Friday, February 13, 2015

Adventures in Gestational Diabetes Testing

I needed a hug!
It has recently become standard practice to test every pregnant woman for gestational diabetes (GD) somewhere between 24-28 weeks along. There are many good things about this, mostly because once identified, there are real tangible things one can do to prevent the associated complications, often only with changes in diet and lifestyle.

My objection, personally, only came up to the method of testing. In an effort to make the process uniform, they use a glucose solution called Glucola to give you a set amount of sugar. The first screening test involves drinking the solution (50g of glucose from dextrose/corn sugar) within 5 minutes, waiting an hour, and then having blood drawn to test glucose levels. If your levels are high for this (over 140), you go on to do a similar procedure with 100g solution. This time, you have to come in fasted, have blood drawn, drink the solution, and get tested each hour for 3 hours. If any two of your values are considered high, you are officially diagnosed as having GD.

I get why this would be a very convenient and standardized way to do this for the medical community. You can compare data across populations and have very clear procedures. However, as an individual patient with my own needs, concerns, and medical history, this procedure was not in my best interest. As someone who has followed a whole foods based diet low in processed sugar and grains for several years (four now), I know that my body does not handle those things well at all. And I'm not alone in this. I am in no way perfect with my eating, but I do eat far less than the average amount of refined sugar. As a result, my system isn’t used to having to deal with large doses of glucose all at once and takes a bit longer to clear such occasional occurrences. I don’t believe this to be a pathological state or any problem for my overall health. Ironically, if I was eating an unhealthy diet of processed food, my body would probably be better equipped to deal with the sugar load, in the short term. The problem with this, though, is that over time my system would get worn out from such a taxing business and that is how Type 2 diabetes develops. You basically get burned out. With my former habits and family history, I know that would have inevitably been my fate, had I not changed my ways.

So back to this whole GD thing. I was pretty sure I was going to fail that test. I talked with my doctor about an alternative – what *I* care about is how *my* body is handling the actual food I eat every day, not how I handle a glass of flat sugary soda I’d never drink willingly in a million years. I bought a blood glucose meter and told her I’d be willing to test my sugars 4 times a day for a couple weeks to see how my body was handling what I actually eat. No dice. I was told I must do the glucose tolerance test. I know in theory that all health procedures are, in the end, up to the patient and that no one could force me to do anything. But that’s not how it feels. It felt like I had no choice, no options. I debated what to do and finally decided just to do the initial screening test. I have to say that I felt very pressured and uncomfortable with the whole thing.

And… I failed the screening test. Of course. This left me staring at the next step of the 3 hour test, which would be quite unpleasant. Try telling a pregnant lady she can’t eat anything when she gets up, has to make it to the lab, drink sugar, and sit for 3 hours – and get 4 blood draws. Women do this all the time and I am so sorry for that. That sounds like a lousy day. Couple that with how large amounts of sugar make me feel (exhausted, light headed, sometimes nauseated) and that just is not something I wanted to do. All so they could tell me I have GD based on completely abnormal behavior *for me*.

I should say that I don’t fear having to test blood sugar or monitoring it on my own at all. I certainly don’t fear the diet and lifestyle recommendations they’d give me (ironically to basically eat how I normally do and exercise). What I fear is a needless diagnosis on my medical history that would open me up for additional interventions and higher probability for things like being induced or even a C-section. Don’t get me wrong, I don’t think any of those things are bad, they’re just overused and not optimal, if they can be safely avoided. I do not want to be classified high risk if my actual lifestyle, behavior, and health do not warrant it.

As a result, I started testing my blood sugar (BS) 4 times a day – fasting (goal of 95 or less) and 2 hours after meals (120 or less). I did that for a couple days between failing the screening test and seeing my doctor. (All but one of the values was in range – the outlier? The night I had gluten free pizza, a processed food that I eat occasionally – proving that I do not handle processed food well). I did this to show her not only that my numbers were fine based on what I actually eat, but also that I’m willing to be proactive about my health. Refusing the 3 hour test (which is what I went in to the appointment determined to do), was not about putting my head in the sand and pretending I don’t have a problem that might harm my baby. It was about individualizing my care and making sure I’m not treated for a disease I do not have.

It was an uncomfortable appointment and it was upsetting to me that the doctor was most concerned about checking things off her list – she just couldn’t fathom not doing B after A (if you fail the one hour, you do the three hour test). She barely looked at my BS numbers and food diary or even commented on the fact that they were almost all perfect, which would be impossible for anyone with gestational diabetes that wasn’t already being treated. I finally just had to say, “I’m not going to do it” – as an emphatic statement regarding the 3 hour test. Multiple times she threatened that I’d have to test my BS 4 times a day for the rest of my pregnancy, as if that was the worst thing in the world (people with GS do this, of course). Every time she said that, I just replied that would be fine with me. I love data and the info is very interesting to me, in any case.

In the end, she wrapped her head around the fact that I wasn’t going to budge and agreed to treat me like a gestational diabetic, in terms of monitoring BS, education, etc. but hold off on any official diagnosis until such time that I demonstrated that my numbers were not staying in range. This, was all I wanted. It was hard won, but totally worth it.

Coincidentally, my doctor is also expecting a baby so I will have to switch providers soon anyway. I will be asking about how the next one feels about this plan of action first thing!

The info I’m getting from testing has already been so enlightening. Knowing that pizza is not my friend (is anyone surprised?) is good to know since it is something I indulge in every so often. I’m going to test after making my own crust at home from this Paleo Spirit recipe which I love, to see if I tolerate that. If not, I will just avoid it, but it’s good to know either way. Another cool thing I’ve noticed is that putting maple syrup, honey, or dates in hot cocoa, tea, and protein shakes does not spike my BS at all. I don’t use a lot at any given time, but still, it’s good to know that I don’t have to go down to very low carb, something I was avoiding during pregnancy. Brown rice is fine, too. I will check on potatoes and sweet potatoes as they come up in my diet. I’ve had a few apples and a banana at one point, none of which pushed me over, either.

Overall, this has been a really interesting experience. It was frustrating to feel so misunderstood about something so important to my health and our little Cute Baby. I’m sure it won’t be the last time I’ll have to stand up for what should be common sense in this Bizarro world of ours. Personally, I hate confrontation and dealing with this was super tough on me. I definitely don’t do any of this lightly. For me, drinking something not-optimal once or twice isn’t the issue or a big deal. We are resilient beings, thank goodness. But, I don’t think it’s crazy to want to avoid all the potential downstream effects. So in the end, I’m glad I bothered to take a stand and I hope this might just make it a little bit easier on the next crazy lady who doesn’t want to drink the Kool-Aid Glucola.

Friday, February 6, 2015

Cute Baby Chronicles: Heading into the Third Trimester

Back in August, 40 weeks seemed like an eternity and waiting until we felt OK sharing the news was excruciating. But now it's suddenly February and I'm staring at the 28 week mark coming on on Tuesday. That will put us into the THIRD TRIMESTER, as in the final one. To think, we have 2/3 of this process under our belt already (no pun intended!)

I'm starting to feel like a "real" pregnant lady. The belly is now pretty obvious and I feel a ton of movement which never ceases to amaze me each and every time. There is actually a little mini human in there!

It's not all unicorns and rainbows, of course. My body is starting to feel the pressure of this additional responsibility. The last couple weeks have spawned the onset of sore feet and wrists, pelvic and lower back pain, and some sleep disturbances. But on the whole, I am feeling pretty great, grateful, and just over the moon to be blessed with this experience. I try my best to focus on all the positive and address any concerns proactively instead of just complaining. Cute Man is pretty empathetic and helpful when I do have to get a bit of that off my chest :)

To help me feel my best, I've started going for prenatal massage, which is heavenly and should be mandatory for all pregnant women. I'm also looking into going to a chiropractor to help with the pelvic pain, which is not fun at all. I'm doing a bit of yoga at work and a 4 week prenatal series with the teacher of the fertility workshop I did last summer. 4 of us are now preggo and it's so nice to be in a class with them again. My wrists can't seem to take any weight, so I'm modifying a lot, but it's still worth it and extremely relaxing. It just feels good to move!

I'm excited to be going to Ikea this weekend with Cute Man to scope out nursery furniture. We're not quite ready to buy anything yet, so it'll be more of an exploratory trip. Cute Man may have to strap my hands to my sides, though, to stop me from buying up all the adorableness. I'm pretty proud of my restraint so far. I have yet to buy much of anything baby related. I guess I'm afraid that it could break some sort of seal and open the floodgates of spending that I can't stop. So far, so good. Wish me luck!

Monday, December 29, 2014

Cute Baby Chronicles: Catching up

Written on December 18, 2014...

After the initial surge of excitement which I didn't feel OK to share right away (so frustrating!) I stopped writing altogether. I'm not sure why, but I guess I was just trying to stay in the moment and experience everything as opposed to focusing on chronicling it. This post is catching us up closer to the present....

As is my habit, I've been consuming tons of information about pregnancy, child birth, and babies. I'm a bit obsessive like that. It's mostly podcasts and blogs at this stage. I just don't have the patience for books. I've listened to almost all the Pregtastic, Preggie Pals, and Birth, Baby and Life podcasts so far. So much great info!

Now, just at 20 weeks I'm starting to feel like this is really happening. I'm finally starting to show a bit (that took forever!) Careful what you wish for, I'm sure... I no longer obsessively track my food intake, but I'm working to incorporate as much good whole healthy food and I can. I've hardly gained any weight so far (and nothing in the last month before my last appointment), but I'm trying not to see that as either a good or a bad thing. My doctor isn't concerned but warned me that it WAS coming and it would be OK :) My chiefest concern is just getting the nutrition both of us really need right now.

My zeal for prenatal yoga also waned as the first trimester queasiness and fatigue set in. I haven't been to a class in awhile, but have done some at home. Now that I'm starting to feel more like myself, I plan to start attending the classes again. I really did enjoy them!

Yesterday was my latest doctor's appointment and it is so fun to listen to that heartbeat! I also got my first unsolicited "Are you pregnant question" yesterday. It was tentative, but I certainly did appreciate it! Tomorrow Cute Man and I will go for our 20 week ultrasound - the anatomy scan. Can't wait to see the little guy!

And yes, it's going to be a BOY. We already know due to a genetic test we did early on so here's to announcing the impending arrival of Samuel H. Dodson V due on or about May 5, 2015. How crazy would it be if he actually came on that date? Baby Sammy Five born on 5/5/15. Wow :) But, he'll come when he's ready (no elective inductions for me!)

Tuesday, December 23, 2014

Cute Baby Chronicles: Containing the Excitement

This was written on August 29, 2014...

I just can't seem to contain this excitement. All I want to do is read pregnancy blogs and listen to podcasts. I've also started mining the internet for good movies. I'm all about my beloved Knocked Up and What to do When You're Expecting, but I need some variety. Suggestions welcome! I've even started looking at maternity clothes online... Soon will come the books, but I just don't have the attention span for those yet! Gotta check Audible...

Meanwhile, mum's the word of course. It feels so weird not to share something I'm THIS excited about, you know? I'm pretty sure I'll wind up spilling the beans to the fam when I visit both sides next weekend. But maybe not. I go back and forth on this. I'm definitely not mentioning it at work for obvious reasons.

As for what I usually talk about here... I'm still tracking my food in My Fitness Pal. Surprised? No, I have not developed Pregorexia (which is a very real and sad thing). However, I know that eating well is super important, now more than ever. Having a detailed record can only be helpful down the road. I changed my settings to "maintain your weight" and it seems like such a boon to eat that much! If I start to feel restricted, I will raise it or ignore the "limit". That is not what I'm doing here -- I'm not counting calories to try and avoid weight gain. I'm sure some WILL happen. But, it does serve me (and Cute Baby) well to keep things on an even keel and not go overboard with weight gain which would make things harder on me in the long run and add stress to my body, which is working hard enough as it is!

I now have my first appointment (with sonogram!) scheduled for a few weeks from now when I'll be around 8 weeks along. It feels so weird to not go in right away, like it isn't even real at this point because an expert hasn't declared me "pregnant". Well, I guess I'll just have to dig deep for some patience.... I took photos of the positive tests and my belly has felt strange all week, like very mild cramps. It might all just be in my head, but I'm rolling with it! If nothing else, my cycle is nowhere to be seen, which is of course, reassuring (and bizarre!)

And I'm very much looking forward to my second ever prenatal yoga class tomorrow :) I'm a happy mama-to-be!

Monday, December 22, 2014

Prenatal Yoga

Still waiting before posting this... Writing on August 28, 2014.

As I mentioned in my previous post, it has been a dream of mine to someday get to go to a prenatal yoga class. It seems so silly, but I was incredibly excited to have finally earned the right to go to one of these classes. The teacher and teaching assistant were both incredibly welcoming and introduced themselves to me right away, realizing I was new to the class despite the fact that the rather large studio room had over 30 women in it. They helped me set up this little incline made out of two yoga blocks and a couple of blankets plus a bolster under the knees. Although not yet necessary for me at this early stage, later on it's not recommended for pregnant women to lay flat on their backs. Regardless, it felt nice and supportive. I enjoyed it! I was just so overwhelmed with gratitude that I even felt some tears as the class got going and I was laying there, comfy and happy where I'd always wanted to be.

The class pace was perfect -- not too fast but definitely challenging. There were a few poses that we did 1 min on/1 min off to practice breathing through discomfort. Although wall-sits are difficult, they are a far cry from labor, I am sure. But the idea is there. You can survive being uncomfortable/in pain for short periods of time, especially if you know it will be intermittent.

The last part of class had us pairing up for some tandem stretching. It was nice to chat and get to know someone else in the class, which I'm sure was why they did that. The class ended with final relaxation in the supportive Sivasana pose in which we started and I again felt the tears come. I still cannot believe this is finally happening but at the same time, I have this incredible sense of peace, knowing it is the right time - the journey to this point has been completely worth it.

Thursday, December 18, 2014

Healthy Baby On the Way!

I have just reached 20 weeks so I'm ready to start sharing my thoughts... I planned to wait until I hit the magical 12 week mark to start posting these updates. It was very hard to contain my excitement but I totally get why waiting until then is the convention. 12 weeks came and went and somehow, I still wasn't quite ready. But here, at the halfway point, it's time to let it fly! 

This post was written on August 27, 2014 -- the day after I got my positive test. I just cannot wait to start cataloging this journey! So, for now, this is just for me with the idea of posting these updates starting in a couple months.

I am still very much in shock. It's been over 4 years of not preventing conception, with only one other pregnancy, which was an extremely early miscarriage that happened before I knew I had been pregnant. It was traumatic physically, but emotionally I just couldn't process that I had lost something I didn't even know I'd had. My doctor thought it was ectopic (a tubal pregnancy) because they didn't see anything on ultrasound, despite my insistence that I could only possibly be a day or two pregnant due to knowing my cycle. They did eventually see something in the uterus, but it was not viable by that point in any case. 

That was two years ago and since then, nothing. I went through periods of actively charting my cycle and doing tons of research and planning. I also went through times when I couldn't think about it at all. I needed to enjoy my life the way it is, which is fantastic. 

All the time, the clock was ticking... I was staring at my 37th birthday and just knew that it was now or never in terms of taking a proactive approach. I saw my doctor, got some preliminary tests (all seemed fine). Sam was checked. We started jumping through the hoops my insurance needed for our referral to the fertility center (dealing with two different sets of medical systems -- Kaiser and GW was quite the fun time!) 

I signed up for a Yoga for Fertility Class. I joined Baby Launch Camp. I worked with a Health Coach. I downloaded Fertility Meditations. I recommitted to daily temperature and fertility sign charting. I was on this! But, somewhere in the back of my mind was Negative Nelly whispering how this just wasn't going to happen for us. I started looking into adoption and foster care (the latter something we want to do eventually, regardless of whether was have a biological child). Those are great options that I support but there was this niggling craving to have this all-too-human experience. I wanted to find out "for sure" (at least as much as the medical establishment can determine this) before exploring other options. 

I'm not sure what "did it" this month. Not much has really changed -- I still eat a Paleo diet, which has been including Perfect Health Diet starches to varying degrees. I had been counting calories and slowly losing a bit of weight (nothing significant yet). The main difference is that I did put my intention on the process to a much greater degree. 

I also read somewhere that stevia is used for contraception in some cultures (totally controversial and not an established fact) so I stopped using it. I had been using it quite a bit in smoothies and coffee/tea. I'm telling you, if that turns out to have been the issue I will scream! I was trying to avoid sugar at all costs only to be undermining my fertility? So wrong! But, who knows? These days, I'm working to eat things without a sweet taste and to use honey sparingly when I really want it. Sugar is sugar, but at least the body knows how to process glucose/fructose. I figure that small amounts won't cause too much trouble. The idea is to avoid the dreaded blood sugar spikes. 

That brings me to several days ago when I realized that my temperatures weren't starting to drop in advance of my expected period. That was a good sign! Then, a few more days went by... And yesterday, I decided what the heck? Just take a test. And it was positive! I could not believe it. So, I took another one. Also positive! Seriously? Was this really happening? I stared at the sticks for a minute or so, then ran down two flights to find Cute Man. He was surprised but very happy! 

I contacted my doctor right away to ask to take a blood test to confirm. She said that it wasn't needed and that the home tests are accurate. I should just make an appointment in a few weeks for my first sonogram. Really? It didn't seem like it could be official without a doctor pronouncing me pregnant. Even so, I know in my heart it's true -- it's happening. I have such a wave of joy that has just permeated everything for the last two days. And tonight, I'm going to my very first prenatal yoga class! Is it weird that I've dreamed of going to prenatal yoga? It's like a club that I just couldn't get into. Now, I have my free pass  and I'm not wasting any time taking advantage of it! 

Tuesday, August 19, 2014

Health Coach - Part 2

I like this picture because it's from a time when movement was nothing but fun. I adored gymnastics as a kid and that joy has translated into my love of yoga as an adult. Where else do you get to stand on your head as a grownup? It's also nice to see evidence of a time before my hormones went haywire and I was just a normal, cute little kid.

As I mentioned earlier, I've been working with a health coach to try and get things back on track. Sometimes you just need a little outside perspective! It's been a very positive experience and I would recommend that anyone who feels stuck to try working with someone.

Some things I've been working on:

  • Tracking all my food on My Fitness Pal
    • This is something I've actively resisted for a long time. Finding Paleo seemed to free me from the need for this but over time, the weight has started to creep back on. Seeing my food choices documented in black and white helps keep me honest and also allows for some wiggle room for a few indulgences within reason
    • I've finally made my peace with this. I've found that tracking things really does keep me accountable. I also must do this 100% for every penny I spend so it shouldn't surprise me that it's important for my food intake as well. I feel great about it these days, which has surprised me. I've let go of the resistance and I'm just letting it be a tool that is helping me. 

  • Meaningful Activity
    • I've been focusing on walking and yoga, mostly. I'm thinking about doing a membership at a local yoga studio -- it's the only "exercise" I really look forward to so why not go all in with it? 
    • I also think sprinting (interval training) is super important. I've only actually done it a couple times since instituting it as a goal but the plan is to an interval workout once a week: 30 seconds hard; 2 min recovery. Repeat for 15 minutes. Doesn't sound like much, but it really gets the heart rate up and has great hormonal effects. I use the elliptical at my work gym and do some stretching afterwards. 
My initial bundle of consultations is now up with my coach and I'm deliberating about whether to continue. I was indeed super helpful, but it is another budget item. It's coming down to either the coaching or the yoga membership at this point and I'm leaning towards the latter. I can always seek out help again if I feel like I'm slipping.