A prescription for steak and BJs

Another three weeks have gone by and today was another OB appointment. This visit was markedly different in that at least I was in and out in under 30 minutes. I think that has to be a new record (hooray free parking!). I'm the same weight as three weeks ago (189) and my blood pressure has gone down to "are you sure you're pregnant?" normal versus just normal (104/67). Everything is very much in order. It seems I can't have a doctor's appointment, though, without at least something getting on my nerves. Each visit I realize more and more how much I dislike dietitians.

On the one hand, they tell me that the hormones affect my blood sugar and certain things are out of my control so I just have to do the best I can. And on the other hand, the dietitian wants desperately to prove her worth by giving me some suggestion to change so that I feel like I'm getting my money's worth.

There are two dietitians I deal with, Georgia and Marilyn. Georgia is the one that "doesn't like my numbers" and complains about my refusal to user their precious log book. At least she's consistent. Marilyn's theme seems to be one of protein. That's all she can talk about is that I need to have protein with every snack. I'm basically forbidden from eating something unless it also has protein in it.

Marilyn: "I see you ate a banana here. What is this about?" (Seriously, she said that, like it was an episode of CSI: Uterus.) Me: "Uh, we were walking out the door and I hadn't eaten in a few hours so I grabbed a banana." Marilyn: "But you didn't eat any protein with it. That will make your blood sugar high." Me: "I was walking out the door! I don't keep a jar of peanut butter in our car's center console." Marilyn: "Well, you know you need protein with every snack and meal."

I'm supposed to have a minimum of 60g of protein a day. Really, as a "high risk" pregnancy, the books would like me to get as much as 100g a day. That number seems impossible to me. If I eat a burger from Five Guys or a Chick-fil-a sandwich, that's 30g. But Marilyn is not satisfied unless she can see each time I ate something, I had at least one serving of protein. What's ridiculous is if I write down that I had almonds, she's satisfied even though there are only 3g of protein in that serving. She wants to see protein on every line that shows food going into my body.

I just cracked open the dreaded diet section of the "What to Expect" book (which I've been largely ignoring because that book is pretty much an encyclopedia of Things That Will Kill Your Baby Dead). It says, "to get your 100 grams, all you have to do is eat a total of four servings of Protein Foods from the Best-Odds Food Selection Groups." They then provide a handy list. Their list includes servings such as 5 (!) eggs or 3 (!) cups of milk or 1/2 cup of Parmesan cheese. Who eats like that every day?!

As I review what I've eaten the last week, I can see where I could have chosen items that had more protein in them, but it doesn't seem to matter if that's what I want to eat. It's enough to make me cry (then again, certain cleaning product commercials are enough to make me cry). I'm all about telling the Internet to go to hell with its advice on what I should and shouldn't be eating. But this lady is in my face and tsk-tsking me every three weeks about it.

My new plan is to start logging blow jobs in my diabetes journal. The Internet says those provide the same amount of protein as an egg. (God bless the Internet.) The next time we're rushing out the door and I don't have time to grab a handful of almonds, we'll just have to have some auto shenanigans to keep my blood sugar in check. It's for the baby, of course.

It certainly beats choking down a Parmesan cheese egg smoothie once a day.

Educating the diabetes educator

Today was another baby appointment. After the last visit three weeks ago where I waited for over an hour I was concerned this visit might involve me flipping furniture in the lobby like Godzilla. They must have made a note in my file, though, because I was called back at 1:35pm for my 1:30pm appointment. They whirled through my blood pressure, weight and other stats in under 10 minutes and I was situated in the exam room. The rest of the visit is usually where the nurse listens for a heartbeat, the diabetes educator looks at my blood sugar logs for the last three weeks and I wait to chat with the OB for a bit about anything pertinent. They take a few vials of blood for lab work and I'm on my way.

I love my OB but have had a strained relationship with the diabetes educator, Georgia. Because I'm forced to deal with her each visit it adds stress to the entire process. In the last visit (after waiting over an hour and having her dump my purse on my chest during the ultrasound) I got a little snippy with her. I wondered if she would remember me.

Interestingly, a new diabetes educator, Marilyn, came into the exam room. She had obviously been prepped about me because she knew I don't use their precious book and didn't give me attitude about it. She seemed to do better about not judging my blood sugars but then we started talking food. She fussed that I'm not eating enough protein during the day. When I asked her what she suggested, she said "you could have cheese or Canadian bacon." Seriously? Those are the two first things that come to mind when you think about protein? And why Canadian bacon? Not chicken or regular bacon or ham, but Canadian bacon.

Me: "I don't eat cheese." Her: "Oh, are you allergic?" Me: "I'm 19 weeks pregnant and you can see my food logs for the last three weeks. I eat 10 grams of fiber every morning. As far as I'm concerned, cheese is evil." Her: "Ahhh. Well, there's always Canadian bacon or other meats."

Marilyn returned to my logs. "I see you had a burger and fries. That's high in fat and will mess up your blood sugars." I just waited stoicly for her to get to the next line. "Hmm, but your sugars seem fine afterwards." Yeah, I'm kinda down with the Five Guys cheeseburger and fries combo.

"Frosted Mini Wheats? You shouldn't be eating stuff like that." She actually shook her head and looked over her papers at me. "You should eat multi-grain Cheerios instead of sugary cereals like that." I just looked at her and didn't say a word. I was starting to wish I had just dealt with Georgia instead.

When I was first diagnosed with diabetes in 1985, I was told I had to go the children's hospital instead of my parents' preferred and closer hospital because the children's hospital apparently had experts on juvenile diagnosed diabetics. We learned later that I was the first juvenile diabetic they had ever treated. The dietitian told us that I could have all the fruit juice I wanted but no sodas because fruit juice was a natural sugar and wouldn't affect my blood sugars. These people went to school to tell us that. I was allowed to have eggs and toast and milk for breakfast but not allowed to have french toast without the syrup because french toast was a forbidden food.

When I got back to the office and could look up my precious Frosted Mini Wheats, I found they have 10 fewer calories per ounce than Cheerios and more protein. Besides, Cheerios is now considered a drug so I'm sure they're bad for the baby.

After Marilyn left, I still got a visit from Georgia. She asked her usual question of "am I going to like these numbers?". I stammered. I knew she would probably ask this question and I wondered how I would react. I had scripted a few caustic retorts but nothing really sounded right. So instead I just stammered.

Georgia: "That sounds like I'm not going to like them." Me: "No, it's more like I don't like the question. I've been diabetic for exactly 24 years and every doctor and dietitian has stressed that I am responsible for my blood sugars. It's a lot of pressure to feel like you're responsible for anything that goes wrong with your disease because you could have prevented it."

I was surprised at how calmly I delivered all that. I think Georgia was surprised too because she turned from her paperwork and her mouth fell open.

Georgia: "But that's not fair to say that. The hormones affect your sugars and you can't control those." Me: "I think the whole point is that it's not fair. I just think a better way to phrase the question would be to ask me if I am happy with my numbers or even just to ask if I'm having any issues or problems." Georgia: "I ... you're right. That's a much better way to phrase it. So are you happy with these numbers?" Me: "I'm relatively happy with them, but maybe we can fix a few things."

So my appointment was still not very speedy but they're trying. I think by the time this baby is born, we'll all be a little better educated about maternal fetal medicine.

Perhaps we'll name the baby Google

Don't forget that April 1 at 9pm eastern is the deadline for the latest Living Out Loud project. This month's theme is food. Details are at the original entry. Speaking of food, I was trying to come up with the assignment for this month and I mentioned something about folks writing down what they've eaten all day. Rich (and maybe Kim too) said that most folks wouldn't bother to do it. I found this particularly interesting since it's what I'm doing EVERY SINGLE DAY. By the time this baby comes, I will have a complete log of everything I've put in my stomach for the last 40 weeks. I'm a medical statistician's dream!

Ever since I was diagnosed with diabetes back in 1985, doctors and dietitians have stressed the importance of logging your blood sugars and food. I can imagine it is hard for them to help you build good patterns of behavior if they have no patterns to look at in the first place. But it's one thing to say you'll write down what you eat for a day or a week. But every day? It gets old real fast.

When I first went to Eastern Virginia Medical School (EVMS) to talk about getting pregnant, they gave me a log book to track my food and sugars in and told me to bring it to every visit. I haven't touched that log book except to scan a page for your perusal. I politely accepted their log book knowing I would never use it.

First I tried using my own Moleskine notebooks. My main issue was needing more space to log the random times I ate and/or checked by blood sugar. This worked okay except that it was a large notebook to drag out every time I ate. The other issue was that the whole thing was hand-written and lived in my purse so if it disappeared or got messed up I was lost.

Then I decided they just needed to see my blood sugars so I just logged those in Excel and made them some charts of my blood sugars by week. This blew their minds, but not in a good way. They wanted a log book. I hated their log book. They couldn't understand the highs and lows on the chart and they wanted to monitor what I was eating. Fine. I told them I would try a new log approach for my next visit.

Enter Google Docs. I'm absolutely in love with this method for tracking my food, insulin, activity and anything else going on. I'm rarely not near a computer, and I can get to Google Docs from anywhere. To make it even better, Google recently made it so you can edit the spreadsheets from the mobile web so I could even enter data from my iPhone if I were inspired. Generally, though, I can log everything a few times during the day, remember what I ate with a few prompts from the insulin pump bolus history and my blood meter. I can make notes about stress levels, changes to my basal rates, or any other factor that might be affecting my health or the numbers on the chart. And I can print them all out before my appointment so the diabetes educator can peruse them by week.

My next appointment is Monday afternoon, so we'll see if she approves of this latest method. Frankly, if she still doesn't like it I'm going to tell her to suck it up and deal. Because I'm finally staying on top of it and since I'm the one who has to keep doing this until October, that trumps whatever she wants. What's she going to do - fire me as a diabetic mom?

I know they previewed a LifeScan iPhone application recently and it sounds intriguing. For now, I'm overjoyed just to have Google Docs.