Is this really happening?

One of my best friends who I’ve known since elementary school just had her first baby last week.  And one of my co-workers just had her first as well.  As I met one newborn and have been seeing tons of fun pics of the other, I realized that it still hasn’t quite hit me that I’ll be there soon enough as well.

I mean, on a logical level, I know this is happening.  Unlike before, when the pregnancy didn’t quite seem real, it’s obvious now.  I’m 28 weeks now, and for the past month or so, many patients will straight up ask/notice that I’m pregnant.  And then many see the bump but are just afraid to ask.  Because we all know that if you ask a woman if she’s pregnant and the answer is no… AWKWARD!

And by now there’s no mistaking Little Willie’s movements.  So the pregnancy is definitely real.  But realizing that I will have a newborn in a few short months has not quite set in.  I suppose it’s a process- eventually my husband and I will get all of the baby stuff ready.  The car seat, stroller, breast pump and all of that business.  We’ll see what happens, but hopefully I’ll have some time from when I start my maternity leave to when he comes.  That’ll give me a chance with no work to worry about, to finally focus on preparing for his arrival.

On a complete side note, I knew about some of the weird things pregnancy does.  Like I’ve noticed in the shower when I wash my hair, I don’t shed as much as I used to.  Which I’ve heard comes back to haunt you later when your hair falls out weirdly after the pregnancy is over.  Earlier in the pregnancy, I started getting a little melasma, or the “mask of pregnancy,” which causes hyperpigmentation of the face.  Since then, I’ve been slathering on the sunscreen daily in an effort to keep it from worsening.

But yesterday, I was going to shave my legs since I was planning to wear a short dress this weekend.  And despite not shaving my legs for a week, I noticed there was not much growth.  To the point that I decided not to shave my legs.  This morning, I noticed one spot with a little stubble, but I’m not trying to impress anyone these days so I’m not about to shave.  Just thought that was really random.  As most women know, this would be great if it lasted forever and I didn’t need to shave my legs as often.

Also, I hadn’t noticed it before in patients, but one recently asked me about hyperpigmentation of the armpits after her delivery.  I myself have noticed that the creases in the armpit areas have gotten darker.  Her whole armpit areas got dark.  So weird.  I told her most likely it’ll get better as the pregnancy resolves.  Certainly hope so!

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The 3 hour GTT

Hooray!! I don’t have gestational diabetes!  Such a relief!

I spent my Sunday morning with the nice folks at the lab.  This time, for the 3 hour glucose tolerance test, I was given more specific instructions.  I had to have half a sandwich and a glass of milk between 10 pm and midnight, and then come in for my fasting blood draw between 8 and 10 hours of fasting.  Since the lab opened at 8:30 am on Sunday, that means I had to eat my sandwich at the earliest at 10:30 pm.  So I had to stay up past my usual bedtime to have the sandwich and milk.  I did soy because I can’t stand the thought of drinking regular milk, even since pre-pregnancy.  And soy is closer than almond milk in terms of content.  I don’t know the exact reasons for the instructions, but I didn’t want to vary too much in terms of sugar, protein, and fat content in case it mattered.  It felt kinda gross to then go to bed shortly after, but oh well.

Surprisingly, I wasn’t starving by the time I got to the lab.  They drew my fasting level, then gave me another 10 ounces of artificial orange, except this time with 100 grams of glucose.  I then proceeded to wait in the waiting room reading magazines and such as I had my blood drawn each hour for 3 hours.  They want you to remain seated for the most part, because you can imagine if you’re running around during the test, you’d falsely lower your blood sugars.  Same reason that normally it’s good to walk around after a meal.

Monday morning, I got the results- all 4 normal values!  If you have 2 or more high values, then you’d be diagnosed with gestational diabetes mellitus (GDM).  I did notice that compared to the 1 hour test, I felt better.  Presumably because my blood sugars weren’t high.  Which makes me relieved that despite my regular carb and sugar intake, my blood sugars probably haven’t been climbing abnormally high.  Given my eating issues and feeling sick throughout the pregnancy, I’m just so relieved, because it would have been VERY painful to have to be super careful with my eating habits if I were diagnosed with gestational diabetes.

I was upset after seeing the abnormal 1 hour result, in part because like any other patient, it’s upsetting to see an abnormal value.  But also, I knew immediately that even if I weren’t diagnosed with GDM, I’d be labeled with “glucose intolerance,” suggesting that my body has some hardship processing sugar, and therefore conferring some elevated risk for diabetes in the future (just not as high as if I had overt GDM).  Now, I’m not sure if that’s really the case.  I don’t know if my Paleo lifestyle pre-pregnancy somehow affected this test.  My parents were born and raised in Japan, and despite my urging for them to go Paleo, at least partway, they have continued to eat rice and noodles all their lives.  My mom is 66 and my dad is 71, and neither of them have diabetes, so I figured I probably wouldn’t be that susceptible.

Ultimately, the testing for GDM is a screening tool.  As painful as it is for women like me to get that abnormal 1 hour result and have to endure the 3 hour test with 4 needle sticks, it helps catch more women with GDM.  Which is better than missing a bunch.  Now, there’s a reason I didn’t go into academic medicine and I don’t care to scour the studies behind all of this.  But there are different methods of screening for GDM.

My particular institution, like most places in the US, does the two-step testing with the 1 hour test and the 3 hour confirmatory test.  According to the ACOG Practice Bulletin on gestational diabetes, some experts have proposed a one-step two hour test.  It involves a fasting draw, a 75 gram oral glucose load, then drawing blood at one hour and two hours later.  The reason why this hasn’t been accepted widely is that it was thought that it would increase healthcare costs without a significant improvement in maternal or newborn outcomes.

Some have proposed lowering the values for an abnormal 1 hour test.  This would pick up some more gestational diabetics, but that also means a lot more false-positives.  Which means more unhappy women like myself who have to endure the 3 hour test.  Ultimately, no test is ever perfect, and they try to find the best balance of appropriate sensitivity at picking up the disease, without an undue burden of false-positives and health care costs.

Despite my unhappiness at having to go through this process, I know how important it is to diagnose GDM appropriately.  Bottom line is that untreated GDM is bad for baby and mom.  And like many aspects of this pregnancy, it also helps me as a clinician to have gone through the 3 hour test and know what it’s like to experience it.

The dreaded glucola

I did my one hour glucola test yesterday, aka oral glucose tolerance test (OGTT).  It involved downing 50 grams of artificial orange goodness:

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It’s done for gestational diabetes screening at 24-28 weeks, and my blood was drawn exactly one hour after drinking the concoction.  It felt gross ingesting that much sugar in one go, and I legitimately did not feel well the rest of the day.  I felt even more sick than I usually do, and then in the evening I developed a sore throat.  I haven’t been sick since I had a cold when I first found out I was pregnant.

This morning, besides still having the sore throat, I got the result and it was elevated.  I FUCKING FAILED THE GLUCOLA TEST!  I couldn’t help but keep thinking that.  I was so upset, I started to tear up, but I had to get it together because I had patients to see.  Now I have to take the follow-up 3 hour test, which involves checking a fasting blood draw, downing 100 grams of more artificially-colored liquid sugar, and then getting my blood drawn each hour for 3 hours after drinking it.

This is all very upsetting for me.  I hate to be overly dramatic, because I know better than anyone that there are way worse complications of pregnancy that I thankfully don’t have.  But when it comes down to it, this daily challenge with my eating during pregnancy has been really hard.  Maybe I jinxed myself by starting this blog, because this formerly Paleo girl has not been able to stay Paleo in pregnancy, and now I have an elevated 1 hr glucola.

This has been my typical day.  I wake up, and sometimes start feeling sick even before I’ve eaten anything.  I usually try to eat something more Paleo for breakfast, like unsweetened Greek yogurt with blueberries, but sometimes I’ll just want my waffle with almond butter and honey.  If I go with the latter, I feel a little twinge of guilt.  I’ll usually have a snack in the late morning, and then I’m hungry by lunch.  For lunch, I’ve been having a regular-sized meal like a wrap or sandwich.  When I eat, it just tastes SOOO good and I want to keep eating.  Often it’s hard to stop.  And then later I’ll feel sick.  I usually have a late afternoon snack when I’m done seeing patients, and even after having just a bar, I’ll often feel sick.  Then I get home, again want to keep eating and have a hard time stopping, and then later feel sick.  And mind you, I’m not gorging myself on huge meals, it’s just hard to stop myself after a smaller or regular-sized meal knowing that the more I eat, the more likely I’ll feel sick later.

I had given up on remaining Paleo long ago, because the food preferences in pregnancy were just too strong.  Also, despite eating way more carbs than I did before pregnancy, I haven’t been gaining the recommended amount of weight.  So I figured my body was telling me that I need some more carbs to help gain weight.  I didn’t think I was going that overboard.  Many of my patients are drinking juice and soda regularly, eating fast food and junk food regularly, and not surprisingly gaining too much weight.  I wasn’t going THAT crazy, so I thought I was fine.

Well now with this elevated glucola result, I can’t help but feel like my body is betraying me.  As long as I wasn’t going completely crazy with the carbs and sugar, I wanted to try to stop feeing so guilty, and try to enjoy what I was eating.  Because most of the time, I so badly want to eat more, but I can’t because I feel sick all the damn time.  But now this abnormal glucola result makes me wonder if I’ve been eating too many carbs.  On the other hand, I don’t think I’ve been limiting carbs to the point that my body couldn’t handle this sudden glucose load.

Once again, I feel like I can’t win.  Given this daily misery of feeling sick multiple times daily since 7 weeks (I’m 26 weeks now), it was at least nice to be able to be more relaxed and enjoy some carbs.  Now I’m terrified that I might actually have gestational diabetes, and then I’ll have to really be super cautious with what I’m eating, not to mention check my blood sugars 4 times a day.  I’m really hoping I’ll pass the 3 hour test.