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Thursday, May 26, 2011

Sugary Mess Part 2

Ok so I've sat down several times to blog about this. I know there may be plenty of people who disagree with me, but I still feel it's ok for me to have my own opinion as well. Ready? Here goes: I am not convinced gestational diabetes is even real.

Before you totally disregard anything else I say, please allow me to elaborate. I have researched this A LOT the past couple months from various sources, including actual clinical studies. I found three links particularly interesting. They are quite lengthy, but if you're truly interested in why I feel this way, I would encourage you to take a look for yourself here, here, and here.

For those of you who aren't familiar with GD, here's what the "standard of care" is: Around 24 weeks at your doctor's office, you are given a sugary drink called Glucola that contains 50 grams of glucose. After an hour, your blood is drawn. Some women are told to eat normally before this screening, others are told not to eat any sugar, while others are told not to eat at all (doesn't sound very "standard" to me). If your number is higher than 140, you are told you need to do the 3-hour test because, as mentioned before, this is just considered a screening.

For the 3-hour test, you are told not to eat or drink anything except water after midnight the night before. They bring you in first thing in the morning and test your blood sugar right away (fasting blood sugar). Then, you drink the same drink you had for the 1 hour screening again. One hour later, they draw blood again. An hour later, more blood is drawn. Then after another hour, the last blood draw happens. You can imagine how awful this makes a pregnant mom feel. I felt a bit dizzy and extremely sleepy during this test. They offered me a place to lie down and constantly asked how I felt (as I'm sure they understand many pregnant women don't tolerate going half of a day without any food).

Out of the 4 blood draws, if 2 are abnormal, you are diagnosed with gestational diabetes. Here's what's considered abnormal:

fasting: 95 or higher
1 hour: 180 or higher
2 hour: 155 or higher
3 hour: 140 or higher

Here are my numbers from my 3-hour:

fasting: 76
1 hour: 217
2 hour: 184
3 hour: 140

So, my fasting number was excellent and 3 hours after drinking the glucose drink, I was 1 point from having what's considered normal glucose levels. Considering the fact that my blood sugar jumped from 76 to 217 and was STILL able to come back down within a point of being normal in the end speaks volumes to me at my body's ability to process sugar.

Regardless, I was labeled as having gestational diabetes. I was then referred to a class (which lasted 3 hours) at a local gym where I was given a glucose monitor and a few supplies to get me started, a nurse spoke about what gestational diabetes is, and then a nutritionist gave me a meal plan to follow. I won't go into many more details but basically, the nurse informed us the way GD is being tested is already changing from a 3-hour test to a 2-hour test (I have no clue why) and the nutritionist could have summed up the entire hour and a half by saying, "Eat a variety of healthy foods, keep sugar and processed foods to a minimum, eat small meals often (3 small meals and 2 snacks or 6 small meals a day), and exercise." - all of which I was already doing even before I got pregnant.

I've been monitoring my glucose levels 4 times a day since last Wednesday evening - so almost a week. I decided that I wasn't going to change my diet as the nutritionist had recommended (her diet consisted of a very detailed, very confusing way to eat healthy - which I already felt I was doing anyway) and if my numbers were high, I'd take a look at the literature I was given and adjust accordingly.

What I've found? My numbers are absolutely normal with the food I've already been consuming. In fact, they're not even borderline to the limits of what's considered high. The only time my numbers were close to being high (5 points away) was yesterday - Memorial Day - when I had a cheeseburger with mayo and all the toppings, potato salad, and sweet tea for lunch and then a hotdog with baked beans and a lemon bar for dessert (45 minutes before I was supposed to test my levels) at dinner. I've also had a "Like-It" size ice cream from Coldstone (yummy!), homemade mochas at breakfast (Swiss Miss hot cocoa with instant coffee), and various helpings of chocolate.

My question to the doctors would be, if I would have skipped the 3-hour test and agreed to self-monitor the rest of my pregnancy and my numbers looked like they do, would they consider me as having gestational diabetes? I don't know if I'll get to ask this question...as I believe it's best not to make any more "waves" and just jump through the hoops. But still, it was hard to sit at my appointment today and hear the doctor say, "You definitely have gestational diabetes" but then say, "Your numbers look great" after I told him I hadn't changed my diet and not be able to feel safe discussing further why this all still doesn't make any sense to me. Have you ever been called something you don't feel is true? Maybe a liar, or a cheater? Well...being called a gestational diabetic when I feel it's completely not true stinks too - especially when I don't feel like my doctors care to take the time to truly consider how I feel about this.

Do I believe women may be pre-diabetic and perhaps it's caught during pregnancy? Sure. Do I believe women who eat absolutely horribly and don't exercise at all during their pregnancy can have larger babies? Of course.

Besides the research I've done on this topic as well as what my own numbers have indicated, a few things my doctors have said to me confirm my opinion. First, one of my doctors admitted to me that glucose levels may be normal at week 24, but then high at week 28 (this was his reason for telling me if I wanted to completely skip the 3-hour glucose test, he wanted me to self-monitor my levels for the entire rest of my pregnancy - which I couldn't financially do because the supplies are too expensive without insurance). If that's true, then couldn't a pregnant woman pass the 3-hour test at week 24, but if given the same test at week 28, not pass? I even asked the doctor this question and he replied yes. I asked why then, if a woman passes the first time, do they not ever test again? His reply was that something would show up in the urine sample (which they do every visit) to indicate something wasn't quite right. If that's true, then why would monitoring my levels the entire rest of the pregnancy even be necessary if something would end up indicating a problem by my urine sample? Not to mention, what if I had taken the screening and the 3-hour sooner? Due to all of the miscommunication (from my "Part 1" blog about this), I didn't do the 3-hour until I was 30 weeks. Perhaps I would have passed if I would have done it earlier...or later...if glucose levels can and do change.

Secondly, another doctor told me there have been women whose blood glucose levels, after being diagnosed as gestational diabetics, have been completely normal and he wondered to himself if they really did have it. My guess? They didn't.

I guess for me, relying on a one-time test to diagnose something such as this during pregnancy when hormones and blood volumes are constantly changing, makes no sense - ESPECIALLY when some OBs (thankfully, not mine) standard of care for women labeled with this is to induce and perform late ultrasounds to determine the size of the baby (which aren't very accurate) which leads to induction which leads to a higher chance of cesarean. Not to mention, normally the babies are pricked and prodded a lot more after they're born. This diagnosis carries many negative possibilities for both the mother and the baby. Because of this, I feel it's imperative that the way it's diagnosed is seriously reevaluated.

There's a lot more I could say...but if you're still reading, you probably don't have much longer before you give up. Congratulations on making it this far.

Wednesday, May 18, 2011

Watery Mess (hopefully there is no part 2)

Sooo....last night, I walked into the living room to get the laundry out of the washing machine and found water covering the floors of our dining room, kitchen, laundry room, and slowly creeping into our living room. Apparently, our washer forgot to STOP filling up with water during the wash cycle - for over an hour. We didn't notice because we were in our room watching TV.

I called my parents. They have a rainbow vacuum that can suck up water. But we're talking A LOT of water here people! But, what else were we to do? We couldn't go to sleep with an inch or so of water covering our floors! My dad headed over. Then I called our friends who lived about 5 minutes away, the Barnetts. They had TWO huge shop vacs...lifesavers! So at 10:30pm, Creed graciously came over with the shop vacs and him, Septtro, and my dad did all they could to dry out the floors. We do have engineered hardwoods in our dining room and living room so that was definitely a concern.

The water ended up in our master bedroom closet and bathroom as well as a little bit in the hallway. Honestly, I found myself surprisingly calm. Perhaps all these experiences of things not going according to my plan during this pregnancy had helped prepare me for this? :)

The guys finished about 1:00am. This morning, Septtro called our insurance and they sent a restoration company over. The estimate? Well over $4,000...not including a new floor and a new washing machine - if we needed one (insurance won't cover the washing machine since it caused all the damage but should cover anything else that was damaged because of it). They will cover the hardwood flooring but it's not been determined whether or not that can be saved (the ceramic tile will be fine).

So my day today was not quite spent how I had planned. I had carpet pulled up, fans everywhere, my entire master closet emptied into my bedroom, baseboards taken off the floors - not quite the place for a toddler. Not to mention, I can't do ANYTHING in my house while this is going on. Everything is misplaced, dirty, and unorganized.

Here are the positives:

1. This could have happened while I wasn't home or even while I was by myself.
2. Tax return (not exactly how I would have liked to spend that money but God provides doesn't He?)
3. Ri slept part of the time the clean-up was going on last night and went back to bed very easily
4. After our deductible, insurance should be covering everything with the exception of our washing machine

So here's what my house looks like now. And I imagine, it can only get worse these next few days with the floor being torn out and more baseboards being taken apart. But, I keep reminding myself it's only temporary and one day, I'll have my house back. And what a blessing it is to even have a house...and insurance!

Those two huge red things are dehumidifiers.


This is the kitchen and the doorway into the laundry room (and pantry). These two rooms got the worst of it. The guy that came today had to drill holes in my kitchen cabinets at the very bottom so they could blow air in under the cabinets to dry out everything.


And this is our bedroom. Our master closet floor had to be cleared out since there was water in there. Guess it's a good reason to go through everything and do a lil spring cleaning!


Apparently the humidity level in the house was 70% - kinda high. We have fans and dehumidifiers that will run for at least 3 days - possibly more. I'm still trying to figure out how to handle Ri during the day while all of this is going on. But, as I've been learning, God is teaching me to be flexible....VERY flexible - and to trust that He's in control.

Sunday, May 15, 2011

Slide!

Ri loves the slides - or "side" as she says - at the park.
Published with Blogger-droid v1.6.9

Saturday, May 14, 2011

Sugary Mess - Part 1

So, the past couple of months have - shall we say - stressful as far as my prenatal care is concerned. I've told some people bits and pieces so here's everything that's happened:

The week before my OB was going to the 1 hour screening for gestational diabetes, I asked the doctor I saw that day about skipping it. I was told it was mandatory. I assumed that meant if I didn't get go through with it, they'd drop me as a patient and as much as I'd like to say I wouldn't have cared, from all the research and all my (limited) options for a vbac, I was at the best practice - and hospital (which is very important too) for what I wanted. I should have asked the doctor to elaborate on what they meant by "mandatory".

The next appointment came, I drank the nasty glucose drink and had to wait an hour before getting my blood drawn. In the meantime, I saw a different doctor (as they like to rotate so you can see all doctors - in my case, only 3 total - before delivering). I spoke to this doctor about how I wasn't thrilled about having my hemoglobins checked every other visit as they routinely did if there was no other concerns pointing to that need. I explained I just wanted everybody to be on the same page and didn't wanna surprise the nurse again by refusing it and could we come up with a plan to put a different schedule on my chart. I wasn't opposed to checking - but every other visit seemed a bit much; especially when I'm paying for it. The doctor agreed and said we came up with a plan. This doctor seemed very open in saying, "I don't want you to ever feel bad about refusing a test. There are very little things that are mandatory. If you refuse something, we just have to document it for our own safety (lawsuits...yeah, I knew that)." I then explained I was told the previous visit that the glucose test was mandatory. The doctor replied, "Well, that's probably not the best word. Yes, we recommend it. But we've had other women refuse it. If you want, you can refuse the blood draw. But since you've already drank the drink, why don't we just see where you are?" I explained that even if I went ahead with the 1 hour, no matter the results, I'd refuse the 3 hour. He didn't so much blink an eye at that.

I was very concerned that IF I went ahead with it and IF, for some reason, it came back indicating I had gestational diabetes, they wouldn't be as supportive of my vbac. The doctor assured me that wouldn't happen. So, what did I have to lose right? I went ahead with it.

But I didn't want to. I'll explain why later.

A couple days later, the nurse calls back to tell me I didn't pass the 1 hour screening and needed to take the 3 hour test. I told her I didn't want to. She explained "this is how we do things". I told her I understood but I had spoken with the doctor and I didn't want to take the 3 hour test. She asked which doctor, I told her, and she said she's speak with them and call back.

A week later, the nurse calls back. She says the doctor told her they believe I should go ahead with the 3 hour test and would I like to schedule it. I replied, "No, I would not". She then said, "Ok, the doctor said if you said that, they want you to come into the office and speak with them."

What?!

At this point, I'm thinking the doctor was backtracking. Now I REALLY didn't want to do the 3 hour test. Because even though they previously said they'd still support my vbac, he also said I could refuse the blood draw from the 1 hour screening. And if I had just done that, no one would be any the wiser and we would be going along our merry way. So how am I to trust that they'll REALLY be supportive of my vbac if the 3 hour test results come in as unfavorable?

I asked Septtro to come with me - hoping that would help the doctor know I had his support and I wasn't just some crazy woman refusing tests left and right at the risk of my baby.

When we saw the doctor, he had a VERY different tone. He went on to say that he just didn't understand why I wouldn't want to go through with the 3 hour if all it would do would benefit my baby. I explained that, with a toddler, it's not exactly fun to find a sitter for very early in the morning for several hours AND have to go without eating for half a day while pregnant. I went through that with Ri's pregnancy and it was not fun - oh, and I passed by the way. Not to mention, I don't want anything permantly on my medical charts such as "gestational diabetes" that could somehow affect my future births. I don't know how insurance or laws may change in the future. And I don't want a diagnosis (that I don't feel is accurate - like I said, I'll get to that later) preventing me from doing what I feel is best for my health and the health of my future babies. I also said I had done research and didn't find any significant risks to not going through with the test. The doctor's reply??? "The risk is that your baby can die".

Wow.

The doctor went on to explain how if gestational diabetes goes untreated, the baby can be too big and their shoulders can get stuck (shoulder dystocia) and they can suffer permanent damage to their shoulder and/or arms or even die. (Scuze me but have you ever heard of the Gaskin Maneuver? Not to mention, there are MANY reasons for shoulder dystocia (although many times, it cannot be prevented) - including getting an epidural. But do they warn women of that before administering the epidural? I know I wasn't. (source)

So we went back and forth as pleasantly as possible until I finally said, "Could I just monitor myself at home?" This is what they would ask of me anyway (as well as going to a class on gestational diabetes and having a nutritionist give me a strict diet) if the 3 hour test came back unfavorable. "Sure" was the reply, and then "but I would just think that'd be more of an inconvenience than doing the 3 hour test". I explained that if I could eat my normal diet, not have to find a sitter for my child, drive over to the office an extra time, and not fast for half a day, I found that to be much more convenient. He said he'd like to see the numbers for a week. A week? "Interesting", I thought, "as your office relies on a one-day test before slapping the label of gestational diabetes on a pregnant woman. A test that gives a sugar shock to a pregnant body and isn't even close to their normal diet." Oh well, I can prick my finger four times a day for a week...no biggie.

My next regular appointment was less than a week away. I went to the local pharmacy and got a glucose monitor that was on sale. I didn't open it as I wanted to speak with the doctor (a different one, again...the 3rd one) about how exactly how they wanted me to go about this at home.

Almost immediately upon this third doctor entering the room, he asks, "So what are we going to do about this glucose test?" I replied that I wanted to monitor at home. He didn't seem too thrilled with that idea. He went on to explain that "this is standard practice with OBs across the country". Excuse me while I don't currently agree with "standard practice". "Standard practice" used to be to completely knock out a laboring woman, automatic enema, shaving....

That's another blog.

This doctor's tone was very harsh, I might go as far as to say, condescending. I was then told that if I wanted to do self-monitoring, that I would have to do it the remainder of my pregnancy. I explained I was previously told a week - to which I don't remember getting a reply. I asked why, if my glucose numbers on my normal diet looked good, would I need to continue monitoring the remainder of my pregnancy. "Oh, because, for instance, at week 24 your insulin levels could be fine but then at week 28, they could be higher". This is true because of the placentas role during pregnancy as well as increased blood volume.

Interesting. So I asked, "Well then what about the women who pass the 3 hour test at 24 weeks. You don't ever test them again."

"Right, but in those cases, their urine sample would indicate something was up".

Oh. So my urine sample wouldn't? I didn't ask this. Like I said, he was very harsh. And I was by myself. He had on scrubs...and a shiny stethoscope! What did I know?

I think towards the end, he was starting to get annoyed and said, "If you don't monitor at home the rest of your pregnancy or do the 3 hour, that will affect how quickly we pull the trigger during labor". Thanks doc. That's super-duper encouraging!

Honestly, I didn't wanna monitor for the rest of my pregnancy. That really wouldn't be all that convenient. I wish I would have, though. I just felt like he was trying to make any alternative other than the "standard practice" of the 3 hour test such a pain, that I would ultimately choose the 3 hour test. So...I did.

I never was eating a lot of sugar during this pregnancy...I prefered fruit. In fact, for my birthday, I asked my mom to make fruit salad in lieu of cake. Especially because I'm at home, my food choices are limited and have been much better than with my pregnancy with Rilynn. I always eat whole grains, usually a snack consisted of an apple or some yogurt, I walk about 6 miles a week, I've gained near 20 pounds less than I did at this point with Ri, and I drink mostly water. The week before the test, I completely cut out sugar and tried to eat as much protein as possible.

I went in for the 3 hour this past Tuesday morning. I got dizzy and felt very sleepy. But thankfully, the time passed fairly quickly. Wednesday evening around 5:00, the nurse called. I failed.

And I lost it. I didn't expect that. And I didn't want that label.

The nurse said my first number (fasting level) was good. But after I drank the drink, my levels shot up REALLY high. Shocker...my body had nothing to eat since 9pm the night before and hardly gets sugar and then all the sudden, gets a drink full of it. Well once that number was that high, I was shot. There's no way the other two numbers could come down fast enough to be within their range limit. I never did get my 4th number but she said because my 2nd and 3rd numbers were too high, it didn't matter.

So...that's what's happened so far. I have a lot more to say about how I feel about GD after researching it from various sources...but that's another post. And then there's how I'm handling this in my relationship to Christ. That's another post too. :)