Monday, August 26, 2013

What Do You Wish Health Care Professionals Knew?

Editor's note: This is a post that was written for me (which is nice, since I'm up to my ears in baby-tending) (speaking of which, she's starting to stir again, quick quick quick type faster) in relation to a research study being done on how HCPs might learn from online health communities like the DOC. If you think this sounds like something you're interested in, please feel free to spread the word and/or participate in the study. Thanks!

A researcher in a medical school in Quebec City, Canada (who is type 1 herself) is doing a study about how health care professionals might learn from online communities of people living with conditions like diabetes.

I have been collaborating with her on this study since November 2012. Other people in the DOC are involved. I encourage you to participate in the study and to spread the invitation to be a part of this.

This study is open to anyone who has personal experience with diabetes. You may have type 1, type 2, LADA, gestational diabetes, or another type. You might have diabetes yourself or you might be a family member or friend of someone with diabetes.

Tell us what you wish that health care professionals (doctors, nurses, dietitians, physiotherapists, counselors, you name it) understood better about diabetes.

If you want to participate, sometime in the next two weeks, put up a blog post or post a video, and then post a link to it here: Tell us what you wish health care professionals knew!

After the two weeks are over, we will ask you to vote to help us prioritize which ones we should show to health care professionals first.

If you have questions about the study, contact Dr. Holly Witteman, PhD, the lead researcher on the study, or Dr. Selma Chipenda-Dansokho, PhD, the research professional running the study.

Wednesday, August 21, 2013

Rabbit's Arrival: Part Two.

(Part One can be found by clicking here.)

It's a little surreal to be wheeled into an operating room for the first time. What I remember thinking as the nurses glided me and my wheely bed down the hall: "I'm about to have surgery. She's about to be born. I hope she's okay. Do I still have legs?"

The doors flew open, and Justin Timberlake greeted me in song.

"Are you kidding me? I really get to listen to JT during this? BEST OPERATION EVER."

The nurses laughed. "We're happy to leave the radio on for you, or turn it off - whatever you prefer." "No, no, this is great - it will help relax me a bit." I hadn't realized until that moment that I couldn't stop myself from shaking. I couldn't tell if it was the drugs, the nerves, or all of it.

My bed and I were glided to the middle of the room. One, two, three, LIFT! All of a sudden I was on the operating table/bed in the middle of the brightly lit, all-white room. A blue cloth was draped from my shoulders up to a height that obviously I wouldn't be able to see over (I remember thinking, is this really necessary? It's not like I'm going to try and sit up to see what you're doing...), and an anesthesiologist/nice man in glasses greeted me.

"Hi Kim, do you know what we're here to do?" (I imagine this is a litmus test of some sort to see how "with it" I was; that or someone didn't get the day's agenda ahead of time.) The drugs were definitely doing their work on my body, but my mind was still lucid. "I'm having a c-section so we can get this baby born!"

The doctor grinned at me. "Good, good, good." He spoke with a kind voice and told me what we were doing, what I should expect, and who was in the room. He tested how high up in my body the anesthesia was working and electrodes were placed on my chest.  Aaron joined us, and took a seat by my head. I couldn't exactly tell at what point the procedure started, which I guess is a very good thing, but soon I could feel some light pressure on my stomach, moving from left to right. I felt more pressure. Bruno Mars took his turn at the microphone. A few minutes passed.

"There you are! It won't be long now!", my OB enthusiastically called out. Aaron and I looked at each other, or rather I tried to twist my head in a way that would allow me to make eye contact with him. He rubbed my hair through the surgical cap.

A few moments later: "She's here!"

I looked to Aaron, whose attention focused past the drape. "Go; go see her; take pictures", I told him. The room was a flurry - me being sewn up; the baby being attended to.

All I wanted then was to hear the sound of her being "okay"; the sound that would let me know her lungs were more than just intermediate. I needed to hear her cry. Ten seconds, twenty, thirty... I'm not sure I breathed while waiting to know if she could.

It was only a few more moments (though they seemed so much longer), and then I heard her. It was the most beautiful whimper I've ever heard, and the crescendoing sound seemed to be directly connected to my tear ducts. I teared up immediately, thankful to have gotten to that place in time where I knew that she and I had made it.

She was here, and she was okay.

* * * * *

A few other here-and-theres:

The anesthesia had me feeling quite fuzzy by the time Rabbit arrived, so much so that I had to struggle to keep my eyes open while they cleaned her off and got her stabilized, and I also threw up in the recovery room. Like you do.

Rabbit experienced some low blood sugars in her first 24 hours in the world - immediately after birth being one of those times. Soon after I had ralphed, they alerted Aaron and I to this and asked if we'd prefer to feed her a bottle of formula or to have her hooked up to an IV; we opted for the bottle route. (I'm still surprised they let me hold her right after getting sick, but I really did feel much better afterwards. Maybe that's normal "I Just Had Surgery" stuff.) By the next day she was pancreasin' just fine.

As for me, I'm still amazed at how well things went diabetically during my hospital stay:

How I thought to take a picture of my CGM graph right in the middle of labor is beyond me.

My Dexcom graph, the day after Rabbit's arrival.

Not being able to eat anything once we started the medications Monday night helped my Dexcom graph stay steady, as well as the insulin IV drip we had me hooked up to. It also became apparent to me that nursing has a huge impact on blood sugars, as I didn't have to bolus for food the entire time I was in the hospital. (What?!) I've been adjusting my basal rates now that we're home so things are a little more back to what I'm used to, but man, was that nice.

I had planned ahead for the "just in case" option, knowing from Kerri's posts about her daughter's birth story that a Dexcom sensor on my lower body would likely be removed in the case of a c-section. When I checked into the hospital, I had both my Dexcom sensor and my insulin pump site in my left arm. It worked beautifully.

And as for Billy, he seems to have found his calling as a baby alert dog:

He goes where she goes, comes running when she cries, and sometimes whimpers when her diaper need changing. They share tummy time, and though we are careful to keep him at a bit of a distance (he is a dog, after all), he would love to snuggle up to her if we'd only let him:

In short: things are pretty great around here.

Wednesday, August 14, 2013

Rabbit's Arrival: Part One.

Every time I have sat down to write a post about the baby bunny's birth story ("I should really get this written down before I start forgetting stuff"), I get distracted by the thought: "....oooor, I could just cuddle with my daughter some more", and guess which option usually wins?

My daughter. Wow.

She arrived two weeks ago (about halfway through week 37 of pregnancy) at 9 lbs. 2 oz., 20 inches long, with a full mop of hair and the most kissable cheeks I've ever seen. There were many surprises for me throughout the delivery process, but I like to think that she and I handled it pretty well. After all, she's sleeping in her bassinet right next to me as I type this (and I'm listening to my favorite sounds in the world, which are the contented sighs/hums she often makes while sleeping or eating), and getting her here safely and in good health was the only thing that really mattered. Mission accomplished.

Or "touchdown", if you're so inclined.

Be warned that there will be a great deal of TMI in these posts, so read at your own risk. I don't feel the need to censor much of the story, as it involves me personally - childbirth really does erase a lot of one's modesty.

Aaron and I visited my doctor's office one last time before delivery in order to have an amniocentesis performed; a procedure recommended by the high-risk OB to determine how developed her lung function was. I laid on the familiar ultrasound bed and with the wand we searched around for a "good pocket" to poke into. Upon finding one, that part of my stomach was injected with a numbing agent and then was stuck with a giant needle that I tried really hard to not look at too closely - all the while watching the little bunny baby on the ultrasound monitor. She did a very good job of staying put during the procedure (too much movement could have resulted in her getting jabbed by the needle, thereby necessitating an immediate delivery - and yes, we had our bags packed and in the car before this appointment, just in case), and we got the amount of amniotic fluid needed to get the testing done. 

We were relocated to a monitoring room where I sat in a surprisingly comfortable medical-grade recliner while hooked up to a machine that took note of my contractions and her heartbeat, in addition to recording the baby kicks I was tracking with a button press (indicated on the chart by a musical note) for each movement. We were there for about an hour to make sure that the Rabbit was going to be okay post-procedure, and when we were all confident that she would be, Aaron and I headed home for our last few hours as Free People Who Do Not Have Kids. 

The test results took a few hours to come back, and they showed that her lung development was in the "intermediate" zone. My doctor and I talked through the options, and mutually decided that keeping our plan to begin induction that night made the most sense for our particular circumstances.

And so, at 7:00 pm that Monday night, we checked into the hospital. The only other time I'd been admitted to the hospital was for my diabetes diagnosis 27 years ago, so that was a little weird.

We were shown to our room, and after changing into some glamorous (no) hospital gowns, the labor-inducing circus got underway. Blood was drawn, and two IV lines were put in place for later - one in my left forearm, and one on top of my right hand. The left would be in charge of labor-related medications, while the right would be reserved for my insulin drip once labor began. (I was given the option of keeping my insulin pump on and being in charge of my own diabetes management during labor, and I'm very glad I went the route of the IV insulin drip. Not only did I not have to think or do much about diabetes for several hours, but it also worked beautifully. Proof coming in a future post.)

The medication I was given that night and into the morning was to help get my cervix in a baby-expelling state of mind, and other than the very uncomfortable manner in which it was delivered every few hours, that part of the process was pretty uneventful.

That is, until 6:15 am the next morning, when surprise! My water broke. (We hadn't begun the actual labor meds yet, so this was taken as a good sign that my body was ready to do this.) You know how in movies it's this huge gush of water, and then everyone tells you that in real life, it's not like that at all?

It was exactly like that. Perhaps the most embarrassing part was that I couldn't tell if I was peeing or bleeding or what the hell was going on, so my reaction was something like, "Oh. OH. Aaron! Something is happening! Something is definitely happening...", while I simultaneously pounded the "someone please come help me right effing now" button on the side of my bed.

Stuff began to get real pretty quickly. A catheter was inserted (yay, no more wheeling IV bags with me to the toilet!), and doses of pitocin began coming my way via IV. Labor contractions began as small, intermittent discomforts, eventually snowballing into horrific pain on a 90-second continuous loop. I remember thinking, wow, people are not exaggerating one bit when they talk about how painful labor is. I would have gladly signed over my house for even a small dose of something to quell the pain.

Somewhere around 11:00 am, the anesthesiologist/angel appeared and after a few minutes, we had an epidural set up in my back. I can tell you that I have never felt such grateful relief in all my life. Holy hell, what a difference. The epidural allowed me to tolerate (read: mostly not feel) the increasingly intense contractions, and for the next few hours I was even able to take some short naps (!). Everything was progressing as my medical team hoped it would.

It was, that is, until around 3:00 pm. Progress in terms of dilation began to stall, and baby Rabbit wasn't giving any indications that she was ready to budge (meaning, she hadn't "dropped" any lower). In addition, the fetal monitors were indicating that with each growing contraction, her heart rate was dropping.

That's not good.

And so, at 3:17 pm, my OB came into our room to tell us what the new plan was. "She was tolerating labor just fine up until now, but we don't want to take any chances so we'll be doing a c-section. Aaron, here are some scrubs for you to put over your clothes. Kim, we're going to wheel you into the operating room now and Aaron will join you in about ten minutes."

Aaron started sending the "get here now!" texts to family, and I was given the numb-the-bottom-half-of-your-body drugs, while my hair was shoved into one of those meshy shower caps. I began to feel tingles, then the strange feeling of dead weight throughout my legs, hips, stomach, and eventually even out to my arms and hands. I also began to accept that, once again, I really had no control in how this all would play out.

My doctor looked from me to Aaron, then back again. She smiled.

"You're going to have a baby within the hour."

And all I could think was:

(To continue to Part Two, click here.)