Friday, March 30, 2012

Just Sweet Enough

So here's the update on the past week or so.  I had my glucose tolerance test last week to check for gestational diabetes.  This involves fasting for a couple hours prior to the test, drinking a bottle of corn syrup (not literally), and then checking my blood sugar an hour later to see what happens.  Well.  Ever since I had the test with Henry about two years ago, I've been saying that I passed that one by one point.  The normal range is 74-139, and with Henry, I had a 138. Which I now realize is actually passing by 2 points, because *this* time, I had...a 139.  Thank you, pancreas, for not betraying me in my hour of need.  So as the title of this post would suggest, I am officially just sweet enough.

A couple days ago we had an appointment with the Maternal Fetal Medicine (MFM) folks.  The first thing was an ultrasound with the world's fastest sonographer. Zippy zip, measure measure, click click, and "Oh look! She's got some hair!"  She steps out and comes back in with The Doctor.  Dr. M--white hair and a mustache, probably in his 60's, and looks like he could've been a football player back in the day.  He seemed *really* tall, but that could have also been because I was lounging on an exam table about two feet off the floor at the time. He was one we hadn't met before, and I wasn't sure what to think of him at first, because he kept asking me questions that were sort of alarming, in a "why are you asking that?" sort of way.  "How old are you?  How far along are you? And have we looked at the baby's chromosomes yet? Are you diabetic?  How far along did you say you were?"  This line of questioning was going on while I was back under the ultrasound wand, so for the paranoid among us (me), one can't help wondering why all the questions.  Also amusing was Dr. M's use of the phrase "the kid" when referring to our baby.  As in, "You know, it's hard to predict the outcome with these CDH babies.  Until the kid's born, it's all kind of up in the air."  Pretty sure he referred to Bee at some point as a "he" also.  Despite the questionable first impression, I really did like this guy.

Following this second round of ultrasound viewing, Dr. M looks at me, gives me a big grin, and announces that everything looks good.  Bee's heart continues to look good, with "good ventricular output" (or some such cardiology jargon).  Basically he was saying it wasn't getting too smushed by her abdominal organs hanging out in her chest.  Also, it appears that her liver is still down below the diaphragm.  Jonathan asked if, at this point, there was much chance of the liver moving up.  Apparently the left lobe of the liver is a sneaky little thing and can find its way up there pretty much at any point.  So please keep praying that it stays down down down.

Then there's the lung to head ratio (LHR).  Here's a diagram that I stole from Abby Knoll of "It's How We Roll" fame (check out her blog over there in that list on the right--->)

First, they measure (or at least make a valiant attempt at measuring) the right lung.  (Here we have a cross-sectional area of 21mm x 10 mm, which is 210 mm squared.)  Then they measure the head circumference (200 mm).  Then you divide! (For the math geeks among us, the units don't quite match up because we're dividing an area by a distance, but just go with me here.)  In this example, it's 210/200, which gives an LHR of 1.05.

I mentioned this briefly in a previous post, but there's some controversy as to whether the number even matters.  It looks at the relationship between the baby's head size and the amount of lung tissue present.  The higher the number, the more lung tissue.  (Over about 1.4 is considered pretty darn good.  Bee had an LHR at 21 weeks of 1.8.)  This is a good thing, obviously, but the reason (I think) that the docs are hesitant to make any major predictions based on the LHR is because, you know, it's all up in the air until the kid's born.  Despite this, I asked Dr. M about an LHR, because inquiring minds want to know.  He tells me that he'd rather not give me a number because it's hard to get an accurate measurement of the lungs, it's not reproducible, etc etc.  I basically told him "Yeah that's great and all, but you seriously have got to give me *something*."   Long story short (because ol' Dr. M couldn't remember how to calculate an LHR until I told him, and also because they got about three different lung measurements), Bee's LHR is somewhere in the 2.1 to 2.3 range.  Yay lungs!

One more little piece of info is that my amniotic fluid levels are in the normal range.  That's important because sometimes the fluid levels can get too high with CDH babies, which increases the risk for preterm labor.  We don't need Bee to be a preemie on top of everything else, so she needs to stay cooking as long as possible.

So there's the update.  Lots of good news!  To recap:  1.) I'm not diabetic!  2.) Bee's heart still looks good. 3.) She's got a good amount of lung tissue.  4.) Normal amniotic fluid levels.  Many many thanks for everyone who has prayed for us or sent positive thoughts. God definitely has his hand on our little girl.

I did get some super cute pictures of Bee at this last ultrasound.  When I get a few minutes to play with the scanner, I'll post them. :)

(Also, my younger sister is due any day now with her second little girl...please keep her in your prayers as well!)

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