Thursday, August 25, 2011

Sugar,Spice and Snips,Snails

Today we went in for the 19th week screening ultrasound. Typically,I go alone...but this one is a milestone so this time,it was both me and my husband. I go to a maternal-fetal medicine high risk consult,typically every 3-4 weeks(for an ultrasound,at 8,10,and 14 weeks) and they've also done blood work screening for Trisomy 18/Downs Syndrome.(of which,it was all within normal limits so there's little chance the baby will be born with it. Not impossible,but I believe the more info I have,the better I'd be prepared to begin dealing with that possibility anyway. I need lots of information to keep me sane.)

So,after waiting about an hour,we were called back & the tech started the comprehensive ultrasound scan...looking at the heart,arms,legs,head,etc. (naming what she was looking at) As she was leaving the room,I asked what it was (she certainly wasn't volunteering that information) & in a voice as dry and uninterested as humanly possible said "It's a X" before making her escape. Seriously,we've waited 19 weeks for this moment and that's how you act? (I don't know if she was having an off day or harbored a personal prejudice against moms with diabetes,like they have no business being pregnant) Then the doctor came in,and he was much nicer with explaining everything. Took another look at the fetal heart & proclaimed everything to be right on track.(weightwise,about 8 oz and no abnormalities) And it's kind of nice that they're concerned that I have someone to help with the blood sugar rollarcoaster, as the regular GYN office really doesn't care(or ask)about diabetes stuff at all. But the high-risk group only does the monitoring,not the actual delivering of the babies.(its all very specialized) My Endo handles it,but they've offered the services of their diabetes educator should I ever need it.(emergency or otherwise)

After that,we saw the genetics counselor for an in-depth discussion regarding my medical conditions/chance of passing them on.(more specifically,about my Bartters Syndrome) Because most variants are autosomal recessive,that means that I won the genetics lottery and got it from both parents(while my five siblings got Nada). In the general population,the chance of being a carrier is 1/1,000 so the chance that the baby will have Bartters is 1/1000 but there is 100% chance that they'll be a carrier. That's if it's recessive linked,I could have the (extremely rare) dominant form and in that case,the child will have Bartters Syndrome. (if that were the case,it would be apparent at birth) Insurance,of course,doesn't cover gene testing and I don't see spending $6000 on it,it wouldn't change anything anyway.It would be nice to know at some point in the future though(if I could find a research facility that would test for free). My nephrologist says that since it doesn't change the treatment regimen,there's really no need (I guess the only thing one can do,is be alert & proactive with any changes,at birth).We talked about medical issues on both sides of the family tree,they drew more blood,and scheduled the next screening in 4 weeks.

And it's a boy!!!

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Monday, August 15, 2011

Taking the Plunge...

and switching to Wordpress. I've decided to not totally abandon this blog,but just use it for "nursing school" related posts. Although I don't think that anything that I've ever said violates HIPAA/patient confidentiality,(I've never put name, age,location,or particulars) it's just better not to have one's diabetes life mixed up with one's professional life on the internet. (especially if your name is very, very, Google-a-bil) Posting anything at all (about my experiences) may be considered too much info, in the eyes of some of the professors. This blog though, I can safely rant away (without too much worry).

Stay tuned.

Thursday, August 11, 2011

Profiles (Week 17)

(warning...belly shot below. Consider yourself forewarned!)

Here,you can see my abdomen at 17 weeks,& yes,this is pretty much what it looked like 17 weeks ago.(mostly just blubber) It's hard to believe that I've packed on a good 11 lbs. (where on earth is it?oh,that's right,it shrinks other vital things in the lower abdomen to the size of a pea) I haven't been overweight in quite a while,but wow that 2nd trimester came in with a roar.(and the lbs as well,the scale is starting to groan everytime I step on it) It's a bizarre feeling,having your stomach measured with a tape measure.(as well)He/She
is already producing insulin from it's tiny itsy bitsy little pancreas(is it wrong to envy one's kid?because sometimes,I wish it could share,& I know that's bad because genetically I may have passed on my bad luck)& setting about to double in size in the 3 weeks.And speaking of weeks,in just 2 weeks we'll get to find out what it is. In the meantime,there are plenty of things to keep occupied(like school,which begins in less then 2 weeks) Gulp...

It is afternoon on December 31,2011. I am doing a POD change,when said water breaks & my husband immeadietly rushes me to the hospital,ahead of the New Year's Eve revelry.After 5 hours of labor,at precisely 10:46 pm,a healthy 7 lb,8 oz baby is born (with no complications)

And that's what will probably not happen (although as long as it's healthy,I don't care what they do to me)

I don't like hospitals. I don't like the way they smell,feel,or degrade a person of the basic rights of human dignity. Unless you're the one in the white coat, you'd really like to be anywhere else on the planet. But when it's your job to care for sick people,well, it's not that bad being in the hospital. Because mentally,you're not don't "have" to be there.You can leave at any time. But a patient can't do that.(unless they want to get sicker/die)

It's something that I have to start thinking about,that yes, I'll be headed back to that place at some point in the next 5 months.And the choices that have to be made...which hospital is it going to be at? There are no shortage of hospitals in this region,and my OBGYN contracts at two of them(the one nearest our house,however,is the one that has diabetes care straight out of 1955). And that's a problem,even if my Endo's office is right down the street.(this hospital doesn't give two beans if your blood sugar is 350,as long as you're still breathing & your pain is well managed) 2008 left a really bad taste in my mouth regarding that hospital.(they pretty much ignored my Endo's orders,because most of the time I was 300's & looped out on painkillers) The other option,is the hospital with all the major equipment to handle anything that might go wrong..NICU,& such. That's definitely the way I'd go if I needed a C-Section,but for now, I have no,no clue which one to pick.I need my diabetes care to be stellar,(more for the effects on the infant,then for me) & I don't know if I'll be in the position to handle that aspect myself. And I sure as heck cannot trust Local Hospital not to kill me(if they'd take over the diabetes care). Personally, I think keeping the pump on is the way to go but things can get pretty dicey afterwards & your insulin needs drop to practically zero while you hypo nonstop & therein lies most of the problem,if you're zoned out on painkillers you aren't going to be able to catch that low & a nurse who checks you 2-4x a day is sure not going to catch it. At the other hospital,they also employ nurses that teach at my college(& the perks of that are many...since you get to know them,when you're a patient you get waited on hand & foot). I kind of also think they might do better with the D-care over there since they are like Baby Hospital Central in the county.(level III NICU) I don't think my Endo has privileges there though,& that is a problem.(I'll need major help in the diabetes dept.) Those are uncharted waters...& I need all the help I can get.

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Thursday, August 04, 2011

Code 4 on the Colorado

It was a typical June day in the lazy little town of Williams, Arizona...& at the unearthly hour of 5 am,there were very few of its inhabitants up yet. Except us,because we were going to go white-water rafting on the mighty Colorado River (ok,white water rafting is a stretch...more like smooth water drifting) and had to meet the tour bus by 6:15 AM. (right outside the Grand Canyon park entrance) As it takes an hour to get there,we had to leave by 5. Met the bus, treated a 69,drove into the Park, picked up more people..and took off for the town of Page, AZ. (some 2.5 hours away) Scrub pine soon gave way to desert & rock formations and it stayed that way. Drove onto the Navaho reservation (huge, spanning several states)
and you could tell it was hot outside.(up by the Park entrance, it was in the 50's & everyone still had their coats on from that). On the reservation, they go by Daylight Savings Time so that put the actual timing of the trip back an hour. (the rest of Arizona does not go by that) They also put on a mandatory "Canyon" movie (which after 2.5 hours got extremily dull, I reckon I know more about every single person who has ever rafted the Colorado then I ever wanted to) but we finally arrived at the agency headquarters, where we got off, stretched legs, perused the gift shop,and sprayed liberal applications of SPF50 from head to toe. It was just 9 AM and 85 degrees. An hour later, another group of river goer's joined us, we all signed release forms, and this Marine-looking type gave us a briefing on what to expect. Boarded buses, took off for the "secured area" which is at the bottom of a dam. To get there, we passed through a two mile tunnel in utter pitch
blackness. (claustrophobic, much? You would be by mile 1.5, our bus seemed to be moving at about 20 mph) came out at the bottom, donned hard hats, (because we were at the bottom of a dam/bridge) and all trotted off towards the river,(provided)lunch boxes in hand.

At the river, we tossed all the hats in a bin & boarded boats. It became very obvious that when they said that it would be hot, they did indeed mean, hot. A blast of 105 degree heat greeted us the instant we stepped off the bus. I wasn't thinking it would be quite that hot... but I was grateful for one thing,that I hadn't brought any back-up vials of insulin with me. (I'm not sure even the Frio would have done any good in that heat) Of course,if my pod would have gone bad I would have been up the Colorado without a paddle(figuratively), and a 4 hour drive to the nearest pharmacy.(not really a good thing,but I was lucky,nothing happened)

There were 17 of us on that boat. Our tour guide was a young Navajo Native American named Ritchie. I was most immeadietly concerned with my blood was already trending low & in the insane heat, there's no telling what it would do.But there was lots of sugar on board(both in the form of the lunch boxes,glucose tablets,and the "net" of MinuteMaid Lemonades being drug in the water so I felt safe, in that regard.Checked my blood sugar every hour (during the 4 hour trip),& it held pretty steady. My meter, however, went completely off the deep end & started issuing random Error Codes like crazy.

I had no clue what an error 3, or error 4, was initially pretty freaky & I envisioned my Omnipod/meter dying right there,it's electronics fried by the Arizona sun.But I could still test(didn't give any sort of "device outside temperature range" messages, and those blood sugars correlated well with what my Dexcom was telling me so I just trusted that whatever was going on,it wasn't screwing with the trusty-ness of those readings. It continued to self generate Error Messages (about 20, over the course of an hour and a half) & then stopped. I bolused once(for lunch),& the function of that also seemed to be working just fine, so I stopped worrying about it.

We made two stops during the stretch legs,etc. The French Europeans on board took those oppurtunities to strip off as much clothing as humanly possible & go swimming/skinny dipping in the river.(why they bothered wearing anything is beyond me,since you could see more then you ever wanted/needed to) Fortuantly, they made a bit more of an effort to cover up
on the rest of the journey.

The river was as ice cold as the sun was hot...compliments of the mountain run-off.
After three seconds,you couldn't feel your feet anymore.(45-50 degrees) It certainly helped prevent heatstroke. (those are my frozen toes,FTR)

We had a cooler of water on board,& were encouraged to keep up the H20 intake (as well as wear protective gear,sunscreen) & that got everyone through the 4 hour trip. There was no shade on the Colorado though. (other then when we stopped a couple of times. More then once doubted the wisdom of taking such a trip (despite the guide's reassurances that this "was the best time of year to go"-he may be used to the heat,I was not) but things did work out & it was pretty much fun.

The sun was so hot that I didn't take that many pictures...much less videos (I couldn't see the screen, (hence the upside-downness of any videos,& I am currently tearing my hair out as how to insert those videos...may take a day or two,check back)

It takes between 10-14 days to fully "raft" the Colorado...& its all regulated by private industry, so you just can't go out there and do it on your own. The discoverer/conquoror of the Colorado (one John Wesley Powell) did it in a rowboat, and he only had one arm (they had to tie him to the boat during the really bad rapids...if the boat went down, he would have too. As with the Grand Canyon, alot of people have died (on this great national wonder) & it commands an awesome power.

(Obligatory stop at a reservation store on the way back,& the resulting "Oohhh I really need/want this!" gush (that is,until one viewed the five digit price tag. Probably not as comfortable as a Baby Bjorn,either)

Boarded the bus again,drove the 3 hours back to the car/hotel...and then my blood sugars crashed hard for the next 13 hours.(effects of the heat, perhaps,I certainly didn't do anything that might be considered "physical exercise"-much of that day was spent sitting) The SPF 50 was more then effective in preventing the dreaded "day after" sunburn,although since I reserved my left hand to be SPF free(in order to not mess up blood sugar results) that hand/arm did burn some. The next 24 hours were spent recooperating from the day/hypo night from heck. Despite not being white water rafting,it was still pretty grueling. (I am most definetly not the "diabetic adventurer" type..once in a while is ok,but being away from civilization for an extended period of time is nerve wracking stuff,and the blood sugars were every bit as crazy as I thought they'd be,although mostly after(not during) the trip.

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Monday, August 01, 2011

25 Commands (of a pregnancy with D)

(I'm not trying to turn this blog into a Mommy blog..but let's face it,kids do have a way of taking over the vast majority of your life. Plus, it's summer, & is not much else to blog about so it is what it is.)

Upon being diagnosed (with most any chronic disorder), comes THE LIST of rules/regulations for that disorder. Meds you can take, meds you can't take, what you can eat/drink/etc. blahblahblah. It's a whole new lifestyle, & "breaking in" does not come easy when you've done it a certain way all your life. Diabetes is a rather extreme example of that (I think it took years for me to "accept it" ) ,& I know that most of my blog readers are familiar with what that entails. On the day that diabetes "becomes yours(till death do you part)" it's an automatic stressor that can lead to a host of other stressors.

And then comes something else, say pregnancy,& an extra layer of stress gets added to the pile. More rules, more regulations, more doctor visits,more everything. I can't say that I'm used to it yet,I'm not sure that I ever will be. (I like my bad habits too much) And that list, the list of "diabetes rules" gets picked up & spun into infinitum (only this time,your opinion doesn't mean jack squat) like the 613 Commandments of the Old Testament/Torah beating you over the head until you're senseless. (I couldn't come up with 613, but here are a few "laws" of pregnancy)

#1 You will go from drinking Diet Coke non-stop to 1-2 a week. (or drink Caffeine-less)

#2 You shall pretty much forget about Starbucks for the next 9 months. (even the decaf has SOME caffeine)

#3 You shall email your endo twice a week with complete blood sugars/FOOD logs. (yeah, fun)

#4 You shall only take Tylenol when the headache/etc. gets so bad that you want to jump off a cliff...all other pain killers are verboten. Be prepared to see the line on your Dexcom go HIGH for the next 6 hours. (and screwy for the rest of the day)

#5 Your deli-meat, blue cheese chomping days are similarly, over.

#6 You shall stand by and watch every other adult sip beer, wine, margaritas, etc. (and not that I drink much,but there's nothing like watching someone else do something to make you wish you could do it yourself)

#7 You shall not eat Danish pastries every morning for breakfast. (even if you have figured out the bolusing sequence, just right)

#8 You shall not stare at random strangers in the doctor's office & wonder if you're the only person who still doesn't look pregnant. (at 16 weeks) The only thing thus far is 7 more lbs.

#9 You shall come to accept that between blood sugar checks and bathroom calls, you will never again sleep longer then a 3 hour stretch.

#10 You shall read Six Until Me (daily) until your eyeballs bleed.

#11 You shall not Google anything on the internet.

#12 You shall take a nap(as often as possible).

#13 You will discover that it is completely possible to have an overnight flatline Dexcom graph (in the 70's) without going low.
Not that it's easy, but it is "easier."

#14 You will go through test strips like a chain smoker goes through cigerettes.

#15 You will discover that chicken (and fish) are not your friends....steer clear of consumption.

#16 You will become a big fan of glacier-cold ice water. (for chasing away those nausea pangs)

#17 You will trim your list of "essential drugs" down to three. Everything else just complicates matters.

#18 You will enjoy the last fleeting moments of regular insulin requirements, for every soon everything will start going up & you'll be blowing through 3.5 bottles a month easy-peasy.

#19 You shall exercise (daily). (seriously, just get out there and do it...even if it is 97 degrees in the shade) It will soon be the start of the 2nd semester, and you'll be lugging more then just books this go-around.

#20 You shall spend many, many hours on the phone with your insurance company, trying to convince them that 6 strips a day just does NOT cut mustard during pregnancy.

#21 You shall change your infusion set (or Pod) faithfully, every 3 days, and under no circumstance put it off (like at 3 AM) just because you'd rather do something stupid, like sleep. (Pods completely expire every 80 hours,& you've got to change it, or go without a basal rate)

#22 You shall avoid diabetes related conversations with certain friends, because it does no good to freak them out too. This is our burden, & one that would probably send normal parents into complete meltdown. Heck, it even sends me into meltdown (on occasion) but I've got a great support system. I guess its normal to worry,& it's normal for that to be compounded by 100 (fueled by every disaster story I've ever heard). Normal people assume everything will be fine,PWD (or at least me) hope everything will be fine but assume the worst until told otherwise.

#23 You will learn to pre-bolus....for everything.

#24 You will realize, that if you didn't have diabetes, there's little chance you'd go the traditional OB route where you never seem the same practitioner in office & get stuck with the backup on the day that you actually do deliver. Discontinuous, much?

#25 You'll discover that any old movie will doesn't have to be particuraly emotional, for you to become emotional.