October 26, 2009

GD - Appointment with the Nurse!

Met with the nurse today at the Diabetic Center (I typed "fertility" instead of diabetic and had to correct myself - haha... once an IF, always an IF!)

Before getting to the discussion of how it went... I feel overwhelmed! I have cried my eyes out at least 4 times in the last whole week. I don't know what I am crying for (I am crying for anything and everything)! I know GD is not a super life threatening issue, but I feel like I have lost control over one thing I knew well - how to eat! I am scared to eat any carbs, and that's not how it should be... I need to eat carbs to keep functioning and for the babies to grow well, but I just feel like I don't know how much I need and how much I don't! On a general basis, I would have been able to control what I eat... but in this case, I just don't seem to figure out how much is enough!

Anyways, the appointment went well! It was pretty informative. We went over a few technicalities (the info that is generally found on the web)! I was given a diabetes monitoring kit (Accu-Check Aviva - yay for more poking)... I have to monitor: before breakfast and then 2 hours after breakfast, lunch and dinner (total 4 times a day) and then I have to check for "Ketones" in my morning urine sample! This was the one which startled me a little bit. In the last whole week of not knowing what to eat, I have probably been eating less carbs! When one is deprived of carbs/glucose (instant energy supply), the body acquires the required energy from your fat reserves... fat is broken down, energy is released and the by-product is Ketones. This spills in to the urine... it can also pass through your placenta and reach the baby. It is suspected that excessive Ketones can lead to learning disabilities in babies (though this has not been completely proven either ways)... so they prefer not to feed the babies with Ketones. Typically, if one has not consumed enough Carbs (and does not have a sufficient glucose supply) during dinner... during the long fasting night period, the body will try to access the fat reserve and Ketones will be found in urine the next day (One could be gaining weight, while not consuming enough carbs... and then loosing some of the weight (fat reserve) and releasing Ketones in the system)! When we checked for Ketones at the center... it was detected in my urine sample (almost 1.5 hours after a cheese sandwich breakfast)!

With the whole insurance issue, we have decided that we are seeing a dietitian outside the diabetic center I went to today. This person works at another diabetic center (catering towards pregnant women, infants and children), but also runs her private practice/service and will cost us almost 1/4th of what we would be paying at the diabetic center I went to today. She seems experienced, knowledgeable and approachable... so hopefully we will be satisfied... and if we are not we can always pay 4 times more and go back to the diabetic center. So the appointment is on Thursday, October 29th! Hopefully this will ease my mind. My DH is accompanying me and hopefully he will grasp everything that I loose by being overwhelmed! Hopefully with all the monitoring and diet control... we should be okay in the long run!

Also, October 30th is my first Cervix check! Hoping and praying that everything looks okay! I will also get to have a quick peak at my babies! :)

October 23, 2009

GD Results

After some waiting, panicking, crying, waiting and some more waiting... finally I got the results today! I had to call the lab to make them fax the results to the OB, because I was not willing to wait over a week (as of tomorrow) for my results to reach the OB (in mail)... I guess I still expect my RE's fast service and coordination! So here it is...

Fasting (cut-off: 95 mg/dL) = Normal
1 Hour (cut-off: 180 mg/dL) = 118
2 Hour (cut-off: 155 mg/dL) = 190*
3 Hour (cut-off: 140 mg/dL) = 108

If two values are higher than the cut-off value, then the result is a "Gestational Diabetes" (GD). So according to my OB, my results were weird. I was normal all the way up to the 2nd hour test and then I spiked (190*). Since two of my results are not exceeding the cut-off, I am not classified as a GD patient, but when one of the results is abnormal (high), they treat the patient like they would a GD patient. Though, I can choose to start monitoring now... or wait till around 24-28 weeks, perform the 3 hour test again and then go from there. Being the obsessive compulsive IF that I am, we are going to start monitoring NOW! I called a diabetic center that the OB recommended and am waiting to hear back from them about my insurance acceptance et. al. But the idea is, assuming I can go to that center... I will be going in to see a nurse and a dietitian. I will be monitoring my blood glucose 4 times a day and will have to follow a diet recommended by them... and they will be testing me for some other stuff. My OB said, that GD normally does not cause any harmful effect on the baby or mom this early in the pregnancy, so there is nothing to panic about! So, lets see how things shape out from here. Thanks for all your comments and for following up on my results.

About our SUV hunt, we did test drive one and did like it... but we are looking at buying a 1-2 year old certified pre-owned (CPO)... so we need to look out for some good deals. I just don't see a point in buying a brand new car and loosing 5-10k on it as soon as we drive out of the dealers parking lot! So it will be a few months before a car lands in our drive way!


Insurance Update:
So, it seems my insurance covers the consultation with the nurse but not the dietitian part! They would have covered it had I been a real diabetic! If I want to pursue this further, I need to appeal to the insurance company... which every one knows is a waste of time... It takes 2-3 weeks for them to acknowledge the receipt of your appeal after which they will move ahead with whatever steps they need to take (with no guarantees). What is the point of an appeal if half the time of the remaining ~20 weeks (hopefully) of this pregnancy are gone in these legal matters? I plan on speaking with my OB and will see if there is a way to work around this. Our other options are to suck it up and pay some $700-800 of the consultation fees with this diabetic center... or seek another cheaper dietitian outside the center... I have spoken to one that I like. We will be making a decision about the dietitian early next week after speaking to the OB and the diabetic center nurse (the appointment is on Monday, October 26th)! I don't wish to take this lightly... diabetes runs in my family and with PCOS, I am at a higher risk of having a proper GD!

October 16, 2009

Off to a 3 hour Glucose Screening...

My GD results back at the OB's office came back higher than we would have liked it to be (144)! So, I am off to the 3 hour Glucose Tolerance Test tomorrow morning! Not something I had hoped for, but I guess I am willing to check and take every possible step to keep this safe! Wish me luck!

October 15, 2009

14 Weeks Today!

Yesterday was my second OB appointment at 13W6D. Each passing day makes me a little bit more comfortable with the idea that I am PG... I guess I am just a worrier! Not much has happened in the last 2 weeks, though time sure is flying by!

A summary of the OB visit: NT scan results came back as 1 in 4,200… so the chances of having a baby with DS are pretty low and we won’t be testing any more. My TSH levels have dropped to 0.9 (from 3.6) and the OB decided to redo the b/w to see what is going on. If the levels are still low, I will be stopping my TSH medication (Levothyroxine) and we will be monitoring the levels. I was tested for Gestational Diabetes and am awaiting the results. I hope I don’t have to deal with GD! If the results are negative, I will be tested directly at 28 weeks.

Ultrasounds: I scheduled for the cervical check u/s! The first one will be at 16W1D and will continue thereafter through the pregnancy (every 2 weeks). I am glad that I will get to see the babies so frequently… hopefully that will reduce my anxiety! I also scheduled for our anatomy scan. We will know the sexes a day before Thanksgiving (November 25th at 19W6D)! Besides figuring out a day before the holidays, I am also hoping that I can get some good Thanksgiving deals. I am not very big on sticking to pinks and/or blue, but I would definitely like to have a tinge of it in the decor and clothing. Our spare bedroom is colored blue (by the previous owners)… we might not do anything if it is 2 boys… but it if is 2 girls or a girl/boy combination, we probably will repaint and make it neutral.

I can’t get myself to start shopping yet, but we definitely have been trying to narrow down on the items we need to get. We are planning on test driving a SUV this weekend (I am reluctant to become a minivan driving soccer mom… let’s see how far I can hold up on that! :)), so we can at least make up our mind as to what we want to get. We currently share a 2 door car and that is definitely not going to work (space + safety)… so we have to buy a car before the babies arrive. I have looked at all cars (of course online) of all shapes and sizes and prices over the last 2 years (and have probably mentally owned each one of them), but have kept on delaying on buying one… it was that one thing we wanted to wait till we figured out that we were PG.

We told a few more friends yesterday! And we also told my Grandma! She was on cloud nine after hearing the news… she told my Mom that she felt like dancing (She is almost 80 and has trouble walking!) :) I hope she gets to see her first great grand kids and can spend some memorable time with them as they grow.

Life Before Birth - The Fetal Senses

I came across this article yesterday and thought of sharing it... The Fetal Senses: A Classical View by David B. Chamberlain, Ph.D.

Most of the items discussed in the article we probably already know, but it is interesting to read the timeline and the science behind it. The article describes tasting, smelling, listening, hearing, vision and senses in great detail.

October 3, 2009

An Update: OB, 12 Weeks, NT Scan…

Yes, I am 12 weeks 2 days today! Every week is a milestone and I am glad to have reached where I have! You girls have been the greatest support in the journey thus far – Thank you so much! This is going to be a pretty looong post. I haven’t quite posted much in the last 2.5 weeks and there is so much I want to say. I am going to try to keep it simple by putting up some bullet points! Here goes…

• I had my first OB appointment at 9W5D. We absolutely loved him (as mentioned before I was planning on changing my OB because my previous OB did not go to the hospital I wanted to go to… with twins, we definitely need access to a hospital with a level III NICU – I hope we never have to use it though). We spent around an hour + at the doctors office discussing our history, current status and all our options. He is very friendly, comforting, and as much as he has firm opinions about certain things, he is very open to listening to your concerns and discussing issues. I am very uncomfortable with doctors who won’t listen to you and will shove their decisions on you…. So far, I think this doctor is wonderful! My next appointment is at 13W5D.

• The doctor performed an u/s, but his machine was very old. Nevertheless, it was an u/s, we saw the babies and heard strong heartbeats! The doctor does not perform actual high def u/s at his clinic; I will be going to the hospital for u/s.

• I will be tested for gestational diabetes (GD) at my next OB appointment. My insulin has been at the higher end of normal range (PCOS!) and I was put on Metformin during the fertility treatment. Hopefully, I will pass the test. Depending upon how things go, I may be monitored more frequently.

• The OB discussed about vaginal vs. c-section deliveries for twins. Vaginal deliveries are possible for twins but things can change at last minute (as last minute as – one baby is out and the other baby moves and is in an unfavorable position). As much as I would love a natural birth, I think 95% we are going for a c-section!

• After my “scared” post – my cold lasted for around a week (reducing day by day)… I did not get any fever and the sore throat was very intermittent… fortunately, drinking warm water helped, I did not end up taking any other medications. Though, after the scare, speaking with my OB and going through several medical websites, I decided on taking the flu vaccine! And I will be getting vaccinated for H1N1 as well!

• With all the twin PG blogs I am following, most seem to have issues with their “cervix”. That is incompetent cervix is very common and most gals end up with a cerclage and bed rest. I was given an option (by the OB) to monitor the cervix every two weeks starting at 16W. I have to tell the OB if I choose to monitor - and of course my answer is yes! It also means that I will get to see the babies every two weeks starting at 16W.

• I had my NT Scan yesterday (12W1D)!!! From 9W5D to 12W1D was a very long haul! The last few days, I was very anxious and a complete nervous wreck… it was around 4 weeks since a proper u/s (last one at the RE) and I was praying hard that all readings would come out with in the normal range. But, I was a happy gal by the end of it! Things looked great, the babies measured 12W3D and 12W4D, with a heartbeat of 160 and 162. The NT measurements were below 1.4. Honestly, the technician was going so very fast that I lost track of the exact readings! The technician could not see any source of new bleeding. The babies were pretty active and we could see a few punches too! I hope the (associated) b/w results come out normal!

• I almost jumped with joy after the scan and my DH had to calm me down! We also did our first baby shopping on the same day! I have been so nervous all this while, that I needed to do something to overcome this immense fear and believe that this is really happening! We went and bought our first pair of baby clothes from Macy's. It is a
Carter’s Newborn Fleece Sleeper (cute little yellow ducklings). I also shed some (happy) tears after coming home while looking at our purchase - it was just overwhelming! I am starting to e-window shop for all the stuff that I would like to buy/have. I hope I am not starting to get over confident!

• We informed both sets of parents at around 6W. They are very excited! A few of my very close friends know about the PG, but we are still tight lipped over all! We will be telling a few more friends in the next couple of weeks, but overall… we are going to keep it undercover for as long as we can. I am not sure how to handle the congratulations and the PG talks! This still feels surreal and I still feel like anything can happen any time!

• I feel fat (5 lbs IVF + 7 lbs PG = 12 lbs)! But, after looking at all the other preggo (singleton/twin) bellies (around 12 weeks), I think I am starting to accept the fact that what I am seeing is not just fat - it’s a bump! :) We still haven’t taken any belly shots yet! (Though, I did mentioned to my DH that we should probably start taking belly shots and he was like "Baileys Shot?!" ...Men!) Staying undercover might not work for very long! But we will see!

• I realized that I haven't mentioned anything about my symptoms till now! I haven't thrown up even once! I have had intermittent nausea... but nothing extra ordinary! Though, I just can not stand any kind of meat! I am trying to load up on protein through milk, eggs and nuts! I am constantly hungry... I gained 7 lbs in the begining, but in the last 3 weeks, no matter how much I eat... I don't seem to put on any weight! Not gaining weight has never been an issue for me! :P I am constantly thirsty and consume any where between 3-5L of water in 24 hours! Out of which approx 2L is consumed at night (during the 3-5 pee breaks I have to get up for)! People talk about PG glow, I think I am going to be one of those who get "acne". Acne has been a problem for me (thanks to PCOS) previously, and it just doesn't seem to subside!