Tuesday, April 24, 2007

And I thought AMA was bad!

A few posts ago I talked about how my diagnosis of "Advanced Maternal Age" was a bit degrading. Well.
I finally got the lab bill for the amnio in January and out of curiosity, I looked up the ICD-9 codes. Those are the International Classification of Diseases, commonly used by insurance companies. Mine were:
  1. Elderly multigravida (woman pregnant for at least the third time)
  2. Habitual aborter
  3. Antepartum Diabetes mellitus

Boy, that brings to mind an ugly visual, doesn't it? Like a decrepit old woman huddled in a dark, dirty back alley somewhere.

I am sure I will get flamed by lazy googler's - Habitual aborter is "a rather insensitive term for a woman who has repeated miscarriages."
In that line-up - Diabetes is my FAVORITE diagnosis!

In other news:
My persistent non-productive cough has morphed into a painfully major sore throat. On Friday I was negative for strep, but today it is so much worse, I may get re-tested, just because strep can be so dangerous for baby. I got some narcotic decent prescription cough syrup yesterday after trying to work most of the day. I am now committed to rest and lots of fluids until I get better. Maile has been much less active which alarms me.
I am up at 3:00 am due to this condition. Apparently swallowing becomes so painful as the meds wear off, that it wakes me up.
My sugars are fluctuating wildly - not only due to the illness and meds, I suspect, but because the only appealing foods are carbs - of course. I am so thankful I got the humalog pen last endo visit, at least I can bring them back into line quickly.
My HbA1C came back at 5.6 - a slight increase from my 5.5 the last couple of months.

Sunday, April 22, 2007

Into the 8th Month!

See my ticker above? I have moved into the 2nd to the last month - yes, I am in my 8th month of pregnancy! It still seems I have so far to go, but it really is moving right along, less than 9 weeks -- at least until my due date! Only 5% of babies are born on their due dates, so it should be called a guess date.
Today is the tour of the birth center, then next week childbirth classes begin. I suppose I'd better get the kids' room finished off so that Kimo can move in and be settled before we uproot his life.
Darned cold still hanging on with this very annoying cough. Oh Well.

Thursday, April 19, 2007

Sick Day

Yet another cold - my 2nd in a month. I didn't sleep much last night, so called in sick about 5:30 am, fasting sugar was 86 and went back to bed for 4 hours. Then I got up and my sugar was 87. I am never quite sure how to handle sick days. The hand-out from my doc's office is little to no help, so I try to eat well or some for the baby, take my metformin, because I think consistency with that prescription is key; and wing it for the rest.
For example, I decided with an 87 and no metformin in me, I could do the met and skip the insulin. We will see how that plays out. I managed to get some sprouted wheat toast in me and a banana, but I'm way short on protein. The kitchen is a disaster, so eggs are unlikely and the thought of peanut butter on my toast made me want to hurl. The protein from a diabetes perspective is to slow down the carbs, but my sprouted wheat bread already has 5 grams of protein and 2 grams of fiber for it's measly 15 grams of carbs per slice. The protein is also important for the baby, but nobody gives you numbers on that. This is just really boring rambling.
I admit to be surprised that there wasn't even a single comment on my last post. Here I am baring my soul about fertility and nobody's reading me anyway! Good pinprick to the ego.
I talked to the Lactation consultant and the Thomas W Hale book, Medications and Mothers' Milk - generally the bible for meds and breastfeeding - gives metformin an L1 ranking. Meaning it's about as safe as tylenol! Too bad the PA didn't just tell me that. Funny, it's a $30 book, but neither my ob/gyn, perinatologist nor endocrinologist have a copy for reference. No wonder the US breast-feeding rate is so low.
I don't want to go off on a rant on that topic! I certainly support a mother's choice to feed her baby however she decides, but c'mon - we have these appendages on our chests for a reason - and that reason is not to inflate them to a Double-E cup for the amusement of males of the species.
Back to bed for me, with lots of fluids and maybe a sudafed to see if I can lose awareness of my sinus cavities!

Friday, April 13, 2007

Advanced Maternal Age

I have been thinking about this label a lot lately. It is the first diagnosis on all my perinatologist's reports - ahead of Type 2 Diabetes, Recurrent Pregnancy Loss and Hypo-thyroid - obesity doesn't even make the list although I know it is yet another factor for my high-risk assessment.
I will be 62 when this baby graduates from high school. My Mother died at 62. She died of lung cancer after 40+ years of smoking. I quit after 27 years - was it soon enough?
How can I continue my slapdash approach to my health (mainly weight and exercise)? Am I crazy or just selfish?
Who came up with such a derogatory sounding diagnosis? And why would it start at 35? Most women can conceive well past their 40th birthday and the risks increase at the same gradual pace from age 25 onward.
I saw my OB yesterday and told him I definitely want the tubal ligation while in the hospital for this baby's birth. I think that's what triggered this introspection. It is hard to make that decision to end your fertility, but it makes so much sense for me. As much as I would have theoretically liked a 3rd biologic child, the reality is that I will be 45 in August. I am most likely capable of having one more - but at what cost? I had 3 miscarriages before this pregnancy and 1 before Kimo. Would that mean 9 more miscarriages to have another child? My psyche cannot comprehend that much pain. They (my medical team) have me running between Perinatologist, Ob/Gyn and Endocrinologist NOW - I can't imagine keeping that up for another 3 years either. Hell, if it took 3 years again to conceive a viable pregnancy - I would be 48 at delivery! HELL NO, I won't go!
However, it is still a very final decision. Fertility has been part of me for some 30 years now. Most of that time it was an inconvenience and something to outwit, not celebrate. But it was an integral part of my womanhood. I distinctly remember being told the (only) benefit of menstruation was that I was capable of having babies.
Trying to turn that around in my head, I can see a certain freedom in no longer having to consider pregnancy. No diaphragms, no fertility charts, no trying to weigh the pros/cons of the pill, no buying pregnancy tests at 6 am on the way to work and no more dashed hopes by the negative results. No more dashed hopes by miscarriages. No more excruciatingly painful 1st trimesters (aka weeks) while I wait with breath held to see if I will miscarry or not.

In other news -
I return to my ob in 2 weeks for my first NST (Non Stress Test) - this is a fetal monitor they hook up to watch heartbeat, movement, etc for 10-20 minutes, or even longer depending on what baby is or is not doing. I will then have an NST every week until delivery. I must be getting closer.

Endocrinologist on Monday - I just HATE that I won't have results from the bloodwork until Friday. I really must ask why they are still in the dark ages and sending me info via snail mail. They have the results late Monday, mail out a form letter to me when they get around to it - Tuesday most likely and apparently the only outgoing mail is in the am - so it's not in the mail til Wed. My home is 60 miles away, so at least 2 days for delivery - voila! Friday. I don't get the mail until I get home from work, so god forbid if I have a question, it must wait until Monday when I can catch their office open. They only answer the phone from 8:30 - 11:30 and 1:30 -4:00 Mon- Thurs and only half a day on Friday. I would freak if I was expected to accept this type of service from or just about anyone but a medical professional!

Day Off today - I took a vacation day today. Full weeks are exhausting and I have some time saved up. I've actually been taking a day every other week now - if you count Good Friday, or the politically correct version - Spring Break day. We are having a bad snow storm - almost a blizzard according the news. A blizzard in mid-April. This and the piss-poor soil here are the 2 things that may drive me from Colorado. I really must get started on my to-do list!

Wednesday, April 11, 2007

This Month's Ultrasound

Amazing, isn't it? I am stunned by how much Maile resembles Kimo. Head shape, face shape, nose and chin. I have a pic of Kimo at about 1 hour old and it's really uncanny. I realize they are full siblings, but still!
Maile weighs about 3 lbs now, and measures right on for my dates. Everything looks good except perhaps a little excess amniotic fluid. This is a common occurance for diabetics who's sugar is uncontrolled, which really isnt me. My next A1C is Monday and I expect it to remain within a point or two of 5.5, where it's been since conception. The doc didn't ask me to come back early, so I know it's not anything to fret about. Of course I came home and looked it up all over the internet and scared myself ~ but then realized he did say I didn't actually have the diagnosis.
I am mightily uncomfortable. I hate to complain because I am so grateful to be pregnant and this far along.
We are doing childbirth classes the month of May, 4 weeknights, I have arranged childcare and all. We tour the birth center later this month. We have decided against a doula for the time being, subject to reconsideration after lamaze class when we know better what we're facing.
I am excited this is all moving along, but also overwhelmed by the stuff left to do. Homelife is not the greatest. Worklife is not the greatest. I wish the person I was training to fill in for me would bother to take notes or act the least bit interested. Said person has absolutely no background in my job, and seems to think he can just call me every day. We are moving to a new building May 5th, and that is quite a project also.
The more blogs I read, the more I dislike my own, but perhaps after birth I will decide to get serious or give it up or turn it into Maile's development diary. We shall see.
My sugars have been "ok". I had a bowl of cocoa puffs at 2 am this morning and that was a HUGE mistake. I not only had heartburn for an hour and couldn't get back to sleep; my fasting sugar was 96. Now I don't want to send my sugars in because they will want me to up my dinnertime NPH dose again and that's not really the issue!
OB/Gyn appt tomorrow, Endo appt on Monday, then a break for a couple weeks again. I'm on every 2 weeks for OB, every 4 weeks for perinatologist and ultrasounds, every 6 weeks for endo. Since I only have about 10 weeks left, that's not so bad!

Sunday, April 01, 2007

Diabetes Slump

I'm just in that place where I don't really care, I just want to eat what I want to eat. I already can't drink, have cut my caffiene drastically, get heartburn from nearly everything I do eat (how the hell do you get heartburn from a damned donut?), and am pretty uncomfortable. I have another 12 weeks to go. I don't really want to have a string cheese and an apple for a snack, I want a Payday bar. I don't want peanut butter and honey on sprouted wheat bread for breakfast - I want a sausage, egg, and cheese croissant. How about some jellybeans?
This is awful because I *should* be oh-so-motivated because of the baby. That's why it's taken me 2 weeks just to own up to it enough to write this post.
I'm up to 18 U NPH at dinner and 10 U at breakfast to try and stay in range. My A1C is going to blow this month, I'm sure of it.
I guess the way to get back on board is to start journalling my food and meal/snack planning every day in advance. *sigh*