Week 34: Not so much.

I am completely drained.  Yes, I have been staying up until well after midnight every night for the past few weeks.  Yes, I have been getting up early and fight the good fight to have two fully dressed children at the breakfast table by no later than 7:20 each morning.  Yes, I am eight and a half months pregnant and being tired is just a way of life.  But, no, these reasons have nothing whatsoever to do with the bottom of the barrel, running on empty, complete exhaustion that my day today introduced.

For the second week in a row, HB couldn't make it to my perinatal appointment at the hospital due to his looming work deadline.  Having overcome the oddity of this mommy-only situation last week, I pouted momentarily this morning when looking at the traffic reports before leaving just early enough to arrive twenty minutes prior to my "we don't actually have appointments available, but we'll schedule you for 8:45 and least know you'll be seen" time.   Skipping the waiting room in favor of the conveniently located bathroom at the nurses station, the nurse I bumped into on my way out decided to have me start my non-stress test immediately since I was already back in the exam room and it didn't matter scheduling wise where I was fit in so long as my NST occurred.  Reassured by my old-hand-at-this attitude toward the procedure, she quickly took my weight (down 1 lb from last week) and my blood pressure (118/79) before hooking my belly up to the various monitors and letting Baby, my book and me be for the twenty minutes of monitoring.

About 15 minutes later, she came in with a concerned look upon her face.  Looking at Baby's heart rate on the chart, she asked me to roll to my left side and down a large cup of ice chips to encourage him to show proper heart accelerations.   As I have previously explained with GV's pregnancy, a non-stress test is a way for a MFM to look at the fetal heart rate to see if it increases to a certain level for at least 15 seconds for a minimum of two times over the course of twenty minutes.   When this kind of acceleration is seen, the baby is considered to be "reactive" and in good health; but when this acceleration criteria isn't met within the appropriate time window, the baby presents "non-reactive" concerns that require additional testing.  Well, today, my coffee didn't rial him up, my movements didn't change his agenda and the ice bath I gave him must have been soothing because Baby wasn't having any of it.   Much to the concern of my nurse who continually went back and forth from my monitor to Doctor Bronsky's office, Baby showed marginal accelerations within a thirty minute window - reactive enough for Dr. Bronksy to take me off that particular monitor, but non-reactive enough to require a previously unplanned biophysical profile to be completed on Baby.

Sent back to the waiting room to fret over the "I guess you passed" (aka "I'm trying not to say you failed") results of the NST, it was only a brief moment before the extremely informative sonographer, Sandra, came out to collect me for my ultrasound.  Explaining every little thing she was looking at as she clicked with the mouse and slid across my swollen belly with the probe, Sandra went out of her way to praised the "precious/adorable/sweet baby" each step of the way through the 8 part biophysical exam as if trying to boost his ego and put my parental concerns at ease.  Stating that "it's no wonder why you guys failed the NST with how squirmy he is and how much fluid you have," my heart sank as she reported my amniotic fluid index levels had increased to 29.6 cm.  Reassuringly trying to indicate that this increase should be "no problem, as long as ..." she ended her pick-me-up speech with a rushed "but, the doctor will talk with you more about that...  Want to see the baby in 3D and color?" 

Nice try to distract me, honey, I'm still going to obsess about it. But, yes (duh), I want to see him in 3D and color.  

Left: 01/13/2015 Baby #3 at 34 weeks gestation.  Right:  10/31/2012 GV at 34 weeks gestation.
I think they'll likely look alike.  

Ushered directly from that non-sequitur into see Dr. Bronsky, I sat down and immediately noticed the oddly stiff straightness of my posture - there was absolutely no denying my concern about the changes from last weeks glowing reports to this week's failure to respond and abnormal AFI levels.  Looking over my chart - and once again not providing me with a take-home copy of the ultrasound report - he automatically launched down the "how are your sugars?" worm hole.  Explaining that my A1C is slightly elevated, but likely more as a result of fewer hypoglycemic episodes than otherwise, I braced myself for what I assumed would be a sink-hole of criticism to engulf my chair and self-esteem. 

Frankly stating that he wasn't pleased to see that my amniotic fluid levels increasing at this point, Dr. Bronsky used the magical word "however" when reviewing Baby's biophysical profile results: 8/8.   Indicating that this doesn't necessarily replace the non-responsive NST but provides him with significant more confidence that Baby is still looking good, he requested that I begin daily kick-counts and expect a more comprehensive work up next week rather than the week after. 

Feeling quite a bit battered around the head by the appointment, I took one final emotional blow as I left the hospital:  as I walked over the catwalk from the Women's & Children's Hospital to the parking garage a friendly hospital volunteer handed me a flier about the campus' new visitation policies.   Taking a gander over the bold face type as I approached the car, I stopped dead in my tracks and had to actively fight back tears as I read that "all children under the age of 16 (including siblings) are not permitted as visitors on hospital premises for the duration of flu season."  In other words, when baby comes and we're left in the maternity ward for hopefully a brief stay of two to three days, GW and GV will not be permitted to come see me or to meet their new baby brother as GW did when GV was only an hour old.  Granted, I understand the medical necessity of trying to decrease the spread of infection and control the rampant spread of the flu across the DC metro area, but they've had their flu shots and we know better than to take a sick child to a place full of depressed and/or brand new immune systems!  I just... I just was really looking forward to that moment when we could all share the newness of Baby together.   

What a freaking emotional roller coaster.  Let's just hope next week brings better news. 

Last Pre-Baby Endocrinology Exam

Going into day four with my CGM down and no estimated delivery time for my new transmitter battery, I went to my endocrinologist's office today for yet another pregnancy check-up with very little confidence that my sugars have been as tight as they ought to be this week.  Knowing full well that these few days won't have a huge effect on my HgA1C as it's a three month average of my blood glucose readings and since I'm getting measured more frequently than is typical, I could somewhat safely estimate that today's A1C reading would be relatively close to last month's of 5.5.  

Sans kids, Grandmama or HB (aka taunting the traffic Gods to let me get home from NOVA in anything resembling a reasonable amount of time), all of my attention was focused on the appointment and I cannot even begin to tell you how mystified I was by the ignorance of my nurse as she asked me questions about my diabetes. 

"Are you still taking Dexcom G4?"  she inquires.

"Yes, I still use it,"  I respond patiently. 

"How many units of that do you take a day?"

My internal monolog: "Seriously, are you freaking kidding me? It's my continuous glucose monitor, woman! It doesn't use or even measure units! And come on, there are only so many of them available on the market and used by this office! Are you seriously asking me this as if it were a prescription drug?!"

My answer: "It's my glucose monitor."

"Oh.  Are you still taking Medtronic Minimed?"

"Yes..." I said in attempts to mask my skepticism of what was to come next. 

"Is that a pill or something?"

My internal monolog:  "O. M. G.  You have got to be kidding me!"

My answer: "It's my insulin pump.  I use it with humalog." 

"Oh.  I'm new to this diabetes thing."

My answer:  "You're lucky."

Scurrying out of the room after checking my blood pressure (98/80 - um, shouldn't that have been of concern?) and taking a sample of blood for my A1C, she skips several of the typically routine pregnant-diabetic questions and leaves me to wait for the significantly more competent and well trained Doctor.  

Surprised to see me without entourage, Dr. Rogacz dives right into my chart and the CGM trends I've provided for her covering the previous week.  Reporting that my HgA1C is up to 5.9, she theorized that this increase - while in the wrong direction - is likely as a result of less prevalent overnight hypoglycemia and an apparent growing trend in mid-afternoon highs.  Merely suggesting that I add Symlin to my late-morning coffee or adjust my bolus settings for my mid-day meals, she snaps my chart shut and announces that as far as she's concerned I'm doing beautifully.

"The next time I need to see you is two weeks after delivery.  Otherwise, make sure that you set your pump to your lowest basal setting for delivery and that your husband knows to turn off or disconnect your pump at the infusion site if you need to have an emergency c-section.  If he doesn't do that, anesthesia will just rip it out and you'll need it after the procedure is complete." 

Finding it terribly ironic that she didn't really feel like she needed to see me today and that the more serious conversation she planned to cover was intended for HB instead of myself, I appreciated the vote of confidence from my go-to diabetes expert that I'm doing everything motherly-possible for Baby #3 and that on her scale of patients - both pregnant and not - I'm one of the few she's not slightly concerned about.  Wishing she could send those exact words over to the perinatologist for their diabetes-rant days where I come away feeling like I'm the biggest diabetic screw up on the planet, it was nice to know that at just shy of 34 weeks of gestation that I'm off the hook for additional "you need to be monitored" appointments until the end of February.  

Again: go me. 

And to top it all off, there wasn't a bit of traffic on the way home and door-to-door my typical 2.5 hour Friday afternoon commute took me 52 minutes.  Now that's a good way to end the week on a medical high note! 

Week 33: All Alone.

It felt absolutely bizarre to walk into the Antenatal Testing Clinic by myself today.  Finding the waiting room set up completely different than it was the last time I was here in 2012 (back then all of the chairs sat in rigid rows facing away from the door toward the television; now the chairs sit in four sections with two rows facing the door, one row directly opposite those two that faces the center of the room and one row adjacent to the door that still faces the television), I was startled by the collective curiosity that hit me as I walked into the crowded room and became immediately aware of all the couples… Every single chair, but one, was composed of a matched set of mothers- and fathers-to-be and all of them looked up in some sport-like synchronized motion when the door opened and I stepped into view.  In an ideal world, I am sure that would have elicited a walking on water kind of feeling from me or anyone else who was noticed by everyone when walking into the room, but the odd man out, something’s not quite right feeling that stuck with me as I took that last chair in the corner under the surveillance of the paired off parents was enough to make me wonder if I had spinach in my teeth or forgot my appointment was supposed to be black-tie attire required rather than pregnant mommy comfy.   

I realize that this might seem overly self-conscious of me to write about or perhaps entirely too trivial to even mention, but the strange thing about that moment wasn’t so much the receipt of these people’s innocuous attention as it was the fact that I’d never before noticed that pregnant mom’s rarely arrive at the ATC alone and when they - I guess I should say “we” - do it’s enough to distractedly drop People magazine to wonder what’s her story.  I mean, as a high risk clinic it makes sense to have someone there with you to endure whatever bad news awaits or to confirm that whatever medical phrase the doctor just said is actually a positive thing, heck that’s how I’ve been operating up until today, but to realize in such black-and-white, seriously look at your surroundings that, yep, it’s completely strange to be here without HB today was a whole new level of surreal.  Maybe I’m applying too much weight to the shift, but I’ve heard tell that going from two to three kids is the hardest transition for parents to learn and this might just be the first taste of that difference I’ve noticed. 

Anyway, so there I am (no shit) all by my lonesome at my first unaccompanied perinatal appointment dreading whatever gloom and doom report of fetal complications, maternal weight gain or what-have-you when I’m called back for the NST which, much to my shock, Baby passed within the first five minutes of being monitored.  Required to remain on the machine for a minimum of twenty minutes, the nurses let me be and read the final chapters of Lisa See’s Red Princess Mystery series (thanks for sending that AS! Loved it.) in relative peace and quiet with only the constant background noise of little one’s wub-wub-wub heart rate to distract me.  Feeling skeptically hopeful that the appointment might not be such a disaster, I went back to the waiting room (alone) and began my next book (okay, Mom, I’ll read the Eragon series… you happy?).  

Shortly there after, Lin, the Chinese sonographer who works part time at the ATC and part time at the main doctor’s office called my name.  Seeming a bit shocked to see me (alone) at the hospital rather than in the normal office environment (with husband and kids in tow), she was quite a bit more eager to chit-chat while checking on Baby.  Covering the weather, the older kids and what we can only assume is the adorable face of this Baby (he’s shy and keeps his hands in front of his face for the 3D sonograms), she could feel me tense when she began measuring the four amniotic fluid pockets around his body.  

“What were you last week?”  she asked. 

“30.0,” I responded. 

“Oh… well you’re down to 26.8!” she announced with a note of triumph.  

Taking that emotional leap of faith from tentative hope to actual happiness as a result of the appointment’s exams, I couldn’t help but smile with relief at the positive turn of numbers this measurement indicates.  See, the thing about AFI levels is that they are supposed to peak between week 32 and 36 before gradually beginning to decrease as full term approaches - so the concern for the past several weeks has been whether or not this decrease would occur or if, Heaven forbid, the AFI levels would continue to rise making for higher risk complications at the onset of birth (namely premature rupture of membranes or placental cord prolapse).  Given that this 3.2 cm reduction would indicate that Baby and I are actually headed in the right direction… holy smokes! What a weight off the world!

Practically floating into my appointment with the doctor, it was such a pleasant surprise to find the soft spoken, kiddie-gloved Dr. Nies waiting behind the desk with her welcoming smile and perpetual encouragement.  Looking over the NST and AFI results, she announced that they wouldn’t need to see me twice a week at this stage of the game as they had initially anticipated and that, if I had no questions, I was free to schedule a once weekly NST for the upcoming three weeks.  Explaining that we’d be repeating fetal measurements week 36 when we’d also be looking to go-ahead and schedule induction (did you see that?!  She said “INDUCTION!” NOT C-SECTION!) for the second week of February…  what A-W-E-S-O-M-E news. 

You can imagine the unrestrained pregnancy glow that emanated from my being as I reentered that couples-only waiting room a full five inches taller than I had when first arriving earlier in the morning.   Soaking-up the five seconds of “single-mom” fame that repeated itself in the group stare as I began to check out, there was no second-round of doubt going through my head about my vegetable-free teeth or my chic mommy-comfy outfit because, yeah, I am the third-time mom that came alone to the hospital’s high risk clinic and you know what I just did? I had a kick-butt appointment.  All by myself!

Dexcom Down!

I am feeling like the biggest idiot on the planet.  About four days ago, my Dexcom monitor began to doo-da-loo at me with an error message I'd never seen before: "Transmitter Battery Low.  Order Replacement."  Thoroughly confused by this message as I'd just replaced the monitor this past September, I plugged in my CGM to it's USB port and rolled on with life.

Then, at about one o'clock in the morning this past Sunday, it hit me.  The error message was so darn clear, the transmitter battery is low, not my monitor battery -- in other words, the gray piece I attach to my new sensor on a weekly basis needs to be replaced.  So no matter how well charged my blue CGM monitor is or how fresh my sensor is, with a dead battery in my transmitter my CGM is about as useful as when trash day falls on a national holiday (yes, we were hit three times recently thanks to Thanksgiving, Christmas and New Years Day all falling on Thursdays... no, I am not annoyed...).

Having contacted my Dexcom customer service rep first thing on Monday morning, I learned that it will take 3 to 5 business days to arrive here at the house.  So with a possible arrival time of this Thursday at the earliest or next Monday at the latest, I have been crossing my fingers that the low battery holds out until the earliest possible time that my replacement transmitter can arrive.  Unfortunately, however, as I was going about the morning routine today my monitor stopped reporting my glucose trends and indicated my transmitter is out of range.  As I'd seen this error message before it didn't initially register that my CGM needs more than my sticking the monitor in my pocket for a while... so you can imagine how dumb I felt after carrying this thing around for an hour to no avail when it hit me that, yet again, I'm being completely dense.

My transmitter battery is d-e-a-d, DEAD.  I have yet to receive shipment notification from my supplier that my new transmitter is on it's way.   I've officially thrown myself back to the Stone Age of diabetes management as, for the second time this pregnancy, I'm back to finger sticks to track my blood glucose.  As my insulin requirements continue to change over the course of the third trimester with the placenta making my body increasingly insulin resistant and with baby and me being incredibly sensitive to glucose swings - him and my AFI levels, apparently, responding to my in-range 70-140 mg/dL blood sugar variations; me responding emotionally to the mere suggestion of my diabetes incompetence or a potential c-section - this is NOT the ideal time to have my high tech gismo go out on me.

Keep your fingers crossed that my new transmitter arrives soon and that the mean time doesn't somehow manage to make my head explode.  I head to the perinatologist later today (solo... boo hiss) and it's my first appointment at the hospital's Antenatal Testing Center, so I'll report back sooner rather than later on how things are going... so, seriously, all the fingers you can spare to crossed are appreciated!

Nesting

I feel like my whole world, including the baby, are upside-down.  Generally speaking, things are lining up where they need to be and they are heading in the right direction (literally, he's vertex), but that doesn't seem to be translating into anything except what I hope to be a short term stint of full on topsy-turvy.   When we moved into our new house two summers ago, I had every intention of leaving the place as is; the previous owner was an interior designer who'd clearly spent quite a bit of time, money and effort on designing a very formal, Virginian colonial theme to the place so it we've been treating the house as move in ready... but the longer we've been here, the more we've found that's needed replaced and the more I've started to feel like we are living in the previous owner's space and not in our own.  

Wishing to remedy that with at least one of the rooms we've yet failed to unpack (at least 1/3 of the house is still in boxes), nesting fever accosted the house as HB and I began to look at simple paint combinations for Baby #3's nursery and maybe a pinterest-sourced wall accent.  I don't know if you have looked at pinterest before, but what a life-sucking, bottomless-pit of amazing ideas... we could do this! Or we could do that!  Or... or... or... bottom line:  what initially started out as the bright idea to "spruce up the nursery" has morphed from a simple application of a few paint coats and maybe new carpet to what feels like a whole house make over. 

Thanks to Home Depot's gentle reminder that it'd be a better investment to take advantage of their free whole house carpet instillation and lifetime carpet/carpet pad warranty than to only superficially replace the carpet in one room, project creep seeped through our entire top floor: we've ripped the carpet and old carpet pad out of all four bedrooms in prep for new flooring to be installed on Thursday; we've repainted both the nursery and the kid's bedrooms top to bottom; we're soon to be wall papering a room for the first time (HB and I have only ever removed wall paper, so this shall be a learning experience); and, much to my literary glee, we've begun work with a contractor to build a series of built-in-bookshelves that will transform our main floor whatever-room into the dream library we've been fantasizing for years.   So you can imagine the mess the house is... both kids are camping in the master bedroom (so much for my bedtime reading routine), Grandmama is back to sleeping on the couch, there are four dressers crowding the landing upstairs and the dog is bunking with all of the extra furniture that needed to be piled elsewhere for safe keeping.  It's the epitome of absolute, piled to the ceiling, someone make more coffee, where's my left shoe, cereal for dinner, insanity. 

To make things more complicated and (to a spoiled wife like me) less pleasant, HB's work schedule has really ramped up due to an end of the month project review he must complete for his customer.  With a smaller than ideal team working on his particular program, this task - while not insurmountable - is demanding to say the least and causing his hours to lengthen both in the mornings and evenings.  While you might be sitting there thinking "so what?" I have to take this time to remind you that at 33 weeks pregnant, I'm going to NOVA for non-stress tests and sonograms once a week, soon to be twice a week, and that as of yet HB hasn't failed to attend a single prenatal appointment with any of our pregnancies.  Unfortunately, my appointment this week marks a first... we can't have him home to help with carpet installation (a must since I can't move furniture) and at doctors appointments and still enable him to make his deadline while simultaneously fighting shorter weeks due to the holidays being "forced" days off -- it's just not going to happen (#FirstWorldProblems).    So cutting slack where it's curable, he's not coming with me to my appointment(s?) and that makes me sad.  Perhaps I'm just whining at this point, but it's a big shift for us to have me head into the unknown with Baby #3 at the hospital on my own...  granted I'm carrying him on my own and I'm responsible for all things baby-making post x or y chromosome contribution, but it's been a team effort thus far and it feels like for the first time I'm fielding an incomplete roster for the MFM reindeer games. I'm sure that I'll get over it, but the anticipation of going solo tomorrow is nauseating for the time being.  

I guess at the end of the day, the boxes are all still getting checked: we're moving forward with nesting by creating total havoc in the house and the baby is being checked on even if only 50% of his parental team present.  I know it's all working toward a positive end state that is family-time oriented, but in the upside down world of progress I feel like my current steps forward are backward and the finish line is perpetually out of reach, yet somehow it's still rapidly approaching.  Hopefully this dizzy, confused feeling subsides and come Thursday evening we'll be so far past the remodeling, nesting, emotional mess we're currently working through that this blog post will seem utterly ridiculous in retrospect.

If I weren't pregnant right now I'd go back up to my bedroom, shut the door, put my arms out and spin around in circles like I have GW do to "change his attitude" in hopes that my vertigo would reorient life into some ultimately sharper form of clarity... but, since spinning while 8 months pregnant isn't exactly recommended, I'll just continue as is down what I can only understand to be an Escher interpretation of my life circa January 2015.

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."

OUCH.  

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. 

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. 

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. 

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 ;)

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.