Monday, August 1, 2011

Tired and frustrated

I contrived to enjoy my weekend, even though it was a challenge. Despite being with my husband, BIL, and best friend, enjoying a responsibility free weekend at a bed and breakfast, and generally relaxing, the diagnosis of gestational diabetes was always in the back of my head. I was also worried about Chicken Biscuit. Then, as we were leaving to come home today, the AC in my car died. It's a 13+ year old car, I knew it wouldn't last forever - but come on! It's 90+ every single day outside, I am now 8 months pregnant, I NEED MY AC. Unfortunately, there is no way we're blowing $1000+ to fix the AC on a 13+ year old car with 210k miles on it. I'm not sure what we're going to do yet. I'm working on keeping all of this in perspective...but sometimes I'm failing miserably. Thankfully, my husband has been solicitous and concerned and taking care of my mental health (or trying to).

So, my GD diagnosis has further instilled in me no confidence in the human medical profession. This is how it went down: I took the test on Tuesday. I was told that I would have the results on Wednesday afternoon. I double-checked with the nurse that someone would call me with the results. I was assured they would. No word on Wednesday. When I realized what time it was, it was too late to call. I assumed the results were normal. Still no word Thursday, so I finally called around 2pm. The nurse says, "oh yeah, your results were very high. We need to schedule a 3 hour test."

"WHAT?" Why had no one contacted me? It was Thursday now, with plans for us to leave town that evening. I asked if they could get me in that afternoon, as I was luckily (accidentally) fasted. No can do. We'll schedule you for Monday.

Fine, whatever.

Then, on Friday - while I'm lounging on the front patio of the B&B, relaxing, a different nurse calls me and informs me that my blood glucose was so high that I get to skip the 3 hour GTT and go straight to a diagnosis of gestational diabetes. She told me that the dietician/nutritionist would call. That was it. No information, no discussion with the doctor, no mention of re-testing to make sure the high reading wasn't an error, no confirmation with a 3 hour GTT. No "hey, in the meantime, you should do the following thing...." WTF?

In my line of work, if I get a bloodwork results that are high, unexpected, or concerning on a patient's bloodwork - my first response is to make sure that the sample was collected and run correctly. Then, if I think that was done properly, I repeat the test to make sure that the result wasn't erroneous - wrong patient, wrong blood sample, sat too long, didn't sit long enough, etc. Then and ONLY then do I believe my results. In other words - one concerning result does not = disease.

Apparently, in human medicine, a one-time high blood glucose reading is sufficient to diagnose gestational diabetes. On the one hand, I understand this. It is a cost/benefit scenario. It is better to assume that I am diabetic or borderline diabetic, and stick me in the diabetic group. This way they can monitor me closely and ensure that I have a healthy pregnancy and baby. It also decreases the liability of my doctor should there be an "adverse outcome." With the high volume of patients that my office sees, I'm sure this is the MO.

The downside is that it labels me as high risk, meaning that the medical team will want to do all kinds of interventions that may or may not be necessary in what was a previously perfectly healthy pregnancy. I am now a "high risk pregnancy" and thus, must be monitored very closely with more testing than previously. Also, I'm sure I will be counseled that my baby is going to be too big and that I should be induced and/or undergo c-section (estimates on fetal age and size can be wildly inaccurate - acknowledged by some medical texts I've read and anecdotal experiences with friends).

Today, on the way home from Asheville, I downloaded a med school textbook on managing the diabetic pregnancy and read it. Reading the laymen's book was too frustrating - as I wanted to know what was taught to OBs as far as recommendations and WHY. It was helpful, and I feel more knowledgeable now. I'm still very frustrated with the whole procedure. I plan on calling the OB tomorrow and asking that I either re-take the 1 hour or take the 3 hour. I'm not in denial and don't believe that I can't have GD - I just think the responsible thing/medically correct thing to do is confirm with another test before I get all stressed out. In the meantime, I'm keeping a food journal and checking my BG as recommended in the medical text (4 times a day - fasting/just woke up, 1 hour post-breakfast, lunch, and dinner). So far, my readings have been fine.

In Chicken Biscuit news, we are taking him to get an ultrasound tomorrow. This will help determine if he has a good kidney left. I'm hoping very much that the does, otherwise we will be managing chronic renal failure with an uncertain prognosis.

I am really, really tired right now. And really stressed. I go back to work Wednesday, and I can't tell if that's a good thing or a bad thing!

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