Posted tagged ‘type 1’

Postpartum: In the blink of an eye

March 4, 2011

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.

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Labor: Day Two

March 2, 2011

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!)

March 1, 2011

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”

Metformin: Another tool in my toolbox

January 25, 2011

My last appointment with my Endocrinologist was at the end of August. It was my second post-pregnancy appointment, and I was a little nervous about how things would shake out. You see, between colic and reflux for Lukas and insomnia and exhaustion for me, the Big D had sort of taken a back seat.

But things had been on the upswing for the last month or so, and while my A1C had soared from 5.4 to 6.2, I was still well within the acceptable range for an adult (non-pregnant) diabetic.

The doctor had little in the way of suggestions for improvement, so I asked him what he thought about either Metformin or Symlin. My weight had dropped off significantly during the first few months after the pregnancy, but had since leveled off and my BMI has been pushing the line between overweight and obese for years now. And try as I might, I just cannot seem to bring it down. No amount of exercise or dieting seems to help. And despite careful attention to carbs and calories, my insulin needs just keep going up. And up.

Like almost every other Endocrinologist I’ve ever had, my current doctor is not concerned about my weight. And my insulin needs, while much higher than they used to be, are relatively low when compared to those of other, more insulin-resistant diabetics. He is delighted that my A1cs are so good, and chalks up my extra weight to the extra calories consumed while treating frequent lows. But when it gets hard to find clothes that fit, and when it’s uncomfortable to bend over to tie your shoes, it’s time to do something.

I’m not sure that I convinced him that those extra calories were not at fault, but he was willing to try something new. We decided against Symlin because of the contraindication for patients with delayed gastric emptying. While I am not officially diagnosed with gastroparesis, we are fairly certain that my stomach empties slowly. And I tried Symlin when it first came out. Twice. It left me feeling like I had a lead balloon lodged in my stomach. So Metformin it was. He thinks that the extended release version works better, so I tried that. Luckily enough, one of the local grocery store chains offers Metformin for free, so I did not even have to pay for it.

I have to admit, though, the first few weeks were rough. The intestinal pain was enough to leave me, at times, unable to complete a sentence. It also gave me that full-stomach, lump-in-the-throat feeling, especially if I ate more than about 30-45 grams of carb at a time. And I occasionally experienced acid reflux. But my fasting numbers started to drop after just two doses. Before taking Metformin, I was taking about 18.5 units of basal insulin. Now I’m taking 16.8. Sure, that’s not a huge decrease, but I am back to almost the exact amount of basal insulin I was taking before my insulin needs started to rise.

And the intestinal distress is more or less gone now. Only occasionally, after a really carb-heavy meal will I feel the effects. I don’t mind this side effect, though. It works as a sort of negative incentive; I am less likely to eat a whole box of macaroni and cheese because I know that if I do I will have to deal with the consequences.

Unfortunately, the Metformin has not helped with my bolus needs, which are my biggest concern. Over the course of the last five years, I have gone from a carb ratio of 1:15 (one unit of insulin for every 15 grams of carb) to 1:9 (one unit of insulin for every nine grams of carb). I have found that Metformin does nothing to reduce this insulin requirement.

Interestingly enough, it does delay the spike from the carbs I eat, but does nothing to smooth out the spike. So if I eat a carb-heavy, but low-fat meal like spaghetti, the spike can occur a full six hours after I eat. Crazy, huh?

The one exception to this rule appears to be pizza, which seems easier to manage since starting Metformin.  That in and of itself could be considered a win, right? Since I started Metformin, I can predict that the post-pizza spike will occur at about 3 hours post meal and will last for about six hours. So I typically use a dual wave bolus, delivering 65% now and 35% over the course of the next three hours. And the clincher is that I don’t bolus until AFTER I eat. It seems that the delayed digestion of the high-fat food dovetails nearly perfectly with the peak of the insulin when I wait to deliver the insulin for this extra hour or so.

Another interesting tidbit: I was sick for about a week with the stomach flu and did not take my Metformin. As you might expect, my basal needs increased after about two days of not taking the med. When I went back on the drug, though, it was more effective for about the first week. That is, I needed even less basal insulin during that first week than I normally do when I am taking Metformin.

I have not lost any weight as a result of taking Metformin, which is disappointing. But I haven’t gained any, either. So I still weigh less now than I did before I became pregnant. It’s not exactly the result I was hoping for, but it could be worse.

So what’s the verdict? I wasn’t expecting a magic bullet when I decided to give Metformin a try. And I am happy that it is helping with my basal rates and my “pizza management”. So while the results are not overwhelming, I think I’ll keep taking it. It’s just another tool in my diabetes toolbox. And who couldn’t use more of those?

One final update before the big day

June 4, 2010

We’re down to just a weekend before the big amnio. If all goes as planned, this might be my last post for a little while. I’ll do my best to at least post a couple of pictures once Baby NoName finally makes his big debut, though.

In the meantime, here is an update on my and baby’s health over the course of the last couple of weeks.

As has been the case throughout this pregnancy, Baby NoName and I are healthy. Neither of us has an diabetic complications to speak of, although I continue to struggle with “real people” pregnancy symptoms like swelling, heartburn, and round ligament pain. These have mostly improved now that I am on my “staycation” and resting more.

For the last three weeks, though, I have really struggled with my BGs. I’ve averaged about 100 throughout the entire pregnancy until these last couple of weeks. Now my average is up to 120. I’m seeing an alarming number of post-prandial readings in the 170-180 range and an occasional number in the 200s. Of course, I do my best to bring these numbers right back down, but they are alarming after all of the great numbers I saw up until this point. I have no idea how much of an effect this new development will have on baby’s BG when he is born, but you can be sure I am worrying about it. Hopefully all of the good numbers I’ve managed to accumulate throughout the pregnancy will offset some of these higher ones.

It seems that my basal and bolus rates are increasing every two to three days. And the needs are not consistent. One day this week, I used a 140% temp basal all day, and the next day, my numbers dropped back down into the normal range.

My average daily insulin intake is up to 82 units, up from 35 units pre-pregnancy and up from 75 units a couple of weeks ago.

I’ve gained about 17 pounds over the course of this whole journey. Given that I came into this at a less than ideal weight, I was hoping to keep my weight gain to about 20 pounds or so, so I am pretty happy with this number. Still, I am not exactly thrilled with my new, flabby and water-logged figure. I do my best to avoid seeing my rear end. It has widened considerably. And my arms and legs look increasingly like stuffed sausages. Yikes.

Psychologically, I am a bit of a mixed bag. I am so excited to finally meet this little guy. But I am scared and nervous, too. Can I actually do this? Childbirth? Breastfeeding? Childcare? What if it turns out that I am not “mom material?” I’m sure we’ll figure it all out as we go along, but that doesn’t mean that these thoughts don’t keep running through my head.

Spending the last couple of days at home has not helped. When I was always running to work and appointments, I didn’t really have time to think about what was coming up next. But now that I’ve had a chance to relax and regroup, it’s given me time to think about these types of things.

Tip of the week: Avoid the TLC channel and the shows Baby Story and Bringing Home Baby during the last couple of weeks of your pregnancy. I’ve seen all sorts of births on TV this week: c-sections, at-home births, natural births, medicated births. In one episode, the mom was in so much distress that the doctor asked the camera crew to turn off the cameras so that they could deliver the baby. My mind made up all kinds of scenarios for what happened while the cameras were off.

My life is about to change in ways I can’t even begin to imagine. And this is something that I’ve always dreamed about. The journey has been long and stressful but oh so worth it. But I realize now more than ever that this journey is not even close to over. In fact, you might say that it’s just beginning.

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.

Why I Didn’t Buy a Dexcom

May 21, 2010

I had my monthly prenatal appointment with my Endocrinologist last week. We have seen each other once a month and traded e-mails once a week for eight months now, so we seem to sort of “get” each other now. My appointments are friendly and chatty. This month, he gave me a good ribbing for choosing not to purchase the Dexcom after my trial. He says I am the only person he’s ever met who decided that she didn’t really need it.

While he is right that I did choose not to purchase the Dexcom after my trial, his understanding of my reasons for doing so are a little off.

Let me start by saying that the device is impressive. I tested a Medtronic MiniMed CGMS several years ago when it was in trials. It was clunky, was not remote, and was not waterproof. You had to put the thing in a little waterproof shower pouch that you could hang around your neck in the shower. Really? You had to go to the doctor’s office to have the sensor inserted. To top it all off, the thing was testy. The first time I trialed it, it crapped out after just a day. The second time, the result were better, but you could only wear it for three days. Probably the worst part about the device was that it did not communicate any of its information to me, the patient. Instead, all of the information was stored in the device until the doctor downloaded it. So much for catching highs and lows.

Today’s CGMs are in another realm completely. The Dexcom sensor was really pretty simple to “install” and the user interface on the device itself, while basic, was relatively easy to figure out and was functional. The sensors are now remote, so I was not tethered to the device, and they’re also waterproof, so I could attend water aerobics and take a shower without worrying about a shower pouch. Perhaps most importantly, this new generation shares its information with me, so I have “real time” information about whether my BG is trending up or down, or is out of range. I’ve got to admit, that’s pretty helpful.

When I trialed the Dexcom, I managed to get over 14 days out of one sensor, although by the end, I was seeing a lot of ??? screens. The low and high warnings were a bit annoying in the beginning, especially when I was recovering from a low and it was STILL beeping at me. The lag-time was frustrating. But once I got the alarms set to the right levels (60 and 160 worked well for me,) this annoyance was somewhat tempered. Of course, the fact that it caught untold numbers of pending highs and lows during the trial is not lost on me. My graphs and charts from the second week, once I got used to the thing, were amazing.

So why didn’t I buy? It basically comes down to a sort of psychological burden. I really felt like the thing just put too much of my focus on this damn disease. Before the Dexcom, I was already testing 16 times a day. Now I had to do even more finger sticks either to calibrate, or because Dexcom thought I was high or low and I needed to confirm. It was like the thing was whispering in my ear all day, “Hey you … you’re diabetic. Don’t forget.”

I’m also really hung up on the idea of yet another hole in my skin. I don’t like wearing all of these devices on my body. When the pros outweigh the cons, I’m willing to do it, but otherwise, I’d like to get away from sensors and infusion sites. If they ever figure out how to put the two together into one site, then I would be really interested.

The device is big and cumbersome, too. It did not fit in most of my pants pockets, and the clip was worthless. The size and shape were a constant reminder … when the darn thing popped out of my pocket in the bathroom … when I would leave it on my desk at work during a meeting … when it took up precious real estate on my nightstand where it was jockeying for position with my tester and my juice boxes and my box of Dots.

In the end, I looked at my current diabetes regime, the fact that my A1C’s have been amazing throughout my pregnancy, that my baby is healthy, and that my non-pregnant A1C typically hovers in the 6.0 range, and I decided that the slight improvement in my control was just not worth the psychological pressure.

The day I returned the device to the sales rep, I caught a low in the 20’s only because I tested. I didn’t feel it. I wondered if I should have bought the Dexcom. I still wonder sometimes. And maybe I will change my mind one day, when my A1Cs are not as good, or the lows and highs are more frequent. But diabetes, and life in general, is all about balance. We need to find a way to manage this disease while staying mentally healthy, too. And the best way to do that is different for every one of us. For now, I think this is the best decision for me.