Tuesday, October 25, 2016

Week 34: Trusting Your Gut

I think it's appropriate to call the title of this post "ironic." I'll explain that in a minute.

During my last two pregnancies, I focused on resting my body and eating a little less. This served the purpose of controlling my weight gain and my blood sugar levels. Reduced weight gain reduced both insulin resistance and blood pressure readings. Reduced food intake kept my blood sugar levels more even. Everyone was happy, and babies were born at 8 pounds each. Perfect.

This pregnancy, though, the doctor I saw during the first several months at my rather large OB practice insisted that I needed to be walking for at least 30 minutes every day. "No big deal," I thought, because we live in a small town with a post office, a library, a parish, several friends' homes, and even a grocery store within walking distance. Plus I have boys, we homeschool, and it was a perfect opportunity to squeeze in some P.E. and get those little guys moving.

Over the summer, though, I was walking a lot less because of the heat and the fact that trying to keep four little boys safe on bikes is a bit like herding cats. There were days when it was downright terrifying. So I felt guilty answering, "Yes," when the doctor queried me about the walking. Basically, it was only happening a few times per week. She grew concerned about my weight gain one month when I had jumped up about four pounds in four weeks. I began to think that perhaps she was right, and I should be more intentional about getting that 30-minute walk into my day. For their safety, I'd have to do it without the kids.

The only way to do it was early, so I started waking at 5:30 every morning. This was refreshing for a couple of months. I probably would have said that I enjoyed it for a couple of months. I got to walk at sunrise every morning under the shadow of a mountain that I have come to love dearly. Waking up the birds as I walked past the tree where they were sleeping and praying the rosary first thing in the morning became a lovely and delightful routine. So really, I did enjoy it for a couple of months. It had some positive effect on my blood sugars. I certainly noticed that they went haywire if I skipped a few days of walking... I began to trust that this was good, and it would work to keep my weight gain down and my baby's weight gain down. So far, so good.

But then September came and it got kind of cold some mornings. Mornings were darker and it was pretty clear that cars didn't always see me until they were a little too close for comfort. One four-day period it rained every single morning and I told my husband that I could do cold, I could dark, or I could do wet, but I simply couldn't get up and walk when it was all three outside.

I was also exhausted. I pulled myself out of bed by sheer willpower to walk three miles every morning. I was actually finding myself falling asleep during the day. Like, while driving. Yikes! I always thought it would be a low blood sugar that would do me in if it came to that... I was crying from fatigue every night before dinner. I was only sleeping for about 6 hours every night. I began to develop something like a stress fracture in my foot. I could barely keep myself from eating all the leftovers off my kids' dinner plates because I was so hungry all the time, yet I knew that I had to put the brakes on for every single meal because otherwise my blood sugars would get too high.

And still, I pressed on. Doctor's orders, right? It's good for baby. I have to. Plus, it was corroborated by all popular wisdom, the recommendations of countless other doctors, and every magazine article you've ever read. Eat more fruits and vegetables, exercise more, and all your problems will disappear.

But you know what the worst part about this plan was? I mean, aside from the falling-asleep-while-driving and crying every day part? I've gained more weight during this pregnancy and my A1Cs have been slightly higher all pregnancy than during the last two. Walking 30 minutes per day was prescribed to help lower my blood sugars and to keep my weight gain down, and it has done neither. In the last six weeks, I have gained 10 pounds. I haven't experienced pregnancy weight gain like that since my first pregnancy when I was eating like a horse! My latest A1C really was pretty good (5.9), but still somewhat higher than in other pregnancies. My last two pregnancies, which were completely devoid of exercise and full of rest, had lower A1Cs throughout and much more moderate weight gain. My total weight gain up to 35 weeks this pregnancy is now 40 pounds. Last pregnancy, I gained less than that the whole nine months.

At my last doctor's appointment, when I saw the number on the scale clock in at a full 5 pounds higher than my visit a mere two weeks before, I resolved to utterly abandon the walking plan. I slept nine hours the first night, eight hours the second, and no less than seven hours ever since. I took two (yes, two) naps on Sunday and still went to bed at 9:00. And I feel great. I decided not to worry about weight gain at all this pregnancy and just call it water under the bridge, since what has happened since the beginning is someone else's fault and no one has a crystal ball to tell me what will happen in the last few weeks. My blood sugars, which I was especially worried about, have been totally great since I stopped walking. (That part I can't explain, except perhaps to thank the patron saint of our in utero baby, to whom I have been praying unceasingly about this anxiety).

So I have returned to trusting my "gut." That is to say, trusting my instincts about how to get through a diabetic pregnancy safe and sound, given all the circumstances of my life. At the beginning of pregnancy, I planned to follow the pattern of the last two, eating moderately and resting a great deal, because those two ended really well. But then my doctor's insistence that I exercise got in the way. I wish all along that I had ignored her counsel and trusted what I know has worked before!

And as I mentioned at the beginning, the ironic part about "trusting my gut" is that I find I actually have to say 'no' to my gut an awful lot. I don't eat everything I want to, and I pretty much want to eat everything all the time. At least now I don't feel like I have to get out of the house and run away from it by walking three miles a day. I just pour myself a glass of sparkling water and take a nap!

Sunday, October 16, 2016

Week 33: "You're A Worrier, Aren't You?"

The clouds do part occasionally, even though I have been super grumpy about my last visit to the perinatologist, and I think it's worth mentioning that my obstetrician - that is, the one who will actually deliver this baby, the one who will be attending me in my hour of need, the one who will be helping me through really intense moments of self-doubt, the one who will sew me up if I tear, the one who is far more responsible for helping me to have a healthy baby than the perinatologist who sits comfortably in his office behind a computer making dire predictions about life and death - is far less concerned about this than I am.

"You're a worrier, aren't you?"

That was the obstetrician's question to me at my last visit. Half statement, half question, but he definitely nailed it. Yeah, I guess I am feeling a little jumpy about having my ability to give birth to a healthy baby called into question for the umpteenth time in five pregnancies. I guess the anxiety every time I see my blood sugar climbing up those sensor dots is palpable in the exam room. I suppose that when I talk as fast as I do during my visits, it's pretty plain to see that I think and stress about these things so often that I can't even put it all into words that will fit into a 15-minute office visit.

He told me I was a little big, but also said, "maybe you just grow your babies that way." He said it sounds like I'm doing everything I can. He was utterly un-phased by the ultrasound news. He said we could do the testing in his office, rather than sending me over to the perinatologist, except for the growth ultrasounds every few weeks. Thankfully at this point, I should only have two more growth ultrasound visits to that office to endure.

Why is it that I'm not able to absorb my OB's confidence? Why is it that the perinatologist's disapproval about the size of the baby and my fears about what the endocrinologist would say about the low blood sugars are totally winning right now?

Anyway, I thought it worth mentioning that the OB is really not worried, and he's the one I really need to impress. Not everything is going badly as a result of one (possibly inaccurate) ultrasound reading. But of course, if I'm honest, I'm still kinda grouchy and anxious, and it's not even about whether or not the baby will be healthy. I'm utterly convinced about the fact that I am capable and that this baby will emerge strong and healthy one way or another. Oh, isn't that the irony? How terribly miserable to be the slave of someone else's opinion of you when you know that opinion to be false!

From the desire of being approved, deliver me, Jesus.

Wednesday, October 12, 2016

A Picture of My Kids

A while back I got freaked out because it seemed like some traffic from porn sites was being forwarded to my blog. I guess when you're talking about vaginas and all the other stuff that goes into making a baby, you're bound to get a few weird hits. So I had a couple pictures where my boobs might have been partly showing because nursing, and those had to go for sure. But I ended up deleting every single photo on the site, save the one on my "About Me" page, and I've been hesitant to post any others. I don't know, some days it feels like there are people who are just so gross that even the most mundane things get them started on dirty jokes or worse.

But I think I've decided that I just can't resist showing you a picture of those four sons I have. You know the healthy ones that I keep talking about? Well, none of them are babies anymore, even though I can still remember their births like it was yesterday.

 In order: The Scholar is age 2, The Pious One is age 7, Braveheart is age 5, and the Statesman is age 4

Here they all are, eating ice cream, for the first time that day. (I'm the one that has diabetes, not them, okay? I ate no ice cream that day, unless my blood sugar was low at 1:00 am. And yes, I do check their blood sugar with some regularity just to make sure. I will also happily check your child's blood sugar if you're worried about diapers that seem wetter than normal lately!).

Aren't they cute? People ask me all the time when we're out in public, "Are they all yours?" Sometimes I can't believe they all are!

Sunday, October 9, 2016

Week 32: From the Desire of Being Esteemed, Deliver Me

These last few weeks have been so extremely normal, and it has been good. There were a few days when I could not get out walking in the morning, and since my insulin regimen depends quite heavily on about an hours' worth of walking between 5:30 and 7:30 in the morning, it really threw me off for a couple days. "But," I thought to myself, "as with most diabetes-related things, this probably feels worse than it actually is." I jumped back into the walking, then went to visit the maternal-fetal specialist late in the week, and got some really bad news.

Baby has jumped up in growth percentile, from just under 50th to 80th. In addition, they insist that his chest measurement - the one they use to distinguish a big baby from a baby that's big due to diabetes (macrosomic) - is excessively high (97th percentile).

My A1C was, as of Thursday, 5.9%. This is somewhere around where my A1Cs have been during all my pregnancies. I have always started out pregnancy with a somewhat high A1C. My first pregnancy was over 8.0%, and this one was 7.1%. My all-time lowest pregnancy A1C was 5.2%. This fabulously low A1C occurred during my third pregnancy, and if I'm honest, I will say that was one heck of an uncomfortable second trimester. Most of them have been under 6.0% I think, but probably a few in the low 6.0%s too. I don't remember every single one; I guess because it never seemed to matter so much before.

So the A1C is at the high range of normal, but not that much higher than what I've had before. The news of a big baby was a huge blow. But wait a minute, what's the problem with a big baby? I've actually delivered mostly kind of big babies, and mostly kind of fast when it gets to the pushing-out part. All of them were over 8 pounds, and one was 9 and a half. No one has gotten stuck. Three of them had slightly low blood sugar after birth but recovered just fine. So what's the problem again?

The problem is that suddenly the perinatologist seems to be calling into question my ability to take care of myself and make good choices for my baby, and that makes me more angry than I can even put into words. Two weeks ago with the perinatologist, it was, "I trust you. I wouldn't trust everyone, but I trust you." That was when the baby appeared to be in the 50th percentile. But did you catch the sub-text there? "I wouldn't trust everyone [with their own health, or the health of their baby]. But I trust you [right now, or at least this week]."

Then this week, the perinatologist and I had a discussion about how frequently I will be going to see them for monitoring now that I'm approaching the end of my pregnancy. I insisted that I will not come in more frequently than once a week - in other words, on the same schedule that I'm coming to see the obstetrician who will deliver, and on the same schedule that I came in for all my other pregnancies - because I simply do not find any benefit to these anxiety-producing tests which have never told me anything of value about any of my babies. It's too far to drive, too much sedentary time in the car, too much money to pay a babysitter, too much money to pay out of pocket after insurance gives their due, and most importantly, could still leave me with a dead baby at the end of it all. In fact, none of my babies were about to die and were saved, none of my babies were very sick and needed to be induced immediately, none of my babies were too big to be delivered full-term without a c-section. Nothing of importance has been detected by these tests at any time, in any pregnancy, except that my babies and I are pretty healthy. But now that I have a baby that has now appeared to increase in size significantly, the comment from the perinatologist was, "Well, I'm just trying to make sure you have a healthy baby." Did you catch the change in the sub-text? "Well, I'm just trying to make sure you have a healthy baby [and I'm not sure whether you can or whether you care to]."

This is infuriating for several reasons. First of all, because I ALREADY HAVE, AND I GUARANTEE YOU THAT I CARE MORE ABOUT THE BABY'S HEALTH THAN YOU DO. I HAVE HAD MANY HEALTHY BABIES, AND DON'T YOU KNOW THAT NO ONE CARES ABOUT A BABY'S HEALTH MORE THAN A MOTHER. Okay, off caps. Second of all, because none of these tests have ever told me anything of value about any of my babies, and believe me, I've been through a lot of them. Third of all, are we allowed to consider that your measurements are wrong if they have suddenly changed in the course of a month even though I haven't been doing anything different with my blood sugars? I know for a fact that ultrasounds technicians don't always do their job correctly. One time they told me that my baby was in the third percentile and he was actually in the 35th. And fourth of all, is it possible that when you see the "diabetic" label on my chart, you might actually be looking for evidence - perhaps even to the point of drumming it up - to confirm what you suspect is true of diabetics? That we are fat people who eat too much, don't exercise, can't take care of ourselves and therefore have babies that are too big?

Grr...er, I mean, I have a list of several things that I am telling myself to keep calm.

"You have delivered a big baby before."
"You are doing everything that your doctors have recommended for your blood sugars (walking per the OB, using the CGM per my desire to have more blood sugar information to help me make decisions, not letting them get so low as they did in other pregnancies per the endocrinologist)."
"You are doing your best to eat with precision, not overeat, and eat the right kind of foods."
"Ultrasounds and doctors can be wrong about the size of a baby."
"Your A1C is still technically within the normal range of 4.0%-6.0%, even though it's at the top of that range."
"Some babies are just big."
"This baby's father was a whopping 9 pound 13 ounces at birth."
"Extra monitoring at the end of pregnancy has never been correlated with a reduction in stillbirth for diabetic mothers. Babies can die 24 hours after passing these tests with flying colors."
"Your sensor goes for days at a time without topping 130 mg/dL."

But I tell you what, I can say these things to the perinatologist pleasantly, firmly, confidently, with a smile, and repeatedly until I'm blue in the face and I still don't get the sense that it matters one iota to them. It does not change his mind about what he thinks are the most important facts: that I am a diabetic, need extra testing, probably can't be trusted to have a healthy baby, and that was just confirmed by (what might be an inaccurate) ultrasound reading (though it's totally offensive to ask such an impolite question with the technician in the room, because her feelings and sense of competence must be respected at all times!).

From the desire of being esteemed, deliver me, Jesus. I do not need a perinatologist's respect to deliver a health baby.

From the desire of being praised, deliver me, Jesus. I do not need the perinatologist to tell me that I am doing a good job to grow a healthy baby.

From the fear of being suspected, deliver me, Jesus. The perinatologist can suspect whatever he likes, but the data about baby's size and whether it will be a problem for me to delivery vaginally is far from definitive and clear.

From the fear of being wronged, deliver me, Jesus. The perinatologist may slander me all he wants in his mind and soul, but this baby is still mine and I am perfectly capable of making him healthy and strong and giving birth to him in the same manner.

For now, just in case, I'm doubling down on letting those blood sugars dip low. I'll spend long periods of time low overnight. I'll spend long periods of time low while I try to bring it up very slowly and incrementally. Whenever I suspect that I might be able to go through a 3.0-5.0 unit blood sugar spike, I'll give a bolus, even though it may mean I'm chugging juice an hour or so later. Whenever I'm at home and think I can afford to spend a little more time with a low blood sugar because I'm near food and I can lie down if I have to and worst-case scenario my kids can call my husband to come home and take care of me [NB: this worst-case scenario never actually happened, I walk the low blood sugar line pretty well and have done it lots]...I do it. This has the unfortunate effect of making me angry at endocrinologists who insist that my low blood sugars are too dangerous. What am I supposed to do if the endocrinologist thinks it's too low but the perinatologist thinks the baby is too big? There is not a lot of wiggle room in here, folks. Not a lot of wiggle room. It's like the ideal A1C is somewhere between 5.5 and 5.7. NOT A LOT OF WIGGLE ROOM.

So I'm not in a very good mood this week. I feel fat every time I look in the mirror, even though I haven't gained an unusual amount of weight (31 pounds over my starting point). I feel grouchy at all doctors who have ever given me advice about anything diabetes-related. I know somewhere in the back of my mind that this will probably not matter in the slightest about two months from now, but...I'm grouchy, that's all. Thanks for listening, I think?