Archive for April 2010

Another day, another appointment

April 29, 2010

I had another non-stress test today. They were busy this morning – all of the reclining chairs were full of moms-to-be, bellies bared, and the wub-wub-wub sound of baby heartbeats was bouncing off of the walls.

While the nurse was hooking me up to the monitor, a lady who is 33 weeks pregnant with twins was sent over to the hospital because she was having pre-term contractions.

This made me a little nervous, so I kept peeking at my print out to see if the contraction monitor was catching anything. The line was flatter than flat. Then I started to worry that there were not any contractions at all, not even the little “practice” ones … sometimes my mind gets the best of me.

Baby NoName is still hanging out in the top of my uterus – way up above my belly button and just below my chest (That explains the constant assault on my ribs.) He really likes my right side, for some reason, too. Even when I lay on my left side, he manages to stay up there, as if he’s hanging from a tree or something.

The nurse keeps saying things like, “this baby is only 31 weeks” and I keep thinking ONLY 31 weeks?! This has been the longest 31 weeks of my life! What she means, of course, is that Baby NoName’s heart rate does not fluctuate as widely as some of the other babies. This is OK, though, because he is so young.

Luckily for us, Baby NoName continues to pass his “tests” with flying colors. Sometimes he is a little sluggish, but who can blame him? This schedule is grueling, and seeing as his mom is barely able to hold her eyes open lately, he is probably feeling some sort of overflow fatigue from me. In the end, he always manages to come through with at least a couple of good kicks and then we are on our way.

After my physical therapy appointment tonight, I am appointment-free for a whole three days before the routine starts up all over again next week.

Onward and upward!

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FDA crack-down on insulin pumps?

April 28, 2010

This story at Diabetes Health caught my attention today. Apparently the FDA has launched a program to further evaluate the safety of external infusion pumps, including insulin pumps.

You might have heard of the tragic death of Steven Krueger due to a massive dose of insulin. Apparently his insulin pump malfunctioned, reverted to prime mode, and then proceeded to empty his entire reservoir of insulin into him one night while he slept. While there has been no admission of fault on the part of the pump manufacturer, this story has had me a little nervous ever since I read about it. For details, see the story here.

Then there was the recent recall of Lot 8 infusion sets. I had wondered why my sugar was running high after I changed my site. I figured it had to do with the new insertion and that my body was just adjusting to the new “hole.” I had doubled the amount of my fixed prime to try to account for the change.  Months later, I received the nondescript letter in the mail. The manufacturer was recalling all of their Lot 8 infusion sets because the pressure in the set was not quite right, resulting in either too much or too little insulin. I guess I’m just lucky that I was on the “too little” end of the spectrum, not the “too much” end.

Shannon does a nice job of summarizing both of these situations in this post over on her blog.

And then there was my personal experience with one insulin pump manufacturer over five years ago when I upgraded from my first-ever insulin pump, to the latest and greatest. Despite repeated calls to the support line, to my CDE, and to local company reps, and having returned my brand new pump and three different refurbished replacement pumps, I could not get a good resolution from the company.

The pumps were all faulty, with issues ranging from blouses stopped after delivering .2 units, low battery and battery failed warnings immediately after inserting a brand new battery, and, worst of all, failure to deliver basal insulin after infusion site changes, sometimes for hours. All four returned pumps required a response to the FDA, and all three responses were a canned form letter stating that the manufacturer could find no fault with the product.

Nearly a year later, having moved to a new state and having found a new Endo, l requested a prescription for a new pump from a different manufacturer. This new Endo finally put me in contact with a local company rep who admitted that the company had been seeing these problems frequently. After that, I received a new pump with a new software version that worked as designed.

Each time something like this happens, I wonder why there is not more regulation on such a critical piece of equipment. How can these malfunctioning products make it to market and how can the manufacturers get away with brushing aside the health consequences they cause?

So it probably goes without saying that I am happy to see that the FDA is taking a closer look at infusion pumps and their safety. According to the FDA’s press release, they have received 56,000 reports of adverse events associated with the use of infusion pumps in the past five years, including 500 deaths. The press release goes on to say that “many of the reported problems appear to be related to device design and engineering.”

The FDA has also sent a letter to pump manufacturers informing them that they may be required to conduct additional risk assessments before new or modified pumps can be cleared.

They are holding a public workshop May 25-26, 2010 in which participants will discuss observed safety problems and ways to improve designs in order to reduce pump malfunctions and errors. According to the FDA’s Infusion Pumps Website, the workshop is open to the public, but space is limited to 300 participants. You can register online at (http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm203299.htm)

You can also report an infusion pump problem at http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/InfusionPumps/ucm202503.htm

For more information about the FDA’s infusion pump safety initiative, visit the Web page at http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/InfusionPumps/default.htm

31 Weeks: Are We There Yet?

April 27, 2010

Slowly but surely, we’re getting there. Today starts week 31, and I am really starting to get tired of this whole pregnancy thing. I’m pretty sure that anyone who says she loved being pregnant is either sick in the head or lying through her teeth.

On the medical front, my high risk OB is on vacation this week, so I am spared one of my regular appointments. As a result I am only subjected to two non-stress tests and two physical therapy appointments. It feels like a vacation for me, too. Next week it is right back into the thick of it with the two obligatory non-stress tests, two physical therapy appointments, a fetal echocardiogram, an appointment with the High Risk OB, an ultrasound, and an appointment with the Endo.

Speaking of physical therapy, those appointments are really starting to pay off. The pain in the front has subsided considerably. The therapist showed me a great exercise that pops the front of the hip bone back into its rightful place, which alleviates almost all of the inflammation. I can finally sleep on my side again. The massage is also helping to loosen the muscles in my back and hips. I’m not ready to run a marathon or anything, but I can move again, and that’s a pretty big accomplishment.

On the diabetes front, things have fallen into a sort of pattern. That is, a pattern of constant flux. My BGs, while not overly high or overly low, tend to fluctuate a lot. There is very little in the way of a trend. One day I will wake up at 90, and then be at 150 an hour later, even without breakfast. The next day I will wake up at 90 and be at 65 an hour later. The good news is that my overnight numbers have been relatively stable (I know this because I typically have to pee two to three times per night, so I test at the same time.)

As a result of the constant state of flux, I am relying heavily on regular BG tests, corrections, and juice boxes. The only trend I can discern is a tendency for my BG to plummet around dinner time, but I can’t be sure whether this is due to bolus stacking over the course of the day, or just too much basal insulin. Hopefully the Endo can help me sort that one out next week.

My pump tells me that I am averaging 14 BG checks a day and that my average BG is 106. I am averaging 70 units of insulin per day, up from about 35 units pre-pregnancy. I’m surprised that my insulin needs have not gone up more dramatically. I expected to be pushing three times my normal dosage by now. If you’ve already been through this, what was your experience? Can I expect to use a lot more insulin in the next seven to ten weeks?

My belly is growing exponentially. Everything feels tight and stretched to the limit. My insides feel squashed, especially my lungs. The walk up the stairs to the nursery leaves me breathless. The ligaments around my belly are all pulled to capacity and they are really giving me grief. I sure hope my body can hang on for another couple of months. Other, less annoying, physical symptoms include heartburn, leg cramps, and swelling.

Emotionally, I am a basket case. I’m tired, cranky, and tearful. I can go from hysterical laughter to a teary mess in the blink of an eye. At work, it is hard to keep my eyes open in meetings. At home, I my head starts to bob when my husband is telling me about his day at work.

On my way into work this morning, I was thinking about how hard this journey has been. If I had it all to do over again, I might try to arrange things so that I could work part-time during pregnancy. I have said it before and I’ll say it again: A diabetic pregnancy is a full-time job.

I hope this post does not scare anyone away from this experience. I am still excited about the upcoming arrival of Baby NoName, but I don’t want to sugar-coat it. This journey, though well worth the trouble, is hard work!

More Pregnancy Stuff

April 22, 2010

Baby Shower at Work


Last Friday my co-workers threw me a baby shower.  A couple of the girls arranged it all. Something like 20 people showed up, and many more contributed to a card-and-money gift. That’s saying a lot when you consider that I work for a small company of maybe 80 or so employees. I had a really nice time, and was surprised and touched by the generosity. My colleagues pretty much cleaned out my baby registry, and the monetary gift was impressive. We were pressed for time because the event occurred over our lunch break, but everyone seemed to enjoy themselves. I know I had fun, and I hope the others did, too.

House Preparations

This week we are busily preparing our home for Baby NoName. You might remember that we moved in just about a year ago, and we have not done many of the improvements that we hoped to do. Now that our tax return has arrived safely in our bank account (thank you, First Time Homebuyer’s Tax Credit,) we can finally get a few things checked off of our list.

A couple of weeks ago, my husband painted the baby’s room. It was Good Friday. He was off of work and I was not. We also assembled the crib Easter weekend, so even though we don’t have a mattress for the crib yet, the room is starting to come together. We are still looking for a rocker/glider and a low, long dresser that can double as a changing table. Does anyone have any suggestions? We’ve been looking high and low, but have yet to find anything that fits our style and our budget.

The blinds for our windows arrived last week, and my husband has been busy hanging them. Thanks to the Energy Star appliance rebate program, our new kitchen appliances are being delivered this weekend. I have been eyeing a Samsung convection range for over a year now, and it will finally be mine! I can hardly wait.

Maternity Leave

I’m still haggling with my company about maternity leave time, but they did consent to an unpaid leave of absence after my FMLA runs out. This will give me an additional month at home, but will not guarantee that my job will still be there for me when I am ready to return.

Swelling

The swelling is spreading now. I’ve had to give up on wearing my rings and I think my face looks fuller. At the end of the day, my feet and ankles are predictably lumpy and round. Even my calves and thighs are looking fairly plump. My weight is creeping up steadily, too, but I think it’s mostly water weight (I hope!) My fears of ballooning to the size of a semi-truck might soon be a reality!

Healthy School Meals Act: More of the Same

April 21, 2010

Mrs. Q over at Fed Up with School Lunch: The School Lunch Project has been getting a lot of press lately about her attempt to chronicle her year of school lunches. As the school lunch debate continues to heat up, so do the comments and commentaries on her blog. I’m amazed that she has managed to stay anonymous for so long. I hope she’s able to make it all year without being outed.

Recently, she posted about the Healthy School Meals Act of 2010. On the surface, this sounds like a great plan. Even the name of the plan sounds good – how could you go wrong with healthy school lunches? That’s what we all want, right?

But, I took a look at the plan, and now I am not so sure. The plan is less about a well-balanced, calorie-appropriate meal for our children and more about plant-based alternatives to meat and dairy. According to the program’s website, the act would

improve children’s eating patterns by encouraging the inclusion of healthful plant-based options in the National School Lunch and Breakfast Programs. This important legislation will introduce plant-based foods to schools, increase the availability and affordability of these foods, and provide incentives for schools to provide daily plant-based options.

Don’t get me wrong, there is merit in a vegetarian diet and lifestyle, and one can definitely eat a varied and balanced diet while avoiding meat and dairy. But this proposal does not seem to give much guidance in terms of which plant-based items to include on our children’s trays. What, exactly, is “healthful?” And what makes this group think that plant-based options are not already on school trays? Many of the items we detest … white bread, soy fillers in the meats, breadings and coatings on the “nuggets” and “patties”, white potatoes in all of their many forms, other starchy vegetables like corn, and peas, and canned, syrup-laden fruits appear regularly on school lunch trays today, and they are all plant-based.

Given that the current National School Lunch Program considers canned baked beans, frozen French fries, and instant mashed potatoes in the vegetable category, I shudder at the thought of what my child’s tray would look like if his school opted to replace the meat and dairy options with plant-based options. I’m picturing trays loaded with white bread, rice, pasta, frozen potatoes, and canned corn. Sure, the website suggests soy milk instead of cow’s milk, but what’s to stop a school from replacing the cow’s milk with calcium-fortified orange juice or, worse yet, calcium-fortified “orange drink?” And what’s wrong with skim white milk, anyway?

These plant-based alternatives are some of the cheapest foodstuffs out there. Seeing as our schools are struggling to find enough money to feed our children, it only makes sense that these are the types of foods they would migrate too. Goodbye chocolate milk and chicken nuggets, hello French fries and white bread.

The problem with school lunches today is not hard to recognize; it’s a lack of balance. What our children need is a healthy, balanced meal, complete with fiber-rich carbs, lean proteins, and vitamin-dense fruits and vegetables. Simply replacing one food group with another is not the answer here. The answer is switching from calorie-dense, nutrient-poor foods to lower-calorie, nutrient-rich ones. We need to replace the French fries and baked beans with REAL vegetables – green beans, tomatoes, broccoli, and spinach, for example. Get rid of the soy-filled and artery-clogging “hamburgers” in favor of lean protein alternatives like chicken breast, ham,  white turkey meat, and low-fat yogurts and cheeses. And beans are a great source of protein, but they are not a protein exchange (or a vegetable exchange for that matter.) We need to count the carbohydrates in those black bean burgers … and those cups of baked beans.

Resources

Healthy School Lunches, by the Physicians Committee for Responsible Medicine, http://www.healthyschoollunches.org/index.cfm

30 weeks: Childbirth Classes and More Non-Stress Tests

April 19, 2010

We spent the weekend in Childbirth classes. Two loooong days of PowerPoint slides and breathing exercises. I am officially scared out of my mind about labor. The pain, the uncertainty, the exhaustion, and then when it’s all said and done, you have to be healthy enough to care for a newborn. And I’m not too impressed with the hospital where I will be delivering, either. I didn’t exactly expect a Ritz Carlton or anything, but a postpartum room with an attached shower would be nice. Maybe I am just spoiled, but I thought my days of shared showers went away when I graduated from college. Heck, even most dorm rooms have fully equipped en suite bathrooms these days!

I’m starting to spend more time at the hospital in the big city than I am in my own home. Between the classes, the non-stress tests, and the doctor appointments, I am there several hours every week. The parking attendant in my go-to garage recognizes me now. As I wander the halls from appointment to appointment, I’m starting to recognize the staff. I’m even starting to get the hang of navigating the crazy hallways and the four different sets of elevators.

This morning I had physical therapy, which helped a ton. My husband had to help me up at one point last night. I was in tears over the whole pain-in-the-rear/pelvis thing. In physical therapy this morning when the therapist snapped those two bones back into place, I immediately started to feel some relief. I hope I can make it until my next appointment on Saturday. I asked about coming in more often, but my insurance only covers 20 visits. So I’ll try to stick it out until Saturday. The therapist did give me some good exercises and seating positions to try to keep everything aligned and strong. We’ll see what happens.

After physical therapy, I drove across town to the hospital where I had a non-stress test and a visit with my high-risk OB. My doctor mentioned that I looked tired. I thought to myself that I am doing pretty well if tired is the best adjective to explain my appearance. I am utterly exhausted. I’m swollen. I’m sore. I’m on an emotional roller coaster. He’s lucky I didn’t burst into tears of frustration and fatigue right then and there.

He says everything looks great … except after he measured my belly, he said with a grin that I am measuring a bit big. Great. I was too distressed to even ask if I should be concerned. I have another ultrasound in two weeks, so I guess we’ll get the scoop then.

In between the physical therapy and the non-stress test, I made a mad dash into a grocery store to to pick up a BG meter. I managed to leave mine on my nightstand this morning. Luckily, they were offering Freestyle Lite starter packs for FREE. It included ten strips and a handful of lancets. It was the highlight of my day.

Tonight it is back to the hospital in the big city for Childcare classes.  We’ll learn how to change diapers, how to feed, and how to bathe Baby NoName, but we’ll also learn tips like when to call the doctor, and what to expect month-by-month. Seeing as neither of us has much experience actually caring for a baby full-time, we’re pretty nervous about it all. Everyone tells you that you just have to figure it out as you go, and we’re trying to keep that in mind, but hopefully the class will give us a little confidence until we sort it all out.

A Pregnancy Update

April 15, 2010

This pregnancy is really moving along. I can’t believe I’ve made it to 29 weeks and that both baby and I are doing so well. I sure am thankful. Here’s a rundown of the latest news:

Today is our Anniversary!

Today my husband and I celebrate our marriage four years ago. It was a beautiful Easter weekend on the beach in North Carolina and the ceremony, though small and quietly arranged, was wonderful. I’m so lucky to have him in my life. I don’t know what I did before I found him.

Pain in the rear moves to the front

Just when I thought I might be starting to get a handle on the hip pain thing, it threw me a curve ball. Now I have pain in the front, too. It’s like the ligaments and muscles around my pubic bone are out of control. Every time I move, the pain shoots through my pelvis, especially when I move my legs. Putting on my socks in the morning has become an epic struggle. When the baby kicks, or I cough or laugh, the pain shoots right through me. It takes me a good couple of minutes to roll out of bed or to climb into the car. TMI alert: It even hurts when I pee.

The books call it Symphysis Pubis Dysfunction, but I call it torture. Apparently, the pain in the front occurs because that is the spot where the two hip bones come together. They’re held in place by ligaments, which become loose and relaxed during pregnancy, in preparation for childbirth. The result is a wobbly pelvis, misalignment of the bones in the pelvis, and possible muscle spasms as the muscles attempt to hold the bones in place. Here is a really good first-hand account of the condition. I think Kmom is onto something when she says she suspects that the root cause of the pain is the misalignment of the hip bones. I have to admit that she has me a little freaked out about the potential for injury during childbirth when Symphysis Pubis Dysfunction is present. I’m going to need to ask my doctors a lot of questions to ease my mind!

I have my second physical therapy appointment tonight. Hopefully they can offer me some sort of remedy. In the meantime, I’m able to get a small amount of relief from a maternity belt wrapped low around my hips, the exercises that the physical therapist suggested, and an ice pack.

The Big Swell Returns

My ankles have started their swelling tendencies again. Even with the compression stockings, they’re still fairly fat and feeling a bit achy by the end of the day. Luckily, the swelling has not spread to my face or hands (I’m even still wearing my rings) and a couple of hours with my feet up does wonders for the bulges around my ankles.

Wishing for a Plan

I’ve been pestering my High-Risk OB for an inkling of what to expect during the birth of my son for a while now. I am a planner, and when things are uncertain, I start to worry. Last week, I pressed for information again and this time I got a little, but not much. He says that we will try to get me to 37 weeks before we deliver. This sort of shocked me when I realized that 37 weeks is only 8 weeks away. Wow.

I pressed for information about the mode of delivery (will Baby NoName use the vaginal route or the uterine, aka cesarean, route?) He sort of put me off on this one, although, it seemed that he was leaning toward the vaginal plan. I’m guessing it’s because my pregnancy, despite the diabetes, has been pretty “normal.” Again, I am freaking out a little (OK, a lot.)

As my belly has gotten bigger and bigger, I’ve begun to realize that this baby has got to come out of me somehow and none of the options sound especially pleasant. I think my preference might actually be for a c-section. At least I’ve had (minor) surgery before, so I could have an inkling of what to expect. Plus, the controlled environment makes me feel better about my diabetes management during the procedure – one less variable, you know? It doesn’t hurt that I’d be likely to get another two weeks of Short Term Disability pay out of the deal.

When I started to freak out a little in the appointment, the doctor just smiled at me, and continued the exam. Sigh. My husband and I attend childbirth classes this weekend. I’m sure I’ll be a worried mess by Monday.