positive and pushed at an average ten minute mile pace (okay, HB pushed the pace and I tried to keep up... BUT I'LL FIX THAT!).  By the end of our second mile, my legs were exhausted, my blood sugar had dropped to 84 mg/dL and my body was soundly expressing it's disproval for my bra selection.  It's normal to have glucose ranges drop that far when exercising, but seeing that this was my first time running while breast feeding and diabetic I am thrilled to see that my sugars are acting like they did when I was running and simply diabetic.  Obviously I'll monitor it each time we go out, but hopefully the numbers I saw today will be a trend (and how about next time I nurse GV before we go, rather than after... ouch).  I'll keep you posted.

So with two weeks remaining before I'm officially cleared to exercise at my six week check up, I'm taking my life back and saying screw it.  HB and I both have about 22 pounds to lose before we get back down to our pre-pregnancy weight - and, for me at least, this is after losing 20 lbs in child birth! I definitely gained more this go around than with the first baby (only 26 lbs gained with GW), but hey, I was allowed to exercise in the first pregnancy and I didn't have to scarf simple sugar to keep myself going.  I don't think it'll be all that hard to drop the baby weight with the right amount of effort, the real challenge will be seeing how much time it takes to get back into competitive running... I'm thinking maybe going for a full marathon this year, so hopefully the pounds will shed right off and I can start training to step up into the big leagues of diabetic endurance athletes! I mean, really, half marathons are so last year... 

Sunday, December 23, 2012

What an idiot!

I've been having one of those days.  You know what I mean - when you not only wake up on the wrong side of the bed, but you fall out of it as well? It's not that I'm in a bad mood or anything, it is just that I'm just not entirely there...  putting the clean dishes away in the refrigerator and the milk in the pantry, shaving only one leg, writing the return address on both the "from" and "to" lines of a card and misspelling just about everything on the grocery list (let's just pretend I was writing in code).  All things considered, these aren't that significant of mistakes - especially when I have HB looking over my shoulder and laughingly correcting my blunders - but the one that is the real kicker, that really gets a burr under my self-loathing saddle and will have me lying in bed cursing myself for stupidity this evening is my forgetting to put the insulin vial back in the fridge.

Back in April 2011, I remember when I was being tested on my pump skills by a pair of Medtronic representatives (yes, they test you to make sure you wont kill yourself before they arm you with insulin) that one of them said to the other that "diabetics DO NOT like to waste insulin." For whatever reason, that statement got stuck in my head and I have been an insulin conservationist ever since... I might only have 0.50 units left in my pump reservoir, but I'll wait that extra 15 minutes for my basal injections to deplete that measly amount before I do an infusion change because - and I quote - "diabetics DO NOT like to waste insulin."

So after doing my infusion change this morning, I got distracted by something - I don't remember what exactly, but with two kids, two barky dogs and a Christmas cooking list about a mile long (I'm obsessed with holiday cooking) it's really not surprising - and I left the vial sitting on the counter.   While it's not that big of a deal to leave insulin out for twenty or thirty minutes, it's a completely different story to leave it sitting out for hours upon hours... it's not that insulin is like milk and curdles or straight up spoils, but the efficacy of artificial insulin goes down the longer it is exposed to inconsistent temperatures (I wonder if Goldilocks was a type 1 diabetic?).   Granted there is no way to know one way or another if that insulin had really "gone bad," but seeing as this vial was probably 3/4 full and that is about another month of insulin for me, I can't risk injecting myself with sub-standard insulin for fear of knock on side effects (hyperglycemia).  Into the trash it went.

Boo.

Which reminds me... I did a similar bone headed move while at the hospital.  The night that HB and I went to INOVA Fairfax to begin the induction process, I packed an extra vial of insulin just in case I needed to do an infusion change while there.  I put the vial in an insulated lunch bag with a couple freezer packs to keep it cool and we rolled out.   Several hours after I was checked in and we were anxiously awaiting the labor process to begin, I remembered my vial and asked HB to pull it out and get it into the refrigerator behind the nurse's station desk.  Retreiving the lunch bag from my purse, HB pulled out a completely frozen vial of insulin... I mean rock solid, white as snow, nothing resembling usable frozen.  What was worse was that this vial was brand spankin' new - the cap hadn't even been removed yet!

Agh!

So I don't know what it is that has me so distracted - maybe mommy brain? Simple exhaustion? Holiday exacerbated drama? - but whatever it is it has crossed a line!  Messing with my ability to complete simple tasks is one thing, but screwing with my insulin is below the belt! As mortifying as it'd be, I'd rather make inedible cookies for Santa (gasp!) than waste as much insulin as I've absentmindedly  squandered in the past month.  Somehow I think dear old Mr. Claus would be far more sympathetic than our insurance company will be...

Wednesday, December 19, 2012

Learning to Juggle



Finding time to write with two little ones certainly is harder than I initially anticipated.  I remember what it was like right after I had GW - in between nursing sessions I'd work on whatever I wanted while he was napping.  But now, while GV is napping I'm tending to GW and while he is napping I'm quite often tending to GV or whatever other to do list item that is pressing.  Don't misconstrue what I mean, I am certainly not complaining, but I am quite baffled at what happened to my clocks while I was at the hospital... I think my Mom and GW must have reprogrammed them because there is absolutely no way that 24 hours pass as quickly or as unnoticed as they do now.

No? Wishful thinking.

For months now, HB and I have been told that the most difficulty parents of multiple children will have is in the transition from one to two kids.  I'd rationally thought it through while pregnant and come to the basic conclusion that, yes, that makes sense. But now that I am physically trying to juggle two kids - one with a newborn fragile neck and the other with 38 lbs of momentum - I must admit that I while I anticipated there'd be difficulty, I didn't comprehend what shape or degree that difficulty would be.

Things between GW and GV are phenomenal.  He's taken to her like he's been waiting for her arrival his whole life.  He constantly asks to hug or kiss her and he always does so with the most gentle actions you previously thought were impossible from an otherwise over-enthusiastic three year old.  When she cries he'll drop whatever he is doing and rush to her side to ask "what's wrong?" or to say "it's okay, honey" and if his arrival doesn't sooth her he'll immediately attempt to corral me or HB by yelling "hurry, GV needs you!"  He even - get this - likes to help with diapers... 

Obviously at three weeks GV is still a bit too young to express sentiment beyond quiet contentment or outright audible frustration, but she doesn't mind his near by antics (she sleeps through everything) and quite often seeks GW out with her eyes if he is within her line of sight.  In fact, I believe she might even prefer GW's singing to mine given her faster response to his oh-so-cute version of "Goodnight My Someone"... I think they'll be just fine together. 


Me on the other hand, thank God I know this is supposed to be hard.  In those moments where one's tantrum is topped off by the other's wailing it's all I can do to figure out who is on first... then you throw in low blood sugar, the oven timer going off and the dogs growling because something is bothering their baby (our Cane Corsos have decided that GV is most definitely their baby) and you've got a recipe for instant tears.  And there I thought I was just making Christmas cookies...

In a lot of ways my life right now reminds me of middle school - and not because of the weird things hormones do to one's complexion.  In seventh grade I tried out for my school's basketball team and after five days of busting my tail to get that dang ball into that hoop I was cut.  Mortified and heart broken, I went home and cried and cried and cried about it because I was sure that I blew "my shot" in more ways than just putting points on the score board.  But, instead of crumpling under such pre-teen humiliation, I kept practicing my dribbling and I went over to my neighbor's driveway to work on my shooting every day until eighth grade try outs... and some how that second go around I made the team.  

Now while it may seem like there is nothing that corresponds between this outwardly random story and my current reality, there is one similarity that I boil it down to:  practice makes perfect -- okay, perhaps not perfect, but at least markedly better.  Back then I needed that extra year to improve my ball handling, and now I cannot expect to be perfect day one (heck, month one) and I need to take each day to practice my zone defense... I may be on the junior varsity team of multi-child moms for the foreseeable future but one day all the struggling I'm doing now will pay off.  I'm not sure when that day will be or what  I can do to make the grade sooner rather than later, but hey, at least there is the comforting thought that when we eventually have more kids, I'll have figured out the juggling routine with these two to the point that adding a few more will be a cinch!  

Until then, I'm just going to be grateful that GW and GV get along and that she's growing beautifully (she's officially outgrown premie clothes!).  The rest, well, we've got time and many more blog posts for that... 


Sunday, December 16, 2012

NO BIG SHARP!

So this morning, while stressfully attempting an infusion change in between nursing GV and dressing myself for Mass (which we were of course running late for), GW walks in on me in our bedroom and begins to cry.  Yelling "No, Mama don't!" he crumples onto the floor in complex anxiety and begins a chorus of extraordinarily loud "NO! NO! NO!"  Rousing HB to abandon his half-eaten bowl of cereal, I quickly found myself the center attraction of an early Sunday morning family circus.

Since delivery, I've been able to swap my infusion site from the side of my torso back to my abdomen because my uterus is no longer in the way and, frankly, I find my stomach to be a much easier place to reach for insertion purposes.  Unfortunately, however, in making this switch I apparently forgot to debrief my toddler and he was absolutely horrified to see me putting a needle to a formerly identified "big ouch" spot.  Attempting to put me in time out so as to stop the wreck from unfolding before him, GW pointed at my belly and sobbed "no big sharp on the baby!!"

Despite his sister being bundled in her chair beside him and my obviously (dear Lord I hope it is obvious) smaller belly, GW apparently doesn't quite understand that the baby is no longer in my belly... which I must admit is either enough to make a person collapse from laughter or in tears.  HB picked up the crumpled kid and pointed out that GV is safely out of the way of the trajectory of the needle for my infusion change.   Sniffing and wiping his tears away with the back of his sleeve, GW looked from his sister back to my stomach with a perplexed look and, with an expression of at least some understanding, he changed his tune:  "Oh...  NO BIG SHARP FOR MAMA!"

Ah well... I wish I could acquiesce his request, but alas diabetes reigns and no amount of toddler passion will dethrone it.  I love that he is already protecting GV, even if he doesn't exactly know where she is, and I appreciate that his attempts to save me too are at least sealed with a make it better kiss.  It might not be the cure for insulin dependence, but if I have to stab myself then I will happily accept his cherry on top of an otherwise unpleasant experience.

Friday, December 14, 2012

Mommy Genes

You know when you stop doing something for a while how difficult it can be to start up again? Even if it's something you love like exercise, cooking, flossing or ... writing ... it's just hard to get back in the habit after letting things slide to a tranquil, yet non-evolutionary stop.  But as GV and I have been home for two weeks and she is growing ounce by ounce (up to 7 lbs 6 oz!), it's really about time that I get back on the horse and begin regularly writing again... So thanks to some persistent and much needed prodding from HB, here goes:

While I can rationally look at the calendar on my refrigerator and see that I was pregnant only a matter of days ago, it physically and emotionally feels like it has been ages.  While I am still not entirely sure how to parent two kids at the same time instead of just one, it feels natural to have both GW and GV here and I love them both like they've always been the best part of me.  All of the traumatic worrying and flaming mental "what if" hoops of the pregnancy are now seemingly irrelevant and inconsequential - which at the time I thought would never come to pass.  Essentially, the magic "mommy genes" have once again kicked in and wiped the slate clean... 

After my first dose of mommy genes back in 2009, I happily anticipated their wondrous impact this go around: the phenomenal disappearing act it makes of labor pain upon first sight of the new baby, the awe inspiring, tantrum-taming patience it provokes, the sleep-deprived juggling and plate-spinning it balances and don't even get me started on the gigantic seemingly oversized heart it straight up causes.  It's like when the Grinch's heart grows three sizes in that one day - Dr Seuss must have mistakenly infected that green-goof ball with mommy genes!!  But, in all seriousness, the biology behind child birth and motherhood amazes me in it's combination of emotional simplicity and physical complexity...  there's nothing quite like it and, no matter how sympathetic a person you may be, until you've got 'em, you just don't really get 'em.

Big brother week one - October 2009

Little sister week one - November 2012
Actually, I must admit that despite having two children I still don't understand the breadth of impact mommy genes have on a person - especially on a broken pancreas.  Don't get me wrong, I remember very well the differences between the before GW me and the after and I've done more than enough reading on the medical explanations of what to expect when you're diabetic and expecting to catch the gist, but these super-genes have still managed to surprise me in the last few weeks with their significance... namely their apparent panacea for insulin dependence.  Okay, maybe that takes it a bit far... I wish mommy genes were like some hopped up version of stem cells or something that could actually cure diabetes, but the effects breast feeding is having on my body are a pretty darn good consolation prize.  

So, breast feeding while diabetic is like constantly running or doing any other endurance sport because the body is perpetually burning calories and glucose to make milk.  This means that there is an incessant risk for diabetic mothers to become hypoglycemic and, as such, results in a decrease in the artificial insulin required to maintain a healthy HgA1C.  Combine this with the much lower presence of hormones in a new mother's body and you're looking at insulin rates that are at - and in my case, much lower - than pre-pregnancy levels.

On one hand this means that, if not careful or aware of on setting hypoglycemia, that there is an increased risk for new mothers to go into shock post-delivery (remember my third trimester hypoglycemia was abnormal).  On the other hand, this can mean a very welcome return to eating carbs with absent minded fervor... for example (yes, this is seriously a big deal) I can eat upwards of six - repeat: SIX - miniature Heath bars just because I feel like it before my blood sugar will respond like they "ought" to.  Now that I am reading this it sounds kind of wantonly gluttonous to eat that much candy in one sitting, but pardon me while I cackle at my new found ability to smuggle simple carbs past my pancreas! THANK YOU MOMMY GENES!

Now I doubt this new trick the mommy genes have introduced to my body will do anything positive toward me getting back into my other jeans, but hey, we've got to cut them some slack... they have me cooing and gooing over my sweet little girl (she's sleeping in my lap right now and so darn cute with her smiles - see video) and able to pretend I'm somewhat normal for the time being.  Exercise is still four weeks off before I'm "cleared" to hit the pavement again by the perinatologist and there is plenty of time to cover that topic once HB and I've figured out our post-pregnancy work out plan.  In the mean time, I'm going to continue enjoying my maternity pants, turn my insulin pump on ultra-low, and grab a candy bar -- I'd rather be snuggled up with these two kids than out running anyway!

Newborn GV

So in the last post I think I got the point across that despite all the concerns that labor and delivery itself went well and that as of 10:12 AM on November 27 HB and I have a daughter.  Yes? Okay then, moving on!

Once she was out, the nurses began their typical new born checks and double checks and successfully reported that GV scored highly on her APGAR and has ten fingers and ten toes (which after 21 sonograms was redundant, but still good news).  But seeing as I am not a normal mother, they had to run atypical checks on her as well to make sure she was healthy diabetes impact wise.  Course I knew that was coming and had worked hard to mitigate the worst case scenario with tight glucose regulation during labor (see my "Induction Begins Tonight" blog post for an explanation), but checking her blood sugar regardless of my control was just the responsible medical thing to do.

Pricking her little heel, the nurse applied the Accucheck test strip to the blood and reported a bg reading of 41 mg/dL for newborn GV.  While I would consider that number dangerously low for me, any number above 40 mg/dL is considered to be normal for newborn babies; in other words, she was borderline and verging on hypoglycemic despite my efforts to ensure her glucose would be in a safe range.  Hoping her sugars would go up on their own, the nurse handed her back to me for skin-to-skin time, immediate nursing and explained they'd need to check her sugars again in 30 minutes.


Holding that little baby and keeping her safe in my arms after so many months of worrying felt phenomenal... but in what felt like mere seconds after handing her to me the nurse was back to check GV's sugars again.   With HB supervising and being my emotional proxy, the nurse started the whole process again and pricked her heel.  The meter read 32 mg/dL.

Shit.  (Pardon my french).

Asking the pediatrician for a call on whether she needed to go directly to the NICU, the nurse reported back that GV's hypoglycemia wasn't "bad enough" to warrant a trip to the second floor but that we'd need to get her on formula right away.  Because a new mother's breast milk doesn't come in for two to three days after delivery and colostrum doesn't contain much in the way of glucose, we grabbed our Nutramigen formula and I tried to get at least an ounce into her before the next bg check in 45 minutes.  Warning that if her bg wasn't up by then we'd need to take "alternative measures" (aka the NICU), the nurse wished us luck and left us to it.

Fortunately, if there is one thing this kid does well, it's eat!  By the time the next check came around she'd gone up to 53 mg/dL!!  Unfortunately, they had to have a minimum of three readings over 70 mg/dL so even though her sugars were in the right range, the nurses on the "Family Centered Care" floor had to prick her several more times over the next 12 hours for record purposes -- all of which, thank the Lord, were in the perfect range.

But would that be the end of it?  Heck no -- that would be far too easy of an ending to an otherwise medically stressful pregnancy.

So we get up to the 7th floor recovery unit and we learn that GV's bilirubin levels are excessively high for a few hour old baby at 6.8.   The pediatrician initially said that they'd just keep an eye on it and see how she responded to simply being fed, but if the levels weren't better the following morning that they'd need to put her under the ultra violet lights for 24 or more hours.  I tried my darnedest to feed her  and combat the onset of jaundice (at 38 weeks, really?!), but the next morning her bilirubin levels had risen to 8.4 and the pediatrician made the call to get her under the lights.



I know even "normal mothers" have to put their babies in the grow box sometimes - heck even my husband had to go in it when he was born - but after everything this complication was simply one I hadn't emotionally prepared myself for.  I braced myself for all the plausible diabetes and abruption complications, but jaundice? It hadn't even crossed my mind.

Only able to take her out every three hours for a brief feeding, we sat up the entire night on Wednesday watching her tiny little chest rise and fall with each breath.  Feeling helpless to fix the problem, we waited for five o'clock Thursday evening to roll around and the defining bilirubin levels check to be completed.  If the labs showed that her levels were still high, I'd be discharged and sent home while she'd remain hospitalized in that incubator, but if her levels were low "enough" we'd be able to bring her home with us.  Needless to say we were praying and risking to hope for the second of those outcomes.

So with bated breath, we watched the clock until 6:00 PM on Thursday, November 29 when the nurse finally came in and gave us the verdict... GV could go home!!  Her bilirubin levels were still elevated higher than they ought to be, but not so high that at two days old she'd be in any risk by going home.

Thank God.

Sunday, December 9, 2012

Labor & Delivery

On Monday, November 26 at 8 PM we wandered into the Fairfax INOVA Women's and Children's Hospital in exceedingly high spirits.  After months and months of worrying about how the hour long drive along I-95 and the Beltway would go it was a relief to calmly pull up and saunter in without traffic or fear of imminent baby delivery on the lobby floor.  But, with major relief, I was suited up in an oh-so-glamourous hospital gown and lying in a hospital bed well before Baby made her debut into the world.

After debriefing my nurse and getting fully checked in to their new computer system, the MFM resident came in to check Baby's position via sonogram one last time (#21) and to evaluate the condition of my cervix.  At about 70% effaced, 3 CM dilated and -3 vertex station, he decided to hold off on the Cervidil until 2 AM to make sure that things didn't progress too quickly over night -- which given the last quick delivery made HB and I very happy because, let's face it, we didn't work with Perinatal Associates of NOVA all this time to wind up being delivered by some random resident.  So the resident (to give at least this one credit, he was a nice, competent guy) put in the orders, requested that my blood sugars to be checked every four hours and instructed the nurse to start Pitocin at 6:30 Tuesday morning.  Completely on board with the Cervidil and Pitocin plan (what the heck do I know about that to have an opinion on it?), HB and I decided to blatantly blew off the blood sugar instructions and checked my bgs every hour to make sure they were tight for delivery... Needless to say that kind of ate away at our last night of sleep with out an infant, but we kept my sugars in between 70 and 80 mg/dL from the first time I sat down on that bed to the time I was being wheeled to a recovery room baby in hand.  


Go me!


So with irregular Braxton Hicks, the nurse put me on Cervidil from 2 AM to 6 AM -- which initially was no big deal, but after a few hours caused the start of real, regular contractions at just under 5 minutes apart.  Having spent the past nine weeks of merely uncomfortable contractions wondering if I wanted an epidural this time, when the nurse asked me if I wanted one I politely said "HELL YEAH" and got my name on the first slot of the sign up sheet for the day.  Needing 30 minutes between Cervidil and Pitocin, the nurse got fluids hooked up and into my system so that by the time the anesthesiologist got there somewhere between 7:30 or 8 o'clock (or by every 3 minute contractions on my watch) I was ready to get the show on the road.  The epidural was no big deal (the iodine scrub brush was the worst part of it) and once the magic meds kicked in, HB and I agreed that this was the perfect opportunity for him to get himself breakfast before he collapsed from hunger exacerbated excitement. 


But, really folks, is sending your husband off during labor a good idea?   NO! 


He wasn't gone more than three minutes when the nurse came rushing in to flip me on my side, stop the Pitocin and put me on oxygen.  Baby's heart rate was dropping well below the acceptable range of 110 to 160 after each contraction (now spaced every 2 minutes) and that kind of fetal distress this "early" is very worrisome given the intensity of active labor.  So by 8:30 my new day-shift nurse paged Perinatal Associates and - much much to my surprise - a different doctor from the practice assigned herself to my case and within minutes arrived to evaluate the situation.  Seeing the progression of contractions and the baby's positive response to oxygen, Dr. Al-Kouatley (who, I must say is the nicest woman in the world) decided to manually break my water, restart Pitocin and asked me to turn off my pump before the real exercise of labor began.  Since I wasn't having any issues with my blood sugars and I could afford to go higher by another 20 mg/dL, I thought this made sense and we moved forward. 



While all of this was happening, I'd been texting HB to let him know what was going on and that he might want to get his butt back to the delivery room sooner rather than later.  Since he didn't respond I guessed he'd missed the messages, which by the look of absolute horror on his face when he came back at 8:45 to my much altered appearance, was confirmed.  The nurse and I explained what was happening and that there was no longer a big need to worry, but I've got to give the guy a lot of credit because even with that reassurance he didn't let go of my hand after that and he was johnny on the spot for all of what happened over the next hour.   

Side bar:  It is a really regular occurrence for me that women at random places like doctors offices, the grocery store or  the play ground pull me aside and comment about how wonderful my husband is for being so supportive and involved.  While I can't explain how I got so lucky to have him be  my other half, I can with 100% authority say that I know how good I've got it and that I appreciate every one of the little things that you do, HB.  Thank you for being there with me each step of the way, for blessing me with your love and making my world better by simply being in it.  

Now this whole time, as the endocrinologist had warned us to do, HB and I were explaining to the nursing staff that my first delivery went quickly, that my blood glucose control has been fantastic throughout the pregnancy and that this baby was last measured at over a pound less than GW was at birth.  But, seeing as the typical experience with diabetic mothers involves wanton neglect of sugar control resulting in gigantic babies and hours of pushing, my nurses apparently didn't believe us and ignored our hints that a) they should be ready and b) things were progressing:

At 9:15, much to my previously drugged surprise, I began to feel some serious contractions again and HB went to tell the nurse something was changing either with the contractions or the epidural (before the epidural my contraction pain was at about a six on a one to ten scale, now it was about at a seven or eight).  Saying she'd be there in a minute, we waited and I attempted to breath through the every 45 second contraction pain I was now experiencing...

At 9:30, HB went back out to the nursing station to tell them that the pain was seriously much worse (about a nine) and that I was feeling "pressure" - which if you haven't had a baby means that the baby is ready to exit.

Finally, at 9:45 a nurse came in and checked the baby's position - which HELLO, was right there at +1 station (typically you don't start pushing until +3 station, but waiting for that was seriously not going to happen) and frantically tried to get the completely unprepared room prepped for delivery.  She called the Dr. Al-kouatly, who needed about ten minutes to change into scrubs and come up from the testing center, so low and behold look who walked in to check on me but my worst nightmare Dougie Howser... at this point I was without any pain meds (we don't know what happened to the epidural) and doing everything I possibly could mentally to not push until a doctor - a real doctor - was there and ready to catch.  But before I had a chance to slap him for his horribly arrogant, "I haven't read the chart" bed side manner and instructions to do practice pushes (seriously?! BAD IDEA KID!), my prayers were answered... It was at this point that a Hollywood director would have flooded the room with white lights, used slow motion camera effects and some sort of "halleljah" music because Dr. Bronsky just happened to walk in ready for action.  Ridiculously unhappy with the lack of preparedness, my MIA pain plan and his not having been paged for "his case," he barked orders at the nurses to get their act together and, within ten minutes of sitting down, delivered my beautiful daughter, GV at 10:12 AM.  


While things didn't go 100% smoothly communication-wise for delivery at INOVA Fairfax, HB and I are incredibly pleased with Dr. Bronsky's phenomenal care for me as an individual patient and I must say that I am grateful for his Hail-Mary reception of GV.  I am sure that Dr. Al-Kouatly would have done a wonderful job as well, perhaps even Dougie too (gag), but Dr. Bronsky helped get me from pre-conception nerves to post-delivery beautiful baby... Assuming that there aren't complications or reasons I've yet to learn (the placenta has been sent to pathology), I am really looking forward to working with him again for future pregnancies because we have a battle rhythm and positive relationship that I wouldn't trade for the world.  

Alright, all for now, the little one has been peacefully sleeping in my lap for all these paragraphs and now wants to be fed... Consider this post one of a few on the diabetes and L&D topic, I'll fill in the post delivery blanks soon. Thanks again for the support and love -- it is appreciated like always!


Monday, November 26, 2012

Induction begins tonight

Well, today is the day.

I go into the hospital tonight to begin fetal monitoring, receive a dose of Cervidil and then bright and early tomorrow morning we'll begin Pitocin to really get things started.  Based on my past pregnancy history and the dosing amounts he's planning, Dr. Bronsky expects that we'll have the baby by sometime tomorrow afternoon.  On one hand I am absolutely relieved to know that there is a definitive plan and an end to the pregnancy in sight, but I conversely find it a bit weird to know for a fact when the baby is arriving after so many weeks of uncertainty.

Hopefully my body will be responsive to the drugs and things will go smoothly with the induction, but seeing as I've been struggling with my blood sugar in hypERglycemic ranges the last couple days I'm a bit concerned about what this means for Baby.  I'm not sure where the high numbers are coming from exactly, but I'm trying to do whatever I can to get the numbers back down into normal ranges as soon as possible because if my sugars are high when she is born Baby will be required to go to the NICU to correct her hypoglycemia.

I think I've explained this before, but just in case I haven't or simply for review, when a fetus is in utero it's pancreas creates extra insulin to balance the excess glucose that is transmitted via the placenta from the Mom if her blood glucose is too high.  But when the baby is born and the external sugar source is cut off (literally), the insulin the newborn's pancreas is putting out becomes excessive and leads to their blood glucose dropping into dangerously low ranges.  Since the only way to correct hypoglycemia is to ingest more carbohydrates and colostrum does not contain much beyond antibodies, the NICU needs to feed the baby supplementally with sugar or formula and monitor his/her blood sugar until the baby is stable on its own.  Once the blood glucose balances out, the baby shouldn't need to stay in the NICU longer unless there are other complications that require additional intensive care... knock on wood.

I'm doing everything I can to keep things were they need to be, but if the placenta makes a last ditch effort to screw with my blood glucose then it's kind of out of my hands since hormones are simply unpredictable.  The reality is that Dr. Rogacz told me to expect Baby to go to the NICU and since we don't know with 100% certainty that her lungs will be fully developed by tonight I've kind of resigned myself to the fact that she might need more help than vitamin D like GW did when he was born.  Of course HB and I have prepared ourselves emotionally and medically for this and we're as ready as we can get...  At the most basic level, instead of using what basic brand the hospital provides, we've decided to bring our own hypoallergenic formula if Baby needs supplementation because research studies have indicated there may be a link between cow protein based formulas, type 1 mom's and babies developing autoimmune diseases later in life.  I can explain more about this research later since this topic goes hand in hand with the breast feeding post I still need to write (good thing we're not quite there yet), but we've decided not to take any chances and we're covering down on every detail we possibly can to keep her as healthy as we are able to.

Anyway, we'll see how things play out over the next two days.  I keep sending up prayers that the increased risks for infection and slower healing time because of diabetes will be of no concern coming out of this, but like I said, we'll see.  There's nothing about diabetes that makes life easy and it effects everything that involves the body -- much like carrying a baby, go figure.  I've somehow managed to avoid the swollen ankles and several other unpleasant side effects of pregnancy this go around, so here's hoping that some of the diabetes and delivery complications will be irrelevant as well.

I expect this will be my last blog post for a while since the hospital has spotty internet connectivity and I'm planning to be very busy with our TWO wonderful kids for a while...  But I'll be sure to put up an update when we get home and we're all settled (please don't call while we're at the hospital since we're not out of the woods yet).  Until then, thank you so much for reading my posts and giving me your support and encouragement over the past many months.  Writing about what is going on is a great outlet for me and, although things have been rough with the pregnancy, knowing people out there care is appreciated more than you know.

Talk soon :)

Saturday, November 24, 2012

Week 37, part two

Thankful for a labor free and turkey full Thanksgiving holiday, I was positively giddy to go into my last perinatal appointment at the Antenatal Testing Center on Friday.  Knowing that Baby's lungs aren't mature and that there wouldn't be a change in plans for what we'd do after this particular appointment ended, I felt like the day was going to be predictable pregnancy-wise for the first time in weeks.   Considering how worried I've been about the stability of my blood sugar, the occurrence of another abruption or whatever else could go wrong, it was a relief to walk in expecting a "simple" a non-stress test, my last sonogram (#20) and a quick conversation with the doc.

Being the day after a holiday, the testing center was ridiculously busy with two days worth of appointments -- there were 16 pregnant women and their spouses in the waiting room when we arrived -- we had a bit of a wait, but it was actually quite a pleasant wait because a 28 week pregnant woman came up and introduced herself to me because she saw my pump clip in my jeans pocket.  As it turned out, she has been a T1 diabetic for almost twenty years, she uses the same pump that I do and, as this is her first baby, she was glad to meet another insulin dependent mom juggling a kid and a baby.  Course I didn't have the heart to tell her that GW wasn't a diabetic baby, but it was nice none the less to swap battle stories and commiserate over the difficulty of our current circumstances... while it sounded like her diabetes gets along much better with her pregnancy than mine has, I really appreciate how this charming woman made me feel far less alone and stranded by my beta cells than I've felt in the last nine months.  So Erin, wherever you are, thank you for that!

Having seen me twice a week for what feels like months, the nurses called my family back to the NSTing area by asking GW to bring his mommy back.   While they're perfectly professional and good at their jobs, I must admit it is the personal touch these nurses give to patients like me that make me absolutely love them...  they put up with my family's quirks and a few of them have even let GW help with the testing process by allowing him to squirt the goo, place the fetal doppler and even help steer the sonogram wand.  Since things were going smoothly today and nothing was abnormal with the sono or NST, they had nothing but nice things to say and well wishes to our family upon my "graduation" from routine testing. It'll be kinda sad not to see them all the time, especially Tam and Sandy, but Lord knows there's always the next pregnancy, right?

Reviewing all the little details, checking my cervix for progress (2 CM) and confirming the plan for my induction on Tuesday, Dr. Bronsky verbally walked HB and I through the last few days of pregnancy.   Knowing my interest in moving about for the sake of labor progression, he said to fly be free and have a nice weekend but to plan on being bed bound from 8 PM Monday until post delivery (boo, walking helped so much last time) on account of how "brittle" my diabetes is and how closely they'll need to monitor the baby because of it.  While I am not thrilled to hear that, I understand the priority and I value that he's concerned with/aware of how sensitive my body is because of my stinking pancreas.   All we can hope for is stable, low (but not hypo) numbers over the next several days and through delivery...

All that being said, I've got a couple days of pregnancy left and by Tuesday (at the latest) we'll go from a family of three to a family of four.  We're going to spend the next several days enjoying our time with just GW and, hopefully, we'll go into next week with minimal complications and confidence in the arrival of a happy, healthy baby girl.

Thursday, November 22, 2012

Happy Thanksgiving!

 
Happy Thanksgiving from the odd looking place setting  :) 

Wednesday, November 21, 2012

Week 37, part one

I don't know how coherent or comprehensive this post will be, but I'm attempting to put something together before the complete emotional exhaustion of the past few days knocks me out.  That said, bear with me.

After writing my blog post Monday night, I had a bit of a melt down.  Caused in part by nerves for the amniocentesis and in part by simply being overwhelmed by the significant differences there have between this pregnancy and the first, I found myself as curled up as a nine month and one week pregnant woman can get in a heap of tears.  You see, with GW, the pregnancy couldn't have been smoother...  I didn't realize I was pregnant until week 12 so I "missed" the morning sickness phase (had it, but didn't know what it was), there weren't any medical complications and he came early and very quickly.  I wasn't restricted to bed, I was very physically active and we generally treated me like a normal woman rather than the delicate creature pregnant women actually are (I distinctly remember carrying a full size mattress from our trailer, across our lawn, into our house and upstairs by myself at 8 months because I felt I could).   Back then I didn't have a clue what I was signing up for or what I could lose if something happened to my fetus.  I didn't have the Mommy Gene, I didn't feel connected to the baby and I generally was waiting for labor to begin so that I could get my "skinny pants" figure back.

But this go around, there is nothing smooth and the stakes couldn't be higher.  Now that I fully comprehend what it means to be a Mom, just how much my son matters in my life and what extent I have given/would give or do anything for his well being and happiness, I am terrified of what a fine line I find myself walking with baby #2.  I knew things would be more complicated this go around with my diabetes, but I had no idea that things would be as hard as they actually have been.  While talking with my nurse at the Antenatal Testing Center Tuesday morning she said that "some people's bodies just don't do well with diabetes and pregnancy" and, unfortunately, that "some people" reference seems particularly relevant to me... which is why all of the complications of the past nine months culminated in a crumpled mess of weepy gooey blah that only marginally resembled me Monday night.

Ug.

So puffy eyed and physically drained, we piled into the truck and drove up to the hospital Tuesday for my amniocentesis and first week 37 prenatal check up.  It took a little while for the doctors, nursing staff and technicians to get things all sorted and settled, but after a quick sit down with Dr. Bronsky I was lying on my back repeating Hail Mary in my head and trying to remain calm for the procedure.  I'd done a bit of research on what to expect and depending on which medical website you look at the sensory explanation of an amnio ranges from a "slight, momentary burning sensation" to "pain worthy of local anesthetic" -- so really I had no clue what I'd signed myself up for as the needle and multiple syringes were laid out on my belly for quick accessibility. 

Taking deep breaths and working extremely hard to keep from contracting my core out of anxiety, Dr Bronsky did a second ultrasound of my uterus (the tech had already done the routine one -- AFI level dropped to 19.6) to locate the best place to insert the needle.  Unfortunately this turned out to be much more difficult than he anticipated because of my anterior placenta and Baby's position. So, if you remember, an anterior placenta means that it is attached to the front wall of the uterus and because I had a partial previa earlier in the pregnancy we know that it is attached quite low to the front wall.  Well, as the baby has grown, so has the placenta and now it covers the entire left half of my belly -- which made it impossible to insert the needle on that side.  Looking to the right side of my uterus, the doctor struggled to find a safe place to test because Baby is curled with her back to my right side and her feet, arms and head pointing to the left.  Since jabbing her with a needle is completely out of the question, that left little to no room for even the thinnest of needles. 

Finally selecting a tiny spot near her tush, Dr Bronsky meticulously threaded the needle between Baby, my rib cage and several many blood vessels through my abdominal wall and into my uterus.  Although I can definitively say that the needle going in wasn't so bad, the needle staying in and being tweaked this way and that to find a clear pocket of amniotic fluid hurt like freaking hell.  Back when I was hospitalized at GTU in 2010 I had to have an arterial blood draw from my wrist and, while that was the hardest blood draw I've ever had to endure, it seemed like a walk in the freaking park compared to this amnio.  OW.  It was all I could do to just keep my eyes closed, continue to breath normally and remind myself that it'd all be over soon...

After what felt like hours of torture (seriously, has anyone told DoD about this yet?) the needle was removed along with enough fluid to check on Baby's lung development and the smallest, dinkest bandaid ever was placed over my cramping, sore flesh wound.  Reminding myself this is all for Baby's own good, my minimal optimism flew out the window when Dr. Bronsky bluntly said that "you know, you can tell lung maturity based on the color of fluid and, from what I'm seeing here, we're definitely not there."  He said they'd still run the tests anyway to see if it'd be safe enough to move the induction date up, but unless things were at a certain level, he and the other doctors weren't confident enough to deliver Baby until next Tuesday -- at the earliest -- because she's just not physically ready to be outside the womb. 

So, not surprisingly, this afternoon we got the results back that confirm that Baby does not have mature lungs...  And although the docs are incredibly concerned about the perpetual drops in my blood sugar and the implications that has for placenta failure, they think it is worth the risk to leave her where she is for another week instead of guaranteeing her a trip to the NICU for breathing assistance.  This, unfortunately, is not to say that she'll have mature lungs by next Tuesday or that she'll be NICU free anyway but it's a calculated risk that the perinatologists think is the best case scenario for a high risk diabetic baby.  I guess this is a good thing that we know she's not ready to come out and that I've got another few days to try to kick this respiratory infection (still feel sick as ever and what's worse is GW caught it), but I'd be lying if I said that I wasn't distraught by the news that things are progressing like diabetes predicted.  I mean fortunately she's not a gigantic diabetes baby, but dang nabit why did my pancreas have to go and screw with her lungs when it has frankly screwed with me and Baby enough for a life time?!  I'm quite done being pregnant and I am completely over being diabetic... one is hard enough as is, but both of them? In the worst combination possible? Not cool.

With November being World Diabetes Awareness Month I feel a bit guilty at just under two years of affliction complaining about the lack of a cure, but you know what? This isn't like a prison sentence -- I didn't do something that made me deserve this disease and therefore the time of incarceration befitting my punishment.  I might not have the decades of frustration and illness that most T1s have, but I'm just as over this disease and the impact it has on my family as anyone else who needs artificial insulin...  How dare diabetes screw with my baby! How dare my pancreas give up on me when I never would have given up on it! How dare people treat me like I'm broken or, worse, like my disease is "not that bad."  This disease flat out sucks and I am frustrated about what it is putting me through and I am angry that my baby girl is being put through the wringer of every possible medical test because I'm stuck with failing beta cells.

AGG!

Since I'm still attached to my pump, still rocking my battle bandage from Tuesday and I still haven't gone into spontaneous labor, we're planning to go back into the testing center on Friday to check on Baby again.   Assuming all continues as is the doctors don't want to move back the induction from November 27, but if things change for the worse or if I go into labor on my own things may either be sooner or later than Tuesday depending on what exactly is going on.  I'll try to keep my update on Friday to something a bit less rant-ish and a bit more concise, but after months and months of high stress composure I was bound to break sometime...

Until then, have a great Thanksgiving folks!

Monday, November 19, 2012

Absolutely Awful Apprehension of Apposite Amnio

Is it just me or is there unjust alliteration in the pairing of "anxiety" and "amniocentesis"?

With the way things have been going since Friday given the increased contractions and labor symptoms I'm having, I'm a bit surprised that Baby isn't here already and that I'm actually facing the needle tomorrow...  Which, obviously, I'm not thrilled about it.  I know that amnios are done regularly and, heck, my mother even had one with me, but given the number of times I see my blood each day and the normalcy of needles in my life I am not terribly ecstatic for yet another excuse to introduce a long sharp needle to my torso.


Perhaps I'm just being a big baby (please refrain from commenting in the affirmative here), but there's just something about the idea of a needle going through my abdominal wall and into my uterus that has me thoroughly freaked out.  It's my basic understanding that it's a generally uncomfortable procedure with very little risk to Baby given the simultaneous use of ultrasound, but I'm kind of done with additional pain and I truly want nothing to do with the stress of further testing.  What's more, I'm not entirely sure what the doctors are going to use the results for in the first place... Amniotic fluid testing during the third trimester of pregnancy is done to check on fetal lung development to ensure that they're mature enough to work properly outside of the uterus.  But with the way my blood sugars have been dropping so dangerously over the past couple weeks, the doctors are talking about taking her out (I don't know if this means induction or c-section at this point) this week and the amnio results they come up with are kind of irrelevant if they think the placenta is too unstable to sustain her until next Tuesday any way.

Don't get me wrong, I'm not scared of the needle or of the pain associated with it.  I've come to accept needles as a given - kind of like the reoccurrence of morning, the unavoidable existence of taxes or the simple fact that all dinosaurs poop (thank you for that insightful revelation Buddy and Tiny Pteranodon).  The part that freaks me out is that this is something I have no prior context to gauge it in and therefore no way to know what to expect, and, also, that the results will either reinforce the current concerns that she needs to be delivered sooner rather than later or that she's got a rough week ahead of her either fighting a failing placenta or struggling to breath on her own.   Bottom line, I'm finding it scary and overwhelming to be counting down the final eight days of pregnancy without even a hint of reprieve from complication... I'd hoped to end this pregnancy on a high, spontaneous labor note but at this point I'm too tired to expend the emotional capital of hoping for something I cannot within reasonable doubt expect.  She'll come out, but only after we've bared the difficulty of pregnancy right to the bitter end.

With my first pregnancy, I went into labor on my own at week 36 and five days -- which would have been yesterday in this pregnancy.  Seeing that this pregnancy is already longer than that with GW (not just by 24 hours, but also 12 weeks longer to be excessively literal), I'm feeling quite a bit frustrated that my water hasn't broken, that labor hasn't simply started and that the anxiety of bringing this baby into the world is dragging on...   Each morning I wake up feeling like another eternity awaits me over the coming 24 hours and given all the complications we've seen over the last nine months, each minute of those hours brings me closer to the end of my rope and a hopelessly emotional precipice.  Now that I know how wonderful being a mom is and how much my babies matter to me, the stakes are higher than ever and I just want to know she's healthy, she's safe and that we've made it across the finish line together, in tact.

I know that doing the amnio is the right thing to do as far as the Perinatal Associates of NOVA are concerned and, as such, I'm on board and will let you know what we come up with.  But for the sake of honesty, my nerves currently have the best of me and I'd definitely appreciate an extra prayer to be sent up for me in the morning if you've got one...  Saint Gerard Mejella please intercede for me!

Friday, November 16, 2012

Week 36, part two

For the third night in a row, I woke up in hell this morning with my blood sugar much lower than it ought to be.  Wednesday I was 34, Thursday I was 32 and today at 2:45 AM I was 43 -- what the heck?!  I mean I love the excuse to wantonly eat simple, quick acting carbohydrates like I am a care free non-diabetic child again, but within the context of the last few weeks of a class B diabetic pregnancy I'm not thrilled in the slightest to need to open my bed side table drawer and raid the stash of sweets HB and I have stock piled for moments like this.  It'd be nice to want a piece of candy for once!!

Any way, I've been going back and forth with my new endo via the phone practically every day this week and I lowered my basal rates by 0.05 each night in an attempt to curb my plummeting blood sugars. Heck, I've practically cut the rate from 12 AM to 3 AM in half over the past three days -- but unfortunately to no avail.  Needless to say my Friday appointments with the perinatologist and endocrinologist couldn't have been better timed this week...

Still gawd-awfully sick with this respiratory infection (I'm now on a new uffdah-uffdah prescription of antibiotics and still coughing like day one), we went back to the Antenatal Testing Center this morning for yet another round of non-stress tests and my 17th sonogram.   The NST was enough reactive to pass and the AFI was much higher than last time (19 on Tuesday, 24.6 today), which the sonographer and resident (ug) dismissed as "symptomatic of being a diabetic."  However, given the smorgasbord of health complications I've had this week - an optical migraine on Sunday, the coughing and vomiting of this infection and contractions - on top of my seriously unstable blood glucose, the resident kicked my case back to Doctor Bronsky who felt it was worth a cervix exam and blood panel to make sure I didn't necessitate immediate hospitalization for preeclampsia or placenta failure.  

Fortunately the blood panel came back showing normal liver function (thank God) so immediate hospitalization wasn't necessary, however Dr Bronsky placed orders for me to have an amnioenteses done on Tuesday (day one of week 37) to evaluate Baby's lung maturity so that he can move the delivery date up from November 27 to as soon as possible.  Soooo, essentially things with my blood sugar aren't stable enough for her to make it another 10 days in utero but the doctors cannot risk her coming out too soon since diabetic babies are notorious for having immature lungs (even at "full term") and you throw in my respiratory infection in on top of that and they've got a very delicate line to walk between letting her stay in and getting her out safely.

Furthermore, from talking with Dr. Bronsky about the possible use of additional steroids as a fail-safe to help her along, HB and I found out that subsequent injections of steroids to mature a premie baby's lungs for delivery is highly controversial after the first dose and there is mixed evidence regarding not only its efficacy, but the safety of it.  So while the doctors back at Stafford Hospital on Sept 25 made the right emergency choice to administer the steroids to me for a possible pre-term delivery, the reality at this point is that my docs aren't sure what they're going to do if a) I go into spontaneous labor sooner than induced or b) if the amnio shows her lungs to be less developed than ideal for a before Nov 27 delivery.

Generally we're feeling like deer in the headlights and overwhelmed by the delicacy of the entire situation.  Having lost the mucus plug and had some show already, I'm feeling like a passenger in a uncontrollable rail car with no clear, straight forward escape plan... thank God HB is the one who has to drive the truck to NOVA, thank God the Perinatal Associates are the best of the best high risk pregnancy docs Virginia has to offer and thank God that Fairfax INOVA has one of the top 5 NICU in the country!

After leaving the testing center, we went straight to my appointment with Dr Rogacz in Fairfax.   Taking a sharpened pencil to my chart, she slashed my basal and bolus rates with the finesse of a Michelin Star Chef at the cutting board.  She then brought up the ever present topic of "when labor begins" ... to which I must say, as a pregnant woman you're constantly thinking about what's this sensation and even as a second timer I find myself worrying about whether I'll know when my water breaks, but adding diabetes management to something I'm already stressed to the gills about is simply exhausting.  It's really no wonder I'm so sick.

Any way, she walked us through what she wants me to do with my pump settings for active labor.  Similar to an endurance athletic event, which let's face it, labor is, the whole physical process of pushing a baby out of your womb causes blood glucose to fall sharply in diabetics because of expended energy... That being said, she's asked me to cut my rates from what they are "normally" (ha, as if they are stable and normal now) to my lowest setting and keeping them at that low 0.2 unit setting until the baby is out.  Of course if my blood glucose continues to drop even at that low basal rate, we'll need to decrease it further and have me put on a glucose drip to make sure I don't go into hypoglycemic shock while in active labor.  Fun stuff.

So after Baby and the placenta are out, I'll need to reprogram my pump again since I'll be back to pre-pregnancy (actually probably lower) insulin needs because the placenta will no longer be present to create an insulin-resistant environment in my body.  For this Dr. Rogacz has instructed me to initially cut all of my basal rates in half, suspend use of the symlin injections and go from there.  Being naturally so hyper-sensitive to insulin will likely make the postpartum diabetes dance a difficult one, but I've been rightly warned that any non-diabetic symptoms I may display -- in other words maybe not even needing artificial insulin -- will be temporary as my body recovers and returns to a new normal.

I only have one word to describe all of this: over-frlcking-whelming.

I wish I was in the blissful period of enjoying the last few days of pregnancy with out a care and an extra foot rub or two, but the reality is that this pregnancy will be medically complicated start to finish.  I knew what I was signing myself up for, but conceptively rationalizing risk and tangibly feeling fear are completely different things.  Honestly, I'd like to just get this show on the road already so that I can know it how things turn out, but it's out of my hands.

Wednesday, November 14, 2012

Hallelujah for Hypoglycemia! Wait, what?

So at 1:50 AM last night I woke up with a start -- something, unfortunately, that isn't uncommon any more.  Between the trips to the bathroom to vomit, the horrendous coughing episodes that violently shake our bed and the occassional contraction that reminds me that no, seriously, labor really is just around the corner I've found myself spending many an early morning wide awake for one reason or another.  But last night, in an ironic sense, was a nice change from the ordinary -- I woke up sweating, over heating and shaking in another state of hypoglycemia.

I managed to get my light on, sit up and, granted I had to stab myself twice to get enough blood for the meter, I tested my blood sugar.   The meter read 34 mg/dL.  With difficulty I managed to wake HB up and he helped me get some orange juice into my system (I also took the excuse to grab 4 pieces of candy corn - life and death situation after all).  So I sit up waiting for my blood sugar to return to normal ranges for an hour or so and by 3 AM my meter finally read a solid over night number of 94 and I was able to go back to sleep.

The funny thing about all of this is that it felt wonderful to wake up without the other symptoms I've been experiencing the last couple nights.  My hypoglycemia was so bad that I couldn't feel my throat hurting or my chest aching, I didn't notice the congestion in my nose or lungs and I felt - ironically - normal again.  Course when I woke up this morning to HB's alarm clock it was with the same coughing, gagging and contracting as yesterday so the escapade back to "normal diabetes land" was short lived and fleeting in the night. 

I called my new endocrinologist to let her know about the low and - get this she calls you back personally - she said that unless I begin to have more hypoglycemic readings during the day that the baby is likely burning through too much of my glucose over night and that is causing the severe lows at that point.  However, she continued, if the lows continue during the day then we need to worry more about the integrity of the placenta - and given that she knows what she is talking about and my perinatologists trust that she knows what she is talking about, then those are the honest to God options for explanations.

So all morning I watched my bgs stay in normal ranges as I tried to decrease my body weight by at least one lung, but this afternoon has been a different story.  My blood sugar post nap #4 was 39 mg/dL... I had juice... I checked again and it was 38 mg/dL... I corrected again... I checked again and it was back up to 39 mg/dL... I waited... I checked again and it was down to 37 mg/dL... and as of about five minutes ago it finally got up to 47 mg/dL.  Needless to say, something is wrong and the grams upon grams upon grams of carbs I've ingested to correct this low aren't going very far.  I've left a message with Dr Rogacz and I'll fax her my logs tomorrow, but seriously this is ridiculous.

Just what I needed - to be excessively sick and having more diabetes complications. If I was a betting person I'd wager that my water breaks sometime soon... because, really, why wouldn't it?

Tuesday, November 13, 2012

Week 36: Antibiotics, Contractions and Misery

It might be sunny and beautiful outside right now, but if you want my straight up honest appraisal of things I think that it is fricking pouring here inside over my head.  Since Sunday night at about 7 PM, I've had contractions at regular intervals that have been more intense and more punctual than I've experenced in several weeks. Given the distance from the doctor and the reality that GW was born at week 36 and change, HB and I decided that false alarm or not it was worth calling the perinatologist and (go figure, it'd have to be Doogie Howser on call) he said "to be better safe than sorry" and come on in for a labor check. 

So with somewhat high hopes that Baby would be born early Monday morning - Nov 12 is HB's birthday after all - we drove our way up to Fairfax INOVA without a hiccup (sign number one that we weren't having a baby).  After re-registering for labor and delivery (gotta love new hospital computer systems), we were checked into the L&D Triage bed # 5 for evaluation.  Hooked right back up to the fetal heart rate and uterine activity monitors that I seem to accessorize with daily, I watched Baby's heart beat away in complete appathy to the peaks of contractions I was showing at 8-9 minutes apart.  After about four hours of monitoring, a horrible (seriously, the worst one I've ever met) OBGYN resident came into check for dilation and with about as much grace as an elephant ripping off the door of a smart car in attempts to climb in and drive, she uncermoneously checked my cervix and mumbled her way out of the room. My nurse had to come back and translate for me that the contractions weren't causing dilation yet and that they were going to send me home because it could be a while more.

#-05 in the lower left corner shows my contractions in green and Baby's
heart rate in blue.  Fair sized contractions, but not strong enough to start labor.

Albiet slightly disappointed that the show wasn't on the road already, HB and I were glad that Baby wasn't quite ready to come out since she was only 35 weeks and 5 days at that point - which significantly increases her risks with lung development and the likelihood of a NICU stay.  Course, last Friday, Dr. Rogacz had a very serious and frank discussion with me that most type 1 babies wind up in the NICU for blood glucose abnormalities regardless of what the mommies do to prevent it... So taking a deep breath and trying to maintain the big picture here, we at least were making it one day farther along in the pregnancy than we thought when we first arrived at the hospital on Sunday night.

But would that be the end of things? Of course not! 

As we're driving back home, and yes while still contracting, I begin to cough.  By the time we got home by 2 AM, it was all I could do to make it to the bathroom where I promptly spent the next few hours lying on the floor coughing and vommiting up grotesque amounts of mucus.  Starting out clear and then turning bloody over time, one very concerned HB resolved to take me into urgent care first thing in the morning to get evaluated.  Needless to say, after spending the rest of the night with a deep chest cough and routine trips to the bathroom for more intimate sessions with the toilet, I was releived when 8 AM Monday morning finally came around and I was moved - contractions and all - back to the car for another round of medical proding. 

At urgent care, the doc ran some tests and without anything specific to go on gave me a perscription for azithromycin and told me to come back at the end of the week if I wasn't feeling better.  Not exactly the most confidence inspiring diagnosis, but it's at least something...  It was about that time that we got a call from my Mom saying that GW was throwing up as well, which as all of the mothers out there know, is just about the best news you can get when you're already sick yourself - boo! Swinging home and picking him up we took him back to the same urgent care doc (our pediatrician is up in NOVA as well) and even after he behaved so beautifully for her examination she couldn't put her finger on one specific thing that was making him ill.  Instructing us to keep him quiet and on a bland food diet, she sent him home with us with little more than a look of pity.

So, let's tally this up so far: contractions, check.  Vommitting, check check.  Coughing until crying, check.  Sick kid, check. 

What else can we add to this list?

OH YEAH! It's HB's birthday!  Given that I always have big plans to celebrate my boys on their birthdays, you can imagine the increased frustration I felt with myself for ruining HB's birthday with my attempts to cough up a lung and GW's saddening vomit episodes.  So instead of spending the day in the kitchen making him a lavish birthday cake and dinner as I normally would, I spent the day amid piles of blankets and kleenex.  I downed my first dose of antibiotics, took acetomenaphin for my newly setting in migraine and attempted to only vomit when absolutely necessary.  I don't know if any of you have ever tried to out will your body from being sick, but let me tell you, it doesn't work.  My body is just as stubborn - probably more so - than I am.  Between the respiratory thing I've contracted, body aches, head aches and these fricking inconsiderate, irrelevant contractions I don't think I could be more miserable or be more unhappy with the current state of things.

The really unfortunate thing about all of this is that if Baby decides to be born while I'm still sick and if (I'm not ready to say when yet) she needs to be in the NICU, then I can't see her. Fairfax INOVA has an increadibly strict policy for NICU visitors - as they should - and even if I'm one of the two approved people to be allowed in to see her, I can't (nor would I) go if I am even remotely sick... it's not worth the risk to her fragile immune system. Even if it'd break my heart to be away from her.  So while the doctors at my perinatal appointment this morning are pleased with Baby's development and how things look with her NST and sonogram (#16) stats -- she's 6 lbs 2 oz right now and her head size is at 38 weeks -- they're not thrilled by my continuing contractions or the thought of delivering a high risk baby to not only a high risk, but sick mother.

Awesome.

Thus under orders to do everything I possibly can to get better and quick (increased fluid intake, tylonal and loads of rest) all I can do at this point is keep things as quiet and non-stressful here as possible.  I can't do much to stop the contractions and I certainly can't replace the mucus plug that dislodged itself in anticipation of labor, but I can pray that the antibiotics work and hope that Baby waits until at least later this week to make her big (albiet she's smaller than GW was at this point) debute.

I'll keep you all posted as to how things are going...

Sunday, November 11, 2012

Week 35, part two: Beta Cells are Complicated!

Okay, so this post is coming a couple days later than it ought to have been put up - but with good reason.  It's been gorgeous here and I've been trying to soak up all of the warm sunny vibes from the world around me to balance the completely diabetes-world rocking appointment I had on Friday with my new (and might I add fabulous) Endocrinologist.  But before we get into the nitty-gritty details of what happened there, indulge me with a quick recap of the the second week 35 Baby check up...

As of Friday morning, Baby was incredibly active in her non-stress test (I credit HB for that since he sang to her) and her amniotic fluid index reading was slightly elevated but still within normal limits at just over 19.  "My doctor" was the only one of the four from the practice to be at the office rather than at the hospital testing center, so he had me see the nurse practitioner, Laura, for my check up.  With nothing earth shattering to report she ran the group-B strep test and checked for any effacement -- I hear back about the strep Tuesday at my first week 36 appointment and once again I've received compliments on my solid cervix (which I have to admit, I'm getting kind of tired of).  So she patted me on my head and sent me on my way... by far the least eventful and non-dramatic perinatal check up I've had in ages. 

So we go get lunch in Old Fairfax City while waiting for my endocrinology appointment to start, but when we eventually got there... oh my goodness, people... it was the nicest doctors office I've been in in ages AND they have the good sense to decorate with gorgeous photos of mountains (I'm a native Rocky Mountains girl, so mountains are a quick quick way to my heart).   With a 72 page chart faxed over from my old doc at UMW and a stack of freshly filled out new patient forms, the receptionist warmly welcomed me to their practice as if they'd been waiting for me for to grace them with my (albiet sickly) presence. Considering my first endo kinda dropped me on my head when we moved (we hadn't planned to change providers, but she insisted because of the "distance" ) and my second one was seriously incompetent, I think the look on my face at this woman's kindness must have been one of a deer in the head lights. What a pleasure.

Within minutes, a nurse was checking my vitals, taking blood for a HgA1C test and running through a basic history of my current diabetes status.  A few minutes later the door to the exam room opened and in walked this glowing angel of diabetes know how, Dr. Suzanne Rogacz.

Taking her time to look through my chart, to get a detailed verbal history of my life with diabetes and to talk through my current blood sugar roller coaster ride, she listened to what I said and responded to how I feel better than any specialist I've ever seen.  She didn't reprogram my pump - at all - or even ask me to take it off to verify it's settings.  She didn't ask for justification of my blood sugar logs and she confirmed that while the lows are concerning, the post-meal highs are more critical for this point in pregnancy because of the impact they have on Baby.  HALLELUJAH! After the ambivelance my last endocrinologist showed to those post prandial numbers, this was amazing to hear a licensed medical professional say something I expected!!

I'm seriously in love with her.

But, what is a good story without a twist right?  So we're going along through this appointment without surprises when WHAM! Out of the clear blue, Dr. Rogacz turns the tables and suggests that I reintroduce amylin to system ... In the two years that I've been an aggressive type 1 diabetic, I have never heard of it, I have never read about it, and I most certainly have never been told that I am missing it!!

Reading the look of confusion on my face, Dr. Rogacz explained that amylin is a hormone that is co-secreted with insulin by the beta cells of the pancreas to help regulate blood glucose.  Since my body destroyed those beta cells and made me externally dependent on synthetic resources, I'm not only naturally lacking insulin, I am also failing to self-produce amylin as well. She explained that it's not essential to "healthy living" like insulin is and that very few diabetic patients are selected to be put on amylin supplementation because it's a sensitive hormone that requires acute self-care to deal with the nuances of taking it (sever hypoglycemia becomes far more likely on amylin than just insulin by itself) and aggressive diabetes goals that are (unfortunately) uncommon with most diabetics, regardless of type.  But seeing as the hormone, which is only available in "Symlin" pen injection form, would smooth out my blood sugar patterns - making the peaks less high and the lows less low - she thinks that it could take me to the next level of blood glucose control that I am currently unable to do with an agressive insulin regimine alone.   Which, hypothetically speaking, is exactly what I need right now and what I want out of life in general --  the closer I can make my blood sugar resemble a non-diabetic's the healthier I can be for my husband and my kids.

 
Sooooooo... with little persuasion and a vote of confidence from a doctor I trust, we called the shot (haha) and I'm now injecting amylin at least three times a day in addition to wearing my 24/7/365 pocket-buddy of an insulin pump.  I'll admit that it's hard to get back into the routine of doing an injection whenever I want to eat anything more than 250 calories or 30 grams of carbs, but I'll fall into a routine one of these days and it'll eventually be old hat:  sit down evaluate the meal, input carbs into the pump and bolus insulin.  Pull out an alcohol wipe, clean off the symlin pen tip and abdominal injection site, attach the needle, set and stab. 

Simple enough, right?

We'll see how this goes.  I go back to see her again next Friday for another prenatal+endo check up.  I'm relieved to be working with someone who gets my goals and the factors that play in my individual case... she's supportive of my family planning, she's understanding of my physical goals and my running addiction, she is eager to help balance breast feeding and blood sugars... she's everything I could have asked for in an endocrinologist all wrapped up with a pretty bow. 

Merry early Christmas to me!

Wednesday, November 7, 2012

Week 35, part one

After the abominable doctors appointments I had Friday and the horrific blood glucose readings I had over the weekend, I was in full on pissy mode yesterday morning for my first week 35 perinatal appointment.  Between my baby-doc accusing me of irresponsibility and my pancreas-doc being a full on moron, it was impossible to not anticipate the worst coming into the appointment and to not expect another unnecessary, unwelcome tongue lashing.  I mean I know that these doctors are on my side and that the doc-patient relationship has been fine until now, but Friday's appointments were off putting enough to make me dread the next interaction.  It's almost like when I do an infusion change -- the needle doesn't always hurt, but once in a while I press that button and that needle jams into my skin and smarts like crazy! And, while that particular time stinks and I want nothing to do with the pain I'm in as I'm experiencing it, the next time I go to do an infusion change after the that is always worse because I'm just waiting for the sharp twinge that I just simply have zero interest inflicting upon myself.  So with a facial expression of complete exasperation mixed with anxiety, I give into the inevitable and subject myself to the (sometimes literal and sometimes figurative) jab again.

Oh the psychological stress of diabetes and pregnancy... fun stuff.

So while HB and I are waiting for round two of the verbal one-two combo (your diabetes management sucks and you're a horrible mother) to begin, I scowl my way through the (reactive) NST and (normal) AFI before being told my chart has been singularly assigned to the same doc that came down so hard on me Friday.  I was not happy.  Not only is this non-standard procedure for this practice - you usually get who you get and patients can't request to work with only one practitioner - but, while I thoroughly respect the guy and appreciate his knowledge with regards to the baby, his criticism of my diabetes control hurt like hell and I do not (repeat DO NOT) appreciate him stepping on my toes outside of his respective medical specialty lane.  Of course, this is all on top of the fact that the nurse practitioner I talked with via the phone on Monday said that this doctor is considering hospitalizing me again for the problems I'm having with my sugar control and that I should bring my hospital bag to every appointment... in other words, he's saying don't make plans.

Don't get me wrong, if I need to be monitored more closely for Baby's sake I'm fully willing to do what I need to do, but I'm not thrilled to be put through the stressful wringer of "am I coming home today?" at every single appointment!  I want to be and feel that I need to be home for GW's sake so as to keep his world as normal as possible pre-baby and Lord knows I have very little interest in bonding more with the High Risk Perinatal (HRP) Unit staff if I can avoid it.  No offense.

Clearly I was in a good mood and thrilled about the whole situation -- which of course didn't get much better when we got called back to the doctor's office to watch as he silently juggled my latest blood glucose logs, a due date calculator and flipped through my chart. Eventually looking up, the doctor confirms my gestational age as 35 weeks to the day and that the combination of my abnormal AFP levels and continuing reduction in insulin requirements means that "the placenta is conking out on us early."  Having done the research I already know this isn't a good thing and that the situation poses a bigger issue for Baby's health than anything, so it's no surprise that the doc explains that Baby may need to be delivered sooner than Nov 27 and that he's calling for more detailed sonograms to be done at least twice a week between now and delivery.  He'll be watching to see if her weight gain falls off, her non-stress tests are non-responsive, the amniotic fluid level changes dramatically or if her movements decrease because any of those symptoms will indicate that the placenta has transitioned from "just" extremely delicate and impaired to full on dysfunctional and dangerous. 

Awesome.

Amid all of this lovely news that surely did nothing to reduce my stress levels, the doctor surprised the heck out of me by going out of his way to reassure that none of this is my fault and that I'm doing an excellent job of handling what is going on.  You can imagine the look of confusion on my face...  either he genuinely altered his opinion of the situation from last Friday or he simply wanted to survive what I can only assume were death rays coming from my eye balls.  He encouragingly tells us that he made several calls and has arranged for me to see a better, NOVA based endocrinologist as soon as possible (this Friday).  So while things aren't going well placenta-wise and I am feeling beyond anxious about how the next couple weeks are going to play out, at the very least I can say I came out of yesterday's appointment with a plan for better, more consistent and aggressive medical care for the remainder of this pregnancy and beyond.  No longer having a single health care provider within an hour of our house, I guess it'd be fair to say that the writing is on the wall and it's just a matter of time before we move again... go figure.

The bottom line is that I managed to not get hospitalized yesterday and, God willing, that will stay the case at least until Friday.  My blood sugars are currently "stable" with lows only dipping into the 60s (not the 50s) and highs peaking in the 170s (not the 200s), so we continue the wait and see game that I wish with all of my heart had lower stakes.  It's funny, in a random conversation I had recently, someone assumed that my current existence is simply composed of "taking it easy at home" rather than actually doing something -- and while I have to laugh at the ignorance of the statement (clearly they'd never been on bed rest), it was beyond frustrating that this person couldn't wrap their head around the implications of what I'm medically facing.  I'm not scared of what child birth could mean to my life or safety, but the risks that go into delivering this baby into the world given the complications she is already fighting are more than enough to cause the insomnia, nausea and muscle knots that I can't shake.  I truly hate the combination of diabetes and pregnancy, the I-95 corridor and NOVA traffic, the distance to the hospital and the complete inability to predict anything with regards to delivery...  

There's nothing easy about this.  Absolutely nothing.