Tuesday, January 29, 2013

Running, sans supervision!


The last couple weeks have been over cast, cold and dreary - more or less the meteorological embodiment of my state of mind and energy levels.  I've avoided leaving the house without HB in an attempt to reduce the overwhelmed feeling I get when GW is melting down, GV is hollering to be fed and Lord knows what else is pulling me in six different directions and making my back seize with stress.  Fortunately when HB is home I've got the backup I need, but, I tell you, when it's just me and those clouds I couldn't feel more unmotivated to complicate my life with a trip to the grocery store or rainy playground outing.  But today things were different.  It was the nicest, warmest weather we've had in Virginia in ages - seriously the sky looked fake it was so blue! The sun was shining and, even though HB wasn't here, I decided to take my chances and get out of the house.

Going through the pre-outing check list, I tested my post-breakfast blood sugar to make sure it'd be stable enough to take the kids out on my own.  My meter beeped and it read 230 mg/dL; way high.  Now, granted, hyperglycemic blood sugars ensure I wont randomly pass out and leave my children unsupervised on a walking trail or vulnerable on the swings, but for someone who takes pride in tight glucose control such high numbers are horrific.  I don't know what's causing them, but I've seen several high readings like this lately - I mean I am not under bolusing, miscounting carbs or over eating... I'm just off.   I'll need to talk to my endocrinologist about this...

So I punch in the bg numbers into my pump to see if a correction dose is necessary; which it isn't.  I've got 2.3 active units of insulin left in my system from my breakfast bolus and I only need a measly 1.3 units to get back down into my ideal blood sugar range.  But not wanting to wait for it to take it's sweet time (haha, get it?) to come back down I decided to throw out the mental debate I'd been having between taking GW for a bike ride or simply going to the playground and opt to go for a run instead. 

Now, I've never done this before... "this" being running with the stroller and "this" also being running by my-diabetic-self because HB always pushes the stroller and HB always runs with me.  You might think this is mean of me for not helping tote the extra weight around (stroller: 34 lbs + GW: 38.5 lbs + GV: 13.3 lbs + GV's car seat: 11.7 lbs = 97.5 extra lbs!) or you might think I'm genius for creating a scenario that "requires" HB to exercise, but the reality is the stroller makes my hands go numb (a sensation I loath) and I am terrified of the worst case outcome when combining diabetes with exercise, passing out.  If I pass out with HB around he knows what to do, but if I pass out without him the what ifs start to pile up and I typically don't find the risks worth running. Literally. 

But with my blood sugar sky high, the weather this nice and my mood more zipp-a-dee-doo-dah than normal, I detach my pump, place it on the night stand, lace up my Asics and we head to the car.  Since exercise works to improve insulin efficiency in the body, I know that by running my glucose levels will drop and by starting with my blood sugar so high, removing my pump and strategically checking my bgs along the way I can get back down into a healthy range sooner and then consume quick acting carbs as necessary to prevent going too low.  So without my babysitter and child-pusher, I put my music on and hit the pavement... within one mile my blood sugar was down to 138 mg/dL and by the end of the three mile loop it'd gotten down to 65.  

Admittedly I failed to keep my sugars in the safe range, but I accomplished everything else.  I'd put a mental block in my head about my ability to push that stroller and run on my own that didn't need to be there.  So what that my hands loose sensation? And, yeah, my diabetes still requires conscientious treatment, but oh well, c'est la vie. The point is I can do it - and not half badly either!  Granted I'm not about to let HB off the hook now and run on my own all the time, I'd still prefer to have him around... it just goes to show that the lesson learned today is that I run with HB because I want to, not because I have to.  

Monday, January 28, 2013

Two month update

GV is two months old already.  I don't really know where the past eight weeks have gone, but they have and, to be honest, the drama of the pregnancy feels like years ago. Our life with GV around feels so natural and normal - albeit crazy at times, but that is typical.  We've found a battle rhythm that seems to keep everyone happy, most of the time, and despite GW's lectures to GV that she "needs to poop in the toilet, not the diaper!" I think they're doing remarkably well together.  He is very eager to help out with her and she just lights up whenever he is around - lectures and all.

We took GV into the pediatrician today for her third well baby appointment and, despite the tears she shed over her three vaccinations, I am glad to report that it went really well.  She's a very healthy, happy baby and the doctor had nothing but positive things to say about her development and growth.  Check out her stats:

Weight: 13 pounds 3 ounces (96% up from 22% week two)
Length: 23 inches (75% up from 50% week two)
Head Circumference: 15 3/4 inches (81% up from 26% week two)

Despite the diabetic baseline and the number of additional complications we had in the pregnancy, it seems that the care I took to make sure she'd be safe both in utero and after birth paid off.  She's a perfectly normal baby and that is the most any mother - diabetic or not - could hope for!  I just continue to pray to God that she stays healthy, happy and safe for her whole life... and may it be a long one.

 
Love you GV - xoxo

Friday, January 25, 2013

Honesty: a scary policy.


I have been struggling the past few days with very conflicting interests.

On one hand I create these posts with the intention of providing family, friends and strangers alike with a comprehensive view of what my life is like as a type one diabetic.  I mean for them to act as an educational tool and a running commentary on my daily trials and tribulations so as to prevent perpetual ignorance about my disease and to demonstrate the breadth of impact diabetes has, regardless of the topic.  Of course this has been somewhat embarrassing at times, but in light of the goal I set out to accomplish with this blog I've been striving to say whatever I ought to say that is relevant to the subject.  Face it, one can't "comprehensively" talk about such things as pregnancy and diabetes without mentioning such socially uncomfortable details as one's cervix.

Which brings me to the other hand. The reality is, there are topics that I am quite self-conscious to cover and I avoid for fear of other's judgement and censure.  Not to mention, if I don't write about a topic, then I avoid acknowledging it and inadvertently providing validation to pieces of myself that I'd rather didn't exist. The lens that I voluntarily create, therefore, has the ability to insulate me from vulnerability by allowing me to share information on my own terms, edited as necessary.

But in placing my concern for criticism above my goal for "comprehensive" topic coverage, I stifle any self growth I could otherwise achieve and I might as well resign a career in creative writing before even starting! What's that old saying? If you can't stand the heat, get out of the kitchen.  Well... I like to cook and I like to write... so I'd better work on tougher, more heat resistant skin.  That said, I find myself being untrue to you, the reader, by purposefully not writing about something that is central to my current life with diabetes: postpartum depression.   

I'd suffered from chronic depression a lot when I was younger and, mainly due to the social stigma around the condition, I've always found it very difficult to talk about being unhappy and why I was so.  I remember a conversation I had with HB early on in our relationship where I tried to openly share this part of my world and he dismissed the diagnosis as snake oil and advised that I attempt "keep more busy." Obviously that hurt, but that was then and we've since had time to come to terms with the factual existence of complications caused by chemical imbalances and to build a more constructive, supportive relationship.  (To his credit, I must say that such a quote seems horrifically misattributed to him and I very much appreciate his new found open minded approach to me and the world.

There is no appropriate time to talk about depression and there is certainly no easy way to go about it, but seeing as I've written about every other pregnancy complication I've experienced, it seems disingenuous to omit this one from the record simply to spare my own discomfort.  The fact of the matter is that postpartum depression is a childbirth complication that is caused by hormone changes and imbalances... and I seem to be struggling with it.  I'm moody, withdrawn, fatigued and frustrated.  Don't get me wrong I love being a Mom and some of these feelings are standard operating procedures for the job, but when showering sounds like too much work, the couch is my new best friend and I have no will to fight my son watching Chitty Chitty Bang Bang for the billionth time it is time to admit something isn't quite right.

I don't recall having issues with this after my first pregnancy, but in doing some reading about the condition, I am not at all surprised by its occurrence now.  As it turns out, a 2009 research study competed by the Harvard Medical School and University of Minnesota School of Public Health found a definitive link between diabetes and postpartum depression.  Among the 11,000 women who were tested, those with any kind of diabetes - be that type 1, type 2 or gestational - were two times more likely to develop depression during or after pregnancy.  Unfortunately the research did not extend farther to identify the connection between the two illnesses, but it is the first study to demonstrate the existence of a relationship and it certainly warrants further inquiry on the topic that I ardently hope they'll do.  Until then I guess I just happen to be one of the lucky 1 in 10 diabetic mothers who get to figure out how to deal with it... 

I wish I had a plan of action that would spell out S-U-C-C-E-S-S in treating this complication, but I don't want to be on medication and I can only guess at what other changes might be effective. I think writing about it here is at least one step in the right direction because no matter how hard it is for me to admit its exists or how much I dread what people may say, it is part of my reality and ignoring it wont make it disappear.  And if I am scared to write about this then what else am I going to be too afraid to publish?  I can't afford that fear and there shouldn't be a place for it here. 

I'm not perfect, but I am honest.  As terrified as I may be in saying these things, I believe it's the right thing to do and, on the off chance there is a diabetic Mom out there reading this and experiencing what I am, you're not alone.  It's not the best hand to be dealt, but we've got to face it and keep moving. If not for us, then at least for our kids. 

Thursday, January 24, 2013

Two Year Anniversary

Two years ago today, at some forgotten hour in the afternoon my existence changed with a diagnosis of diabetes.  I remember the relief I felt that day when the doctor announced my newly acquired accessory (because, let's face it, diabetes manifests itself as battery operated, pocket sized baggage) as if I'd some how dodged a bullet and gotten off easy -- it's not cancer, after all.  But sitting here 730 days later I can't help but feel very sad that I wound up in such a serious, long term committed relationship with artificial insulin.

In a lot of ways I feel like I am married to my pancreas and not in a happily ever after, ride off into the sunset kind of way -- it is more like the drunken, bad idea, spur of the moment Vegas wedding with divorce banned in the prenup kind of way.  I was a happy, healthy and independent woman before January 24, 2011 and then BAM! I woke up and found myself in bed (one that I did not make, by the way) with a disgustingly lazy pancreas that is inexcusably and exhaustively high maintenance.  I don't like it, I certainly don't love it and I'm sick (literally) of it.

Honestly folks, I am tired of being diabetic.  I am (postpartum-exacerbated) depressed about being diabetic. I mean when you get the flu it is horrible and you curl up in the fetal position for a week or so and then you're back up on your feet, good as new.  But with diabetes, it's emotionally like I've had the flu ever since I left Georgetown Hospital.  I rationally understand that the disease I have could be a worse one and that my diabetes is not nearly as bad as it could be (or as the flu feels), but the work it takes to keep it this way and to prevent all of the worse diseases that diabetes can cause takes constant attention.  And I am tired.  I want to be done.  But there is no cure, there is just treatment.  Maybe someday this will change, but until then the unfortunate relationship continues.

So, my non-honey, anti-sweet, not-so-dear pancreas, happy anniversary.  Seeing as this is year two, I guess I'm supposed to give you something cotton and I think any one of these t-shirts expresses my true sentiments about you.  Take your pick!


Wednesday, January 23, 2013

Six Week Check

Now that GV is officially eight weeks old, I should probably get around to writing about my six week post-delivery follow up with the Perinatal Associates of NOVA as that appointment really and truly acts as the finishing period to a very long, run-on pregnancy sentence.  A lot happened over the course of those 38 weeks that I didn't expect and coming into this appointment I had a list of eleven multi-part questions I needed answers to.  Fortunately, the office purposely scheduled my appointment with Dr. Bronsky and seeing as he cared for the majority of my case I was able to receive much of the information I was looking for... Since you all have accompanied me on this journey, it seems only right that you get closure to my questions as well:

1.  What results did the placenta pathology find?

Instead of sending the placenta to disposal as hazardous waste as is typical of most hospitals, Dr. Bronsky sent my placenta to the lab for pathological analysis in hopes of more in depth answers to why my AFP levels were abnormal, the extent of the abruption and why my blood sugars were atypically trending low.  Unfortunately, the report wound up being predominantly uninformative, save one factor: the placenta's weight.  Apparently a typical, healthy placenta for a typical, healthy pregnancy weighs nearly 1800 grams or, at a minimum, 1/6 the weight of the baby at birth - which in GV's case would have been about 600 grams.   This placenta weighed 298 grams.

This excessively small size for a placenta could be the reason for the abnormal AFP levels and my blood sugars dropping given it's insufficient capacity, but there is no way to know for sure.  Furthermore, there is no way of knowing why the placenta was so small in the first place - it is possible that the abruption could have caused its small size or it is conversely possible the small size could have played a hand in the cause of the abruption... it's just another version of the chicken and the egg debate. Only God knows.

The only thing Dr. Bronsky definitively said on this topic was that he is shocked that GV was as large as she was at 6 lbs 14 oz because such complications usually present issues of growth restriction -- which if you remember was the concerns we had with possible placenta calcification.  Guess this goes to show that placenta deterioration was an issue, not because it was prematurely breaking down but rather because it was abnormally petite.

2. What happened to the epidural?

There is no way to know why the epidural failed.  Dr. Bronsky said that there were clearly some mistakes made by the nursing staff in that they didn't attempt to fix the issue quickly or call anesthesiology to have them evaluate what was occurring. But given how quickly GV arrived their intercession would have likely been irrelevant in this case anyway.

3.a. Are additional pregnancies safe?

Assuming my blood sugar is under tight control prior to conception, Dr. Bronsky believes there are no reasons why future pregnancies would be inadvisable.  Granted, they will all be complicated and high risk because of my preexisting diabetes, but my safety and the well being of potential babies is not inherently in jeopardy based on what he saw with this pregnancy.

3.b.  Are there different timing requirements between pregnancies for a diabetic?

No, diabetics don't need to wait x number of months longer than non-diabetics to conceive again.  However, like with all women, it is advisable that new mothers wait twelve months before trying so as to permit their bodies time for full recuperation before attempting the physical stress subsequent pregnancies.

4.  At what age should I stop having babies due to compounding diabetes and age risks?

Knowing that pregnancies are considered to be high risk for women over the age of 35 due to an increased risk for birth defects, low birth weight, and macrosomia, Dr. Bronsky explained that while it's not exactly advisable the reality is that it all depends on how things go between now and then.  If over the next several years pregnancies go smoothly and I continue to stay healthy, then there is no reason post age 35 pregnancies can't happen safely.  Alternatively, if pregnancies become more difficult and present more serious complications, then fewer pregnancies, even before age 35, may be called for.

5.a.  Will multiple pregnancies as a diabetic increase my risk of diabetes complications?

No, but the longer that my body is exposed to the disease of diabetes, regardless of the number of pregnancies I may have, the more likely I am to have complications.  Fortunately the better controlled my diabetes the less probable complications are.

5.b.  Will multiple pregnancies as a diabetic increase the in utero risks for future fetuses?

No, the number of pregnancies I have as a diabetic is irrelevant to the degree of risk future babies may face.  The complications of previous pregnancies, however, will potentially increase this risk factor and should be considered after the completion of any additional pregnancies.   See question 11.

6.  Will the complications from this pregnancy be likely in future ones?  And can I do anything to proactively prevent them?

All of the complications I faced with this pregnancy are possible - and to one degree or another, more likely - in future pregnancies, but there isn't a definitive way of predicting what complications may or may not happen again.  Seeing as this will be discovered on a case by case basis, there isn't anything I can do now to prevent x, y or z complication except to be as healthy as diabetically (diabolically?) possible.

7.  Is there anything I can do differently in future pregnancies that will prevent complications?

No.  (Hmph)

8.  Can we expect my blood sugar to behave similarly in future pregnancies?

No.  It could be the same, it could be better or it could be worse.  (Hmph)

9.  Should I assume that the next baby will arrive faster that GV did?

As the skids are greased with GW's quick arrival and GV's 3 pushes, it is quite likely that the next baby will arrive quickly as well.  Dr. Bronsky advised we move closer to the hospital before then... I tend to agree. 

10.  Is there anything I should do perpetually to prepare for any possible future pregnancies?

Beyond keeping my diabetes in check with a stellar HgA1C, the only thing I can do regularly is take a folic acid supplement.  Since the majority of critical organ development happens almost immediately upon conception daily pre-pregnancy doses of folic acid decreases the likelihood of birth defects and ensures proper neural tube formation.

11.  Will I always be a class B diabetic or will that change?

Yes it will change, but background information first: there is a scale called the "white classification" used by perinatologists to classify diabetic women into various explanatory groups based on their diabetes and the risks associated with it.  I currently fall under the "class B" group as I am a person who was diagnosed less than ten years ago and after the age of twenty.  In eight years, however, I will become a "class C" diabetic because my exposure to diabetes will be greater than ten years and in eighteen years I'll once again be "upgraded" to a "class D."

The White Classification was created by Priscilla  White in 1949
to partially predict the course of treatment for a pregnant diabetic
and the chances of newborn survival.

And there you have it...

I'll admit to being extremely relieved that this appointment didn't shatter my dreams of a large family.  I've long been fearing that one complication or another may push me over the edge in terms of risk, but for the time being I'm alright and that is all I can ask for. I'm not sure how many kids we ultimately want in the end (maybe four? maybe five? maybe twelve? ... just kidding... sort of), but God willing however many healthy babies we can have we'll get - after that there's always adoption, HB willing.

Monday, January 21, 2013

Inabilities.

For the past several weeks I have been fighting tooth and nail with the word "can't."  I can't cook dinner with a migraine.  I can't nurse GV and "rock-a-baby" GW simultaneously.  I can't test my blood sugar one handed.  I can't find a spare moment to write more than a sentence or two at a time.  I can't fit my new books onto the already full bookshelves.  I can't get GW to take his (much needed) nap - and consequently I can't take a (much needed) nap.  I can't get a quality resolution picture of GV with my camera phone.  And, the cherry on top of it all, I can't stand GW saying the word "can't."

I guess my little sponge has picked up on my repetitive use of the word lately and has usurped it for his own use.  I shouldn't blame him for adopting the vocabulary he hears - I mean, at least we don't use vulgar language around him - but you can imagine my annoyance with his perfectly quipped and quick response to "go to time out" being a simple "I can't." Fortunately, being infinitely wiser than he at age 3 (wiser sounds much better than older, don't you agree?), I have miraculously found maternal ways to overcome such toddler identified inabilities; unfortunately, the limitations I find myself facing aren't quite as easily solved by sitting in the green and white striped chair in his room for some predetermined number of minutes.  Granted, GW regularly tries to send me to said chair and I'm sure he would love to see me work through my "case of the can'ts" from the corner, but the double sided nature of being Mom is that while I'm immune to such punishment, my problems are as well.  Seeing as I can't shake my troubles that way, I'm forced to find alternative methods of treatment... which appears to be gripping about them here.

Now, I could spend the next several paragraphs writing about any number of things I can't stand or can't fix, but when it comes down to it there is only one thing that has me completely infuriated: my inability to make air rise.  Scientifically speaking this should be a God given faculty that I share with every other human being on earth - I mean it is a known fact that warm air rises and that density has a correlational relationship to gravity - but for whatever reason I am physically impaired in this department.  Let me explain:

Scenario One:  When I do an infusion change, I have to attach a new reservoir to an insulin vial in order to fill it with the appropriate number of units to last me two to three days.  I make sure that the reservoir is full of air, I attach it to the top of the vial, inject the air and invert the vial.  By doing this I create pressure in the vial and enable the insulin to transfer containers more easily when I pull the plunger back down and suck insulin into the reservoir.  At this point I need to get all of the remaining air in the reservoir back into the vial so that I do not wind up with air pockets in my pump tubing, so I tap the side of the reservoir to make the bubbles rise and then I inject them back into the vial.

Only problem is that I can tap, flick, even bang the reservoir until my fingers bleed, my pencil breaks or the reservoir flies off at impact on the table and I still can't get those fricking air bubbles to rise.  They stubbornly stick to the bottom or side of the reservoir and I can imagine them cackling at my frustration each time they evade my scientific understanding of liquid vs. gas.

It's maddening.

Scenario Two:  My little GV is a phenomenal eater.  At seven weeks old, she has put on just under four pounds since birth and she's starting to put 2 + 2 together and she makes a beautiful smile every time I pick her up to nurse.  She usually nurses for twenty to forty minutes at each feeding and, typically, she needs to be burped once in the middle and once at the end.

Unfortunately, however, no matter how I attempt to burp her or how many times I pat her on the back I can't get that gorgeous little girl to eruct! I'll spend an infuriating amount of time attempting to fix my loosing record, but every time I wind up needing to pass her off to HB who immediately gets her to burp within seconds of the exchange.

Again, maddening.

After attempting what feels like every possible technique change known to man, I don't know what else I can do to change such obnoxious inabilities.  I've tried hard to be creative in my solutions (and yes, I've even tried time outs) but sometimes it just seems like the deck is stacked against me and there is just no winning.  I'm trying my darnedest to cut the can'ts out and to implement a more can-do optimism to my naturally pessimistic self, particularly for GW's vocabulary sake, but with frustration and annoyance I am throwing my hands up and leaving the raising of air to the rest of humanity.

Perhaps there is something else, like the completion of this blog post for example, I actually can do something about... take that can't I'm attempting a come back!

Left: My fall 2009 can-do solution to GW wanting to be held
and the necessity to finish a grad school research paper.
Right:  My can-do solution to GV wanting to be held and
the need to complete summer 2013 course reading.   

Wednesday, January 9, 2013

Coming soon...

So I've been working on a blog post titled "Inability" for about a week now and I just seem unable to finish it.  How ironic.