Wednesday, July 26, 2017

Another Diagnosis, But 'Good' News!

Last weekend was a whirlwind. Just as I was getting comfortable with my new routine of no exercise and lots of downtime as a result of the placenta previa diagnosis, things changed.

On Friday John left town for a bachelor party that would entail camping and backpacking, so there was a good chance he'd be off the grid at times.

Saturday I woke up and went to the bathroom as usual, at which point I discovered I was lightly bleeding (TMI - thankfully it was brown blood, not "active" red blood). Regardless, it scared the shit out of me and I paged the on-call midwife from my birthing center (there are about four midwives I see), and she got right back to me and was the sweetest. She told me to relax, not worry and just rest all day -- basically do as little as possible -- and drink a lot of water. I followed orders, and my day was as lazy as they get. I watched nearly two seasons of Schitt's Creek haha. Later in the day I did go to my parents and we went to the hospital to visit my grandma, who had just been admitted. That's a story for another day, but for now the good news is my grandma has since gone home and is doing ok.

My parents were also so awesome to help out with Finley and doggy-sit him while I was on rest. His 50-pound puppy energy was too much for me to handle when I needed rest. Finley loved it, as he just got a long weekend playdate with their dog, Ashe.

John was in the loop on all this but there was no need for him to come home early.

My bleeding cleared up but then came back and was even a bit heavier by Monday morning. This time the midwife said go to the ER to get checked and make sure everything's ok. Hearing her say that certainly scared me at first and there was a surge of uncontrollable tears for a couple minutes, but I did my best to hold it together and not totally lose my shit. This time, John was off the grid with no service and my mom took me to the hospital.

Long story short, here's what happened:

There is NO placenta previa anymore. If I did have it, it already cleared up and the placenta is no longer covering my cervix. it was very clearly in an anterior position away from the cervix. Seems like that shift happened really fast, but I'm not an expert on this stuff, and I'm certainly not complaining because this is good news.

So what was causing the bleeding?

Turns out I definitely DO have a subchorionic hemorrhage, which is basically a blood clot in the wall of the uterus. It's the "most common sonographic abnormality and most common cause of first trimester bleeding (1)," and thankfully I was told it's "less threatening" than previa and should work itself out (i.e. dissolve and disappear) in a matter of days or weeks. The exact cause isn't exactly clear.

I've wondered, and others who I've told have wondered: Was it always the hemorrhage and never even previa? I don't have a clear answer on that. In my opinion, that seems reasonable, but I'm not worrying about it. Either way, it was good that I started resting when I did!

I won't get another ultrasound for another 4-5 weeks, so in the meantime, I still have to be on the same regimen of lots of rest, no exercise, no lifting heavy things, and no sex. We don't want the bleeding to get worse and it needs to heal without me being overly active.

I was able to get ahold of John while at the hospital, and this time he did end his trip early and came home as soon as he could. I needed (and will need) his help especially if we want to have Finley home, which of course we do!

Despite the scare, all this gave me a huge sense of relief. I was extra grateful to my on-call midwife (she's everything a gal would hope for in a midwife!) and also the ER staff who was so kind and thorough in their assessment. Yea maybe I sat in the hospital for 5 hours, but what else would I have been doing?! This is my life, this is my baby's life, and he/she means EVERYTHING to me.

I'm confident this baby is healthy, I'm certain the hemorrhage will clear up, stoked the previa is no longer an issue, and excited to get on with my second trimester!


1. https://en.wikipedia.org/wiki/Chorionic_hematoma

Saturday, July 15, 2017

First Trimester Placenta Previa

Just hours after my last post I had an ultrasound appointment for prenatal screening. I was starting to second guess getting this voluntary testing done at all (it includes bloodwork + ultrasound) but decided to go through with it and now glad I did.

Nothing is wrong with the baby, so that's the very good news. We got to see him/her flopping around (it literally did a 180 for us), moving limbs, and heart beating... it made my heart melt.

However, the ultrasound tech saw a gap by my uterus and said that it shouldn't be there. On the screen it looked like an inch-long black hole. She said she'd run it by the midwives and they'd contact me to talk it over. She was also asking how much I exercise, etc.

The midwife called me right away, in fact while we were driving home, and said the baby's fineeee but that I have placenta previa, meaning I have a low-lying placenta that's partially covering my cervix (not fully covering). I've had zero signs or symptoms of this; symptoms normally entail bleeding.

The midwife said it's soooo early on (12 weeks when I found out) so there is an incredibly strong and likely possibility this will self-correct on its own and never pose a real problem. Self-correcting means that as the uterus grows, the placenta will essentially migrate up and away allowing the cervix area to open back up, and everything will be back to normal. The placenta doesn't actually relocate since it's implanted, but when my uterus is bigger it'll have more room to live away from my cervix. From what I've been reading and also what my midwife said, this is actually incredibly common in the first trimester since the uterus is still so small and often the placenta has nowhere else to go. So what usually happens in cases like mine (i.e. when placenta previa is detected in the first trimester), it'll get out of the way long before labor and it's a non-issue. If this issue were found in the third trimester, it'd be a whole other story.

In the meantime, though, to be safe there are some things I have to adhere to:

  1. NO EXERCISE
  2. NO SEX


If you think I'm freaking out, I'm absolutely not. Not over the placenta previa diagnosis, not over the no exercise, not over the no sex. Ok, so I cried and worried for like 10 minutes but then I got rational about it.

It is what it is. The condition is 100% out of my control. What I CAN do is whatever it takes to make sure that everything remains safe, this baby is healthy and he/she stays in my womb as long as possible (pre-term births are an associated risk if the previa were to continue). I really didn't even bat an eye when she told me that exercise and sex are out (I won't tell you what John said lol). I mean, it sucks, for sure, and I was especially enjoying my #fitpregnancy routine so far, but hey this is real life and I'm a mature mama-to-be.

I'll have another ultrasound at 18-20 weeks to monitor progress and reassess the plan as needed. Until then, i.e. 6-8 weeks, I can walk but not much more than that. The instructions to avoid exercise may extend to even longer depending on how things evolve. I've never not exercised for months at a time, so this will be very interesting, but I'm looking at it as an opportunity to do life a bit differently and learn. I'll have more time to meditate, more time to work on that book I've been procrastinating on, more time to just chill out and rest this body, more time to do things for others... the list goes on.

Hopefully it clears up. If not, and it's still an issue in the third trimester, there's a pretty good chance I'd have to get a C-section, which would royally suck, but I'll cross that bridge when I get there. Let's put it this way, my midwife was not suggesting that I start researching hospitals and OBs ;) I'm not even thinking that far ahead. So much will change in before then.

The best I can do is live in the moment, repeat positive affirmations, treat myself with kindness, say loving things to my little one in there, be gentle and stress-free.

All these lessons pre-conception and since have been amazing for my soul and life outlook.


Friday, July 14, 2017

First Trimester Thoughts - Rolling With the Changes!

I'm 12 weeks pregnant today, which means my first trimester is winding down (already?!). All in all, preggo life has been a rather easy adjustment for me. You don't have a choice over your body feeling so different, it often acting crazy nor your new set of "rules" by which to live, but you do have a choice in your attitude, response and general mood. You can freak out and worry or just roll with it and enjoy this special time. I had one freak-out episode in the beginning and learned my lesson very quickly. Since then I've been rolling with it... every single little thing. I really have never felt so relaxed for a three-month period in recent memory.

New norm - double-fisting water while everyone else drinks cocktails.

Here are some thoughts and highlights from my first trimester:

Diet - Pre-Conception & To 6 Weeks


Turns out leading into my pregnancy, I was actually in a mild state of ketosis (not my first time), thus very likely in ketosis when I conceived (unless all those desserts and drinks I had at the wedding we attended the weekend it happened threw me out of keto lol). I was not trying to be keto whatsoever, but as I said in the this post, I had rather intuitively transitioned back to lower carb around late April and that combined with the other things I did, I was quickly feeling awesome, physically and mentally. Pretty certain I was still eating more than 70 grams of carb, if note more than 100 grams on some days, but apparently I was low enough to be pushing out ketones as confirmed on a pee test. The thing is, and why I think it worked out, is that my daily calories were consistency high, I was eating very nutrient-dense foods, and my "training" was moderate -- not too intense and about 7-10 hours a week including walking. So apparently this is one example of when ketosis/low carb can work out without negative ramifications when it comes to hormones, fertility and even stress management.

In fact, when I told this to Dr. Phil Maffetone, he said low carb/ketosis can work great for fertility and is safe for pregnancy. I'm not so sure that I agree with that across the board nor should we force anything that doesn't feel right, but given my own situation I'm less of a skeptic. I asked a very accomplished pro triathlete friend of mine, who's also currently pregnant, if she was still in ketosis when she conceived and if she's remained low carb. I know this diet approach worked wonders for her (she's one of the few), and it turns out she has stayed low carb all throughout her pregnancy so far (she's almost 3rd trimester), and she was keto when she conceived as well. She says she's had the easiest pregnancy, no cravings, no aversions, no nausea, able to workout but not "train." Wow. Must be nice, right?

All this doesn't mean I'm advocating ketosis for fertility, pregnancy or otherwise, I still think it's a very individual decision to go low carb and in many cases it can be playing with fire. Plus, on the flip side there are plenty of gals who've gone higher carb/higher calorie and not only fixed their fertility but got pregnant this way, just look at the evidence presented by Nicola Rinaldi in No Period Now What. Plus carbs are not the reason one would get more nauseous or sick despite what some may say; plenty of women who are higher carb also have easy pregnancies with little to no morning sickness. So it just depends. Regardless of macro ratios, what does matter, arguably the most, is that you're eating a lot of calories and not being underfed. I know that's Amanda, I know that's me, and I also know that's my friend Tina Muir who overcame amenorrhea and got pregnant right away (we talked about it on her podcast, which you can hear here).

Btw, a huge shoutout to Tina for her massive lifestyle changes that helped her overcome amenorrhea and achieve her next dream of becoming a mama. She hired me as a consultant in 2016, and we talked a lot about this stuff. I knew she'd pull the trigger when she was ready, and I'd like to think I had a tiny influence on her journey and where's she's at now. I couldn't be happier for her :)

Anyway, once I found out I was pregnant at 4 weeks, I didn't try to maintain or force low carb by any means, I just ate what I felt like, but little did I know things were really about to change...

Diet - From 6 Weeks On...


As soon as I hit six weeks my diet changed drastically! All of a sudden my carb cravings were literally THROUGH THE ROOF. Unlike anything I'd experienced before and I was dreaming of pizza, ice cream, waffles, granola, bread, you name it. Meanwhile my food aversions hit me like a ton of bricks. I went from loving sunny-side-up eggs, avocado, all the veggies and salad to being grossed out by all of that for the most part. I could eat veggies but only if they were hidden in a dish with other things like sauces and carbs (i.e. curry with rice... with some veggies tucked in), or pureed veggies in a creamy soup. To make sure I was getting daily greens I started drinking a lot of organic green juices.

I have not had consistent cravings; it seems like each week (sometimes each day) my body is asking for something else. I was digging granola and yogurt in the beginning and now it makes me want to puke. I was ALL about dairy for several weeks, like I NEEDED it, and now I can take it or leave it. I'll enjoy high-fat smoothie bowls for breakfast on some weeks and other weeks they make me wanna gag.

Overall I'd say I'm still eating really healthy, mostly organic (except if we eat out and I have no choice), and I'm avoiding shitty ingredients from junk foods. Personally, though, I feel like I'm eating crappier simply in the sense that the increase in carby and sugary foods are often replacing my usual greens, veggies and in many cases fats or animal proteins, but it's not like what I'm doing is unhealthy by any means, it's just different than my normal standards. Also on the eating out thing, my motivation to cook hit an all-time low and we've been eating out more than usual, like 2-3 times a week, so I'm sure I've been served vegetable oils and conventional meats and produce, but what can you do. I'm not trying to control everything and I need to just do what's best for me right now so if I don't wanna cook I won't (PS - John is busier lately, and picking up a lot of my slack, so I don't except him to slave over the kitchen too). I do my best to get in quality animal protein in most my meals, but there are times when I simply don't want meat and/or I'm incredibly picky about what meat I'll be able to eat. There's not rhyme or reason and it's always changing. One night I will looooove salmon, one night I just can't do it.

My favorite random cravings have included lobster bisque (WTF is that about), seaweed salads (iodine), sauerkraut (probiotics), pad thai, curry, waffles but NOT pancakes, pumkin pie (have yet to have any) and an old throwback to a childhood comfort food: egg sandwiches with strawberry jelly, mayo and butter. Yes you read that correctly, jelly and mayo together with egg on toasted bread with butter. You can ask my grandma about how that one came to be. I'm using sugar-free jelly (just the sugars from fruit), Primal Kitchens Mayo, Kerrygold Butter, pastured farm-fresh eggs and a gluten-free paleo bread from the farmer's market, so actually pretty darn healthy!

The days I feel most nauseous carbs are the name of the game, and often some interesting choices...

This was a real DINNER - three or four GF waffles and Halo Top ice cream, with tea. Word.
John had leftover chicken with his waffles lol!

I've also craved a lot of "normal-people food" like pizza (keeping it GF), ice cream, burgers, all the fruit, tortilla chips (not the healthy kind), rice bowls, "healthy" rice crispies cereal. I've had pizza (aiming for healthy organic ingredients) at least 8 times so far, more than I've eaten in the past three years likely!

By week 10 I felt like was feeling a lot better most days and wanting to eat more of my usual foods -- back to salads, avocados, and lots of veggies -- but usually still piling on more hearty carb choices. It's not that paleo.
One night I got my act together and made homemade green curry!
I ended up eating about 3x more rice than what's shown.

This was a good dinner.

Exercise


I'm so glad I love to exercise and that I started out my pregnancy out with a decent base -- not necessarily "fit fit" but very adapted to daily exercise. But weeks 5-8 I didn't do a whole lot of exercising at all (minimums like 30min/day, and lots of walking). At first it was likely because deep down I was a bit afraid to "over" exercise and risk anything. I got over that. Then it turned into minimum exercise because I wasn't feeling too hot. At the very least, I'd get out and walk every day with Finley, if not a couple to three times a day.

My nausea could come any time of day or night, but it would usually set in after breakfast before lunch so if I got moving around that time it helped. However some days exercise was not the answer and I needed a nap instead, so I'd go crawl back into bed and not even think twice about it. I've been incredibly proud of my flexibility and intuitive nature. I'm not letting anything bother me -- food choices, exercise choices, whatever -- and just rolling with it. If I take a nap before lunch, so be it. If I take a two-hour nap at 3 p.m., so be it.

I started feeling better and better, thankfully. At this point, I'm running about three times a week on average, between 3-5 miles, probably all at a 9:00-12:00 pace depending on heat and terrain. I'm not wearing a HR monitor but I am keeping my effort in check, i.e. aerobic, and not doing anything that feels too aggressive. I'll always walk if HR feels like it's getting a bit too high or there's a steep hill (and I end up walking at least some portion of every run I do). Some days I feel like a rockstar other days I feel like I'm carrying a ton of bricks.

I'm also strength training at home about 2-3 times a week, easy sessions of 15-30 minutes that include kettlebells, TRX, and bodyweight exercises. I'll usually round out these sessions with some mobility and yoga poses.

I have eased back on paddleboarding since my race, but started swimming again in July, and, oh man, for the first time in a long time I'm really enjoying the pool. So refreshing and especially a nice way to get moving and not overheat during this HOT summer. Since my form still sucks, I have to be careful to not let my HR soar due to inefficiency; I'm mostly doing sets of 50s and 100s -- and that's currently "endurance" ;)

Then there's lots and lots of walking, thanks to Finley! A lot of athletes talk shit on walking, and I can understand why, but I think they're wrong. Just sayin. I love it, I find it so beneficial -- mentally and physically -- whether in training or not. Science supports me ;) I've been taking short walks after meals, especially dinner, to aid in digestion, and that helps too.

Tonight I'm going to my first prenatal yoga class and excited to learn some new moves, and I hope to keep up with that.

I'm also getting massages, albeit much LESS frequently than when in training mode. But with the swimming and strength, I build tension and massages help. Thankfully my gal who I've been seeing forever is certified in pregnancy massage.

Energy


My energy (and fatigue) = a rollercoaster. I never know what to expect next; some days I feel so great that I wouldn't even know I'm pregnant and other days I'm so dead that I barely leave the house and take multiple naps. Thankfully overall I've had way more good days than bad, and on average I feel pretty decent, not normal, but decent.

I quit coffee the day I found out and that was a tough transition from a fatigue standpoint. I didn't get headaches or anything but I was wasted tired for like three days before coming out of the fog. Then I felt ok not having coffee but was still often slow to get moving and often finding it hard to focus and get shit done. I don't blame the lack of coffee for that, I blame the hormones and all the changes in my body!

I met with my naturopath during week 8, and she said it'd be totally fine for me to have a tiny bit of coffee each day, just don't exceed 200 mg/day (which is actually quite a bit so it's pretty easy to stay under that). Around week 9 I started drinking a shot of regular homemade cold brew per day, which I further diluted in water -- about 1 part coffee, 3 parts water. I'll sip on that after breakfast only (never on an empty stomach) and usually won't even finish all of it. But even having that tiny amount has been so nice and it does help me.

My work productivity has really suffered the past two months, and of all things going on as of late this is the one thing that's caused me a bit of stress. I don't like feeling like I'm not being productive or contributing to our family. I mean, I'm still working -- I have all my coaching clients (thus writing workouts, frequent communication with them, guiding health plans, etc.), doing some consults, writing for and managing my inner-circle lifepostcollective.com, etc. I took the break from the podcast, which was probably a great call, but I'm ready to go back to it and will return later this month. WOOT!

My original plan during this summer, even before pregnancy, was to get busy writing my first book. I've done a fair amount of prep, outlining and even wrote the first chapter, but I am nowhere near where I'd like to be by now, and I feel very guilty about that. Since it's on my shoulders and no deadlines, it's been easy to procrastinate... or go nap or scroll through social media instead when brain cells feel dead. Ugh.

Everyone says just be kind to myself and don't put too much pressure on myself during this time (especially the first trimester!!!). For the most part I've been living up to that (obviously I'm letting myself relax, take naps, chill, etc., rather than busting my balls) but I'm normally a go-getter and it's just weird to be so low-key and not living up to my usual productivity. I'm sure once baby is here it'll get even more chaotic for a while. Thank god I have a supportive hubby who always says, "don't worry about it" when it comes to work and stuff.

Meanwhile, we've been getting out a lot and not being hermits whatsoever. Parties, concerts, dinner dates, whatever... I'm not in the mood to just sit around and I can always find energy for a good social outing or live music. This weekend we're seeing Jack Johnson, hell yea.

My Body


I was already at a very healthy weight/normal BMI when I conceived, 142 lbs, which was up from my average weight of 135 in recent years, but apparently my body wanted even more "cushion" because I went through an initial surge of putting on another 5-6 pounds right away in those beginning weeks (averaging about 1 lb gain a week)... my naturopath and midwife said that's totally fine and normal (despite books saying that NO weight gain is often normal in the first trimester). No doubt my diet played a role, but I was just listening to my body's needs. Since then, the weight gain has tapered off to where recently I'm not even gaining a pound a week. Right now (at 12 weeks) I'm holding steady at 148 lbs... but by the end of each day I'm probably more with the bloating I usually get.

I feel really strong, in fact I feel like all that muscle under my fat has hypertrophied a tad (getting swole for baby!), but I also just feel so big already. I'm certainly NOT one of those petite pregnant ladies who barely gain any fat and who don't show until week 28 or something. Ha, anything but! Whether it's a food baby, bloating or the real baby, I certainly have a tummy bulge already and certainly have more fat everywhere... And I'm proud of it! No bump-only pregnancies over here.

Most my clothes still fit, although certain clothes I'm not even bothering with, and I have yet to try on my jeans (it's too hot anyway so why bother). While it's most comfortable to wear my baggiest clothes, I also don't shy away from a tighter stuff. I'll still run around in 2-piece swimsuits and wear tight workout tops or booty shorts (booty shorts = my shorts that used to be loose and baggy lol). I live in my lululemon run shorts (stretchy!) and sports bras over real bras all the way. Speaking of, I had to buy some new sports bras (all mine were size small) as I was getting smashed and it was starting to hurt. Some of my swimsuits fit, whereas some make it hard to believe I actually looked good in them at some point (hello muffin top). I will say, it's very nice to have bigger boobs, that I am enjoying ;)

I'm the type of person who gains weight all over, and that's holding true during this pregnancy so far, so I don't look too fat in any one area, just like a larger bigger-boned version of me. No shame, and I'm not trying to hide a thing. This is pregnancy, you're not supposed to remain rail thin!!!!!!

I know my mom was ginormous with my sister and I, so I expect that'll be me too. At some point, I'm sure I'll weigh more than John, and I'll proudly flaunt it.

12 week "bump" shot!


Anyway, that's my story so far. thanks for reading!