Wednesday, April 29, 2009

32 Weeks & 5 Days - Some Bad News

Thankfully the bad news is NOT about the baby....but it is about the pregnancy. I'm thinking most of you blog-readers already know about this, but I wanted to update the blog for it anyway.

As some (most?) of you know, a couple of years ago I needed laser treatments in both eyes for proliferative diabetic retinopathy. Here's the quick explanation of proliferative diabetic retinopathy and the laser treatments - if you already know this, feel free to skip ahead:

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Basically, long-term and/or badly controlled diabetes can lead to problems with blood-flow to the retina. (Note that even people with well-controlled diabetes CAN experience retinopathy, although controlling your diabetes carefully does greatly reduce the chances of this happening. Also note that diabetes care methods are MUCH better now than they were in the 70s, 80s, and even 90s, so those of us diabetes-veterans have lived through a time when it was much more difficult to have tight diabetes control, and unfortunately do have a greater risk of complications like this as a result, even if we have much better control now. Anyway...) When the retina doesn't get adequate bloodflow, it doesn't get adequate oxygen. Because the retina needs oxygen, the brain sends signals to the retina to make new blood vessels to help move the oxygen around. This is called "proliferation" (hence "proliferative diabetic retinopathy"). Sounds good, buuuut....the new blood vessels are weak and fragile. They break easily, and when they do blood leaks into the retina and can cause vision damage. (Also note that not all diabetic retinopathy involves proliferation. In the early stages there may be blood vessel leakage, but no proliferation of blood vessels. I'm not going to go into that here, though.)

Retinopathy is not curable, but it is treatable to help slow (and hopefully stop) the process. Treatment involves getting numbing drops and/or gel squirted into your eye(s), having a glass lens pressed up against your eyeball, putting your face in a machine that makes you feel like you should be on A Clockwork Orange, and then getting a couple of thousand (yes, thousand) of laser zaps on your retina (called pan-retinal laser treatments). It's not as painful as it sounds like it could be, but it is painful, and it's VERY stressful. The light is very bright, and with every zap it takes your breath away and makes your other eye want to roll back in your head. It only lasts a few minutes, but it's pretty low down on most people's list of enjoyable ways to spend a few minutes. :P

The point of the treatment is to kill off a portion of the retina. It sounds counter-intuitive, but it basically allows the less-important parts of the retina to be sacrificed to save the more important central part of the eye (i.e. the macula), and hopefully protect your (my) vision by doing so. You end up with a grid-like pattern of scars on your retina (permanent), and typically a bit of damage to your peripheral vision and your night vision, but the end result is (or should be) that your retina then requires less oxygen, so your brain no longer sends signals to make new (fragile/leaky) blood vessels...reducing the risk of bleeding and vision loss.

And that's a quick retinopathy lesson. Now back to our regularly scheduled blog.

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So, this past Sunday, I noticed a new "spot" in my vision of my left eye. I got in to see my ophthalmologist on Monday and the news wasn't great. There is bleeding in my retina that my ophthalmologist says is due to more proliferation (i.e. new growth) of the blood vessels. He said the pregnancy (i.e. the growth hormones running rampant in my body) and the slightly elevated blood pressure that I've been having are likely both coming into play here. (I'm not too surprised re: the growth, given that my baby has grown 1.5lbs in the last 2 weeks according to the fetal assessment - a normal level of growth for this stage of pregnancy.) We knew this was a possibility during pregnancy because of the growth hormones, but we had hoped for the best. Everything was going so well before the pregnancy and during the first two trimesters - no sign of proliferation or bleeding since my last laser treatment in September 2007 - but I guess I just didn't quite make it through the third trimester.

So, I had more laser treatments on Monday - 1000 zaps in my left eye. It sucked. A lot. (I didn't get woozy at all, though, which as some of you know was a BIG problem for me last go-around.) I'm going back next week Thursday for more, but it should just be the two treatments, and he is just doing my left eye. He has a new machine since last time, though, that does multiple shots at once, so 1000 zaps is much faster now than it was before. I guess that's the silver lining on this cloud. It's still pretty miserable, though, and my eye was sore and a bit red/puffy for the next day or so.

So, I suppose the good news is that, since the ophthalmologist feels it's so directly related to the pregnancy, I don't necessarily have to expect that I will continue to have bleeding every few years for the rest of my life. The bad news is that this calls into question how wise it is for us to try for more children in the future as there's nothing to say it won't happen again with another one - maybe even worse next time. The doctor says not to worry about that now - it's not out-of-the-question. We realize that it will depend a lot on how the next 6 weeks go, how the years after this baby go (i.e. when I'm not pregnant anymore) and how my eyes are doing before we would be ready to try for another one. For now, though, we are focusing on the fact that we have one beautiful baby on the way and are VERY lucky for that. We refuse to let this setback get in the way of our joy and excitement about our little Bud!

Another development related to this is that my ophthomologist doesn't want me to push during labour, so I will be asking my OB for a c-section. The baby is still breech, though (and apparently unlikely to turn since she's been in this same position for so long now), so this is likely a moot point anyway.

I'm seeing my OB on Friday and will discuss the bloodpressure issue with him then. We'll have to talk about ways to reduce it....which may or may not involve leaving work early or figuring out some other work option between now and my scheduled mat leave.

So, it was a less-than-good day on Monday, and a frustrating experience - especially so close to the end of the pregnancy. I feel like we ALMOST had a perfectly successful diabetic pregnancy, but didn't quite make it. But this too shall pass.

Anyway, just wanted to keep you all updated. At the end of the week I'll post the Bud facts and the new fetal assessment pictures (she's got some chubby cheeks!)

Until then....

Saturday, April 25, 2009

32 Weeks & 1 Day

This week I have been really reminded that the "easy" trimester (i.e. T2) is over - most notably with respect to my swollen feet/ankles. We had our prenatal classes last weekend. They were a compressed version that was all evening Friday and all day Saturday. Sitting in a chair for that long without much walking around made my feet balloon up, and unfortunately they didn't want to go back down in size after the classes were over. (As an aside, the classes were actually quite good. We took them through the Youville Centre and found them quite interesting and informative.) I worked from home for a day this week to try to keep my feet up and give myself plenty of chances to walk around, but the thing that finally worked was compression socks. They're expensive and really hard to put on, but they work (and thankfully they just look like regular socks)!! My doctors still aren't concerned about the swelling and tell me it's normal, but since it's uncomfortable, I really needed to do something about it. In addition to the swelling, I've also had heartburn and indigestion. I had never had heartburn before pregnancy, but now that I have experienced it I have new respect for those who deal with it all the time (including Martin and some of his family). I also no longer sleep restfully as I'm up every two hours to pee. And then on top of all of this I feel big and clumsy. I think it's a bit of a cruel joke to make someone drop things all the time when she can't easily pick them up. :P Oh the joys of the third trimester.....just giving me more incentive to want to get her out in 6 weeks :) Wow....6 weeks....so soon!

Bud is still moving around a lot and seems like she's maybe shifted positions, but it's hard to tell. Apparently it's quite normal to have heartburn and indigestion with new baby positions, so I guess that falls right in line with how I've been feeling. It seems like she may be bum-up now, but I think still feet down (based on where I'm feeling movements), so it's hard to say. She definitely seems to mostly be on my right side, and she seems to think she's cramped in there because she very often is pushing outward on my belly, trying to make more room for herself. (Personally, I think she has plenty of room - more than my organs currently have, anyway.) We have another fetal assessment on Monday, so we'll find out exactly how she's positioned, and how much room she has, then.

I just had one doctor's appointment this week - with my endocrinologist. It went fine. We did a bit more problem-solving, but everything is still going well overall.

Other than that, there's nothing much new. I've started back into my prenatal yoga and find it more difficult than it was 5 weeks ago when I stopped doing it, but it still really does feel good. I managed to go for some longer walks this week too, which helped my feet feel better and gave me a good dose of fresh air. :)

And with that, here are this week's Bud-facts:
- Bud will gain 1/3 to 1/2 of her birth weight during the next 6 weeks, fattening up for survival outside the womb. Her skin is getting plumper and looking healthier.
- Bud now weighs approximately 3.75lbs/1.7kg (more, per fetal assessments), and is about 17"/42cm long from head to toe.
- Although her lungs won't be fully developed until just before birth, Bud is inhaling amniotic fluid to exercise her lungs and practice breathing.
- Some babies have a head of hair already, others have only a few wisps.

And, finally, here is a picture of me at 32 weeks, and another picture that begs the question "Should pregnant women wear orange?"



Sunday, April 19, 2009

31 Weeks & 2 Days

This was a busy week, appointments-wise. But first the non-appointment-related stuff....

This week I have been pretty tired. It could have to do with this stage of pregnancy, but it was also a very busy week, so that could explain it too. Also, Bud has been putting more and more pressure on my bladder, so my visits to the bathroom are becoming more and more frequent - including during the night, which probably also helps to explain the tiredness. I'd really LIKE to be sleeping well NOW because a good night's sleep will be nothing but a memory once Bud is actually HERE - but it's getting more and more difficult to sleep soundly at night. Oh well...such is the life of a pregnant woman, I suppose.

Bud is moving more and more all the time. This week it's been a lot of pushing by her, instead of so much kicking. Often I can feel exactly where her head is, but I haven't managed to pin-point any other body parts. Just her cute little head that's still on top (I'm urging her to put in down, but she's not listening to her Mom...practice for the future, I suppose).

So this week I had an appointment with my OB again. My bloodpressure is still a little elevated, but he's still not worried about that. It was pretty soon after I got there (walked), so I'm not surprised it was a bit elevated. It was much lower than the reading last week at the endocrinologist (I'm always elevated there). Bud's fetal heart rate was good. Fundal height (i.e. uterus length) is 32cm. Interesting b/c I'm 30 weeks, so it would normally be closer to 30cm. Which begs the question.....were we right about the due date the first time?? Hmmm.....more on that in the Fetal Assessment section below. My ankles are swelling a bit, but he's Ok with it. Baby is still breech from what he can tell. He showed me how to feel her head and it's definitely on top! I asked him what the reasons would be for inducing any earlier than 38 weeks, and he said if (a) the baby is big (re: diabetes), but he said that is very unlikely given my good control, or (b) if she's no longer getting adequate nourishment from the placenta. So it sounds like 38 weeks is definitely what we're aiming for.

We also had another fetal assessment this week. Bud is over 4lbs now (we can't remember if she said 4lbs or 4.5lbs). She is at the 60th percentile, size-wise. She was 40th last time, but they said the difference is due to the margin-of-error, and that her growth is perfect and that she's still definitely the right size for her age (i.e. new due date is still considered correct). This is a much more precise measurement than the fundal height measurement at the OB's office (i.e. a tape measure on my belly). They said everything looked great and there were no concerns. She is still breech, and has her feet up by her ears (she's doing yoga already!), but still has plenty of time to turn. We only got one picture and it's very hard to distinguish because she was being very difficult and moving around a LOT. I'm attaching it anyway....you folks can see if you can decipher it any better than we can. The resident doctor who was observing could see my belly moving from about 4 feet away. They seemed surprised, but pleased, at how much she was moving - although it made taking some measurements difficult, and made a good face-picture impossible, unfortunately. Maybe next time.

I also had a massage therapy appointment this week. I can't remember if I've mentioned this previously, but I have been getting massage therapy every two weeks and I HIGHLY recommend it during pregnancy. It really helps my back and my hips during pregnancy, and it's very rejuvenating too!

And, once again, here are the Bud facts for this week:
- Bud now has less room to move and can't do the back-flips and somersaults we're both used to.
- By this stage most babies have turned head down into the "cephalic" position ready for birth. A few (like our sweet, stubborn Bud) take a little longer. Bud still has time to turn.
- Bud's arms, legs and body continue to fill out and they are finally proportional in size to her head.
- Bud weighs about 3.3lbs/1.5kg (more, according to the fetal assessment...see above) and looks more like a newborn.
- Bud measures about 16"/41cm from crown to toe. (This may also be more, but they don't check this at the fetal assessment.)
- Bud will likely gain at least 2 more pounds by delivery.
- Bud's organs are continuing to mature and she is passing water from her bladder.
- Brain scans have shown that fetuses have periods of dream sleep around month eight (about what, I have no idea).

And, lastly, here's the picture from fetal assessment:

EDIT: My mom just noticed that the name on the picture is not mine. The picture is definitely mine because I do remember that pose and I was there when this picture showed up on the screen, but somehow they got the wrong name on it. I'm going to contact them about it. In the meantime, here's a cropped version to protect the identity of the woman whose name is on my baby's picture. :)

Sunday, April 12, 2009

30 Weeks & 2 Days

Short post tonight as I'm exhausted!

We just got back from a very nice long weekend at Martin's mom's house, which is why I'm posting so late, and also why I'm so tired.

Not much new from this week. My hip was bothering me a lot all week, but it finally loosened up over the weekend. I think it helped that I was walking around a lot instead of just sitting at a desk all the time (like I do during the week).

As usual, Bud is moving around a lot. I'm getting the sense that she's positioned differently now, so hopefully she'll get out of the breech position (if she isn't already). We have a fetal assessment on Tuesday, so we'll find out then. There's still lots of time for her to move, though, too.

My doctor's appointment this week was with the endocrinologist. It was pretty quick and went well. Nothing noteworthy to mention.

Here are the Bud Facts for Week 30! Eight weeks to go!

- Bud's lungs and digestive tract are nearly mature.
- Researchers believe that Bud can actually see now, but no one knows how much she can make out. She can probably see what's going on in utero, distinguish light from dark and even track a light source. Some researchers think baring your stomach to light stimulates visual development. (I guess I"ll have to try that.)
- Bud is opening and shutting her eyes.
- Bud has eyebrows and eyelashes.
- Bud is becoming more cramped and less able to move so freely.
- Bud may soon slow up growing in length, but she will continue to gain weight until she's born.
- Bud is about 15.7"/40cm long
- About a pint and a half (approx. 1 litre) of amniotic fluid now surrounds bud, but that volume will decrease as she gets bigger.

Sunday, April 5, 2009

29 Weeks & 2 Days

Well, this was another good week! We had Grandma Rose here all week again, so there was lots of "baby time" :) On Tuesday I took the day off work to do some baby shopping with her. That was a fun day! We were hoping Grandma Dyck could join us, but she wasn't feeling very well, so wasn't able to. After that day of shopping, we now have just about everything! We still need to buy cloth diapers, but we're not planning on using them until Bud's a couple months old, so we have some time.

After we did our shopping, we just HAD to set up the crib because Grandma Rose bought a beautiful bedding set for Bud and we wanted to see how it looked! It looks GREAT! So now we have a combo office/nursery. We have the change table and crib up, but we still have the computer desk in the same room, so it's doing double-duty right now. Eventually the computer desk will move out.

My baby-related appointment this week was the OB. Everything was A-OK! I'm still healthy and Bud's still healthy! I"m at the point now where I'll be having OB appointments every other week, endocrinologist appointments every other week (not the same week as the OB), and fetal assessments every other week! Ack! Busy! And at some point at least some of these will be moving to EVERY week! Thank goodness my boss is very understanding and accommodating! I'm very lucky in that respect!

Bud is still VERY active, and is putting a lot of pressure on my bladder still. On Thursday I had an appointment with my massage therapist and Bud got so active during my massage that my massage therapist could actually SEE my belly moving! Crazy! Also, Bud got the hiccups for the first time...but I think I may have mentioned that already in my last blog post. Also, this week without thinking, I gave my belly a little smack with my hand - not hard, but I guess hard enough because she JUMPED inside me! I must have really startled her!

I'm still craving fruit and bread & butter pickles, but I've also started craving coffee (decaf). That's a new one. It seems like things with strong flavours are appealing to me a lot now.

Last night, Martin and I went on a date! We're not sure how many more chances we'll have for that, so we thought we'd better make the most of a free weekend! Thankfully he's not opposed to dating a pregnant woman :) We had a very nice dinner at Joey's and both ate waaay too much. It was just impossible to pass up the banana bread pudding! Mmmmm...... Thankfully I've gotten pretty good at managing my insulin around little indulgences like that and had a pretty stable bloodsugar evening - even after a decadent dessert!

Alright, here are the Bud facts for Week 29:
- Bud's head is getting bigger and her brain is developing billions of neurons (important for later learning) at an amazing rate!
- Bud's nutritional needs are growing. Her bones, in particular, are soaking up lots of calcium right now. (Good thing I've been eating lots of cheese and yogurt! And my prenatal multivitamins, of course.)
- Bud weighs around 2.5lbs/1.1kg and measures about 15"/38cm from head to toe.
- Bud is reacting to sound - or will be soon.

And now, some pictures of me at 39 weeks (ready for our date night) and the bedding from Grandma Rose!