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Posts tagged ‘pregnancy’

Full Body.

The scar on my lower abdomen is close to healed, after six weeks of careful care.  The incision is evidence of the arrival of my son, the same place my daughter escaped from.  The skin above the incision is still swollen from months of pregnancy and oddly puckered due to surgery.  It’s not a flat, perfectly sculpted specimen of an abdomen.

But I try hard not to care.  My kids were created here.

The marks on my fingertips move every few days as I use a lancet to draw blood every few hours.  Sometimes the dots left behind look like I stuck my finger into a jar of ground pepper, other times they are light brown marks that appear to live deep beneath the surface of my skin.  But they represent moments when I needed to check my blood sugar and actually followed through on gathering that data.

When I look at them, I see evidence of me taking good care of myself.

The scaly patches of skin on my outer thighs are itchy and refuse to respond to lovely lotions and dermatologist intervention.  They are left behind by continuous glucose monitor sensors that I wear to keep tabs on my blood sugars throughout the day and night.  These skin issues are not comfortable or enviable, but the protection provided by streaming my glucose data helps me to sleep better.

My health is worth the inconvenient itch.

And, of course, there’s the shifting of my body, shaped by time and illness and exercise and pregnancies.  Baby weight.  Aging, even when I don’t remember to.  My leg muscles are softer, but eager to be used again.  My eyes have improved during this pregnancy, somehow.  My blood pressure is carefully watched.  My stomach is paunchier than it was 10 months ago.  I weigh myself to see what’s happened over the last six weeks and try not to get too excited or sad at the result.

But the number on the scale doesn’t define me.  Neither does the number on my meter.  Neither does my age.

… right?

I look at my body sometimes and feel a little embarrassed or ashamed because I don’t physically conform to what magazine pages and commercials suggest I should look like.  I’m not tall and willowy with shiny hair and slender arms.  And I admittedly care about the size of the pants or the cut of the dress.  It’s been harder than normal lately because I’m trying to recognize this new person in the mirror, the one who has carried two children and thirty years of chronic illness under her skin, never mind life’s normal wear and tear.

I’ve lived with body image issues that haven’t caused chaos but have given me pause from time to time.  Diabetes has forced me to see my body through a specific lens, not always rose-colored.  Sometimes diabetes makes me feel like I’m broken, unable to make insulin and struggling to create a child.  It’s weird to look in the mirror and see someone who doesn’t look sick but who has felt unwell physically many times, and who requires effort to stay emotionally well.

Other times, the diabetes lens makes me feel as if I have superpowers … like, shouldn’t I be dead because I don’t make insulin?  Every mile I’ve run or weight I’ve lifted stands in contrast to my unmotivated pancreas.  How has my body managed to stop producing a life-sustaining hormone and yet I’m still here?  Can’t I fly, too?  And melt steel doors with my eyeball lasers?

I have to remind myself that there are marks and imperfections on this body that I’ve fucking earned.  There are a lot of scars.  Some visible, others harder to see, but all of them, earned or self-imposed, have contributed to creating me.  This body is recovering from, responding to, reinventing itself in life, and that’s the image of my body I’m holding tightly to.

Releasing the Kraken … Into Our Home.

… he’s definitely not the Kraken.  That nickname will never stick because so far, our littlest friend is mild mannered.  He’s more Clark Kent than Kraken.  (Mixing my superheroes and myths this morning; feel free to blame the sleep debt and my attempt to repay it with caffeine.)

But he’s home, and even though he’s a sweet boy, he’s still an infant and our house is ROCKED by his presence.  My body remains equally as rocked by his escape, and my diabetes management is so confused that my pancreas, were it to have a head, would be scratching it with confusion.

OUR HOUSE:  Remains in the middle of our street, only it’s bursting at the seams with burp cloths and tiny little articles of clothing that require origami skills in order to snap up.  The laundry this little man produces is astounding, as are the number of diapers he rips through … and the number of times he’d like to eat during the course of a day.  For someone so small, the baby came with a lot of stuff.

(But I’m so glad he’s here.  I’ve never been so happy to have my house turned inside out in my life.)

MY BODY:  Is slightly less than a wonderland.  I talked about the c-section and cannot stress enough how different it was from my first surgical birth experience.  When I examined myself after having Birdy, I had a sizable scar and serious gas pain, but didn’t feel as though I’d been put through the wringer.  Ringer?  (W)ringer.  This c-section was very different because it felt busy during (lots of pressure and they actually needed to use the vacuum to assist in removing my son from the womb, poor kid) and the aftermath was not pretty.  I had a lot of bleeding after this one, more than the first time.  I also didn’t get a good look at my scar, etc. while I was in the hospital (they are smart to keep full length mirrors OUT of the postpartum recovery rooms) so I saw the mess for the first time when we came home.

Holy shit, the bruising.  The three or four inches of skin real estate underneath my incision was entirely black and blue and it looked as though I was wearing blue underpants.  I (am embarrassed to say) that I cried when I saw it because it looked so frigging VIOLENT.  Thankfully, 15 days later, the bruising is entirely gone and all that remains is the incredible shrinking uterus and the healing incision, but for the first week or so, I had a hard time checking the incision because it looked so Frankenstein’s monsterish.

And aside from the obvious diabetes stuff, I’m currently taking a blood thinner (thank you, Factor V Leiden) for six weeks, and am also unable to drive for six weeks.  The blood thinner is a little painful but totally manageable (one injection every night – easy enough).  The not driving thing is MAKING ME GO BANANAS because my freedom is entirely MIA.  I’m relying on friends and family for trips to the pediatrician, picking up prescriptions, getting groceries … every little thing requires assistance from a volunteer chauffeur.  And since I don’t want to trouble anyone more than I already have to, I’m placing some screwball orders on Amazon … like for the dry erase board eraser required on my daughter’s back-to-school list.  Or the long sleeve, size 0-3 month onesies for my son.  Or coffee, damn it.  I’m really excited to be able to get back behind the wheel and reclaim some semblance of independence.

DIABETES HEY OOOOH:  I cannot complain about how diabetes did its thing during the 38 weeks of pregnancy.  I didn’t have any tragic lows, there weren’t unmanageable highs, and the lack of pre-eclampsia was an excellent change of pace for this round.  During delivery, even though I was terrified, my blood sugars stayed solid.  And throughout my stay at the hospital, my blood sugars were without issue.  It was kind of awesome, and surely will stay that way forever, right?

HA HA HA HA HAAAAAAAAAA … now that my placenta has been kicked out of my womb and I’m breastfeeding a newborn, all kinds of diabetes hell has broken loose.  My blood sugars – once calm and dare I say predictable? – are now pinging and ponging all over the damn place.  My insulin:carb ratios are 1:20 (versus pre-pregnancy 1:11 and during pregnancy rates as low as 1:5) and my basal rate is 0.3u per hour (versus pre-pregnancy of .5u and during pregnancy rates as high as 1u per hour).  And absent the breastfeeding, these rates would probably hold tight for a few weeks until they started to require increasing, eventually bringing me back up to where I was pre-pregnancy … at least ish.

But breastfeeding is its own circus.  The act of breastfeeding does not make me hypoglycemic, but the act of producing milk does, so I’m going low mostly while my milk supply is filling up.  If this was a predictable cycle, I could plan snacks/meals around my son’s appetite and my anticipated refilling, but the cycle isn’t one I can map.  I can’t even guess.  Some times, I go low 15 minutes after feeding him.  Other times it takes up to an hour and a half for the low to hit.  I’m not sure when I should eat, causing my CGM graph to look all Ms and Ws.  If my experience with Birdy helps inform this round, I should have a more predictable blood sugar response around the time that my son is a month old.  Which means that I have two more week of letting my body ebb and flow and get all confused before it aligns to some kind of schedule.

The madness of a newborn added to the mix of an already all-over-the-place family is exactly what we had anticipated.  We’re exhausted.  (While driving home from a pediatrician appointment, Chris turned to me at a stop light and asked, “This is really happening, right?  Like this isn’t a dream?  We’re actually driving right now?”  The lack of sleep is like we’re on the tumble dry setting in the dryer, all jumbled and confusing and warm and is this real life?)  We’re adjusting.  (Birdy is doing her best to make sense of the new little creature in our house.  She loves him.  But I’m on the watch for sibling angst as well.)  We’re grateful.  (Issues like a messy house? Exhaustion? Sore body?  Bring those issues on, because I’m happy as hell to have these as my problems.)  And we’re in love with this little guy, who despite being only 15 days old, feels like he’s been part of the party forever.

 

Being a Rotten Patient.

Yesterday, I was a rotten patient.

At this point in my previous pregnancy, I had already been in hospital on bedrest for two weeks, so this whole rolling around on the “outside” while a few days shy of 37 weeks pregnant is new to me.  The emotions I felt on bedrest were really volatile and I cried a lot and HEY that same shit keeps happening even though I’m not on bedrest currently.  Which means that my third trimester experiences are consistent, at least emotionally.

Which sets the stage for yesterday. I had an appointment at the maternal fetal medicine offices and then at my endocrinologist, both up in Boston.  Usually, the ride takes me about an hour and 45 minutes, but I give myself 2 hours and 15 minutes every time, to anticipate traffic.  Yesterday, the ride took two and a half hours because of wicked traffic on Brookline Avenue, which made me late for my scheduled ultrasound.

I do not like to be late.  And yesterday, being late made me all emotional.  My car crawled up Brookline Avenue while I imagined having to reschedule my appointment for the following day, making the stupid drive all over again.  By the time I pulled into the parking garage, I had six minutes to find the right hospital wing and check in for my appointment.

Which, of course, I did not do efficiently.  Late pregnancy hormones and emotions have my brain mostly scrambled, so I ended up in the wrong wing of the clinic, nowhere near where I was supposed to be.  My blood sugar started to tumble at this point, bringing emotions even more to the surface while I left a trail of glucose tab dust along the hallways of Beth Israel.  Add that to the fact that I was late and mildly lost in the myriad of signs and corridors and I lost my cool.

Man, I felt stupid.  I was crying while waddling through the hospital, asking random people how to get to the proper hospital wing.  Their directions weren’t making sense to my slightly hypoglycemic head.  I could not pull myself together, awash with frustration and embarrassment and unable to control the emotional maelstrom swirling around me.  I was unjustifiably angry that the best care for myself and my kid included a four hour road trip for every doctor’s visit.  I was so tired from the low blood sugars that kept me up from 3 – 5 am and were the most symptomatic I’ve had in ages.  I was angry that I couldn’t guarantee safety for my child as a result of my own health garbage.  I was afraid that the stress of the moment was kicking my blood pressure into dangerous ranges.  I was a frightful mess and it wasn’t anyone’s fault but mine but holy moly, I was blowing up balloons by the dozen for this ridiculous pity party I was throwing for myself.

By the time I arrived at the right place, I was 15 minutes late and trembling.  And angry.  So when the nurses were waiting outside of the bathroom to grab me for my appointment, I snapped at them.  When they took my blood pressure while I was crying (could NOT stop for some reason), I knew the result would be elevated and would trigger a whole catalog of panicked responses from my healthcare team.  Of course it was high, and of course I snapped at them again.  Not their fault that I was late and my BP was high, yet they were the unfortunate recipients of my rage.

When the nurse I’ve been working with and a new doctor came in to discuss the results of my ultrasound (baby is fine) and my blood pressure (elevated for reasons I knew but they couldn’t pretend it couldn’t be a symptom of preeclampsia), I was still ranty and snapping.  I could not calm down and I felt terrible – TERRIBLE – that I was lashing out at a medical team whose purpose was to protect my health and the health of my baby.  But I still couldn’t get my shit together and acknowledge that for more than five minutes.

I was a rotten patient, all frustrated and angry.  (The ultrasound technician told me it was okay and that they see a lot of emotions during appointments, and I felt myself simultaneously apologize and then get all upset again.  No control.)  I snapped at healthcare professionals who were not to blame for my terrible mood.  I could not control my emotional responses to their reasonable requests.  I’m embarrassed at how I acted.  I hate admitting all of this.

The appointment circuit was finished later that afternoon, after everyone had reached the conclusion that I was able to go home until the next appointment (later this week) and reassess then.  I apologized to the people I had acted bananas towards and drove home, hoping to be more emotionally stable the next time.

I need to see this pregnancy through safely, but the last nine months have really opened my eyes to what I need to receive, as a patient, and just as importantly, what I need to bring to the table, as a patient.  Sometimes I can’t effectively perform as a full-time pregnant person, or a full-time person with diabetes (and clearly I’m struggling with doing both of those things at the moment), and I need to own that part of my healthcare experience.  Or at least stop crying in the stupid elevators, making everyone on there with me think I’m about to give birth in front of them.

Diabetic Pregnancy: Third Trimester.

Ten weeks left until the little man arrives, which means I’m in the third trimester and ready to fast forward through the summer.  FAST.  FORWAAAAAAAAARD!!

Swelling.  So far, so good.  I don’t have any swelling to speak of, which is a far cry from my first pregnancy, when I was in StayPuft mode starting around 28 weeks and stayed there until I delivered.  But thankfully, I’m a little more comfortable this round.  I can still wear my wedding rings, all my shoes, and my feet look like feet (instead of inflatable kayaks).

And I’m grateful to be back home from Utah, which was the scene of the swelling crime six years ago.  Something about being that far above sea level seemingly kicked off my incoming preeclampsia last time, and I’m glad Utah this year didn’t bring about any repeat performances.  (Also, I’ve only been to SLC twice, and both times I was seven months pregnant.  Weird theme.)

Blood sugars.  I still have them.  And they haven’t been entirely pleasant lately.  Some high numbers are returning in the evenings, which caused me to kick up my insulin : carb ratio for dinner as of this morning and I’m also side-eying my basal rate a little bit.  Still attempting to pre-bolus for as many meals as I can manage, which is working out pretty well.  I am aiming to keep my A1C in the same range it has been for as long as I can.

Some lows are back, only without symptoms at all, and those suck.  The other night, my CGM was screaming LOW for about an hour and I woke up the next morning with glucose tab dust all over the bedside table, a text message conversation on my phone that I have no recollection of having, and a low hangover that kicked my ass for hours.  Also, there was a missing burrito, which I can neither confirm nor deny responsibility for.

(Have I mentioned the Comfort Burritos that have lived in my freezer for the last five months?  Cravings were weird and intense during the first trimester, and there was a specific day when I NEEDED to have a burrito but didn’t want to eat so many carbs in one sitting, so I bought a frozen one and threw it in the fridge next to Animal.  It’s been in there since, comforting my cravings without having to be consumed.  I will plant it in the backyard after my son is born.  Perhaps a burrito tree will sprout?)

Baby kicks.  My daughter is strong and quick now, but I do not remember her being such an athlete in the womb.  However, her little brother is a storm of flying feet and hands at all times.

“Are you pregnant?” asked the lady next to me on my flight over the weekend.

“Yes, I am,” I confirmed, grateful for people who don’t assume/don’t say “WHOA! ARE YOU DUE TODAY?!”

“I thought so.   Your baby has been moving like crazy since we took off.  You have an active little one in there!”

Awesome.  You can see my son moving around through my shirt now.  And he clearly digs long flights.

Doctor’s appointments.  We’re turning up the dial on doctor’s appointments for this last trimester, moving to weekly appointments next week and then twice-weekly appointments until delivery.  My team at Beth Israel and Joslin are in sync and tracking me closely, in addition to keeping tabs on any eye disease progression (holding steady), kidney issues (none to speak of), and blood pressure spikes (still not back on BP medication yet, so feeling good about that).

I’m grateful to have so many medical professionals at the ready and tracking my baby’s progress.  (But I can’t lie; I’m looking forward to never seeing any of them again, post-delivery.  I’m emotionally done making that frigging drive to Boston.)

August.  We’re still working towards a late August escape date, with my body cooperating so far.  If the weather holds in this lovely 72 degrees and no humidity pattern for a few more weeks, I’ll be the happiest third trimester lady of all time.

Reimbursements.

“I’m not positive I can make it in for that appointment, since I’m traveling for work for the majority of those weeks.  Would it be possible for me to send my device data by email and have you review it for any issues?”

Without pausing, my endo said, “Yes, we can do that.”

We’ve seen a lot of one another over the last seven months, as my pregnancy has progressed.  Appointments are at least monthly and while we review the same things during every appointment, reviewing these same things is necessary over the next few weeks.  She made a note in the computer system and something occurred to me.

“Do you get paid to review those emails?”

“The emails?”

“Yes, when I email you blood sugar logs and you review them.  Are you paid for that?”

She paused from her typing.  “No.”

I never forget that the issues I have with the hospital system are not related to my endocrinologist specifically.  She’s forced to work within that system, and her ability to flex her capable caregiver muscle is hindered by billing codes and administrative responsibilities.  But I do forget that she goes above and beyond in many circumstances, oftentimes not paid for the work she does for her patients.  And I’m not nearly as appreciative of her work as a clinician as I should be.  It’s not her fault the system sucks.

“Thank you for doing that,” I said.  “I appreciate it.”  Our appointment continued.

Being a patient is hard work.  I didn’t choose this road, and I would not choose this road.  But being an endocrinologist is hard work, and her road was chosen.  I have to remember to say thank you more often.

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