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. 

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? 

GV is TWO!

Well, it happened.  I watched a friend’s 15 month old for a few hours one afternoon last week and in that time GV magically transformed all bibbity-bobbity-boo like from my baby into a full on little girl.  Okay, clearly she didn’t change all that much in that one instant, but the contrast of my friend’s baby next to my former perception of GV as an itsy-thing put her growth in a sharp reality and abruptly ended her baby phase.  Shedding all resemblance of her babyhood, I'm all of a sudden aware of these grown up things about her that I knew were there, but didn't recognize:  she speaks in (very opinionated) sentences, suffers from a daily case of serious bed head, sings along with the darnedest of songs ("all about that bass, about that bass, no treble!") and – much to my inexperienced horror – seems to be entering the very real, very obnoxious phase of the terrible two.

Right: Hours old.  Left: Almost two. 

When GW was this age, he seemingly skipped the terrible twos, consolidated his attitude and promptly presented HB and I with his new persona as a threenager upon turning three by not only saying "NO!" but with reason.   GV, on the other hand, appears to have no intention of waiting for reason to challenge the world with her very deliberate use of the word "NO!"   The only good thing that I can see coming from this is that her appetite for argument for the pure sake of argument is, thank goodness, entirely manipulatable at this age... for example:  

"GV do you want lunch?"

"NO!"

"Okay, fine, you can't have lunch! No lunch for GV!"

"Want lunch!!"

"Okay, if you really want it..." 

Point: Mama!

She and GW regularly get into in it the back seat of the car and while the decibel at which they argue is quite regularly something that mandates I intervene, their arguments are in and of themselves quite hilarious.  The conversation typically start off with one or the other wanting something the other has or doing something the other doesn't like and then it quickly escalates to one shouting "NO!" and the other shouting "YES!" until one or the other either gets confused or decides to switch sides for the simple sake of switching.  Eventually they both realize what happened with their argument and they fall into a fit of uncontrollable giggles... a sound I don't mind at any decibel. 

Anyway, to get to the point of this blog post, GV celebrated her first Thanksgiving Day birthday this year and is now finally able to announce to the world that "I TWO!" with accuracy.  For the past several months GW has been teaching her to say "one and a half" when asked the question of "how old are you?" (or "how are you?" depending on how carefully she's listening...), but the only portion she ever cared to say was "half!" Finding the confused look on people's face to this response, we began to teach her that she is "almost two" which she, of course, also shortened.

For a brand new two year old, I have to say, she is miles a head of where I expected her to be development wise.  This is not to say that GW was slow by any stretch of the imagination, but with his example to follow she's picking up what he's putting down much faster than any first-child or only-child could on their own.  Desperately eager to keep up with GW and be just like him, she already has a solid interest in books and letters (she can even pick out letters if you ask her to find a specific one), she is chocolate chip and smarty-pants-dance motivated to use pull-ups and the toilet (I didn't bother until GW showed interest at 3.5, she began showing interest at 18 months!), and, since she's been allowed to tag along to his lessons, she shows great interest in and potential for the piano as she wants to play notes or sing scales whenever given the possibility (whether or not GW is currently practicing seems to be irrelevant to her).   It seems to bother GW upon occasion that she's always right there beside him mimicking his every move, but more often than not he's glad to have her to play with, take care of and teach.  He's a pretty great big brother and with his example, I bet she'll be pretty great at being a big sister too. 

One of the things that astounds me more than anything about GV is her attention to detail and attention to emotion.  For example, while many children - GW included - take years to gain an interest in the celebration of mass, GV watches the people around her and knows when to fold her hands, when to sing/what to sing, how to kneel and, although occasionally disruptive, she likes to chime in her personal prayer intentions for her good friend Winnie the Pooh (particularly when HB is the lector).   It's this last bit that gets me most of all about her - she just seems to have this deep sense of compassion for other people (or stuffed animals as it were) that goes beyond the typical range of emotions I've seen in other toddlers.  Granted, she expresses happiness and disapproval like a typical two year old, but the way she shows concern for others feelings is something I find sweetly her own.  When there are hurt feelings, she is quick to say sorry and to give a hug.  When there's been an ouch she is quick to offer a kiss to make it feel better.  When someone is crying, she always goes to their side asks them with big concerned eyes "you sad?" and then she lays her head against their shoulder and pats gently in a there-there kind of manner on their knee.   I assume most of this is learned behavior from how we interact with each other around the house, but the degree to which she's picked it up and applied it in her own interactions is beyond me... what a nice kid. 

I could keep going and going and going about these two, but this is already more parental mush than she'll be comfortable reading someday anyway so I'll leave it here.  GV, you are my little dove and I am so incredibly grateful that you were born healthy and that you are thriving so beautifully in your childhood.  You make a Mama proud and I love you very, very much. 

Happy second birthday, sweet girl!

Week 25 new complication: Macrosomia

What a way to celebrate HB's 35th birthday - two doctors appointments and a trip to the dealership service shop! With the exception that he wonderfully took the whole day off of work to enable us to be together as a family, it was definitely one of those days that you wish you could be granted a do-over.   Fortunately, he's the best sport on the planet and, hands down, the most amazing supportive husband and daddy ever so while I would have been mortified by the days events effects on my birthday, he stood unwaveringly by to make the most of the day's misadventures.

About two weeks ago we purchased a new car to accommodate the growing family and to replace the truck HB purchased just a few weeks after we began dating in 2006.  Having purchased used, our new Yukon has a couple parts that the dealership needed to order before replacing - which we were under the impression would be installed today.  So getting up extra early to fight the commuter traffic along I-95 North, we started the day with an hour and a half of sitting in what I can only describe as the quietest waiting room I've ever been in at a dealership... there were several many serious looking business suits sitting about the room focused on books or laptops and, of course, because I'm that Mom, I stressed the entire time about GW and GV's behavior so as to be courteous to these other patrons.  For the most part the kids did a good job of keeping the ruckus to a dull roar by looking out the windows at the various cars on lifts, but if HB hadn't been there to help me wrangle at those particularly loud moments I am quite sure my head might have exploded.   Anyway, we eventually had to approach the front desk reiterating that we were on a schedule with doctors appointments and couldn't afford to wait longer for our vehicle to be returned only to learn they hadn't done a single fix to the car in that time frame and the parts that were needed had to be ordered.   Oui.

So frustrated with the morning, we proceeded to the Perinatalogist's office for our 25 week appointment.  It's the first appointment in weeks that we've brought GW to as his school schedule and the baby's appointment schedule haven't been compatible, but knowing how much he enjoys the sonograms and how excited he is for his new baby brother it only made sense to include him in the day's "festivities."  We had just piled into the waiting room where the kids promptly fought over a few magazines and a specific chair next to Dada when I was called back into the triage area for my vitals check.   Pulse - check! Blood pressure - check! Weight - WTH!?!

"Okay, you'll be called back for the sonogram shortly."

Reporting to HB that my weight registered as five pounds heavier than the scale at home did just a few hours prior, I tried to shake off my weight-consciousness and focus what positive attention I could on the kids as they leafed through the various baby and parenting magazines.  Shortly there after, we were called back as a family to the sonographer's room.

"Can I help you?" GW asked of the sonographer as she squirted the warm goo on my growing belly.

"Sure, can you hold the wand steady?" the sonographer asked.

Taking the wand and prodding the baby bump with a bit too much enthusiasm, GW willingly accepted assistance from the pro and images of Baby #3 began to appear on the screen.   Things looked fine from what I could tell - the heart beat sounded right, the parts were in the right place and there weren't any particular spots on which the sonographer abnormally lingered.  Handing me a towel to clean up and GV the pictures to carry - "carefully!!" - we packed up and went back to the waiting room for some more, you guessed it, sitting.

Fortunately this doctors office is spot on with their scheduling and it wasn't too long before we were called back to talk with Dr. Khoury, the MFM at the office who appears to be taking point on my case this go around.  Upon inviting our tribe in, GV promptly walked to his knee requested up and sat quietly through out the appointment.  GW on the other hand seemed to think that the sofa in his office resembled a tumbling mat - which, as you can imagine, did nothing positive to assist the appointment along in my eyes.  Dr. Khoury, who is apparently ready to have grandkids, didn't seem to mind terribly, but still...

"So, correct me if I am wrong, but have you gained 42 pounds this pregnancy?" he asked bluntly.

"Well, the scale at home says 37, but yes, I've struggled much more with quick weight gain this go around." I responded.

Going on to inquire about my blood sugar control ("are you chasing lows?"), my exercise routine ("are you able to exercise?") and a smattering of other weight-relevant questions, he launched into a new diagnosis as he typed in my electronic chart:

"Well, your baby is macrosomic and, unless you can get this weight gain under control, you're going to have a c-section."

I've known since GV's pregnancy that most diabetic pregnancies result in overly large babies - macrosomic babies - that cannot be delivered safely through vaginal delivery, however, I've also known that tight blood glucose control (which is measured by the HgA1C) can prevent this over padding of fat on the fetus.  What I didn't know was that there may also be a coorrelation between maternal weight gain during pregnancy and macrosomia regardless of diabetes.  Awesome.  So while I've been thoroughly on top of my glucose levels with a recent A1C of 5.5 (well within normal limits), my seemingly uncontrollable weight gain is causing some of the exact problems that I've been trying so hard to avoid.   Granted, my glucose control is helping in other areas like organ formation and an absence of birth defects, but you can imagine my frustration...

I might be considered abnormal for this, but one of the best parts of pregnancy that I have previously enjoyed and that I am actively looking forward to is labor.  The pain is terrible, but the way my body knows what to do and how quickly I progress through active labor (30 minutes with GW and 15 minutes with GV) is a source of pride that I take incredibly personally and even the mention of a c-section makes my heart just crumble with a sense of loss.  I know that in emergency situations it's unavoidable and many women haven't had the option to pursue vaginal delivery, but wrapping my head around Dr. Khoury's words sent me into a self-depraving sense of grief... I've been working so hard to keep Baby and me healthy and now this?!

Maintaining as much composure as possible, we scheduled our follow-up appointment for week 28, walked to the car and I promptly burst into tears.  Consoling me as much as he possibly could, HB held my hand and repeated words of encouragement as I pulled up the Mayo Clinic information pages on fetal macrosomia.  While a c-section will prevent much of the structural damage that could endanger both me and Baby and, at the end of the day, a healthy baby is a healthy baby for which to be thankful, there are several complicating factors as a result of macrosomia that make my mind reel:

For Baby the risks, even with c-section, are immediate as well as having longer term implications:

• Baby faces the likelihood hyperglycemia and impaired glucose tolerance at birth - the exact opposite of concerns for blood sugar levels we faced with GV.  With her, we were concerned with her glucose levels being to low (which they were), which was easily fixed by feeding her.  With Baby, I don't know what the doctors will need to do to address elevated glucose levels or if they can do anything. 
• Baby faces a higher likelihood of suffering from childhood obesity as research indicates some degree of link between higher birth weights and excessive weight gain in school age children. 
• Baby faces a higher probability of suffering from a variety of conditions - such as increased blood pressure, high blood sugar and elevated cholesterol - that, when combined, directly lead to a heightened risk of heart disease, diabetes and stroke. 

For Mama the risk for complications increase if future pregnancies are considered (which, yes, future pregnancies are something for which HB and I are hoping):

• The risk for fetal macrosomia increases with each pregnancy, especially those for male babies.  So Baby #4, should we be able to have another, is not only at a higher risk for a higher birth weight due to birth order, but given that we're struggling with macrosomia with Baby #3 he or she will be at an elevated risk because of my maternal history with the condition. 
• Given my history of placental abruption and the compounding issue of a potential c-section, my risk for uterine rupture with future pregnancies is heightened due to the damage I'd sustain to the anterior wall.  This also decreases my candidacy for a vaginal birth after cesarean (VBAC), for which I emotionally am holding out. 

I can rationalize that a c-section isn't the end of the world and I can also rationalize that I have two, soon to be three, beautiful children that I've been blessed with by God, but the picture I have in my head of what I want and expect out of life versus the rationalization of what options and outcomes are just not in my hands are two irreconcilable things.   I understand how fortunate I am to live in the United States and to have access to the comprehensive medical care that so closely monitors me and Baby.  I understand that it's up to me to curb weight gain for the remainder of the pregnancy and that the chromosomes and genetics involved are beyond my control.  I can understand that my crying in the car today has absolutely no correlation whatsoever to what happens with delivery of Baby come d-day... I get all of that, but for the time being, I'm miserable.  I'm overwhelmed.  I'm scared.   I don't know exactly what I'm going to do or how best to go about it, but so help me God I've fought this hard to have a healthy baby in the way I want to that I'm not about to give that up now.

The only thing I can possibly say about the day that is remotely positive is that HB and the kids were exactly where I needed them and that I couldn't have gotten to this point of writing about all of this without their love and support.  I am beyond grateful for HB's consistency, GW's compassionate hugs and GV's constant attempts to make eye contact with me and inquire about "Mama happy?"  Without them, I'd be in ball somewhere suffering from complete self-loathing rather than actively working to acknowledge the good that exists in my life already.

I wish it could have been a better birthday appointment, HB, but thank you for everything you did today and simply embody in spite of it all.  

Halloween 2014

Little Red Riding Hood & The Big Bad Wolf

GW is 5!!

I can't even believe it... my little boy is 5 years old.  Part of me feels like this is absolutely normal and nothing strange to wrap my head around as the reality is that I can hardly remember (nor do I want to) what life was like before him.  A bigger part of me, however, is completely floored that the little 7 pounds 14 ounces baby I held for the first time on Columbus Day in 2009 is now 50 pounds, the size of an average 6.5 year old (he's just shy of 3 feet 11 inches) and full of a whole-adult's worth of energy.

Left: age minutes.  Right: age 5 years. 

This kid astounds me.  I'm sure pretty much all parents say that about their children, but getting a front row seat for his development is like watching an unedited version of my favorite show - nothing is censored, nothing is primped and everything is so genuine that I can honestly say I envy his star-eyed perception of the world.  I'll admit that I am sometimes shocked by the things that he does and says, for better and for worse, but to have such freedom and joy of expression is flat out beautiful... even if sometimes embarrassing.

For much of this past year, GW was suffering from a serious case of the "I can'ts" - stubbornly unwilling to identify letters, play structured games by the rules or even wash his hair just because.   Attempting to break this through encouragement and attention, HB and I have been pushing GW to just try things... and, go figure, it's working: 

Reluctantly beginning speech therapy at the end of the summer to help correct his annunciation (for example, replacing the "f" sound for "th"), he appears to have surprised himself with how much progress he can make with just a little bit of effort.  Over the past four months, the number of comments we receive as a family for how much easier it is to understand what he says seems to be directly impacting his confidence and, as a result, his willingness to expand his sentence structure.  Using longer, more complicated sentences to express himself, he wants to talk and ask questions about everything - particularly what new words mean and when he should use them.   His latest words of interest are "wisdom," "convenient" and "immersion blender" (yes, I do think the budding chef in him is interested in the combination of those three... bam!)

For those of you who knew me as a child, you may remember the struggle I had learning how to read due to an ocular-motor disfunction that caused my eyes to operate independently.  Worried this might be an issue our kids will need to address, HB and I decided to have GW's eyes checked and the optometrist found that, unfortunately, he's in the same boat as me and is currently struggling with similar eye teaming issues.  As the correction for this is to strengthen his eye muscles through eye exercises, GW is about ten weeks into his first 24 week session of vision therapy. I remember the process being long and painful as a child, but with GW starting much younger than I did and with his enjoyment of anything exercise-related, I'm relieved that he's breezing through his sessions like it's flat out no big deal. He's still not a huge fan of the glasses he needs to wear for reading and doing school work, but the carrot of not using them after he "graduates" from vision therapy has him motivated to get "big strong eyes" and learn how to read.  Hopefully this will result in a much easier learning curve for him during elementary school than the steep wall I ran straight into and eventually fought my way over.  Fingers seriously crossed!

For the second year, GW is taking music lessons at the local piano school. Starting out last year in a music appreciation course, this year he's moved up to actual piano lessons - something, I'll admit, I wasn't sure he was ready for when the year began back in September.  But much to my surprise, he's taken to music and the piano like a fish to water (Lord knows he's nothing like a fish in actual water, sorry HB).  Able to sight-read the g clef staff in key of c and to use the right fingers on the correct keys, he can play all of the songs from his lessons without looking down at his hands... sometimes he even plays melodies from memory with his body turned away from the piano entirely!  His latest accomplishment was to perform in his first recital during the school open house for the community - he played "Hot Crossed Buns" and "Mary Had a Little Lamb" and bowed very nicely at the end.  I'm ridiculously proud. 

Another thing that made HB and I glow with pride was GW's running in and finishing his first ever one mile road race (no official time, but oh well, that doesn't matter at age 5 anyway).  He's been along for the stroller ride for most of our races thus far, but this time he wanted his very own bib and he wanted to compete!  It was an after dark, glow run that looped the local mall, which meant that the majority of the race was wind sheltered except for the last quarter mile... when we turned that corner and the wind hit GW face-on he whined to me "the wind is pushing me back!" to which I responded "are you going to let it stop you?" and - get this - he yells "NO!" as he started to sprint to the end.   That moment was the first time in his life that he hasn't responded to a challenge by saying "I can't" before even trying... my Mama heart just welled with pride and I waddled (yeah, Baby bump isn't so helpful with a smooth stride any more...) my way after him.  Crossing the finish line with a big smile, he promptly turned around and wanted to give high-fives to all of the runners still coming in...  Doesn't. Get. Better. Than. That.  #EagleEthos

Granted, I can't say that every moment this year has been rainbows and pop tarts, but even with the bumping of heads and the random sticky-yucky-gross moments of childhood it's been an experience I wouldn't change in the slightest.  I am so glad I quit my job to stay home with him and his siblings.  I am so glad that he's still willing to hug and kiss me at school (even if sometimes only in the hall way when no one is looking).  I am so glad that he's my boy and I'm his Mama.   

Happy birthday my silly billy goat gruff, we love you very, very much. 

Week 20: Fetal Echo

One of the challenges I'm finding about having a baby when you already have a child, or two in my case, is that working the baby's fetal schedule into the already complicated, busy family day is actually harder than it sounds.  With 19 weeks to go until baby #3 truly requires his own car seat, planned dinner and established bath routine (remember, I'm not allowed to go past week 39 without induction), his doctor appointments are already clashing with GW's school hours and GV's nap schedule.  Granted, it's pre-school for big brother and nap time can still happen pretty much any where for little miss, but the fact that I'm starting to get a taste of what juggling activities is going to be like and baby bump isn't even baby yet is somewhat comical

As the pre-ramble suggests, I had to move some things around today to get up to a doctors appointment in NOVA.  Due to the elevated AFP levels that we've been seeing over the last several weeks, my MFM is requiring that I see a pediatric cardiologist to examine baby's heart thoroughly with a fetal echo to rule out heart defects as the source of the abnormal numbers.  Given that diabetics with poor glucose control during the first trimester, notably the first seven weeks of gestation, can directly impact the formation of the baby's heart as a result of untreated hyperglycemia it is a logical concern of theirs (and, rightly so, one of mine) that is easily confirmed or ruled out with this exam.  So, taking the first availability we could to see the MFM's  preferred fetal cardiologist, we scrambled our selves and our typical Monday schedule to find out what we could: HB took the morning off of work, GW forfeited his morning school and romp session, GV resigned herself to a reclined rather than prone daily siesta and I held my breath for the ride north in extreme hope that the morning would prove an exercise in multi-child parenting, aka flaming-hoop jumping, rather than necessity.

We arrived at the Child Cardiologist Associates office with just enough time to fill out all necessary forms and initiate a sibling fight over the best child sized chair and waiting room toy before we were directed back to an exam room.  Finding the room to be exactly what you'd expect of a cardiologist, HB immediately began to field four-year old questions about "what's this?""can I touch that?" "do I have one of those?" about the various posters, replicas and kid-friendly props scattered about the counters adjacent to the table on which I impatiently perched.  Showing the kids the "foramen ovale" and various chambers of the heart from his inexplicable daddy-memory, HB kept the kids occupied just long enough for the doctor to come in, squirt the goo on my belly and begin our exam.

whub-whub-whub-whub... click, click, click, click... whub-whub-whub... click...

If you didn't know this already, it's torture watching someone who knows what they are looking at look at something important, like your baby, without commenting about it is they are seeing.  Giving the medical student with him a chance to drive the echocardiogram, two two white coats began to quietly discuss what parts are what, why they conduct sonograms in particular ways and how to check for this, that and the other malformation...  all of which, I then found out, were fortunately not present in my belly and therefore very ho-hum vanilla as teaching-aids.  I would have apologized to the poor student if I actually felt such disappointment were warranted, but frankly my boring belly and I were more than happy to be a non-noteworthy case study and deprive her for one more appointment of something to call home about. THANK GOD!

So, wiping my belly off, bundling the feisty siblings in their coats and scooting HB towards the door, we emerged from this high-stress, directly relevant to my self-/baby-care appointment with a sense of relief.   We're pretty much up-a-creek with the high AFP levels at this point as we've ruled out the main complications it could be leaving it as a likely indication of a prematurely aging placenta, but as I went through this process with GV I at least know what this could imply and the knock on affects we could see with baby #3s development.  The MFM will keep a very close eye on the placenta from this point forward to check for calcification and will monitor baby's growth to ensure we aren't seeing significant growth restriction due to inadequate function of the placenta, neither of which I can change or impact out of sheer will power.

All in all, it was a hectic morning that'll take the remainder of the day to recover from, but I'm happy we were all there.  I know we'll each need to sacrifice things as the kids get bigger to be there for each other's big moments - soccer games, piano recitals, science fairs - so the fact that we're starting it now is kind of nice.  We care about you, baby #3, and wish you nothing but congratulations on your big win today - just keep in mind that I'd prefer your next family togetherness moment be for something far less pressure filled than an fetal echo... like birth! Well, maybe not the labor process, but the clean baby snuggling right after doesn't sound half shabby to me.

Accessorize your Triceps!

With the littlest man growing and making my formerly soft-squishy belly the taut, thin skinned home to exclusively my uterus I've had to start moving my infusion sites and my CGM away from my go-to, formerly pain-free spots on my abdomen to both old-reliable locations and new, um, more revealing sites.  With my pump cannula pushing upwards of 55 units of insulin into my body a day (30.7 of which is now basal - which is holy cow high!), I'm swapping my infusion sites from hip to hip every few days as it's one of the few spots left around my middle with enough subcutaneous fat to avoid searing pain upon insertion.  Struggling to work up the gumption to shoot that huge needle into my skin is hard enough with that nerve-wracking claaaaaaaaang the spring makes upon release, let alone with the anxious knowledge that if I get the spot selection wrong, it'll sting not only now, but five minutes from now and - if thoroughly wrong - until I change the site all together.

As I've narrowed my go-to site options from four alternating spots (near my belly button and on my hips) down to two (hips only), the reality that my CGM transmitter and my pump cannula cannot be within three inches of each other for accuracy purposes creates the necessity to use previously avoided site locations.  As I only change the CGM once per week, I can't place it on one side and my cannula on the other because of the rate at which my cannula needs to be changed and the requirement that it be placed in a "fresh" spot every time I change.  Requiring more creativity and, well, diabetic confidence than I've previously been willing to display, I'm quite clearly wearing this inconvenience on my sleeve.

Literally.  

Both the CGM and the pump cannula are required to be inserted in a sight that will not only appropriately transfer insulin to my blood stream but to also accurately read the current glucose levels circulating through my system.  These locations, while seemingly everywhere, are actually pretty limited: the abdomen, the hips/glutes, the thighs and the triceps.  Having long since lost my comfort with my cannulas in my thighs due to running (OW!!), the options for my new CGM sites were pretty limited.. either a pain in the butt or the back of my arm.

Cannula and CGM location options

Not finding this first option at all appealing (who wants to sit on a lump all day?), I've had to swallow my insecurity to a large extent and be okay with the possibility of my CGM being visible to the world with my short sleeves shirts.  Knowing this will cause a lot more weird looks from strangers and probably several many pointed questions from curious kids, I wiped down the spot, adhered the tape to my skin and, due to the awkward angle, asked my Mother to push in the needle.  Both of us wincing at the mere idea of this new experience, it actually turned out to be much, much more pleasant a location than my abdomen had been previously.  Barely feeling the pinch of the needle, it seems that I am trading comfort for concealment...

Not quite as trendy as a bracelet or watch,
but, hey! It works! 

Fortunately, in the few days that I've been rocking this new look (note the implied confidence) I've seen more accurate readings popping up on my CGM receiver screen for my calibration tests and it showed in my endocrinology appointment this week.  Meeting with Dr. Rogacz to adjust my pump settings, get a grasp on appropriate symlin usage and run a new HgA1C I'm thrilled to report that all is looking tight and tidy.  My A1C is down to 5.6, my symlin dosages have been increased from 15 units once a day to 30 units up to two times daily and my settings are as accurate as they can be for the next five minutes.  So thank you for that, Dexcom!


Long story short, as this is my first pregnancy with a CGM, this new equipment is forcing me to actually have new experiences with my diabetes and my body.  Feeling like this whole disease is pretty much old-hat now and that there isn't much it can throw my way that I haven't already figured out, it's oddly refreshing to have to learn something new and different for a change... course I probably just tempted Murphy there (knock on wood) and will come back to redact these words in a few weeks, but for the time being, I am learning how to work my new arm-accessory and, fingers crossed, I wont ram it into too many walls or rip it out accidentally.  That would NOT be fun.

All for now.  Fetal Echo on Monday.  Keep your fingers crossed!

It's a...

 

 

 Baby#3 is a Boy! 

Week 18: Level-II Ultrasound

With most pregnancies, moms-to-be go in for an ultrasound only a couple of times in their 40 weeks of gestation.  If I remember correctly, we only saw GW four or five times in total and that was excessive because of the circumstances (realized we were pregnant after we were already 12 weeks along).  With baby bump #3, today marks sonogram number six in only 18 weeks and I know for darn sure that we have many, many more to come. 

We went into the perinatal office today for our level II ultrasound to check on baby's physical development.  As I talked about with the previous pregnancy, the risk with elevated alpha fetoprotein levels is that either there is a malformation with the baby or there is a maternal issue impacting the reading.  While the second isn't necessarily a walk in the park, the first is obviously the more scary of the possibilities and this in depth analysis of baby's body helps rule out conditions like spina bifida and abdominal wall malformations. 

GV in tow, the sonographer gels-up my belly and projects the images of our little one on the screen inciting excited squeals and flailing toddler enthusiasm at the sight of  "BABY!!"  Starting with the spine, the image gradually works down the vertebrate one by one until the sonographer reports that all looks good there before moving on.  Skipping the heart because I'll require a fetal echo in a week or two anyway, she examines all the internal organs, the baby's growth in girth and length and, again, pronounces all's well.

Lapsing into momentary euphoria, all I can think is "THANK GOODNESS!!"  I can't even begin to tell you how relieved I am to once again have a healthy baby despite my abnormal readings.  Granted I know this means there is something up with either my diabetes impacting the pregnancy (typical) or that there may be issues with the placenta (likely), but as we went through these hoops last time I know that I'm in good hands and that my MFMs wont let anything get out of hand.  If it is, in fact, an old placenta as it was with GV, I can only pray that we don't repeat the abruption of all things.  High AFP, okay.  Placental concerns, gotcha.  Abruption - heck no!

Bringing me back to reality, the sonographer then asks the one question every second trimester mom is tempted by: "are you finding out the gender?"

Answering yes, but no - we're doing a fun gender reveal this go around because, why the heck not?! - she tells HB and me to look away from the screen while she pokes and prods the little guy/gal into a conclusive position. Taking a folded card from the cabinet she then announces "I'll be right back, I don't want you guessing from my scratching!" and exits the room.   Upon returning, she hands me the thoroughly stapled shut card and says "CONGRATULATIONS!"

As tempting as it is to open this card now and know what we're having, we found out the quick way the past two pregnancies and knowing now or this weekend doesn't impact what we'll have the rest of our lives.  Either, this card says it's another little girl (what I want) or it says it's another little boy (what I think it is) - but either which way, I'm putting that card in my purse, handing it straight off to the best mommy-buddy a girl could ask for (yeah, you, SP) and thanking God that baby is healthy and doing exactly what he or she is supposed to be doing: growing!    

Next appointments:  week 20 fetal echo and week 21 MFM check up.  But first: gender reveal! 

What do you think baby will be?  :)

Broken CGM. DANG IT!

I don't know what my problem is. I seem to have this amazing knack of breaking equipment that I've become thoroughly reliant upon.  At just over three and a half years into my life as a type 1 diabetic, I'm not only on insulin pump number three, but I'm now on continuous glucose monitor number two. 

Last night, our local RWB community hosted a September 11th memorial event supporting both Team RWB and another veteran service organization, Operation Enduring Warrior.   Intent on participating in this moving tribute, I anticipated run-walking between three and six miles of this "11 on 11" relay, but my blood sugar had other plans.  Waddling almost the full length of one whole block (see how I made that sound like a loooooong way?), I reluctantly had to turn around when my CGM announced my impending hypoglycemic doom.  As I didn't have sugar on me or on the stroller (bad habit to get out of, eh?), I shuffled my way back to our start/finish line to avoid catastrophe and wait for the triumphant return of our patriotic crew. 

HB leading the event invocation (check out that growing belly! Oh my!) 

Upon flopping down on top of the large green cooler RWB provided for the runners, I set my glucose monitor, keys and cell phone on the ground beside me as there was plenty of time (11 miles, even for the fastest will take a while) before needing to pack up for the evening.  I then spent the next couple hours cheering for our athletes as they completed their laps and knocked out their memorial miles, I conducted a quick interview with a local online newspaper and I chatted with both new and familiar faces about this, that and the other thing -- none of which did I conduct near my piled electronics. 

Finally, the event completed, we packed up our belongings and made the collective family decision to scrap the idea of going out to dinner as it was approaching 10:00 PM and,  therefore, well past the hour of human/toddler decency.  Having tucked the kids into their respective beds, I came downstairs to check my BG and grab a quick piece of toast or whatever else to eat before crash landing on my own pillow… little did I know, my night was just beginning. 

Upon reaching the kitchen, I pressed the main button on my CGM and promptly covered my ears as the receiver made the loudest BEEEEEEEEEEEEEEEEEEEEP I'd ever heard.  Reading the never-seen before message on the screen saying "HWFR CALL TECHNICAL SUPPORT," I attempted to compose my angry, confused and concerned mind into a calm and collected voice-mail to the Dexcom support team.  Unsure of what happened or how to fix it, I waited next to my phone for a return call until I'd fallen asleep.  Much to my annoyance, it was only when I called them back again this morning that I began to get even the slightest hint of what might have happened and what we could do to correct the problem.

Supposing that the receiver was stepped on, dropped in the ice water or some sort of combination of horrible fates one doesn't wish for one's electronics, the Dexcom representative attempted to walk me through the "simple" process of resetting the receiver before we determined that, nope, there was absolutely no shot at saving my barely six month old CGM from warranty replacement.  

So here I sit today, up a creek without my monitor and I'm feeling absolutely lost in the world.  A year ago, I was doing exactly what I am doing right now - occasionally pricking my fingers to test my glucose levels - and it wasn't at all a problem, but now that I've become so conditioned to having CONSTANT access to my trending information I feel uncomfortably naked and horribly ignorant of my own body.  It's like part of me has been amputated and my phantom parts are just too much for me to wrap my head around…  I keep reaching for my CGM and groping the bottom of my purse in hopes that the last 24 hours didn't actually send me back to the stone age only to remember that, yep, I was in fact stupid to be so careless. 

Fortunately, since my system is so young and still under warranty, Dexcom is overnighting me a replacement receiver and I should be back up and bionic tomorrow.  However, even with this quick solution turn around,  I can't help but kick myself for the irresponsibility, the unappreciation, the negligent behavior I exhibited yesterday that cost me, yet again, a piece of technology I am thoroughly reliant upon.  In a lot of ways I find my angst today incredibly ironic given how hard I fought against this system in the first place, but it just goes to show that the mind and the body can adapt to anything and I guess I'm finally okay being part plastic and batteries.  Maybe one day scientists will make a pump and CGM that will actually be able to withstand the trials and tribulations of an active life like mine, but for the time being, let's just hope I've learned my lesson and my new electronics are blessed with a much longer life than their predecessors.  

Week 15: Abnormal AFP Results

And so it starts.  

Had to provide my doctors with the oh-so-charming 24 hour urine test this past Monday along with several many blood samples to get the ball rolling on our alpha fetoprotein testing.  Somewhat anticipating abnormal ranges given the high numbers we found with my second pregnancy, I've spent the last several days stressing and nights tossing and turning.  And, for better or worse, my concerns came to a head today. 

Had my 15 week appointment with the newest partner at the Perinatal Associates practice, Dr. Obi (ironic name if you ask me), and I could tell just by the way she walked into the room that my AFP numbers were high.  Not having experience with our case history or our family's generally stoic response to medical complications, I expect that she anticipated a full on melt-down from HB and me to her news that my levels were 2.2 multiples of the median (MoM).  In the non-diabetic world, this number is perfectly fine given that "normal" ranges from 2.0 to 2.5 MoM, but given the higher risk for complications for both me and the baby due to my diabetes "normal" in my case is nothing higher than 1.8 MoM.   

Responding to her with a disappointed, but accepting "we kind of figured as much" she wasn't entirely sure how to respond.  Explaining that we'd been through this rodeo before, Dr. Obi obliged me by avoiding the implication-explanation and the if-this, then-that details and jumped straight to the next course of action.  

"It's standard to run the test again to double check the results and we can do that today.  If the results are high as this first test would indicate, we'll need to do a level-II ultrasound in about three weeks and get you scheduled for a fetal echo."

Having familiarity with both of these exams, we nodded and left with at least the conciliation that we'd have full answers in a few short weeks (not to mention that we'd likely know the gender of baby two weeks earlier than otherwise). 

That said, I'm still waiting to hear back on the results of the second AFP screening but I'm not expecting the results to be different from the last.   We go in for the level-II ultrasound on Sept 24 so, until then, fingers crossed! 

Freaky Friday, Medical Style

For the past three and a half years I've become accustomed to being "the sick one" in the family.  Hospital visits seem to be typical, a variety of specialists are on speed dial and I can't help but feel that one medical complication usually leads to another.  Throughout this roller coaster of diabetes induced boohockey, the rest of my family has been at my side and, GW in particular, has been my little trooper.  There to snuggle me through my hospital stays, to entertain us through longer than normal waits at doctors offices and to tell all nurses to "be very careful" when drawing blood because he doesn't want me to have another ouch, you could easily say that he's acclimatized to the world of medical issues. 

Left: diagnosis hospitalization at Georgetown University Hospital, January 2011.
Center:  partial-abruption hospitalization, September 2012.   Right:  week 36 ultrasound, November 2012.

Well, yesterday, GW and I swapped places and I have to say, it has me respecting him in a whole new light.  At the beginning of August, GW started speech therapy to help correct his articulation (for example, he often says the "f" sound in place of "th") and his therapist made the suggestion we have his tongue evaluated because of it's heart shape.  Indicating that this shape is caused by an overly tight frenulum (the flap of skin that connects the tongue to the bottom of the mouth), she said it may likely play a contributing factor in his difficulty pronouncing certain sounds.   

Thinking this made sense, I called our pediatrician to get her take on it and she recommended that we take GW directly to see a pediatric ENT by the name of Dr Robert Bahadori in Chantilly, VA who would be able to evaluate the situation much more accurately without being overly quick to surgery as a solution.  Stating that she'd take her children to him specifically if she were in our position, I thanked the pediatrician and promptly called to get GW an appointment with Dr Bahadori no matter how long the wait.  Having several years of experience with specialists as the "new patient" with minimal necessity requiring prompt scheduling, I anticipated it'd be several months before we could get an appointment with this particular doctor or that we'd be given the "our junior practitioner has availability" option, but much to my surprise GW was promptly scheduled for the following week for a frenulum evaluation. 

So back-roading it around the early morning commuting horror that is I-95 North, we arrived at the doctors office (which has an amazing children't play room by the way) where we were promptly seen by a nurse and then Dr Bahadori.  Walking in just as you'd expect a pediatric ENT to - aka Patch Adams style in a yellow shirt and polka-dotted bow tie - he casually asks GW to play with him by sticking out his tongue.  Looking at me for approval before doing something that would under other circumstances get him in trouble, GW darts his tongue out as far as he can (barely to the edge of his bottom lip). 

"Yep, tongue tied," says Dr. Bahadori. 

After a few more playful checks, the doctor looks at me and informs me that there are two points at which he typically sees frenulum issues.  The first is in the first four weeks of life when infants struggle with their tongue movement enough that it negatively impacts their ability to eat and inhibits growth; and the second is roughly in the three to six age range when speech issues begin to appear, as is the case with GW.  Recommending that we do a frenulectomy, Dr Bahadori explained that for those children under four months old, the procedure is a quick in office snip that can be taken care of at any time, but as GW is almost 5 years old it would require that he go to a surgical center and have full anesthesia to make the cut.  

Taking a moment to think about what's best for GW, all of these thoughts about the issues he's had flash through my head:  he can't push food into his cheeks when he takes too big of a bite, he always spits it back out… he uses his finger to swipe away the food that collects between his teeth and his cheeks… he can't whistle and substitutes a "hoot" he learned from Dinosaur Train as his version of whistling… the way he says "teef" instead of "teeth" and "birfday" instead of "birthday"…  the way he's commented that so-in-so is able to stick out his tongue (both because, well, his mom let's him and because he physically can).   Feeling like his little 4 years old life played out in seconds of random memories and snapshot images, I decided it made more sense to go ahead and enable him to use his tongue for the rest of his years by doing the clipping than it did to protect him from the terrifying idea of a scalpel anywhere near his beautiful little body. 

Estimating it'd take less than five minutes to do the procedure and roughly 1 to 2 days for recovery, Dr Bahadori helped me to schedule the procedure for two weeks later and, for better or worse, that came and went yesterday.    While I waited in a consultation room, HB escorted our popsicle-motivated little toughie into the operating room where he helped GW get into place on the table and helped to calm him as the "super-hero" anesthetic mask was placed over his nose and mouth.  While acknowledging that he was glad GW wanted his Dada to accompany him into the OR, HB reported that there was nothing quite so scary as leaving our little man lying unconscious on the table surrounded by scrub-clad strangers… 

HB and GW happily playing in the children's waiting room.

Having been "the sick one" for so long, this reversal of roles introduced a new level of helplessness into my hospital-based repertoire that I must admit I never want to feel again.  Knowing that my own cooperation with doctors orders, control of glucose levels and attempted maintenance of personal health is entirely irrelevant to the ultimate outcome what's happening with my loved ones made the experience far more terrifying than any of the other times I've been lying in any ER waiting for results on this, that or the other thing. 

Fortunately, my patience vs. parent-concern ratio wasn't tried as it otherwise could have been as it was literally two minutes after HB joined me in the consultation room that Dr Bahadori appeared.  Reporting that everything went smoothly, he cleared GW for regular activity within 24 hours and asked for us to call if there were any concerns that arose after discharge.  Impatient to get to the recovery area and see our little guy, we thanked the Doctor and eagerly walked to where GW was curled up under a blanket and eagerly awaiting not us, but the popsicle the nurses had promised to him.  Forty-five minutes, one popsicle and two boxes of apple juice later, he was discharged.  He had a rough afternoon and evening coming off the anesthesia, but in looking at him this morning he is keeping food down and appears to be happy about his new found ability to wiggle his ever-so-slightly medicated and considerably longer tongue.  

Left: Frenulum before procedure.  Right: Frenulum after clipping.

Out of all the procedures he could have had this one was particularly minor (knock on wood), but this reversal of roles provided me a considerable dose of my-own medicine and it definitely was lacking in Mary Poppins' sugar...  I've come to accept my own medical issues as typical and I'm no longer shaken when something new pops up with my body that requires additional attention, but I'd never really stopped to think about how my being sick makes my family feel.  They don't have the symptoms, they don't have to do the tests or get the injections, but they are just as much smacked in the face with my diabetes as I am and it's just as present in their daily lives because of me.  Seeing GW in his scrubs and having these doctors poke and prod at him was more painful than any of the things I've had done and it's opened my eyes to how high of a pain-tolerance this little guy has for everything he endures to be there for me.  For better or worse, he's grown up quicker because of my pancreas and he knows more about hospitals than any almost 5 year old should (Heaven help those children who know even more...), but Lord love a duck is that kid tough and I cannot say how thankful I am to have him at my side or to have the blessing of being there, as his mom, at his. 

"Can I have another popsicle?" 

Okay, fine. I'll talk.

It's probably about time that I actually start writing again… for a long while I've been buried under a voluntary pile of community service work and my hectic schedule transformed itself into a convenient excuse to avoid writing about what I wasn't ready to share, but now that it's pretty darn obvious I haven't just eaten one or two too many burritos I'm pretty sure the shelf-life of my "busy" excuse is up.  

So… long story short… we're pregnant!  HB and I are excitedly expecting Baby #3 this next February and, as of right now, I'm just about 15 weeks along.  It's been difficult this go around to feel comfortable announcing our news given how rough things were with GV's pregnancy, but, let's face it, not writing about this baby-bump doesn't impact the way things go anyway so I might as well get over it.  

Goodbye running condition!

Things started out a bit on the scary-end of the scale for us as we went in for our 7 week viability appointment only to have the sonographer and perinatologist say the baby was measuring much smaller than it should.  Instead of showing a yolk-sac size appropriate to the estimated date of conception - which is initially based off of the first day of the last menstrual cycle and then confirmed by ultrasound - the yolk-sac size was measuring closer to 5 weeks of gestation.  Asking to repeat the test in one week, we went back in with hopes of getting better numbers… unfortunately still measuring small the doctors prepared us for the higher probability of a miscarriage… something, you can imagine, we were terrified to hear.  Repeating the ultrasound again the following week as requested, the numbers were at least showing consistent growth from one week to the next so the doctors felt at least comfortable enough to grant us a due date two weeks later than initially expected:  February 21.  

Obviously this size-discrepancy left us still very concerned about our small baby, but powerless to do much about it we were sent home to wait for further information.   With five weeks until my next prenatal appointment, i tried to find pro-active ways to help care for baby since all else was out of our control:  I decided to limit my physical activity to the stair stepper as I did with GV to keep my heart rate below 140 beats per minute (going on the previously identified concern that hyperthermia could hurt baby) and we cut my carb intake as much as possible to control my glucose levels.  Unfortunately I found myself regularly chasing lows as a result of morning sickness and this second attempt wasn't terribly successful, but with a bit of hands on help from my endocrinologist we smoothed things out. 

One thing Dr. Rogacz taught me that I didn't realize with the previous pregnancy is that the injection of symlin during pregnancy hasn't been formally FDA approved yet.  So while she prescribed that I use it for the later trimesters of my pregnancy with GV, she was adamantly opposed to the idea of starting symlin during the first trimester with Baby #3.  I found this to be somewhat disconcerting, but GV turned out perfectly fine and those injections helped me to regulate my glucose - and therefore her development - so I anticipate that I'll start them again here in a few weeks or months. 

Anyway, so the next few weeks went by ever so slowly with more weight gain and vomit than ideal, but we finally made it to the week 12 neural translucency test.  Knowing that if all goes well this test would be only the start of the flaming hoops I'd be jumping through in the second trimester, we anxiously awaited the doctors assessment on baby's growth… 

… 

And, thank God, heart rate and size were right where he wanted to see them!!  The weight of the world seemed to lift from my shoulders as we discussed the normal ranges they were discovering across the board… talk about music to my ears!  Granted the doctor warned that we'd need to start alpha fetoprotein testing week 16 - the tests were we started to see abnormal results with the second pregnancy - so the music may be short lived, but hey, where we are right now is a definite step in the right direction! 

I must admit that starting to finally talk about the pregnancy, while nerve wracking and definitely to a certain degree unsettling, is cathartic.  I've been so worried about judgement and commentary from the peanut gallery about this, that and the other thing that all my concerns and angst have been bottled for the past several months to the point of pure exhaustion.  I haven't so much minded the exhaustion up until this point thanks to the support from HB and Grandmama, but getting past this phase of stress and morning sickness, and into the second trimester honeymoon phase that was so unfortunately truncated last time will be a huge relief.  

So with that, you now know, and there's no going back from here.  More soon!