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Ultrasound 7.10.2009 This week has been a big week in pregnancy.  We are at 36 weeks, and I have checked in with the Endocrinologist (everything with The Beetus is dandy), had another BPP (he once again scored a 10/10, and is very, very clearly a boy), a visit to the OB (who said that I’m making pregnancy look easy), and our last visit to the perinatal doc for a growth ultrasound and a looksee at our little one’s bowels.

At our 28 week ultrasound with the perinatal doc, she mentioned that he had a bit of extra fluid in his bowels that wasn’t necessarily worrying, but different.  Yesterday at our ultrasound his bowel looked perfect.  His EVERYTHING looked perfect.  We were once again assured that he’s a boy (and WhattaBoy, seems to be the consensus of local ultrasound techs), and he was active and showing his breathing activity and has dropped into my pelvis, getting all ready to get born.  His current weight was estimated at 5 pounds and 15 ounces.  He’ll gain anywhere from half a pound to an entire pound per week from now until delivery, so I am guessing his birth weight at a little below 9 pounds.  Put in your guesses in the comments, and we’ll see who is closer.

The OB indicated this week that we are still going to be induced before I hit 40 weeks, and we will set the exact date on my 38 week visit, which is July 23.  Watch this space for details.  Jeff thinks I will go into labor before I have to be induced, and I think that I’ll be induced on July 27.  I had my cervical check this week (sorry, male readers, for that visual) and I am currently dilated at 1 cm, and the OB did not think that it was out of the realm of possibility that I would go into labor on my own before 39 weeks.  We’ll see.

Jeff and I have been hauling some serious ass to get the house ready this week.  The baby’s room is all painted and cleaned, and starting to gather all his stuff.  Thanks to his Aunties Alison and Sarah, we’ve got a TON of baby equipment – every time I see one of them I cross more items off my Target and Babies R Us lists.  We got our shipment of cloth gDiapers in the mail today, so I can start washing those and putting them away.  It will be a few weeks before he sneaks into the mediums, but they will be all ready when he is.

I got the garden all mulched and weeded, and of course, now it needs to be weeded again.  We haven’t had any natural rain in ages, and the poor garden can tell.  I keep seeing on AccuWeather (yeah, right) that we have a huge chance of rain, but it never seems to come through.

Today we have been cleaning the upstairs, which is usually sadly  neglected, as no one ever comes up here.  However, the spare room in the back of our bedroom needs to become an actual spare  bedroom in the next couple of weeks, so there is lots to do, as it has been used as a dumping ground since we moved in.  Jeff is moving all that stuff into our storage areas, and we’ll set everything up to make it at least acceptably comfortable.  One complication:  the box spring for the spare bed will not make it up the stairs, and the  mattress will have to sit on the floor until I can get a good deal on a split box spring. Those things are apparently gold right now.

Thanks to my friend Julie, I have hired a cleaning lady to come  help me on Tuesday.  I can get all the tidying up done, and the set up of the baby’s stuff, but anything below waist level is just not happening right now, so Laurie is coming to help me out.  I can’t wait, and I can’t even tell you how much knowing she’ll be here for a few hours has reduced my stress level.

We’ve been awfully busy, but doesn’t seem like there was much to report – I guess I was wrong.  This week: I go to the dentist to get my sleep appliance adjusted, get the blue back in my hair, get a clean house, and the usual doc-go-round.  Also, looks like we’ll be lowering the price on the condo, if you happen to know anyone that would like a lovely one bedroom condo in the University area….

We Can Do It!!A few weeks ago, I mentioned here that we’d had an ultrasound and that we got the best.ultrasound.picture.ever.  It was especially good timing, as I had just found out that I had gestational diabetes, and wasn’t sure how well I was going to do with 11 weeks of restricted eating, shots, and at least two doctor’s appointments every week.  But, my little guy, who is already as supportive as his daddy, sent me a message that WE CAN DO IT.

I’ve enlarged this and put it on the  front cover of my calendar, and I can’t tell you how often I’ve looked at this and found the strength to keep going through the fatigue and the frustration and all the shit that needs to be done in the next couple of weeks.  We can do it.  We ARE doing it.  And we’ll keep on doing it…

Beetus2 I think that my new best friend Wilford would be very disappointed in this turn of events.

Since Friday, my blood sugar numbers have been way up for fasting and after breakfast.  In response, I’ve been cutting down on the carbs the rest of the day to keep things where they are supposed to be, but those two numbers continue to be a problem.

At the same time, my ketone levels were skyrocketing – two things that I didn’t even think could happen at the same time! From Wikipedia:

Ketones are elevated in blood after fasting including a night of sleep, and in both blood and urine in starvation, hypoglycemia due to causes other than hyperinsulinism, various inborn errors of metabolism, and ketoacidosis (usually due to diabetes mellitus). Although ketoacidosis is characteristic of decompensated or untreated type 1 diabetes, ketosis or even ketoacidosis can occur in type 2 diabetes in some circumstances as well.

To my non-medical self, the elevated ketones meant that I wasn’t getting enough carbs/sugar in my diet, and the elevated blood sugar meant that I was getting too many carbs/sugar in my diet.  WTF?

On Tuesday, I called the Beetus RN to report my issues (she’d been on vacation until then – not that I was unaware of the problems).  She called me back with the suggestion to raise my nighttime insulin (no problem), but then wanted me to talk to the dietitian because very obviously, I was doing the food thing wrong.  Sigh.

So, I talk to the dietitian, who enlightened me with the following:

  • I’m doing it wrong
  • I need MORE carbs in my diet, not less
  • Because that will bring down the ketones and the blood sugar
  • I need to eat even when I am full
  • But I am starving myself

I had been eating at the low end of my carb range, mostly because I noticed that my blood sugar was in control when I did that. Now I have been accused of not eating (that’s why we can’t keep the fridge full, and why most of the charges on our bank account if from a food establishment….cause I’m anorexic) and that I need to be eating at least six times a day, with at least 30 carbs in each feeding (yes, she said feeding, like I’m a farm animal), even though I am not hungry enough to eat more than three or four times a day.  I have to eat when I am full.  And to accomplish this, she listed off a whole bunch of processed foods that I should integrate into my diet, despite the fact I have told her repeatedly that we don’t eat a lot of processed foods. Why can’t I have an apple (30 carbs) instead of a V8 Splash?  Cause I’m starving myself.

Sigh.  I would also like to mention again that I have had to explain most of the food that we do eat to this dietitian.  I don’t think that we eat that strangely – we have a veggie CSA that is fairly mainstream (most of the reason we chose them – we had actually heard of some of the veggies, unlike some of the other CSAs out there), we don’t eat a lot of processed foods, and those that we do tend to be organic or natural.  Considering this clinic is in Uptown, I didn’t think we were doing anything unusual.  Her only suggestion:  Kashi frozen meals.  Sigh.

Then, since I was going to be difficult about my diet, she dropped the big bomb:  Ketones cross the placenta, and I am hurting my baby by having them in my body.  HOW exactly am I hurting him?  She didn’t know, but it’s bad.

Thank God that’s all cleared up.

Although the Beetus RN and the dietitian are in the same office, they can’t be bothered to talk to each other, so I had to call Beetus RN to report what was said, and to reiterate that I didn’t really understand how any of this was working.  Her response?  “It’s complicated” and changed the subject.  You know what, lady?  I’m smart.  Try explaining it to me.

She tried to get me to buy into the More Carbs = Less Blood Sugar, even when I referenced my numbers (which I’d emailed to her that morning) and showed her that the exact opposite was true. She then told me that the important part was to get the ketones under control, and that it was “just fine” for my blood sugar to be high.  Well, then, why am I treating the diabetes?  Why don’t I go back to my two cakes a day habit and let the ketones take care of themselves?

After a bit more frustrating discussion, she finally agreed to up my insulin at night and to add me to insulin before breakfast, as that seems to be the meal that makes me spike out of acceptable levels.  That was to start the next day.

(Just for giggles that day, I ate at the high end of my “carb choices” for the day and saw both that my ketones were higher than ever and that my blood sugar was higher than ever.)

Wednesday and Thursday I followed the new regime, and while the overnight numbers came down into acceptable levels this morning, the after breakfast are still too high.  Although I was supposed to check in with Beetus RN this morning, I was going to see the OB this afternoon, and wanted to hear what she had to say.

I gave her the brief explanation (Beetus RN and the dietitian are saying I’m doing it wrong) and she said, “You know, we make it sound like this is all under your control, but it’s not.”

That’s information I could have used a couple of weeks ago.

Basically, she said, there is a fine balance between ketones and blood sugar and my body and the baby’s body, and it’s really hard to keep those things in alignment.  Not only that, but my needs and the baby’s needs are changing all the time, and we are always going to be playing catch up with this.  We have to keep an eye on the numbers and make constant adjustments as needed.

(And she actually looked disgusted when she affirmed my belief that more carbs do not lower blood sugar.)

I love this woman.

So, basically, Beetus RN and dietitian:  I don’t fail Beetus, YOU fail Beetus. You have filled me full of misinformation, and shown me (and my doc) that  you don’t have the first idea how to deal with this.  I know that gestational diabetes is probably a small part of what you deal with, but it’s within your scope to either have some knowledge of it, or pass me off to someone who does.

In that vein, Dr. McK the Wonder OB is sending me to an endocrinologist – an actual doctor that knows about this stuff – to get back on the right path, and get some information.  Yay!!

Or, How I Will Spend the Rest of My Pregnancy at the Doctor’s Office.

Sorry for the big break in blogging, but there have been some time-consuming developments in Little Sawatdee Land.  Read on…

RosieTwo weeks ago, at Week 28, we went in to see the perinatal doc and then on to our regular OB appointment.  At the perinatal doc, we had another ultrasound.  I haven’t scanned the pics yet, and my not, as most of them are of his face and hard to see if you didn’t have the tech there to point out what we were seeing.  But there is one that I need to get online for you – it’s a picture of his arm, exactly mimicking the Rosie The Riveter stance..all you can see is his flexed little arm.  It’s adorable!!

Everything looked pretty good on the ultrasound – he is not only sending Mama a prenatal message (We Can Do It!), but he is measuring within two days of his due date.  There is some extra fluid in his bowel that the doc can’t explain, but doesn’t seem to be much of an issue.  She can see the fluid, but there is no distension or blockage that she can see, so we’ll have another look-see ultrasound at 36 weeks, and just make sure that he poos after he’s born.  She thinks that he’s just drinking more amniotic fluid than usual.  I figure that, as Irish as he’ll be, he’s just taking advantage of any drink he can get.

At the regular OB, I had my first gestational diabetes test, the one hour test.  I failed it spectacularly.  I was not surprised.  After all, I am high risk for the GD, being fat, old, and having insulin problems before I got pregnant (I was finally diagnosed with metabolic syndrome last April).  Also, my eating habits once I had to quit my metabolic meds at 12 weeks have been appalling – my body has been craving sugar, and there have been about half a dozen foods that I can eat with any regularity.  They are all high-carb, high-sugar, and things I would generally not touch when I’m on the medication.

BeetusWe scheduled my three hour glucose test for that Friday.  My fasting glucose should have been under 80 – it was 124.  After drinking the hideous fruit punch sugar drink and waiting an hour, my glucose should have been under 180 – it was 221.  I didn’t even  have to wait for the next two blood draws – they sent me home and told me to wait for the call from the diabetes clinic.

Before I even heard from the clinic, my regular OB nurse called me and told me that my doc, the fabulous Dr. McK, wanted me to up my visits to her to once a week, and that I was to report to the Maternal Assessment Center (MAC) at the hospital once a week for bio-physical monitoring.  I’ll be doing that every Thursday until Little Sawatdee decides to grace us with his presence.

I finally got a hold of someone at the Beetus clinic Monday afternoon, and got an appointment the next day.  We had a bit of a struggle over the phone on that – my OB had indicated that I was to get on insulin right away, and the Beetus RN wanted me to do diet modification for a few weeks first.  I finally had to get tough and tell her:  Look, I’m only going to have this for 10 more weeks.  There are half a dozen things I can eat right now.  If you get my insulin working again, we can talk diet modifications when I can eat like a normal human being again. I wasd trying really, really hard not to be a pain in the ass, but we’re not talking about a wait and see approach with this in my mind – I have 10 weeks to make sure this kid is healthy, and I want it done NOW.

She finally came around.

I did meet with a dietitian who outlined the maximum amount of carbs that I should have and at what time – it’s a whole lot less than I’d been eating, what with my new two cakes a day habit.  We then met with the nurse, who showed me how to monitor my blood sugar and give myself the insulin shots.

For right now, I am limited to:

  • Less than 30 carbs for breakfast
  • 30-45 carbs for lunch
  • 30-60 carbs for dinner
  • Up to 45 for a bedtime snack

Basically, I’m on Atkins, but with a few more carbs.  I’m now testing my blood sugar four times a day (before breakfast, one hour after each meal) and having to measure my level of ketones in the morning.  It’s been interesting trying to eat three meals a day, and having to plan those meals – since I stopped working full time, I’ve kind of been eating what I want, when I want, and this has been quite a chance.  However, I am less grossed out by food in general, and have been able to eat more variety than I have in months.  That’s worth the price of admission right there.

BPPOn Thursday, we had our first Bio-Physical Profile (BPP) at the Maternal Assessment Center (MAC) at Abbott, where we will be delivering (I still haven’t been able to convince Jeff that Cabbie should be delivering me in the back of a cab).  Basically, I get hooked up to a heart monitor and another monitor that measures the baby’s activity and movements.  The nurse was looking for movements (check) and increased heartbeat with  movements (check).  As with pants, LS didn’t like having the pressure on him/me, and kicked right on the monitor belt.

Then we had an ultrasound.  It’s lower quality than the one we’ve gotten used to, but the nurse was measuring adequate amniotic fluid (check), breathing exercises (check), gross movement (check) and fine movement (check).  He had half an hour to preform all of those things, and did them within a few minutes.  He passed his first test with 10/10.

After the BPP, we went over to see Dr. McK and do our weekly check in.  Nothing much to report there, but we set up a schedule of things for the next few weeks.  She was also momentarily worried that my belly was measuring three weeks more than my pregnancy (I was 29 weeks, my belly was measuring 32).  She was reassured when she saw his measurements from the ultrasounds (he’s at 51%), and I reminded her that I have NO TORSO.  Where else am I supposed to grow?

So, it’s been a busy couple of weeks.  I’m getting into the swing of eating normally and regularly.   I had to get a new purse calendar, as my old one was too small to keep track of all my appointments in.  It has a photo sleeve cover, so I’ve made a copy of the We Can Do It! ultrasound to remind me that Little Sawatdee and I are in this together, and that we can do what it takes to keep both of us healthy and have him come out healthy and happy.

Coming Up:

  • Every week:  BPP, OB visit, check in via phone with diabetes clinic
  • 32 weeks:  growth ultrasound at regular OB
  • 36 weeks:  ultrasound to check on growth and bowel at perinatal clinic

Only 10 weeks (hopefully!!) to go!!