Small Wins: 34 Weeks Pregnant

I brushed my teeth with real toothpaste today.

If you know anything about HG, or have been following my other posts about it, you’ll know what a big deal it is for me to brush my teeth. I’ve mostly been brushing with just water, which is a huge step up from not brushing at all (which was the case for many weeks during the worst times). Every once in a while I could use the special strawberry toothpaste that my husband got me–very mild taste, not as likely to trigger my gag/vomit reflex as the minty stuff. But today I used real mint toothpaste! And only got close to vomiting once, which I think I’ll blame on this lingering cough/throat tickle, not on the toothpaste.

I’m feeling relatively good today, though I wonder if that’s because it’s overcast and supposed to rain tonight. Last week I was dealing with depression, which could have been due to my thyroid levels, but could also have been because of the hot weather (really, it’s not supposed to be hot out in February!!). So it’s nice to see how the light is different in the apartment with cloud cover outside, and to look out the window with my cat at the beautiful grey blanket protecting everything from the sun.

We’re very much playing the waiting game with this baby now. I had contractions a few days ago that happened every few minutes for about three hours, and were worsening in intensity as we went. But then I ate some food and took a bath and they went away. 😦 My OB says from here on out we will just deliver instead of stopping the contractions with meds, which is a huge relief. Of course, as soon as he says that I stop having as many contractions as I was before. *sigh* They will definitely induce me at week 39, if we make it that far, because of the gestational diabetes. But baby and I are also taking longer and longer to pass the non-stress tests each time, and I keep hoping that means my OB will want me to deliver sooner rather than later. There’s also a chance that at the 37 week growth scan they will say the baby is already getting too big, and we should induce then. Fingers crossed, I guess. (I know how much other moms worry about delivering early, and I don’t mean to make light of it. But the month of steroids I was on for the HG probably helped with the baby’s lungs, and a good number of babies born at or after week 34 don’t even need to spend time in the NICU. It’s tough balancing my desperate desire to be done with this pregnancy (which has been the hardest challenge I’ve ever faced in my life, let me tell you) and concern for my kid. But mostly the desire to not be pregnant anymore wins out, because I’m confident about my little one’s health and fortitude.)

I have another non-stress test tomorrow, again at the hospital I need to deliver at (no NICU at the hospital ten minutes away, of course, so I have to deliver at the one 40 minutes away…). So I went to the grocery store today after my gestational diabetes appointment, and got some prepared foods to bring with me. The plan is to go early and spend a few hours at work (which is five minutes from the hospital). The trick, of course, is that maybe by going to the store today I have exhausted my energy reserves, and tomorrow I’ll be feeling worse. That happens super often. So I’ll just take it a day at a time, like I’ve had to do this entire pregnancy.

At this point, I’m almost tempted to push my limits as far as I possibly can every day, to possibly go into labor sooner rather than later. I just have one more week to wait until the full 30 days will have passed since I signed my consent form for the tubal. So really, any time after that, I’m ready to meet this baby. It would also be super nice to get just one normal paycheck under my belt before delivery–we would’ve been lost a long time ago without short-term disability, but I still miss my full income and worry about the six to eight weeks I’ll have to take off after having the baby.

Every day feels like a confusing mix of progress and mounting frustration. I don’t know if I’ll really know what to do with myself once I don’t have nausea and headaches and potential vomiting hanging over my head. Or when I can eat whatever I want again, because the diabetes will be gone. It seems so foreign. Too good to be true. I really think I’ll be one of the only moms out there who says that a newborn is so much easier than pregnancy. And while I hate the HG and wish I had never had to go through it…it’s like a small consolation prize knowing that life will actually be easier once this kid is born, instead of more difficult.

You can find the other posts in my series on hyperemesis gravidarum here.


Hypothyroidism: A Tricky Beast

Disclaimer: I’m not a doctor/medical professional. Don’t take health advice from me, and do your own research.

I had a recognizable pattern of “bad summers.” It started when I was 16, or at least that’s the first time we noticed it. I was sleeping all the time, preferring it to being awake. The summer in between tenth and eleventh grade was hell. I had just spent the previous few months helping my best friend with her campaign to be elected on the student body council—we had tons of fun making posters and she ended up winning. Then through the natural rhythms of life, she had a super busy summer. A lot of it was outings with the rest of the student body council. The first sign that something was wrong (though I didn’t realize it at the time) came when I hadn’t heard from her in a while, but heard through a mutual friend that she had visited Stanford. It was a routine sort of field trip, nothing crazy. We were all thinking about colleges then, and she just happened to go with the student body council. I got so mad. Not really jealousy that she had gotten to go visit the campus, but anger that she hadn’t told me about it. Irrational anger, obviously. I justified it in my head by saying that Stanford was one of the most prestigious schools for writing, and she should have known I would care about it as a writer, and so she should have told me.

I gave her a hard time about it, left angry voicemails, and generally acted like a crazy person. She stopped talking to me entirely (can’t really blame her, when we were only sixteen and I was obviously off my rocker).

My mom was worried about me, thought that all the sleeping meant that I was depressed. She took me in for blood tests, and we got my thyroid levels checked. I don’t remember much about it—just the probing questions from the doctor about whether I felt sad all the time, and the rebellious sullen answers a typical teenager would give to those sorts of questions.

Fast forward to years later. I’m 24, and realizing the pattern of horrible, depressed, sometimes suicidal summers. I’m mystified—seasonal affective disorder is certainly a thing, but reverse seasonal affective disorder was still new enough to maybe not be real. So I start researching. And asking about family history. And finding obscure internet articles about how depression can be linked to thyroid issues. And even more obscure references to the seasonal fluctuations in thyroid levels. I think I was determined to find something that meant I could treat my depression with something other than antidepressants. I’d already been on the suicide crisis lines for a while, and I hated that so many of the callers were dealing with suicidality as a side effect of their mood stabilizers. And so many of them weren’t monitored as closely as they should have been, with follow-up psychiatrist appointments months in the future, when they were obviously having adverse side effects to the dosage NOW.

I dug through old paperwork and managed to find the results from that thyroid test when I was 16. My TSH was at 4.5. Most labs say the cutoff for a normal thyroid is 5.0, but some big group of certified Endocrinologists said those numbers should be revised, that anything above a 3.0 was worrisome… So I started the hunt. I saw a doctor who said that if I was depressed I should listen to happy music. She was also the one who asked about my religion and tried to imply that I was depressed because I wasn’t Christian. That was a fun visit. I saw an endocrinologist who said that she wouldn’t even think of treating me unless I had a TSH above 9.0 and an obviously enlarged thyroid (goiter).

Finally, the third doctor agreed to treat me based on my symptoms rather than the lab numbers. My TSH was coming back as 4.3, near the tail end of another difficult summer. What doctors now call “subclinical hypothyroidism” but what for me means a terrifying stretch of time when depression and suicidal thoughts rule my life.

Long story short? I got on thyroid meds and haven’t had a bad summer since.

Just to prove how delightfully tricky it is to recognize thyroid issues, though, here were my symptoms back when I was trying to get treatment:

-Hair loss (which, due to my genetics, meant that my very thick, vibrant, copious amounts of hair clogged my hairbrush more than it should. I wasn’t going bald, my hair was not noticeably thinning out, strands would just fall out more than what was “normal”)

-Temperature sensitivity (Cold was super cold, hot was unbearably awful. It’s most obvious when I go to work at our company’s beautiful warehouse-style location that takes a while to warm up in the mornings. The guys are down to shirt sleeves within an hour. I’m still in two sweaters after lunchtime.)

-Depression/Suicidality in the summertime (Confusing, because some people who are hypothyroid are hypothyroid enough for the depression to last all the time, whereas my numbers are low enough that seasonal fluctuations mean some of my symptoms go away during the colder months…)

-Fatigue (Difficult to distinguish from the depression, since they’re usually wrapped up in each other. Mine was most recognizable after spending time in hot environments—any time in the sun and I would have to nap for hours to get anywhere close to a normal energy level again.)

-Weight gain (This was very gradual. Just over ~5 pounds a year, over the course of several years. But that certainly adds up.)

Then, along came pregnancy and my lovely hyperemesis gravidarum. Sleepless nights spent scouring the internet for any little distraction that might help me put off the next vomit session by a half a minute uncovered the weird link between thyroid hormones and hCg. HCg is the growth hormone that is detected via pregnancy tests. Your numbers multiply for a while, peaking somewhere near the end of your first trimester, and then remain elevated somewhere into your second trimester, until the placenta can start taking over some of the hormone production. High levels of hCg are thought to be linked to hyperemesis, a nifty explanation for why women pregnant with twins often end up with HG or just higher levels of nausea and vomiting during pregnancy. Turns out the alpha subunit of thyroid stimulating hormones is nearly identical to hCg. What does that mean for me? It shouldn’t have meant anything. Unless my hypothyroidism is caused by Hashimoto’s autoimmune disorder, in which case it could mean very bad things.

I don’t really want to go into all the intricacies—everyone should do their own research on this stuff, and since I haven’t been formally trained in it there are probably bits that I’m getting wrong. But basically when you have Hashimoto’s your immune system is trained to attack your thyroid, slowly breaking it down until it loses more and more of its mass and ability to produce the T4 hormones that are converted to T3 and then used throughout your body to regulate everything from your metabolic system to your temperature. Homeostasis in the face of Hashimoto’s? Pretty tough on the body to maintain.

So, basically beyond a certain threshold of hCg, my immune system started going into overdrive. I’m guessing (though it isn’t proven) that this is why my body was rejecting everything useful during the worst times of my hyperemesis (ex: food, liquid, any nutrient whatsoever). The hyperemesis, again for unknown/unproven reasons, sometimes causes what they call “transient hyperthyroidism.” Which meant that for a while my TSH numbers went the opposite direction. I had to stop taking my Synthroid (synthetic T4 replacement hormone used to treat hypothyroidism), because I was getting all these symptoms of hyperthyroidism. I had heart palpitations, increased heart rate, I was losing weight at an alarming rate (also due to the hyperemesis though, of course).

So I’ve been off my thyroid meds for a few months, ever since the last hospital admission. Unfortunately, in most normal pregnant women, doctors don’t have a standard protocol of checking all areas of thyroid production/health throughout pregnancy. In one routine blood test (I think for the second trimester screening) they only tested my free T4 numbers, which came back normal. They advised me to not re-start my thyroid meds, because everything looked good.

Along comes a visit to my primary care physician, who is following up on my overall health now that my body has been going through so much (and to think, before the pregnancy all I was dealing with was a vitamin D deficiency!). He runs some tests, and low and behold, my TSH is all the way up to 7.0!

Have I been dealing with depression? Just the normal amounts for any woman with hyperemesis, which thankfully died back down after the steroids started allowing me to eat and drink again. Am I sensitive to cold? Hell no, I’m pregnant, I run way hotter than usual and end up soaking my sheets in sweat every night.

The depression is usually my big indicator that something isn’t right. If the depression isn’t present, I don’t really notice that anything’s wrong. So the recent levels of insane fatigue I’ve been feeling, I just attributed to third trimester symptoms, plus a possible correlation with my gestational diabetes diagnosis, because high blood sugar numbers can cause extreme fatigue.

It’s only after my doctor comes to me saying myTSH is at a record 7.0 that I realize I’ve been having to clean off the hair from my hairbrush about five times more often than I normally would have to.

Interestingly enough, women with hypothyroidism are something like 17% more likely to develop gestational diabetes. Probably something to do with how the thyroid hormones are hooked into your metabolism, and therefore the way and rate your body metabolizes glucose…

The lesson in all this is pretty simple, for me. Stay more on top of my thyroid condition. I’m a little hopeful now that with some thyroid meds we might see some improvement in my fatigue levels, which would mean I can go back to trying to work again. Who knows, maybe it will even make the gestational diabetes easier to keep in check. I’m a little miffed that my body is so complicated right now…my PCP says that it’s probably due to the lasting effects of the steroids on my system that things are so complex and confusing now. I thought that hyperemesis gravidarum was enough to have to deal with—I wouldn’t wish it on my worst enemy. Then add the gestational diabetes, and now thyroid issues…

The one definite good thing in all of this is that we’ve finally tested for, and confirmed, Hashimoto’s. Right now with my weird dietary restrictions/needs, I can’t do much about it. I’m still eating whole wheat carbs and just trying to manage my blood sugar numbers in any way I can. But after delivery, when I can get rid of this placenta and my body will return to functioning the way I’m used to it doing…I can go gluten-free to help limit the negative affect of the Hashimoto’s. It feels good, knowing that I will finally be able to manage a health problem myself, with just some lifestyle tweaks. I don’t have to feel like such a victim, buffeted by the endless storms of uncontrollable pregnancy complications. Just ten weeks to go. Longest ten weeks of my life…but the end is in sight.

Finding Peace in Additional Pregnancy Complications

My battle with hyperemesis gravidarum isn’t over yet. It won’t be, until I give birth, and even then I know I will struggle with post-traumatic stress disorder brought on by this debilitating illness.

This week we’ve had a new pregnancy complication to deal with, on top of everything else. I just barely failed the one-hour glucose test set by my doctor. They had me go in for the three-hour test next—a rather hopeless undertaking considering my state. Fasting for twelve hours and then putting 100 grams of glucose straight into my empty system almost guaranteed a poor outcome. I made it past the one-hour blood draw, but then the exertion of walking back to the waiting room to wait for another hour sent me over the edge. The bathroom had nice thick walls, so no one could hear the retching as I lost all of the sugary lemon-lime awfulness that hadn’t yet been absorbed by my system.

It was scary, walking into that handicap bathroom stall with no one else around. The world was spinning and my vision was going dark. I couldn’t help thinking about my obstetrician’s warning, that a fall at this stage could seriously hurt, even kill, the baby.

Nausea and I are old friends by now, so I lay down on the cold floor. Sometimes if I can cool my temperature enough by contact with the tile floor, I could stop myself from vomiting or passing out. Unfortunately, it works a lot better when I’m in my own home, not wearing any clothes (any pressure or constriction from fabric can exacerbate nausea, and even seems to make my skin crawl more violently when I’m dealing with an episode of restless legs). There wasn’t enough of my skin exposed to the cold laminate, so lying down didn’t lower my body temperature enough. I barely hoisted myself to the trash can in the corner of the stall fast enough.

Luckily for me, I didn’t pass out. Emptying my system of that horrible glucose concoction stopped my vision from greying, and made me feel more steady. My system was still reeling from far too much sugar entering it at once, and the baby was definitely doing the flips and tumbles that I now associate with a transferred sugar high. The phlebotomist I informed seemed scornful and disappointed, like it was my fault that I couldn’t keep the drink down. I’ve gained more compassion for people who seem to judge me for my illness, though. Early the very next week she was the one to draw my blood for other tests, and she was kind and efficient, going straight for a butterfly needle the way all exceptional phlebotomists do when faced with my difficult veins.

One of the midwives in my doctor’s practice told me to track my fasting and post-prandial blood sugar levels for a week, and report back to her. Something I wish I could have just done right away, without enduring the trial of attempting that brutal three-hour test.

My numbers came back on the verge of being bad the first day, but we weren’t worried yet. There was a special cleaning and purging session at work, and for the first time in months I had my husband take me in so that I could cover the phones while my colleagues worked on the special project. It felt so good to be useful in such an obvious way.

The exertion of those hours sitting at the phone though, seemed to act the way light exercise does—by the next day, when I was completely wiped out and unable to do anything physically exerting, my numbers were already higher. They keep climbing up. I’ve noticed a terrible feeling of dis-ease that seems to correlate exactly with the height of the numbers. A friend took me to the grocery store, an undertaking that completely wiped me out yet again. Even eating a “diabetic diet,” I can’t get those numbers under control.

For the past six days I have been sleeping close to 20 hours a day. I’m more nauseous all the time, a nausea that the Benedryl doesn’t seem to touch anymore, I suspect because it’s brought on by the high blood sugar. My fasting numbers are always high, and even limiting carbs and making sure to have a good protein source with every meal and snack isn’t helping much.

I suspect that my body is just too worn down to deal with this new complication. Gestational diabetes is similar to Type II, where your body is still producing insulin but your cells are more and more insulin-resistant. It is likely to get worse as long as I have this placenta in me, producing greater and greater amounts of hormones that are helping baby put on the fat stores it will need for protection in its first weeks out in the wider world. I have to wait to see an endocrinologist—I don’t know how long it will take them to call me to set up my first appointment, but I’m hoping it’s soon. I haven’t gotten a single bit of work done this week, because of how awful I feel on a constant basis. I don’t think my blood sugar ever drops below 90, and even two and three hours after a meal I still see numbers that are very high for a non-diabetic. I can’t go for a half hour walk after meals to help use up the sugars entering my system—I hardly have the energy to make myself eggs in the morning, though their protein is one of the only things that doesn’t make my blood sugar shoot higher.

With all of this going on, I’ve been feeling very defeated. The hyperemesis is in NO WAY my fault. Likewise, the gestational diabetes is NOT MY FAULT. Likely the GD is actually caused by the HG wearing down my system—nothing is working as it should, and if I was able to keep up a normal diet and routine of exercise I might not have ever gotten into the range of GD. Even knowing that there’s nothing I could have done to prevent either of these illnesses/complications, I still feel targeted by the universe. It feels like everything that can go wrong at this point will likely go wrong, because my body is so worn down and incapable of handling this strain. That’s a mixed bag in a lot of ways. The more complications arise, the more likely my doctor is to decide on an early cesarean, which means pregnancy is over that much faster, and recovery is right around the corner. But at only 30 weeks pregnant, I still need another six or seven weeks before we wouldn’t have to worry too much about baby’s health at being delivered early. And even at 36 or 37 weeks, baby’s lungs might not be as developed as we’d like, and we could be looking at dealing with baby being in the NICU post-delivery.

The title of this post might be a little misleading. I haven’t actually found peace yet in these additional pregnancy complications. But I’m trying. I’m struggling, I’m battling, I’m trying to cultivate acceptance and a calm mind. I write late-night rants to a friend who is a good listener. I reach out to my cousin who was the man of honor at our wedding, the brother I never had. He has a way of reminding me that life is worth it, that I’m worth it, no matter what I’m facing in the current moment. I kiss my husband and long for a return to normalcy for us, when I can shop and cook and clean for him again, when our sex life is normal because my body is no longer frail. I fear, every day, that I might never get better. That the instant relief other HG moms feel as soon as they deliver the afterbirth won’t come, and I’ll be looking at a life of nausea and complications, at failed organs and feeble health. I read books on Buddhist acceptance and release from suffering. I dutifully record my blood sugars and count the kicks of my squirming tenant.

I am trying, and that is all anyone can ask of me.

You can find the other posts in my series on hyperemesis gravidarum here.