Tuesday, July 27, 2010

Pregnancy and Chronic Illness: Discuss.

Late July
Pregnancy and Chronic Illness Webinar August 2

Laurie Edwards, of the excellent blog A Chronic Dose and terrific book Life Disrupted, and I will host a webinar on Pregnancy and Chronic Illness at WEGO Health next Monday night, August 2, from 8-9 pm eastern time. Thinking at all about pregnancy with a chronic condition like diabetes, or heck, anything else, and want to hear more perspectives than just mine? Definitely RSVP and check us out!

May 18

Weight, Weight--Don't Tell Me

I met with my endo and the nurse practitioner who works with my high risk OB on Friday.

Two weeks after my last appointment.

The NP was someone I’d never met before, though I suspect I will get to know her very well over the rest of this pregnancy. The first thing I learned, going in to see her, was that I’d gained three pounds in the last two weeks. Bringing this pregnancy’s total to five pounds in ten weeks.

Is that some kind of new record?

I’ll admit that last week, I ate a bunch, and covered for it with ginormous amounts of insulin. I’ve also started eating a LOT of cheese. In part, because cheese doesn’t really wreck my sugars the way many other foods can. I also treat at least one, if not more, insulin reactions a day, with some amount of juice.

So the weight gain isn’t really surprising.

I pointed this out to the NP, and she was all, “are you concerned about your weight?” I replied that it seemed like a lot, and that while I’d lost all my pregnancy weight the first time, I’d put on a good ten pounds or more since starting with actively trying to conceive and taking copious amounts of infertility drugs a few times over the past year. I told her I’d gained 40 pounds with the first pregnancy.

“So do you want to gain 30 this time?” she asked.

“I want to deliver a baby that’s healthy, happy and alive,” I responded. “If I put on more weight, so be it. I need to do what I can to maintain my blood sugars.”

She said she sympathized, that type 1 pregnancies were so hard. Yep. Weight gain is really the least of it.

No one even blinked when I stepped on the scale anytime during my first pregnancy, and that was from a starting point of about 30 pounds over where a height-weight chart says I should be.

The rest of the NP visit was uneventful, because she tried to listen to the baby’s heartbeat through my stomach. I was nine weeks six days that day, and she told me she typically doesn’t hear a heartbeat until 12 weeks. Nothing happened, so she sent me to my endo appointment and told me to return to her office after the endo visit, where she’d do a regular ultrasound to check on things.

You Say 90, I Say 80

I then saw my fabulous Kind Endo, who was pleased that I’d actually brought not just weekly and daily Dexcom readings, but actual logs of insulin rates and boluses and carb counts written out for a few days. Looking at the Dexcom readings, particularly the weekly ones, have scared me. I see a lot of peaks and some valleys, but the valleys don’t freak me out the way the peaks do.

Kind Endo was nonplussed, telling me that I need to just let the insulin do its job and not to worry about short bursts of high blood sugars. She thought I was overcorrecting, and worried that I was running too low at times.

“But I feel fine at 60. And I work from home, so it’s not like I’m driving much with such lows. And I always treat them.”

We have also battled about the target blood sugar I should set on my pump to correct to. I have set it to 80, with the reasoning that you’re suggested to be between 60-99 before a meal, so 80 is in the middle. She argues that’s too low, and that she typically tells people to correct to 100, but that I should correct to 90. We went back and forth on this point.

“Surely I’m not the only patient who fights you on this, right?” I asked. (I end up saying something like this to a lot of people)

“Well," she conceded. "You're a journalist.”

The Downside of Writing A Book

Because my A1c dropped recently, from 6.1 to 5.7, Kind Endo really thinks I’m doing fine, despite the highs I see more frequently due to the CGM. “You really don’t think this baby is going to be deformed because of these highs?” I asked.

“Absolutely not,” she said.

I feel like I overthink everything these days. Mr. Lyrehca, who is just now reading my book, will quote it back to me when I tell him I’m worried. “The book says …. That highs will happen. The book says… that you need to take care of yourself,” he reads.

Whoever thought my published words would be used to taunt?

The irony is that Mr. Lyrehca rarely reads for fun, so he’s s-l-o-w-l-y making his way through the book itself. Which gives him all the more time to find sentences to read back, sometimes citing page numbers as well.

I also think maybe the Dexcom CGM is adding to my fears. Before, I tested regularly, sometimes every hour, but not always. Now, the Dexcom shows me a sharp incline immediately after some meals. Sometimes I can counteract the climb by immediately hopping on the elliptical and doing a 20-30 minute workout, but I can’t always exercise within the hour after a meal. Sometimes I have to work. Or drive. Or do something that makes exercise impractical. And while I can and sometimes do bolus a hit of insulin, the damn stuff doesn’t start working for an hour or two. It is beyond frustrating to see my sugar spiraling upUpUP and know I can’t do anything but sulk and wait for the insulin to kick in and then I watch the spiral reverse and come back down.

Moving Forward

So after Kind Endo, I went back to the NP, who tried to do an abdominal ultrasound (cold gel on my belly), but again didn’t find a great view of the uterine activity. “Would a vaginal ultrasound do it?” I asked. It would, so once again, the Tam Cam did its job and voila! There’s finally a clear shot of what’s going on, and hold-my-breath… all is good.

The NP found the gestational sac, the fetal pole, and look at that--the heartbeat. “It’s in the 150s, 160s,” NP said. “Totally normal.”

The funniest thing was that both she and I could see things moving, as tiny as they are.

“The arms and legs are waving, see?”

And what do you know—I could see tiny limbs all akimbo, dancing around.


Afterward, I went to have blood work drawn so that we can learn some early chances of whether this baby has higher chances of carrying some chromosomal concerns. Three years ago, the nuchal fold test was done on the same day as the blood draw, so the full results came after a week or so after the blood was analyzed. This time, they draw the blood first, then we go back in two weeks and see the nuchal fold test. This is where they measure the fold of the back of the fetus’s neck to see if its chances of having Down’s Syndrome are high. Last time, the result came back great, but this time, I’m three years older and officially an old lady being pregnant at 40.

I hope it’ll be all good.

Despite the highs.


Dani said...

I love reading your blogs...have for the last four months while being prego with my 1st baby (Type 1 for 23 years now). I also have your book and loved it too! Just thought I'd let you know...thanks for all the information...it helps this clueless pregnant girl out A LOT when there is so much scary stuff out there! I think you are about 5-7 days behind me with your pregnancy! I love comparing stories! Oh, and I also gave you a shout out on my pregnancy blog (www.anothermariniscoming.blogspot.com). Thanks again! Dani

sweets said...

Mmmm, the weight gain. I am still battling with the weight I gained (9 months to the day...), although most of it was gained while on fertility drugs, rather than the actual pregnancy. I am going to have to do something about it soon! But finding the time with baby (and back to work full time for the past couple of months) is really hard...

C. Collins said...

Please be a guest blogger for our site at http://www.ouruniquelives.com . We are community support site for those who deal with chronic illness's and their family and friends. Basically everyone. Our site is about carrying on unique and vibrant lives in the face of illness. Your blog is inspirational and very informative.


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