Consult with the High-Risk OB

Last week I had an appointment with the high-risk OB. My regular OB practice sent me for a consult. Originally, my OB told me that he felt comfortable taking care of my pregnancy, unless anything unusual happened, at which point he would refer me to the local high-risk OB. But then, the message got mixed up. You see, my OB works as part of a larger practice, and despite my attempts to see only my doctor, I managed to see three different doctors and a nurse practitioner over the course of my first few months. And each of those practitioners had their own opinions about the best strategy for a healthy Type 1 pregnancy.  It was confusing at best.

As a result of all of this confusion, I ended up at the high-risk office for a consultation. The high risk OB works alone, without partners. There are obvious advantages to this set up, but also disadvantages. For example, when we went for my consultation, the doctor was delayed because a C-section he was scheduled to perform was bumped from the OR. When there is only one doctor in the practice, there is no partner to share the load. On the plus side, there are fewer conflicting opinions and more consistency. But there are fewer ideas and fewer minds working on my “problem.”  There just isn’t an easy answer, is there?

At the appointment, he was practically dumbfounded by my record A1C (5.3 — Yay!!!), but he did pour over my BGs and suggest a few tweaks to my basal rates. I liked that he seemed open to my opinions, and to  a  more collaborative approach to managing my sugars. He said that I probably know more than him about the disease given my 27 years of living with it. He might be right, but it sure is nice to have a professional opinion every now and then!

On the down side, it seems that he wants to manage my endocrine issues throughout the pregnancy. This is not necessarily a bad thing. Afterall, he did make good suggestions. But I am just now getting this relationship with my Endo worked out. And he does have my A1C down to record lows. I hate to abandon that relationship.

My OB from the regular practice called the next day to say he thinks that the high-risk OB should manage my entire pregnancy. He feels that I would get the best care that way. I can still have some of my run-of-the-mill appointments at my regular OB’s office so that I don’t have to spend so much time on the road (the high-risk OB is in a neighboring, larger city), but the high-risk guy will be in charge and he will deliver my baby.

But there is this nagging feeling in the back of my mind that maybe this is not the best solution. Sigh. I don’t know what to do. I just don’t want to screw this up. My baby is depending on me.

I have an appointment with my Endo in early January, so I expect to ask him  for his advice. I think he may be a bit miffed that he is sort of  being forced out of the equation by the high-risk guy. But maybe my Endo knows another high-risk guy who works more closely with the Endo. As a third alternative, I asked my mom to ask her Endo for advice. Her Endo recommends a hospital system in another surrounding city, but it is even further away from home. However, that hospital seems to be “the place” for pregnant diabetics in the area. And it has had that status for quite some time. In fact, it is the same place that my mom delivered me 31 years ago.

So what should have been a settling appointment has left me with new questions and few answers. Maybe I just need to relax a little and go with the flow? What would you do?

A Tight Fit

Monday I went shopping for maternity clothes with my mom. I am down to just one pair of regular pants that fit. They are two sizes bigger than my normal size. And I am relying heavily on four extra-large long sleeve t-shirts to cover my top half. Even though my weight is only up a pound or two from pre-pregnancy, all of my clothes are tighter, especially in the waist.

The bad news is that most of the better department stores either don’t carry maternity clothes at all, or don’t carry them in the mall. Thankfully, there was one store in the mall devoted to maternity clothes: Destination Maternity. Unfortunately, they had next to nothing for a short girl like me (I’m 5’1″).

I did manage to find three pair of pants there, but they all need to be hemmed because they are at least three inches too long. Also, I learned that the stretchy belly panel that covers the whole belly is particularly bad for pumpers. I ended up with a lot of cord snaked around underneath and then on top of the panel before I found a pocket to put my pump in. I am hanging my hopes on a seamstress that my mom knows. Hopefully while she is shortening the length she can sew in an access hole or something. Also, one pair that I found doesn’t even have a pocket, so I will need to find some other way to wear my pump with those. Hopefully the seamstress has some ideas.

None of the shirts fit me there, either.  Everything seems to made for a super skinny girl who wants to show off her belly … and her hips and thighs and butt.  How many pregnant girls are super skinny? I’m certainly not one of them!

I did find two long sleeve maternity t-shirts at Gap Maternity. They are huge on me now, but I think they will come in handy in the next couple of months because my extra-large t-shirts are already a little on the short side.

Next it was on to the lingerie shop for the best news of the day: my bra size is a full two cup sizes bigger. Amazing.

I am still on the lookout for a couple more shirts, especially something that I can also wear now during this in-between stage, and a pair of slip-on shoes. It is getting harder and harder to tie my shoes, and I don’t want to be stuck one morning before work without any shoes to wear. I’d also like to find some sort of cardigan or other sort of layer. It is freezing in my office, but my internal thermometer seems to be on the fritz lately … I’m either hot or cold, but never comfortable.

Do you have any tips for where to find well-fitting maternity clothes for short women? It turns out that most of the maternity lines do not even offer petite options. Any other ideas?

What’s for dinner?

This question is the hardest one of the day. As a result of my recent morning sickness, which is thankfully finally starting to subside, nothing sounds good.  Couple that with my complete exhaustion, and the digestive distress that pregnancy has brought along with it, and dinner time has become one of the most difficult times of the day for me.

My husband is probably nodding in agreement right about now. Normally a pretty basic guy when it comes to dinner, he favors a no-fuss, simple-to-prepare and simple-to-eat menu. If it weren’t for me, I think he would live on bologna sandwiches (complete with squishy white bread, American cheese, and ketchup) and SpaghettiO’s. Most of his suggestions sound less than appealing at this point in time, but he has been a real trooper, continuing to suggest ideas that I continue to turn my nose up at.

Luckily, he has been more than helpful in the kitchen, pretty much taking over all of the food preparation and clean-up duties. This is no small feat for a man who prefers not to make meals that require more than one utensil to prepare. Have I mentioned how great he has been through all of this?

Additionally, I have had to nearly abandon most of my normal, diabetic-friendly foods. Fiber is a no-no for my newly sensitive digestive system, so I have had to cut out most of the whole grains and strictly limit my vegetable intake. So much for my vow to eat lots of veggies throughout my pregnancy. I am reduced to low fiber fruits as well (think grapes, not apples). Even a modest amount of fiber leaves my stomach feeling like it has a lead weight in it, while at the same time, resulting in bloating and smoother-than-preferred results on the other end. Luckily, my blood sugars are still running on the low side, so I have not had to rely on the fiber to offset my insulin resistance. Yet.

Acid is also an irritant thanks to my new heartburn and acid reflux issues. That limits my intake of tomatoes and all tomato-based sauces, and acidic juices and fruits like oranges and pineapple.  And I really miss my spicy foods. Bye-bye chicken wings, salsa, hot pickles, and Tabasco sauce.

Milk products and most proteins are also causing me grief in the nausea department, although I have had some success with Carnation instant breakfast mixed with skim milk.

So what’s a pregnant diabetic to do? I’m growing tired of boxed macaroni and cheese, white pasta (sometimes with a small amount of mild spaghetti sauce,) and white toast, English muffins and bagels. Besides, Baby is not exactly getting a well-balanced diet out of these selections. Thank goodness for prenatal vitamins, I guess.

Does anybody have any easy-to digest dinner ideas that are quick and easy to prepare? My husband would be oh-so-grateful for your advice.

12 Weeks

Baby says, "Hi"

Today was my 12 week OB appointment. The purpose of the appointment was twofold: To set me up as an “official” pregnancy patient and to start genetic testing.

The day started out with an ultrasound. Part of the 12 week genetic testing, called Nuchal Translucency, is to measure the amount of fluid in the baby’s neck. This measurement, coupled with some blood work, assesses the baby’s risk of having Down syndrome and some other chromosomal defects.

This whole genetic testing thing is complicated. As parents, you do not have to do the testing, it is just an option. Also, the tests are known for producing false positives, which can cause a lot of worry and heartache. It was hard for us to decide whether or not to do it, but we finally decided that we would rather know what the odds are, and to be prepared for the outcome at delivery.

The ultrasound was somewhat uncomfortable. Because the baby is so little at this stage (something like 2.5″ – 3″!,) you need to have a full bladder to push your uterus forward so that the ultrasound wand can pick up the sound waves. I dutifully drank my 20 ounces of liquid 1.5 hours before the exam. As anyone who has been pregnant before can probably tell you, there is a lot of pressure in the bladder area. Even when your bladder is not full, it sort of feels like somebody is trying to wring it out. I am in the habit of peeing every 1-2 hours, even when I have not had a whole lot to drink. So maybe you can start to understand the pain I was in when I walked into the doctor’s office.

Luckily, I did not have to wait long, and the ultrasound experience, as usual, was mesmerizing. Hearing that heartbeat (171 beats per minute this time!) and seeing a “real baby” in there is just amazing. This time it looks even more like a baby, less like a fish. Baby looked like s/he was posing for us, with his/her right hand in the air as if to wave “hello”. The ultrasound tech also instructed me to leave a urine sample, which was not problem at all!

Afterwards, we spent several long minutes trying to draw my blood. They need something like 6 vials of it for this genetic testing, and my veins are apparently still weak from my dehydration and hospitalization. So we finally gave up on that. I have strict instructions to rest and drink tons of water. On Tuesday I have to go back for another try.

After that, the nurse practitioner recorded some of my genetic history, and then took some cultures. And then I was free to go.

All in all, a tiring visit, but I am so relieved to hear that baby is healthy and growing as expected.

Morning Sickness Remedies: What Worked for Me

The name Morning sickness is such a misnomer. It lasts ALL DAY everyday, for weeks. And, at least for me, it was so much more than just a little queasiness. It was like nausea on steroids. And no matter what I did, it just won’t go away. It threw me into bed every night, exhausted and miserable, and greeted me first thing in the morning as soon as I woke up.

Luckily, I seem to be through the worst of it now. It still hits me now and then, but I am SO much better than I was three weeks ago.

One of my goals with this blog is to share what I’m learning on this journey with the rest of the Diabetes OC. So I thought I would dedicate this post to the things that worked for me (and those that didn’t work, too) when I was trying to survive the worst of my morning sickness.

Here they are, in no particular order:

Things that worked

• Jelly Belly Jelly Beans. I found that if I nibbled on these tasty little candies a few at a time throughout the day, they helped keep my stomach from gnawing a hole in itself. An added bonus: they also helped keep my plummeting blood sugars out of that dangerously low range.
• Macaroni and Cheese. You know, the good, old-fashioned Kraft version with powdered cheese mix. This  dinner time go-to turned out to be just bland enough to allow me to keep down a decent quantity, and calorie-dense enough to help inch my weight back up into its pre-pregnancy range.
• Apple Cider. I can’t explain it, but I tolerated and even craved this fall-time drink, which came in especially handy when trying to treat those late-night and early-morning lows.
• Saltine crackers. True to their reputation, these little gems turned out to be the best nausea reducer for first thing in the morning. Believe what you read in the books: keep the saltines on the nightstand and eat one or two before you even attempt to put your feet on the floor.
• Salty potato chips. I read somewhere that a handful of salty potato chips could settle morning sickness. I was doubtful, but was also desperate. This one turned out to work pretty well, but the limit is just about 15 chips, or one carb exchange. After that, they started contributing to that full tummy sensation.
• Almonds. A handful of almonds helped take the edge off when it was too soon to take another anti-nausea pill. An added bonus is that they do not affect my blood sugar.
• Ice Water. It had to be ice-cold, but a few sips would quell my queasiness at least enough to help me get ready for work in the morning. Of course, the additional fluid was also key to keeping me well hydrated.
• Phenergan. I don’t know why my doctor initially told me that the only anti-nausea drug I could take was Zofran. Once I switched to Phenergan, I could finally start to eat again. The side effects can be debilitating, though. It does make me feel tired and loopy in high doses. If I can manage with the lower dose, though, it works pretty well. An added bonus: it is available in generic form, so it is much more affordable than Zofran.
• IV Fluids. When all else failed, I checked myself into the hospital for some good old saline. Two days and three bags later, I felt like a new person. It sure was a nuisance, but it really did help me turn the corner.
• My husband. He did EVERYTHING while I was stuck in bed. From laundry, to dinner, to waking me up to test my sugar,he has really taken a lot of the burden in this new journey. Thank goodness for him. I don’t know how I would have made it this far without him.

Things that did not work

• Bananas. Forget the BRAT diet (Bananas, Rice, Applesauce, and Toast,) which the doctor suggested when I was in the hospital. Bananas contributed to my full and queasy feeling and added a new symptom: heartburn. Applesauce was not much better. Rice and toast worked out alright, though.
• Ginger and lemon. Whether in the form of tea, ale, or candy, these remedies just did not cut it.
• Scrambled eggs. Yuck. This sounded like a good idea, but just did not work out. I couldn’t even finish one egg. Ever since, the thought of any type of egg makes me a little queasy.
• Zofran. I can’t believe I paid so much for a drug that did so little. I could have been taking a sugar pill. Just to prove that everyone is different, I have a friend who is taking this right now and it is working like a charm.
• Reglan. This drug is supposed to help the stomach empty, which should help the full-tummy sensation. Unfortunately, its side effects contributed to my incredible fatigue and helped to make me feel loopy. It did not help much with that full feeling, either. THe good news is that this is available in generic form, which helped keep my drug costs down.

Do you have any secret weapons for morning sickness? What worked  (or didn’t work) for you?

The Endo is Growing on Me

Last week I had my second “pregnant” appointment with my Endo. If you are a regular reader, you will remember that we have had some … er .. communication issues in the past.

This visit went better than previous visits, though. I think maybe we are getting used to each other. We are, after all, seeing each other once a month now. Granted, he still does not respond when I send him my weekly BGs, and still complains when I send them a day or too late, but his pluses are starting to stack up and offset his minuses.

In particular, I was especially pleased with the way he handled the OB when I was admitted to the hospital for IV fluids. You see, I am still only seeing the “regular” OB, not the high risk one, because I am so early in this whole pregnancy journey. His office typically does not do much with type 1 diabetics and the hospital in our city does not even perform deliveries for  diabetics that are on insulin because they do not do IV insulin drips. So you can imagine their concern when I showed up in Labor and Delivery for a couple of liters of fluid.

The nurses were sort of out of their element with me in the beginning. I did my best to ease their worries, but they were simply not comfortable with my just-below-target-range BGs.

But then my OB called my Endo and he seemed to have all of the right words. Apparently the OB was concerned that my sugar might be too low. It was 72 at the time and I was testing hourly (!)

The Endo, now one of my favorite people, assured the OB that everything was fine and that I was doing very well. He instructed them to let me handle my diabetes and to contact him if there were any problems. Can you believe it?! And even more remarkably, the OB consented! This act earned my Endo my Hero of the Day award. If not for his kind words, the OB was considering transferring me to a neighboring hospital for the night where they would be “better equipped” to handle my diabetes. We diabetics know what that means: A total loss of control over our own care. What a relief that I would not have to deal with overbearing nurses, “diabetic diets,” and my own stealth blood-sugar tests in between the official ones that the hospital would perform.

Additionally, during this last appointment, I saw the lowest A1C I’ve ever seen. Are you ready for it? It was 5.3! Of course, this has a lot to do with the numbers I have been seeing in the 30’s and 40’s, but it also has to do with the 10-15 tests a day I’ve been doing and the almost complete lack of numbers in the 200’s. The 30 day average on my meter, computed from 360 total tests (12 per day,) is 112! Amazing. I guess maybe this guy knows what he’s doing.

The rest of the visit was also successful. Aside from a slap on the wrist for not testing for ketones while on vacation, he verified that my blood pressure was really good (104/70) and my feet still have plenty of feeling. He will check my Thyroid again next time. It is running a little low, but this is apparently normal in the first trimester.

All-in-all, the appointment was a relief. I spend a lot of time stressing over those couple of high numbers, and his reassurance has meant the world to me. He also reminded me that there is no evidence that BG spikes cause harm to the baby, only highs for extended periods of time. And I am also relieved to hear that the lows are only painful for me, not the baby. Apparently the baby takes whatever sugar it needs and leaves the rest for me.

With that appointment out of the way, I am now stressing about the 12 week appointment with the OB tomorrow.  If all goes well there, I might be able to relax (a little) for the holidays.

Back from the (Near) Dead

So the first trimester has turned out to be quite a roller coaster. After the initial tubal scare, and the relief of a peanut with a heartbeat, we received a third bit of good news … our fourth ultrasound showed a still growing peanut and a heartbeat that was over the 150 beat threshold. We could finally consider this peanut “viable”.

The relief was short-lived though. It was followed almost immediately by morning sickness that would not die. It laughed in the face of the $50 Zofran prescription I took religiously. I was miserable and actually starting to second guess this whole pregnancy thing. Would I actually live through this??

Around week nine, after three weeks of increasing sickness, I finally broke down and had myself admitted to the hospital for IV fluids. I received 3 bags of fluid over two days and a new prescription for the nausea, this one for generic Phenergan. For the first time in nearly a week I was able to eat, even if it was just toast and ginger ale. I started to feel better almost immediately.

The nausea is stubborn, though. It is still hanging around now in week 12, but I am feeling MUCH better than I did back in week nine.

The big D is also doing it’s best to kick my butt. I have never seen so many lows and they come on fast and hard. Despite all of my efforts with temp basal rates and the suspend feature, I still find myself sometimes hovering in the 50’s and 60’s with quick dips into the 30’s and 40’s I have even seen a few numbers in the 20’s … wow, that’s scary.

My low-blood-sugar-treaters-of-choice have become apple cider, Carnation instant breakfast, and Jelly Belly jelly beans. In fact, I am forcing a pint of apple cider into my over-full belly as we speak.

As the first trimester nears its end, I am preparing for my 12-week ultrasound, and feeling nervous yet optimistic. Sometimes it is still hard to believe that there is a baby in there, and I am still worried that the technician will find something on the ultrasound, but I am getting a little more used to the idea of being pregnant. At times, it seems like the time will never come when I will finally hold this baby in my arms, and at other times, it feels like the time is just whizzing by. 12 weeks already! And I spent most of it curled up in a ball in bed. There is so much to do and so little time!