ASA’s Task Force on Preoperative Fasting suggests the following for patients taking GLP-1 agonists for type 2 diabetes or weight loss who are having elective procedures. It is also calling for further research to be done regarding GLP-1 agonist medications and anesthesia.
Day or week prior to the procedure:
Hold GLP-1 agonists on the day of the procedure/surgery for patients who take the medication daily.
Hold GLP-1 agonists a week prior to the procedure/surgery for patients who take the medication weekly.
Consider consulting with an endocrinologist for guidance in patients who are taking GLP-1 agonists for diabetes management to help control their condition and prevent hyperglycemia (high blood sugar).
Day of the procedure:
Consider delaying the procedure if the patient is experiencing GI symptoms such as severe nausea/vomiting/retching, abdominal bloating or abdominal pain and discuss the concerns of potential risk of regurgitation and aspiration with the proceduralist or surgeon and the patient.
Continue with the procedure if the patient has no GI symptoms and the GLP-1 agonist medications have been held as advised.
If the patient has no GI symptoms, but the GLP-1 agonist medications were not held, use precautions based on the assumption the patient has a “full stomach” or consider using ultrasound to evaluate the stomach contents. If the stomach is empty, proceed as usual. If the stomach is full or if the gastric ultrasound is inconclusive or not possible, consider delaying the procedure or proceed using full stomach precautions. Discuss the potential risk of regurgitation and aspiration of gastric contents with the proceduralist or surgeon and the patient.
Full stomach precautions also should be used in patients who need urgent or emergency surgery.
All people with type 2 diabetes should be offered access to ongoing DSMES programs.
Providers and health care systems should prioritize the delivery of person-centered care.
Optimizing medication adherence should be specifically considered when selecting glucose-lowering medications.
MNT focused on identifying healthy dietary habits that are feasible and sustainable is recommended in support of reaching metabolic and weight goals.
Physical activity improves glycemic control and should be an essential component of type 2 diabetes management.
Adults with type 2 diabetes should engage in physical activity regularly (>150 min/week of moderate- to vigorous-intensity aerobic activity) and be encouraged to reduce sedentary time and break up sitting time with frequent activity breaks.
Aerobic activity should be supplemented with two to three resistance, flexibility, and/or balance training sessions/week. Balance training sessions are particularly encouraged for older individuals or those with limited mobility/poor physical function.
Metabolic surgery should be considered as a treatment option in adults with type 2 diabetes who are appropriate surgical candidates with a BMI ≥40.0 kg/m2 (BMI ≥37.5 kg/m2 in people of Asian ancestry) or a BMI of 35.0–39.9 kg/m2 (32.5–37.4 kg/m2 in people of Asian ancestry) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.
In people with established CVD, a GLP-1 RA with proven benefit should be used to reduce MACE, or an SGLT2i with proven benefit should be used to reduce MACE and HF and improve kidney outcomes.
In people with CKD and an eGFR ≥20 ml/min per 1.73 m2 and a UACR >3.0 mg/mmol (>30 mg/g), an SGLT2i with proven benefit should be initiated to reduce MACE and HF and improve kidney outcomes. Indications and eGFR thresholds may vary by region. If such treatment is not tolerated or is contraindicated, a GLP-1 RA with proven cardiovascular outcome benefit could be considered to reduce MACE and should be continued until kidney replacement therapy is indicated.
In people with HF, SGLT2i should be used because they improve HF and kidney outcomes.
In individuals without established CVD but with multiple cardiovascular risk factors (such as age ≥55 years, obesity, hypertension, smoking, dyslipidemia, or albuminuria), a GLP-1 RA with proven benefit could be used to reduce MACE, or an SGLT2i with proven benefit could be used to reduce MACE and HF and improve kidney outcomes.
In people with HF, CKD, established CVD, or multiple risk factors for CVD, the decision to use a GLP-1 RA or SGLT2i with proven benefit should be independent of background use of metformin.
SGLT2i and GLP-1 RA reduce MACE, which is likely to be independent of baseline HbA1c. In people with HF, CKD, established CVD, or multiple risk factors for CVD, the decision to use a GLP-1 RA or an SGLT2i with proven benefit should be independent of baseline HbA1c.
In general, selection of medications to improve cardiovascular and kidney outcomes should not differ for older people.
In younger people with diabetes (<40 years), consider early combination therapy.
In women with reproductive potential, counseling regarding contraception and taking care to avoid exposure to medications that may adversely affect a fetus are important.
In November 2022, I opted to try a continuous glucose monitor (CGM) to track my blood sugar readings. Granted, I am not diabetic, however my father and my aunt are diabetics and I had gestational diabetes during my 2nd pregnancy. I’m a bit of a data nerd and like to see how my body responds to the things I eat. So, I signed up for a program through Zoe and started following the app and logging my food. After I completed the 14 days, I then stumbled upon Glucose Goddess and want to try another 14 days with the CGM. Here’s the data from the first trial.
I felt that my blood glucose was actually pretty well maintained. My average reading was 94 and I fluctuated from 72-138. That’s pretty much carrying on with my regular lifestyle: protein shake for breakfast, whole food plant based meal for lunch, and regular dinner and a snack before bed. After reading the Glucose Revolution book, I find that I have an even better understanding of what I can do to improve my stability and consistency of my glucose curve. 2nd trial coming soon!
April 2023
I opted to try the CGM again for a two week period. Similar results with the diet/nutrition and knowledge that I had from before. Biggest issue is will power.
Breakfast: ACV water when wake up. Vedge protein shake
Lunch: PBM or balance of veggies to protein w ACV
Snack: Vedge protein shake
Dinner: ACV, balance of veggies and protein
Kept wine/bevies to 1-2 on weekend only. My body just doesn’t like it and I sleep like crap. If I am to have alcohol, it’s better at lunch for me so it doesn’t mess up my sleep.
After listening to the Huberman Lab podcast (and you should too! He’s got nuggets of info on health!), I decided to schedule a Dexa Scan as well as VO2 max test. I want to have a baseline of where I am at my age. This year has been a huge year of change. I’ve committed to my health (yes I’m currently 7 months in with a strength program called Rise; I started 1-2x/wk rowing; MMA 1x/wk). I’m changing jobs. I have cut back or cut out unnecessary or harmful things to my life. I’m participating in a glucose monitoring study. I wish I had done these metrics every decade of my life starting at 10.
The more I dig into the world of health and wellness, the more there is to learn. Hormones, gut health, nutrition, supplements, macros/micros, exercise (role for mobility, flexibility, cardio, strength, functional, etc). I wish they taught this stuff in medical school. This is the real foundation of health and wellness.
Overall, I felt I could have pushed a bit harder but I was nervous on the treadmill. My legs were burning. Oh the dreadmill.
UPDATE 6/2023:
Peter Attia, MD: recommends 3 hours/wk of Zone 2 activity (30 min per sesh at the least). Metformin depletes mitochondria and increases lactate levels.
Got my glucola test today (11/26) for my 24 week test. This time I stayed NPO. My diet has NOT been good this pregnancy. Everything sweet has been so appealing to me. Sweets and carbs have been my jam. But, I have no real cravings like I did with the first pregnancy.
On Jan 11, 2018, I took my 3 hour glucola test. It’s as awful as the first time but now there’s a 100g sugary drink (yuck!) and 3 hours of hanging out at the lab. Took my 3 hour glucola test and passed the first two blood draws (fasting, and 1 hr after 100g drink)… then got the call that my glucose was slightly elevated on the last two draws (2 hours after the drink and 3 hours after the drink). I’m disappointed that now I have to go and meet with a diabetic educator. Pretty much since I found out that I had a positive 1 hour glucola test, I have been on a lower carb, no-sweets diet. That’s been about a month and a half. I totally related to what this gal said about her diagnosis of GDM.
So, I did more research on what I actually need to do now before meeting with the diabetic educator.
Took a fasting BS bc the perinatologist said if there was only one fingerstick I could do, that would be the most important one regarding prognosis and future DM.
Fri, Mar 1, 2019
2 hour post meal @ 8:50a = 88
37 weeks, 3 days
Had a protein shake, hard boiled egg, 1 tbsp peanut butter, 1 orange, and 1 small can diet Dr. Pepper.
Well, this is quite the title. We knew we wanted to expand our family. Arden has been such a good kid, and we felt like we could handle another kiddo. But little did we know it would/could happen so soon.
The first day of my last period was May 31. I’ve never had a regular period, so I didn’t think my period would be any different post-pregnancy. Arden had a mixed formula/breast milk feed since she was about a week old. Despite breastfeeding/pumping 12x/day, I could never get my milk supply to meet her feeding needs. Even knowing this, I still tried to pump for about a month at work before my supply went completely down to nothing. So, my pumping ended around June 20, 2018.
As it was nearing Arden’s 5 month birthday, my husband and I thought I should take a pregnancy test just for kicks as I hadn’t had my period yet… but that wasn’t out of the ordinary for me to go 30-40 days between periods. But something gave me an inkling that the pregnancy test may be positive. About two weeks before the pregnancy test, I had what felt like a period cramp right in the middle of my abdomen. It lasted for about a day, and I thought I was going to get my period soon. Then, I also had breast tenderness… but that wasn’t uncommon as that’s a common symptom for me prior to my period. But two weeks passed after these symptoms and still no period. So, I took the pregnancy test a day after Arden’s 5 month old birthday. Lo and behold it was positive! I couldn’t believe it! I had to show my husband. He was shocked and happy all at the same time! We get our first ultrasound in two weeks and this time I promised my hubs that we could know the gender before the delivery.
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Week 7 – Aug 6, 2018
Today I’m 7 weeks, 6 days. I had my first ultrasound a week ago and by ultrasound the Nugget measured 6 weeks 6 days. The fatigue has been unrelenting. I need naps daily or I hit the sack early like 9p. Last night, Arden kept rolling over onto her tummy and I was getting up every two hours to turn her over. It makes me a little nervous for her to be on her tummy still as she still hasn’t mastered rolling over to her back. The Nugget’s due date is March 19, 2019. That means the two kiddos will be 13 months apart. Whoa! For right now, I still have my Mondays off… but that is going away mid-October. I’m a little worried when it does go away. I haven’t been able to workout for the last 3 weeks bc of fatigue. I just have no energy. But I know I need to do something so I’m trying to still get evening walks in before Arden goes to bed. I ordered a 1 year subscription to SugarySixPack because she has workouts for pregnancy and they’re safe as she’s a certified trainer and she did them herself throughout her pregnancy. Obviously, listen to your body and see how it feels… everyone is different. Another workout plan that I thought was helpful (but I only did during my third trimester) was Expecting and Empowered. Cravings have included pineapple, baked potatoes, sandwiches, ice cream, VG plain donut, Nilla Wafers, potato chips… let’s just say it’s not the healthiest cravings. The morning sickness is getting more intense and certain foods are turning me off (fried foods, onions, sauces, tomatoes).
Week 8 – Aug 14, 2018
This week was a rough long week at work. I worked for 13 days with one day off (Sunday – post OB). Also, this week, Arden got hand, foot, and mouth disease at day care. My post of her illness is here. The worst of it was probably the first 3 days she had the illness. My morning sickness is getting better. I find that I have a little more energy to go for walks around the block and not just be a dud on the couch. Feeling better this week despite the work hours. Thanks to my mom and husband for being here this week to help out with Arden. And the craving of Le Croix is back!
Week 11 – Aug 28 – Sept 3, 2018
Cravings this week: mashed potatoes, pizza, Le Croix, cookies…. everything but healthy. On weekends, I find that my energy level is zapped! My best productive times are from 7a-11a and then 5p-8p. From the hours of 12p-4p… I’m pretty much a zombie or need to nap during that time. It’s a bummer bc I feel like such a bore. My poor husband! Earlier this week, I took the NIPT to test for common genetic issues in our baby. It came back negative for any of the common chromosomal abnormalities. And, we found out we are having a little boy! I am so excited to hear this news! For some reason my husband was thinking we would have another girl… and I was thinking ‘oh man, we’re gonna have to try again for a boy if it’s a girl and I don’t know if I can handle being pregnant a third time.’ Well, luckily, we hit the jackpot and we couldn’t be more thrilled!! So far everything is looking good for our lil Nugget!
Week 12 – Sept 4 – 10, 2018
This week, we’re going to surprise the moms with the announcement of our pregnancy. I found a cute lil shirt on Etsy for Arden that says “Look Whoooo’s going to be a big sister!”. I also ordered gluten-free cupcakes with blue buttercream filling on the inside as a gender reveal for the moms. Lastly, I was able to get a colleague to help cover my #2 day from 5p-8p so I can witness my mom’s happiness when she is here. I’m so glad we’re telling them this week as I’ve been starting to show probably since week 9. That’s way sooner than I showed with Arden.
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Week 13 – Sept 11 – 17, 2018
This week was a blur! Trying to get ready for the trip and making sure everything is packed. meeting with the contractor, interior decorator, and architect for our lil building project.
Although I didn’t anticipate this to be a busy week… it was. Bear had multiple deadlines and was really worked this week. I missed seeing Arden 2 days this week. That’s so heartbreaking for me. The days that I don’t see her really makes me stop and think about priorities and changing my work schedule.
M O M G U I L T.
Yes, it’s a real thing. Before Ardenbug, I focused on my education and career. I didn’t have a problem putting in the time, staying up late, covering extra shifts, taking extra call, working on weekends and holidays. Then it all changed when she was born. My priorities changed. I’ve learned to give up my weekend calls and happily take the early day home if need be. It was an adjustment. But I want to be as present and available to my lil girl. There are still days/nights where I won’t see her. This past week, I didn’t see her two of those days because I left before she woke up and got home after she went to sleep. Those days are especially hard for me. Not because of the work hours, but because I didn’t get to see my Ardenbug’s smiling face. I ever thought it would hit me so hard. I was never the baby type. But, this whole process proved me wrong. And that’s ok. I’m human. And I want to be present as much as I can. So, if I don’t say YES to weekend activities or things…please don’t take it personally. I just want to see my kiddo and spend time with her because time stops for no one.
Work hours = 33 (in 3 days)
Week 16 – Oct 2 – 8, 2018
Nothing new this week. Arden started really crawling and getting about the house this week.
Work hours = 44.75 (in 4 days)
Week 17 – Oct 9 – 15, 2018
Arden has been having a productive cough and sometimes the mucus will cause her to gag and vomit. Poor thing has vomited 3x this week. And to top it off, Bear and I both got some food poisoning over the weekend. After multiple episodes of vomiting and diarrhea, I called my OB bc I wanted to check on baby G. One of the midwives said I probably ate something that didn’t agree with me and it wasn’t food poisoning. Nope. My hubs and I were both having diarrhea and vomiting. So, I called Bears’ mom for backup and as soon as she got to our place, Bear and I headed to the ER and got 2L LR, Reglan, Zofran, and some labs. Lil G looked good on ultrasound (I HAD to come and check him out,….couldn’t help it). After a couple of hours, we headed home and laid low and slept for most of the afternoon/evening. Thank goodness for the moms being relatively close by (my mom would’ve helped but she got a stomach bug too). We’re now on the mend!!
Work hours = 36.5 (in 3 days)
Week 18: Oct 16 – 22, 2018
I had this week off, but was able to pick up some work at some surgery centers. It was nice to be able to pick Arden up from school. She’s such a happy kiddo! This week, we’re moving everything out of the downstairs bathroom, bedroom, den, and laundry room in anticipation for our renovation. I really hate moving bc I hate the packing and unpacking. Luckily, my Bear is super supportive and is the muscles behind the move. This week, I’ve been feeling Lil G’s kicks and I have missed that feeling of those lil flutters in my belly. I’ve also been feeling pretty tired this week. Not sure if it’s bc I’m still recovering from our sickness last week, or if I’m just overall more tired. Seems like nap time wants to hit me around 2pm.
Work hours = 23.25h (in 5 days)
Week 19: Oct 23 – 29, 2018
This has been a busy week! We have moved all the stuff from the downstairs bathroom, bedroom/closet, den, and laundry room. We moved the upstairs couch downstairs, and the downstairs couch upstairs. We re-arranged the newly placed downstairs couch. We’re exhausted. Not only that, Chase Travel rewards happened to screw up our flights that we need ASAP. So that was a stressful debacle just now. Just found a super great website for traveling with baby to decrease lugging stuff across the country: Baby’s Away.
Work hours = 22.75 hrs (in 3 days)
Week 20: Oct 30 – Nov 5, 2018
Had an excellent vacay up in Nor Cal!! We stayed in a cabin in the woods and went hiking in the forests/redwoods. Big Basin Redwood State Park and Henry Cowell State Park were my fave. Is it bad that I have an inkling to move up there? Not gonna lie that I browsed Redfin for housing.
Work hours = 10.25 hrs (1 day)
Week 21: Nov 6 – Nov 12, 2018
First full week back to work. Was a bit brutal of a call night and pre-call day. Had this one patient on OB and the husband was trying to make all the decisions for his wife. She was a primip and he insisted on a C/S for his wife when she was just slowly progressing. I placed her epidural and she was comfortable and went from 1.5-3cm dilated in about an hour. However, apparently it wasn’t fast enough for his liking. So, he insisted on his wife having a C/S. Baby looked fine on the monitor, and had been looking great since admission. It’s unfortunate that bc he felt he was a doctor (a plastic surgeon) that he could make these decisions for his wife. The OB and I proceeded to talk to him that it was normal to take some time to progress for the first pregnancy, but he wasn’t having it. Once she finally gave consent (but you could tell unwillingly), I spoke to her about the risks/benefits of anesthesia for C/S. The doctor husband said he’s very familiar with anesthesia. So, I asked if he was an anesthesiologist and he said he was a plastic surgeon. Unless you did an anesthesia residency and are well-versed in the basic knowledge of anesthesiology, please do not confuse your plastic surgery/medical degree with my expertise. He set a great example of how I will never be with another physician or healthcare worker who is providing care to me. (end rant) 🙂
Lil G is moving around and kicking nicely. 🙂
Work hours = 40.75 (in 4 days)
Week 22: Nov 13 – 19, 2018
Arden turned 9 months old this week. Otherwise, feeling good and about 10 weeks ahead in size vs my first pregnancy. The peeing on myself when I sneeze has commenced again.
Work hours = 34 hours (in 3 days)
Week 23: Nov 20 – 26, 2018
This week was busy and rough. Work the day before and after Thanksgiving. Got the Christmas tree up yesterday! Lil G is kicking around. Got my glucola test today (11/26) for my 24 week test. This time I stayed NPO. My diet has NOT been good this pregnancy. Everything sweet has been so appealing to me. Sweets and carbs have been my jam. But, I have no real cravings like I did with the first pregnancy.
This was a hectic week. Got a bunch of things squared away with the renovation. It’s coming along. We’ve passed two inspections so far. Got my eating in gear with no sugar and meal planning in place. Really cut back on the sweets. I actually feel better. I’ve even managed to get in two workouts over the weekend! Lil G is an active kicker! There’s not set time when he gets active… I just feel him kicking around randomly. That is so different from Arden bc she would typically be quiet throughout the day and then kick around 8pm when I sat down on the couch.
Work hours = 53.5 hours (in 5 days)
Week 25: Dec 4 – 10, 2018
I have been clean eating for the last two weeks since I failed my 1st glucola testing. Today, I did an experiment of doing random blood sugars.
7:00a — fasting since 8pm the night before.
BS = 84
8:58a — done one hour after my last bite of breakfast (1/2 cup greek yogurt, strawberries, paleo granola)
BS = 97
9:22am — last bite of homemade beef and bean paleo chili (1 cup). 1 tbsp unsweetened, unsalted organic crunchy peanut butter.
12:33p — last bite of work soup (1/2 chicken and sausage jambalaya, 1/2 lentil and chickpea, salt load thru the roof).
13:43p — BS 93
16:45p — last bite of grilled chicken, brown rice, veggie bowl from FlameBroiler. 1/2 an orange.
17:36p — BS 120
19:15 — granny smith apple; 1 tbsp natural, organic crunchy peanut butter. 1 piece of dark chocolate.
This was a really rough week for me. In fact, this past month has been really tough with the increased work hours, remodel, baby at home. This is the most I’ve been depressed in a long time. I know it will pass. But, there’s no ME time for just the self and there’s no together time with husband. It’s taking it’s toll on me, but I know it’s temporary and that it will all pass. I was really lucky to not have any postpartum depression… but this is how I imagine it would feel. Somedays I’m lucky to see my lil girl for an hour before she goes to bed, but lately it’s been 30 minutes. I’m exhausted. I’m sad. And I’m ready for December and the holidays to be over.
Hubs and I had our first date night out without baby in at least 10.5 months. It was wonderful. Went close by to Amaya… but we were both exhausted. We need to make some changes to when the moms come to help. I think if I’m working late… that would be a good time to help hubs. Or I proposed a weekly date night and I think that will help get back to that closeness we had before baby.
Work hours = 41.75 hours (in 4 days)
Week 28: Dec 25 – Dec 31, 2018
We had Christmas at both families’ homes. With two kids and my work schedule coming up, I’m not sure how long that will be sustainable. I’m more than happy to have everyone come to our home. Simplicity and less stress. We had a terrific Christmas at home. Arden absolutely loved hearing the gift wrapping tear and the sights and sounds of Christmas. She always acknowledged the Christmas tree everytime she woke up in the morning as well as when she woke up from naps. She got so many wonderful gifts and I had so much fun watching her interact with her new toys. we put the fireplace on for the first time and she got to see fire, which intrigued her greatly! On the 26th, we drove up to Big Bear to show our lil one some snow. She totally looked like the bundled up kid from A Christmas Story! She wasn’t too fond of getting all the layers on, but once she got out into the cold, she was ok. She got to see snow falling down as well as snow on the ground for the first time. We also took her sledding, which she seemed to be open to the idea when we would drag her on the sled. But when we got on the sled with her on a little slope, she would cry at the end of the run. It was so completely cute! I’m glad she could have this experience. One of my main goals in being her mom is to give her many different experiences. I don’t want her to be spoiled with stuff…. but I do want her to be spoiled with healthy food, cultural experiences, and travel.
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Work hours = 7 hours (in 1 day)
Week 29: Jan 1 – Jan 7, 2019
Back at work… lil G has been kicking up a storm. I’ve started kick counts and he has no problem meeting the 10/hour during the day (whereas Arden would get her kick counts around 8pm when I sat on the couch). The reno was on hold for the holidays. I’m definitely looking forward to it being done by the end of January! Talked to hubs about potential middle names for our #2, and I’m really loving Lukas. 🙂
Work hours = 40 hours (in 4 days)
Week 30: Jan 8 – 14, 2019
I am off this week. What that really means… I have no work responsibilities. But, I’m getting up in the middle of the night to nurture/feed Arden and getting her ready for school in the mornings and taking her to school. She’s such a good kid, but there is definitely more effort involved in getting all these things ready. The last two days, I’ve taken Arden to school in my sweat pants and no makeup. And honestly, I’m ok with that. I really do appreciate my husband bc he normally takes Arden to school on his way to work. We don’t have the moms coming this week as they really were a huge help this past weekend to allow Ross and I a baby-free weekend. The Reno project has restarted from the holidays. Tiling will be started this week! Garrett has been kicking like crazy and meeting his kick counts. The meal prep has been going well.
Felt a bit lightheaded one night this week. Not sure what happened… I hadn’t been working. I’ve been doing very well with my diet, healthy stuff, no sweets. Everytime I would standup (esp after being bent over), I would feel lightheaded. It wouldn’t help with sitting either… I had to go full on horizontal and lay down to feel better.
Took my 3 hour glucola test and passed the first two blood draws (fasting, and 1 hr after 100g drink)… then got the call that my glucose was slightly elevated on the last two draws (2 hours after the drink and 3 hours after the drink). I’m disappointed that now I have to go and meet with a diabetic educator. Pretty much since I found out that I had a positive 1 hour glucola test, I have been on a lower carb, no-sweets diet. That’s been about a month and a half. Ugh. So, I’ll have a separate entry on Gestational Diabetes Mellitus (GDM).
Work hours = OFF!
Week 31: Jan 15 – Jan 21, 2019
I’ve been battling a nasty cold that I got from our Bug, which she got at daycare. It’s an upper respiratory infection, most likely viral in nature. A lot of coughing, sinus pressure, headaches… but I’m going the minimalist route for now — good wholesome foods, fluids, rest, and Tylenol. Lil G has been kicking around as usual. He’s so active compared to Bug. I feel him all throughout the day and night. Makes me worried that he won’t be a good sleeper.
Work hours = 37 hours (in 4 days)
Week 32: Jan 22 – Jan 28, 2019
I’m still battling my cold. It’s been almost 2 weeks. I have an OB appt today, so I’ll kill two birds with one stone and just get a second opinion. The reno is coming along: baseboards are in, W/D is in, tiling has occurred in the laundry and downstairs bathrooms. Plumbing and toilet are in. Waiting on paint, vanity, bath accessories, cabinetry, and countertops to arrive… the end is in sight! The project was supposed to be done by the end of January, but realistically looks more like mid-Febrary. LLC established and getting business accounts setup. It’s been busy, despite my random days off. I’m getting up to pee every 2 hours…so I just feel tired all the time.
Work hours = 50.25 hours
Week 33: January 29 – Feb 4, 2019
This week has been a blur! Everyone at home has been sick. I worked on Super Bowl Sunday. Happy Chinese New Year — it’s the year of the pig!
I’ve started splitting my night calls as I just don’t have the stamina (nor can I get comfortable sleeping in the call room) to do a full night call anymore. I’m definitely feeling more tired this go around. Lifting and chasing Arden, preparing meals, working full-time, it’s tougher. But, I’m still planning on working until I go into labor or have my set maternity leave (whichever comes first!). Not only am I tired, I’m insatiably thirsty…despite drinking 3x 32oz waters throughout the day and 2x 32oz waters at night…. waking every 2 hours to pee…. eating such small meals bc I have early satiety…. constipated despite my best efforts to get in green juice and poop tea. 😉 I think the month leading up to delivery is the hardest. Lil G is active as usual and definitely more active than Arden was in utero. Hopefully he’ll be a good sleeper like his older sister.
Work hours = 33.5 in 3 days
Week 35: Feb 12 – Feb 18, 2019
I am off this week. The reno should be near complete this week!!! It’s been going on since the beginning of November 2018! I’m ready to have the garage back as well as a porta-potty out of the driveway and access to our movie room and downstairs bathroom and hallway again! There was a lot going on with this and coordinating things. Plus, I watched the Bug on Friday and it is A LOT to take on…. especially while pregnant. I have a huge respect for stay at home moms who tackle this daily! I was exhausted after the day. But, we went out to the Aquarium Friday afternoon and she had a wonderful time looking at the fish and seeing the movement of the water. It was great to get her out of the house and I know she enjoyed the external stimulation. Sunday, she ended up developing a fever of 102-104F and that scared the crap out of me. I gave her Tylenol immediately. She was lethargic after her second nap (she typically has two naps for 30 minutes at a time, but this time she had 2 two hour naps!). Plus, instead of wanting to play after her nap, she just wanted to be held… she’s typically not this cuddly. After calling urgent care to let them know we were on our way, the answering service transferred me to the nurse and they both kept telling me that they close in 5 minutes…despite us living 5 minutes away and with our daughter having such a high temp. I was furious. I hung up and opted to go straight to our Children’s hospital ER. They were fabulous. After Bug went through a series of vitals checks and physical exam (which she was not stoked on), she got some motrin and we were in and out of the ER in an hour! That’s a huge feat by any medical facility!! By the time we got home, her fever had subsided to 99F and she was wanting to eat, drink, and be merry. We watched her like a hawk all night and the rest of the holiday weekend.
Tylenol 15mg/kg
Motrin 10mg/kg
Hours worked = 0
36 weeks: Feb 19 – Feb 25, 2019
Bug went back to school today. Her highest temp after the ER visit was 99. We still gave her some tylenol this morning before school just to help her through the day. She also has molars coming in…. so that can help with the pain. Lil G has been meeting all his kick counts. I’m still peeing every 2-3 hours at night…and drinking about 100oz daily. I have this insatiable thirst esp during the 3rd trimester…and that has been with both babies. He’s looking large in the belly. We had our 36 week growth scan and everything looked good. He’s looking like he’ll be 7.5 lb at birth. NST/AFI was great. No issues. Had my last OB shift on Friday and it was busy! But luckily, got to go home around 9:30p and didn’t get called back. Saturday, my mom and aunt came and watched Arden while hubs and I organized the media room, Arden’s new room, and Garrett’s room. Lil G’s bassinet is setup in our room and ready to go. We cleaned, dusted, mopped, vacuumed and were exhausted. I’m super thankful that my aunt cooked up some great meals that got us through the day!! Sunday, Ross’ mom came to help watch Arden while Ross did some heavy cleaning of the garage (where I could park the car again!! woohoo!). The construction has come to a close… they moved the port a potty on Friday, Feb 22. The construction guys have been using the house toilet, despite me paying for a port a potty, so I was pissed. Now, we just have a final walkthrough and some flooring to tackle and painting. It’s so great to have this done. Arden has been having some little colds/runny nose, but has been playing and her happy self. She’s started becoming more vocal about what she wants and what she doesn’t want. She had a lil temp (100F) and we gave her some Tylenol.
Hours worked = 48.5
37 weeks: Feb 26 – Mar 4, 2019
This week was brutal. We are on the home stretch with our renovation. The grandmas now come on the weekends to help with Arden while we organize, clean, and recover from the reno. It’s crazy to live in the space during the reno…I’m not sure I’d do that again. There were 3 days this week that I didn’t get to see Arden bc I was at work late those days. That absolutely killed me. As much as I love my job, I love my kiddo more and I feel like I’m missing out on her activities, milestones, etc. This week, I also caught Arden’s cough — it’s productive, but I’ve felt ok (no sinus pressure, headache or fever). My sleep has gotten noticeably worse this week — I’m insatiably more thirsty; drinking about 60 oz at night. I pee every 1-2 hours and can’t catch up with my thirst. My blood sugar checks for GDM have been stellar. Fasting blood sugars have been less than 90. Lil G is kicking away and moving. All is good on the home front… just looking forward to meeting this lil dude! Had a realization with Ross… how the heck are we going to do this without losing our sanity? 2 kids under 14 months? Arden will be 13 months old in a week. We just re-enrolled her for the next school year, and our future son is on the waitlist and they couldn’t tell us when we could start. That’s super stressful for us bc we both work full time jobs. Our moms are out of town. I’m just annoyed and stressed that he may not be able to go to school at 4-5 months. But, we just have to wait and see. 4-5 months down the road….Arden will be 17-18 months and eligible to move up to the toddler class. So hopefully this will all work out and I won’t have to be worried about that. There’s been a ton on my mind and my memory is not keeping pace. Perhaps it’s the sleep deprivation for the last 2 months (getting up to pee)… or just trying to remember everything going on in life. Does it get easier?
Hours worked = 48.5
Week 38: March 5-11, 2018
Final walk through with inspection completed this week. Final painting, flooring, and touch ups. It finally feels like this project is coming to an end and I am grateful!! Last night, Arden was super tired and fussy to go down to sleep. We were working on transitioning her from her bottle to a cup, but there’s something soothing for her about the nipple that the cup simply won’t comfort. I’m getting up every hour to pee. My U/S looked great. AFI was 14. NST was terrific. Cervix is still high and just waiting for lil G to come on down. He’s still super active and kicking. It’s nice to be able to be home and laze and eat and pee when I want/need to. I weighed 161 lb,…the exact same since Nov 2018. The only thing I did was change to a modified Whole30/paleo diet cutting out processed sugars bc of the GDM. Don’t worry, lil G is growing… him pushing on my stomach and decreasing my food intake and more intake of healthier meals is probably causing my weight to just plateau. We have weekly U/S and NSTs moving forward. Dr. W and I discussed possible induction on March 18 bc I really don’t want to go beyond 40 weeks with this pregnancy. I’m just not comfortable in this state.
I was shocked to see that the NHS could ban surgery for the obese and smokers. That’s socialized medicine. You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare. But in a way, it’s empowering patients to take responsibility for their own health. Smoking, for sure — I agree 100% that surgery should be banned for this population. Obesity is a bit trickier — there’s genetics and environmental factors at play in this one. I don’t think anyone chooses to be obese. But, people do have the power to change their eating and exercise habits. Despite these efforts, there are some people who are still obese…. and these people should not be faulted.
Why single out the obese and smokers?
From SlideShare
From SlideShare
From TobaccoFreeLife.org
Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.
From HealthStats
I think the NHS is on to something here. They’re opening doors to moving the liability and responsibility away from physicians and towards patients. This is a plus. Outsiders may see it as separatism and elitist to only provide care for people who are healthy. But look at the facts and the data…. obesity has a lot of co-morbidities associated. Smoking has a lot of co-morbidities associated as well. Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough? In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness. With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health. I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation. It’s not easy, but my health is 100% my responsibility. I refuse to pass the buck to my husband, my family, my physician, etc. I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.
Patients need to change their mindset re: health. It is not your spouse’s responsibility to track your meds. It is your responsibility to know your medical conditions and surgical history. The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery. This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care. Please do not forget recreational drugs, smoking habit, and drinking habit in this list. It is very important to know all of these things. Also, your emotional history is very important. Depression, anxiety, failure to cope, etc. This all helps tie in your current living situation with stressors and your medical history.
Links for educating yourself in taking responsibility for your health:
Sleepy Time 