Tuesday, April 29, 2014

29w4d Scan and stuff

I am on a two week mid-term break from work at the moment, so no teaching. But there are so many appointments and baby-things to do that it's not exactly a restful time either. I will try and put this down in the right order but things are starting to just become a big ol' blur!

Since my last post the weekend before Easter (when I got sent to labour and delivery for a minor bleed on a Sunday night 13 Apr) I took the Monday off work to rest up and recover, then on Tuesday morning I phoned my diabetes nurse educator (DNE) and told her what had happened and do a pump download. She promptly got me an urgent appointment with both her and my OB for Wed 23 April. She saw that my blood sugar levels were too high (averaging about 10 - 13 mmol/L semi-constantly) and was worried that this may have contributed to the bleed. She also saw that the tests the midwife had taken on Sunday night hadn't been entered in the hospital database and asked me to pop into hospital on my lunch break to re-do tests including a complete blood count and urine test for infections.

The Wednesday appointment was good, if for no other reason that getting two of my 3 medical care team in the same room! The OB took my blood pressure (118/73?? slightly elevated for me) and blood/ox (95% slightly low) the measurements were so out of character for me that the OB tested the machine on himself! That was like the highest BP I've ever had. But I know why... it was raining, I was stressing about my blood sugars and getting to the appointment, and having to reschedule the class I was teaching. Oh, yeah, and I was having another bleed just before leaving campus for the hospital! The OB basically said that since the bleeds were so minor, and apart from slightly elevated white blood cells, and slightly weird BP and blood/ox readings, and slightly raised blood glucose, everything was fine and there was no sign of any definitive problems. He wasn't fussed and put my mind at ease :) saying that some women just have bleeds, and that it could be the placenta previa??

My DNE took me up to her office afterwards, which is just two floors above antenatal clinic, and we went through my blood sugar CGM graphs with a fine tooth comb. I made another bunch of changes, and they seem to have worked out ok. Well, better for now, but things are requiring constant adjustments.

That was the last week of term, and the OB had speculated that it may just all have been caused by stress. An excellent time to have two weeks off!

First week of the hols was supposed to see me have a midwife apt, growth scan, and OB apt.

The appointment with my midwife was supposed to be on Easter Monday 21st April. And I promptly forgot all about it and we went out to have morning tea with friends then have lunch at a cafe instead. I felt VERY guilty when I looked at my phone and saw all these missed messages! Whoops! Brain fade. Got it rescheduled for later in the week.

In the meantime, on Wednesday 23rd April, I had my first growth scan ultrasound which was done at the hospital, and that was followed by another appointment with the OB.

At the growth scan we got to see Tiny Fish looking happy and healthy, with a good heartbeat of 142bpm. Growth sitting at 1417g which places in the 61% percentile. That lines up with what the midwife had measured with the tape measure at previous appointment. Baby was facing towards my spine with head down. Thankfully, we were able to see that the placenta had well and truly moved up and back, right out of the way. No more placenta previa hooray! This means I now have the opportunity to give natural delivery and/or induction a go.

The scan itself was quite quick, and Tiny Fish seemed too big to fit in the picture nicely like had done in the past. And was hiding and squirming about making it nearly impossible to get a nice shot of the head. Here are the pics:

This is, believe it or not, a front-on shot of the head. It is upside down, with the nearly horizontal curved line in bottom-centre of image the top of skull. See the two white horizontal lines on the left of image? They are pointing to Tiny Fish's chin. You can kind of see the right eye socket, and some smudges where nose and mouth are. Tiny Fish was head down way down low, and did NOT want to be photographed thank you!

This one is easier to understand. It is a whopping great foot. See the two little cross-hair markers, those are the heel (top) and toes (bottom) and it is nearly 6cm long! Wow that is big!
The OB appointment was good, and after the Dr talked for a little bit and made happy noises about no more bleeds, that I was looking better, and my blood sugars were now averaging much lower, I made sure to ask a bunch of questions:

  • Can I keep my pump and CGM on during labour? Yes, that sounds like a good idea for you to do that.
  • Is it possible for me to avoid an induction, as I have read that artificially induced contractions can be much more painful. Plus I don't really want the additional risk of more interventions - specifically a c-section. Yes, if you spontaneously go into labour before 40w, and you are both still healthy then that should be possible. Ideally you would start or be induced between 38 - 40w. But you can't go longer than 40w. That's the max.
  • I want to restrict who will have management rights of my diabetes, will that request be respected? Yep we are happy to work with you.
  • Can the IV line be placed nice and early in case I need dextrose / glucose? Yes.
  • What is causing the nerve pain in my thigh? That's your femoral lateral subcutaneous nerve.
  • I had more questions to ask, but silly me didn't actually pull out my phone to look at my list. D'oh. Oh well, next time.
Yes, this post is continuing... feel free to reach for some snacks and refreshments. You deserve some form of chocolatey treat for reading thus far!

Thursday 24th April rolled around and I decided to bake a cake to have ready to come out of the over at just the time when my midwife was due to pop round. What a coincidence! I was thinking that would be a nice touch since I had stood her up on Monday :P

Well, cake was delicious*, but midwife didn't get any of it cos SHE forgot! hahaha We figured that she had been called to a birth as she told me when I rebooked the appointment that that could happen. No drama. More cake for meeeeee! *it had ganache om nom nom.

The step kids came for the weekend and we had some family in from out of town. We went to the 10am ANZAC Day service at the Cenotaph, then took poppies up to Hubby's Grandfather's grave. I Facebooked my midwife and she phoned up terribly apologetic to have missed our apt and we got another one scheduled for tomorrow. Third time's the charm!

Oh, and yesterday I lost my sh*t for the first time in this pregnancy journey. It wasn't a bleed, or blood sugars, or even concerns about whether I will make a good Mum. It wasn't worries about breast-feeding, or how my diabetes will be managed in labour, or what it will be like to leave my job and go on maternity leave. No, all of these things are scary to a certain degree, but have not yet freaked me out.

So what did it?

I feel silly admitting this, but I lost the plot over our earlier purchase of stroller and capsule. See, I was thinking how the capsule didn't have much/any real padding in it and from there it was a short trip to looking at online safety ratings websites and finding that our capsule wasn't listed at all. This did not give me a good feeling and my instinct was that I needed to get a better capsule. The stroller is ok, not great, but I could live with it.

Then things got awfully complex quickly, since that particular model of stroller and capsule are designed to go together, and capsules with higher safety ratings wouldn't fit in the stroller at all. Not even with adaptors. The old capsule we thought had the option of getting a base as the lady at the store we got it from advised us, but when I called the shop they said no, no base to go in the car. Boo. And then I started thinking about how hard the stroller was to fold up. And I wanted to get rid of them and start again. It was a difficult thing to admit because a) I felt stupid b) I felt like I was making a fuss c) the items in question were not broken and would probably be perfectly fine d) Hubby didn't understand, initially, what I was trying to communicate, which upset us both e) I was incredibly confused about what I actually wanted to do to remedy the problem - or even how I defined the problem in the first place.

But once I got my ducks in a row and explained my worries more clearly to Hubby, he was lovely and understood my sometimes awkward feelings-logic.

The end result is that we will look at either selling the current stroller and capsule (about $300 worth) or if we can't then may keep them as spares. I have selected a top-ranking capsule which was an absolute bast4rd to get a stroller to fit it, however I had a ray of sunshine from a local store owner who actually knew what she was talking about. I visited her today and she presented a plan of attack to get the capsule I want with a base that fits in my car (we can hire this for 6 months), with a fantastic new stroller that is easy to fold up. Just waiting on her to order the adaptor and check that the two items will indeed marry-up. Other than that, it looks like a go. So you will get pictures of said stroller etc once it's all done and dusted :)

I know I have been stingy with the belly pics, but it is nearly midnight and I was awake until about 6.30 AM!!! last night (3 x lows, 2 x pee trips + lots of general aches and uncomfortableness) I saw dawn. So I am too tired to take photos right now. I promise to take some more but I will probably just post them to my twitter feed - you can get that over here in my sidebar - - - - - - - - >

Got my HbA1c results in, and even with that spell of higher glucose results, I have dropped ANOTHER mmol/mol:

Don't you dare call me normal.
And now my brain is feeling really scattered, but I will just tack this on the end. I promise, it's the last thing:

I had a bit of a scare on Saturday night when my blood sugar came down from a high to normal reasonably fast, over about 2hrs, and I noticed an anomaly in the vision of my right eye. I was trying to read the fine text on a Beatles album cover that my step-daughter was playing, and I noticed this blurry fizzing shape that was tracking with my vision, just to the right of the centre of focus.

Because I have a Dad who had detatched retinas, and because I am a pregnant Type 1 Diabetic, all these warning signs lit up in neon and screamed OH-MY-GOD-YOUR-VISION-IS-CRAPPING-OUT!!! Followed by a whispered ***don't panic, it's Saturday and no eye place is open now. Just be calm, be calm, and call them on Monday morning***

I called my optometrist first, noting that ironically I have just had my diabetic retinopathy screening within the past 3 weeks and got the all clear. They explained that I needed to see an opthalmologist, and to go via my GP to get a referral. I called the GP's nurse/receptionist and we both agreed that I may be able to phone the opthalmologist directly and get a private appointment quickly. Nope. They were booked up and short staffed and the only was in was for me to go to the GP and get an "acute referral". The nurse phoned me back and said, sorry, you'll have to come in for an appointment. So I did that yesterday (Monday), and the GP had me lay on the bed while he shone the light in my right eye, checking the blood vessels and looking for signs of any pressure or damage. He found none, and declared my eye ball perfect, like that of a 10 year old, and said I didn't need to the urgent appointment since there had been no change in 48hrs. Although he did say to monitor it like a hawk and any change at all I could get the referral letter in a flash. It's still there, but no change so far. I am wondering if I should go back to my optometrist anyway?

So yeah, it's been a busy 3 weeks.

Sunday, April 13, 2014

27w2d First official trip to maternity

Okay, so you may remember that at about 12w I had a minor bleed and ended up in the emergency room in the middle of the night? Well, this evening I had another, very very very minor bleed.

It took me all of 3 seconds to argue with myself about whether or not to call my midwife. I lost that debate and texted her immediately. I knew with near certainty that everything was fine, but bleeding is literally at the top of the list of things to call her for. And last visit she had drilled all the signs of pre term labour into me. And she would have my head on a platter if I didn't call her. So. I behaved myself and called.

She was really lovely and concerned, but it is always a hyper-awkward conversation discussing the intricacies of a bleed. Look away now cos TMI coming up....

... Went to the loo and wiped, got a mixture of pale pinky brown mucus type blood and also some bright red fresh blood. But only a super teeny tiny amount. And baby was (is) moving. And I felt fine. Well, sore lower back which is kinda new, and oh shit isn't that a sign of pre term labour? Yes, txt the midwife!

She let me know that I needed to go straight up to labour and delivery. She would call ahead for me, and that I would most probably have to stay in overnight so pack a bag. I am sooo thankful that we live less than 2mins drive from the hospital. Can see it from the road out front of our house. Comfortingly close.

Hubby was out of the house with the 2 younger step kids (eldest has gone to college last week!!!!) and in characteristically he had left his phone on the armchair. So I was just about to call step-daughter to try and get hold of him when they pulled up in the car. He helped me pack, grab extra supplies for the pump and Dex, and we both kind of felt a bit of nerves about having to go up there and the enormity of maybe needing to stay overnight. Serious stuff. But we were calm.

We got up there and met with the on call midwife, S. Ours was 40mins away and didn't know whether it was serious enough to warrant her coming in. S was lovely and looked after us very well. She made up a room for us and got me to do a urine sample, then took my blood pressure and hooked up the CTG monitor to check baby's heartbeat.

Everything came back fine and normal. We got a good long look at Tiny Fish's heartbeat sitting around 120 - 140bpm. There was also heaps and heaps of fetal movement. It seemed that Tiny Fish took an instant dislike to the CTG monitors strapped to my belly as he/she kept trying to kick it off!

Hubby ducked out the room to go to the bathroom and there was drama in the corridor as a lady got wheeled in a wheelchair at top speed towards a delivery suite, right past him. She was screaming some mighty screams - arrived right in the nick of time by the sounds of it!

After S switched the monitor off cos the results were perfect, showing no contractions and a very good heartbeat for bubs, we had to wait a short while for a doctor to arrive to do the exam. We used the time to install a new Dexcom sensor since is taken the old one off that arvo, after 21 days of brave and valuable service.

Then Dr K arrived and asked a few more questions. S prepared me for the exam with a sheet overtop and it was actually quite a hilarious event as all four of us were laughing and joking about how with S doing the exam (training) that she was going to put all the doctors out of a job! Hehe

It was over quickly and the good news was my cervix showed no signs of dilation or any serious bleeding. The urine test came back negative for bacteria so that helped rule out a bladder/kidney infection. They concluded that we may never know what caused the bleed, although the low lying placenta could be a potential cause.

I am intrigued to realize that both this bleed and the previous one have been right on the cusp of a change in trimester. Maybe it's partially a hormonal fluctuation causing it? Maybe it's exhaustion, or blood sugars (had a few more lows overnight, but a bit high today, generally ok though, just done a big set of pump changes with DNE) or maybe it's a delayed reaction to having the flu shot and whooping cough vaccination last week. Who knows.

The good news is that all is well, and even if I feel a bit ridiculous traipsing up to the hospital I am very relieved to know for sure that it's all well and good. Tiny Fish is happy in it's apartment. :)