THE REST OF THE STORY

Sorry it's taken so long to post this! Here's the rest of the story...

It kind of all started on Friday, May 22nd. My obstetrician was very interested in taking the baby out ASAP because my blood pressure was continuing to go up, and we were worried that (among other things) this was putting my eyes at risk of retinal haemorrhages because of my diabetic retinopathy. But on the 22nd, the baby was only at 36 weeks, so there was a risk that the baby’s lungs were not sufficiently developed at this point (apparently it takes a baby of a diabetic mother longer than usual to develop). To check this, I had an amniocentesis (a big long needle stuck in my belly – actually not as bad as it sounds), and then I had to wait at the hospital for the results to find out if she was ready to come out. The test showed that her lungs weren’t quite developed, so the doctor sent me away and we scheduled a c-section for the following Monday (the 25th), with doctor’s orders being bed-rest for the weekend.

Well, you know what they say about the best laid plans…. As it turned out, my body wanted the baby out sooner than my doctor did. At noon on Saturday (May 23rd) I got a bad retinal haemorrhage. It was very scary. I could actually see blood seeping into the vitreous of my eye and clouding my vision. It looked like a spatter of blood everywhere I looked. Definitely one of the scariest things I’ve experienced. I made a few calls – to my nurse friend, to Health Links, to my “retinopathy mentor”, and finally to my obstetrician….at home. He was adamant that he wanted the baby out ASAP, and said he’d make some calls to find a hospital with room and a doctor with time to do a c-section. Within about 20 min. he called me back to tell me to go to the hospital and he’d meet me there (on his day off) as soon as he’d dropped his daughter off at a friend’s house. (This man is my hero….I truly truly love him. He has a heart of gold.)

So we got to the hospital and waited for the last of my food to digest before they were willing to take me in to surgery. (Ask me sometime about the half-a-pickle story…ugh.) By early evening I was in the OR and by 7:30pm (or 7:41pm, depending on who you ask), our daughter was born! The c-section went remarkably well…especially for someone woozy and squeamish like me. My husband actually watched part of it, and saw her get yanked out by her little bum. Oh yeah…for those of you who don’t know, I had to have a c-section because the baby was breech, but also because my ophthalmologist was worried what pushing a baby out would do to my eyes. So a c-section was a clear choice. I got to see my little girl for all of 3 seconds before she was whisked off to be poked and prodded and tested and monitored. Judging by her deep purple colour, I’m pretty sure that was the safest option for her. She was beautiful, though – even with only 3 seconds and bright purple, I knew she was beautiful! Later in recovery I was able to spend about 10 minutes with her, and then they brought her down to the Intermediate Care Nursery (one step up from the Neonatal ICU), which was her home for the next three weeks.

For those of you interested in the “stats”, our little bundle of joy was 8 lbs 9 oz, and almost 22” long. Pretty big for 36 weeks, but I’m told that’s common for babies of diabetic mothers (even with well-controlled diabetes like mine). Her eyes are blue (for now) and her hair is black (for now…so was mine when I was born, and look what happened).

I was in the hospital until the following Wednesday. The recovery from the c-section has gone very well. Before long I was actually feeling pretty good and having very little pain, but I did definitely have to take things slowly for a while. My blood pressure stayed high for a number of days until I got on some new meds for it, but it is finally made it’s way down. (I’m just weaning off of the last of my meds now.) After-the-fact now, we’ve realized that I had pre-eclampsia – pretty scary. It’s actually quite shocking how swollen I was, now that I’m back to a reasonable post-pregnancy weight. In the first 4 weeks after the baby was born, I lost 40lbs – some of which was baby and amniotic fluid, obviously, but a large portion of which was water weight. I lost 20lbs in my 4 days at the hospital, and the next 20lbs at home in the next few weeks. (It takes a lot of peeing to lose that much water weight….trust me!) My eye got a bit worse for a few days (almost certainly related to the still-high blood pressure), but has settled down since. It is still a mess to look through, but the blood is slowly dissipating. My friend who has had a similar experience has told me that it may take a number of months to go away altogether, but that hopefully it will. I had an appointment with my ophthalmologist soon after the c-section and he wanted to wait and see if it goes away on its own, but there is a procedure (vitrectomy) that he can do if it doesn’t. It’s not a very fun one, though, so he didn’t want to do it now with everything else that is going on in my life. It doesn’t sound like there’s a huge risk of permanent damage if we leave it to see if it goes away on its own, so that’s definitely my preference. As of my most recent appointment with him, he is seeing improvement too, and is very comfortable just waiting for it to clear up on its own. Whew!

Also the week following the c-section (while I was still in the hospital), my husband came down with strep throat, so that really complicated things for a while, and also kept him from being able to see the baby, which was very difficult. Thankfully he got onto antibiotics very quickly and was feeling better in a few days, and was able to visit at the hospital again.

Our daughter was in the hospital for just over three weeks. Because she was early, and because she’s an IDM (infant of a diabetic mother), she had a bit of maturing to do before she could come home. Because her lungs weren’t sufficiently developed, she needed to be monitored constantly to ensure she was getting enough oxygen. She didn’t often completely stop breathing, but she did often breathe too shallowly. She had an oxygen tube in her nose for a number of days. She was also jaundiced (also common for an IDM), which made her very sleepy. Between the breathing problems and the sleepiness, she also had a lot of trouble feeding – often she couldn’t stay awake long enough to finish and needed to be tube-fed (a really tiny tube that goes down her throat to her stomach – didn’t seem to bother her at all). When she was awake enough to eat, she sometimes had problems coordinating the “suck-swallow-breathe” process, and unfortunately sometimes forgot the oh-so-important “breathe” step. She needed to have 3 good days before she could come home. The neonatologist kept saying that she was progressing really well and he had no concerns. It was just an exercise in patience.

We went to the hospital for a number of hours every day to visit her. Some days she was really sleepy and we just cuddled her and fed her if she was awake enough. Other times she was quite awake and we could watch her make funny faces and grab at anything that gets near her hands. When we weren’t at the hospital, we were both really trying to relax and get our health back (and my blood pressure down). Our friends and family were so very supportive! We really really appreciate all the support we have received.

On June 15th our little one finally came home from the hospital! It was interesting getting “used to” having a newborn when she was 3 weeks old already, but we were SO GLAD to finally have her home. Since then we have really been enjoying getting to know her better. She definitely has some fussy moments, but she sleeps very well at night and she is usually pretty easy to calm down during the day when she does fuss. It helps that she’s starting to get into a bit of a routine with her naps so I know how to work around them. We really feel more like a normal family with a new baby now, and are starting to put some of the less pleasant aspects of the experience behind us.

So it’s been an interesting ride. Not the one that we’d hoped to have, but we were able to make the most of it and stay positive for the most part. We realized throughout those difficult first weeks that in a short while life would be back to normal (well, new-baby “normal” anyway), and that this would all just be part of the story – which now it is. When it comes right down to it, we really are very lucky.

So I guess that's the end of my story here. If there's one thing I've learned through all of this it's that good control of your diabetes is IMPERATIVE during pregnancy...but that things can go wrong even with good control, and it's important not to beat yourself up about it if they do. (Is that one thing or three things?) A diabetic pregnancy IS riskier than a non-diabetic pregnancy - for mother and baby - but in my mind it's still DEFINITELY worth the risk. When it comes down to it, my bloodpressure is going down now, my eye is going to heal, and my beautiful baby girl is healthy at home. Everything that went wrong is/was temporary. We'll definitely have to have some serious discussions with my doctors (my OB, my endo, and my ophtho) before we decide if we want to have another one, but it's definitely not out of the question. These problems we've dealt with were a small price to pay to end up with our beautiful daughter.

Another thing for those of you considering having a baby to keep in mind when you read about my experience is that I have had diabetes for almost 30 years now...with quite badly controlled diabetes for a large number of those years, and neither the technology (i.e. pumps) nor the medicine (i.e. super fast-acting insulins), nor the knowledge to better control it. I had complications (i.e. retinopathy) going into this pregnancy already. If I didn't, chances are this would have gone much more smoothly. So keep in mind that my experience will not necessarily be your experience....but also that good diabetes control during pregnancy will significantly reduce your risks of having some of the complications I did.

So, I guess this is my last post, unless I feel inspired to write more at some point. Please do feel free to email me anytime, though, particularly if you have any more questions.... pregnantbethany@gmail.com.

Thanks for reading!

WEEK 40 - OH MY OH MY

Sorry for the long delay in posting.

Long story short...our beautiful daughter was born on May 23rd by unscheduled c-section because my bloodpressure problems ended up causing a pretty major retinal bleed (of the proliferative vessels in my left eye) and my doctor wanted her OUT as soon I told him. It's actually looking like I may have developed pre-eclampsia by the end of the pregnancy.

After just over three weeks in the Intermediate Care Nursery at the hospital due to underdeveloped lungs and some problems feeding, our little one is now home with us as of Monday, June 15th. We are thrilled to have her home and are happy not to have to go to the hospital to visit her anymore!

I will post a more comprehensive explanation in the future, but as you can imagine things are a bit crazy here these days. :)

WEEK 36 - NO BABY YET

Well, no baby today. Her lungs aren’t quite ready. The amniocentesis went really well, but we weren’t able to get the results until around 4pm so we waited around the hospital ALL day. I was on a fetal monitor most of the time and it showed that the baby is doing GREAT! Very very healthy and strong! (And getting chubby, per the fetal assessment.) We do have some good fetal assessment pictures, but I have to try to be quick on the computer now because my feet/legs are really swollen and need to be up, so I won’t be able to post them.

All of my bloodtest results re: bloodpressure came back fine, so that was good. My bp is coming down a bit, but not enough to make my doctor happy, so he’s upped my meds again. Interestingly, I was also having Braxton-Hicks contractions ALL day. Wouldn’t that be interesting if I just ended up going into labour over the weekend now….

So the plan now is that I’m on virtual bedrest for the weekend (instructed to only do boring things), taking more bp meds, and then going in for a c-section at 9:15am on Monday morning. No amnio this time – we just take her out. Her lungs were almost ready, so by Monday they should be close enough.

So, by Monday at 10:30am, we should have a daughter!

I'll post again when I can!

WEEK 35 - TOMORROW???

Quick update!

The baby is probably (HOPEFULLY) coming out TOMORROW!

Long story short, my blood pressure is not going down, even with meds. So my obstetrician wants the baby out as soon as it's safe for her to come out. He's worried about the potential impact on my retinopathy. The amniocentesis tomorrow morning will determine if her lungs are developed enough for her to come out.

So I get the amnio at 9:30am, and then I'm supposed to stay at the hospital to wait for the results (3-4 hours). I'm also not supposed to eat anything after breakfast, in case we're good to go for the c-section. While I'm waiting for those results, I'm also supposed to get some bloodwork done regarding the high blood pressure (my understanding is that they're checking for pre-eclampsia, even though I don't have all the symptoms). The good news is, my blood pressure should go down within a few days of the baby coming out. So by 12:30 or 1:30 we should know the results of the amnio. My obstetrician is at the hospital all day tomorrow, so when he gets the results, he's going to meet with us. If the results are good, I go to get prepped for surgery and hopefully by 2:30 or 3:30 I'm having a c-section, and hopefully by 3:30 or 4:30 we have a brand new baby! (Of course, nothing goes as quickly as anticipated, so it could be longer.) If the baby's lungs are not sufficiently developed, then, according to my obstetrician, we "wait a few days"....which I'm guessing puts us at Monday or Tuesday. I REALLY hope it's tomorrow, though. I just want to get this over and done with and meet our baby!!!

So, it might be a while until my next post, but I'll update you all as soon as possible - with pictures!

Wish us luck! I know we're in good hands!

WEEK 35 - TO AMNIO OR NOT TO AMNIO

I figured a mid-week update was in order this week, given the current up-in-the-air state of affairs. :)

First of all, my husband and I got lots done this weekend in preparation for the baby - her room is almost completely ready now and all her clothes are washed (some of which may actually be too small when she comes out, the way it's going). So we're starting to feel quite ready.

Today was another fetal assessment. My obstetrician assumed they would do an amniocentesis at this one, but they didn't. They said that there was virtually no way the baby's lungs would be ready already - particuarly because often babies of diabetic mothers do take a little longer to mature - so there was no point in doing an amnio yet. Instead, we have one scheduled for Friday morning, at which point the baby will be 36 weeks. So no baby this week (barring the unforeseen), but perhaps next week.

The doctor at fetal assessment was actually quite happy with the results of the fetal assessment. They baby's still big (almost 8 lbs now), but she's steady at the 90th percentile - not still rising, so that's good. Everything else about her looks great - heart, lungs, liver, kidneys, brain, etc. She's not showing any signs of problems. In fact, her responsiveness to touch (she kicked the ultrasound machine numerous times), and the practice-breathing she's doing are very good signs of both physical and mental developement, so that's good to hear. We even saw her make sucking motions with her mouth! So there's definitely no cause for immediate concern, but we/they definitely want to keep an eye on her.

The resident doctor doing the fetal assessment said that the baby had moved since last week. She's still breech and her head is still in the same place, but instead of having her back along my right side, her back is now along my ribs and left side. How she has room to move around in there, I have no idea! That said, she also mentioned that I have a LOT of amniotic fluid in there, which is part of why I have gotten so big and uncomfortable, and also part of why I'm having so much swelling in my legs/feet - I guess my heavy belly puts a lot of pressure on the veins in my hips and doesn't let things flow around between my legs and my body the way they're supposed to, so it all gets stopped up in my legs. Fun fun.

It's interesting with all these doctors' appointments how often I'm hearing phrases that start with "babies of diabetic mothers often..." or "babies of diabetic mothers usually...." It's starting to get a bit old, honestly. I keep feeling like I need to say, "But I'm a WELL-CONTROLLED diabetic mother!" I keep feeling lumped in with all the poorly controlled diabetic moms they see - and if good control really does make a difference during pregnancy, I shouldn't have to feel like that! It was especially frustrating today because I actually had high bloodsugar when I went in there. It was just "one of those things". I guess I underestimated my carbs at lunch, or haven't been active enough today, or the stress of the appointment got to me....but before I went in, I was 14.0. I took a correction bolus, so at a break in the appointment I quickly checked it to make sure it was coming down, but not too fast. It was still 14.0 for some unknown reason. Of course the resident doctor wanted to know what my bloodsugar was and why it was that high, and of course "I don't know - it's just one of those things. I'm almost never this high! (I'm really not!)" just doesn't cut it. Instead, I get a note in my file. Super. :P Then, of course, when I say "but I'm well-controlled, so these 'diabetic mother' comments shouldn't all apply to me" I feel like I have no way to back that up. I'll tell them what my A1C is, and they ask, "Ok, but what's your bloodsugar like right now?" or "Ok, but what is your bloodsugar usually?" Huh? Really? Define "usually". Do we mean an hour after I ate, or when I first wake up in the morning?? I truly don't feel like they get it. So when I get the "most diabetic mothers" spiel, I just smile and nod, and make a mental note to discuss this with the people who actually understand me and my diabetes control - i.e. my endocrinologist, my CDE (Michelle), my doula (who has been Type 1 for as long as me), etc. Anyway - it's just another hurdle, I suppose. Ok, rant over :)

So, for now we're still in this "wait-and-see" mode. I'll post an update after Friday's amnio.

Here are two pictures from today's F.A. They're both a nose & lips shot. Look at those lips!

WEEK 34 - A WHOLE LOT OF APPOINTMENTS....AND SOME CHANGING PLANS

Ok blog-readers, this could be a long one. I had lots of appointments this week, and some fairly significant potential changes have resulted....

Monday:

Monday was another fetal assessment. Unfortunately my husband was unable to come to this one due to some stuff at work, but my parents happened to be in Winnipeg that day and they were able to join me instead, which was very special for me and for them! We got to see the baby open and close her eyes again, and this time we even got to see a little bit of hair on her head! So cute! She rated very well on everything except her size. As you may recall, 6 weeks ago she was at the 40th percentile, 4 weeks ago she was 60th, 2 weeks ago she was still 60th, but this week she had jumped to 90th! She's 7 lbs already and suddenly growing very fast! This is quite common in babies of diabetic mothers with poor control of their bloodsugars, but since my control is really very good, this was a bit surprising. So we left it as a bit of a wait-and-see...see what my OB says, and see how much more she's grown by next week. (More on that later.) It's good to know, though, that she is otherwise VERY healthy and looking great!

Monday night our doula came over for a meeting and also brought her back-up doula. (Since our doula has 3 small children, she may not be able to be at the hospital for the whole time I need her, in which case she will call on her back-up.) We talked about the change in plans (i.e. to a c-section), and how she will be involved under the new circumstances.

Tuesday:

Tuesday's first appointment was my counsellor from the Youville Diabetes Centre. She gave me a recording of her reading a relaxation exercise (hypnotherapy) to help me relax for my c-section. (As some of you know, I'm a bit nervous about the idea of surgery.) I've listened to it a number of times already and it's really great! I just need to get it embedded in my brain before the c-section so that I can get into that relaxed state without the recording by then.

Tuesday's second appointment was the pre-op appointment at the hospital. It involved some physical checks and a lot of questions, but also gave us a LOT of information about the day of the c-section and the recovery days to follow. It actually made both of us feel a LOT better about the whole thing. I am now much more at ease about the thought of being cut open :)

Wednesday:

Wednesday was my appointment with my endocrinologist. She noted that my blood pressure is still too high. We talked about the frustrations of having my retinopathy resurface and the too-quickly-growing baby, and she encouraged me that I really am doing the best that I can, and that sometimes these things just happen anyway. It was good to hear her say that, because it's easy to feel that these complications are a result of something I'm doing wrong...and that's not the case. It's just the way the cookie's crumbling, unfortunately. (The downside is that it means there's not really anything I can do to change it....) We also talked about bloodsugar management during the pre-op fast and during the surgery itself, and about how my bloodsugar is going change significantly once the baby and the placenta are out. She doesn't want me to stay on my pump during the c-section because of the chance of something happening with it (e.g. occlusion, or it gets pulled out, or something) when nobody will really be in a position to fix it. I can understand that and accept it, even though I cringe at the thought of somebody other than me managing my diabetes. So I'll be on an insulin drip (the hospital's version of a pump) and a glucose drip, and my bloodsugar will be monitored very carefully! I'm hoping to keep the pump attached and just on "suspend" so that as soon as possible afterwards I can get it going again. We'll see how that goes....

Thursday:

Thursday's appointment was a massage. I can't complain about that one. ;) My lower back has been bothering me and the swelling in my feet/legs has been bothering me as well, so this was great! She was able to ease my sore muscles as well as get some of that fluid in my lower extremities moving around. I highly recommend pre-natal massage!! (Especially by Tracie at Ankyo Therapeutic Massage.....there's my plug for her!)

We had intended to go to the hospital's labour & delivery information session Thursday night as well (they hold these once a month), but opted out of that one. We had so many of our questions answered at the pre-op appointment, that we just felt it wasn't necessary and that we'd rather spend the evening at home relaxing.

Friday:

Yesterday was my obstetrician appointment. A couple of things came out of this.

First, my blood pressure is still too high and going up. (After this busy busy week, I'm not surprised!) So he gave me a prescription for baby-safe blood pressure meds. I had hoped to avoid those, but clearly it has become necessary. As an added incentive, I actually had another spot in my eye yesterday, likely indicating another small bleed in my retina. (This is not terribly surprising as the leaky blood vessels take a while after pan-retinal laser treatments to shrivel up.) I'm not overly surprised or concerned at this point, because I'm confident that the laser treatments I had in the last couple of weeks will deal with this in time, but it does make me quite anxious to get my blood pressure down. (As a side note, I think the spot is gone today, which hopefully indicates that the blood cleared up.) I started the pills today, so hopefully they make a difference.

Second, and more significantly, my doctor is tentatively planning on taking the baby out earlier than anticipated. He is concerned about the fast growth at this stage, as this type of growth in babies of diabetic mothers can sometimes lead to sudden unexplained intrauterine death. Not something we want to risk. He didn't seem worried that she was in imminent danger, but we definitely want to weigh the various risks and take her out as soon as doing so is less risky than leaving her in. What this means is that I will likely have an amniocentesis (i.e. a big long needle stuck into my belly to extract a sample of amniotic fluid) at my fetal assessment next Tuesday (the 19th) to determine if Bud's lungs are sufficiently developed. If they are, she comes out. If they aren't, we wait a few days and then she comes out. (I'm not sure if I'd need another amniocentesis first or not.) I will see my obstetrician either on Tuesday after the F.A./amnio or on Thursday and he will make the decision then. So, in theory I could be having my c-section as early as next Wednesday, but it sounds more likely that it would be Friday or later. By next Friday she'll be 36 weeks, at which point taking her out is very safe (as long as her lungs are okay), but she will likely need to stay in the NICU (Neo-Natal Intensive Care Unit) until she's full-term (i.e. 37 weeks), so we may end up coming home without her for a few days (well, nights - our days will be spent in the NICU with her). Obviously that's not what we had wanted, but obviously we want to do what is best (and safest) for her, so we will roll with the punches! It will probably make for some new challenges with bonding and breastfeeding, but at the end of the day we will be able to bring home a healthy baby girl - and THAT's what's important. :) If her lungs are fully developed, she will not be considered "premature", just "pre-term", and we are told that pre-term babies at this stage are just fine in terms of health and development, so it shouldn't have any lasting effects on her. She'll just need a bit more help and observation at the outset.So...that's that. Now we wait and see what happens on Tuesday at the Fetal Assessment and the amniocentesis.

My husband and I have become very aware this week how lucky we are to have all of the fantastic medical support that we do. The appointments are definitely frequent and tiring, but we are so happy with the wonderful team of health professionals we have behind us. This includes our soon-to-be pediatrician, with whom I've already been in contact with, and with whom I'm already VERY impressed! We've often heard "Oh he/she is the best in the city!" about various of our doctors too, which makes us feel EVEN better! The three of us are in very good hands! In spite of these factors that are making a diabetic pregnancy a little complicated, we do feel very very lucky.

Also, after the initial "ohmygoodnesswemighthaveababynextweek" shock from yesterday, my husband and I are VERY excited about the possibility of meeting our little baby sooner than we thought. We can hardly wait!! (And since I'm at the get-her-out-of-me stage, I'm starting to daydream about having my body to myself again...well, mostly.) We whittled down our to-do list to only the must-do-before-she-comes items, and it's really very doable. We're hoping to have most things finished by the end of this weekend, in fact. So it looks like we'll be ready! (And I do use the term "ready" loosely, as I'm not sure if anyone is ever truly ready for this.)

In other news, I have been exhausted this week, but I guess that's not surprising given all those appointments! Also, I haven't been sleeping as well as my belly is just getting so heavy and I've been having a lot of Braxton-Hicks contractions at night which aren't painful but aren't really comfortable either. Plus, now that the baby is so big, anytime she moves around in there I REALLY feel it! (And she still moves around a lot!) On a kind of cute note, she seems to really like her daddy's voice. When he talks to her close-up, she moves around in response to his voice!

Now, a couple of pictures from the fetal assessment, and a few more pictures from the photo shoot with my very talented friend!

33 WEEKS - MORE APPOINTMENTS

So last week Tuesday was my last day of work. I t was pretty weird to leave there, realizing that it would be over a year before I'm back. I was glad that I already had a pretty good idea that my doctor was going to recommend stopping work, because I spent a lot of time the previous week cleaning stuff up and passing my work off to others. I'm still trying to get the hang of this whole "relaxing" thing. Between my numerous appointments (8 this week) and various "baby projects" at home, I have to consciously make an effort to keep things at a reasonable pace and not overdo it. It looks like I may also have to be okay with leaving some of the baby projects until after the baby gets here. Oh well. Keeping relaxed and healthy is the most important thing.

I only had two appointments last week and both were on Thursday. Thursday morning I saw the obstetrician. My blood pressure wasn't as good as last time, but still nothing too scary. (I think my blood pressure now goes up when they check it just because I get nervous about what it will be...) He's still okay with leaving me off meds for now. I see him again this Friday. He gave us a tentative date for the c-section - June 1st (around noon)! He did say it may get pushed to the 2nd, though. He said I should expect to be in the hospital for about 3 days, so that would have me getting home on Thursday the 4th or Friday the 5th, I assume. He also quelled some of my fears about nausea during/after the c-section, saying they have some new drugs that apparently work VERY well to help manage nausea. This was one of my biggest concerns, because I'm a bit phobic about nausea/vomiting. There are a lot of aspects of the c-section that I'm still really not looking forward to, but I've been hearing so many encouraging stories from friends who have had them, so I'm starting to feel a lot better about it. A nd when it comes down to it, even if it's miserable, it's FAST! (The OB said about 35 min!)

The baby is still breech, but obviously this is a moot point - except for the fact that her growing head is really starting to push into my ribs and make it difficult for me to bend over even to put on my socks and shoes! Also, my belly is soooo tight - even the obstetric nurse at the OB's office was commenting on it. I've gained almost 40 lbs now, and very little of that is anywhere other than in my belly (maybe 10 lbs elsewhere, but not more). Given that the baby was 6 lbs at the last fetal assessment, that leaves almost 25 lbs - pretty much all of which is in my belly! Ugh! No wonder my back is sore and my feet are so swollen! I feel like a pin prick to my belly would pop me like a water balloon!

Anyway, the second appointment on Thursday was my second laser treatment for my left eye (i.e. the retinopathy). We didn't get any more of an assessment from the doctor, just the treatment. I got 1400 zaps this time and the ones near the end were VERY painful and left me with a terrible headache for a few hours afterwards. But it was the last set of treatments, so at least it's over now. I see the ophthalmologist again during the last week of May just to assess if there has been any further pregnancy-related damage to my retinas. This will help us in the future if/when we need to assess the risks to my eyes of having another baby. He did say, though, that there is still a lot of "room" to treat my eyes if things did go badly again in the future...but obviously that's not terribly desirable either. We'll just have to take things one step at a time.

My bloodsugars have been a bit of a challenge lately with the stress of my eye treatments, plus making the adjustment to not working anymore. My meal times are different, so I'm finding I get some insulin-stacking between breakfast and supper, plus I'm slightly more active as I putter around the house or take the dog for a walk than I was sitting at my desk at work. Also, my eat-oatmeal-for-breakfast-every-day pact with myself is over. I'm soooooo tired of oatmeal! Ugh! I'm also still having a weird nighttime drop in bloodsugar. I've got my basal rate down to almost nothing at this point, so I'm not even sure where to go with this anymore. It seems like the only thing to really do is to have a bedtime snack every night. That works for me because it seems that I'm always hungry, but it's still a bit of a puzzler. Maybe my endo will have some new ideas for me at this Wednesday's appointment.

On Saturday we hit the big Whyte Ridge Mothers Day Garage Sale. We didn't have anything specific in mind that we wanted, but we came away with some toys and some clothes (all in VERY good condition) for the baby. It was quite a success after walking around for an hour in barely-above-freezing temperatures (there was actually snow on the ground when we woke up)!

I'm attaching a few pictures today that were taken last weekend by a very talented friend of mine! We did a whole "pregnant photo shoot" and I get to see the rest of the pictures tomorrow, so I may add more to next week's blog, but for this week I'm just putting in a few of my favourites. Here they are!

WEEK 32 - BETTER NEWS

My last post was the bad news from this week, so this will be the good news (and I guess some neutral news too).

On Monday we had another Fetal Assessment (right before the ophthalmologist appointment). The baby is still doing great! She's approximately 6 lbs now, which keeps her right around the 60th percentile like last time. She grew about 1.5 lbs in 2 weeks! It seems like a lot (and it is!), but it's normal for this stage of the pregnancy. She's still tracking perfectly on her growth chart and the Fetal Assessment nurse was very happy with everything she saw. She estimated that she'd be approximately 7.5 lbs by 38 weeks (i.e. when she'll be born). The baby is still breech, but that's kind of a moot point now that we know I'm having a c-section anyway. The nurse actually said that, since she's been in this position for weeks now, there's not a great chance that she'll turn. But that's okay. If she's comfortable like that she might as well stay there :) Her head is up under my ribs on my right side (I can very often feel it there), and her bum is on my bladder (which explains my frequent bathroom trips). She's facing my left side and kind of has her legs folded up. The most exciting thing was that we got to see her open and close her eyes! She was sleeping at first and when the nurse started to prod her she woke up and blinked a few times. :) It was really something else to be able to see that! She has the cutest, chubby cheeks...I've attached pictures below.

I'm starting to get a lot more comfortable with the idea of a c-section. It's not what I had hoped for, but there are definitely some advantages and since it's what's best for me and for the baby, I might as well focus on the positives (e.g. it's quick!!) And really, with the previous scenario (i.e. induction) there was always the possibility that we'd go through an uncomfortable induction that wouldn't work and still have to go for a c-section after a lot of stress, whereas now we can plan for one and know exactly what to expect...and we can definitely have MY obstetrician (who I love!) So I'm starting to get a lot less nervous and a lot more excited!! So soon we'll be able to meet our baby! And I know I'll have a lot of help during the longer recovery period. My husband is able to take a couple of weeks off, and his mom will be staying with us for a while, and my mom will be staying with us for a while...so we'll be well taken-care of. :) It'll just be frustrating that I won't be able to lift the baby carrier and/or take the stroller in/out of the car by myself for quite some time. But I'll just have to exercise patience :)

Yesterday we had an appointment with the OB. I explained the retinopathy situation to him and we talked about the c-section a bit. He actually pulled out his schedule, but it's pretty full so he said he'd have to move some things around and get back to me. He wants to do it between 37 and 38 weeks, barring further complications, which puts us in the week of June 1st - 5th. As soon as we have a solid date, I'll let you all know! We all want to keep her in there as long as possible, as long as it's not threatening her health or significantly threatening mine. We also talked about my bloodpressure (which, incidentally, was EXCELLENT when his nurse checked it...I guess my efforts to slow down and reduce stress this week have been working). He initially wanted to put me on meds (baby-safe), but then suggested that it would be better to first try quitting work...and then go on meds if that doesn't work. So...as of this coming Wednesday, I am on mat leave! I had been anticipating that he might tell me to quit work, so I had spent most of this week cleaning up. After Monday/Tuesday next week, everything should be in order, so I'm feeling alright about it. My boss had a slightly panicked look in his eyes when I told him, but he did also know it was a possibility, and really everyone at work (including him) has been very supportive. My doctor says I don't have to sit around with my feet up all day (i.e. I"m not on "bedrest"), and I can still putter about doing the things I want to do before the baby comes, but I am to take it slowly and easily and relax a lot and keep from doing anything stressful or strenuous. I think I can handle that. :)

So that's the update! My husband and I both feel like we're in a much more positive place now than we were on Monday. We've had a chance to process everything and have some good solutions on the go now, so we're optimistic. And if the rest of this pregnancy plays out well (i.e. with my eyes and my bp), maybe the risks of having another child in the future won't seem so significant. Either way, our focus now is definitely on the exciting event that is only a month away!

In other non-medical news, we have been cleaning up around the house to get the baby's room all ready. Also, my mom and I went to the Welcome Wagon Baby Shower on Sunday. The baby's still moving around a lot, but it's more pushing now than kicking. I think she's going to one day just poke a fist out through my belly. The nurse at the OB's office said my belly is really tight (a comment I would have welcomed when WASN'T pregnant), but it sounds like that's normal based on her position so high up - she's really sticking out. I guess that's why I can feel her pushing so much too. It's neat, though, to be able to rub her little head or pat her little bum. :)

Anyway, here some pictures of our chubby-cheeked cherub. :)

SOME DIFFICULT NEWS

Thankfully the difficult news is NOT about the baby....but it is about the pregnancy. This is a difficult post for me to write because my hope in starting this blog was to be able to be encouraging and inspiring to other diabetic women out there who weren't sure they could have a successful (dare I say "normal") pregnancy. I wanted to show you that we CAN do it. I wanted to be an example of a complication-free diabetic pregnancy. Unfortunately, as of this week, I can't be that example.

It concerns me that posting this may discourage some of you from getting pregnant....or even that it may just discourage you in general. I really don't want that to be the message here. This is a set-back, but it's not a failure. I am still pregnant with a very healthy baby girl, and am determined that she will be a success. This doesn't change that.

So at the risk of being less-than encouraging, I do feel that it's important for me to remain true to the intent of this blog, and give you the whole story - not just the easy stuff. So here it is....


A couple of years ago I needed laser treatments in both eyes for proliferative diabetic retinopathy. For those of you who don't know what that is (or who need/want a refresher), here's the quick explanation of proliferative diabetic retinopathy and the laser treatments - if you already know this, feel free to skip ahead:

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Basically, long-term and/or badly controlled diabetes can lead to problems with blood-flow to the retina. (Note that even people with well-controlled diabetes CAN experience retinopathy, although controlling your diabetes carefully does greatly reduce the chances of this happening. Also note that diabetes care methods are MUCH better now than they were in the 70s, 80s, and even 90s, so those of us diabetes-veterans have lived through a time when it was much more difficult to have tight diabetes control, and unfortunately do have a greater risk of complications like this as a result, even if we have much better control now. Anyway...) When the retina doesn't get adequate bloodflow, it doesn't get adequate oxygen. Because the retina needs oxygen, the brain sends signals to the retina to make new blood vessels to help move the oxygen around. This is called "proliferation" (hence "proliferative diabetic retinopathy"). Sounds good, buuuut....the new blood vessels are weak and fragile. They break easily, and when they do blood leaks into the retina and can cause vision damage. (Also note that not all diabetic retinopathy involves proliferation. In the early stages there may be blood vessel leakage, but no proliferation of blood vessels. I'm not going to go into that here, though.)

Retinopathy is not curable, but it is treatable to help slow (and hopefully stop) the process. Treatment involves getting numbing drops and/or gel squirted into your eye(s), having a glass lens pressed up against your eyeball, putting your face in a machine that makes you feel like you should be on A Clockwork Orange, and then getting a couple of thousand (yes, thousand) of laser zaps on your retina (called pan-retinal laser treatments). It's not as painful as it sounds like it could be, but it is painful, and it's VERY stressful. The light is very bright, and with every zap it takes your breath away and makes your other eye want to roll back in your head. It only lasts a few minutes, but it's pretty low down on most people's list of enjoyable ways to spend a few minutes. :P

The point of the treatment is to kill off a portion of the retina. It sounds counter-intuitive, but it basically allows the less-important parts of the retina to be sacrificed to save the more important central part of the eye (i.e. the macula), and hopefully protect your (my) vision by doing so. You end up with a grid-like pattern of scars on your retina (permanent), and typically a bit of damage to your peripheral vision and your night vision, but the end result is (or should be) that your retina then requires less oxygen, so your brain no longer sends signals to make new (fragile/leaky) blood vessels...reducing the risk of bleeding and vision loss. And that's a quick retinopathy lesson. Now back to our regularly scheduled blog.
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So, this past Sunday, I noticed a new "spot" in my vision of my left eye. I got in to see my ophthalmologist on Monday and the news wasn't great. There is bleeding in my retina that my ophthalmologist says is due to more proliferation (i.e. new growth) of the blood vessels. He said the pregnancy (i.e. the growth hormones running rampant in my body) and the slightly elevated blood pressure that I've been having are likely both coming into play here. (I'm not too surprised re: the growth, given that my baby has grown 1.5lbs in the last 2 weeks according to the fetal assessment - a normal level of growth for this stage of pregnancy.) We knew this was a possibility during pregnancy because of the growth hormones, but we had hoped for the best. Everything was going so well before the pregnancy and during the first two trimesters - no sign of proliferation or bleeding since my last laser treatment in September 2007 - but I guess I just didn't quite make it through the third trimester.

So, I had more laser treatments on Monday - 1000 zaps in my left eye. It sucked. A lot. (I didn't get woozy at all, though, which was a BIG problem for me last go-around.) I'm going back next week Thursday for more, but it should just be the two treatments, and he is just doing my left eye. He has a new machine since last time, though, that does multiple shots at once, so 1000 zaps is much faster now than it was before. I guess that's the silver lining on this cloud. It's still pretty miserable, though, and my eye was sore and a bit red/puffy for the next day or so.

So, I suppose the good news is that, since the ophthalmologist feels it's so directly related to the pregnancy, I don't necessarily have to expect that I will continue to have bleeding every few years for the rest of my life. The bad news is that this calls into question how wise it is for us to try for more children in the future as there's nothing to say it won't happen again with another one - maybe even worse next time. The doctor says not to worry about that now - it's not out-of-the-question. We realize that it will depend a lot on how the next 6 weeks go, how the years after this baby go (i.e. when I'm not pregnant anymore) and how my eyes are doing before we would be ready to try for another one. Either way, it will likely be a very difficult decision to make. For now, though, we are focusing on the fact that we have one beautiful baby on the way and are VERY lucky for that. We refuse to let this setback get in the way of our joy and excitement about our little girl!

Another development related to this is that my ophthomologist doesn't want me to push during labour (i.e. to avoid more bleeding of these weak blood vessels in the retina), so I will be asking my OB for a c-section. The baby is still breech, though (and apparently unlikely to turn since she's been in this same position for so long now), so this is likely a moot point anyway.

I'm seeing my OB on Friday and will discuss the bloodpressure issue with him then. We'll have to talk about ways to reduce it....which may or may not involve leaving work early or figuring out some other work option between now and my scheduled mat leave.

So, it was a less-than-good day on Monday, and a frustrating experience - especially so close to the end of the pregnancy. I feel like we ALMOST had a perfectly successful diabetic pregnancy, but didn't quite make it. But this too shall pass. Anyway, just wanted to keep you all updated.

At the end of the week I'll post more about this week and the new fetal assessment pictures (she's got some chubby cheeks!)

Until then, please don't let my experience this week be a discouragement for you. I just really felt the need to share this here.

WEEK 31 - TRIMESTER THREE DISCOMFORTS

This week I have been really reminded that the "easy" trimester (i.e. T2) is over - most notably with respect to my swollen feet/ankles. We had our prenatal classes last weekend. They were a compressed version that was all evening Friday and all day Saturday. Sitting in a chair for that long without much walking around made my feet balloon up, and unfortunately they didn't want to go back down in size after the classes were over. (As an aside, the classes were actually quite good. We took them through the Youville Centre and found them quite interesting and informative.) I worked from home for a day this week to try to keep my feet up and give myself plenty of chances to walk around, but the thing that finally worked was compression socks. They're expensive and really hard to put on, but they work (and thankfully they just look like regular socks)!! My doctors still aren't concerned about the swelling and tell me it's normal, but since it's uncomfortable, I really needed to do something about it.

In addition to the swelling, I've also had heartburn and indigestion. I had never had heartburn before pregnancy, but now that I have experienced it I have new respect for those who deal with it all the time (including my husband and some of his family). I also no longer sleep restfully as I'm up every two hours to pee. And then on top of all of this I feel big and clumsy. I think it's a bit of a cruel joke to make someone drop things all the time when she can't easily pick them up. :P Oh the joys of the third trimester.....just giving me more incentive to want to get her out in 6 weeks :) Wow....6 weeks....so soon!

The baby is still moving around a lot and seems like she's maybe shifted positions, but it's hard to tell. Apparently it's quite normal to have heartburn and indigestion with new baby positions, so I guess that falls right in line with how I've been feeling. It seems like she may be bum-up now, but I think still feet down (based on where I'm feeling movements), so it's hard to say. She definitely seems to mostly be on my right side, and she seems to think she's cramped in there because she very often is pushing outward on my belly, trying to make more room for herself. (Personally, I think she has plenty of room - more than my organs currently have, anyway.) We have another fetal assessment on Monday, so we'll find out exactly how she's positioned, and how much room she has, then.

I just had one doctor's appointment this week - with my endocrinologist. It went fine. We did a bit more problem-solving, but everything is still going well overall. My insulin needs are still going up, which is causing some evening highs and night-time drops still, but we have a few strategies to fix that.

Other than that, there's nothing much new. I've started back into my prenatal yoga and find it more difficult than it was 5 weeks ago when I stopped doing it, but it still really does feel good. I managed to go for some longer walks this week too, which helped my feet feel better and gave me a good dose of fresh air. :)

And, finally, here is a picture of me at 32 weeks.

WEEKS 29 & 30 - APPOINTMENTS...

The frequency of my various appointments is really increasing now. It's a lot to juggle, and it's making me a bit tired, but it's WONDERFUL to know that I have such a good group of health professionals looking out for me and for my baby!

First, the non-appointment-related stuff.

I've been starting to feel more tired again. It could have to do with this stage of pregnancy, but I've also been very busy, so that could explain it too. Also, the baby has been putting more and more pressure on my bladder, so my visits to the bathroom are becoming more and more frequent - including during the night, which probably also helps to explain the tiredness. I'd really LIKE to be sleeping well NOW because a good night's sleep will be nothing but a memory once the baby is actually HERE - but it's getting more and more difficult to sleep soundly at night. Oh well...such is the life of a pregnant woman, I suppose.

The baby is moving more and more all the time. Lately it's been a lot of pushing by her, instead of so much kicking. Often I can feel exactly where her head is, but I haven't managed to pin-point any other body parts. Just her cute little head that's still on top (I'm urging her to put in down, but she's not listening to her Mom...practice for the future, I suppose). She still has been getting the hiccups from time to time, which is a funny feeling.

Last week I had an appointment with my endocrinologist. It went very well. My bloodpressure was high, but it's always high there, even though it isn't nearly as high at my OB appointments. There's actually not much to mention from this appointment. I had a couple of things I wanted to discuss with her (e.g. I'm having some mild lows at night), but also had a couple of suggestions for fixing these things. She agreed with my suggestions and said she had nothing else to recommend. I'll be back to see her again next week (the schedule is every 2 weeks now).

This week I had an appointment with my OB again. My bloodpressure was still a little elevated there, but he's still not worried about that. It was pretty soon after I got there (walked), so I'm not surprised it was a bit elevated. Like I said, it was much lower than the reading last week at the endocrinologist. The baby's fetal heart rate was good. Fundal height (i.e. uterus length) is 32cm. Interesting b/c I'm 30 weeks, so it would normally be closer to 30cm. Which begs the question.....were we right about the due date the first time?? Hmmm.....more on that in the Fetal Assessment section below. My ankles are swelling a bit, but he's okay with it. Baby is still breech from what he can tell. He showed me how to feel her head and it's definitely on top! I asked him what the reasons would be for inducing any earlier than 38 weeks, and he said if (a) the baby is big (re: diabetes), but he said that is very unlikely given my good control (all my hard work is paying off!), or (b) if she's no longer getting adequate nourishment from the placenta. So it sounds like 38 weeks is definitely what we're aiming for.

We also had another fetal assessment this week. The baby is over 4lbs now (we can't remember if she said 4lbs or 4.5lbs). She is at the 60th percentile, size-wise. She was 40th last time, but they said the difference is due to the margin-of-error, and that her growth is perfect and that she's still definitely the right size for her age (i.e. new due date is still considered correct). This is a much more precise measurement than the fundal height measurement at the OB's office (i.e. a tape measure on my belly). They said everything looked great and there were no concerns. It is SO good to hear this! I know I've been taking very good care of my diabetes, but there's still the worry at the back of my mind - Is it enough? So far it's definitely been enough because she's doing GREAT! She is still breech, and has her feet up by her ears (she's doing yoga already!), but still has plenty of time to turn. We only got one picture and it's very hard to distinguish because she was being very difficult and moving around a LOT. I'm attaching it anyway....you folks can see if you can decipher it any better than we can. The resident doctor who was observing could see my belly moving from about 4 feet away. They seemed surprised, but pleased, at how much she was moving - although it made taking some measurements difficult, and made a good face-picture impossible, unfortunately. Maybe next time.

I also had a massage therapy appointment this week. I can't remember if I've mentioned this previously, but I have been getting massage therapy every two weeks and I HIGHLY recommend it during pregnancy. It really helps my back and my hips during pregnancy, and it's very rejuvenating too! I think I'd be curled up into an achy little ball by now if I wasn't doing this! I also recommend prenatal yoga for the same reason...but I do have to admit that I put off doing it for about 5 weeks (tsk tsk)...so do as I say, not as I do! ;) That said, I did really feel that it was helping in a lot of ways while I was still doing it, and I have noticed some discomfort creeping back since I stopped, so I can definitely vouch for the value of it! I did it again last night finally and am going to aim to do it at LEAST twice/week from now on. (I've even asked my hubby to hold me to it!)

Another appointment I had this week was with a counsellor from the Youville Diabetes Centre here in Winnipeg. I've been seeing her from time to time for a while, and realized that I should be making the most of her services during the pregnancy and in preparation for labour! This week she did a "hypnotherapy" exercise with me that I REALLY liked! (To clarify - "hypnotherapy" is not "hypnosis" as you would see on TV or in the casino or something like that. During hypnotherapy you are fully conscious and know what is happening, but you're in a deep state of relaxation that allows you (and the counsellor) to tap into your subconscious as well. It's very interesting and I have had some amazing success with it in the past too! Email me if you want to know more about it!) Anyway, this session brought me to a deep state of relaxation, and then helped me to "imbed" in my mind a number of positive thoughts about the pregnancy, the upcoming labour/delivery, and about being a mother. My counsellor recorded the session, and now I have it on my blackberry so I can listen to it (and do it) anytime I want! It's really great and really relaxing!

As an aside, I just want to put in a plug for the Youville Diabetes Centre! This week they celebrated their 25th Anniversary, as well as the re-opening of their newly renovated offices (which are BEAUTIFUL)! Congrats to them!! I always have such a great experience at Youville and have made use of so many of their services - from their Certified Diabetes Educator (three cheers for Michelle!), to a dietician, to a counsellor. Everyone there is so friendly and so helpful and they are a FANTASTIC support for me! (And don't forget that they count on donations from the public - they're a very worthwhile cause and you'll get a tax receipt!) There's my plug - RAH RAH YOUVILLE! :)

Anyway. Long post this week, but that's all for now. Here's my latest fetal assessment picture - maybe you can decipher it better than I can!

WEEKS 27 & 28 - SOME IMPROVEMENTS!

Overall, the past two weeks have been pretty good.

My energy is starting to wane a little and I'm definitely starting to feel bigger and more awkward. Sleeping is starting to get less comfortable too. I wake up everytime I have to turn over, and I also wake up to pee a lot. My right hip has been bothering me still, but it's managable. I'm still craving fruit like CRAZY - mmmmm....pineapple! mmmmm....apples! - and the newest craving is now bread & butter pickles (which have a lot more sugar in them than I thought!), and now coffee (decaf) too! The baby is kicking LOTS - unfortunately many of her kicks are directed at my bladder - my poor tiny bladder! Last week I'm SURE she had the hiccups. It's the first time I had noticed a feeling like that, but it was sure funny! Apparently that's very common at this stage.

My mother-in-law was in town staying with us for a while, so she and I did a bunch of baby shopping. We are now ALMOST done with the shopping! The crib and the changetable/dresser are set up in the nursery now too, but the computer desk is still in there. (We'll be losing our "office" when the baby comes.) It's a bit crowded right now, but that will change soon enough.

The baby is still VERY active, and is putting a lot of pressure on my bladder. On Thursday I had an appointment with my massage therapist and the baby got so active during my massage that my massage therapist could actually SEE my belly moving! Crazy! Also, this week without thinking, I gave my belly a little smack with my hand - not hard, but I guess hard enough because she JUMPED inside me! I must have really startled her!

Last night, my husband and I went on a date! We're not sure how many more chances we'll have for that, so we thought we'd better make the most of a free weekend! Thankfully he's not opposed to dating a pregnant woman :) We had a very nice dinner at Joey's and both ate waaay too much. It was just impossible to pass up the banana bread pudding! Mmmmm...... Thankfully I've gotten pretty good at managing my insulin around little indulgences like that and had a pretty stable bloodsugar evening - even after a decadent dessert! (Have I mentioned how much I love my pump and CGMS??)

I've had two baby-related appointments in the last two weeks. Last week was the endocrinologist appointment. It went very well! My A1C was even better than last time, and is now the lowest it's ever been! (Yes, I rock!) Also, my endo signed my Disability Tax Credit forms (yay!) so now all that's left is for the CRA to sign off on it too. I really REALLY hope they do, because the refund could buy me a lot of sensors!

I had been having some problems with high bloodsugars in the afternoons and evenings and then low bloodsugars at night, but my endo and I devised a few strategies to deal with them, which I have put into practice since the appointment and which really seem to be working! Another yay! :) I also realized that I have a surefire way to keep almost completely stable morning bloodsugars. One word: oatmeal. Yes, from now until the baby comes, breakfast is oatmeal and only ever oatmeal. It's boring, yes, but it's worth it. Thankfully I like oatmeal, and thankfully even instant oatmeal seems to work (even though it has a higher GI value than the non-instant stuff), and thankfully instant oatmeal comes in a wide variety of flavours. I'm also subbing in Red River Cereal from time to time because it seems to work too. With this sort of breakfast, I can get my 2-hour post-prandials under 7.0 and still not go low before lunch! I really never would have thought that I could do that! Thank you Mr. Quaker! :)

The small bit of bad news at my appointment was that my bloodpressure was a little elevated. We're going to keep an eye on that. Hopefully it was an anomoly. It wasn't way too high, or anything, but definitely something to watch, especially because I am seeing some occassional swelling in my ankles. (None in my hands/face, though, so I have no reason to suspect pre-eclampsia or anything.)

My baby-related appointment THIS week was the OB. Everything was A-OK! I'm still healthy and the baby's still healthy! He checked my bloodpressure too and said it was fine. It was still a tiny bit high, but he wasn't worried about it. All of my latest bloodtest results came back just fine too, which is always a relief!

I'm at the point now where I'll be having OB appointments every other week, endocrinologist appointments every other week (not the same week as the OB), and fetal assessments every other week! Ack! Busy! And at some point at least some of these will be moving to EVERY week! Thank goodness my boss is very understanding and accommodating! I'm very lucky in that respect!

Another piece of good news is that my infusion sites are working again! Yay! I'm still using thigh sites with the Silhouette sets. If I put them in too shallow they can be uncomfortable and bruise, but as long as I get them in at a deep enough angle, they've been good! I haven't pulled any out yet either! I still am putting the CGMS sensors in my abdomen, but it's really been a good break to not have the infusion sites in there too!

And now for something I have learned this week: Accurate Carb Counting Makes A Difference!

I was having a lot of trouble understanding why I kept going high in the evenings. I weigh a lot of my food on a food scale (the kind with the database of foods in it that'll tell you how many carbs a certain weight of food has), but I"ve taken to eyeballing a lot too. It turns out that, even when you're a good eyeballer (or think you are), it's worth checking from time to time. It also turns out that some of those standard carb-values we're taught in Carb Counting 101 aren't always accurate. Just to test it out, I measured absolutely everything carb-y on my scale for one meal. It was 20g of carbs more than I would have counted it!! Ridiculous! These days I'm on a 1:5 ratio at supper, so that would have meant I would have underbolused by 4 units!!! That's a big difference! Some of the biggest mis-counting culprits were fruit! A small apple (emphasis on small) was 20g of carbs! I figured a medium apple would be 15, so a small might be 10! I was also miscounting pineapple, and TOTALLY underestimating the carbs in bread & butter pickles! When I actually counted the carbs right and took the correct bolus for them, my bloodsugar was fantastic in the evening! Who would have guessed?!

So, from my lesson, here are some suggestions I would like to offer to you other carb-counters out there who are looking to refine your carb-counting (and, in turn, your diabetes control). Take 'em or leave 'em, but they're making a big difference for me!:

1. Invest in a good food scale - the kind with the database. Mine was about $40 at Canadian Tire, so they're not TOO terribly expensive. They are FAR more accurate than the measuring-cup method. For example - how do you measure a cup of spaghetti? How do you squeeze those wiggly noodles into a measuring cup, and how tight do you pack them in? How do you measure a cup of Corn Flakes when they're at the bottom of the box and broken up vs. the top of the box and whole? A good food scale makes this SO much easier and SO much more accurate! It's also good for measuring anything that has nutritional information on the package, if it's not in the database (or even if it is). For example, a big container of yogurt tells you how many carbs are in 125g of yogurt. Instead of looking it up in the database, you can just weigh 125g and figure it out that way. The one caveat to all this is that you have to make sure you're only weighing the part of the item that you're eating. This is particularly important to keep in mind for fruit. For example, if you put a whole apple on the scale it will count the weight of the core and include those carbs, even though you're not going to eat the core. To weigh it properly, you really have to cut out the parts you aren't going to eat and just weight the parts that you are. But then, if you have a whole bag of apples all the same size, you really only have to weigh one like that, and then you can assume that the rest will be the same. Anyway, I'm a big supporter of the food scale! Rah rah food scales! :)

2. Don't assume that the "standard" carb values we're given in Carb Counting 101, or even on packages of food, are accurate. Don't get me wrong, these standard values are a GREAT place to start, and are MUCH better than nothing, but if you're looking to fine-tune, they may not cut it. My apple example is a good one, but also a piece of bread. There are so many types of bread out there now, and so many sizes of slices, that you can't really assume they're all going to be a standard 15g of carbs (and most of them aren't!) Even when you're reading the bag for nutritional information, you need to consider if all the slices are the same size. With rye bread, for example, they usually aren't. This is another place where a food scale comes in handy.

3. When you think a food is likely low enough in carbs not to matter, read the label anyway! I thought bread & butter pickles would have negligible amounts of carbs - I mean how much sugar could they REALLY pick up from the brine? Well, it turns out that one slice has 2g of carbs! So if I eat 6 little pickle slices, I've just eaten 12g of carbs! That's significant! The same applies to sauces - e.g. BBQ sauce. There are carbs hidden everywhere!

Anyway, if what you're doing is working for you, feel free to ignore all that, but if any of you are trying to fine-tune and could benefit from the lessons I've learned, then great!

(It's funny how I'm still learning so much even after 27 years with this disease.)

Alright, that's enough rambling for this time. Finally, here's a picture of me at 29 weeks, ready for my date last night :)

WEEKS 25 AND 26 - INFUSION SITE FRUSTRATIONS, ANOTHER FETAL ASSESSMENT, AND THE DISABILITY TAX CREDIT

First with the non-diabetes stuff.... I'm still doing well. I'm starting to get a bit more tired, but I've been waking up more at night lately, so that could be why - perhaps because the baby's kicks are getting stronger now. My ankles started swelling a bit too, but I'm finding ways to reduce that (including elevating my feet a bit at work and sleeping with a pillow between my knees).

I'll start with the bad news and move on to the good news.

Bad news is that I have been having SO MUCH TROUBLE with infusion sites! ARGH! I decided that my abdomen needed a break because it is so holey (between infusion sets and CGMS sensors) that I'm afraid soon I'll take a drink and leak like a sieve! Plus, it's kind of a pain to have to move (or remove) sites when I go for fetal assessments, and even if I don't move them they're totally in the way. I don't want to start moving my sensors around because I don't want to pay $50 just to find out that a new site doesn't give as accurate readings and/or is uncomfortable, so alternate infusion sites it is!

I started with upper buttocks. Problem #1 - VERY easy to pull out when taking down my pants to go to the washroom. Problem #2 - Painful! Problem #3 - Slow slooooowwww absorption. Bah. To be fair, I only tried one type of infusion set in this site, so maybe I should have given some others a try before giving up on my butt, but I'm pregnant and impatient for my bloodsugars to normalize again! I have been using the Sure-T sites, which are a 90 degree steel set. That's right folks - an actual NEEDLE stuck in me all the time. I suppose I shouldn't be surprised that having a "thumb tack" stuck in my butt is uncomfortable - especially considering that my butt moves a lot when I walk, sit, etc. (Don't laugh - yours does it too!) So even taping the site down with loads of adhesive dressing, while taking care of Problem #1, didn't make the butt a successful or desireable alternate site. I'll spare you all the details, but suffice it to say I wasted about 6 sets trying to make it work and experienced pain, yanked-out sites, and unusually high bloodsugar levels. I gave up.

The next alternate site I tried was my thigh. I don't have a ton of excess fat on my thigh, so the thought of those little thumb-tack-like Sure-T's didn't appeal to me. Instead I switched back to Silhouettes. I had been using these prior to my pregnancy and had switched to the Sure-T's because I suspected that the teflon sets were causing "tunnelling" (i.e. absorption problems) when I had to start changing them every 2-3 days. But even 2-3 days is better than the 1 day at a time I've been getting out of Sure-T's lately. So, I've now had a Silhouette (i.e. angled teflon set) in my thigh for about 2 days. I've taped it down very well, otherwise I'm sure I would have pulled it out by now. It's been a little uncomfortable from time to time, but definitely better. The absorption does seem a little slower than in my abdomen, but definitely not as bad as the butt sites. And who knows...it may be that my insulin needs are just starting to increase again now that I'm heading into the 3rd trimester. So, I'm cautiously optimistic. It's definitely nice to give my abdomen a break. It will also be very good for me to be able to use alternate sites for the actual delivery of the baby - particularly if a c-section becomes necessary.

So now the good news! Yesterday was our 2nd Fetal Assessment. It went VERY well. The nurse said everything looked great - heart-rate, size, placenta,etc - and she said that I must be taking very good care of my diabetes, judging by the health of the baby. This was SO GOOD to hear, especially after a frustrating diabetes-week. It's so nice to know that my hard work is really paying off and that my baby is healthy because of it! The nurse estimated her weight at about 2 lbs which is apparently exactly where she should be. According to her growth chart, the baby is tracking perfectly just below the 50th percentile. Again, it's good to see that we don't have a big-baby situation because of the diabetes - at least not so far.

The baby was very responsive to being "prodded" by the nurse and kicked the ultrasound machine a number of times. It was really neat to be able to actually watch her move around instead of just feel her! The nurse said she had a "very sweet face", but I'm not sure how she could tell in all that wavy black and white :) All of this just makes us SO excited to be able to meet her in a few months!

Another new (but far less interesting) aspect of the past couple of weeks is that I have been working on proving my eligibility for the Disability Tax Credit. To do so, I need to be able to show that I spend a minumum of 14 hours per week on "life-sustaining therapy" - which basically means "diabetes management"....except that you can't count carb-counting, which seems a bit unfair to me. Anyway, it's the first time I've tried to claim it because, in the past, I could never have honestly said I spend 14 hours per week on "life-sustaining therapy" (just being hooked up to an insulin pump doesn't count), but now that I'm pregnant and controlling my diabetes as tightly as I know how, it turns out that I DO spend that much time! So I've got the form in to my endo to sign. Hopefully she likes the support I gave her and fills out the form for me, and then hopefully the CRA accepts my application! Fingers, toes, and everything else crossed! If any of you have any experience with claiming the Disability Tax Credit for diabetes, I'd love to hear from you! Write me a comment or drop me an email (email address is in my profile).

Lastly, here's a picture of me (taken today) and some pictures of the baby from yesterday.

Week 24 - Take Two

Yep, you read the title correctly....we have a new due date! It's now June 19th. This puts the 38-week mark (i.e. induction time) around June 5th...which just happens to be my husband's birthday! Perhaps I will only have to make ONE birthday cake every year for the two of them. :) (Who am I kidding, I've never made my husband a birthday cake!)

Long story short, between the first ultrasound, the first fetal assessment, and clearing up an earlier miscommunication about cycle-length, my OB did a recalculation at my appointment on Tuesday, and we came up with our new date. Under this new date, the baby is tracking perfectly size-wise. :)

Also during the appointment, the nurse was using the doppler machine to listen to the baby's heartbeat, and the baby kicked the doppler machine! She's feisty! The good news is that her heart rate accelerated exactly as it was supposed to when she exerted this little effort, so it was a very healthy response.

Speaking of kicks, this week I SAW a kick for the first time! She is very very active still, and has started a slightly annoying habit of kicking my bladder. I get to feel her movements lots, but every time my husband tries to feel her, she stops moving. I think her Daddy has a calming effect on her, but I think it's starting to make him question whether I'm making all this up about her being so active! ;) The other day I could actually pinpoint where her head was, and when I gave it a little push, she responded by kicking me! I'm really looking forward to being able to "interact" with her more now if that happens more often!

I've still been having a lot of energy lately which is very good. I'm hoping that lasts for a while, but with the 3rd trimester looming, I'm not so sure it's going to. I've still been trying to keep at least mildly active with walks over my lunch break, a few walks after work, and some yoga on the weekend. It actually really seems to help with my energy levels, my bloodsugar, and with the comfort of my joints.

Speaking of bloodsugar, I have had some major frustrations this week! Augh! My infusion sites just don't seem to be lasting as long as they used to. I don't know if it's pregnancy hormones, my stretching belly (I'm still using my abdomen), or developing scar tissue, but I'm starting to only get about 2 days out of them. (I usually lasted about 4 pre-pregnancy, and then I just changed it because the site was getting irritated.) After the 2 days my bloodsugar starts creeping up. I think it's time to start trying alternate sites...

Just this week I had remarkably high bloodsugars this week for seemingly no good reason, and every effort I made to bring it down just wasn't working as well as it should. It wasn't a complete lack of insulin, but there was definitely something wrong. Even after changing the site it was still bad, so I ended up changing the whole reservoir/tubing/infusion site - everything. So finally it worked, but by that point I was up around 17, and then when the "good" insulin hit, I dropped to an uncomfortable 2.5 in the middle of the night. Ugh! (Thank goodness my CGMS woke me!) I know it was just one day, but it's hard not to think about the effects a bad day like this could be having on my baby. Plus it just felt miserable to have high bloodsugar all day. (Not up at 17 all the time...but above 12 pretty much all day.) Yuck yuck yuck.

On a somewhat unrelated note, I have a hint for those of you who are somewhat new to the whole CGMS thing. I have found that the CGMS isn't especially good at keeping up with quickly dropping (or rising) bloodsugars, so to keep me safe at night, I've actually set my low bloodsugar alarm a bit high. I have it at a 4.0 right now. It does mean that sometimes it alarms when I really don't need it to (i.e. I don't need it to tell me if I'm a nice stable 4.0), but it has really come in handy a few times. For example, this last week when I dropped so fast at night, the CGMS alarmed at 4.0 when I was actually 2.5 - I was just dropping too fast for it to keep up. If I had left it set for 3.5 or 3.0 I might have been a lot lower by the time I woke up (unless I would have woken up on my own, which does eventually happen too). It might not work for everyone, but I do find it's a good workaround for one of the CGMS's quirks....it works well for me.

All for this week! I have another fetal assessment coming up later in March, so I'll be posting again in a couple of weeks!

WEEKS 23 AND 24 (OR IS IT 21 AND 22??) - IT'S A GIRL!

Well, big news today! We are having a GIRL!! We had our first Fetal Assessment on Tuesday and found out (with certainty) that we will be having a little baby girl in a few months! (Diabetic mothers-to-be typically go through a lot of fetal assessments - basically a more detailed ultrasound.) We couldn't be happier - especially because it means we don't have to repaint the baby's room, which is pink from the previous owner.

During the fetal assessment the nurse took lots of measurements and looked at all sorts of things to do with the baby to make sure that she is healthy. We were so pleased to hear that everything looks normal and that there is what appears to be a very healthy baby growing inside of me!

As you may recall, during my 19-week ultrasound, the baby was measuring at closer to 17 weeks. Because there can be a bit of room for error in determining the gestational age of a fetus, and becuase we were quite comfortable with the estimated conception date, my OB decided to keep the due date as it had initially been estimated (June 5th or June 9th, depending on who you ask). But at the fetal assessment, the baby was measuring at 22 weeks instead of 24 weeks, so the nurse is making a strong recommendation to my OB to change the due date (I guess that would put us closer to June 23rd, with induction around June 9th).

Since the baby's growth is stable, and since it really does kind of make sense that we could have been off (e.g. perhaps I couldn't get a positive pregnancy test until week 8 because I was actually only at week 6; and maybe I did start to have nausea at week 7 (which is normal) instead of week 9 (which is a bit later than many women)), I'm feeling pretty comfortable with the idea of changing the due date at this point. I see my OB on March 3rd, so we'll figure it out then. At this point, I'm kind of assuming that I'm actually 23 weeks and not 25 weeks, but I'm not going to make any solid changes until I talk to my OB. Because he'll be wanting to induce me around 38 weeks, I'd like to be as sure as possible that we're working with the right due date - otherwise we risk getting the baby out at 36 weeks...which is getting into preemie range. Thankfully I will be having many more fetal assessments before the induction, so the doctor will have a good chance to monitor the baby's development before making any induction decisions.

In addition to the fetal assessment, I also saw my endocrinologist this week. My A1C was the best this time that it's ever been (pregnant or otherwise)! Yay! Still a few things to tweak, but in general it's going very well.

The baby is still moving around a LOT and sometimes we can feel her kicks with just a light touch. It's nice to know that she's healthy enough to be so active! So far she's not keeping me up at night either. Hopefully it stays that way for a while.

I'm still having some discomfort in my knees and hips if I use them too much, but otherwise I'm feeling very good. I had lots of energy this week! I've tried some more of my prenatal yoga and enjoy it, and I've also tried to go for some indoor walks (my office building is attached to a mall) over my lunch break in order to get some exercise without having to navigate icy and uneven ground outside.

And now it's photo time! First, I have two pictures of the baby from the fetal assessment. The first one is her face. She's lying down with her chin on the right and her forehead on the left. (Eyeballs don't show up on ultrasound, so she just has eye-hollows in the picture.) The second one shows her head and her hand waving at us! (The nurse added the "hi mom, hi dad".) We were very pleased to be able to take photos home from fetal assessment free of charge, as the regular ultrasound pictures cost $50 (or maybe even more)!

I'm also attaching a photo of me taken today. So I guess it's either my 25-week or 23-week picture, but I'm thinking more likely 23 weeks.

WEEKS 21 & 22 - MORE APPOINTMENTS

Well, since I last posted, I've had a couple more doctors appointments.

On Monday I had another appointment with my OB. We talked about the ultrasound results. It turns out that their results (re: gestational age) were only off of my expected due date by 9 days, and they have a "+/- 10 days" added on, so we're still in range and there's nothing to worry about. Good! So my due date by me is still officially June 5th. The doctor's due date is still officially June 9th (calcualation methods are slightly different). He has said that, if all is still going well, he's willing to wait until 38 weeks to induce, but doesn't want to wait any longer and jeopardize the health of the baby. So we're looking at around May 26th for the induction. I'm hoping that Bud decides to come a couple of weeks early on his/her own and that we can skip the whole induction, but we'll see....

My first fetal assessment (i.e. a more detailed ultrasound) is scheduled for February 17th. My understanding is that we will be able to find out the gender of the baby at this appointment and that we will also be able to take some pictures home! We're pretty excited about this appointment! After that I will be having monthly fetal assessments for the time being, but more frequent ones eventually.

On Thursday I had my appointment with my ophthalmologist to make sure all the growth hormones coursing through my body aren't causing more retinopathy problems (i.e. vascular growth in my eyes). I got the all-clear! Everything looked good and he didn't see anything that looked out of order! Whew! I don't see him again now until early May. This was a huge relief for me!

The baby has been moving around LOTS this week! I'm getting kicked by him/her many times a day. My husband has even had a chance to feel the movement once! (The movements are not always strong enough to feel.) Apparently 22 weeks is quite early to be able to feel it on the outside, so this could be a very strong active baby in the next few months!

My biggest craving lately is fruit! Strawberries, pineapple, apples, grapes, blueberries...you name it!

Last week I was able to decrease my nausea meds a bit more, so now I'm down to 2/day. I thought I may have noticed a bit of nausea come back when I did this, so I think I'll stick with 2/day for the time being. (The little bit of nausea is definitely bearable, though, and it's not every day - mostly just when I'm tired.) Hmm....maybe I wrote this already in my last post. Sorry if it's old news. :)

This week I've started to get REALLY tired of watching my bloodsguar so closely. I"m surprised it's taken until now, but I'm just finding it sooooo tedious. :P I'm taking a brief "break" this weekend. No - I'm not abandoning my efforts altogether (don't worry). I'm just going to take two days of being ok with slightly worse control (emphasis on slightly - nothing that would be risky to the baby), so that I can be refreshed and ready to go on the tight control again on Monday. It's what I have to do to preserve my sanity while still keeping the baby safe.

All for now!

TODAY - A FEW MORE THINGS...

Well, that should bring you up-to-speed on this pregnancy as it stands today. There are a few things I wanted to touch on that didn’t really fit into the previous posts, so here they are now:

Cravings:
I have been SO LUCKY with cravings – especially considering my diabetes! My biggest cravings have been protein (especially salmon and eggs) and fruit (especially apples)! I do crave salt from time to time, and chocolate of course (but that was a pre-pregnancy craving too), but it’s this healthy stuff that really makes my mouth water! This has been especially good as I was trying to get my A1C back down and my bloodsugar back under control, and now when I’m trying to maintain that control!

Doctors’ Appointments:
Obviously pregnancy involves a lot of doctors’ appointments. So does diabetes. As can be expected, pregnancy PLUS diabetes, involves a LOT of appointments! This is my pregnancy-related roster of health-care professionals:

1. Family doctor: I saw him to get the initial pregnancy test, but then he passed me off to the OB and said he doesn’t need to see me about anything else pregnancy-related.

2. OB: I see him once a month for now – but will see him more frequently later in the pregnancy.

3. Ultrasounds: My first one was at week 19. Starting at week 24 I will be having “regular” fetal assessments. I don’t know exactly what they mean by “regular” yet.

4. Endocrinologist: I see her once a month for now, but in another couple of months I will start to see her every 2 weeks, and then every week when I get closer to the end of the pregnancy.

5. Certified Diabetes Educator (i.e. Michelle): I have been seeing her once a month too, but this is actually sort of on an “as-needed” basis. We communicate a lot via email too and she’s great at helping me problem-solve as I adjust to my changing insulin needs.

6. Dietician: I’ve only seen her once so far. Because she was happy with my diet I likely won’t go back unless I have concerns at some point. If she wasn’t happy with my diet, I’d be going back more frequently.

7. Ophthalmologist: I see him once every trimester. In 2007 I was diagnosed with, and treated for, proliferative retinopathy in both eyes, so he wants to keep a close eye on me (pardon the pun). The same growth hormones that run rampant in my body to help the baby grow can also cause vascular growth in my eyes, which is NOT what we want. So far so good, though! No changes noted!

8. Registered Massage Therapist: I see her every two weeks to help me deal with the aches and pains that come with my changing body, including my lower back and my knees (as well as a chronic shoulder problem that goes back well before my pregnancy).

Thankfully my boss is VERY understanding about all my appointments as a good number of them happen on work hours! Also, most of them are within a 3-block radius of my office building, so that makes the appointments nice and quick!

The Pump and the CGMS:
I won’t go on and on here, but I just wanted to reiterate how much of a help the pump and CGMS have been for me during the pregnancy. I am positive that I would not have been able to maintain the tight control that is required during pregnancy if I wasn’t on the pump/CGMS. That doesn’t mean that this is necessarily the “only way” for all pregnant women, but for me…I wouldn’t consider going back. There are adjustments to make between pre-pregnancy pumping and pregnancy pumping (e.g. I had to change the type of infusion set I was using, and I’ll have to work with some alternate sites eventually to keep my abdomen clear in case I need a C-Section), but in all it was a pretty easy transition to make, and well worth it.

Baby Stuff:
Totally non-diabetes related, but I just wanted to say how much fun I’m having accumulating baby stuff! It’s not cheap, so the more you can get used, the better. We were able to buy a number of things used, and we’re getting some used items for free! The rest we’ve bought on some really good sales! Our basements is now full of stuff that’s just waiting to be used – crib, high chair, swing, stroller, jolly jumper, etc., etc. So much fun!

Being Pregnant:
In spite of some of the frustrations (e.g. nausea, bloodsugar gymnastics, etc.), I LOVE being pregnant! It is such an amazing experience! To know that there is a little human growing inside of me, and totally dependant on me, is really something else! I can hardly wait to meet my little one!


And that’s all for now! I will do my best to update this blog on a regular basis. In the meantime, as I said in my initial post, feel free to contact me with any questions you may have (either through comments on the blog or through the email address in my profile)! Even if you have personal questions – give me a try, I might surprise you. If I’m not comfortable answering, I’ll let you know but I won’t hold it against you! I understand that diabetes and pregnancy is a tricky and sensitive subject, and if I can help clarify anything for anyone…especially to put your mind at ease about something…then I really want to be able to do that!

More soon!