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.

Unbelievable.

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.

Book and Pregnancy Notes

Check out my guest post on DiabetesMine--all about diabetes and pregnancy.

November Notes

If you're swinging over here as a result of seeing me as the featured blogger on the Diabetes OC, welcome! And if you're a regular reader, welcome back.

So it's national diabetes month, national write a novel month, national blog every day month, and Thanksgiving is 'round the corner.

With the exception of Thanksgiving, one of my favorite holidays, I'm not really an active participant in these activities.

I've got a novel half-written, but it won't get finished in a mere 30 days. Same thing with the blog: I blog, but don't have the time or stories to keep it interesting every.single.day.

And sure, I'm diabetic, but since that's a year-round thing for me, I don't see the point of singling out one month, or even one day, commemorating it. To me, it's like saying one day of the month is National Breathing Day. Or National Eat Healthy Day. 

On November 14, though, I have my next appointment with Kind Endo, where she hopefully will give me the go-ahead to start trying to conceive kid number two. It'll be my own personal diabetes awareness day.

I fully support the efforts of other bloggers making mention of any of these activities, though. More power to you.

Over here, I've done a little housekeeping. 

My archives are now more easily searchable by keyword, date, category, and for anyone who wants to know my history, by stage of life. Blogger only lets me link to the latest posts first, so if you're interested in reading the blog this way, start from the bottom from the appropriate date and read up. It's all over there on the left.

I've tweaked some colors to make things more eye-catching and added some excellent reader kudos on the right. Thank you for those!

None of this would have been possible without the fabulous Julie at Absolute Stock Photo. Definitely contact her for your web design or stock photo needs.

Week Nineteen Update and A Nomination

UPDATE: I've just been nominated for "Best Female Blogger" in the Diabetes OC's Second Annual Diabetes OC Blog Awards. THANK YOU! It's an honor to be nominated among such top contenders.

Voting for the top spot takes place throughout December, so hop on over to get your votes in. (Lyrehca in '06: Covering T1 Diabetes, Infertility and Pregnancy. Honestly, people, can it get much more Female than that?)

And now back to the regularly scheduled program:

Week Nineteen Update

We had a big ultrasound today.

It took about 45 minutes and we were able to see a lot of Baby L's parts: legs, arms, feet, kidneys, bladder, skull, brain.

And while the kid had its back to us and clearly liked showing off its spine, we had three people (the tech, the resident, and finally the attending) come in to try to get a good look at the kid's heart.

But the kid wouldn't flip around and give us a good look.

The attending, who signed off on all the paperwork, said he could see the heart looked OK, but just couldn't get specific measurements. I'm scheduled for a cardiac fetal ultrasound in three weeks (which is standard for all diabetic patients) so I'm not all that worried. Nobody else seemed to be, either.

In other news, also saw Kind Endo today and High Risk Ob. I have officially passed a weight milestone that I'd hoped to never see in my lifetime, but neither doctor seems to think I'm gaining an excess amount of weight. And if you saw me in person, you probably wouldn't believe me if I told you what I weighed this morning. Both docs seemed to think I was doing well, although it's clear that insulin resistance is starting to kick in for me. Endo adjusted a few overnight basal rates and some meal-to-insulin ratios, so we'll see how that goes.

Was exhausted at the end of the workday (and workweek) today, and while I know raising a newborn is no walk in the park, I'm almost looking forward to cutting out my daily commute and the long hours tethered to my desk at work to be able to focus on a priority (my kid) that I have far more invested in than anything I do at my job.

(And this is coming from someone who has always put career first. A woman I worked with a few years ago who'd had one child and gave notice on the anniversary of her year of working at my company once told me that she just didn't care all that much about the mission of the office where we both worked. At the time, I told her I had a lot invested in my career and the thrill I got telling people what I did and where I worked. But now, with a kid on the way, I am starting to relate to what she was saying. I haven't officially decided what to do about returning to work or not after a maternity leave, but I've freelanced in the past before and am seriously considering doing it again. Leaving my commute and office politics behind sounds really great to me right now.)

I've also sent out emails to people I know who work in my field and work from home with kids to ask how they handled it and have gotten some great feedback. Anyone else want to weigh in about working from home with an infant and if/how you made it happen. What kind of childcare did you have? Were you able to put in a solid amount of time each day, or did you end up getting distracted by things to do around the house? Were you able to make a good chunk of money working from home? (I realize I'm being somewhat vague about my specific situation. Suffice it to say I work in journalism, have for many years, and have good contacts in the field.)

And in unrelated news, I'm thrilled that Erica from This Body Provides A Comfortable Home is back online. She was another woman writing about her type 1 pregnancy a good year before I was, and I always wondered where she was while her blog was quiet for a few months. Go welcome her back.

IVF, Week One

It's been a busy week filled with freelance jobs, my regular job, Mr. Lyrehca's company picnic yesterday, a hair color change, and oh yeah, Lupron shots.

Lupron has been a minor ripple, to be honest. It's just like taking a shot of 10 units of insulin, except that when I flick an air bubble out of the vial and notice a bit of medication bubble out of the needle onto the floor, I think, "Oy, that was expensive!"

Mr. Lyrehca has been very involved in the Lupron administering. Not in giving the actual shot, of course. But telling me to "wipe the top of the bottle with alcohol. Then withdraw 15 units of Lupron and return five units to the vial so that no air bubbles are in the syringe channel."

"Honey, I've been taking insulin for three decades. I know what to do."

"But this is different. Did you use a second alcohol swab to wipe your skin like the nurse showed you?"

Um, no.

And for any fellow diabetics out there, shooting Lupron is just like shooting insulin. The shots have to be taken at the same time each day, or within an hour of each other, and I've been on top of that. I've had a bruise here or there appear, but nothing that worries me. And despite what pops up on Google when you type in "Lupron and side effects," I haven't noticed anything different since taking it.

(Actually, I'm lying. Last week, I had some weird rash on my ankles, of all places. A quick call to the IVF clinic confirmed that my red ankles were probably heat rash. A Lupron-related rash would be more all over the bod. And a week later, the ankles look fine.)

In fact, considering the high humidity and temps over the past week, I've been more concerned that maybe the Lupron isn't working right. Last weekend, we went to a ginormous antique show/flea market and walked around in the heat for hours each day.

I carried the Lupron vial in my purse on Sunday, because by then we'd already checked out of the motel room where we were staying. I've been refrigerating the Lupron while at home, and keeping it in the meat-locker air conditioned motel room, but had to stash it in my purse (instead of in my hot suitcase in the hot car) as we searched for fun stuff to buy. (I like heart-shaped items and scored an awesome rhinestone-studded flower-shaped belt buckle; the Mister collects vintage telephones and picked up a cool U.S. military compass.)

So when I returned to work this week, I called the pharmacy where I ordered the fertility stuff and asked if the heat would bother them. Besides the Lupron, they sent the stimulation drugs (which have lived in my fridge for the past week and a half, per instructions), and two other meds that didn't have to be cooled (so they've been in the cardboard box they arrived in, in my unairconditioned-during-the-day kitchen).

The pharmacy assured me that everything should be fine, so I'm going to release my Type A tendency to think otherwise ("But it's been 90 degrees for part of this week. Are you sure the Lupron was OK inside my heavy blue leather pocketbook (now adorned on the strap with said rhinestone flower)?" and just see what happens.

The latest fertility event to happen is that my period arrived yesterday and today, right on schedule. While this has caused some negative energy in the past (see the "meltdown when the second IUI didn't work" post, or the "resignation, there it is again" past posts), the month-of-first-IVF-cycle period says to me "OK, we're moving on to the stimulation drugs. Here are the big guns."

So now I reduce my Lupron dose in half and also start Gonal-F, which hypes up my follicles to hopefully make some decent numbers of (and just plain decent) eggs. So while I'm annoyed about the extra trip to CVS to buy some tampons to replenish my stock (oy, I really thought I'd be done with those for awhile by now, months ago, when I bought what I thought was my last box of multiple-sized tampons), I'm pleased that things are moving along, IVF-drug-wise.

Once the egg stimulation begins, I'm not supposed to do things like train for a marathon or color my hair. While the training is something I wish I could say I'd miss (I haven't worked out seriously in ages, besides walking), coloring my hair will be a major life change. I've been enhancing my natural color, with various degrees of bleach, for a solid 20 years. As of Thursday, I was a typical over-processed, over-highlighted, roots-come-in-like-clockwork-every-three-months light blonde. And while I could see the hair colorists' concern that it was too light, too trashy-looking, too one-dimensional, and too drying for my hair, I just loved the look.

But on Thursday, I went back to my natural eyebrow hair color, which in the stylist's vernacular, is a "dark blonde." To me, it's just dark. Happily, no one's asked why, or even seemed to notice much of a change (which says that my natural hair color isn't all that dark, I guess) and Mr. Lyrehca said he liked it. The whole idea, though, is that should I actually get pregnant, I can avoid the whole should-I-or-shouldn't-I debate about hair color during pregnancy. Some docs forbid it, some say it's OK. Personally, I'd like to know how healthy Gwen Stefani's kid is, because I certainly didn't see her showing any dark roots over the last year.

Otherwise, this week was a nice blend of light work at my day job, and heavy freelance work from my side jobs. Oh, and my husband's company picnic yesterday, which I took a day off from work to attend. It was fine, and everyone was super friendly. One guy, though, who claims the Mister is like a grandson to him, came by to chat and wanted to know when we'd have "some crying around the office." I played dumb, and the Mister was similarly vague.

"You know, some little feet crawling around here," the guy pressed.

"Um, like cockroaches or mice?" I asked. "Hopefully not anytime soon."

He went on to talk about someone he knew who had adopted three kids. Which I appreciated. But at the same time, I certainly didn't need to get into a discussion about why we don't have children yet.

In the midst of all this, I was very clearly feeling some annoying cramps coming on, so I knew that the period was on its way. But because of all the IVF hoops, I knew that Advil wasn't recommended. So the Mister and I found a nurse at his company picnic who had access to Tylenol.

"I'm getting my period," I confided. "Do you have any Tylenol?"

"What about Advil?"

"I can't take it."

"Why not?"

"I'm diabetic and Advil's really hard on the kidneys," I purred. Who knew where that came from, or how I managed to say it without tripping over the real reason I was avoiding Advil, but I managed to get the nurse to give me the Tylenol. Blessedly, those cramps were history.

And now it's the weekend, where I actually have a free morning to blog without worrying someone's monitoring my computer at work. So enough about me; how are all of you?

Oh! I forgot about this because it's been up for a few days already, but Jenni at ChronicBabe featured my recent IVF post on Grand Rounds earlier this week, along with a few other diabetes blogging babes. Go check it out.

STOP s1955, more Clomid and a Media Mention!

FIRST OFF, please go check out Kassie's smart post about why you need to call your senator's offices RIGHT NOW and tell them to vote AGAINST s1955. Here's what you'll lose if this thing passes.

NOW, back to me. I'm on day five of the second round of Clomid. Waiting for the next ovulation prediction, and then the next IUI, and then the next two week wait.

Things are otherwise slow, although my blood sugars were out of whack for about a week. It's really easy to eat whatever when you know you aren't potentially pregnant on any particular day. Those are coming back down, thankfully.

In blog news, however, I noticed on my site counter that I was getting a lot of traffic from the diabetes site at About.com, which led me to realize that my site was listed as one of five diabetes blogs you'll want to bookmark. It was totally unexpected, and very much a pleasure. Thanks, About.com! And welcome, new readers! Please do feel free to comment or otherwise let me know what you think about the site narrative. At times I feel like I'm writing into a void and I'm so easily psyched by feedback. Go ahead, leave some. You know you want to.

Extra! Extra! Read All About It!

I'm super excited that Jenni from
Chronic Babe has featured me and my site in her Lady Bloggers column.

Jenni does a terrific job writing upbeat, snappy columns and comments on news about all kinds of chronic illness, and I'm thrilled to be a part of it.