Tuesday, December 30, 2014

Week 32

Squeezing just one more appointment into 2014, today marks the beginning of my incessant trips up and down I-95 for perinatal appointments.  Starting weekly appointments, soon to be bi-weekly appointments, I went into today with my fingers crossed that we'd be able to receive more complete information about Baby #3 than we did just two weeks ago from Doctor Bronsky.  It's not that I've been worried - okay, maybe it's more accurate to say that I am no more worried than normal - since we received jack-squat in hard-fact updates, but with how hard I've been working to keep my glucose on target and my weight (and the eggs...) down all while enduring near constant Braxton Hicks contractions leaves me feeling like knowing something - knowing ANYTHING - more than last time would at least give me a context within which to frame my insomnia and compulsive (aka distracting) fiction reading.  

Having received a reminder call yesterday about my "appointment with Dr. Bronsky tomorrow at 10:00 AM," I became more anxious for answers as we walked into the, once again, full waiting room.    Realizing something must have changed with their scheduling procedures, I said a quick thank you to God that we brought GV along for the day given her compact-sized entertainment value package. While waiting... and waiting... and waiting... and waiting to be called back for my lab work, sonogram or first non-stress test (NST) of this pregnancy, GV took it upon herself to wish everyone in the room an individual "Happy New Year!" in her best Shirley Temple attempting to be Santa Claus voice.  Noting the several holiday decorations around the room, she also began a ruckus round of who's on first with me, much to the delight of the other couples and staff witnessing the conversation: 

GV: "Look Mama! My found a Christmas tree!"
Me:  "No, GV, say 'I found a Christmas tree."
GV: "You found a Christmas tree, Mama?"
Me:  "No, I didn't find a Christmas tree.  GV found the Christmas tree. Can you say, 'I found a Christmas tree'?"
GV:  "My found a Christmas tree!"
Me: "No, say 'I found a Christmas tree.'"
GV: "You found a Christmas Tree?" 
Me:  "AGH!"

You get the gist...

Anyway, eventually I am called back by the quiet Chinese sonographer and we traipse our way back to the exam room (where GV promptly insists we should look at baby via her belly button).  Knowing it's now or maybe never that we get our answers about Baby #3 for the day, we promptly start to hound her with questions about my AFI levels, his weight and size.  Happy to please, she not only provided us with another set of 3D pictures of the little one, but the cold hard facts I was craving: 

Amniotic fluid index: 30.0  (99%)
Fetal weight: 5 lbs 2 oz (74%) 
Head circumference:  32.2 CM (84% or 36 wks 3 days)
Abdominal circumference: 30.0 CM (88% or 34 wks) 
Femur length: 6.3 CM (38% or 33 wks 4 days) (huh...)

Thanking her profusely for her assistance, I head back out to the waiting room where GV and I inevitably continue our two-year old pronoun reindeer games until I'm called back for my basic biophysical profile check.  Finding my weight to be up one pound since my appointment two weeks ago and my blood pressure to be perfectly within my normal range (114/63), the nurse sticks a gigantic pink sticky note to the front of my chart reading "KETONES (++)" before sending me back to wait for Dr. Bronsky's patient que to call my number.  Another fifteen or so minutes later, we're finally shown in to his office where we sit down and I automatically tense from nerves and HB puts on his "drill the doctor" face.

"So between his weight and the AFI levels, are we looking at scheduling the induction shortly?" HB asks in a leading manner.  

"The hospital won't allow for us to schedule an induction farther than 3 weeks out," Dr. Bronsky responds barely looking away from my electronic chart. 

"Even with him measuring several weeks ahead and her amniotic fluid levels so high?"

"Well, his weight and the AFI levels are all high because you're diabetic," he explained. "We won't let you go past 38 weeks anyway." 

Feeling stung by this last comment given my stellar HgA1C, I chose this moment to chime in that my glucose is under tight control. 

"So why are you spilling ketones?" he asks over his glasses.  

Having gone hyperglycemic over night (peaked at 178 mg/dL) due to changing basal requirements and still coming down post morning coffee (sample taken while at 148 mg/dL), I showed him my glucose monitor and the absolutely minimal out of range fluctuations I've had for the past 24 hours.   Knowing his threat with GV that "if you don't get your postprandials under control, you're going off the pump and onto injections," I shouldn't have been surprised by his expression of curiosity and confusion upon seeing my CGM monitor but his limited understanding of it spewed forth in his following comments: 

"Your glucose still swings dramatically, so these complications are directly relevant to your glucose control."


Even with a HgA1C in the solidly normal, non-diabetic range of 4.1 to 5.9 (currently sitting at 5.5), this comment hit me like a ton of bricks: there is absolutely nothing more I can actively do to protect this baby from my diabetes.  Regardless of my locked down diet, my minimalist insulin usage and my target glucose range of 70 to 140 mg/dL, my limited tolerance of glucose is impacting Baby's glucose  ranges (aka his macrosomia), urine output (aka my AFI levels) and delivery options (induction or c-section, here I come).   It's honestly no wonder that my irritable uterus went into an encore round of Braxton Hicks just in time for my non-stress test to start - gee, thanks doc, for the pep talk.  Fortunately, Baby showed the proper accelerations and decelerations of his heart rate so at least I have that one shred of silver lining for the day that his heart, at least, isn't screwed up because of me! 

Information wise, the appointment was a major success. Emotionally speaking, however, I'd be lying if I said that I didn't feel like I've been run over by a bus.  I so try to put everything into taking care of this little one (and the older two, of course), but today left me with this feeling of unavoidable inadequacy and, it's knock-on effect, a dreaded sense of hopelessness that I am finding difficult to curtail when faced with yet another omelet dinner...  I realize it's only another handful of weeks (GW arrived at 36 wks and GV at 38, so that puts us anywhere from four to six weeks away from show time) until we're at the finish line and fumbling now isn't worth the cost of admission, so I won't, but dang it I'm exhausted and hurt and ... 

Until next week, I guess. 

Tuesday, December 23, 2014

UPS Fail.

Okay, I know that it is the holidays and for that reason alone slack should be granted to the poor schlubs who are working exceptionally long, seasonal hours to deliver packages across the country before the good ol’ Saint Nick deadline of December 24, but right now I am beyond angry.   Just five minutes ago, my Mastiff gave me the pleading look of “oh dear goodness, I need to go outside or you need to get the Bissell” so I wrapped up what I was doing and went to the front door to let her out.  Now, our yard doesn’t have a fence and our dog is one of those freakish varieties that won’t run away, stays on our property and comes back to the door as soon as her business is addressed, so I thought nothing of it when I opened the front door, realized it was raining and stepped back to wait for my 118 lbs of pooch to return.  Seeing as she’s more terrified of rain and water than I am (and that is saying something), she ran down the front steps, skipped her typical condeming look of “wait, you aren’t coming with me?” and proceeded to run out into the darkness.  Wanting to keep a watchful eye on her for good measure, I flipped on the front porch light and waited for her to reappear with a wet-cat skulk.

Scampering up to the door, I opened it and looked down to watch her track wet paw prints into the foyer when I saw it.  A lone cardboard package sitting just beside the door on the brick landing in the puddle that perpetually forms whenever it rains.  Now, I could be mad at the person who incomprehensibly formed the stoop to be concave at just the precise location where packages were apt to be delivered, but they screwed up back in the 1970s and I am fairly positive that the statute of limitations on that one has expired.  The UPS guy, however, knows better.  Having delivered package upon package to this address over the last year, he’s aware of the circumstances that surround our house:  the stoop collects water, the dog barks when you knock or ring the door bell, we always answer the door and say “thank you” regardless of our streetability (I’ll wear what makes me comfortable, dang it, and I don’t care if we live in the “south” make-up should be optional at home), the newly awake child screaming (no it wasn’t nap time, she’s just really excited to see you), or whatever is on the stove (quick someone stir that!).  

But tonight, despite all we’ve been through and come to treat as routine, there was no knock on the door or constructive use of the door bell. There was no barky-dog to alert us of the thoroughly vulnerable package that was placed directly in to the formed (and growing) puddle.  And there most certainly isn’t an appropriate application of the word “thank you” to be found on these lips as UPS messed up R-O-Y-A-L-L-Y.  

This could have been a run of the mill Christmas package - something we ordered or someone carefully selected, packed and sent our way - but it wasn’t.  No, it was far from a frivolous purchase that would have received a muttered curse word and eventual shake of the head with ”what a shame.”  Instead, this package contained medical supplies - three months worth of my continuous glucose monitor sensors to be exact - that I use on a daily basis and rely upon for their unfailing accuracy and constant data for my glucose control.  Something that a night’s worth of sitting in the rain would have destroyed, cost me or the supplier, Dexcom, hundreds of dollars to replace and would have left Baby and me up a creek with the occasional finger prick as my source of sugar control.  I’ve long since left behind the CGM-hating band wagon and Lord help anyone (talking to you, UPS!) who gets between me and my necessary - YES NECESSARY - medical technology…  

All I can say at this point (suffice it to say their customer service will be getting an ear full tomorrow) is Thank God the dog needed to go out just then, thank God I turned on the front porch lights for her despite the need for them, and thank God I had that disparaging thought about her wet paws causing me to look down and notice the package when I did.  If this sequence of events hadn’t occurred, my head would have exploded upon finding the mushy pile of trash waiting for me in the morning.  But, fortunately, the cardboard was thick, the boxes of sensors insulated by tissue paper and the sensors individually wrapped in sterile plastic - meaning I got lucky and the damage is largely restricted to the exterior packaging.   Thank you little baby Jesus!

To the nincompoop who skipped putting the package in a sealed plastic bag, opted out of notifying us of it’s delivery and voluntarily left the box in an EXISTING puddle, whoever you are, here’s your sign.  That was excessively dumb, poorly executed and completely unnecessary.  Clearly someone up there is watching out for you, too, but come on man!  Not. Cool. 

Thursday, December 18, 2014

Week 30

All I can say about my week 30 appointment is that I am beyond grateful that I am already a parent, because if it weren't for GW and GV I'd be a furious, incoherent mess as I sit here typing at the computer.  Having spent the last two weeks fretting about my weight, my amniotic fluid index (AFI) levels, and Baby's rapid weight gain I hardly slept a wink last night as I tossed and turned in anticipation of my perinatal appointment this afternoon.   Waking up twenty minutes after the alarm clock went off and finding an abnormally high weight on my home scale (up two pounds from yesterday... guess I shouldn't have had that banana) didn't start the day off well.  Attempting to look at least partially decent for the first time in a week, I threw on some clothes, quickly did my hair and make-up and went into the kid's room to find both GW and GV awake but still lounging in their beds.  Happy to not continue the morning battle with our usual "but, Mooooom, I'm still tired..." argument, the kids easily slipped into their laid out outfits and went downstairs to the kitchen to begin our breakfast routine - which, again, went surprisingly well. 

So off to school we go and as I'm dropping GW off in his class room, I pull his teacher aside to let her know that I'd need to pick my son up early today to accommodate our perinatal appointment that is scheduled for just after lunch in NOVA.  Informing me that, "well, we're not going to be here today and we won't be back by that time," I was a) shocked to learn of the field trip that the parents weren't informed about (seriously?!), and b) dreading the dream crushing "you can't go" conversation that I was about to have with GW.  As this would have been the first time he would have been able to ride the school's bus, something he's been begging to do since September, you can imagine the near tear confusion and anger that seized his face... I explained the issue and apologized for his disappointment (to which he countered with several suggestions about his walking home from school alone, sleeping at school so we could just pick him up tomorrow and even running to the appointment on the side of the highway so he wouldn't get lost) and we finally came to a calm, albeit not happy, understanding.  We then attended morning mass and began to run some errands. 

And then my phone rings... "Mrs. Cammack?  It's Perinatal Associates.  We have you down for a 1:30 appointment this afternoon, but we're going to need you to come in at 12:45 instead." 

No problem... if you live in NOVA.   Big problem if your husband works 45 minutes away, isn't answering his work phone, cell phone, texts, email, instant messages or my ESP and, in best case scenario traffic, the doctors office is one hour away.  While I had an hour and forty-five minutes before we no-sh*t needed to be on the road, I spent the next 55 minutes trying to reach HB before he finally answered and had exactly 50 minutes remaining to pack up and get home before we were officially late.  Shockingly enough, his little commuter car got him home exactly on time and we hit the road. Thanks to construction and accidents, we wound up only being slightly late to my (considerably earlier than we were prepared for) appointment. 

Then guess what happened... 

For the first time in our experience at this doctor's office, HB, the kids and I were left to wait.  Usually prompt and punctual, we waited for an hour and twenty minutes before my appointment officially began.  So, for those of you who are parents and know the agony of cooping kids for an excessive amount of time in a non-child friendly environment like a business or office, you recognize that had we kept our originally scheduled appointment for 1:30 we would have only fought 45 minutes of "place of business" behavior without lunch, toys or books rather than the doubled length of frustration.  

Enter miracle number one:  those kids were complete angels.  Granted GV didn't want me to read my book and she insisted on climbing to the adjsent chairs exclusively from my significantly smaller lap (at least something is smaller about me!) than from the floor, but they whispered "psst I love you" to one another and to each of us, they snuggled us individually and in turn, and they even managed to let the other two couples in the waiting room wait in what could almost have passed as a child-free sense of peace. 

During that wait time I was called back briefly to the nurse's station for my typical vitals check. My BP was great at 114 over 69 and, thank goodness she measured that first, because the minute I saw the number on their ruddy scale I flushed with anger.  Eight bloody pounds up from yesterday on the home scale and right back to the number I was advised would cause a c-section four weeks ago.   Yeah, yeah, yeah, I know you can't compare results between two different scales and in one instance I weighed myself sans clothes before breakfast and in the other I was fully dressed (a seasonally appropriate sleeveless shirt and flip-flops for today's gorgeously frozen tundra weather, mind you) and it was post 1 cup of greek yogurt, but STILL! Are you freaking kidding me?!

Enter miracle number two:  upon slumping back into my waiting room chair, GV climbs up into my lap and, taking my cheeks between the palms of her hands, she looks deeply into my eyes and says with the most sincere concern "you okay, Mama?" Forcing the deep breath I wouldn't have found anywhere else, I was able to tell her "yes, I'm okay, GV" before giving her a hug and feeling at least some of the world's weight fall from my shoulders.  Too bad I couldn't have been weighed again...

Finally, finally, finally the nurse comes out, calls my name and leads our troop to the sonogram room. Having discussed with GW that he'd be able to help with the sonogram if he asked the sonographer  very nicely, my heart sank when Dr. Bronsky walked in to the room in place of our normal nurse.  Knowing full well the answer to GW's question would be either silence or "no," when he approached the table to inquire "may I try?" I spoke as kindly as I could to him "no, not now GW." Automatically lead to the "but you said I could!" face of anger and tears that I'd already seen that morning regarding the bus, I briefly explained that we'd talk about it after the appointment before shifting my attention back to the sonogram.  I found the doctor ever so casually checking Baby's position (head down, good), heart rate (132 bpm, good) and ... yeah, that's it. 

"What are the AFI levels?" inquired HB, trying to prod for additional data. 

"They looked fine," was the brief response. 

"Oh, well those numbers and his weight have been of concern at the last few appointments..." HB said suggestively. 

Taking the wand back up, Dr. Bronsky then began to actively measure the amniotic fluid pockets around Baby.  Correcting himself, he then stated, "yeah, your fluid level is definitely high.  It's up to 27 cm.  But that's almost the same as it was last time."

Percentile wise, perhaps 23 cm and 27 cm are somewhat comparable for their respective
gestational weeks, but they're both at 99th percentile and not where I ought to be

Upon collecting the two pictures he'd printed for my chart (none for us today - boo), wiping off my belly and instructing us to follow him to his office, HB and I were stunned but the limited information collected and the dismissive statement that equated 27 cm to 23 cm... neither of which is considered a good number.  

Enter miracle number three: every time we've brought the kids to these appointments and it comes time to sit down with the doctor for the last five to ten minutes before their sweet freedom is realized, they've flat out lost their minds. They roll on the floor, flop on the couch, grab things from the desks... anything distracting and disruptive they could do, they've probably done it.  But today, they sat by our feet in relative stillness as they watched a movie on mute for the duration of the appointment.  Feeling rewarded by the access to the iPad (a very rare treat at our house), they didn't interrupt, they were polite and they gave no-reason to illicit the "and you're having another one?" face and/or comment we've unfortunately received from particularly judgmental people previously.  

Sitting board straight out of anxiety, I watched the doctor as he rapidly typed the data he'd collected into my chart and answered the random questions he asked regarding symptoms I'm experiencing and my previous deliveries.  Providing very little council on my and Baby's condition or the red-flag concerns we've been fretting upon since our appointment on HB's birthday at the beginning of November, Dr Bronsky - my go-to guy and ally during GV's pregnancy - practically brushed me aside and shooed us out the door with his paltry information: he noncommittally indicated that a vaginal delivery is still possible; he distinctly commented that I can't do anything more than I already am; he passively dropped that a c-section would be required at "4200 grams or more"  for any diabetic (had to look that up, gee thanks doc, meaning 9 lbs 4 oz); and, to finish things up, he concluded that my weekly appointments and non-stress tests will begin on December 30.  

Leaving the office with my blood pressure soaring from frustration and unassuaged concern, HB and I both felt like today's visit was a waste of time and a full drain of our emotional energy.  I know I should be grateful that a professional looked things over and that he didn't feel comment was required, but less is not more with me and simply dropping off some biometric data on me and Baby surely didn't need to take the four hours - and that's before the drive home! - to accomplish.  I needed reassurance today.  I need hard facts to concentrate on for the next two weeks.  I need to know what progress, be it good or bad, we're making and how things are shaping up just in case I'm hospitalized (God forbid) anywhere except the one place my chart is electronically stored.  Walking away empty handed, empty stomached and cranky is not ideal for anyone leaving a doctors office - let alone for a woman who is 30 weeks pregnant. However...

Enter miracle number four:  those darn kids couldn't have been better behaved, more compassionate or more encouraging than they were today.  On any normal day their actions would have been ten times above and beyond the norm, but given how challenging the day was and how HB and I were seething unhappiness from our every pore, GW and GV rose a whole new level of my esteem that I didn't know I even had.  I've always loved them more than anything, but actively appreciate them? That's something I need to do more often. 

To be honest, I've found myself much more cognizant of the little things with them over the past few weeks that I simply feel I was blind to previously.  I have been so wrapped up in the drama of life and the worries of what if that I haven't given them the benefit of blossoming in my consciousness in the way that they've been doing entirely on their own.   The appointment today was, in my estimation, a complete disaster and something I would gladly take a time machine to, but in the grand scheme of things it's only one afternoon in one week of one pregnancy that will lead to a lifetime of family moments and memories with all three of my wonderful kids.   GW and GV kept my feet grounded today where my temperament alone would have taken me sky high in vexation.  While I hope to come back from my next appointment on December 30 with solid facts, answers and some semblance of comfort, I am clinging to the awareness they gifted me today that appreciating them, our time and our family in spite of the darkness that can cloud around can leave a wake of happiness where otherwise there would be none. 

Thanks, guys.

Good behavior ice cream and Santa all in one swoop?
Yeah, they're that good. 

Friday, December 12, 2014

Week 29 Endo Appt

While the changes with Baby over the next two months transition my perinatal appointments from every four weeks to every two weeks and soon to be twice per week, I take comfort in the clockwork predictability of my pancreas and the resulting routine schedule I have for my endocrinology appointments: when pregnant, I see my doctor every four weeks and when not, every three months.   Seeing as there are still at least eight weeks to go with this pregnancy in the best case scenario, I find myself regularly annoying the receptionists at NOVA Endocrinology with my requests for non-existent appointments in my doctor's overly-booked schedule.  Always tacking me on to the tail end of my doctor's Friday afternoon schedule, I have plenty of time to mull over her suggestions and feedback as we fight our way through the I-95 traffic leaving Washington DC at rush hour - which, thank God, wasn't too bad today. 
After the last three weeks of vitamins and omelets, I anticipated that my HgA1C, like my weight, would be lower today than it'd been at my last appointment on November 12.  But while the scale did indicate that my weight is down, my HgA1C remained stagnant at 5.5 despite my drastic reduction of insulin from roughly 55 units per day down to between 30-35 units daily.  Inquiring about my glucose trends, I then presented the doctor with my latest CGM logs...
Finding my post-breakfast hyperglycemia to be still of concern, she asked if I'd continued the 30 unit injections of symlin with my breakfasts since swapping over to my monotonous diet.  Given that my omelets sometimes include a skosh of milk and sometimes not, I told her no, but seeing as I continue to struggle with post-prandial highs and insulin resistance kicks in to full swing during the third trimester of pregnancy due to the wonderful world of hormones she instructed me to start back up on my morning needle to the stomach routine for better numbers.  Moving on to inquire about my basal rates, I rattled off the nine (yes, you read that correctly: NINE) settings I have programmed throughout the day:
1)  12:00 AM to 1:30 AM:  0.450 Units
2)  1:30 AM to 4:30 AM: 0.625 Units
3)  4:30 AM to 6:00 AM: 0.950 Units
4)  6:00 AM to 7:00 AM: 2.50 Units
5)  7:00 AM to 8:30 AM: 0.875 Units
6)  8:30 AM to 4:00 PM: 1.45 Units
7)  4:00 PM to 7:30 PM: 1.75 Units
8)  7:30 PM to 9:00 PM: 1.25 Units
9)  9:00 PM to 12:00 AM: 0.475 Units
Grand total: 28.075 Units
Recording this with some annoyance (apparently this kind of nuancing of basal rates isn't terribly common at her office), she honed in on the one number that stood out in it's oddity: 2.5 units from 6:00 AM to 7:00 AM.  Otherwise surrounded by practically negligent doses, this "high" dose demonstrates my sensitivity to the body's natural rhythm of hormone production that happens between 2:00 AM and 8:00 AM that is commonly referred to as the dawn phenomenon.  As the knock on effects of this phenomenon haven't been something I've necessarily struggled with previously (maybe I did and just didn't notice), my doctor explained that at some point my honeymoon phase as a new type one diabetic will end and my insulin requirements will plateau to some degree of predictability.  As I've only been a diabetic for three (almost four... golly...) years, she doubts that my pancreas has fully given up the ghost and she thinks this new found requirement for additional insulin for one specific hour each morning may actually be a step closer to life post-honeymoon with my ball-and-chain pancreas.  

In coming out of today's appointment and having the traffic jam to think about it, I'm torn in to two emotions: frustration with my HgA1C remaining stagnant despite my concerted efforts and shock, I guess, that something may be progressing with my diabetes separately from the pregnancy.  I've become so accustomed to think of my medical situation as a high risk pregnancy due to diabetes that my diabetes just being my diabetes is odd... I'm probably putting too much thought into it and overanalyzing the whole thing, but being diabetic is so... normal... for me now that the thought of being considered as "newly diagnosed" floors me.  I understand that there are men and women out there who have had type 1 diabetes since their childhoods and at my age they are likely settled into their insulin routines with a decade or two of experience under their belt, but I feel so settled and so diabetic in my own skin that the comparison takes active consideration rather than passing acknowledgement to register.  

Well, for better or for worse, my diagnosis anniversary is just around the corner on January 25 and, if we're going with traditional gift choices, that means my pancreas and I should exchange either flowers or fruit to mark the date... we'll see how my next endocrinology appointment goes on January 9th, but I have a feeling we'll be skipping the carbs and going straight for the floral arrangements since that, at least, wont mess with me and Baby ;)

Thursday, December 11, 2014

Week 29 jitters

Not going to lie, it’s been a completely draining week.  Ever since I woke up this past Saturday, I’ve had this sense of dread and pending doom that has colored every action, reaction and thought I’ve made, considered and opted out of pursuing.  Some might say it’s the looming holidays, others might call it a particularly moody mood swing, but I know exactly what it is:  anniversaryitus.

For better or for worse, I remember dates and details of events well after the normal person and long after I necessarily should.  Sometimes those dates wind up surfacing some sweet memory like November 8 as the anniversary of when HB proposed, October 27 as the date of my first (only?) marathon, or March 17 as the anniversary of GW and GV’s baptisms… but other times, they take me back to some of the most miserable moments frozen in time and carved into my memory that I want to ignore. December 21 is the day my father gruffly told me my Grandmother died and I, being entirely too young to understand, found blame for her death in myself and the clothes I'd selected to wear that day. October 21 is the day Mandy Morrison died after falling from her window on the fourth floor of the girl’s dormitory to which I was a Resident Advisor.   April 4 was the first day of HB’s last deployment to Iraq, a day I feared would be our last.  And, pregnancy wise, week 29 was the week that all went wrong with GV’s pregnancy when out of the blue I went down with a partial placental abruption.   I know, date wise, that the actual event happened September 25, but that week in the hospital forever changed my view of women’s bodies and the terrifyingly beautiful risks we take when we carry a baby.
The feeling I so vividly remember of my pregnancy with GV before the abruption happened was not one of concern or even of real acknowledgement of my "condition," but rather of simple normalcy.  I’m not trying to suggest that I feel “normal” while pregnant because, really, what woman in her right mind could feel normal while pregnant? But what I mean is that I had no reason to think of myself in any different terms than the way I consider myself while not pregnant – athletic, capable and independent... simply me.  Translating that into my actions, I didn't think I needed to sit down on the metro (what risk of falling?), have help while carrying groceries (I'm pregnant, not weak!), get a hand up after sitting on the floor (I wouldn't have sat here if I couldn't get up), or stop moving furniture (it's called nesting).  But when my hand was covered with gushing dark, thick blood and the thought of losing the baby entered my brain, all of my preconceived notions about myself and my pregnant body went out the window.  I wasn't weaker, but I was different.  I was more fragile and more vulnerable to the everyday slip ups that I would have kept rolling with were it not for the tiny life dependent on me not slipping, not lifting, not eating x, y and z, not sleeping on my back or right side, not exercising with my heart rate above 140 beats per minute, not ... snuffing out its existence through my actions before even having a chance to live.
In some ways I look back on my time before that terrible week with envy - the ignorance of fear was so wonderful and, to be cliché, thoroughly blissful.  But now that the USS Unaware has sailed and I'm fully onboard the USS Worrywart, I can't escape the vast, rocky landscape of ebbing what-ifs.  On one hand, I can find some degree of comfort in the fact that my awareness of pregnancy as something delicate leads me to choose actions or inactions that prioritize the baby's safety before my own that I might have missed otherwise.  Conversely, the opposite of ignorance is hyper vigilance and, let's face it, 180 degrees from dysfunctional is still dysfunctional.  Should I be as scared of GW hugging me with his unbridled enthusiasm as I am?  Maybe.  Should I opt out of walking our 118 lb mastiff for fear of her pulling? Perhaps.  Should the fact that I'm in week 29 this go around mean history is bound to repeat itself? Not at all.
At the end of the day, I guess the superstitious side of my young-self that found blame for my Grandmother's death (at age 91) in my closet persists to one degree or another despite my internal reprimands for logic and reason.  I know I am at an increased risk for repeat placental abruptions because of my previous abruption history and because of my elevated amniotic fluid levels, but neither of these complications guarantees another abruption or a particular pregnancy outcome.  Whether I have an abruption now, in three weeks or down the line with a future pregnancy, I can't do anything more than I already am and my suffering from anniversaryitus does nothing but raise my blood pressure - which charmingly further elevates my risk for adverse complications.  The only cure I see to this ailment is safe arrival at week 30 this Saturday... at which point, I realize, nothing will be different except an arbitrary number that, for whatever reason, I fear. 

Wednesday, December 3, 2014

Week 28 Update

So for the past three weeks I've been on carb-lock down.  Knowing that increased insulin usage has a direct relationship with increased consumption of calories (chasing lows) and fat storage (gee wiz, thanks diabetes), my endocrinologist and I agreed that I would try to cut my insulin use down to the lowest possible rate so as to curb my pregnancy weight gain. Attempting to operate on exclusively my basal dose without bolusing additional insulin to cover food intake, I've pretty much cut carbohydrates completely from my diet with the exception of my guilty pleasure of daily gummy vitamins and one, much needed and nonnegotiable, cup of coffee.  So eating three three-egg and cheese omelets a day for the past three weeks, you can imagine both the success and the frustration I've had with this "diet." 

On one hand, my insulin use is way down and not only has my weight gain stopped, but I've managed to drop several pounds.  At first I was surprised when my pump began to initiate its "auto off" function during the day (this happens only when I haven't actively programmed it for ten hours), but in looking at my how my daily usage averages have dropped over the last month it's not so surprising -- I've gone from a minimum of 55 units daily to a maximum of 32 units daily!  While the numbers on the scale aren't quite so dramatic, which is a good thing, I am also pleased that the home scale is now reading five pounds less than it did at my week 25 check up and that, thank goodness, puts me back under the 35 pound weight gain maximum that I've been advised to maintain.  The unfortunate other hand of this equation, however, is that I am beyond sick of eggs.  Come February and Baby's arrival, I don't know if I even want there to be eggs in the refrigerator as merely an ingredient let alone as a ptotential food source... ug!

Anyway, hovering at right about 30 pounds of maternal weight gain (which is still about ten pounds more than what I ought to be at this point in the pregnancy), I was feeling a bit more confident headed into the week 28 follow up we had today with the perinatologist.  Knowing that my weight and baby's weight are not necessarily linked,  however, I held my breath out of sheer anxiety as the sonographer measured and clicked, measured and clicked, measured... lingered... measured again... clicked.   

"Well, your baby is measuring about two weeks farther along at 3 pounds 4 ounces," she states with an impressed air. 

Thinking back to the beginning of the pregnancy when our dates weren't lining up with the size of the fetal yolk sac causing the MFM to move our due date back from February 8 to February 21, I inquired of the sonographer if that might be why we're seeing him grow much, much more quickly than he should. 

"No," she said with certainty. "Early sonograms are very accurate - within three or four days - for gestational age.  You'll have to talk to Doctor Nies about his weight."  

Finding this information to be far from comforting given our knowledge that the average baby should weigh no more than 2 pounds 2 ounces at 28 weeks, I braced myself for more bad news as HB, GV and I sat down for our consultation. 

"How are you?"  Dr Nies asked.

"Stressed beyond belief," was the only honest answer. 

Being the nicest, most comforting of the practitioners at this particular office, Dr. Nies kept her kiddie gloves on for our conversation as she dove into my chart and looked at the results of the sonogram and compared them to my triage stats.  Upon seeing my decreased weight and confirming that I was in fact still eating, she gently moved on to explain that her primary concern at this point in the pregnancy is not Baby's above average weight, but that my amniotic fluid levels are elevated. So while she simultaneously assuaged my concerns that a c-section for macrosomia may not be necessary (that will be contingent on Baby's weight being above 10, maybe even 9, pounds in several more weeks),  the high amniotic fluid index (AFI) reading of 23.1 requires a diagnoses of mild polyhydramnios.  Stating we'd keep an eye on it but to call immediately if I get "unusually bigger" or experience more contractions (a regular happening of late), we left the appointment with both me and my uterus feeling irritable. 

As polyhydramnios is a brand new complication for the books (oh joy), I promptly began my homework upon reaching the car.  Playing a sick and twisted game of chicken and the egg, the condition could be a result of my diabetes (not likely given my HgA1C) or it could be a bi-product of the macrosomia OR, to keep things interesting, the macrosomia could be a result of the polyhydramnios and exacerbated by structural complications we are currently unaware of in the fetus.  Charming, right? Regardless of cause, however, the presence of even a mild case of polyhydramnios - and let's pray it doesn't elevate itself to a moderate or severe case - on my already high risk case makes the rest of this pregnancy more complicated and more prone to additional issues than before.  Polyhydramnios is associated with: 
  • Placental abruption (because I needed to be at more risk for that...)
  • Pre-term labor and rupture of membranes
  • Umbilical cord-prolaps
  • Mandatory C-section
  • Still birth
  • Post-delivery hemorrhaging due to the excessive size of the uterus during pregnancy

So... that's not good. Unfortunately there isn't anything that I can do above and beyond what I am already doing to prevent either macrosomia or polyhydramnios.  I can keep my diabetes under tight management - check - and I can work to keep my weight gain below 35 pounds for the pregnancy - check, thus far at least.  Beyond that, the outcome is entirely in God's hands and at the whim of my perinatologists when and if things progress one way or another.   In the mean time, I'll just continue to worry and eat my omelets...  someone have pancakes and a couple Christmas cookies for me, will ya?