Living at the Joslin Clinic.
Last Friday, Chris and I (and BSparl) were at Joslin all day long. ALL DAY. But that's what's required with type 1 diabetes and pregnancy, so I wanted to recap these appointment for posterity, and for anyone else who is curious about what it takes to manage this whole party. It's a long post, but with five different appointments to cover, I want to make sure I don't miss a beat.
Grab some coffee. I'll wait. :)
Eye Dilation: At 8:30 Friday morning, I had my eyes dilated to check on my non-proliferative retinopathy. A few years ago, my eye doctor found a few small spots in my eyes, and referred me to a retinologist. Since that time, I've been carefully stalked by different eye doctors, but without any real change or issue with my eyes. Being pregnant, though, can throw eye complications into overdrive, so I'm now being monitored by the Joslin Clinic's Beetham Eye Institute.
First they did a regular eye exam to see if I was experiencing any pregnancy-related vision changes, and I've definitely lost a little. "You've gone from 20/15 to 20/20." Okay, so better-than-perfect vision to just perfect vision? If that's it, I can handle that.
But then then did the dilation, and even though my retinopathy remains non-proliferative, some of the spots have changed. The ones that were there have healed, but there was a new one in my left eye that was a little too close to my macula for my retinologist's comfort. "I want to keep close watch on this one, because it could progress quickly due to your pregnancy. Let's slate a follow up dilation for February, which will help us determine how your OB wants to move forward."
That was that. I slide my sunglasses on, Chris and I went to an early lunch (he read the menu to me because I was so dilated I couldn't read a damn thing), and moved on to the next appointment. No time to get upset about the eyes when there were still three more appointments.
(Note: But in writing this, it surprises me a little to write the word "retinopathy" without a pit in my stomach. Funny how we just move on, despite fear. Despite everything.)
Fetal Echocardiogram: Our next stop was the Boston Children's Hospital, where I visited the high risk prenatal clinic for a fetal echocardiogram. Basically, it was a special ultrasound to check on BSparl's heart, as a high risk pregnancy also comes with a laundry list of "maybes." Our Level 2 Ultrasound (I think that's supposed to be capitalized) came back with no signs of any issue, but we had to make attempts to rule anything out.
Thing is, BSparl wasn't cooperating. (Imagine my shock. She is my daughter, after all!)
"She's really low in your pelvis. Maybe you can walk up and down the hallway and see if you can get her to move up a bit?" The doctor asked, after spending almost twenty minutes trying to get a good look at BSparl's heart.
"Sure thing." So I paced the hallway and danced around a little bit in hopes of getting her to scoot up a smidge.
"Great - now she's even lower. She's breech, and facing away from us, and just about as low in your uterus as she can get at this stage."
"Should I do a handstand?"
They said no. ;)
After a lot of time spent searching for a clear view of her heart, we eventually decided to make another attempt at a later date, once the baby is a bit bigger and less shy. Because she was hiding snuggly in my pelvis, waving her little hands at us as if to say, "Hey! Catch me if you can!"
Obstetrician: After searching for her little heart, we headed back up to the pregnancy clinic for a regularly schedule OB/GYN appointment. Discussions revolved around our flight to Sundance (a hearty congrats from the team for Chris, and then we talked about how heparin worked for me when traveling to Florida), measured my belly (clocking in at the anticipated 20 weeks), and discussed BSparl's estimated April birth plan.
"With this morning's eye exam, that might dictate what we decide to do, as a team. If your retinopathy is still close to the macula at the end of your pregnancy, a C-section will be what we want to move forward with, so that your eyes can stay as safe as possible. But we don't have to make that decision now. We can decide closer to the date."
My OB gave me a rueful grin.
"It's that whole 'the tighter your control, more your eyes rebel' thing."
"Cruel irony, isn't it," I said, my hands across my belly. BSparl gave a defiant kick.
I was a little bit upset at this point - I want to have the option to give birth naturally and the idea of diabetes taking that option from me made me feel frustrated - so my OB leaned in and whispered conspiratorially, "You are having a girl, right? We should go make sure."
And we had a quick ultrasound (second one that day), to not focus on the intricate measures of my baby's heartbeat, but on her round little head and her kicking legs and her hands with their five fingers each. Photos were printed, Chris and I laughed, and I felt like parents-to-be again, not just a lab rat going through all the motions.
Endocrinologist: After visiting the OB, we visited with my endocrinologist, who - in her infinite patience - printed out my logbooks from my meter because I had left my logs at home. (I'm losing my mind - have I mentioned that already?) We reviewed some numbers, did some basal tweaking due to an increasing fasting blood sugar that once was under 100 mg/dl but has been increasing up to 130 mg/dl steadily. We made some changes to my afternoon insulin:carb ratio as well to help bring down my afternoon post-prandials.
"Overall, you look good. These numbers look great, and the ones that are creeping up, we'll get them back down. We're on to the point in your pregnancy when things might change every other week or so, so don't get too comfortable with any of these rates and ratios yet. We're just getting started!"
(I love my endocrinologist. She makes this seem like it's totally doable.)
Labwork: One last stop, to be jammed in the arm. They grabbed a few vials of blood to run standard second trimester testing, including my A1C again, and a test to check for neurotubal defects in the fetus.
And then we left. Finally. After eight hours of intense appointments.
That night, I was exhausted and decided to hang in. And while I was watching a movie on the couch, I felt a few thudding kicks from my baby.
"I feel you, baby girl. I know you're in there."
I would do these appointments every single day if it meant she would be safe. Type 1 diabetes and pregnancy is exactly as much work as they promised it would be, but when I think about this little girl and how excited I am to hold her and to be her mom, I realize I would do anything for her.