Wednesday, June 30, 2010

Relieved. Just Relieved.

Things are still looking good. I had my NT exam today, and the preliminary results look very promising. (Based on the measurements, bloodwork, etc., it looks like the risk of chromosomal problems is one in a bajillion. Give or take.) After being so active at my last appointment, today the Frog was dancing around a lot less. My NT exam with LL took forever, because he absolutely refused to stay still and be measured, but the Frog was quite cooperative. Everything went very quickly.

I also met with the endocrinologist this week, to discuss my GD diagnosis. She agrees that I probably don't have true gestational diabetes, but rather a mild sort of gestational insulin resistance, which only really appears when I'm stressed out. But given that "stressed out" is my normal state these days, it's best to keep an eye on it. She gave me the go-ahead to be more forgiving with my diet, which is nice. And I can ease up on the monitoring. (She suggested monitoring every other day, or skipping the monitoring after one meal each day. Enough to take some of the pressure off, and avoid having to quit my job, but not so much that I'm likely to miss any upward trends that might occur later in the pregnancy.) And she promised that if my blood sugar levels continued to look as excellent as they do right now, she would personally talk to Dr. M to make sure that I could still try for a VBAC, which is normally forbidden for women with GD. So honestly, good news all around.

Even my dissertation seems to finally be coming together. After several weeks of drama trying to find a final defense committee member, and trying to get everyone to pick a date, it looks like I've finally scheduled my dissertation defense. I'm still waiting for final confirmation from my committee, but odds are good that I'll be defending next month. Which is good, because I don't want to tell anybody at school about my pregnancy until after I defend. (Thank you once again to AdvisorA for making me totally paranoid about sexist retaliation.)

So yes, things are looking good. You'd think that my mood would turn around a bit. But so far... not so much.

I'm a little weirded out by how different this pregnancy feels for me than my pregnancy with LL. I expected there to be changes (every pregnancy is different; I'm in a different place; I've been through it before; etc.). But even given all of that, it still feels... different. I feel like I'm more detached somehow. The first several months of my pregnancy with LL, I was constantly worried that something would go wrong. Every time I was without morning sickness, I was sure that the pregnancy was over. Every time I had gone more than a week without an ultrasound, I began to doubt that things were still okay. Things evened out a bit once I started feeling kicks on a regular basis, because I stopped worrying quite so much, but I still felt a lot of emotional highs and lows.

This time around, I'm still worrying, but it doesn't feel like the same type of worry. I'm still worried, but not in an "I hope everything's still okay!" sense. More in a "I wonder if things have gone wrong yet?" sense. I keep feeling this weird sense of inevitable doom. And no, I have absolutely no reason to be feeling this way. Every single appointment has showed normal growth and normal development. Normal everything. With LL, every time I heard a heartbeat or saw LL on ultrasound during an appointment, I was filled with awe and relief and excitement and love. This time, there's a little bit of relief, but mostly it's just... surprise. Really? Things are still okay? Are you sure? How strange!

During my pregnancy with LL, especially during the first trimester, I was consumed with thinking about the baby. Was he okay? What would he look like? I can't wait to tell our parents! I can't wait to tell our friends! Gosh, I feel really sick. How big is the baby this week? Does he have eyelashes yet? What should we name him? This time around, I just feel angry at all the external stuff. Did the car accident affect the baby? Can I recover from the car accident while pregnant? Better warn the physical therapist that I'm pregnant! Gotta hire a lawyer to explain to the stupid auto insurance that I couldn't get an x-ray, because I'm pregnant! Do I really have GD? How can I possibly manage GD diet and blood sugar monitoring and extra medical visits and physical therapy and dissertation and still run my household? Gotta interview for a job before I start showing! Gotta defend my thesis before I start showing!

I was so excited to tell our family and friends when I was pregnant with LL. This time, we've started telling everybody, but I just feel relieved to have it out in the open. Not all that happy, just relieved. And it doesn't help that I'm not showing at all, I haven't gained a single pound, and I'm not really feeling all that much as far as pregnancy symptoms. (Occasional indigestion and leg cramps. That's it.) And while those things would probably make other women really happy, for me it's just adding to the feeling that this pregnancy isn't really happening. It's weird.

It makes me sad that I'm not getting as excited as I was before, that I don't feel as emotionally attached as I did last time. S is convinced that I just have too much on my mind, and things just keep piling on top of it all. Car accident. Gestational diabetes. Advisor drama. Committee drama. Dissertation defense scheduling. But if that's true, it doesn't bode well for the rest of the pregnancy, because most of those things aren't going away anytime soon.

Maybe once I start feeling regular kicks things will feel a bit better.

Friday, June 25, 2010


LL has learned how to hide. He'll be playing somewhere, and all of a sudden, he'll just be gone. Poof! No LL. Total silence. (As any parent knows, total silence is a dream come true, except when it isn't.) It used to be that I could just walk around the house calling his name, and his noisy giggling and inability to stand still for more than five seconds would give him away, but lately he has gotten a lot smarter. This morning, he stood still and silent in our bedroom closet for several minutes before opening the door and jumping out with a loud, "Ta da!" And then laughing hysterically. I really have to keep an eye on this kid.

On the pregnancy front, I have finally succumbed to total fatigue. I think that I spent the first two months of this pregnancy running on pure adrenalin, and it finally caught up with me. I slept all day yesterday. Seriously. All day. I got LL up and dressed, put him in his high chair, then told S to feed him breakfast while I fell asleep on the couch. I woke up to say goodbye when S and LL headed off to daycare, I managed to get myself dressed, then went to run a quick errand before work. But after the errand I was so exhausted that I turned around and went back home and fell asleep again. I woke up to eat lunch, worked for maybe one hour, then slept again and almost missed waking up in time to pick LL up from daycare. I somehow convinced LL to sit quietly in my lap and read books until S got home, so that I could conserve energy. (LL seems to be obsessed with a different book each week. This week's book is Where the Wild Things Are. I'm reading it dozens of time a day. Want me to recite it from memory for you? Because I can, quite literally, do it in my sleep.) And by 8:00 I was exhausted again. I remember being disappointed during my pregnancy with LL to discover that the "second trimester energy boost" was pure myth, so I'm no longer naive enough to expect it to kick in anytime soon. But still, there's a limit to how much a person can sleep, right?

I'm definitely approaching my second trimester, because the big second trimester symptoms from last time (dizziness and headache) have returned with a vengeance. I'm on Day 9 of this headache, and I get dizzy spells several times a day. Thanks to the GD, my blood sugar is being micro-managed to perfection, so I can say with a fair amount of certainty that the headache and dizziness are entirely a low blood pressure thing. Better too low than too high.

All this sudden fatigue and headache has meant a dramatic slowing down in dissertation progress, which has me a bit worried, but not worried enough that I would skip a nap. Also, in conspiracy with AdvisorB, I accidentally took down a major tech company for several hours last week, so it's not like I'm being completely unproductive. And as AdvisorB pointed out, the company wouldn't have gone down if the employees were smarter, so I shouldn't even feel guilty. (And no, I can't say anything more, but no, I didn't do anything malicious or illegal. And it was really kind of fun. But you should probably sell any stock you own in this company, because they really were kind of dumb.)

Monday, June 21, 2010

Sunny Days Are Here Again

Finally, some good news!

I had my 11 week prenatal appointment, and everything is looking good. Heartbeat, measurements, etc. All wonderful. Whew! The baby looked more active than I remember LL being at this stage. Isn't it a bit early for in-utero gymnastics? Also, the baby kind of looked like a frog, but it was probably the weird angle. Expect "Frog" to be the baby's blog nickname for a while. NT exam is in less than two weeks, when we'll get an even more detailed look, but I'm finally breathing easy for now.

Dr. M's assistant asked how the GD stuff was going, and I let everything out. The uncertainty over the diagnosis, the miserableness of the nurse appointment, the inability to get questions answered. If possible, she was even more angry about it than me, and insisted that I repeat everything for Dr. M. And then of course Dr. M reminded me why I love him so much. He's going to speak to the head of the department about an "anonymous patient," and file a complaint himself. And he agreed that the diagnosis was a little iffy, but said that he wasn't actually able to do anything about it, because once GD is diagnosed, all care related to the GD becomes the responsibility of the endocrinology department. Then he expressed outrage that they weren't actually doing their job, as far as answering my questions and treating me with respect. I repeated all of my unanswered questions to him, and he gave me a referral to have a consult with an actual endocrinologist, instead of one of the nurses, so that I can get some answers. And I really really appreciate that he admitted that he didn't know the answers to my questions instead of just blowing me off like the nurse did.

The number one question is going to be whether it makes sense for me to retake the three hour glucose test. I mentioned the GD diagnosis to my physical therapist, who had some interesting things to say on the matter. She asked if my back was bothering me on the day that I took the test. My back was fine initially, but I had to sit in uncomfortable waiting room chairs for three hours without moving, and at that point I couldn't sit for more than an hour without feeling pain. By the end of the test, my back was killing me. Here's some biochemistry that I never knew: when you're in pain, your body releases extra cortisol, which blocks insulin and artificially elevates blood sugar levels. Which goes pretty far in explaining my weird test results, in which my fasting sugar levels were normal, my one hour results were normal, my two hour results were normal, and my three hour results (the one for which my back was killing me) showed that my sugar levels had stopped dropping, causing me to fail this last test. Interesting.... Dr. M agreed that I should probably retake the test and see if the results are different, but unfortunately, he's not allowed to make that call -- I need the endocrinologist to do it. We'll see what she says.

And in a final bit of good news, I have "graduated" from twice weekly physical therapy to just once a week. My back is definitely getting better, and I often go days without feeling any pain. My back definitely gets fatigued faster than it used to, and there are still some things that I can't do very well (like crouching over a tub to give LL a bath) but it's getting there.

Ah, the feeling that things are finally falling into place!

Thursday, June 17, 2010

More GD Frustration

I had my follow-up appointment with the nutritionist today, to see how I'm doing with the GD. What an unbelievably frustrating experience!

The whole appointment started off bad. I have a written log on which I'm supposed to write down everything I eat, and what my four-times-a-day glucose levels are. I dutifully filled in the entire log. The first thing the nurse did was take the log from me, then ask for my glucose monitor. The monitor has a memory function, which stores a month's worth of values. She then proceeded to go through all the numbers in the monitor to verify that I didn't lie on my written log. She did this for the entire week's worth of values. Then she eyed me suspiciously and asked if I was sure that all of my numbers were from my blood and not from somebody else in my household. Nothing quite like the feeling of knowing, without a doubt, that the person sitting across from you is convinced that you're a liar.

Then we had this conversation:

Nurse: Wow, your numbers look great!
Me: Thank you. Given my weird initial test results, and my low monitoring numbers, do you think it's possible that I don't have GD, maybe ease up on some of the restrictions a bit?
Nurse: No, you definitely have GD. Otherwise you wouldn't have failed the test.
Me: But, by the ADA criteria, I didn't fail the test. And my monitoring numbers kind of back that up.
Nurse: Now you're just arguing semantics.

Note to the world: I don't think that she knows what the word "semantics" means.

Next, we talked about exercise. At the GD class, we were told that if our blood glucose levels after eating were too high, they can usually be lowered by exercising a bit during the hour immediately after eating but before testing.

Nurse: Are you exercising after meals?
Me: I do exercise every day, but it is very hard with my schedule to exercise within an hour of starting a meal, because I'm commuting after breakfast, and I'm in meetings after lunch.
Nurse: Oh, okay. Then we should probably put you on insulin.
Me: Pardon me? I thought that my numbers all look great?
Nurse: Yes, they do. But if you're not willing to exercise, we'll need to put you on insulin. Your choice.
Me: You would put me on insulin even if my levels are completely under control without it? What would you possibly accomplish by doing that?
Nurse: We just want to help you to protect your baby.

As an aside: does implying that a pregnant woman doesn't care about her baby really motivate her to change behavior? Because it honestly just pisses me off. So does threatening me with completely unnecessary medical interventions.

The exercise discussion also included this bit:

Nurse: There's lots of ways to exercise. Don't you play with your toddler?
Me: Yes I do, but not after meals.
Nurse: Why not?
Me: An hour after breakfast, I'm at work. Same with lunch. And an hour after dinner, my toddler is in bed. I play with my toddler a whole lot during the day, but it tends to be before breakfast and before dinner, and there isn't much I can do about that.
Nurse: (with a disapproving look) Okay....

And finally, there's this gem:

Nurse: Is there anything that you had trouble with this week?
Me: I found it difficult to test after breakfast, because I'm commuting to work one hour after breakfast.
Nurse: Maybe you shouldn't go to work for a while.
Me: Um, I don't see how that is possibly an option.
Nurse: We just want to help you to protect your baby.
Me: My baby seems pretty well protected without me dropping out of school and quitting my job.
Nurse: Well, I guess that's your choice.

Yeah, not the best medical experience I've had in my life. At a minimum, I was looking for a little support and advice about how to fit all this monitoring into my life. I was not looking for threats, or implications that I'm a bad mother, or being treated like a liar. And yet, after all the disapproving comments during the appointment, she concluded by telling me that I seem to have things so well under control that I can go several weeks between appointments.

And yes, I made sure to make my next appointment with a different nurse.

Friday, June 11, 2010


I have to admit: as much as I was dreading sitting through the gestational diabetes education class, it was actually rather interesting. Very well done. I was afraid that it was going to be two and a half hours of "Don't eat cake. No, seriously, don't eat cake." Instead, they actually taught us the biological mechanism that causes gestational diabetes, how it differs from normal Type 2 diabetes, and walked us through some very practical GD diet advice. Not bad.

I mentioned in my last post that I didn't fully understand why I had even been diagnosed with GD, since I only failed one of the four tests, in a rather odd way, and even the American Diabetes Association says that you need to fail two of the tests to be diagnosed. When the nurse teaching the class put up info about the test, confirming that it takes two fails to be diagnosed, I had to ask, so I went to chat with her during the break. Here are the somewhat frustrating things I learned in that conversation:

First, she told me that the OBs in my clinic are "more conservative than most" and made their own policy to diagnose GD with only one failed test. So at any other clinic, I'd be considered healthy. Second, she admitted to me that she had noticed my test results in particular, because they were so borderline. After looking at my full history and test results, she is fairly convinced that I don't have GD. (She even said, "The one factor that I've seen produce results like yours is stress. Have you been under any stress lately?" And I burst out laughing.) But then she gave me the "better safe than sorry" speech, and said that as long as I was already there, it would be best to continue to monitor me for the rest of the pregnancy. Which, yeah, I assumed would be the conclusion, but it doesn't make it any less annoying.

I've only been following this GD diet for two days so far, so I'm not ready to draw any far-reaching conclusions, but I've found my initial reaction to be somewhat surprising. I thought that I would really really hate following the diet. A lot. I've barely eaten any desserts since getting pregnant, but I have been surviving on fruit. And during my pregnancy with LL, I had horrible food aversions to chicken and beef, so I pretty much survived on carbs. Also, I've been craving milk lately. But, with the GD restrictions, a big glass of milk fills just about my entire carb quota for a meal, and I'm not allowed to have fruit with breakfast or before bedtime. Really annoying. Still, other than the milk and fruit, I've found the limits to be not too bad so far.

The part that's annoying the hell out of me is that I have to time everything. Three meals and three snacks each day. At least two hours between each of those, but not more than four hours. And I have to test my blood sugar exactly one hour after each meal.

The problem with this schedule? Almost every single hour, I have to be sitting down somewhere, either to eat or to test. An hour after I start eating breakfast, I'm usually in the car commuting to work. But I can't test my blood sugar while I'm driving. So, I either need to sit around at home for an hour so that I can test before I get in the car (which makes me very late to work) or I have to eat really early in the morning, which makes me throw up. My afternoon snack almost always needs to happen while I'm driving home from work, but I can't find any "allowable" snacks that are easy to eat in the car. If I wait to have the snack until I get home, it pushes dinner into LL's bedtime. And even if I manage to be able to eat dinner when I want, testing an hour later is even more problematic, because that's when I'm putting LL to bed. I can't hold a toddler in my lap, read him a story, and test blood sugar all at the same time. And the testing that needs to happen while I'm at work is hard, because I need to sneak into abandoned conference rooms to get some privacy, often walking out of meetings to do so.

If I were convinced that all this work was for the good of the baby, then I'd happily do it. But you know what? I don't have GD! I was given guidelines for where they want my blood sugar to fall at various times, and they also mentioned what "normal, non-GD" results would look like. Admittedly, I only have two days worth of date on myself, but still: my results so far all look completely normal. Even though I've been pretty sloppy about counting carbs.

I have a follow-up appointment with the nutritionist next week, and I plan to grill her on whether I can ease up on the dietary restrictions a bit. Maybe monitor a little less often. We'll see.

Thursday, June 3, 2010

Spiraling Further Downwards

I have family risk factors for gestational diabetes. (As in, most of my dad's side of the family seems to have type 2 diabetes.) I've never had any problems myself -- my brother was diagnosed with Type 2 when he was younger than I am now, so I make sure to get myself screened, and all of my readings have always come back normal. Because of the risk factors, though, Dr. M likes to test me earlier in my pregnancy, instead of waiting for the second trimester like is normally done for other pregnant women.

The one hour glucose screen is annoying, but manageable. It is even more annoying during the first trimester, when you're already nauseous most of the time. Still, it's better than the three hour tolerance test, which seems like the ultimate way to piss off a pregnant woman.

I took the one hour screening test when I was 8 weeks pregnant with LL, and I passed with flying colors. (Yay!) I took it again when I was 20-something weeks pregnant with LL, and I passed again. (Yay!) But this weekend, once again eight weeks pregnant, I failed it. (Booooooo!) But just barely. I failed it by the itty-bittiest amount possible. Still, a fail is a fail, so I was given the honor of taking the horrid three hour tolerance test this week. Why is this test a form of mild torture for pregnant women, particularly pregnant women with injured backs? Admittedly, a few of these were just my bad luck, but still:

1. You have to fast for at least 12 hours before the test.
2. While the 12-hour fast is already making your nauseous, you have to drink a big bottle of sugar syrup, really fast.
3. You now have to sit in a waiting room for three hours while they draw your blood once an hour. Still can't eat anything.
4. You're not allowed to move around much, because it throws off the readings. So you're restricted to remain sitting in the awkward waiting room chairs for the entire three hours, even if your back is killing you. The nurse will yell at you if you try to stand instead of sit.
5. There's probably free wifi at the clinic where you're getting your blood drawn, but don't think that you'll actually be able to work for those three hours. The wifi is nearly guaranteed to be out of order for all but 15 minutes of your three hour wait. You didn't have anything important to work on anyway, right?
6. Every single cigarette smoker and perfume wearer will decide to sit down next to you while you wait. What's that? You're in your first trimester and you're really sensitive to smells? And as previously mentioned, you're not allowed to get up and walk to somewhere less smelly? Awwww.
7. After the test, you'll realize that you're about to be late for an important meeting, so you don't have time to grab something to eat. All in all, you'll end up fasting for 17 hours. At least you had that yummy nauseating sugar syrup for breakfast at the clinic, right?
8. You made it to your meeting, and you finally got some food. You desperately want to go home and lie down. Unfortunately, you now have a pounding headache and feel lightheaded every time you stand up. Can't drive home like that!

And the final insult? The cherry on the top of a freaking fantastic week? You fail the test. But again, just barely. The glucose tolerance test has a total of four blood draws. I had always read that failing two of them means that you have GD, but failing just one of them means that you're fine, but they'll want to test you again several weeks later. Well... I only failed one of them. And again, just by the itty-bittiest amount. My other three blood draws were comfortably in the normal range, not even borderline. But this morning Dr. M called to tell me that they recently changed the guidelines, and now failing even one of them is considered enough to diagnose with GD.

So... I have to take a GD nutrition class next week, and then I have to start monitoring my glucose levels. I don't actually believe that I have GD, but I'm no medical expert, so I guess it's better to be safe than sorry. We'll see how it looks after a week or two of monitoring.

Did I mention that I was on my way to meet with my lawyer (yep, as of this week, I have a lawyer) when Dr. M called, because the other guy's auto insurance are being jerks about paying for my medical bills, even though they've already admitted liability for the accident? Did I mention that my in-laws and my entire extended family are all arriving from out of town in less than a week? Did I mention that I'm walking through my university's graduation ceremony in ten days, on the blind faith that I'll be finishing my PhD this summer? Did I mention that AdvisorA has been sitting on a draft chapter of my thesis for more than five weeks without communicating with me at all? Did I mention that I need a full draft of the entire thesis in one month in order to have any prayer of anyone on my committee reading it, and thanks to AdvisorA's neglect, I have to put it all together with zero feedback on how I'm planning to structure it?

Did I mention that glucose levels can be artificially elevated by stress?