Wednesday, August 24, 2011

Catch-up, part one

So...hey, how's it going?

It's been a while. Funny thing about blogging--for me, the longer it's been since the last blog, the harder it is for me to get back into it. I feel like I need a good reason to come back. I've started and stopped a bunch of posts over the last year or so, but many of them never make it up. Sometimes it's because I just needed to vent (though many of those posts do end up on the blog). Sometimes it's because I'm not sure what I want to say. And sometimes it's because I never finish.

I have a google reader feed full of people who blog daily or near-daily. I don't think I could ever be one of those people. Truth is, my life is not that interesting on a daily basis. I used to have outside interests, but in all honesty, kids and work take up all of my time. The kids are cute, but even I don't want a record of how many times they pooped every day or who ate what for dinner. I do wish I memorialized some of their milestones better, but I try to at least take pictures on a regular basis. That doesn't mean it I get them off the camera more than every few months, but it's a start.

Really, my life doesn't change much. There are interesting medical and personal moments almost daily, but I'm not sure I have the time to really sit down and reflect each day. Once the basics of my day are done, and the kids are taken care of, there's housework, then work-work, then bed. That's about all I can handle right now.

So if I said that it usually takes a reason for me to start back posting again, perhaps you are wondering what the reasons could be?

There are several, which I will not try to conquer all in one post. But I figured I'd better start with the most obvious first: we are expecting a third baby this February.

Yep, I'm almost 16 weeks. The three F's (family, friends, Facebook) have known for a while, so it's not a secret. I just haven't had much energy to talk about it.

We were trying to squeeze in the famous "fourth year baby." For those not in the medical field, the fourth year of medical school is much more flexible than the third year, and it's really the last break before residency/fellowship/a real job take over your life. So, at least in my program, many women try to have a baby during the winter of their fourth year of medical school so that they get time home with the baby before residency starts. Ideally, a six month old should be sleeping better than a newborn (or so I am told), so not having to wake up every two hours is a perk.

The fourth year baby isn't the last option for everyone, but I honestly felt it was for me. My pregnancies have not been fun (and boy, is this one living up to that--more later), and I knew there was no way I could be pregnant and a functional resident. And to wait until a break in fellowship meant that there might be as much as 7-8 years between Josh and a new baby (and I would be 38). That wasn't realistic either. So, we decided that if we wanted a third, this was the time.

Things definitely didn't happen right away. Without too many gory details, I actually had symptoms that made me think I was pregnant the month before. When the test was negative, I started to worry. Based on our timeline, we had two more months to get pregnant before we had agreed that the time would be too tight for maternity leave before residency. The next month, I was sure I wasn't pregnant, and I was panicked that maybe a third baby wasn't in the plans.

Then the test was positive. No symptoms, nothing. I went from shocked to excited to...oh crap, what did we just sign up for?

Don't get me wrong--we were hoping for this baby. But we had started to self-talk that maybe two wouldn't be so bad, it's a even number, we've got a 1:1 parent:child ratio, we wouldn't have to buy a bigger car, we'd have more money every month, etc. We were looking for a reason to not be disappointed if we couldn't get pregnant.

When the test was positive, all that self-talk reversed: we'll be outnumbered, we can't fit three car seats in the car, etc. We had discussed those issues before, of course, but now that it was real, we had some panic setting in.

The other thing setting in: pregnancy misery. I am not a glowing, vibrant pregnant woman. More power to those people. I am miserable for all but a few months in the middle. The result is worth it, but I dread pregnancy. This one has exceeded all my expectations, and each pregnancy has gotten considerably less fun. One of my OBs commented that it is "the curse of the third pregnancy." He did try to reassure me that the fourth is usually better. I said hell no.

The first trimester, I had horrible nausea, upper and lower GI issues, a constant awful taste in my mouth, and food aversions to everything that wasn't ginger ale or saltine crackers. I also was nearly incapacitated with fatigue. I described it to Tim like this: imagine that you just worked an overnight shift that involved extremely difficult manual labor. Then someone forced you to take a handful of sleeping pills. Imaging feeling woozy, dizzy, extremely exhausted. Imagine that it feels like someone is pulling on you, making it tough to even lift your arms. Now, you have to fight off all of those sensations throughout the entire day in order to get your work done. That's what I felt like for several months.

There's the other typical pregnancy symptoms too (no need to elaborate--google it if you want, but it ain't pretty). Those are just nuisances compared to the GI/fatigue issues.

I saw my OB early on, and I expressed to her my concern that I might become gestationally diabetic this time. I was barely OK with Sophie and borderline with Josh. I haven't gotten my weight where I want it to be, and I have a family history of type II diabetes. I knew I was at risk. She did the 1 hr screen, which I failed (as always), but this time my 3 hr GTT was positive for gestational diabetes (not by much, but it still counts).

And so began testing sugars four times a day, meeting with dietitians and high risk OBs, and cutting carbs (which were the only things I could stomach). Perhaps the most difficult thing was adjusting mentally. I told my OB at my next visit that I was really struggling emotionally with this--I know my chances of developing diabetes after my pregnancy (1/3 to 1/2 will within 10 years). I know that because this was diagnosed early in my pregnancy, my risks are probably higher. I know that while my family history is unchangeable, my weight is. And I feel like I've put all of my kids at higher risk because of this. My OB was very kind--she said that this is like receiving a serious medial diagnosis and can be emotionally draining in that way. She knows my personality, and she told be that we'll take care of the baby now, and I can take care of the weight after the baby.

I've been pretty OCD with my sugars (shocker, I know). My OB actually commented that she should write a book on how educated mothers are much more thorough with their risk management, and she'd use my spreadsheets as an example. What can I say, I love excel...

I've seen two high risk OBs too. I brought in my chart to the first one. My AM fasting sugars averaged in the low-90s, and my 2 hr postprandials average in the 80s for breakfast and lunch and 90s for dinner. The ADA goals are under 95 fasting and under 120 at 2 hrs postprandial. However, this OB said he likes to be aggressive, so he put me on 4 units of NPH insulin at bedtime, which brought my AM fasting sugars into the 80s. Recently, I've been getting a lot of readings (especially after meals) in the low 70s--I was told that in pregnancy, you can go into the 50s and be ok, but I feel pretty crappy in the 70s. But, I do what I am told.

The aggressive high risk OB had said to come back in a week, and he thought that perhaps I'd have to come back weekly during the pregnancy. This was a major bummer--it's hard enough to take time out for monthly appointments, and weekly would be near impossible. The next week, I saw one of his partners, who said I was doing great, he probably wouldn't have started the insulin but would continue it now that it had been started (drat), and there was no need to come back unless my regular OB wanted me to. That made me feel better.

Now, the sticking four times a day for blood sugars isn't fun, and it sure isn't convenient (nothing like walking away from rounds to check a blood sugar). But the insulin shots suck. Really, they hurt. I've tried a few sites (and given myself some nice bruises), and I can cope, but it sucks. The thought of potentially having to do it more than once a day is frightening.

Of course, since carbs were all I could eat, and now I can't eat many of them, I've lost five pounds so far. I am eating a lot of protein--and calorie-wise, I am on target--but I am so sick of eating the same few things that don't make me want to vomit. This should get better in the next few weeks, but I seriously can't look at an egg or cottage cheese for a little while.

My OB is happy with things (though she did tell me not to lose any more weight--first time I've ever heard that), and the ultrasounds have been good. My first check came back looking good, so that's one worry down. We'll have our anatomy ultrasound in a few weeks and see how things look then. I can't say that I'm ok emotionally with things--I'm sure you've realized I have deep-seated guilt issues, and this plays right into that. But I am working on it.

Now that we are a few months in, the panic has worn off. I think we realize it won't be easy with three young kids and me in residency. Tim knows he'll have his hands full. But, he already does the vast majority of dropoff/pickup, and if I am home late, he manages just fine. Having family in town is awesome too--which is why we'll stay in town (at least for residency). For instance, Josh had a nasty bug for a few days, and between the two grandmas, we were able to make it work. That is definitely invaluable.

We will need a car at some point, but we are going to try and stretch my 150k+ mileage Civic until the start of residency, and then we'll probably upgrade to a minivan. I swore I'd never drive a minivan, but you can't beat the convenience...

I'll try to update on med school and the rest of life soon. But now at least you know why I haven't had much energy for blogging recently.


  1. i knew about the pregnancy from FB - congrats!!! i am having lots of the same symptoms but thankfully not quite as severe.

    have you tried the 'nano' sized needles (they're made my BD) for the insulin? studies have shown they still delivery the insulin sub-q but they're TEENY! most of the kids even say it doesn't hurt. if you don't have them, give them a try!

  2. sorry i meant 'made by BD'

  3. ss that you had such a hard time...hope the shingles do not bother you too much anymore.

  4. Congratulations!.. life is always an adventure!