Doctors' Appointments

Okay, so the last Baby Update I wrote about was the perinatologist appointment on May 31st. Since then, I have had 5 other appointments (I am on weekly appointments with the local ob here in town, and I have seen the perinatologist once more).

Appt. Thursday 6.7.2007
Regular Ob Barrington, IL
31 weeks 2 days

Weight: 173 lbs; gain of 1 lb?
Blood Pressure: I can't remember
Belly: 35 cm

This was the appointment when insulin was perscribed for my fasting blood sugar levels...And I caused all sorts of problems by actually questioning the perscription of it (i.e. I called the perinatologist's office on Friday morning). The peri's office said no insulin, my regular ob's office said take the insulin (we had dropped off the perscription at the pharmacy Thursday night). It was not fun. I got stressed out, and the nurse from the regular ob's office told me to take the weekend to figure things out and calm down. So, I did.

I called Monday morning to tell the regular ob's office that I would take the insulin, but was not happy about it. My doctor called on the house phone as I was telling that to the nurse, and I actually talked to my doctor. She said my numbers looked good the week the peri saw them, but had been "bad" the week she saw them, so insulin was her recommendation, and oh, by the way, you have a risk of stillbirth in third trimester because of the gestational diabetes and hypertension (high blood pressure). If they had just told us that at this appointment, I would have started the insulin that night. She did say that my numbers for the (at the time) current week were good, and I could wait to start the insulin, but if the numbers started creeping up again, I would definately have to start taking it. To her credit, she was not even at her office that Friday, so she came back on Monday to a pile of phone message from me.

She had other blood work results. We found out that:

1. I was/am slightly anemic, and needed to start an over-the-counter iron supplement. This is apparently fairly normal the last trimester in pregnancy.

2. The amount of protein in my urine has gone down slightly to 1617 units. My creatinine clearance number is 1.3, and my uric acid is 8.9. All these numbers are considered to be Stable for me. The uric acid and the protein are both lower than the last time, and the creatinine clearance has remained the same since before I was pregnant.

3. Apparently, all the other results (from the CBC and CMP) all looked good: platelet count, ect. becuase she did not mention any of them specifically to me.

As usual, there is more to the insulin story, but I will tell it when I get the perinatologist appointment on Monday, June 25th.

Appt. Thursday 6.14.2007
Regular Ob Barrington, IL

32 weeks 2 days

1st non-stress test
Contractions- not felt at all
Weight 172 lbs; loss of 1 lb
Blood pressure: 117/72?
Belly: 36 cm

This was the first time I was hooked up to the fetal monitor for the non-stress tests. We had to wait for Baby to be active. It took awhile. Everything did look good, aand even though I had contractions, since I could not feel them, and they were small ones, it did not result in an internal exam.

Appt. 6.21.2007
Regular Ob Barrington, IL
33 weeks 2 days

2nd non-stress test
2 contractions; one small, not felt, one big- felt it- uncomfortable
Weight 173 lbs; gain of 1 lb
Blood Pressure: 111/68
Belly: 37 cm
First Internal exam- VERY UNCOMFORTABLE

The second nonstress test, as you can see from reading the brief version, did result in an internal exam. I was not prepared for it. I was not seeing my regular doctor. It was incredibly uncomfortable. There weren't any changes to my cervix. Again, we were there for quite awhile while the baby was monitored. The internal exam was done after the contractions were seen on the monitor. One was quite large, and I felt it, but it didn't hurt. It was just very umm uncomfortable- felt like a lot of pressure and tightening. The smaller one I did not feel at all. Paul sat right next to the monitor and tried to tell me when they started, but I finally told him not to do that, if I could feel them, I did not need him to tell me (he would read the numbers about how high they would go- that was annoying).

Appt. 6.25.2007
Peri Park Ridge, IL
33 weeks 6 days

Ultrasound
Baby’s Estimated Weight: 6 lbs. 13 oz
Weight: 173 lbs
Blood Pressure: 100/58
Belly: 37 cm
Baby Position: Head Down (Still)

Yes, we had another trip to Park Ridge. Traffic on the way there was not as bad as traffic on the way back. We were supposed to be the first appointment that morning. We got to the office only to see three other couples waiting for the doctor too. One was taken in before us for an ultrasound. The other two just go their vitals checked by the nurses. We had our ultrasound with the same tech as last time. She was friendlier this time, and more talkative than last time. He is still measuring quite large, even though the tech didn't think he was huge.

The consultation with the doctor afterwards was short, but we didn't have many questions either. Remember how I said there was more to the insulin story? Yup, here it is. He says that the insulin will most likely not help me this far along. And that my numbers are soo close to normal that their office would not have even perscribed the insulin. (the doctor who looked at my numbers on 6.8.2007 had said no insulin was his associate, not him. So a fifth doctor's opinion was added to the four we already had, and we were not even aware of it). He told me that taking the insulin would not hurt me, so I might as well keep taking it since we had paid for it. In reguard to the supposed stillborth risk, he said it was Not True. He is very pleased with the way everything has gone so far, big baby included. We are not in automatic c-section land yet. He did say If I could somehow "talk" the baby and my uterus into labor between 36 and 37 weeks, that would be great, but they don't know what starts labor in women, and every woman is different. He said there was nothing urgent that he would need to call the regular ob's office about before my appointment with them on Thursday 6.28.2007. :) The next time I see the perinatologist is on Friday, July 20th for an ultrasound to check on Baby's growth.

Appt 6.28.2007
Regular Ob Barrington, IL
34 weeks 2 days

3rd non-stress test
Contractions: Yes
2nd internal exam- not as uncomfortable

Weight: 173 lbs
BloodPressure: 117/68
Belly: 37 cm

I actually saw my regular ob this time. Yes, the non-stress test took a long time too. Paul was not able to come with this time because he had to work (because he went to the Cubs game on Wednesday. See his blog for details: http://www.ostrichjockey.blogspot.com/). Mom went with me. The monitor and Baby were both not cooperating this time, each at seperate times. The internal exam was not as uncomfortable this time. My doctor was very gentle. There are still not any changes to my cervix. So, I am just contracting without any changes, can anyone say Braxen Hicks?

We learned a few other things on this visit. This baby will be born most likely before his due date of August 7th. My doctor will not let me go past 39 weeks. My due date is not changing, but the baby's birthday will most likely be in July. She checked her medication palm pilot thing, and it turns out, I can breastfeed as long as they do not put me back on my pre-pregnancy drug regiment (the Altace, Cozaar, and Zocor) immediately after birth. This is assuming my kidneys remain Stable as they have been (and it is okay with my nephrologist). She did not up my insulin dose even though my after breakfast numbers are higher than the 120 they want them under. She says they are fairly close to normal, and I should slightly change my breakfast to inculde less carbs and some protein. I have varicose veins in the backs of my legs (I had no idea, the nurse noticed them). As long as they are not hurting me, I don't need the support hose. Apparently they look like they should be hurting though. I can take Pepcid and Tums together for the indigestion I have been recently having. Oh, yes, and the other thing I learned: Do Not Talk While They Take My Blood Pressure- talking causes it to go really high 134/86. My next appointment with her is on Thursday 7.5.2007.

Summary

Everything seems to be going well so far. Even though I have not gained much weight, all the doctors are okay with that because it is clear that Baby is still growing. I am measuring ahead by 3 weeks. This is because baby is big, and the ultrasounds in the last trimester are unreliable for date estimates (hence the reason for ultrasounds early in first trimester for people with irregular periods or who are unsure of their conception date to determine a due date. First trimester ultrasounds are fairly accurate when it comes to due dates). Baby has gained almost half a pound per week for the last month. A normal rate of growth for babies during this trimester. I am on weekly visits with my regualr ob. I will be making as many appointments with her (as opposed to her associates) as possible. :) For anyone who is concerned that Baby will be here not exactly at 40 weeks, full term is actually considered 37 weeks these days.