Thursday, August 30, 2012

Testing, Testing

So I failed my goddamned 1-hr glucose test. They want me to go sit in the fucking hospital for over 3 hrs to do the 3-hr test there and go on a preemptive diabetic diet. I think I am not going to. Here's why.
  1. My failing score was 165 mg/dL. The American Diabetic Association cutoff is 180 mg/dL* to diagnose gestational diabetes. Therefore, the national authority on diabetes says I passed.
  2. A baseline glucose was not drawn, only after 1 hr post-orange drink. So we don't know if the oatmeal I had for lunch prior to my 1PM appointment might have already spiked my glucose level. It might be a baseline issue more than a metabolism issue. (I was told to eat normally.)
  3. Even if blood sugars are lowered -- through testing, diet, exercise, even with insulin or oral antidiabetic medications -- the risk of having a larger birth weight baby remains if I do, in fact, have gestational diabetes. So the intervention is useless for the biggest concern to the baby.
  4. The major risk factors for me are poorly supported by research: increased risk of preeclampsia (conflicting data) and increased 5-year incidence of type 2 diabetes (even experts concede that the gestational diabetes diagnosed for this subset of women likely just uncovered latent undiagnosed type 2 diabetes, and pre- and post-pregnancy obesity is a strong correlate).
  5. Some experts think that gestational diabetes, considering it's estimated to occur in up to 10% of pregnant women depending on the source, may actually be a normal condition of pregnancy that simply bears routine monitoring as with blood pressure (for preeclampsia), fundal measurements (for intrauterine growth restriction), etc. 
  6. My blood pressure remains perfect, my urine shows no spilled protein or glucose or ketones, and my weight gain and fundal measurements are on track (exactly the same as with Jackson).
So as far as I can tell, the lower threshold (set by many OB clinics) is really a catch-all for false-positives and probably leads to lots of pointless intervention. I can agree to proactively reduce carbs in my diet and add more exercise, which is pretty much the entry level approach to management, anyway. The difference is I do not want to do finger sticks four times a day and obsessively record the blood glucose values which will undoubtedly be scrutinized by defensively conservative clinical standards and then end up fending off further intervention. I also don't want to be labeled as high risk come delivery, since I have a fighting shot at an intervention-free labor this time (as my doctor thinks it will go pretty fast and smooth given my first labor). (I opted pretty early on for an epidural with Jackson because I presented to L&D with high blood pressure -- although only around 150/90, which is not that high, and it resolved during labor -- and the work-up protocol for preeclampsia that this triggered made me concerned about emergent inventions. Having the epidural gave me peace of mind that an emergency C-section would not require general anesthesia and that frequent internal exams wouldn't keep making me want to crane-kick the nearest nurse.)

Fuckity-fuck-fuck. Just when I thought I was in the home stretch (3rd trimester!) with single-digit weeks until full-term, and then this bullshit. They are mailing the info to me with the diet (which I'll do my best to follow) and a lab order to schedule the 3-hr test. I might just not do it and then talk it over at my next monthly appointment in 3.5 weeks. And if they call in the mean time, I'll explain my reasons and see what they have to say. I'm not psyched about the prospect of being flagged as noncompliant, so I want to be sure to lay out a clear case for them. I also don't want for the compromise to come down to frequent non-stress tests or whatever, because that's just more intervention of another kind. I feel like the level and nature of monitoring already built in to the OB practice is sufficient to look out for me and the baby. I hope they agree. They are generally a low-intervention practice (which is partly why I chose them) so perhaps I will prevail. Dare to dream.

Of course, none of this can stop the paranoia that I should just give in to the testing and intervention for the sake of safety. I might pass the 3-hr test anyway. I just don't know. I'm not inherently high risk, so I want to proceed like a normal pregnant person. Anyone here know how the hell that even works?

*So I looked into it more and the test should have been done fasting per ADA recommendations, and the 180 mg/dL cutoff is for a fasting test. So maybe I will suggest we simply repeat following the ADA guidelines and then go from there.**

**Okay, after looking into it even further, the routine OB test is non-ADA and is a "challenge" versus a tolerance test, and I roundly failed. So I appear to be screwed and should probably take the 3-hr test and cross my fingers. Fuck me.


Tuesday, August 28, 2012

Check, Please

  1. 28-week gestational diabetes testing: DONE.
  2. Promotional box o'formula gifted casually by the NP with a dismissive hand sweep: DONE.
  3. Flu shot stick: DONE.
  4. Rhogam stick: DONE.
  5. Mental calculation of 9 weeks until full-term: DONE.


Wednesday, August 22, 2012

You Down With L&D? Yeah You Know Me

We are supposed to be on vacation this week. Then Jackson developed a cold and was up all night with sniveling and coughs, and I developed lower abdominal pain so bad I ended up in L&D to rule out preterm labor. We're both fine. His cold is on the mend and it turns out I am merely so constipated I was diagnosed with a bowel obstruction. When offered an enema, I politely declined and am letting colace work its magic a little more gently. Pregnancy is fucking beautiful.

So I am hanging out around the house organizing baby stuff and making things for Jackson's birthday party. Like more artsy craftsy things to decorate outside, where we hope to have his party (fickle September weather permitting). We might rent a bouncy house. (Dude. There was one at my niece's party last week and Jackson went apeshit for it.) And I made homemade play-dough to give out as party favors. It's so easy, you guys. And cheap. I'll write up the recipe below and you have to promise you'll make some. Seriously, so easy. And edible (though it's a salt lick, so probably not so tasty).

We're resorting to having babysitters come over on the weekends so we can finish clearing out the third bedroom of its office furniture to make it into a nursery. Then there's also basement clean-up and organizing to do, so I can sift through all of Jackson's old stuff and pull out what I need for the new bambino. My sister is coming for a whole week (lord help me) since she is soon going to be unemployed and is not trying very hard to find more work (apparently there are no jobs whatsoever in the entire metro Chicago area that meet her extremely specific requirements and she is a little too psyched about a 3-month severance package and unemployment benefits -- I don't know how a hypochondriac can stare down the barrel of affording/losing shitty COBRA coverage, either). She wants to use part of her "break" to come here and help out. So I'm putting her to work. She can help assemble the new crib and hang pictures on the wall. And chase Jackson around the park and spot for him when he's scaling the slide like a freerunner, since I can't anymore. KB will be out of town on a Vegas trip with his friends while my sister is visiting, so the timing is all convenient, at least. I have no idea what I will feed her while she's here, though, since I don't cook much and she claims to be deathly allergic to everything. Did you know you could be allergic to vinegar but still drink wine? Curious.

I'm thinking seriously about a little overnight trip of my own to a hotel, just to have a day and night to myself. My trip to Iowa City for a friend's baby shower was marred by a raucous wedding taking place in the hotel and bar-goers outside my window all night. So I'm plotting to go to one of the fancy casino hotels in downtown Detroit, where I can get a quiet room and book a prenatal massage and pedicure and manicure or whatever and order room service and then have a giant bed all to myself to toss and turn in while I try to get comfortable enough to pass out for the night. But, there will be no waking up to a whining toddler, no chasing a naked toddler around the house, no convincing a toddler to let the Elmo videos go so we can eat dinner. It's the equivalent of my Vegas trip/golf weekend/etc. I love my kiddo to pieces, but a break is a good thing. KB says he's all for it. So I just have to pick a day. Soon.

Now: play-dough. Make it. It kicks ass.

Homemade Play-dough
Combine in a sauce pan:
  • 1 cup flour
  • 1/3 cup salt
  • 2 teaspoons cream of tartar
  • 1 cup water
  • 1 tablespoon vegetable oil
Stir over low heat until smooth (some lumps are okay) and thickened. Add food coloring and keep stirring until it forms one big clump together around the spoon. This will work out your muscles and wrist, hard. Remove from heat and cool on wax paper. I found it helpful to start kneading right away while warm, to ensure the color is mixed through and any lumps get worked out. Store in an airtight container or ziplock bag. If it gets a little dry just work a little water into it and presto! good as new. It shouldn't spoil due to the salt content. It's supposed to keep longer than store-bought stuff -- we'll see!


Tuesday, August 7, 2012

Dr. Frankenstein

Meet my monster:
We don't let people under 3 feet tall watch tv in our house (people over 5 feet tall watch puh-lenty of tv, however). But once in a while, since the laptop on the kitchen counter is closer than the remote to turn on the stereo, we fire up youtube to play music. Our favorite by far has been Dan Zanes, but recently we branched out to Muppets and Sesame Street.


At first, I was relieved because, damn, he sits there rapt for 20 minutes watching educational-ish stuff while I, I dunno, also sit. Which I enjoy immensely. But now? Jackson is addicted. He wants to watch Elmo ("Oh-mo! Want more Oh-mo!") before school, before dinner, and before bedtime. I have to convince him to get up to go outside and ride his new bike. A new bike, y'all. Maybe it needs a bell.

We're hoping that, like most obsessions, it passes or fades in time, since I don't want him watching as much tv as KB and I do (less these days, but still lots). Also, I am getting sick and tired of some of the shittier Sesame Street music videos. sucks. His lyrics can't even hold up in a kid's video. He can only rhyme "high" with "high," and "down" with "go." (We've also decided he's the third-worst rapper of all time, after those two other dudes in the Black Eyed Peas.) Feist, however, is delightful. One, two, three, four chickens just back from the shore....

And then there's this:
You are so welcome.