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.

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