Thursday, September 22, 2011

Our Vacation, The BIG Ultrasound, & My Latest A1C

It's been a couple of weeks since I last posted, and let me just say...they've been a busy (and eventful!) couple of weeks.  First, an update: I never received a call about our prenatal screening tests, so that's a big "yay!"...No news was good news, so that's definitely what we were hoping for.

We also had our big appointment with a maternal-fetal medical specialist last week that included a level 2 ultrasound to check for developmental/anatomical abnormalities.  Level 2 ultrasounds are fairly commonplace these days, even in women who aren't designated as high risk; however, my OB sent us for one specifically because I'm automatically labeled high risk thanks to my type 1 diabetes.  From my first appointment, my OB has been very supportive and encouraging, and was impressed with my A1C and tight level of control.  I appreciate the fact that he's treated me as normally as possible, because a lot of doctors have a standard procedure for treating "diabetic" women (as most of you already know, I hate that label!) that they don't deviate from, regardless of the patient's level of control.  The way I see it, if I'm able to keep my numbers relatively normal and generally within a normal person's range, there is no reason I should be automatically sentenced to C-section or induction at a certain cutoff point, provided everything continues to go as well as it has for the first half of my pregnancy.

I appreciate my OB's approach to my care thus far because he has been thorough and cautious, but optimistically so.  He has said from the beginning that if I'm able to keep my blood sugar levels as close to normal as possible, I should have an easy and uncomplicated pregnancy.  Of course, bad things can happen in pregnancy even for the healthiest of women, so he's also made recommendations (like the prenatal screening tests and level 2 ultrasound) to ensure that everything is developing as it should.  He did (predictably) go over the risks commonly found in pregnancies with preexisting diabetes, but thankfully didn't dwell on them.  Like anything else diabetes-related, pregnancy with diabetes is very YMMV (Your Mileage May Vary), and luckily my OB realizes that.  Some women have excellent control, but their prexisting complications from diabetes (like retinopathy) make it impossible for them to delivery naturally.  Other women have horrible control, but are able to (somewhat miraculously) have a normal pregnancy and delivery.  Therefore, I believe it's important to focus on the individual patient's unique situation in lieu of a textbook procedural code.  In that way, I feel very lucky to have found a doctor whose philosophy is closely in line with my own.

Due to some differences/problems between my OB's practice and the maternal-fetal medical specialists in the city where my doctor's office is located (about two hours from where we live!), we were sent to a different city three hours away to have our level 2.  Since we had a wedding in a nearby town the weekend before, we just decided to make a mini-vacay out of it and spent a few days in Carlsbad, NM, the week before our appointment.  We toured the Caverns and did A LOT of walking, but had a blast.  We stayed at the Trinity Hotel, an old bank that was renovated into a nine room hotel and restaurant.  The room we stayed in had a super comfy bed and the biggest bath tub I've ever seen:

The restaurant, which we ate at twice during our stay, was WONDERFUL.  The first night, we both had the lobster and cheese ravioli with vodka sauce, which was to die for, along with a piece of berry white cheesecake.  A couple of nights later, my husband had a ribeye and baked potato, and I had the Mastachana, penne pasta with massive grilled shrimp and a tomato-bacon sauce.  Per my husband's request, we also shared another piece of the same cheesecake we had before.  It was definitely some of the best food I've had in a long time!

The first day in the Caverns, we did the self-guided Natural Entrance tour, which begins at the Natural Entrance (duh) and ends in the Big Room.  I had never been to this or any cave, so it was a pretty cool experience.  It's like a completely different world down there...a world that remains a constant 56°F yearround.  Surprisingly, I wasn't cold, despite the fact that I was wearing a tank top and capri pants...I guess all the walking (mostly downhill, much to the irritation of my toes) kept me warmer than usual, because normally I'm freezing at 72°! 

Unfortunately, my blood sugar decided to not cooperate that day, leaving me stressed out at 308 post-lunch before we hit the trail.  I hadn't seen a number over 300 since I started insulin, and any number higher than 140 makes me nervous...Not to mention, I still struggle sometimes with the diabetes numbers game even though I have a generally healthy attitude about it most days (see #4 of this post).  It's hard enough for me to deal with an out-of-range number normally, but now that I'm pregnant that anxiety is sometimes through the roof.  After all, it's not just my life that depends on my numbers anymore.  Anyway, I corrected and hoped (and prayed) that the 1.25 miles of walking would bring me back to normal range.  About halfway down I tested again, and was at 209.  My hubby reminded me to not overdo it, but I'd rather be low than high any day, so I did another small correction.  By the time we finished our tour and made it back to the vehicle, I was at 46.  A Nature Valley Oats 'n Honey bar brought me back to normal range once again, and we were back in business.

The second day, we took a ranger-guided tour with 13 other people through the Left Hand Tunnel, which takes you through an unpaved and unlighted part of the cave not open to the general public (except on the guided tour) with only an old-fashioned lantern to light your way.  My husband wanted to take the more adventurous Lower Cave tour, but it was off-limits after I told them I was expecting...I'm pretty sure I would have been able to do it, but they didn't want to take any chances!  Anyway, the tour we took was pretty awesome since we were with such a small group and there was so much neat stuff to see (i.e., a mummified bat).  Towards the end of the trail back, we gathered in a circle and after telling what our favorite part of the tour was, blew out the candle in our lanterns.  The resulting blackout was an all-encompassing darkness that I'd never experienced before.  With absolutely no natural or artificial light in the cave, you literally couldn't even see your hand in front of your face.  Our ranger then re-lit our lanterns for the rest of the tour, and we ended up back by the restaurant area (750ft underground).  Since we'd seen the rest of the cave the day before, we decided in lieu of taking the elevator back up, we'd hike back out the natural entrance.

Mummified Bat (Lying Diagnally Across Above Rock)

Lanterns From Left Hand Tunnel Tour

The reason you "walk" down and "hike" up, we found out, is because the steep grade that leaves your toes aching on the way down is particularly murderous on the way up.  In the cold cavern air, my pregnancy lungs had to be given rest fairly frequently, and my buns/thighs/calves were all aching by the time we made it out.  The funniest part of the whole thing was when we encountered an older couple on their way down.  The woman asked her husband if they'd be hiking back up as well, and when I told her how difficult it was, she told me, "Well if you need any help, just holler and I'll come get you!"  Fortunately, we made it back to the surface (mostly) unscathed, and got back in the truck to return back to town--only to stop at the Living Desert Zoo and Gardens State Park, which gave us another 1.3 miles of trails to walk through that afternoon!  Although there weren't a ton of animals to see, it was a pretty neat place.  I was sad the cougar wasn't in residence (or possibly stalking us unseen) that day, but we did get to witness some prairie dogs freaking out when they noticed the wild hawks circling above them (hilarious!) and a mad rattlesnake (safely behind glass, of course) that looked like it was ready to strike at us.

We left the next day to head back to the city where we'd have our ultrasound and stopped to visit my husband's parents and some of his sisters on the way.  We rarely get to see them since they live so far away, so it was nice to be able to visit with them.  The next morning, I was so nervous that I didn't want to eat breakfast, but I knew I needed to eat something, so I forced down some eggs and cereal as quickly as I could so we could find the doctor's office in time for our appointment.  We made it with just a few minutes to spare, but I still couldn't calm down until they called us back for the ultrasound.  I don't think I've been that nervous in a long time, mainly because everything I'd done to keep myself and therefore our baby healthy up to that point was at stake...I can't begin to explain the tension and helplessness I felt.  I had been praying every night for the baby's and my health, but I still couldn't help but be a little nervous thanks to all the "what ifs" that creep into your mind if you let them.

It turns out all of my worries were for nothing, because our little one was perfectly normal and developing as expected!  After that was out of the way, I was on pins and needles wondering if our baby was a he or a she...I had been convinced throughout my whole pregnancy that I had to be carrying a boy, not due to any evidence but a feeling.  As it turns out, my intuition in this case was totally and completely wrong, because the ultrasound technician told us she was thinking we were having a girl, even though the cord was wrapped between the legs and she couldn't be completely sure.  She scanned a few more important areas then came back to double-check, and sure enough, it was definitely a girl!  I almost couldn't believe it at first, but I was definitely pleasantly surprised.  I always secretly wanted a girl, but wouldn't let myself dwell on it for fear that we wouldn't have one.  It's not that I would have been disappointed had we been having a boy; it's just that I'm so girly that I wanted a little girl to dress up and play Barbies (and John Deere tractors!) with.

I wrote a couple of months ago about how much the gender issue bothered me, not because we necessarily cared much one way or the other, but because of people's comments about our baby in relation to my sister's.  Since she is 10 weeks ahead of me and having a girl, we had to deal with everyone telling us that "maybe we'd have a boy" so that (a) my parents would have one of each for grandchildren or (b) because there'd be less competition between us.  It's hard to know what to say when people make those remarks, and even harder when they ask what you're hoping for.  For that reason, I never told anyone aside from my mom that I really wanted a girl...I didn't want to have to eat my words later.  My husband never said which he'd rather have, but I think he's thrilled at the thought of having a daughter.  He always tells me to be sure and take care of his little girl, and wanted to go buy her a little single-shot pink rifle as soon as we found out what we were having...Ours will be the third girl in our group, which currently contains five little boys to run from!  In the first stages of pregnancy, my hubby thought that baby monitors were ridculously expensive, but just the other day when we were at Target, he was scoping them out and commenting on how "cool" the video monitors were!  It's so nice to see him taking an interest in everything, and I know he'll be an amazing (and protective!) dad.

Last but certainly not least, I got my latest A1C results back yesterday.  Before conception, I was able to bring my number down from 6.5% to 5.7%, which fell safely within the person without diabetes's normal range of 4.0-6.0% that they like you to shoot for pre-pregnancy.  With all the higher numbers I'd been dealing with lately, I was afraid my number may have gone up slightly, but I was just hoping that it would still be lower than 6.0%.  When I got home yesterday and nearly ran to the mailbox, I ripped open the envelope with my test results and was shocked to see that my A1C was 4.9%!  I almost couldn't believe it, and had to read it a couple of times for it to sink in.  With all the challenges I've had to deal with and hard work I've put into managing this disease, it's so nice to see positive results.  In a way, it validates everything I've been doing and re-affirms my confidence in my ability to manage this difficult disease.  Most of all, it reassures me that I am doing everything I can to ensure my child's health and well being, which is the most important end result for me.

Friday, September 2, 2011

The Great Vaccine Debate

I decided yesterday that it was time for a change, so I revised the design of my blog and even got a new profile picture to match-and it actually looks kind of like me, so I thought that was pretty cool!  Every time I decide to embark on a blog makeover, I end up all tense with achy-shoulders from trying so hard to find the right html code to change in order to get the look I want, because the templates rarely work 100% for me.  Anyway, I somehow managed to get it decent-looking, so now I can finally relax!

I had another OB appointment on Tuesday, mainly to do the blood work for the quad screen prenatal testing that we decided to go ahead with.  Long before I was pregnant, I was undecided on the issue of finding out the risk level of having a child with a genetic defect or disorder (like Down's Syndrome or Trisomy 18), but since then I came to the conclusion that IF there was something wrong with our child, I would want to know before birth so I could be prepared for the challenges we'd have to face and get somewhat more mentally/emotionally adjusted to the fact, if that's possible.  A big needle stick (like I'm not used to that...), and 10 days later we should have our results.  They said no news is good news, so that's what I'm hoping for!

Prenatal testing, as I've discovered, is just one of the many difficult parenting decisions you have to make before your child is even born.  From breast/bottle feeding to the circumcision issue for little boys and even pacifier use (or not), there is plenty of controversy surrounding all of these choices.  People on both sides of every issue are passionate about their position, and few are willing to modify their ideas.  None of these debates, however, is quite so polarizing as the issue of vaccines.

Every time I come across an interesting article on vaccines, I post it to Facebook.  I am absolutely pro-vaccine, and passionately so...therefore, whenever I encounter these articles online, I opt to share it with my friends because I think everyone should have the best information possible to base parenting decisions on.  The first was an article about pediatricians who refer kids that aren't vaccinated to other physicians--as the article says, "no shots, no service."  The American Academy of Pediatrics stated that by instating policies like this, these pediatricians might be preventing unvaccinated children from receiving proper health care.  The bigger issue in my eyes, though, is that these children aren't being vaccinated in the first place-is that not considered "proper health care" too?  After all, babies can't decide whether or not they receive vaccines; it's the parent's choice.  And with so many rampant rumors and misinformation on vaccines, more and more parents are making the decision to not vaccinate their children or to delay their shots based on invalid information and anecdotal evidence from parents who claim that their children were injured by vaccines.  The thing that saddens me most is that these children aren't receiving the recommended health care because their parents either do not have access to accurate information, or simply choose to believe that the vaccine schedule is part of a big government/pharmaceutical conspiracy.  What they fail to realize, though, is that vaccines offer very little profit for the manufacturers (especially compared to other pharmaceutical drugs), and that the government has little to gain from children being vaccinated other than an assurance that the threat of disease outbreaks in the country is reduced.  I am not saying that politics do not influence medical issues and vice versa; I am just saying that given the current situation, I do not believe the vaccine conspiracy theory that anti-vaccine advocates are so quick to force.

In all honesty, I think that vaccines should be required by law in all children who aren't allergic to them or have compromised immunity for whatever reason.  The reason I believe this is very simple: the more children who aren't vaccinated, the greater the threat to herd immunity.  The second article I posted regarding vaccines on Facebook was a story about a little boy with leukemia who could not be sent to day care because his parents could not find one in which all of the children had been vaccinated.  The reason this was of such great importance was because this little boy, whose immune system was compromised due to chemotherapy, could not receive vaccines during his treatment--therefore, he (like many others, including young infants and other immunocompromised individuals) relies on herd immunity to protect him from the diseases that vaccines would ordinarily offer protection against.  The problem that scientists and doctors are seeing, though, is that in communities where so many parents are making the choice to not vaccinate their children, herd immunity is compromised so much that diseases that were once thought to be basically eliminated from the modern world are gaining a foothold once again.  As a result, children (both those who are too young or cannot receive vaccinations due to compromised immunity and those whose parents choose not to vaccinate them) are dying of preventable diseases.

Regardless of your views on vaccines, you only have to look at recent news stories to know that this is true.  Last year, the pertussis outbreaks in several states were devastating.  The numbers of children affected by the disease were disproportionately higher than previous years, and many investigators believe that it is at least partially due to the anti-vaccine movement.  It's pretty simple, really: the more unvaccinated children in a given population, the lower the percentage of vaccinated individuals; the lower the level of herd immunity, the greater the chance of disease outbreak.  What scares me the most about this is that the diseases that are emerging in epidemic proportions again are so threatening to babies who are too young to receive the vaccines that would protect them.  The first shot for pertussis, for example, isn't given until 2 months as part of the DTaP vaccine.  Before then, babies are vulnerable to the disease, which can kill an infant in a very short amount of time.

What I've encountered in posting these articles is that anti-vaccine proponents are quick to say, "Well if vaccines do such a great job of protecting your child, you shouldn't be worried about my unimmunized child making them sick."  No matter how often I get this reaction (and it happens surprisingly frequently), it still frustrates me to no end.  First of all, who are you to tell me that I shouldn't be worried about my child's health?  Of course I'm going to worry about my little one getting sick, and I absolutely worry about them being exposed to unvaccinated children for this very reason.  Secondly, if you know ANYTHING about vaccines, you know that they aren't all given on day until they're given the vaccination for a particular disease (which may be months down the road), they're vulnerable to it--it really is that simple and obvious.  The more I've thought about it, the more I realize that this reaction is just part of anti-vaccine advocates' self-affirmation toolkit--the more that they can convince themselves that their children aren't going to be infected with and/or spread diseases, the more they believe they're making the right decision in not vaccinating them. 

I've also found that anti-vaccine supporters tend to surround themselves with people who think the same way they do.  My husband was raised Mennonite, and although he received all of his vaccines and believes the same way I do, there are a lot of people within that group who are part of the anti-vaccine movement due to all the popular horror stories and rumors of vaccine injury.  As Seth Mnookin points out in his book "The Panic Virus", being around other people who support your way of thinking seems to validate your decision: "[...]sustained encounters with a small group of like-minded people almost inevitably lead to the conclusion that everyone thinks the way you do." (pg. 141, Nook version)  Never mind that 90-95% of the population in almost any given area of the country vaccinate their children; being around other anti-vaccine advocates (who are part of the other 5-10%, mind you) confirms that you're making the "right" decision, even if it goes against what the majority of the general public does.  I'm not saying that the majority way is always the right way; it's simply that on this particular health issue, it's logical to assume that if virtually everyone else is vaccinating their children without ill effect, you can be reasonably confident that your child is not going to suffer any adverse reaction from being vaccinated as well.  In fact, the chance of contracting one of the vaccine-preventable diseases is about 20 times greater than being injured in any way from the vaccine.  To further break those numbers down, if the risk of being infected with disease X is 1 in 1,000, the risk of having any ill effects from the X vaccine would be 1 in 20,000.  Furthermore, the transmission rate of most of these diseases is anywhere from 80-100%, so that gives you a 0-20% chance of NOT contracting the disease if you're not vaccinated against it.  Given those odds, I don't see how anyone would willingly not vaccinate their children without a valid medical reason.

Anti-vaxers also like to make the argument that if their child is sick, they're not going to expose them to others.  However, this is a simple statement to refute as well.  Many of these vaccine-preventable diseases have incubation times that are such that you could go days or weeks without realizing your child has been infected before they start to have obvious symptoms.  Pertussis, for example, first appears as a normal cough/cold before turning into full-blown whooping cough.  What parent keeps their child home from school (or any public place) every time they have a simple cough or cold?  I'd wager that it's not many. 

I've had this debate several times on Facebook, and one person even asked me point blank what the chance was of their unimmunized child giving a vaccinated child one of these diseases.  Never mind that the point of the article at hand (the one about the boy with cancer) was the danger posed to children who couldn't be vaccinated (yet), or that the occasional immunized child who for whatever reason does not get full protection from the vaccine(s) they receive also relies on herd immunity; this is what I replied:
[...]Therefore, the disease transmission rates (percentage of susceptible individuals who will become infected by an infected individual, where the susceptible individual is a person with a compromised immune system or one who has yet to receive the vaccine due to being too young) vary based on the particular disease. For pertussis, the transmission rate is 80%+. For measles, it's nearly 100%. This means that when a non-immunized child becomes infected with one of these diseases, the chance that they will infect a susceptible child they come into contact with is 80-100%.

As mentioned previously, there have been many recent cases in which a non-vaccinated child contracts a disease and in turn causes an outbreak. Most notably, there were 21 cases of measles outbreaks in Minnesota in April this year, of which 85% or more were linked to one unvaccinated child. In Utah, another child may have exposed up to 1,000 different people in two different events to the disease. The pertussis outbreaks last year have been linked to the large percentage of children who were nonimmunized, infecting infants who were too young to receive the vaccine and for whom the disease is often fatal. So clearly, it's a very real issue, especially when it comes to the recent epidemics of vaccine-preventable diseases in the U.S.
I also linked to two more articles (here and here) about how recent disease outbreaks have been linked to the anti-vaccine movement and how it is fast becoming a social health issue.  Never mind that the original "study" linking vaccines to autism, conducted by Andrew Wakefield in 1998, has been found to be fraudulent (and, in fact, clearly should have never been published if you read chapters eight and nine of Seth Mnookin's "The Panic Virus") and completely baseless, emerging from his illogical connection between the measles part of the MMR vaccine and bowel disease (yes, bowel disease), leading ultimately to autism.  Even after hearing about the Wakefield study being invalidated, I never realized the full ridiculousness of his claims until reading Mnookin's book.  No matter how crazy and unfounded, however, it is easy to see how claims like Wakefield's can so quickly influence the public's perception and how difficult it can be to undo the damage once it is done.  The media loves a good public health scare, and articles confirming vaccine safety aren't as newsworthy or attention-provoking.  Therefore, once the public is sufficiently enraged over a perceived issue, the retraction or correction barely registers in the collective psyche.

More recently, a review of the current literature on vaccines was completed by the Institute of Medicine (a division of the National Academy of Sciences) and confirmed that vaccines are generally safe.  Before anti-vaccine advocates can shout bias or conspiracy, it is important to point out that this study is unique because it reviewed over 1,000 existing studies on vaccines.  So unless thousands of scientists are publishing falsified research in legitimate, peer-reviewed journals (unlike the some other "scientific" publications, which will admittedly publish any article, even those that appear to be questionable at the onset), it would be hard to refute these findings.  On a Facebook page for Pregnancy and Newborn Magazine, which posted a link to this article after I did, Organic Baby University commented on the link that "I would love in just one article or news piece from someone to provide the actual studies they used to determine no correlation. Never seen a link or attachment or anything to provide the public with the ability to read those studies that prove it. Just that they exist. As educators we would love to read the scientific studies!"  Another person and I both replied with the link to the bibliography from the study.  Perhaps after reviewing 1,000+ research articles, some anti-vaccine advocates will feel more comfortable with the conclusion that vaccines are, in fact, safe. However, there will always be those that dismiss any evidence in favor of vaccines as part of a conspiracy, even though this review was completed by an 18-member committee and included research by thousands of scientists!

That's the thing that has been the most striking about this debate for me--no matter what evidence you provide to anti-vaccine proponents, they would rather believe anecdotal "evidence" from people who have no medical background (not that I claim to have any medical training; I simply rely on facts from those who do to guide my decisions) over scientific fact.  Controlling for any potential biases, I just can't understand why anyone would believe that every single study confirming vaccine safety and neccessity is somehow "not real," or not to be trusted, or that peer-reviewed studies should not be used as a legitimate basis for decision-making.  Just last week, one of my closer friends (who does not vaccinate her child) deleted me as a friend on Facebook because she and her husband were offended by my posts on the subject.  She also took issue with the fact that my husband and I are choosing to not expose our baby (which will be born in February, the height of cold/flu/RSV season) to unvaccinated children until he/she can be immunized, because once again, she posed the question "If vaccines do what they say they do, why should you be concerned about our child?".  After I refuted this claim (again), I told her that my husband and I have every right to do what we feel is needed in order to protect our child.  I would rather take extra precautions to protect him/her and risk stepping on some toes rather than our little one getting sick when we could have prevented it.  I will choose protecting our baby over hurting someone's feelings any day, end of story.  I also told her that while I agreed that being a mom is a job that takes heart, I didn't see how my making educated decisions based on facts would make me any less of one.  I told her that if she chooses to believe other things over scientific fact, that's her decision-but it certainly isn't mine, and never will be. I simply could not make a decision about my child's health that goes against everything I know, simple as that.

I know that all of these people who choose not to vaccinate their children do so out of legitimate concern for their child's wellbeing and feel that they're doing what is best for their children, but it saddens me to know that they do so without accurate information to base their decisions on.  I believe that parenting decisions should be left to the parents until those choices affect my child's wellbeing-or theirs.  There is a reason why you can't get a religious or philisophical exemption for drunk driving or illegal drug use-it's an issue of public health and safety...The thing is, I don't know how many more children are going to have to die from preventable diseases until something is done about the issue.