Friday, December 16, 2011

Week 9, again: Adventures in Pregnancy Dating

On Friday, November 11, I went to see the doctor again. It was a frustrating visit, for a few reasons. I felt horrible, first of all. Late morning is always the worst. I was also anxious because my mother-in-law said she dreamed we were having twins (!). I had no reason to believe I was pregnant with twins, since they don't run in our families, I'm still pretty young, and we didn't use any infertility treatments, but I was freaked out at the possibility of having to buy a new car on a (putting it mildly) modest graduate student income.

Then, I asked if they would do an abdominal ultrasound rather than an internal one. My doctor in St. Louis always did abdominals from 8 weeks on because, he told me, usually women complained that they were uncomfortable. Here, however, my request was neither considered nor heeded. The nurse said, "I don't think the doctor will do that...," and as far as I know, she never even mentioned it to her boss, because the doctor didn't address it when she came in the room. So much for patient advocacy. I let it slide, figuring it wasn't something I cared enough about to make a big stink about. The kicker was when she shoved the probe even further up to look at my ovaries, though, which she had no reason to do. And that part hurt the most! When I winced, she did not even look at me again while she moved the probe out of the way to (ostensibly) make it more bearable. Desired effect not achieved. It still hurt. When I asked her why she looked at the ovaries, she told me that she was looking for masses, and "for practice."

HOLD IT. First of all, you knew or should have known that a transvaginal ultrasound is uncomfortable. If you didn't, it's because you're not listening to your patients. I did, in fact, try to tell you that I don't like them, but apparently the nurse that works for you is too afraid of you to even pass on the message. Second, there was no indication whatsoever that my ovaries were causing me or anyone else problems. And finally, if I was content to be subjected to additional discomfort during my pregnancy for the sake of your education, I would have told you (or you could have paid me).

The last frustrating thing about the visit is that, instead of 10 weeks tomorrow, I am 9 weeks today (and no, I'm not going to try to blame that one on the doctor :). It just means I am about to do the worst week of pregnancy over again. Boo. That means my due date is June 15, about two weeks after my first son turns 3. In the end, I know that its more of a psychological wound than anything else, but it stings. Especially because I almost vomited at the zoo yesterday.

The doctor (who will no longer be my doctor as of my next prenatal visit) gave me a prescription for Zofran, but when I asked her about whether it seemed to make her patients feel better, she answered me with a statistic about rates of hyperemesis gravidarum being reduced after Zofran was made available to pregnant women. Totally not the answer to my question. I am not in any danger of inadequate food or liquid intake. I have not had ANY symptoms of dehydration. I just don't feel good. I haven't gained any weight, but I haven't lost any, either. I have really not shown any danger of becoming a statistical victim of hyperemesis, so why quote me statistics about how much Zofran helps said victims? I re-phrased the question slightly and asked again and she said, "Well, I have had some patients for whom it just never worked..." So, what it sounds like is that the only people you've ever heard back from told you that it didn't help. Do you even ask your patients whether the Zofran helped the next time you see them in the office? I picked up the prescription, but kicked myself for doing so after I looked at the cost. Only $20 to me, but another $80 to my insurance company. Not to mention - isn't it probably a good idea to avoid unnecessary medication, even when it's been proven "safe"? Because it seems like 40 years from now someone could come out with a huge meta-analysis saying that approving Zofran in pregnancy was a horrible idea.

Some of you may notice that I am drowning in contradiction here. I hate statistics, then I quote them. I want relief from discomfort, and then I reject pills. I don't even know what I want any more. I just don't want other people assuming they can quantify risks and benefits for me without my input, alright?

The rest of the week passed in mild nausea and fatigue and self-pity.

The upside is that my blood sugars have been fantastic - truly fantastic - for the last several weeks. I'm hanging out between 70 and 110, reliably, with only a few blood sugars here and there outside the range. I'm having some lows in the morning, and a few blood sugars just a tad high (150-200) after dinner. Not too shabby! My bolus ratios are 1:12 for breakfast and dinner, 1:10 for lunch. My basal rates are 0.5 over night, 1.15 from 4:30a to 7:00a, 0.6 during the day.

Just to prove that I'm not making this up.


  1. They did a transvaginal ultrasound on me at 8 weeks, and the nurse told me it would make things easier to see. It wasn't too uncomfortable for me, but it helped that I peed beforehand. They checked my ovaries, too, which turned out to be a good thing because I did have a cyst on my right one. You wouldn't be able to find that during a regular pap smear. It's an easy check that can be done while they're there--two birds, one stone. I was actually quite glad they are still checking on me as well as my bub.

    Cute picture of your peanut! =)

  2. For some reason I found the transvaginal ultrasounds more comfortable than abdominal ultrasounds - they always pressed SO hard on the abdominal ultrasounds! But that's probably not the norm...