Sunday, December 30, 2012

2 miles down, 22 lbs to go


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.


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!


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


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!