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.

15dp3dt Second Beta (aka 4 weeks 5 days)

Second beta test today came back at 453! Woohoo!

This gives us a doubling time of roughly 42hrs, which is right smack bang in the middle of average.

Got a different nurse on the phone this time, but she sounded very positive and said "it's a good number". The relief I felt when I finally got the call was amazing. As you can tell from my previous post, I was getting a wee bit stressy about it. I was just so unbelievably happy that it came back positive that it was like walking on a cloud for about half an hour. After which time the adrenaline rush wore off and the fatigue set in.

They tested my progesterone too and it is 338 so the nurse said I should start weaning myself off the dreaded progresterone pessaries by dropping the dosage from 2 x 3 times daily, down to 1 x 3 times daily until they run out, or roughly 4 more days. Apparently I am making plenty of my own.

I need to go back in a week (next Tuesday) for another HCG test. The only way I found this out was by refusing to let the nurse hang up on me a la "just one more question!" haha I was determined to get the info out of her! Actually, I think the nurses' office must have been fairly busy, as I could hear other nurses talking to patients on their phones in the background.

I enquired about when is appropriate to enlist an ob/gyn and midwife. Nurse said that the fertility clinic has care of us until the 8 week mark which will be 29th November for me. At that time I should travel back up to Hamilton for my first ultrasound scan. Now, don't get me wrong, I cannot wait for this ultrasound. At about weeks today, I'm about halfway there. These milestones are incredibly important and hold great significance to me and my husband, and all those supporting us. But do I really want to travel over mountains for 3 hrs, have an over night stay, pay for a night in a motel, and book a day off work for two people?? Um, no. I asked the nurse if there was anything special about the ultrasound scan, and she thought about it for a moment, they said "well, there is a radiology place that you could ring and enquire if they would do it, but you would have to pay privately for it, just call and see if you can get an appointment for around the 29th Nov and then let us know so we can send a referral note through to you. They will then need to fax the results back to us." If it's less that the cost of all that travel and missed work, then we'll do it.

I keep thinking it would be great for the fertility clinic to provide a flowchart of procedures and appointments, just a general "what could happen" document. Rather than having to wrangle the info out whenever they choose to phone.

Once I got home Hubby suggested we book an appointment to see our GP this week to get his advice, as we may be able to get the scan for free??? I don't really care too much about paying for it, I just want to know that I won't have to travel. We have an appointment with the GP this Friday so I'm hoping I will learn heaps there!

Some more good news: I got my HbA1c result back. 16 Oct = 45 or 6.3% A slight rise, but this was taken after the transition to the pump (still learning) and before the application of copious amounts of crazy IVF hormones.

Not too shabby.

Went to the two elder step-kids senior high school prize-giving ceremony tonight and they both received awards! Very proud. It was cool with Hubby and I, their Mum and her parents, youngest step-son, and MIL. Some big cheers!

The school hall was packed for the ceremony and it got very hot. I was fanning myself with the paper programme, and started to get some really bad cramps, especially on the right side again but moving all over the place. I felt a bit faint, and figured I just needed to cool down and have some water. Which worked very well.

Thank you everyone for your lovely comments and support. It's wonderful to know you are all out there cheering us on! :D

Overload and low blood pressure

Just because I have not been posting recently does not mean I do not love you all :)

I have still been following you all on Reader, but I have not had time to actually write about what's been happening in my life recently. I've come home early today (Friday) and made time to write to you all!

Life has not been terribly exciting, there has just been lots of it.

I am teaching (creating) 4 papers. I am enrolled in 3 papers. Strike that, as of 2.30pm this afternoon, I am enrolled only in 2 papers. Why does it not feel like a relief? Instead I feel guilty, like I have let me tutor down :( Sigh. Move on. Can't do it all.

I have 2 freelance projects on the go, both websites. One is paid, one is done for love.

My husband and I officially started a freelance business venture together yesterday, when we got a domain name. It has now turned from ideas and conversations to "this is real".

I made plans for us to travel next August to a design conference I like to attend each year. This has been hard to plan because, well, see the next point...

The interwebs at work have only worked 2 out of 5 days this week. For-crying-out-loud-I'm-the-Goddamn-Web-Design-tutor!!!! W.T.F. Sob.

The step-kids have been going nuts. Mr 16 turned up unannounced this afternoon and gave me a heart attack when I walked in the front door to see the TV on full noise and him sitting on the couch eating my noodles. OK, that shouldn't startle anyone, but when you are having a low blood sugar, and it's NOT a kids weekend this sort of surprise is NOT OK. Miss 14 is being a whiny pain, and Mr 10 has decided to revert to the behaviour patterns of a very naughty 3 year old. Last weekend when they were here I got so fed up with the way they were treating us that I gave them a stern talk about treating us better next weekend, because we like to be around them, but not when they make our lives so shitty. I am NOT to be treated as hotel staff, and my house is not to be used as a backpackers! Grrr. (Small voice in my head reminds me that my mother always enjoyed the thought of me growing up and having teenagers of my* own to cope with, and now she has the sage advice "this too will pass") *I think this is part of the problem - they are not my teenagers, and I am feeling left out of the experience.

I am currently low, as you may have picked up from the previous paragraph-o-rama. 3.3mmol/L

I also have low blood pressure. Over the last 3 weeks Kind Nurse at my new GPs has measured my BP every Friday. It's never been above 110/60. Today it was a measly 90/60. GP has (jokingly, I'm sure?) told me that if the bottom number drops below 60 then that = death.

(As a side note: seems that the 24hr urine test I did last week has come back with acceptable numbers, just a request to check I don't have high blood pressure [duh], so that, at least, is some good news in the week. Means my kidneys are not failing as bad as the GP thought, but no doubt I will have to have an appointment with him to discuss in detail what those results mean. Hopefully I don't have to have another kidney biopsy. I have already decided that the only acceptable time for me to have anaesthesia will be during IVF! Well, one can try to make plans eh?)

It is now the weekend and I am behind in everything. I have 3 logos to design, 3 websites to create, 1 assignment due on my Diploma of Tertiary Teaching course, 2 presentations to make, dinner to conjure, house to clean, dishwasher to fix, garden to weed, washing to put in washing machine and push buttons beep beep wish-wash wish-wash...

Day 3 FSH, LH, Oestradiol and cortisol blood tests

I got up super-early this morning (for me, anyway!) so I could get down to the medlab for my 8am blood draw. It had to be 8am because the cortisol test needed to be done specifically at that time. My GP is investigating why my blood pressure is so low (100/60) especially since he wants me to put me on ace-inhibitor to help save my kidneys - which are misbehaving. I believe that if he finds a problem with the cortisol level it will indicate an adrenal issue, which could be what's causing the low blood pressure. So that could be fixed (one hopes??) and then my ace-inhibitor dosage could be increased to PROTECT ZE KIDNEYS! more. Yup.

Also did the CD3 FSH, LH and Oestradiol hormone tests at the same time, and picked up the huge bottle needed for the 24hr urine test for proteinuria - ITZ ZE KIDNEYS U KNOW!

Saw my aunt in the waiting room. She's just got new kittens! Pixie and Poppy! I can't wait to meet them :D

Oh, and then it was off to work. Last day of office work before the students come back from break on Monday.

I had sent out the grades for the students' first projects yesterday, so I was not surprised to get emails from some students wanting to discuss their grades. Of course, my most troublesome student wanted to meet. And bring her Mum.

I asked the other tutors who were in if they would take a bet on whether she would cry or not. They wouldn't take the bet. I so far have a 3 out of 3 strike rate for crying students at my desk. I go through a LOT of tissues. (Let me clarify: they don't cry cos I'm mean to them, quite the opposite. I try to put realistic pressure on them and they get overwhelmed sometimes. It is very difficult to succeed in a design qualification or career because it's so subjective. The students put a lot of pressure on themselves, and getting a low grade can be crushing for them. I offer all the support and help I can, but you can only lead a horse to water...)

Let's just say it was an emotional meeting, but she left happy.

Kids arrived this evening, but one is working and one is at a Pony Club thing, so it has just been Hubby, Me, and Mister 10 for dinner.

Retinopathy Photography and Feijoas

More good news: eyes are fine :D

This is not my retina. But mine looks a bit like that...

I am very pleased that the local eye clinic/hospital has invested in a special anti-diabetic-retinopathy-eye photographing machine, because it means I don't have to have the horrid eye-dilating drops. They sting. They make your eyes sensitive to light (light hurts them), and everything goes blurry so in the past I've had to have a helper drive me home. But no more drops! In and out in under 20 minutes! :)

First day back at work after the hols, and the building was freezing cold. Winter has hit our region with a vengeance. We've had torrential rain and gale force winds for the last 3 days. My cat went mad with the wind and yowled all day and night. Nothing could soothe him, poor thing. There was minor flooding in some places, but the wind! Two trees blown down in my street, and when I got into work today both my colleagues in the office had a big tree down in their gardens too.

I am looking suspiciously at my new fig tree. It has gone from a perfect, perpendicular happy tree, to a slanty, suspicious, "I might fall over, I might not" tree. May have to get out there and tie a rope around it to hold it upright....is that a good idea? I'm not sure...would the tree then just snap?

But winter/autumn is also feijoa season. Yum.

Here in New Zealand, you never buy feijoas. Instead, you wait, until eventually 5 people will offer you a big bag each of fresh feijoas from their trees. "Please take them!" He he he :P I've planted a feijoa tree too, and so far I've eaten 2 fruit off it. I have also stolen many fruit off the neighbour's tree over the back fence as the branches hang low into my vege garden. And I stare wistfully through the fence into the other neighbour's property, where hundreds of feijoas rain down on the dirt and don't get eaten by anyone except the birds. When the sun comes out, and the feijoas on the ground get a bit warm and start to ferment, you can see the birds walking around all tipsy. This is what my cat waits for. :P (Don't worry, he is well fed and only really catches lizards).

I got a bucket load of stuff from the pharmacy last night. Enough bags that the other customers gave me funny looks. Ha.

Top left: pen needles, boxes of Optium test strips, orange plastic case: glucagon emergency kit, Humalog pen vials (insulin), small white and orange box: statin, small white bottle: ace-inhibitor, grey pens at the bottom of pic: Lantus (insulin)

This is actually a small haul for me, as it's the tail end a the prescriptions from my old GP. And how in hell did anyone think that 2 Lantus pens would last a month? I'm using 690 units per month, and one pen only hold 300 units if you're lucky. Stupid old GP. Can't wait to put in my shiny new prescription from my new GP. :)

Took my first dose of the statin and the ace-inhibitor (to PROTECT ZE KIDNEYS!) last night, and I've not had any way-ward symptoms today.

Oh, and had an insulin disaster *smack forehead* moment when I was packing all the above diabetes-crap away. I found out that 3 vials of my oh so carefully hoarded Humalog actually expired last October. So now my stash is significantly smaller. Although I haven't had the nerve to throw them away yet....better to keep them, just in case.

Diabetes Annual Review

I've just returned from my first ever Diabetes Annual Review (DAR), for free at my new GP's office. Good golly they checked everything. It even included a smear test!

I had a bunch of blood tests a couple of weeks ago, and we discussed the findings in detail. I also got the "tickle test" (where they check you still have sensation in your feet - I was pleased I didn't giggle too much this time), the "read the letters from the chart test" (to check vision), pulses wrist and feet, heartbeat in chest and back, and liver check.

I was passing with flying colours, I even scored a brilliant HbA1c of 6.5% (down again! Yay!)

By the way, if you are a diabetic in New Zealand, or if you know a diabetic in New Zealand, get them to login to TuAnalyze and add their HbA1c data to the map! Look, we only need 12 more NZers to get NZ to light up!

But then came the bad news :(

I have proteinuria, which mean that I spill protein from my kidneys into my urine. Usually, with a diabetic, that is a sure fire sign that your kidneys are on the way out. With me they are not so sure. I had a kidney biopsy way back in '95 (I think??) and the results were inconclusive. Basically they told me that I "might just be one of those people who spill a bit of protein".

Well, with this latest round of blood tests it showed that my kidneys are getting worse. I got a microalbumin of 577, which is waaaaaay to high. All other kidney function tests were failing too. Wah. The GP has duly sent me off to get those big lovely bottles so I can do a 24hr urine collection test. (Translation: you will spend an entire weekend at home collecting pee). He said that if the protein comes in over a certain ratio, then I will have to have another kidney biospy. The biopsy itself was not too bad, but diabetes and me and anaesthetic DO NOT GOT WELL together. :( So everyone please cross your fingers that it's not a high result.

The only thing I can do to protect my kidneys is to take an ace inhibitor, like enalapril or lisonopril. I did try that a couple of years ago, but I stopped taking them after only a couple of weeks due to problems with low blood pressure. The GP couldn't believe it today when he checked my blood pressure and it was lower than before! Now down to 110/60 (and he said that the bottom number needs to be above 60 for efficient blood flow throughout the body or something, i.e. not being dead). So two things will now happen: 1) I get put back on the lowest dose ace inhibitor available, about 1/2 a 2.5mg tablet per day, and I go for another blood test, this one to check my cortisol as it may be affecting my blood pressure and making it go too low.

And the last thing? Yup, even with my good cholesterol (HDL) coming in with excellent numbers, and my ratio of HDL to LDL being great, my LDL is still ever so slightly too high at 2.2 - so he's putting me on a daily statin as well! I am awful at taking pills :( Can never remember them and have lots of trouble swallowing them :( But if it helps prevent me having a heart attack or kidney failure, then it's a good idea to TAKE THE DAMN PILLS ALREADY! (p.s. I'm yelling at myself, not at you, dear reader. Feel free to join in and yell at me to take my pills!)

Today is the last day of my mid-semester holidays and we had torrential rain yesterday and now we have gale force winds. I bought my lunch and drove down to the cliffs overlooking the beach and islands, and got actually very scared when it felt like the wind was going to tip my car into the sea. I reversed back into the hill a bit, and the car stopped rocking about like a aeroplane in turbulence. I ate my custard square looking out over the sea. It was pretty and violent and windy.

Progesterone blood testing - again

I had phoned my GP's nurse to put in a request for more diabetes supplies, and at the same time asked if I could re-do the fertility-hormone blood tests. I just wanted to check and make sure nothings changed. She was really helpful "no worries!".

So today is 21st April, which is coincidentally also my CD21, which means it's time to get my progesterone (and HbA1c and Complete Blood Count) blood draw done. I think I will wait until I've got the remainder of the hormone tests done.

One near-snafu is that the remaining blood tests have to be done on CD3, which currenlty looks like it will fall on a Sunday. When the lab is closed. Dumb.