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Catching up!

The last trimester of my pregnancy was busy!  I traveled for work in November, interviewed for a new job, and prepped for the holidays.

On December 12, I found out that I was offered the new job – heading up our local health department.  I negotiated, accepted, and signed the contract on December 17.  I began the new job on December 30.

 

For prenatal stuff, I switched back to a OB in the Casper area due to the job change.  I was getting non stress tests (NSTs) 2x week and an ultrasound every month.  All of my appointments checked out.  However, I had extreme swelling in my lower body during the last few weeks, and my blood pressure continued to increase.  It was never high enough to be considered hypertension or preeclampsia, although I was concerned…

Four days after starting my new job, I went into labor!!

On the evening of January 3, 2014, I came home from working late at about 7:30pm.  My husband had gone skiing in Coloardo that day and was not home.  I was exhausted and laid down to take a nap.  I was woken up around 9:30pm by menstrual cramp-like sensations.  I thought that they might just be Braxton Hicks contractions.  However, I got up to go pee and noticed blood when I wiped.  The night before labor started, I had just downloaded an app on my phone that tracks contractions.  I decided to give it a whirl.  Sure, enough, I had mild contractions coming every 4 minutes.  I checked my books – contractions coming every 4 mins was considered active labor?!  What in the heck happened to early labor?!

At about 10pm, the contractions began feeling stronger and I decided to call my OB’s on call service.  I got the OB on call and she advised that I should head down to the hospital to measure dilation.   She didn’t think I was in active labor despite my regular contractions.  She thought that they might send me home.  Since hubby wasn’t home, I called my sister-in-law to take me to the hospital.  My hospital bag was not yet packed, so I was frantically running around the house trying to throw things into my bag that I knew I would need.  My sister-in-law showed up at about 10:30pm and my contractions had gotten very strong by the time she arrived.  She was very anxious to get me in the car!

The weather was horrible.  A snowstorm had started that evening.  I had called Marshall at 10pm that night to let him know something was happening- he was on his way home from Colorado still and I was worried that he was going to miss the birth.

When I arrived to the hospital, my water broke immediately.  I was 3cm dilated upon arrival.  40min later I was 5cm dilated.  At that point, I opted for an epidural.  The anesthesiologist took over an hour to get the epidural into me.  During that time, I was having extreme contractions and could barely stay still enough for him to insert the needle.  By the time the epidural was placed, I was already 10cm/fully dilated and was feeling the urge to bear down.  The epidural could not have been placed soon enough!  Those contractions were rough!!

 

Once the epidural hit me, I couldn’t feel the contractions coming and labor slowed drastically.  Luckily, baby’s heart rate and other vitals were good.  I ended up pushing for about 2 hours total.  I easily delivered him once the epidural started to wear off a little.  I had a second degree tear, but other than that, labor went very well.

 

Nicholas Blaise was born on 1/4/2014 at 3:40am after 6 hours of uncomplicated labor.  He weighed 6lbs 2oz.  His Apgar scores were 9 and 9 (on a scale of 10).  He is absolutely perfect!

Photo Jan 04, 9 42 40 AM

 

As I’m writing this blog post, he is now 11 weeks old.  We’ve struggled with our breastfeeding journey – although we are still going with it and formula supplementation.  He is a joy!  More later…

 

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Weeks 19-26

I’ve been MIA!  The month of September was filled with travel and fun.

I fell off the blog wagon sometime near Labor Day.  My husband and I were really trying to enjoy the last that summer had to offer in early September.  My sister and my dad came to visit us with their significant others over Labor Day weekend.  We were boating at the lake all weekend.  Good thing too, because we didn’t get the boat out once again this year and it’s been snowing here for several weeks!

On the weekend of September 7th, Marshall and I traveled to Jackson, Wyoming for a friend’s wedding.  We decided to take an extra day off work to visit Grand Teton and Yellowstone National Parks and camped in Wyoming’s beautiful Sunlight Basin.  Our last camping trip of the year too!

On September 12th, we traveled down to Cheyenne to see my OB for the anatomy ultrasound and found out the gender of the baby!!  During this ultrasound, the baby was head down and turned towards my spine making some measurements (like the heart) difficult for the tech.  Here are some pics from my ultrasound!

Baby gender.  It's a BOY!

Baby gender. It’s a BOY!

20w Baby Profile

20w Baby Profile

Baby footprint

Baby footprint

Finding out fetal gender was super fun.  All of my husband’s siblings have girls (we have 4 nieces), so everyone is excited that we are having a boy.  I had no preference on gender.  I’m happy the baby is measuring on target and everything looks good!

After the anatomy ultrasound appointment, I needed to start preparing for my 2 week trip to Asia.  I also received my new insulin pump in that timeframe.  Just in time for my trip!  Check out my new pump – The Green Ping!  I love the color.

The Green Ping.

The Green Ping.

 

On September 24th, I started my two week trip to Hong Kong and Vietnam with some friends from my doctoral program.  My friend, Gabriela, was meeting me in Hong Kong (flying from Kentucky) and we were staying with another friend, Cecilia, an expat who lives in Hong Kong.  I had 28 hours of airline travel to get to Hong Kong – 4 flights.  I flew from Casper to Salt Lake City to Seattle to Seoul to Hong Kong.  I’ve never flown that much in my life!  I was worried about being diabetic and pregnant and being on the plane that long.  On my longest flight (Seattle to Seoul – 10 hours), I was stuck in a window seat in the very back of the airplane.  Keep in mind that I’m 6’1” and pregnant.  Oy.

Gabriela and I both arrived in Hong Kong as planned – amazing that everything worked out so well considering we were both flying for different parts of the US on different routes, different airlines, etc.  But, we made it!  Cecilia showed us a wonderful time for our 1.5 days in Hong Kong.

Cecilia, Gabriela, and Kelly at Stanley Beach, Hong Kong, SAR

Cecilia, Gabriela, and Kelly at Stanley Beach, Hong Kong, SAR

Panoramic view of Hong Kong Bay from Victoria Peak.

Panoramic view of Hong Kong Bay from Victoria Peak.

On September 27th, Gabriela and I flew from Hong Kong to Hanoi, Vietnam.  I lost one of my credit cards within 5 minutes of being in Hanoi (accidentally left it in an ATM in the airport).  Hanoi was completely overwhelming to my senses – first of all, the traffic!  Oh my, the traffic is crazy!  The smells, the noise, the air pollution – this Wyoming girl had culture shock.  Two other friends (Stephanie and Jen) also met us in Hanoi that day.  Everyone arrived safely from their corners of the world!

On our 2nd day in Hong Kong, I had started to develop what I thought was heat rash on my ankles.  It was a hot, itchy, rash along my sock and sandal lines.  Hong Kong was hot 85-90F and humid (compared to where I live), so I had been sweating and red the whole time I was there (and basically for the rest of the trip).  I just do not handle heat and humidity well.  By the 2nd day in Hanoi and after walking 10-12 hours per day each day, the rash had gotten much worse and I was having major ankle swelling.  After a few days of all of that walking, I was having ankle pain when walking and I was concerned that something was really wrong.  I literally thought that I was going to have to end the trip early.  Luckily, my travel companions encouraged me to be seen at an SOS International clinic in Hanoi – to have the baby checked out and to help me make an educated decision on whether or not I needed to come home early or if I could continue my trip!  I was especially concerned about preeclampsia, so I was especially wanting my BP to be checked.

On the 29th, I went to the health clinic in Hanoi.  My BP was 112/75.  🙂  Absolutely no problems with the baby!  What a relief!  The rash was identified as a streptococcal infection (streptococcus cellulitis) and the swelling was a function of all of the flying, hours of walking, loss of circulation from pregnancy and to a lesser extent poor circulation from diabetes.  The doctor encouraged me to continue walking as much as I could, but to elevate my feet when resting.  I received an oral antibiotic (Augmentin), a topical antibiotic, and an antiseptic for the skin rash.  One dose of the oral antibiotic and an application of the cream that evening and the rash was greatly improved by the next morning.  I also decided to rest and relax for two extra days in Hanoi before moving on.  The others went to Halong Bay.  I was sad to not go, but it was a good decision for me to rest in the hotel in Hanoi, get extra sleep to make up for the time change, and rest my legs.  Jen could only join us for the weekend in Hanoi (she lives in Bangkok). Gabriela and Stephanie went on an overnight excursion to Halong Bay and met me back in Hanoi.  While they were gone, I went to the spa and went shopping.

On the 30th, we flew from Hanoi to the coastal city of Da Nang and then moved on to the beach town of Hoi An.  We stayed at a quaint little resort with bungalows.  The resort hosts made the 10 resort guests a traditional Vietnamese dinner one night – so we met some folks from Australia, Belgium, and Germany.  Hoi An was a nice change in pace from Hanoi.  Hoi An is a bit more rural (rice fields surround town), the town is much smaller, and it has a thriving artist community.  It is touristy, but there was plenty of real life Vietnam going on all around us.  Much of our trip was focused on eating the incredible Vietnamese food everywhere we went.  Most of the food was familiar to me – pho nooddle soup, chicken and rice, spring rolls, grilled meats and veggies, lots of fresh fruit.  I did have the ability to try some new foods that I had never seen or tried before:  morning glory greens (one of my favorite finds), pomelo, mangosteen, rambutan, banana flower.  Gabriela was also on a mission to try weasel poop coffee (ca phe chon – similar to kopi luwak).  It was selling for $47.50 per 8.8oz!  We were able to purchase a cup to share for $6 USD at a cafe in Da Nang.  I found it to be bitter…  I’m not a huge coffee drinker.

Before I had left on my trip, I was using about 65-70 units of Apidra per day (a substantial increase over my pre-pregnancy total daily dose).  In Asia, however, my total daily insulin dose was as low as 35 units per day (lower than pre-pregnancy), and I was 23-25 weeks pregnant!  I had amazing insulin sensitivity during my entire trip.  I had to cut back my basal rate by 40% most days and sometimes to 0% when we were walking and site seeing.  I do think the walking explains part of the drop in insulin needs, but I don’t think it explains all of it.  When I hike for hours on end at home, I never had to cut it back by that much!  I thought it was interesting that processed food was completely absent from my diet during my entire trip.  I was eating many more carbs than I normally would – but they were all clean carbs – white rice, rice noodles, springroll wrappers, and fruit.  Everything else was veggie and herb.  The food was delicious, super healthy, and almost entirely made from scratch.  Also, dairy was almost completely non-existent from my diet over there.  The fact that my geographic tongue and other autoimmune symptoms went away completely during my trip has made me pause over my dairy eating while home.

Here are some pictures of food porn!

Banana flower salad with beef and assorted pickled veggie (and pickled starfruit)- This dish was SO beautiful!

Banana flower salad with beef and assorted pickled veggie (and pickled starfruit)- This dish was SO beautiful!

Bitter melon with egg

Bitter melon with egg

duck spring rolls

duck spring rolls

Plate of fruit - we had for breakfast every morning!

Plate of fruit – we had for breakfast every morning!

Green curry chicken

Green curry chicken

Tumeric chicken with pickled veggies

Tumeric chicken with pickled veggies

My first ever foie gras with a balsamic demi glaze and fresh mango,

My first ever foie gras with a balsamic demi glaze and fresh mango,

Green papaya salad marinated in fish sauce, lime juice with herbs and peanuts.

Green papaya salad marinated in fish sauce, lime juice with herbs and peanuts.

Grilled chicken and morning glory greens

Grilled chicken and morning glory greens

Ground beef in lott leaf.

Ground beef in lott leaf.

Fresh shredded coconut wrapped with grilled beef.

Fresh shredded coconut wrapped with grilled beef.

Iced ginger tea.

Iced ginger tea.

Morning glory greens braised in fish sauce, garlic with chiles and peanuts.

Morning glory greens braised in fish sauce, garlic with chiles and peanuts.

Prawns

Prawns

Clearly, food was a major focus of our trip!

In terms of site seeing, we saw a lot!  In Hanoi with saw the Hoa Lo prison (Hanoi Hilton – now a museum – it was very strange), Temple of Literature, Hoan Kiem lake, lots of pagodas/temples, Museum of Ethnology, Museum of Women, and took in the Old Quarter charm/cacophony.  In Hue, we saw the Citadel and what is left of the Imperial Palace.  I wish we had more time in Hue.  In Da Nang, we saw the new Vietnam – shiny, new construction of resorts, dragon bridges, and an attempt to draw in foreign tourists and investors.  The Crown Plaza has a beach resort on China Beach right across the street from an old US air base.  My father is a Vietnam War vet and was a green beret.  I struggled with some of the juxtaposition of the Vietnam I’ve seen in his pictures versus what I saw as a tourist 30 years later.  As I traveled via private car from Hoi An to Da Nang to Hue over the Monkey Mountains – some parts are still cratered from war – I thought a lot about my dad and the war and the people that died.  It was a beautiful place – rugged, jungled mountains, rice fields in the low lands, fog, water buffalo, people going about their daily lives.  I had a hard time imagining the horrible things that too place there, but they were constantly in the back of my mind.  I don’t think I’ll ever be able to reconcile the two pictures that I have in my mind (then and now) of Vietnam.  I need to do some more reading about the country’s history.

Despite some minor lows, I really had NO problems with my diabetes during my travels.  I had no problems with traveling with all of my supplies either.  I love pumping and I truly believe it makes most things in life with diabetes, including travel, easier.

After spending about 4 nights in Hoi An, we headed back to Hanoi for two more days in Vietnam and then we headed home.  I had another 36 hours of airline travel home – 4 flights again – Hanoi to Seoul to Seattle to Salt Lake to Casper.  I had a wonderful time, but I was ready to be home!  While I was away, it had snowed in Casper twice!  One of the storms dumped almost two feet of snow and caused major tree and property damage around town!  It was hard to imagine since I had spent two weeks overheated, red, swollen, rashy, and sticky.  I was so happy to have clean, fresh air and to see my husband and doggies!

Being back home meant I was back to the daily grind and trying to get over my jet lag while six months pregnant.  I had a much harder time adjusting upon returning home than I did when I got to Asia.  On top of the jet lag, the three of us had all developed some mild gastrointestinal symptoms on the third to last day in Vietnam.  I believe it was a mild parasitic bug that we picked up from some of the fresh produce.  The predominant symptom and annoying thing was the stomach cramping that I would get after eating.  After about 10 days, it finally went away.

On October 14th, I had a routine visit with my endocrinologist.  How about that for accountability?!  See the endo <7 days after returning from a two week vacation in Asia where I ate my way through every place that I had been?!  I had very decent blood sugar while I was traveling and the reduction in my total insulin doses was a surprise.  However, as soon as I returned to the states, my pregnancy-related insulin resistance came right back!  And I was having some higher than normal BGs that entire week before seeing the endo.  I was worried about my A1c…Luckily, my A1c at 26 weeks was 5.7%!!!   I’m so happy!

On the 15th, I had a fetal echocardiogram and also a routine OB visit.  The fetal echocardiogram was completely normal!  They look very closely at the baby’s heart – check all 4 chambers, look at the vessels going in and out.  Again, baby was head down and turned towards my spine.  He was being very wiggly and the tech was having a hard time getting some measurements, but he finally settled down and we got to see the details.  His heart rate has been consistently where it needs to be.  My check up with the OB was great – no glucose, protein, or ketones in my urine.  I was up 10lbs from my pre-pregnancy baseline (not bad for being 26 weeks!).  My bp was normal.    I’m feeling good and I hope everything with my pregnancy continues to be this easy!

Here’s a pic of me at 26, almost 27 weeks.

Me at 26w6d pregnant!

Me at 26w6d pregnant!

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Week 18 – Diabetes Guilt and Addressing Increasing Insulin Resistance

I’ve been totally lost in diabetes blogs and diabetes schwag-related research all day today.

I faxed in my paperwork to get a new insulin pump ordered before my Hong Kong/Vietnam trip (9/24/13-10/8/13).  My current silver Animas Ping is having problems with sticky buttons and my meter/remote’s screen is fading and getting lines through it.  I’m nervous that the pump is going to ultimately quit on me while I’m overseas.  Murphy’s Law, right?    My current pump is no longer under warranty, my insurance company will cover a new one every 4 years (ordered this one in April 2009), and I’m close to reaching my maximum out-of-pocket costs for the year.  The timing is right.  I decided on ordering another Ping.  The Tandem TSlim is alluring…  but I just don’t think it’s the right pump for me right now.  I think in 4-5 years I will definitely take a look at the pumps Tandem is offering then.  For now, I’ll be playing the waiting game with Animas…hope they can get a new pump turned around quickly…

I’ve been reading a lot of Kerri Morrone Sparling’s posts during her pregnancy on her blog Six Until Me.  She is one funny lady and I’ve always the mix of patient advocacy and honesty about living with Type 1.  In several posts, she talked a lot about having diabetes guilt (i.e., my BG is now 285mg/dl, and I shouldn’t have eaten that [fill in the blank].  Anyone who is health conscious has guilt over eating foods that may not be the healthiest.  However, having diabetes takes that guilt to a whole new level because you have fairly immediate and measurable consequences for your actions.  And sometimes, it’s just, well….exhausting.

Add pregnancy to the Type 1 and you are in a constant state of near-panic over BGs.  Whether you ate something you know you shouldn’t have, missed a bolus dose, or even did EVERYTHING right, but still had high BG…  It’s hard to explain the constant state of worry and stress about what my BG is doing to the baby.

Today, I binged on 3 pieces of pizza.  Now, pizza is not in my daily, weekly or even monthly repertoire of typical meals.  Admittedly, I caved to cravings.  It was freaking good too.  I have NEVER been able to ace my insulin boluses to perfectly cover pizza, not even one piece.  I ALWAYS end up high after pizza.  Even with an excessive combo (extended) bolus with the pump.  I overestimated the carbs on purpose.  I told my pump 100 g carbs.  At my new I:C ratio of 1:8, it suggested a bolus of 12.50 units of Apidra.  Pizza is SLOOOOW in me.  So I divided up the bolus by 50% and took 50% up front and another 50% extended over 4 hours.  I swear I probably needed to double the 12.5 and take 12.5 upfront and 12.5 extended.  Grrr…  The bolus seemed to work for a bit.  But about 2 hours after I ate, I popped over 140 mg/dl and it just continued to rise over the next few hours.  I think I peaked at about 185 mg/dl.  I was stalking my Dexcom.  Even 3 hours after the meal, I could tell that the extended bolus wasn’t going to bring my BG down to where I wanted it… so I took an extra 4 units via manual bolus on the pump.  I took another 2 units two hours later.    I ate this pizza at about 12pm.  My BG did not come back down under 140mg/dl until 7pm.   I was adamant that I would not eat until I was under 120 mg/dl…  but I was hungry.  I sucked it up and waited until 8pm to eat dinner.

Photo Aug 25, 8 24 27 PM

A day of BGs. Pizza at 12pm and 3 major boluses later.

Obviously, pizza is not a good choice for a number of reasons…  I’ve also been noticing that once I’m high, it takes buckets of insulin and lots of time to bring me back down.  So, I’m having lots of guilt for all of the various dietary indiscretions I’ve had during this pregnancy.  Wondering…if my high BG at any point has caused serious harm to my baby.  Sometimes, I just want to slap myself.  I know better.  I know what pizza does.  Why the hell did I put it in my mouth?  What is WRONG with me?!

I need to do better.  I CAN do better.

I don’t know how my insulin resistance will change over the rest of my pregnancy.  I need to put my scientist cap back on and start paying more attention to trends when I spike and when I don’t respond to correction boluses, etc.  I need to get over my guilt and take some action.  I need to get back to my typical low carb plan.

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Week 17 – Hiking, Headaches, and Belly Photos

Tomorrow, I’ll be 18 weeks along..  Time is flying.

This last week was busy for us with work.  This last weekend, we went camping and hiking in the Cloud Peak Wilderness Area in Northeast Wyoming.  On Saturday, we hiked 6.5 hours total.  Some pics below.

Me at 17w2d

Me at 17w2d

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Waterfalls. We saw several.

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Cloud Peak Wilderness Area

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Having lunch on the top of a scenic ridge.

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Our yellow lab, Tanner.

We weren’t planning on hiking that long.  We headed down an unknown trail and ended up having to backtrack the way we had come in.  Luckily, I had plenty of food and supplies on me.  We were exhausted when we got back to the camper, but it ended up being a pretty good day.

Prior to the camping trip, I had started to develop some pretty intense headaches every day.  I was worried because severe headaches are a sign of preeclampsia.  A recent scientific paper I read stated that approximately 50% of all Type 1 diabetic women develop preeclampsia.  Woah, 50%!!?  Scary.  So I started monitoring my blood pressure more.  I have been consistently around 110/70.  So far, I don’t think that points to preeclampsia.  I think that my headaches may be a function of dehydration + hormones.  I drink a lot of water, but maybe with the growth this week, it wasn’t enough?

Speaking of growth, my belly has very suddenly gotten much bigger.  I swear it happened overnight!  Just today, I wore my first pair of maternity pants.  My regular pants still fit, but they are getting a little tight.  Maternity pants are comfy!  With layers, I can still hide my pregnancy well (I’m in the process of applying for a new job), but it’s not going to last long.

Me at 17w6d in a non-maternity shirt/shell and maternity work pants.

Me at 17w6d in a non-maternity shirt/shell and maternity work pants.

Photo Aug 22, 6 28 44 PM

17w6d showing the baby belly. Lots of room to grow with these maternity pants.

Food – still on a dairy kick.  Here is a random sample of what I’ve been eating.

Photo Aug 20, 10 05 20 AM

Homemade cream of broccoli soup

 

Paleo Mongolian beef

Paleo Mongolian beef
Skillet chicken florentine

Skillet chicken florentine

Ready to make homemade coconut milk yogurt.

 

My yogurt maker with coconut milk yogurt

My yogurt maker with coconut milk yogurt

Blood sugar:  I’m having more difficulty maintaining great blood sugar.  I’m definitely not having the great insulin sensitivity that I was having in the first trimester.  My visit with the endocrinologist on August 6, 2013, we increased my bolus for lunch and evening from 1 unit per 10 g carbs to 1 unit per 8 g carbs.  Soon I think I will be increasing my basal rates.

Decent morning with blood sugars.

Decent morning with blood sugars.

I’ve started shopping around for a new pump.  The buttons to my Animas Ping are getting a little weird/sticky.  I’ve been pumping 4.5 years, so my insurance will cover a new pump.  I’m trying to get along with this Ping now as long as I can, but I really think I will need a new pump by the end of the year.

I had a chance to see Tandem’s TSlim at my endo’s office earlier this month.  It has a lot of features I like:  the touch screen, the program screen (single screen for various basal and bolus I:C programs) which is super sleek.  I have some concerns with it: the newness of the company, TSlim is first model and I think there are some kinks to work out, no remote (I wear my pump on my bra now, so without a remote, I’d be digging around in my bra a lot just to bolus), I’m hearing about problems with the pump overheating, with occlusions, problems with Apidra (the insulin I use).   I sure would love to give it a test drive.  I spoke with a CDE friend of mine.  They have a loaner pump I could use for a test drive, but they are concerned with me being pregnant and rises in my BG if it weren’t to work.    I may end up just going another Animas Ping, since I know what to expect.  Although,  having the 300 unit cartridge in the TSlim would be nice as my insulin resistance increases through this pregnancy!  I also need to decide if it would be advantageous for me to order the Ping before the new year or not.

TSlim pump (above) compared to my Animas One Touch Ping (below).

TSlim pump (above) compared to my Animas One Touch Ping (below).

We can’t wait until the Sept 12th ultrasound where we find out the baby’s gender!!

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Week 16 – Do I really need an ECG?

So on Monday when I saw the OB, she asked me if I had had a electrocardiogram (ECG) on my heart in the past 12 months.  Well, no…but, I have had one in the past 18 months.  Two in the last 3 years.  Both were completely normal.  I have absolutely no indication of heart disease or heart problems whatsoever.  She suggested that they do a baseline ECG on me.

Because of the difficulty in having completely, 100% normal BGs in Type 1 diabetes, they did convince me to get a fetal ECG down in Denver.  There are no pediatric cardiologists here to interpret it, so I have to go to Denver.  Again.  I am on board for this test because of the chance that my diabetic BGs have caused some kind of congenital heart malformation or something.  I’m totally on board with extra screening for the baby.

However, I am not convinced that I (as in my heart) needs an ECG.  I have done a PubMed and Google Scholar lit review and also several general Google searches looking for guidelines that say this test is necessary.  I found nothing.

I do believe that my healthcare providers are good and are following best practices, but I am highly suspicious in the “system” in which they work.  The system is rigged towards profit.  Yes, my insurance will pay for most of the cost for this test.  But why make that claim at all when the test is not clinically necessary?

I also hate having the high risk diabetes label when I feel that I am healthier than the general population even with diabetes.

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Week 15 – Appointments, appointments

I’m nearing the end of my 15th week.  I’m feeling great this week, but a little tired from all of the stuff going on in my professional life.

I had two doctors appointments this weekend.  On Monday, I saw the OB in Cheyenne.  It was a quick visit, no ultrasound.  They just weighed me, took BP, and did doppler to listen to baby’s heartbeat.  I’m still down in weight from baseline.  Down a pound from the last OB visit even.  I met one of the other OBs in the practice.

On Tuesday, I saw my endocrinologist.  According to their scale, I was down 4lbs since my last visit there in April (pre-pregnancy).  My 2nd trimester A1c was 6.1%.  Not as great as the 5.7%, but I’ll take it.  I’ve been a bit lenient on my carb intake over the past few weeks, so I think I need to tighten up.  I’m shooting for an A1c of 5.5% ideally.

At the endo’s office, I got to play with a demo of the TSlim insulin pump by Tandem.  I think my Animas Ping is crapping out on me, so I’m in the market for a new pump.  It’s pretty neat with it’s iphone-like touch screen.  And it is supposed to integrate with Dexcom sometime soon.  I’m still also waiting and waiting for the Animas Vibe system to be released in the US.  I hope my Ping will hang out a little bit longer…

This week, I started taking a fermented cod liver oil supplement from Green Pastures.  Not my favorite thing….but it’s not as nasty as I expected, and my skin has been glowing since I started!  FCLO is a Vitamin D, Vitamin A supplement with EPA and DHA.

I do need to take another belly pic.  I’m still in my regular clothes.  I bought a pregnancy band for when my jeans feel tight.  I love that thing.  It helps keep your pants from gaping in the back.

Well, I hope to have more later and post more pics.

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Week 14 – How Much Weight to Gain During Pregnancy

In my introduction page, I mentioned that I am a public health professional.  I am an epidemiologist by training (Masters in Public Health in epidemiology) and I recently finished my doctorate in public health in health policy and management (DrPH in Health Policy and Management).  I haven’t worked in maternal and child health at all, and since I’ve never had a baby, a lot of this stuff is new to me.  I’ve been having fun researching stuff.

As my belly feels bigger and bigger, I can’t help but wonder what it will look like later in pregnancy and after birth.  Somewhere, I read that Beyonce had gained 60lbs during her pregnancy with Blue Ivy.  I can’t verify the accuracy of that, but 60lbs sounded like a lot to me.  I’ve also had friends say they gained 50lbs.  So, that got me thinking, “how much is too much?  what is healthy weight gain?”.  I’m especially curious about recommended weight gain for women who start off with pre-pregnancy weight too high (overweight or obese).

As an epidemiologist, I know the value and limitations of using BMI as a screening tool.  I’m 6’1” and have always been very muscular, so I’ve always weighed a lot and have a high BMI.  There is no question now, that I am a good 40lbs overweight.    But even in my prime when I was incredibly athletic, I was at the high end of a healthy BMI.    I don’t think BMI is everything.  I’ve always been a fan of percent body fat measurements, arm/leg/waist circumference measurements, and weight/BMI being used together to determine overweight/obesity status.  Several years ago, I was working out with a personal trainer 3x week and my weight was still high, but I lost 5% body fat and body fat percentage was completely normal.

As an epidemiologist, I also know that pre-pregnancy weight has shown to be important markers for chronic disease in both mom and baby.  So that weighs on my mind.

Early in my pregnancy, I read the book, “Primal Moms Look Good Naked“.  The book wasn’t as helpful as I hoped it would be, but there were definitely some very interesting ideas that she discussed, one of which was the idea of weight gain and even zero net gain for women who were overweight/obese.  Zero net gain is where the baby is growing appropriately and his/her weight is where it should be, but the mother has stayed the same weight or gained just a slight amount to suggest that her body has effectively lost weight while the baby was growing.  Interesting concept, but not something that I am going to purposefully pursue.  At some point, I would like to do a systematic literature on it.

I have a good friend who is a maternal and child health epidemiologist.  She directed me to new-ish guidelines from the Institute of Medicine (IOM) in which they re-examined weight gain during pregnancy.  I hold the IOM in high regard.  The new guidelines were published in 2009.  You can download the full report or print out a PDF of the brief report here.

New Recommendations for Total and Rate of Weight Gain During Pregnancy, by Prepregnancy BMI.  Source: Report Brief.  Weight Gain During Pregnancy: Reexamining the Guidelines.  Institute of Medicine.  2009.

New Recommendations for Total and Rate of Weight Gain During Pregnancy, by Prepregnancy BMI. Source: Report Brief. Weight Gain During Pregnancy: Reexamining the Guidelines. Institute of Medicine. 2009.

Even before I read Primal Moms, I knew I knew I didn’t need to gain a lot of weight to have a healthy pregnancy.  Besides the zero net gain, Primal Mom’s author discussed that most women don’t usually need to gain more than 20lbs (she cites pregnancy gains in indigenous populations).  I feel that the IOM recommendations are evidenced-based and are in line with what I was intuitively thinking, so I plan on shooting for 15-25lb total weight gain.    I hope I can do it!  This morning, I weighed myself and I was still down 1.5 lbs since pre-pregnancy baseline.  I probably need a little more aerobic exercise.