Friday, March 06, 2009

Most Recent Appointment

I aced my glucose test, and basically failed on iron. Based on my rudimentary knowledge of diet, I would have predicted the opposite: I get a decent amount of iron but eat my weight in sugars every few days. Since getting those results I've done some research, and now realize that the copious amounts of dairy I consume have probably prevented most of that iron from getting through. (Yeah, the whole fortified cereal thing? It doesn't really do much good if you eat your cereal with milk. Go figure. And chopping up my prenatal vitamins and mixing them into yogurt probably wasn't the BEST idea. Too bad the best spinach is creamed spinach...)

Nurse: "Actually, with iron levels in this range, I'm a bit surprised that you're not experiencing any symptoms from it."

Me: "What kind of symptoms?"

Nurse: "Primarily fatigue. Being very tired, not having enough energy, is the first and strongest sign of iron deficiency."

Me: "Well of COURSE I'm exhausted, but I kind of figured it was from being six months pregnant. Or from the chronic insomnia of the past several months..."

Honestly, how am I supposed to tell one kind of fatigue from another? She seemed surprised that I am still standing up and walking around under my own power. Now, I take most of the doctor's-office tests with a grain of salt or two; half of them are half-useless and some can do more harm than good. But iron, not so much. I know that at about 28 weeks the baby starts storing iron (from MY blood supply) in its own little liver, and that store is supposed to help him or her get through the first six months or so of life. So not having good iron stores means that either the baby saps me dry and I become really anaemic, or the baby doesn't get enough and is either born with low iron or is deficient within a few months, or both. Iron deficiency can also contribute to early labor and premature birth. I'm kicking myself right now for not foreseeing that this could be a problem; I've been turned away from blood drives a few times over the years for not having enough iron to donate, and I know that the last miscarriage took a lot out of me. Now I'm 27 weeks and trying to make up lost ground, and it can take months to reestablish healthy stores. I wish I'd requested an extra test early in the pregnancy, but then I was too concerned with the more life-or-death stuff like progesterone, hCG betas, all that jazz.

So, I am on a separate iron supplement, and (more importantly) a strategy to keep it far away from any stray calcium. (It's not a complicated strategy: don't eat any dairy or other calcium foods after 2:00pm or so, then take the iron a little before dinner around 7:30pm or so, with some orange juice.) I ordered the fancy, plant-based Floradix that so many people swear by, it will arrive next week while I'm in Texas. In the meantime I'm taking prescription samples. I'm also drinking more of my medicinal tea, which itself is high in iron.

Meanwhile, the doctors are quite pleased with my blood sugar and blood pressure, and if they have any concerns about my weight gain, they haven't voiced them. I saw Dr. Zoidberg again, even though I'm supposed to see each doctor in turn. (My fault, because I had to reschedule. No wait, WORK's fault, for making me reschedule.) He is a little odd in that his answer to everything seems to be, "More water, prunes, vitamins." Which makes sense when you're discussing constipation, but this is the answer to maybe four different issues? I mentioned that ordinary activities like walking, or going up a flight of stairs, was making my leg muscles burn as though I'd been working out, and his answer was still more-water-and-vitamins. Meanwhile, his solution to the insomnia was to NOT drink so much water before bed (even though it's not my bladder waking me up), and his answer to the heartburn was Tums, even after telling me that calcium is the enemy of iron. Help. It was quite funny, though, when he was explaining that I would need to take extra iron, and that the iron WILL make me constipated if we don't have a plan of attack. "You will need to plan ahead! Water! Lots of water! Buy some prune juice! Fruits are good but NOT bananas!" (Oh, that banana I've eaten every day for two months? Not helping, apparently. But, it is the only thing that helps with the leg cramps, so oh well. I'll trade brain-freezing leg cramps for being a little stopped up.) I guess it's only funny if you can imagine it in the heavy Eastern European accent, and with the going-to-war-against-poo gesturing. He did explain WHY I have heartburn, which really interested me. Apparently, my body is being ruled by progesterone right now... the same progesterone I couldn't make enough of, so many times. Now I have lots. Progesterone relaxes soft muscle tissue, because part of its job is to keep the uterus relaxed and happy (i.e., not forcibly ejecting the baby.) The little sphincter (hehehe) at the base of the esophagus is ALSO soft muscle tissue, and equally affected by the hormone. So it, too, is relaxed and happy, and not doing its job of keeping the stomach's acid where it should be. Live and learn! (I wonder, although I didn't ask, whether any of the muscles of the bladder or urinary tract are this kind of muscle, too, and whether that would explain the random incontinence of pregnancy; if the uterus is relaxed so that it won't contract before its time, and the esophagus is all relaxed and not guarding itself against acid, maybe the bladder is relaxed and not holding in what it should. Just a theory from this maxipad-packin', pregnant woman...)

Well, I must go now and drink some water, take my vitamins, and eat a few prunes, in preparation for my flights to Texas tomorrow...


Sabra said...

Ok this is so weird, but I had to post a comment for the following reasons:
1, I am also 27.
2, My husband is a whopping 17 years older than I am.
3, I suffered my first miscarriage (first pregnancy) -- a blighted embryo -- at 11 weeks last weekend. I also opted not to have D&C (umm, why again?)
The similarities are freaking me out, making me cry and also making me incredibly hopeful, looking at your beautiful pregnant belly! Thank you SO much for sharing your story! ~Sabra

ayla said...

I think that most of the time, "iron deficiency" in pregnancy is a joke. Do you know your actual numbers? Nurses tend to get stressed out about things that don't matter so much. As for her "symptoms", a true symptom of iron-deficient anemia is a craving for ice chips. No kidding. Take the iron if you want, but you're going to get constipated, and your poop will turn dark green. I took a daily multivitamin sometimes while I was pregnant, and that was it. Sometimes I took a separate folic acid tablet. Otherwise, I wouldn't stress about it.

If you are going to take it, I like your idea of doing milk products in the morning and iron products in the evening. Just make sure your OJ isn't calcium-fortified.

Also: eat more red meat. Red meat is the best source of absorbable iron that you can have in your diet. Plant-based iron isn't absorbed as well, afaik.

Bella said...

I'm going to agree with Ayla here - I'm anemic to begin with, so I was advised to take extra iron while I was pregnant. It's a total joke. All it ended up doing was making it impossible to go to the bathroom.

We're not talking a "little" stopped up, you could be looking at hours on the toilet thinking you're trying to give birth. I can laugh now, but I was crying then!

What did help - I continued to take regular prenatal vitamins, but I indulged in steak, bbq, and low fat burgers. I stuck mostly to things like steak fajitas, lean cuts of rib-eye, or Jordan makes these amazing 96%lean beef burgers with goat cheese and basil...throw that on the grill with some lightly salted asparagus...yum!!!

Cramps - bananas help, but yeah they also aid in constipation. What's in the bananas is folic acid so if you get some yummy juice with a bit of that, and keep your water intake at a comfortable level, it will help. Promise. I also did prenatal yoga which also helped keep cramps at bay and also was a BIG helper in letting me feel more relaxed when I went to bed.

When are you going to be in Dallas? We're driving in on Thursday night (the 12th) If you're still going to be there, I'm getting tattooed on Friday, the shop is on Beltline and Preston - want to chat it up while I get inked???

Give me a call!!!

Mara said...

Sabra-- wow, parallel courses, huh? I'm so sorry about your miscarriage, that's awful. I hope that you are pregnant again as soon as you wish to be. It will be YOUR belly on the internets before you know it, seriously.

Ayla and Bella-- haha, I KNEW at least one of you would be the voice of dissent on this one. My "numbers" were 8.something somethings per something. Sorry I don't have the technical jargon down-- whatever that number is, that should be at least "ten" is closer to "eight". Not anemic or anything, but not optimal. Anyway, my OJ isn't fortified with anything except pulp. (mmmmmm pulp. Keeps Don out of MY oj.)

I already eat a lot of red meat. I'm not going to start eating liver, even though it's a lot higher in iron, because eww. Just no. Seriously, my diet is not low in meat!

Bella-- I am already in Dallas, and will be here through Saturday night. I don't know if I can hang on Friday b/c my mom and I are going to the Dallas Quilt Show, but maybe we can get dinner after? Or if not, I can try to do the quilt show on Saturday instead. I'll call you tomorrow to see.

ayla said...

I've been thinking more about this, and if you are normally "anemic", when you're not pregnant, and you live symptom-free with your "anemia", well, then, you're not really "anemic". Your normal is probably just low. and if you have plenty of red meat in your diet, and you're not excessively tired, and don't have headaches (I get wicked headaches when I'm anemic), then you are probably fine.

so, if it were me, I'd take the floradix for a bit, but the first time I was constipated--the FIRST time--, I'd stop and that would be it.

After my c-section, they kept offering me iron and colace and I kept refusing. I had these headaches but I thought it was just from a lack of sleep. I knew I was supposed to be a little anemic after giving birth and I don't like messing with nature, I figure that my body knows what it's doing (Yours does too, btw). However, I didn't take into account that I'd had major surgery, and so when they told me my numbers, I realized that was why I had a headache--less blood to carry oxygen to my brain. So I took the iron for a week, then had a nice steak when I got home, and after that I was fine.

If you don't FEEL anemic, you're probably not. so that's my little ranty mc ranterson there. And if you ever come to Western Mass, you must come visit me.

Steph said...

I had no idea about the iron/calcium thing. I tend to walk the anemia line and eat a lot of dairy. Good to know!

Funny how the "solutions" all contradict each other! lol. I predict that all pregnancy ailments will resolve in approximately 3 months. Except the lack-of-sleep one.