Getting Ready

So it is getting to crunch time... kinda, technically we still have a month but we are trying to get ready for the little man hoping he decides to show up a little early. The reality of the situation is that he will probably get an eviction notice (I'll be induced) within the next few weeks if I don't go into labor on my own. He is doing well but getting very big. We had an ultrasound today (sorry mom, no pictures) and he was measuring big. The measurements they took all put him in the 40-42 week age range which is 4-6 weeks further than he really is and averaged his weight at a little over 9 pounds (the 97th percentile). It doesn't seem like 9 pounds is necessarily huge but its weird to think that if he was born today he would still be considered a month premature. Charlie just says he's an overachiever!

I go to see my doctor tomorrow so she can review the results with me and hopefully talk about a plan for getting the little man out if he doesn't come on his own, just so I know what to expect. On the upside last week they checked my A1c level which checks overall diabetes control over the last 3 months and it was good, a little elevated but lower than I thought it would be. The plan was that if it was below 6, it was 5.9, I could wait a little longer to be induced as long as he does okay with his non-stress tests and my blood pressure stays down!

My weekend project!
Getting the car cleaned and Asher's seat installed!

Overall I think we are doing pretty well here; my belly itches like crazy, I am getting stretch marks everywhere and I feel like everything on me is swollen but I think that is all normal at this point unfortunately. I'm working for the next three nights with the hopes that maybe that will entice him to keep dropping (or start dropping, I don't think he has yet!). But both Charlie and I are VERY excited for November to finally be here! The plan is to have an update later in the week but we'll see. I hope everyone enjoys Halloween!

Cait

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A rough start, Week 16...

Well... it's been a busy 48 hours since I've hit the 16 week mark. It started Wednesday night with projectile vomiting that continued into the early morning hours! Poor Charlie, I couldn't make it to the bathroom in time no matter how hard I tried so finally he just slept on the bathroom floor with me so that he could help me. I had a difficult time keeping much of anything down, which makes controlling my diabetes even more difficult because every time I would get sick my blood sugars drop very quickly so I have to eat and drink to keep them up (well this would usually just make me throw up more... you see the problem.) Anyways be morning I had stopped getting sick but still had a severe headache and was very dehydrated but I managed to make it downtown for my 16 week appointment.

Unfortunately because of the dehydration, and messed up blood sugars, I was spilling ketones in my urine by the time I got to the office (my bodies last resort to try and compensate for elevated blood sugars when not enough insulin is available or able to be used). Due to the dehydration, and ketones, and my inability to stand up straight without having my heart race and getting dizzy and out of breath my doctor decided to start an IV to rehydrate me. Well after 3 failed IV attempts and 3 failed attempts by lab to draw some blood work that IV turned into a full hospital admission... 24 hours later I am still here, hooked up to an IV, continuous EKG monitor, and hourly blood sugar checks (I thought I looked crazy and bionic before, now there are more wires and tubes attached to me than I can count). I was hoping to be able to leave this morning but the nurse I talked to told me 24-48 hours, which means maybe if I'm lucky later tonight but I will definitely be here for a while still.

Charlie has been amazing, he came home early yesterday to bring me the things from home I needed and stayed with me here last night (which involved eating hospital food, sleeping on the floor next to my bed for an hour or two before we got a guest bed pulled out, and hourly wake up calls through the night by my nurses, poor guy). The good news is I'm feeling much better now, just tired but I'm really hoping to get out of here sooner rather than later but I'll keep you updated once I see the diabetes educator and the cardiologist this morning.

-Cait
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P.S. Stay tuned for a new photo and some exciting news about the sex of our little one!!!

Sterile My A**!!!!

Sorry guys but this is going to be somewhat of a very big rant!

My blood sugars are doing much better these days which is awesome but taking away that major stress is making some of the other more normal difficulties of pregnancy even more irritating! Last week when I went to see the high risk doc he told me he wanted to do a 24-hour urine on me. For those of you who don't know what that is it is just what it sounds; it's a urine analysis checking for protein but instead of just taking just one sample they collect EVERYTHING you pee out in a 24 hour period. So in the office he has the nurse get me a collection kit and a sheet of instructions, she put it in a bag told me not to forget to get blood drawn when I was done and I was on my way.

After I got home I was reading the instructions (not that I haven't instructed patients a million times how to do these but just to be a good patient), as I was reading I was a little concerned that the container they gave me wasn't going to be big enough (roughly 3,000ml) but Charlie assured me that they knew what they were doing, and its in an OB's office so they always have pregnant patients who pee a lot not to worry. Fast forward a week and it was time for me to head back to the Dr's office to see the diabetes educator.

I got home from work Wednesday morning and started the collection at 8am so that I could pee for the last time at 8am today before heading in to the doctors office. What you guys have to understand about me is that pre-pregnancy I peed easily twice as often as the normal person, during this pregnancy its been a giant joke! The only time I can ever go more than 2 hours without making a trip to the bathroom is when I'm sleeping, when I'm awake it's at least once an hour, sometimes as frequently as 3-4 times an hour. I'm going to attempt to spare you guys the details but by 2 in the afternoon when got up for the day I had already filled almost 2/3's of the container. I debated at this point what to do, I knew I peed most in the morning and during the night so I though maybe I would be okay but to be safe I decided to stop drinking as much just incase.

I went through the day stuck in the house, but in the afternoon I had to run to church so I was thinking as I was on my way maybe I could stop by my work and con them into giving me another container just incase. By the time I made it to church and got the things and talked to a few people I NEEDED to go home right then because I though I was going to pee my pants! I don't know about you guys, but I wasn't prepared to tote around 3 liters of my own urine with me in a brown paper bag every time I left the house so I gave up on the idea of stopping by the hospital (most patients didn't even have that option so I figured I'd be fine).

The next thing I'm sure you have all seen coming... around 11pm I ran out of space in my little (giant) orange container. By the time I woke up again at 2am I was running around the house looking for some sealable clean container that I could fill (and never get back). I was planning on using tupperware with the screw-on lids, but much to my dismay they had all disappeared, so I collected a random assortment of bottles and decided on the large 1500ml Gatorade container. I washed it out really well (with no soap so I didn't contaminate the urine) and went on my way. By the morning I had completely filled the gatorade container also.

My appointment with the diabetes educator went really well, we didn't change much and things are getting better so after I saw her I headed down to the lab with my 4,500ml's of urine at my side! I walked in and already the tech was irritated because I wasn't on her schedule, but she said she'd see me anyways. I handed her the urine and she looked down at it then looked up at me with a face of disgust. Our conversation went like this:

Lab tech: "What is this?"
Me: "My 24-hour urine sample."
Lab tech: "Yeah, but what is this? "(lifting out the gatorade container)
Me: "My pee."
Lab tech: "Who gave you this? Why isn't it in the orange container?"
Me: "It didn't fit, the orange container is totally full."
Lab tech: "What am I supposed to do with this?"
Me: Blank stare
Lab tech: "Did I give you this?"
Me: "No, the nurse did, last week."
Lab tech: "Didn't she give you instructions?"
Me: "Yeah, and I read them twice, it says is that if you miss collecting ANY urine you have to start over, it says NOTHING about what to do when the container gets full!"
Lab tech: "Well WHAT am I supposed to do with this?"
Me: "I didn't know what else..."
Lab tech: "You realize this isn't sterile right? The orange container is sterile until it is opened, THIS... (pointing disgustedly at the gatorade container) is NOT sterile! I don't even know what kind of detergent you used to clean this!"
Me: "I didn't use soap cause I didn't want to wreck the test, I just used a lot of hot water."
Lab tech: "They're not going to accept this. I don't even know what I'm supposed to do with this?"
Me: (about to lose it) "It was 2AM, What was I supposed to do!"

At this point there are a million things running though my head! I wanted to scream at her, I mean they make people do this all the time, I can't honestly believe that I am the first person ever to run out of room! And who is she trying to kid, that freaking urine container became unsterile the second I opened it. They are having me pee repeatedly in a hat in the toilet then pour it into the container, with no instruction on how or even if I'm supposed to be cleaning the hat. Do I just leave it and let it collect bacteria and bugs between voids, or do I clean it with tap water and a towel every time (effectively making it less sterile than the gatorade container). I mean common, they weren't even having me do clean catch urine samples, which means that no matter how clean I keep the containers, the urine is FAR from sterile!!!

The conversation above continued for quite a while but after my 2am comment I just stopped talking and stared at her. After she asked for the 5th time what she was supposed to do with the urine it took every bone I had in me not to get out of my chair, grab another clean "Sterile" orange container from the shelf above her head pour my "gatorade" pee into it, hand it back to her and say "Here, problem solved!" But I knew that if I did that I would just stomp out of the room and never go back, and she hadn't drawn my blood yet, and if I left without getting a blood test they would throw the urine away anyways so I kept my mouth shut! Stupid, I was so irritated when I left I didn't even know what to do with myself! She was acting like I was an idiot someone picked up off the street and dropped at her doorstep.

End of story she finally drew my blood (irritated again that no one gave me a lab slip) and let me leave but not before warning me that "the Lab is going to reject this sample and you are going to have to do it again." Well if it does fail I'm pretty sure they better wait a freaking long time before telling me, because if anyone even mentions the words '24-hour' and 'urine' to me together in the same sentence anytime in the next month I might just throw my decaf coffee in their face! Sorry... I'm blaming the pregnancy hormones for some of my irritation but seriously, I'm not joking about the coffee thing!

-Cait

P.S. On a brighter note, I'm seeing my regular OB in the morning tomorrow (if she hasn't gone into labor herself) and will hopefully have a lighter, shorter update to post after that!

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The First Few Weeks

I want to start out by apologizing for what will be a likely very lengthy and boring post (for those without a strong medical background or understanding of type 1 diabetes). But I wanted to post this for family who will likely have lots of questions and concerns about how Charlie and I are managing not only the pregnancy but my diabetes. So please feel free to ignore this post if you don't fit into one of the categories above (or just peek at the photos at the bottom :).

I was told at a pretty young age that if I was ever to get pregnant that I would be considered high risk. This isn't news to me. I have been working as a labor and delivery nurse for the last 5 years so I have seen both ends of the spectrum but walking into this pregnancy I knew there would be changes and challenges but I thought that I was over all pretty healthy so I wasn't too worried. But sitting here today I can honestly say that I was very unprepared for how big these changes would be and how quickly they would happen.

Prior to pregnancy I had talked with my obstetrician about things to look out for, precautions to take, plans for when I was pregnant, so I had been doing all the "good patient" things like taking daily vitamins and folic acid just incase. I had also had an appointment with my endocrinologist shortly after I was married at which point he very bluntly told me that he didn't trust my current birth control methods (smart man) and took me off all of my medications that were considered unsafe in pregnancy.

Jump forward a few months and Charlie and I are preparing for our first mission trip as a married couple to Port-au-Prince, Haiti. In my frantic and last minute planning I realized that I probably should pack some  "personal hygiene products" (as my mom would say) just incase. As I was going though the cabinet I found a pregnancy test that I had gotten a few months earlier and figured I'd just take it to make myself feel better before leaving. Much to my surprise two lines showed up before I could even set it down on the counter! Talk about feeling unprepared, I didn't even have time to process this news before our flight left the next day, not to mention prepare for the things I might need while I was over there! I stocked up on vitamins, folic acid, test strips and extra synthroid medication just like I'd been told by my docs. Long story short after a very long and somewhat trying week working with orphans in one of the worst slums in the world we returned to the states. By this time I had told Charlie I was pregnant and had been feeling pretty sick for a few days, I was seriously dehydrated, exhausted and all around overwhelmed. At the pleading of the nurse we talked to in Haiti (after my feet swelled up to the size of grapefruits because of dehydration) the first thing we did when we got back was to call my OB.

Not surprising after giving them my symptoms (which had at this point included sever right lower quadrant pain and insane blood sugars) they wanted to see me right away that day for an ultrasound and exam. Charlie came home in the middle of the day to come to the appointment with me, as we both very quietly and nervously walked in to the US room we were blessed to see immediately on the screen a little tiny blob situated on the left side of my abdomen (the baby wasn't implanted in my right fallopian tube as I had been panicked for days that it was) and as she focused more clearly we saw a heart beat of 122 beats per minute. We were ecstatic, at not even 6 weeks pregnant (and only 4 weeks post conception) there was a chance we wouldn't have seen any of that! But there he was! (just an FYI we have been referring to him as a boy for unexplained reasons ever since the first time we saw him, we might be in for a rude awakening 8 weeks from now but thats okay!)

Our first view of the little guy at 5 weeks and 6 days. 

(I hijacked this photo from the computer at work, if I'm suddenly unemployed this is why)

After the ultrasound we saw my doctor together which was very reassuring for both of us. We got prenatal vitamins, a prescription for an obscene amount of folic acid, blood work drawn, and an outlined plan for what the next few weeks would bring, this is where the shocks began! I was told to get in to see my endocrinologist ASAP,  I was scheduled for check-ups, appointments, and ultrasounds every two weeks until at least week 14.

By the time we made it to my second appointment, at week 8, I had been sicker than I have ever been with a fever for 9 days, a cough that made it difficult to breath, one panicked trip to the ER, an emergency visit to a dentist. I was diagnosed that week with bronchitis, treated for influenza, and after I just started to get rid of the fever, a sinus infection. I had also been told by my Endo that they could not see me for two months even after I called them crying because my blood sugars with the illness had been so out of control that I had passed out while sitting up attempting to hold a conversation twice within the last week and then had other numbers running in the 3 to 4 hundreds with all the stress.

Our second photo of him at 8 weeks. 

At the second appointment I brought my blood sugar log (amazing right!) that showed the last 3 weeks of my blood sugars listed hourly throughout the day and night! It was at this appointment that I was referred by my OB to see a High Risk Perinatologist, Dietitian, and diabetes educator. And let me tell you these people don't mess around! By early this week, now at week 10, I had had my 3rd ultrasound (baby is looking great, Charlie says he has his families health and resilience, and I am praying he's right!) I spent 4 hours at the perinatology clinic and I wasn't sitting out in the chairs I was going from one doctor to another.

I found out a lot of good stuff that afternoon, albeit overwhelming but good. The high risk docs want me in their office for growth studies (ultrasounds) every two weeks in addition to meeting with my OB. They talked to me about plans for later in pregnancy, my increased risk of developing pre-eclampsia, and the babies risk of having heart problems. They scheduled me for some sort of special ultrasound to check more closely the babies anatomy next week, and walk me through all the other type of diagnostic testing they wanted to do. I refused most of it to be honest, I told them they could take as much of my blood and as many ultrasounds as they wanted but I was not doing anything that involved taking anything from the baby (cord blood, amniotic fluid, part of the placenta??? are they crazy?) So although I refused a lot of the tests they wanted they are still having me meet with a pediatric cardiologist after they do an echocardiogram on the baby at week 20 due to high risk of heart problems.  They also talked to me about delivering and whether it would be best to do it at my hospital, or their high risk unit. They told me that if all goes well that is a discussion I could have with my primary OB later on but if I for any reason need to be hospitalized for any complications before 34 weeks they want me at their hospital incase emergency delivery is necessary they have a Level 1 NICU (which my hospital doesn't).

Week 10, with a strong heart beat!

After all that, I went on to meet with the diabetes educator, who was amazing. She was able to print out literally a minute-by-minute account of my last 4 weeks through my pump, it was incredible (and kind of creepy!). She worked with me for 2 hours changing everything from basal and bolus rates, correction factors, carb counts, everything! She also explained to me that these changes were temporary. At the place I am in right now with the pregnancy my insulin requirements are dropping severely (hence all the crazy lows), but that will all change in about 5-6 weeks when they will start to climb as the placenta makes my bodies ability to utilize insulin go way down. By the middle of the second trimester my insulin needs will double, by the third trimester they will triple and within minutes of delivery I will literally be able to turn my pump off for a few days as my body adjusts to single life again (with the added burden of providing massive amounts of calories to my little one through breastfeeding). Oh the CRAZINESS!!! She also wants me to get a new pump, so that it will function well with the continuous glucose sensor she wants me to have for the remainder of the pregnancy! (I though checking my blood sugar every 1-2 hours was a lot, she's talking about every 5 minutes, 24 hours a day!) I smell an insurance battle brewing to say the least! Despite all of these changes I left the office feeling really good about suggestions made (and so far my blood sugars have significantly improved over just the last 5 days). Due to all the changes however, I need to go back to see her weekly until things get under good control with the sensor. I feel like I am going to need a personal secretary just to schedule and remind me of all my appointments!

 Week 10 again. He's waving Hi!

(The sonographer told me like three times that he was cute, I agree with her!)

I'm assured though that this is just until things get settled, for most of the second trimester I can go back to seeing just one doctor every other week (if my doctors can decide which one of them should take that primary role). Then if things stay okay I will be set until the third trimester, when they will want to start twice weekly non-stress tests... I can't even go there right now!

Very long story short, things are changing fast, but as far as I can tell the little one is a fighter and so far doing great! Enjoy the pictures.

-Cait

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