Archive for the ‘Exams’ category

Finally, an Update

June 1, 2010

First, let me thank the couple of readers I have who have hung on with me through my most recent hiatus. Things are getting kind of crazy in my little world now and blogging has definitely taken a back seat. Without further adieu, here is an update on what’s going on and how things are going.

I am officially 36 weeks pregnant today. Baby NoName is still passing his non stress tests with flying colors. I was scheduled for one yesterday, Memorial Day, and the Fetal Eval Department was closed, so I had to go to Labor and Delivery for the appointment. It was kind of nice to get a sort of dry run for finding L&D and where to park again. The maternity ward was pretty quiet. I’m hoping for the same environment on the big day.

Luckily, when we arrived at the reception desk, I recognized the L&D nurse from the Fetal Eval Department. She fills in there from time to time. Along with Baby NoName’s regular kicks and heart beats, she also recorded two contractions. She says this is normal at 36 weeks. They are just “practice” contractions. They were so weak that I didn’t even realize that they were contractions. They felt kind of like Baby NoName was stretching inside my uterus and just pushing his little walls to their limits. If I have more than six in an hour, I should call my high risk OB.

We officially have a plan for the birth now. Seeing as both baby and I are healthy, we have planned a tentative induction for 37 weeks. That’s next week! I think that if I had resisted and tried to wait this out until closer to 40 weeks, my doctor would have agreed, but the truth is I am tired and grumpy. The testing and prodding and doctor appointments are really starting to get to me. I’m not sure how much longer I can take this routine. Couple that with an increased risk of fetal death in the last month for type 1 diabetic moms, and I am more than ready to get this show on the road.

So the plan is that we have an amniocentesis scheduled for next Monday. The amnio is used to check the maturity of Baby NoName’s lungs. Apparently, the only real risk with an amnio is contractions. When you get an elective amnio in the earlier stages of pregnancy this is more of a risk because it can lead to miscarriage, but at this late stage, the risk is much less because the baby is much more likely to survive if you go into early labor. Basically, contractions at this stage are OK because we are more or less ready to deliver the baby anyway.

If the amnio shows healthy, fully-mature lungs, then we are ready for the induction. If my cervix is not yet dilated, I will be admitted to Labor and Delivery the same evening for Cervidil. This is a prostaglandin gel that they apply to the cervix to soften and thin it. Then they will start the Pitocin through an IV in the morning. Pitocin is an artificial version of oxytocin, the hormone that my body would make naturally during labor to cause contractions.

If I am already starting to dilate on my own, then we will just wait until the next morning, skip the Cervidil, and start with the Pitocin.

I am a little freaked out about the whole induction process. I’m reading that Cervidil can cause painful but non-progressive contractions. And Pitocin can cause contractions to be more painful, but ultimately not work well enough to progress the labor. I have heard horror stories of inductions that last three agonizing and exhausting days and then result in c-sections anyway. It seems that sometimes induction works and sometimes it doesn’t. I expressed my concerns to my doctor who told me that these scenarios are all possible, but that there is no way to know if induction will work until we try it.

He is strongly in favor of induction over a straight c-section given that Baby NoName and I don’t have any of the standard diabetic complications. It is hard for me to believe, but my eyes, my kidneys, my blood pressure, baby’s heart, baby’s weight, and baby’s spine are all perfect. I guess all of those late-night BG checks and the never-ending appointments are finally paying off.

So I made a deal with him. We will try induction for one day (24 hours if we have to use the Cervidil the night before.) If I am not progressing and am not at least semi-comfortable, we will move forward with the c-section rather than waiting another day or two as is his standard procedure.

In the end, I think it just comes down to me freaking out about the whole labor and delivery thing. No matter what route he takes to get out here, it is not going to be a walk in the park,. So ultimately, it doesn’t really matter which avenue he chooses as long as he is healthy.

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A Day in the Life of a Diabetic Mom-to-Be

May 10, 2010

In response to Karen’s great Diabetes Blog Week idea, and also in response to Saffy’s question about how I fit in all of the pregnancy-stuff around work, here is my contribution. The topic is “A Day in the life . . . with diabetes.”

5:45 AM: Can’t wait any longer. Have to pee. I’m dancing in front of the toilet while I fight with the vial of ketone strips. Finally.

6:00 AM: My husband stumbles into the bedroom headed for the shower. Seeing as I have been up at all hours of the night for months now, he usually sleeps on the couch. One of us might as well get a little sleep, right? “Are you done in bathroom?” he asks. I mumble “yes” from under my pile of pillows. I can’t believe it’s time to get up already.

6:30 AM: My husband leaves for work. I do a test: 97. I crank up the laptop and upload my BG readings out of my pump, then print them for my doctor.

7:00 AM: Into the shower. A frantic hour of readying myself for the day ensues: shower, hair, teeth, breakfast, packed lunch.

8:15 AM: Another test: 98. I’m late. I throw everything into my laptop bag and rush out the door. Along the way, I discuss this BG reading with my inner self: “It’s only been an hour since breakfast. Will I be low at the two-hour mark? Maybe not … I did have peanut butter with breakfast. I stuff my meter in my coat pocket and pull out of the garage.

9:05 AM: I’m late for my non-stress test. I roll into the parking garage and make a mad dash for the fetal evaluation center. They hook me up to the monitors, and Baby NoName sleeps. We give him a little jiggle, I drink a glass of ice water, and we use the “alarm clock” to try to wake him up. Finally he startles and starts dancing in there. The peaks and valleys are recorded on the red and white graph paper. A half hour later, the nurse is satisfied. She permits me to move on to the next appointment of the day.

9:45 AM: I arrive on the other side of the hospital at my High-risk OB’s office. I am making good time. Sometimes the non-stress test takes an hour. The office manager smiles and calls me by name from behind the sign-in desk.  I sign in, pee in a cup, and weigh myself. It turns out that the Ultrasound Tech is ready for me already. I do a quick test while I’m sitting on the exam table. The Ultrasound Tech has to wait for me and I feel guilty. 156. Damn peanut butter. I ignore the “insulin on board” recommendation of my pump and dial in a .7 unit correction. Let the ultrasound begin.

Baby NoName is doing great, although the tech discovers for the first time that the umbilical cord is a two-vessel cord, not a three-vessel cord as we originally thought. The doctor assures me that it is nothing to be concerned about, but I make a mental note to google the difference later.

I realize that I left my BG readings on the kitchen counter … or somewhere. Pregnancy brain again. I will have to fax them in tomorrow.

10:45 AM: I finally arrive at work. Another test: 93. Much better. On to e-mails and meeting preparations. I sneak in a quick glance at a couple of DOC blogs between projects. I’m starving, so I eat my mid-morning snack.

12:30 PM: Lunch break. BG is 115. I head out to my car for a thirty-minute cat-nap. I am absolutely exhausted.

1:00 PM: Back in the office, I get back to work, and nosh on my packed lunch. Sometimes it’s one of those “healthy” frozen dinners. Today it’s a ham and swiss sandwich and an apple. Due to digestive woes, low blood sugars, and cravings, my pregnancy diet contains a lot more carbs than my non-pregnancy diet. BG is 62, a little low, so I take a little less insulin than the pump suggests.

4:30 PM: The office is starting to clear out. BG is 55. I peel an orange and start to munch on it while I work on one of many never-ending projects. For whatever reason, my BGs have been plummeting in the evenings, so the 4:30 snack has become a normal part of my pregnancy routine.

6:30 PM: One final test before I hit the road: 83. Afraid that my sugar might be dropping, I grab a handful of M&Ms from the office candy dish. I pack up and leave because the “late shift” support rep is locking up, even though I don’t have all of my hours in for the day. This means tomorrow will be an extra long day.

7:30 PM: I am at home, collapsed on the couch. My husband and I are trying to think of something to eat for dinner. All I want to do is sleep, but my BG is low AGAIN. We settle on grilled cheese sandwiches. I am delighted because he is doing the cooking AND the cleaning up. We watch a little TV while we eat and catch up.

9:00 PM: I can hardly hold my eyes open. I get ready for bed, do a test, take my pills, and double-check my stash of juice boxes and gum drops on the nightstand. Satisfied that I have enough sugar to make it through the night, I fall into bed. Because I under-bolused for dinner in fear of another low, I am at 180 now. I take a small correction bolus and settle in under my pile of pillows.

11:00 PM: My husband is on his way to bed. He wakes me up to test. 105. The number barely registers before I roll over and fall back asleep.

2:00 AM: I have to pee. Again. And my hip is killing me. While I’m up, I test. 65. Eyes closed, I slurp down a juice box and then drop it on the floor in the general vicinity of the trash can. Close enough.

4:00 AM: Again with the peeing and the testing. Luckily, my BG is in the “safe range.”

6:00 AM: My husband stumbles into the bedroom … another day begins!

There are a bunch of other D-bloggers participating in Diabetes Blog Week, too. Check out the list on Karen’s blog here.

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!

The Non-Stress Test

April 13, 2010

This morning I headed to the hospital for the first of many Fetal Non-Stress Tests. The test monitors the baby’s heart rate and measures the baby’s movements to measure how the heart rate changes in relation to the movements. The nurse explained to me that, basically, the heart rate should increase by at least ten beats per minute when the baby moves.

First they sat me down in a recliner and strapped the monitor to my belly. Then they handed me a “clicker,” kind of like the kind you might use in a game show. I was supposed to click the button when I felt the baby move.

It turns out that I did not click the button much today. I guess Baby NoName was feeling sleepy or maybe just lazy, because, aside from a bout of the hiccups, he was not moving much. We tried a drink of cold water, which elicited a couple of weak movements, and a “buzzer” pressed against my belly, that Baby pretty much ignored. Oddly enough, I think he is turning summersaults in there right now. After an hour of trying to coax some movement out of the little guy, the nurses agreed that they probably had enough data and that the data looked good. So we wrapped it up and I headed over to the doctor’s office for a routine check-in.

The doctor confirmed that the results of the test were good, and we talked a bit about my blood sugars, which have been all over the place lately. Despite my best efforts to test and track, I cannot discern a trend of any kind. Sometimes I will run low after a meal, other times high. Sometimes my basals will be right on and others I will run high or low. The doctor acknowledged that this is all par for the course. He says that some diabetics find that their numbers shoot straight up in the third trimester, others find that they increase steadily, and still others find that their numbers rise slightly and then tail off. We’re not sure which of these is happening to me yet, so I will just keep testing and treating, testing and treating. Lather, rinse, repeat.

In other, more stressful news, I found out last Friday that my interpretation of the company’s maternity leave options was grossly incorrect. So my anticipated leave time has been drastically reduced. It’s probably best if I don’t go into the details, but let’s just say that my mom had better benefits when she had me in 1978. I am extremely disappointed, but am trying to adapt to this new normal. It means my husband and I need to re-evaluate our plans for caring for our son for the first six months, and that we may need to find daycare sooner than we expected I really do not need this additional stress right now.

On the bright side, some of the girls at work planned a shower for me for this Friday. I am super excited about it, and am trying to keep focused on the upcoming shindig, instead of the bad maternity leave news.

27 Weeks and an Ultrasound

March 30, 2010

This morning my husband and I visited the High-Risk OB for my 27 week checkup and for an ultrasound. Now that I am an old pro at navigating the crazy, unmarked streets in the “big city,” I had no problem arriving on time, even though I left after my husband. He, on the other hand, got lost and arrived late, despite the directions he printed out before he left (perhaps it’s time we finally join the 21st century and purchase a GPS …) The nurse admitted that even though she has lived in the city forever, she still gets lost from time to time.

The appointment took about an hour, all told. First I did the standard pee-in-a-Dixie cup-and-then-stand-on-the-scale routine. Let me tell you, it’s getting harder and harder to aim for that little Dixie cup. I won’t give you the gory details, but when the cup disappeared below my belly, I had to take it on faith that my sample would make it in there. Luckily I made it another week without any accidents.

Then the nurse checked my blood pressure, which was a little higher than usual at 126/86. She said we will just keep an eye on it. I mentioned to her that the blood pressure cuff I bought seems to giving me low readings, and she said I can bring it in so that we can figure out what the deal is. At the very least, we can see how far off it is from the one in the doctor’s office and then I will know what my reading really is.

The ultrasound went very well. Baby NoName was wriggling and bouncing around in there like crazy. The technician kept saying things like, “Now where are you going” and “He just wriggled right out of my picture!” Luckily we got two great shot of his face and confirmed, once again, that he is definitely a boy. Even though the pics are just fuzzy black and whites, I am already convinced that he is going to be a heartbreaker. He’s just SO cute! More importantly, he is measuring right where he should; Everything is at 26 weeks and a few days, which is just a few days short of his actual age. His tummy measurement is actually 27 weeks, but the doctor says that, while it’s slightly bigger than everything else, it is close enough that we don’t need to be worried. He weighs 2.2 pounds.

Diabetics are at a higher risk of growing bigger babies due to the higher level of glucose in our blood. This is why we have to try so hard to keep our BGs in the “magic” range during pregnancy. You see, when my BG is high, Baby makes extra insulin to compensate, which makes him gain weight (fat.) This weight is seen most obviously in the torso/tummy. Luckily, my awesome A1Cs seems to be paying off. I’m thinking his big belly is just genetic 🙂

The doctor is not at all worried about my swelling, so my worry-fest was pretty much for nothing. He says every pregnant woman swells, and what I am experiencing is just plain old pregnancy-induced swelling. He said the compression stockings were a great idea, though, and that I should keep wearing them if they make me more comfortable. They really do help with the achy, tired feeling, so I will keep it up. He also encouraged me to get back to the pool (this has been difficult given my aching hips,) and even said a hot tub would be fine as long at the temperature was turned down. Apparently the weight of the water helps push the fluid out of my swollen limbs.

We talked a little about my BGs, which seem to be pretty stubborn lately. Numbers in the 150s and 170s are hanging around a lot, despite my best efforts to bolus them down. He suggested an increase in my basal rates of .1 around the clock, and said that this is right about the time that he expects my insulin needs to start really creeping up. I see my Endo next week, which is good because I’m sure that some hard-core rate tweaking is in order.

24 weeks

March 17, 2010

On Monday I made the bi-weekly trip to “the big city” for my appointment with the high-risk OB.

I am starting to get the hang of the whole thing. I’ve not gotten lost for a couple of weeks now, and I’m finally starting to remember which level of the parking garage to park on for the quickest access to the office.

Except for the excruciating hip pain I told you about yesterday, the appointment went according to plan. According to the nurse, my blood pressure was “beautiful” and the heart rate was “perfect.”

The doctor observed that my weight is good, and when I commented that I am always starving, he said, “Don’t starve, eat!” I don’t think he knows what he’s saying … he may have unleashed a monster. Some days I feel like I could eat everything in the refrigerator! He reminded me for a second time that my insulin needs will probably triple over the course of this whole journey, and that the increase is totally normal and it’s not because I am doing anything wrong. It’s just a consequence of those pesky pregnancy hormones and the placenta that makes them.

He asked if I was having any other problems aside from the hip pain. I mentioned the swollen feeling in my pelvis and he explained that this is also normal. He says the ligaments are stretching to make room for my huge uterus. As an aside, I mentioned that my heartburn seems to be making an occasional appearance again, but that this was the least of my concerns given the fact that the hip pain is keeping me up at night. We tabled the heartburn discussion for now.

The appointment ended with the now standard hug and a smile. In two weeks, we are scheduled for another ultrasound.

This past weekend we also did a little baby shopping with my husband’s family. Our baby gear collection now includes a pack and play and an umbrella stroller, and finally the little guy has a couple of t-shirts and a sleeper. We also looked at cribs and bedding, but we didn’t purchase any. We are so indecisive! A special thanks goes out to the in-laws for their generosity this weekend! We had a nice time, and are really happy with the gear.

6 Month Endo Appointment

March 5, 2010

I met with my Endo this morning for our monthly ritual. The appointment was pleasantly short.

When the nurse took me to the scale, and I took off my coat, she exclaimed, “Wow, look at you!” I guess my belly actually appears as big as it feels to me. Some mornings when I wake up and look it the mirror, I can’t believe how big it is. It’s like it grows overnight!

My A1C is holding steady at 5.2. Absolutely amazing. I told the doctor that I’ve noticed some highs in the morning. I wake up at a good number, but by the time I am ready for breakfast an hour later, I have crept into the 160s, even though I haven’t eaten anything. We amped up my morning basal rate. Hopefully that will do the trick. I am averaging about 45 units per day now, up from about 35 units a day pre-pregnancy.

Interestingly, the doctor volunteered the information that my baby has a 2% risk of developing Type 1 diabetes and that the risk would be 7% if my husband had the disease, too. I did not ask him for this information, so I am left to wonder … is he reading my mind … or my blog?

I am skeptical of his numbers given what I read on the ADA’s site, but I sure hope that he is right! I asked if these chances were accurate even though my mom also has Type 1, and he just shrugged his shoulders. We agreed that we will just hope that the baby gets my husband’s autoimmune genes instead of mine.

My blood pressure and my feet are in good shape. I still have the same on-again  off-again swelling in my ankles, but it is pretty minor. I left a urine sample for the microalbumin (protein) test. I am thankful that I was able to at least temporarily dodge the 24 hour test (those are such a pain!)

On the way out, I thanked the office assistant for her diligence with my insurance company. I am now averaging 16 BG tests per day and my fingertips are starting to resemble ground meat. My hard-earned prior authorization for 10 strips per day just wasn’t cutting it anymore, so we had to submit another one. The office assistant spent two hours on the phone with the mail order pharmacy getting it all straightened out and approved. I am so grateful for her help!

A friend at work just became a proud papa for the second time. Their daughter came in a hurry after just 30 weeks of gestation, and will spend five or six weeks in the hospital. So far, mom and baby are doing great. Dad and big sister are frazzled, but hanging in there. This weekend I will be busy preparing casseroles for the family. Hopefully the meals will prove useful as they try to find a way to balance their time between home, hospital, and work.