Discipline(d) breakdown

Posted March 11, 2011 by Nici
Categories: Emotional Health, Motherhood

Tags: ,

It’s Friday – my favorite day of the week because I get to spend it with my little guy. I usually take advantage of my day off by doing all of those little things around the house that just keep needing to be done … laundry, dishes, bathrooms,  kitchen … the list goes on forever.

But today I have been especially undisciplined. Lukas has been sleeping for a record-breaking two and a half hours now and I’ve spent the majority of that time reading blogs, watching TV, and listening to the never-ending rain. I even took a nap (gasp).

My diabetes care gets a little sloppy on days like this, too. This morning, I absent-mindedly munched away at a half a box of Dots while watching meaningless TV before I realized what I’d done. Afterwards, I quickly over-bolused, which resulted in a 219 an hour later and a 40 just a half hour ago.

I realize it’s not the end of the world that this happens every now and then, but I struggle to allow myself such luxuries. Because I fear that one day of indulgence will lead to a downward spiral of sloppy eating habits, poor testing routines, piles of dirty laundry, toothpaste-spattered bathrooms, and crusty kitchen countertops.

Hopefully tomorrow will be a more productive day. But in the meantime,  what do you do to stay motivated in the face of never-ending BG checks … or mounds of dirty laundry? I could use some advice.

I might go wash the dishes now. Or watch Ellen. We’ll just have to see how it goes.

Postpartum: In the blink of an eye

Posted March 4, 2011 by Nici
Categories: Postpartum

Tags: , , , , , ,

This post is the final post in a series about my labor, delivery, and postpartum story. When we left off, the entire family had been delivered to my room in the postpartum unit to recover.

See the following posts for a recap:

Read on to find out what happened during our stay in the postpartum unit.

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It was late in the evening by the time we finally got settled in our postpartum room. I’m really not sure what time it was, because we had been inside the hospital for going on three days now. The flourescent lights were starting to really throw off my sense of time and place. I was disappointed to realize that my room only had a half bathroom (no shower!!!) and was right outside of the nurses’ station, so was quite loud. But I was so tired and elated and just so full of wonder and fear all at the same time that I didn’t even bother to ask if they could move us. We were all here, together, in one piece (or I guess you could say two pieces :)) and that was what really counted.

I was comfortable at this time because I still had plenty of pain killer from the epidural running through me and a catheter to keep up with my peeing needs. So I was anxious to try when the nurse suggested that I breastfeed. I did so, under the guidance of a gruff and less-than-sympathetic postpartum nurse who seemed bothered by my incessant questions. Lukas latched right on like a champ, and the pain was immediate for me. Too bad that epidural couldn’t have spread just a little further north!

Afterward, the nurse suggested that I pump to help bring in my milk. I complied, after observing her rudimentary lessons, but, looking back, I think this is where all of my trouble with breastfeeding started.
And now a sidetrack about breastfeeding:

It turns out that I really didn’t need any help bringing in my milk – It came in on day two with abundance. However, lacking good lactation advice, I continued to pump in an attempt to build up a “buffer” for when I couldn’t breastfeed. But by the time we were discharged, we already had several ounces of stored breast milk and two really engorged breasts. My totally uneducated opinion is that the pumping I did in the hospital set me up for the oversupply I dealt with later that eventually played a big role in my decision to quit breastfeeding.

So if you wondering about breastfeeding and pumping, here is my advice: listen to your body. If you have plenty of milk, DO NOT pump, not even to build up a “stockpile.” If you’re anything like me, you will end up with more milk than you can use and you will pay for it with sore, rock-hard, lumpy, leaky boobs. So much fun.

Instead, just feed your baby when he or she needs it, and let your body do what it’s built to do. And if you have to supplement with formula at night so that you can get some sleep, try not to agonize over it. A healthy mom is critical to the health of a new baby, and if you are a wreck, your baby will be too.

Of course, everybody is different, so take my advice with a grain of salt. If you don’t have plenty of milk, for example, than you have the complete opposite (and much more common) problem from me. In that case, my advice certainly does not apply.

</end sidetrack>

The next morning, the nurse stripped the bandages off of my incision, drug me out of bed, and showed me how to get to the toilet. Getting out of bed is a lot hard than it sounds when you have a belly full of stitches. But they had removed the catheter and my body was starting to flush out the swelling that the Pitocin had caused, so I got lots of practice getting to the toilet in short order.

We spent four days in the postpartum unit and it was just an absolute whirlwind. I fed Lukas every three hours and my husband changed all of the diapers. In between, we struggled with an allergic reaction to two of the three pain meds they tried on me, gas pains, general incision pain, constipation, insomnia, and the standard noise and interruptions that come along with a stay in the hospital. It turns out that I had more pain than most new moms, so this added another layer to my struggle to recover.

I had one nurse who was a real diabetes moron. She gave me a lot of trouble for not finishing my lunches and for treating my near-constant lows with orange soda pop. My doctor set her straight, though, and she laid off. Aside from that one nurse, the hospital staff went out of their way to be helpful, which was a godsend when I was struggling with all of that pain. And they did not try to impose on my diabetes management. Instead, they just wrote down my BGs in their logs and kept track of the changes I made with my pump and the food I was eating.

Speaking of the near constant lows, I was hardly taking any insulin at all during those first few days. I had entered my pre-pregnancy basal rates into a profile on my pump before we left for the hospital, but most of the time my pump was on suspend. My insulin needs increased slowly over the next several weeks, but I still had random lows, especially after breastfeeding.

Our days in the postpartum unit passed in what seemed like moments and I felt so helpless. I could hardly crawl out of bed. My husband had to help me shower and get dressed.

By the time we got home, it had been seven days since we had stepped foot outside of the hospital and I was so happy to see the light of day that I could have cried. It was late afternoon on a sunny day in June. As I walked toward the house, I felt the warm breeze on my cheek and noticed the sun glinting through the tall grass. I looked down to see Lukas asleep in his carrier. I just stood there for a moment, trying to take it all in. We were all here and we were all healthy. It was just incredible.

Day Three: The Delivery

Posted March 3, 2011 by Nici
Categories: Labor and Delivery, Third Trimester

Tags: , , , ,

This post is a continuation of my labor, delivery, and postpartum story. When we left off, the first 48 hours of labor had drawn to a close and I was only five centimeters dilated.

See Labor: Day One for a breakdown of the going-ons on the first day and Labor: Day Two for a review of what happened on the second day.  Read on to find out what happened on day three.

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Things happened quickly after my doctor made the decision to do a c-section. I watched everything as if I were floating outside of myself. I was scared and nervous. It just seemed like a dream. The anesthesiologist came back and injected a boatload of some sort of painkiller into my epidural and they rolled me into a sort of staging area outside of the operating room. Here we waited for our turn.

Once inside, I tried to take it all in, but it was just so much. There were like three or four nurses and two doctors standing at the foot of the table. The anesthesiologist stood behind me. Everything was stainless steel. A nurse asked me if I could move my feet. I tried, but could not, but was not convinced that I was numb. They strapped my arms down to the side of the table like you see on TV and they put up that crazy paper shield right in front of my face so that I couldn’t see anything. I was kind of freaking out.  My doctor was standing on my left and an assistant was standing on my right. Just before the surgery, my doctor leaned around the shield and showed me what looked like a pair of pliers. He says, “I just cut you several times with these and you did not feel it.” I think he was trying to put my mind at ease, but his comment only served to freak me out further.

During the actual event, I did not feel anything. Not even the tugging or pulling or pressure you sometimes here about. Before I new it, my doctor was saying, “He looks good.” He held my baby up over the curtain for just a moment, but I couldn’t really see him because the curtan was basically in my face. I was still pretty freaked out and I said nervously, “He’s not crying.”

They took little Lukas over to a bassinet in the corner of the OR where they had oxygen and all kinds of other treatments, but he didn’t really need them. Just like that, he let out a surprised yelp and then started to cry in earnest. Tears of relief pricked at the corners of my eyes.

Meanwhile, the doctors and nurses were working on putting me back together. They discovered that Lukas’ cord was in a full knot, which explained why his heart rate kept dropping. And they found a large fibroid (the reason for our ectopic pregnancy scare at six weeks), which they removed. As soon as they started to close me up, I felt pressure in my shoulders. Sort of under my collar bones. That and nausea. I mentioned this to the anesthesiologist, who assured me that both were normal (the pressure is a result of gas that is trapped in the abdominal cavity during the surgery) and gave me something that eased the gas pain and Phenergan for the nausea.

My husband took pictures of the baby, of my open belly, of the knot in Lukas’ cord, even of the fibroid. Kind of gross, but I was glad he did it, so that I could sort of relive the expereince later after I had calmed down. I was not able to hold Lukas in the operating room because the pain in my shoulders was too great, but my husband was and we have a great picture of him in his white jumpsuit and “shower cap” holding our little bundle.

It wasn’t long, though, before I was able to hold him. Out in the recovery room, the nurse tested my sugar (the only test that I or my husband didn’t do during this entire week-long event) and then they propped me up and let me hold him. I can’t even describe the feeling. It’s like a dream. It doesn’t seem real. After a little bit of bonding and a few visits from family, they took Lukas to the nursery for a quick checkup and took me and my husband to the postpartum unit. They rolled Lukas into the room just behind us, and reported that he was doing splendidly. His BG was near perfect and he showed no signs of distress. And with that our postpartum adventures began.

Check back soon for one more post about our experiences in the postpartum unit.

Labor: Day Two

Posted March 2, 2011 by Nici
Categories: Labor and Delivery, Third Trimester

Tags: , , , , ,

This post is a continuation of my labor, delivery, and postpartum story. When we left off, the first 24 hours of labor had drawn to a close and I was still only one centimeter dilated!!

See Labor: Day One for a breakdown of the going-ons on the first day. Read on to find out what happened on day two.

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So my second evening in the hospital began similarly to the first evening. They nurse turned off the Pitocin and ordered me a tray from the cafeteria. I was allowed to take a shower and eat a little something before the foley ball would be inserted. Before I was able to shower, though, I started to get pretty significant contractions. This was a surprise to all of us because we had stopped the Pitocin. Luckily the hot shower helped to alleviate the pain and the contractions subsided before the foley ball insertion.

A foley ball is a balloon-like device that is inserted into the cervix through a catheter. Once inserted, the doctor fills it with water to expand the cervix. The expansion is relatively painless. But the insertion is less than pleasant. The doctor could not seem to get the damn thing in the right place. And it hurt. Bad.

The second night passed much like the first night. Testing and waiting and trying to nap between interruptions. Now that we were more familiar with our surroundings, we could make out the activities going on in the rooms around us. We could watch the contraction monitors by the bed and match them to the rooms where the deliveries were occurring. All around us, women were screaming, babies were coming, and families were celebrating. And we were still testing and treating and waiting. By morning, we were more than ready to get this show on the road.

When the doctor removed the foley ball, at least we had some good news. I had dilated to 5 centimeters. Yea! So the next step was to break my water. Which caused immediate, painful, full-on contractions. They came fast and furious. So fast that I hardly had time to catch my breath between them. It seemed like an eternity while I waited for the anesthesiologist to show up and administer the epidural.

So the lesson here? Request the epidural before they break your water. And require painkillers before they insert a foley-ball.

Once the epidural was in and I was comfortable, they started to push the Pitocin again. But every time they increased the level of Pitocin, the baby’s heart rate would drop. At one point it dropped so far and for so long that they started to prep me for an emergency c-section. My husband and I were both scared to death, because they don’t even tell you what’s going on until they have you half wheeled into the hallway. All we could hear was a lot of alarm bells ringing and people talking. There was absolute chaos in my room and a great deal of urgency. And then, just as fast it started, it stopped. The baby’s heart rate returned to normal, and the excitement was over. But as a result, I spent the rest of my labor wearing an oxygen mask and being turned from side to side. Which is especially hard to do when you can’t feel your legs.

At the end of day two, we were exhausted and beat down. The on-call doctor checked my progress and I was still at only five centimeters. Certainly not dilated enough to deliver a baby. So my doctor came in and said we’d be doing a c-section. I was so disappointed. So tired. This was exactly what I didn’t want. But there was no other option. I got a little teary, and started to stress out about what was coming. Major surgery. Yikes.

Check back tomorrow for the details of day three.

Labor: Day One (Finally!)

Posted March 1, 2011 by Nici
Categories: Labor and Delivery, Third Trimester

Tags: , , , , , , ,

Scrolling through the archives of my blog the other day, I realized that I never really told you all about my labor, delivery, or postpartum experiences. I started a collection of posts on these topics some time ago, but never finished them.

It’s just so hard to explain the rush of activities and emotions that occurred over the course of those seven short days. I  kept trying, but was never satisfied with the results. And then my netbook died, taking those draft posts along with it.

So I thought I might try again. And this time I’ll be sure to back up my files.

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You might recall that the day before my induction, we had an amniocentesis which confirmed that BabyNoName was ready to be delivered. The office assistant gave us instructions to arrive at Labor and Delivery the next day at 5pm.

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We arrived at the hospital right on time at 5pm and the nurses were ready for us. I was surprised by the amount of paperwork to be completed and the details to be finalized. But I was comforted by the fact that the nurses seemed confident in their ability to deal with my “special” circumstances and their seeming interest and concern about my baby’s well-being.

It seemed to take forever, but it was probably only a couple of hours before we finally got started with the IV and then the Cervidil. As a reminder, Cervidil is a gel that is applied to the cervix by means of a tampon-like device that is placed in the vagina. It’s supposed to thin the cervix and, in some cases, can even dilate the cervix. As expected. It caused light cramping, but was not difficult to deal with. I was still allowed to get up, walk around, and use the bathroom on my own.

My husband and I fell into a routine of testing and logging my BG every hour. At one point, I was low and the nurse let us treat it with our own stash of supplies, so from there on out, we took care of my BG.

The Cervidil stayed in all night, and in the morning, the doctor on call checked my progress. Boy was I disappointed to hear that we’d only progressed to one centimeter. One! So next we started with Pitocin through the IV. The Pitocin increased the discomfort of the cramps, but they were still not debilitating. They gave me morphine every four hours or so to keep me comfortable. We also used the exercise ball to sort of massage away the pain and to try to take advantage of gravity.

The nurses really went out of their way to keep me as comfortable as possible, and they were very hands off with the whole BG control thing. They wrote down everything I did, from BG tests to basal adjustments, to low treatments, but really stayed at arm’s length. One nurse told me that as long as I was able to keep everything under good control, they would let my husband and I handle it. But if things got out of control, they would step in. And they kept their word. I was impressed.

So after a whole day of labor with low levels of Pitocin, another on-call doctor checked my progress. Still one centimeter. No, I’m not joking. Oh, how I wish I was! At this point I had been in “labor” for about 24 hours. My doctor stopped in and advised me that they would next try a “foley ball”. I’d never heard of this procedure before. Fair warning: if anybody ever suggests it, consider running in the opposite direction.

Stay tuned for “Labor: Day Two”

An endo, a gynecologist, and a patient walk into a bar …

Posted February 28, 2011 by Nici
Categories: Uncategorized

Last Wednesday was that time again. Time for tapping my toe and biting my nails in the waiting room before my endo appointment.

And I had reason for concern this time. As I mentioned a while back, this new birth control pill has really thrown me for a loop. I was pretty sure that my A1c would be up from last time as a result of all of the daytime highs, overnight lows, and all-day cravings I’ve been experiencing.

But amazingly, my A1c was still 6.2. Absolutely no change.

Sidebar: How is that even possible? Sometimes I think these A1c’s are a joke. My prediction:  Someday we will find out that the A1c is just about as accurate as the BG readings we get from our meters. /Sidebar

But my endo was alarmed by the increase in my insulin needs after I started this new birth control pill. I think his concern is warranted given that I’ve jumped from somewhere around 35 units a day to an average of 45 units per day. And I’ve gained around seven pounds. In two months. Yikes.

I’d already called my gynecologist to ask for his advice, but the nurse, who did not believe me when I told her that the new pill was increasing my BGs, never called back. And this particular gynecologist was not exactly chomping at the bit to help solve my female troubles. In fact, he tried to encourage me to just keep with the status quo instead of trying to find something better. So my endo suggested a new gynecologist and recommended a “third generation or newer” birth control pill.

I have an appointment with this new gynecologist in a couple of weeks and in the meantime, I’ve gone back to my old pill. I can deal with the highs and the lows, but I can’t deal with the weight gain. And I can imagine my husband has had enough of my mood swings, too :)

Sigh. This is just another one of those things that we PWDs deal with that most people are blissfully ignorant of. All of our medications and therapies work together to make a semblance of a balanced system, but when we change just one aspect of the system, everything else starts to fall apart, too. And if you don’t have a good team of experts to support you, things can get out of control fast.

I imagine that this is why my gynecologist did not want to embark down this new pill road. He would rather not deal with the trial and error, the ups and downs, and the rebuilding that will come along with the journey. He would rather just do pap smears and write prescriptions. He does not want to be bothered with a “difficult” patient. Why can’t I just settle for “good enough?”

I’ve asked myself that same question many times. Why can’t I just be content with kidney-damaging highs the week before my period and debilitating lows the week of my period? Why can’t I just deal with the cramps, fatigue, moodiness, and bloating? The headaches and heavy bleeding? The backache and swelling?

And then I realize what a ridiculous idea that is. Why should anyone deal with this type of pain and suffering? I realize that this is not exactly a critical medical need. It’s more of a quality of life issue. But don’t I deserve to live the best life possible? I’ve lived with this mess for a long time because it was just too much work to try to fix it. The doctors were not exactly beating down my door to sign up for this challenge, and I didn’t really want to throw another variable into the mix when we were thinking about have a baby. But it’s been over a decade since I worked with a doctor to resolve my “female” troubles. A lot has changed since then. And I deserve better. I deserve more than two good weeks a month. I’m spending half of my life in discomfort or pain!

So I decided it was time to make a change. The trick now is to find a doctor who is willing to come along for the ride.

Disordered?

Posted February 23, 2011 by Nici
Categories: Food and Diet, identity

Tags: , , , ,

I read Lee Ann’s post today about National Eating Disorders Awareness Week and it stuck with me. Not because I’ve experienced diabulimia, but because, even though I’ve not, I can still relate to her comments and experiences.

And, like  Lee Ann, I have often struggled to put into words my complex relationship with food, exercise, and insulin. How do you explain a behavior that is clearly detrimental to your health, but so wrapped up in emotions and memories that you do it anyway?

You see, when you grow up with a constant focus on food, your ideas about it become warped. You learn early to see the two very different sides of food. To treasure it as a sarced gift, and to despise it as an enemy. An ice cream cone can be the reward for a hard-earned 82, the punishment for a foolish 23, or the reason for a disappointing 265.

My mom (also a type 1 diabetic) did her best to allow me to enjoy activities that revolved around food. She learned early on how to use regular insulin to cover an extra treat. But I was still taking shots then, so the treats had to coincide with a regularly scheduled injection or meal.

When we had holiday parties at school, I was allowed to choose three pieces of candy to enjoy with my classmates. The rest was packed carefully in my valentine box or my Easter basket so that I could enjoy it later at home. We tested and corrected for the treats before dinner. At Halloween, I trick-or-treated with the best of them and brought home a large selection of goodies. My cousins and friends would devour most of their loot right there on the spot, but I would have three pieces and save the rest. I was allowed three pieces every night after dinner until the candy was so stale I had no choice but to throw it away.

School lunches were always a struggle and I spent many a lunch with my Cabbage Patch Kids lunchbox, gazing with envy at the trays of my friends and classmates. Oh how I wanted chocolate milk, instant mashed potatoes, and canned corn. The food messages I learned in those early school days are burned in my brain. To this day, I can’t bring myself to eat mashed potatoes with corn, breaded meat on a bun, or canned fruit in syrup.

So even at a young age I was learning about rationing food and choosing my treats carefully. I can remember lining up my skittles by color and forcing myself to eat them one at a time so that the experience would last. I ate them in order from least favorite to most favorite: all of the green ones, then the yellow ones, and so on until I reached the best flavor: grape. This habit stems from a suggestion from my grandma one morning over my oatmeal. After she poured the carefully measured ½ tablespoon of maple syrup onto the center of my oatmeal, she suggested that I eat around the edges, working into the center of the bowl to save the best part for last. I took that one and ran with it. I saved the best for last with everything from breakfast to dinner. When I have a choice, I still eat the foods on my plate one at time, starting with my least favorite and ending with my most favorite. And I still divvy up my skittles, jelly beans, and gummy candies by color if given the chance.

In middle school, I learned that if I wanted to eat something extra, I could exercise to burn it off. So I would ride the exercise bike for an hour, or run up and down the steps until I had “earned” a popsicle.

As a teenager, when I was chunkier and stockier than the other girls in my class, I struggled with body image. My doctors said I was healthy, but I was not tall and lanky like my friends. My mom mentioned to me once that the only way to lose weight is to take less insulin. I never omitted the insulin I needed to cover my food, though. I was too scared of the consequences. Instead, I starved myself: no breakfast, a juice box for lunch, and a light dinner. Of course, I couldn’t survive for long on this kind of a diet, and after months of “success”, I would give in to the cravings and binge on pizza or fast food with my girlfriends.

My exercise obsession continued through high school. I played soccer, swam with the swim team, and generally tried to stay active. During one summer, I worked at a day camp chasing kids all day, practiced with the swim team at noon, and worked out with the soccer team in the evenings. All summer. And I existed, most of the time, on that noontime juice box and a light dinner after soccer practice.

In college, my obsession turned to foods and their values. I embraced carb-counting, but I still also relied on the old exchange program. Always counting and weighing and measuring. A half cup of this. 8 ounces of that. How badly did I want that cookie? It was worth two slices of bread. Or two servings of potato chips. Or a serving of ice cream. Was I willing to give up my afternoon snack? To take an extra shot? To run around the block?

It never crossed my mind that these behaviors might be unnatural, or even dangerous. In fact, I was proud of my accomplishments and my ability to “control” my weight. And no doctor ever asked me about my eating habits or feelings about food. As long as my A1cs where good, I was given a clean bill of health and sent on my way.

Today I like to think that my relationship with food is much more balanced. I do not starve. I eat when I am hungry. But I still struggle with my internal dietician. How bad do I want that order of French fries? Could I settle for the side salad? Just this once? I will pour over a menu in a restaurant, considering all of my options. And if I’m trying out a new place, I might scour the restaurant’s webpage first so that I can compare calories and carbs and fat ahead of time. I am typically the last to order at the table and, at home, deciding what to make for dinner is often an epic dilemma.

And when I finally do decide to have the fries, I blame myself for making a bad decision. If my BG is high afterwards, I tell myself that I deserve it. It’s my fault. I made a bad choice. I should have done better.

I’m on better terms with my body now, too, but it is a daily struggle. I am always trying, but it’s hard. Because this damned disease has done weird things to my metabolism, my appetite, and my body shape. It is hard to keep your weight down when you are always hungry. Add to that the fact that I take exorbitant amounts of insulin to cover the food that I eat, and weight loss and a sense of balance are an uphill battle.

I’ve talked to doctors, dietitians, and therapists about these issues over the years, but none of them really get it. We never really dig into the issue, just skim over the top. There seems to be little interest in helping the diabetic with this ongoing issue. When will the medical community recognize the mental effects of this disease on our ability to maintain a healthy perspective on food and body? And, as patients, what would we ask them to do to help us?


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