Friday, November 2, 2012

Week 34, part freaking two

Hmph.  Double hmph.  And grump!

It has just been one of those no good, down right horrible, get off my back, leave me alone or give me chocolate kind of days.   I didn't sleep well last night because GW, who is usually the best snuggler in the world, kept trying to head butt me in the chest to make space for his legs to go sideways on the bed and that of course made the fact that the alarm went off extra early so that HB and I could get to the hospital on time for my bi-weekly testing all the more gruesome.  Normally an hour drive, we left an additional 30 minutes early to fight the in-bound morning traffic to NOVA and DC and managed to get to the valet parking at the hospital with a few minutes to spare before my 8:30 appt.  Of course the antenatal testing center was running a bit late and we wound up sitting for an additional 45 minutes, but whose counting? (Oh yeah, me).

So we finally get back to the non-stress testing area and it's beyond freezing -- and for those of you who do not know me personally, I do not do well with any temperature below 70 degrees F.   The nurse, who I'll admit was very nice, squirts the non-heated (gasp!) goo on the paddles and hooks it up to my belly.  About fifteen minutes into the test she grumbles about the sleeping baby, gets me cold ice water to drink (again, gasp!) hoping to wake up the baby.  After the next fifteen minutes she decided to shut off the monitor and get the doc's take on my NST since the accelerations were borderline to where they ought to be (ideally they should rise by 15 beats per minute over the course of 15 seconds or more, Baby's were going up for like 13 seconds).  Leaving me sitting there in frigid goo under an air conditioning vent for another while, she eventually came back to announce that the results were acceptable and she sends HB and I back to the waiting room for the next available sonographer.

Waddling down the hall back to the waiting room, we turn the corner and find that the formerly sparsely filled room is now as packed as it possibly can be with pregnant women and significant others.  We found ourselves a corner and, to fill the dragging time, I started counting...  at any given moment there were between 11 and 16 pregnant women in that dang room.  Some closer to popping than me, others barely showing -- but all obvious with their hospital band bracelets.  It's funny how pregnant women take on different shapes and how differently we all carry... at 8.5 months I look like the typical woman does at six months and one woman's jaw actually dropped when she learned my due date is only two weeks after hers since we look so drastically different.  Course she'll probably get lucky and meet her baby sooner than I will, so size - ladies and gentlemen - really doesn't matter.

Anyway, the sonographer finally calls me back and does the quickest sonogram of my pregnancy yet.  She absolutely knew what she was looking at and clearly took speed clicking classes because bang bang bang and "you can go sit down and the doctor will call you back shortly."  I think if I had been a normal pregnant woman and that this was one of the very few times I could see my baby on the monitor I'd have been annoyed, but since this was sonogram #15 and I wanted part two of breakfast asap it was perfectly fine with me.

So back out to the waiting room we march and waited among the collection of mamas.  We watched the third interview with Sarah Silverman on morning television, we cringed at a 3 year old little girl with horrible manners boss her mother around and we joked about our lapse in judgement at leaving our entertainment (GW) back at home.  Some time later, this random doctor comes out and calls my name and I have no freaking clue who this guy is.  His jacket says that he's a "MFM MD" which is at least one step in the right direction, but seeing as I'd never heard of him, he looked like he is 12 years old with facial hair and I admittedly have little to no faith in medical fellows I was not exactly thrilled to see a non-familiar face behind the desk.  After pulling out a phone book to sit on and figuring out which way is up on my several inches thick chart, Dougie Howser then reviews my tests says that things with the baby were fine with the exception that the AFI was a bit high (even though it was lower than Wednesday).   Understanding that it was in normal limits, I moved on from that comment and handed him a print out of my blood glucose charts from the last three days and that - my friends - began the worst part of my day...

Not understanding the charts or what information I was trying to explain to him, Dougie decides to take my print out down the hall to my normal doctor (why couldn't I just see him in the first place?) for his take on things.  The next thing I know is that we're being called into the principal's office for a serious parent-doctor sit down...  Thoroughly disappointed in my asking him for "input" (which I did not), the normal doc began a lecture about insulin care during pregnancy and how off my blood glucose numbers are and how poorly programmed my pump must be.  Looking specifically at my pump settings and seeing that my basal rate is no where close to 50% of my daily insulin usage (which it ought to be), he said that I needed to stop self-managing and start working more closely with my endocrinologist or that he'd need to take me off the pump and put me back on injections so that he could manage my glucose.

ONLY OUT OF MY COLD DEAD FINGERS WILL 
A DOCTOR PRY MY PUMP AWAY FROM ME. 
(Adapted from a Charlton Heston quote)

I attempted to explain that I've tried to work with my endocrinologist's office and that they typically aren't responsive or they just tell me to do what I'd otherwise do for myself, but that just seemed to result in more frustration on my doctor's part than understanding.  He then said that I needed to get into see my endocrinologist today for an emergency reprogramming of my pump or that I'd at the very least need to begin seeing a different NOVA based endocrinologist next week.  I tried to explain that my concern in bringing up my blood sugar with him isn't that I need external input in how to decrease my settings (that's straight forward and I've done it successfully for the last 34+ weeks without problem), but the cause of the lows -- to which he pretty much left me with no answer except "see you Tuesday."

Thus leaving the hospital in near-tears from the feeling of being completely misunderstood and the "you're a horrible mother" treatment, I immediately called the endocrinologist to pass the buck along.  Fortunately having space for me in the schedule once we got back from NOVA, I was able to get in and sit down with my endocrinologist to go through my logs with a fine tooth comb.  Agreeing with me - and the NOVA doctor - that my logs show far too many lows, she did exactly what I would have done on my own and lowered my basal rates even farther.  Cutting every single basal setting by 0.050 units, my total daily basal rates are down to 12.875 units!!  I asked her about the randomly high postprandial readings, but she said they weren't of concern to her because of the extreme prevalence of hypoglycemic lows and she lectured that those 40s and 50s should be my only concern as well.  When asked about how I should address the chastisement I received for the 50-50% ratio of daily bolus to basal insulin usage, she essentially told me that my perinatologist would just have to get over it since that's just how things are going.

So... my perinatologist yells at me for horrible diabetes care and my endocrinologist barely does anything to "solve" the problem AND neither have an explanation for why my sugars continue to drop but rather they each individually want to point the finger at the other and say, "well, that's their job."

AGH!

I don't know... I feel like my blood sugar control has been pretty good for the pregnancy all things considered.  These lows are definitely concerning to me and they make me frustrated and scared, but I can recognize them and treat them as they happen so it's not the worst case scenario of hypoglycemia I could face (knock on wood).  I'm angry that my doctor up north would blame me for the problem I am only trying to fix and I'm annoyed that my doctor down south is being so passive...   All I can say is that I am hella happy that the baby is due in 25 days or less (less, please God, let it be less) and that I can put this excessively hands on medical care out of my life for a while.  I'm looking forward to working with our pediatrician (aka a doctor for someone else, not me) for regular well-baby appointments and I cannot wait to get back into running.  Any outlet for frustration besides chocolate would be fantastic right about now, but hey, I'm a hypoglycemic, post-placenta abruption, 8.5 month pregnant woman on modified bed rest so that just isn't going to happen.

Pass the chocolate.

Hmph.

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