November 26, 2004
a bit of whining
Trying to control my gestational diabetes is like trying to catch a little monster. Each time I think we're getting close with the insulin doses, it's like grabbing the little beast by its tail, only to have it slip away the next moment.
I know that even if we do catch the monster, we can't kill it. The best we can do is keep it under control until it goes away on its own. Or doesn't.
But to this date, it keeps slipping out of my grasp and the chase continues.
November 22, 2004
Gestational Diabetes Update 3
Since I began insulin, I've had to call in and have my dosages increased on almost a daily basis. I started at 2 units of Humalog (fast acting, short duration) before each meal and 2 units of Humulin N (slow acting, long duration) before bed. As of today, I'm up to 20 units of Humalog before breakfast, 18 units before lunch, 12 units before dinner, and 22 units of Humulin N before bed. For several days, I also had ketones in my urine in the mornings, so I've had to start eating a middle of the night (4 am) protein snack in addition to the three regular 'snacks' I'm supposed to have between meals.
I'm eating WAY more than I'm used to, and I'm still only gaining about 1pound/month instead of the 1pound/week that I should be.
Anyway, the increased insulin dosages meant that my first pen ran out on Saturday, so I went to the pharmacy to get a refill. I was told that insurance wouldn't cover it because they deemed it too soon for a refill. Apparently, the prescription on file stated "2 units, 3x day," instead of "PRN" (which means 'refill as necessary'). So, I had to pay for the pen, but the pharmacist said they'd call the clinic and have the doctor update the prescription. If he authorized multiple pen refills at one time, then the pharmacy would probably be able to refund what I paid for my pen instead of me having to file a claim with my insurance for reimbursement.
This morning, my endocrinologist's nurse called. I told her about the pharmacy situation and she sounded annoyed (with them). She said they were supposed to dispense one BOX of (5) pens at a time, not just one pen at a time. So she said she'd call them after we finished talking and update the prescription. That's good, because I need to pick up more pens since we'll be in Virginia for the next week, and running out then trying to find a place where I can get a refill would not be fun.
Some good news is that the current dosages of insulin seem to be working. My last four post-meal glucose levels have all been below the limit.
31 Week Prenatal Appointment
Today's appointment went fine. The baby's heartbeat was good and we're measuring on schedule. Dr. Litzinger gave my belly a quick squeeze and determined that the baby is head-down (right now). She may still turn around. Dr. Litzinger said they don't usually settle and stay head-down until about 36 weeks.
Austin Heart Hospital sent the results of my echocardiogram to Dr. Litzinger. Everything looked fine, so that's one less worry.
After the exam, Dr. Litzinger surprised me by saying she wanted me to go in for an ultrasound before my next appointment. They aren't normally done after 20 weeks, but she said she always likes having an excuse to do one, and in this case, my low weight gain was the reason. They just want to double-check the baby's measurements since I've only gained about 1/3 of the weight I was expected to. (I was up only another pound since my last appointment, 3 weeks ago.)
I mentioned being concerned about the baby's size because of the gestational diabetes and Dr. Litzinger said, "oh, thank you for reminding me of that." I told her how it was going, how they had to start me on insulin just days after my "class," and how they've had to increase my doses nearly daily because I kept getting high readings. That didn't please Dr. Litzinger very much because the endocrinology clinic hadn't bothered to contact her and tell her they'd started me on insulin. Apparenlty, if you have gestational diabetes and are taking insulin, they want to see you WEEKLY. So, starting in December, I'll be going in to the clinic once a week.
The somewhat plus side to this is that I'll be getting an ultrasound before each visit. They want to visually monitor the baby. I'm actually excited about my next appointment, which is December 3rd. As Dale pointed out, we might be able to confirm that I'm carrying a girl.
November 17, 2004
The first ever baby Olivia betting pool!
My friend Genevieve has started a betting pool on when my baby will be born. This is mostly aimed at Livejournalers, since the prize is a 1 year paid subscription to Livejournal, but anyone can go ahead and pick a date. Maybe if the winner is a non-LJer, I'll send out an Amazon gift certificate instead.
At any rate, if you want to get in on the game, here's her Livejournal post with the information. (If you're not a Livejournal member, be sure to leave your name with your comment!)
November 15, 2004
The Baby Shower Gallery
Dale converted and resized the photos taken with our camera, and I've uploaded them.
November 13, 2004
The Baby Shower
[Crossposted from my regular blog]
Genevieve, Aaron, and Gretchen are awesome people!
Genevieve organized a sweet, wonderful couples baby shower for me and Dale. She helped create some really cute invitations, made me matching 'Thank You' cards, turned her popular 'baby bear cake' into a 'baby monkey cake' for me, bought snacks, put together some games, and decorated tables at Aaron's house.
Aaron, a guy to his core, opened up his house to pink tablecloths and tableware, plus a sizeable group of family and friends, and cooked up 10lbs of kalbi that my Mom prepared and overnighted to us.
Gretchen flew down from Nebraska to come to this shower, despite never having met or spoken to me in person yet. Then she helped Genevieve set up for the shower, took pictures, and choreographed the gift opening like a pro. Then she helped clean up!
I also have much love and thanks to everyone for coming out (Dale's family drove up from Houston, and Mel hobbled in on crutches) and for the wonderful gifts! Dale and I are blessed to have such people in our lives, just as Olivia will be.
(Tons of photos were taken and will be posted soon!)
November 12, 2004
I keep failing the glucose tests
Since yesterday, I've checked my glucose level five times, and each time it was well above the limit. Even throwing out the first test, which was done before altering my diet, that's four high readings in a row, and after just three we're told to contact the nurse.
I left a message at the clinic this morning, after my post-breakfast test, but I didn't get a return call until noon, and it was the wrong nurse. (She doesn't work with the gestational diabetes patients.) The proper nurse called about 45 minutes later.
After going over my glucose levels with her, she told me to begin insulin injections, starting with a very low dose. So a trip to the pharmacy is on the agenda for this afternoon. I'll do my first injection right before dinner.
I have been eating within the guidelines I got yesterday. Actually, I've been under the required amounts because I missed my late afternoon snack yesterday. That didn't stop my post-dinner result from being 149 (instead of under 120). My 'bedtime snack' (required just before I go to sleep) last night was two glasses of milk, to meet the 2 carb servings requirement. When I tested at 8:15am, my pre-breakfast glucose level was 122 and it should have been under 90. Post-breakfast (1/2 cup of Cheerios with 1/2 cup of milk), it went up to 129.
After my lunch and dinner results were high yesterday, I looked at Dale and said, "I think I'm going to end up on insulin." He looked back at me and said, "Yeah, I've been expecting that." When I asked why, he said, "Because your body is a Drama Queen, even if you don't want it to be." I think he's right about that. There's certainly been a lot of medical drama in this pregnancy, and we'd have been so happy to have avoided all of it.
November 11, 2004
Gestational Diabetes Class
Today's 'class' was interesting. Dale and I did learn more about gestational diabetes than we'd known, which is useful. We were given booklets and printouts and sample meal plans. Basically, I can't have any more sugar or sweets (cake, candy, honey) or fruit juice or soda. But I can eat all the non-starchy vegetables, meats, and fats that I want. It's almost like a controlled Atkins diet. My carbohydrate intake has to be very carefully restricted and monitored. I have to keep a food journal and take it with me to my appointments with the doctor or his nurse. I also have to check for ketones in my urine three times a week and check my glucose level four times a day and report my results to my doctor's office once a week.
Checking for ketones is simple. I have a prescription for a small pack of strips. I just pee on one M W F after I get out of bed.
The glucose testing involves a little more work but is pretty simple too. I was given a little kit that contains a digital analyzer and a lancer tool. Separately, I got disposable lancer needles and the test strips. To do a test, I have to load a test strip in the analyzer, make sure my hands are clean, use the lancer to prick a finger, squeeze up a drop of blood, and apply the blood to the test strip. In 15 seconds, the analyzer shows my current blood glucose level.
There were three women in the class, two of us with our husbands. The three of us all got to do a test there so we could see how it was done. I had eaten a large bowl of cereal at 7:15am, and my glucose level three hours later was at 140. Ideally, it would have been under 120 one hour after eating, so it was pretty high. And I was already hungry again. But I didn't feel quite as guilty when the healthy-eating Indian's woman's level was 135. And the other woman, who'd gotten her test kit yesterday, showed that her first reading (after dinner last night) was a whopping 193.
After we got home, I fixed myself a suggested 'snack' - two pieces of bread with peanut butter. Later, I had a cheese and salami sandwich and a 1/2 cup of canned pineapple with cottage cheese, all carb amounts within my new dietary limitations. I was supposed to check my glucose level an hour after lunch but lost track of the time, so it was closer to 1 1/2 hrs later. It read 143, still too high.
If I have three out of bounds readings in a row, I'm supposed to call my doctor. They'll decide whether to adjust my diet or start me on insulin. The first test today doesn't count, since it was prior to starting the new diet, so I'm hoping my glucose level will come down in the next two tests (after dinner and tomorrow morning before breakfast).
I'm rather bummed about this. If the gestational diabetes had been detected just one week later, I could have pigged out on the cake Genevieve's making for my baby shower on Saturday. As it is, I shouldn't have any, but I do plan to have a small piece. A very small piece, honest.
November 10, 2004
An amusing baby update
The baby is getting more and more active, for longer periods of time. I can sit and watch a spot on my belly pop up suddenly, then retract. Once, a small bulge appeared on my left slide, slid sideways a couple of inches, then disappeared.
Late last week, I think I felt the baby having hiccups. I know she gets them, because we could see her hiccuping during the last ultrasound (at 20 weeks), but I hadn't felt them yet. This time, I noticed some mild thumping going on low in my abdomen that was strangely rhythmic and regular, so I figure it was hiccups.
This morning, something thumped against my upper belly on the right side. I pushed back with my hand, then the object moved, to pop up again a couple of inches away. I pushed down again, this time distinctly feeling a small hard object underneath my hand. I think it was a foot.
Then this afternoon, she pulled some sort of movement that made me shudder. It felt like she grabbed the front wall of my belly, then pulled it around her or wrapped herself in it like it was a blanket. It was freaky feeling!
Gestational Diabets Update
The evening before my appointment, the clinic called and told me that my scheduled appointment was a "combo" - I was to see the nurse practitioner and then the doctor - but the nurse wasn't going to be available so they wanted to reschedule me for another doctor and push the appointment back an hour. Fine with me.
After I checked in at the endocrinology clinic, Dale and I waited a good 20 minutes or so before I was called back. During the wait, we heard one of the front desk workers calling a patient to reschedule an appointment because the doctor had an emergency situation and wouldn't be available. The doctor she named was the one I was scheduled to see.
Finally, we were called back by a nurse. She got my weight and blood pressure, then asked if I had a copy of my glucose test results. I told her I'd called my ob/gyn last week and they were supposed to have sent over the results. They hadn't, so I gave her my doctor's name so the nurse could call them. The hospital I was in was literally across the street from my ob/gyn, so someone could have walked over and gotten a copy and been back in 10 minutes.
Anyway, the nurse asked if I'd had some test done called a AR5 or something like that. It measures average blood sugar levels over the previous two months. It didn't sound familiar, so she went ahead and did one. It involved a finger prick and putting a tiny bead of blood into a cartridge that went into a small machine. She said we should have the results in about 6 minutes. In the mean time, Dale and I were shown into an exam room.
After another 10 or 15 minute wait, the doctor came in. I guess we'd misheard or misunderstood what the front desk scheduler had been saying on the phone. The doctor introduced himself, then asked if I understood why I was there. I told him I'd been diagnosed with gestational diabetes. He asked if I understood what that meant, and I said, "sort of," so we got a brief lecture on gestational diabetes and how it affects the mother and the baby.
The nurse popped in briefly to hand over my recent test results, along with a copy of my records from my ob/gyn that had just been faxed. Apparently my AR5 (or whatever it was) results came back 'fine' so the gestational diabetes is probably a recent development. Then the doctor took a few minutes to look over my records, and we got the question again: "so, you're pregnant with twins?"
Dale and I had to spend a few minutes explaining what had happened to the doctor and when we were done, he just looked thunderstruck. It's strange to think that something that happened to me still takes medical professionals by surprise.
The doctor moved on to doing a quick physical exam, checking my eyes and such. Then he said what we'd do is get me into a diabetes management class that would explain how I'd check my blood sugar levels at home and use diet and excercise to manage my glucose levels. Then he escorted us to the patient check out. I got signed up for a class tomorrow (Thursday) morning, and we left.
I can't really say I felt that that doctor visit had been very productive. I didn't really learn anything that I didn't already know, but I guess it was something to get out of the way before the diabetes class. Dale and I also agreed that the first impression we got of the doctor was that he was either drugged or half asleep. When he first came in, he was mumbling so I could barely understand him, but he seemed to perk up through our meeting. Overall, it was a strange experience.
Heart update
Monday was my appointment at the Austin Heart Hospital. I was there because I'd complained to my prenatal RN that my pulse rate almost always seemed to be really high lately, and at times it beat so strong, I could feel it in my fingertips and eyeballs. I also have bad shortness of breath issues from time to time, especially after first lying down.
The first nurse took my blood pressure from both arms - good. Then she took my pulse and all but said, "DA-YAMN, girlfriend!" when she saw the results. Sitting still in the chair next to her, it measured 104 beats/minute. Next she did a quick EKG reading, and I think the results were fine/normal.
Next, a medical student came in and introduced herself and explained the doctor who'd be seeing me shortly was her mentor, and would I mind if she asked me some questions and participated in the exam? I told her that was fine then answered a lot of questions about my family and personal medical histories. During that, the RN came in. The intern and RN took turns asking questions, listening to my heart, and feeling my pulse. Apparently, my ob/gyn had sent over some of my records because the RN looked at my file then said, "oh, you're having twins!"
I had to explain that no, I wasn't. I'd had a dual pregnancy, but I lost one in May because it was ectopic. She and the intern kind of stared for a minute, then she apologized. I assured her it was all right, and though it made me miserable to think about it, I was able to get by without crying.
After the doctor came in, he listened to my heart, checked pulse points, and basically did everything the intern and RN had already done. Then he said he could hear a small heart murmur, so he had the other two listen to it while reassuring me that it was very faint and probably nothing to worry about. He said it's likely caused by my heart having to cope with the greatly increased amount of blood in my circulatory system and would be gone after the baby is born.
The doctor also said that while my pulse rate is high, it's not out of the normal range for a pregnant woman. A bigger worry would be if I had an irregular heartbeat or noticed my heart skipping any beats, which I don't. So, he thinks I'm just fine, but he's sending me to get an echocardiagram next week, just to have a look at my heart and make sure it looks good.
November 05, 2004
Doctors and tests
This morning's appointment went quickly. The nurse did a throat culture that came back negative for strep. The doctor said my throat is red and irritated, and he can see in my nose where it keeps bleeding (whenever I blow my nose). He said it's due to my allergies being out of control because of my pregnancy. I'd only been taking Alavert as I felt like I needed it, but he said to start taking it regularly and to take Benedryl at night. He said it's safe for the baby, but I want to run it past my ob/gyn first, since she never mentioned it before.
The ob/gyn's office just called back with the results of my glucose test. Unfortunately, I have gestational diabetes. My blood sugar was 174 and they like it to be below 140. So they referred two endocrinologists. I called the one on my insurance plan. She's pretty booked. At first, the receptionist said the next available appointment was in three weeks, but then she put me on hold for a few minutes. When she came back, she said I could get in to see the nurse practitioner at 8:45am on Tuesday, then just wait until the doctor could pop in to see me. Then I'll be going back to the clinic on Thursday for a diabetes class that lasts a few hours.
I guess it's a good thing I've already told Dale to hide the bag of Halloween candy.
November 04, 2004
28 wk prenatal appointment
At 1:15pm, I chugged down 10oz. of orange-flavored "Glucola."
At 2:00pm, I arrived at the lab.
At 2:15pm, two small tubes of my blood was drawn and I was sent downstairs to my ob/gyn.
At 2:30pm, I was called back for my appointment.
As usual, we started off by weighing me (up 2 lbs), and then I got to pee on a small strip of paper. If my blood sugar read high this time, it was attributed to the Glucola. Next was pulse and blood pressure (just fine).
In the exam room, we first listened to the baby's heartbeat. It took the nurse about a minute to find it, but then it was good, up in the 150s. When Misty (the RN) came in, she measured my belly (29 weeks, slightly ahead of my actual date) and said it looked good. Then we had the usual discussion of my aches, pains, and concerns.
I've had a lot of shortness of breath, even when there's been no recent exertion. Sometimes, it suddenly feels like there's a big, wide band around my chest, squeezing. My pulse rate also tends to be right around 100 constantly, and at times (again, no exertion causing it), I can feel my pulse throbbing in my fingertips and my eyeballs will even jump minutely with the force of my pulse. Because of this, Misty referred me to the Austin Heart Center. (I have an appointment for Monday morning.)
The pelvic pain is just something to be endured. I can see about visiting a massage therapist, or I can take Tylenol as needed.
I have had a mild sore throat that comes and goes for the last two weeks. Misty took a look and first asked me if I still had my tonsils (yes). She said she could see scar tissue and some irritation, but nothing that looked like strep. She told me to contact my GP for a check up. (I have an appointment for that for tomorrow morning.)
I also discussed flu vaccination with Misty. Unfortunately, I do qualify as high-risk and should get one, but the clinic doesn't have any. Misty told me to ask my GP. I called his clinic and was told they never got ANY. The receptionist suggest I call 211 and find out if any place near me had any vaccines. I've been trying, but I keep getting a busy signal.
Finally, I did discuss my weight again with the nurses. My NET gain (from pre-pregnancy to now) is a whopping 6 lbs. My gross weight gain is closer to 10 or 11 lbs, considering I lost 4 or 5 lbs during my first trimester. Either number seems awfully low to me (my Pregnancy Week by Week book says I should be up 17 to 24 lbs by now) but Misty isn't worried. Technically, I'm losing weight to the baby, but since I AM gaining overall, though very slowly, and as long as the baby is measuring on target, we're ok.
So, tomorrow I'll visit my GP in the morning about my throat, then get my glucose tolerance test results later in the day. Then on Monday, I'll go in for a heart consultation. And maybe some day I'll get an answer at 211 about a flu vaccination.