24 Week Update: Hypertension and tachycardia

The week before Christmas and New Years, I began feeling unwell. I felt more tired, short of breath easier, and just... off. I started getting concerned about my blood pressure again and kept making a point to get it checked but then kept putting it off.

Until January 2nd, when I finally went into the drugstore and my suspicions were confirmed: 141/84, up from 104/66 at my last doctor's visit three weeks prior. Panic began to set in as I wasn't even at 24 weeks gestation yet. At my scheduled counseling appointment on 1/4, she checked it again and it was 142/85. I was glad to have my OB appointment scheduled for the following day. To say I was panicking would have been a slight understatement. I realized that in my last pregnancy I was blissfully naive to the true dangers and likely course of preeclampsia, but this time I have been reading and studying, for better or worse.

At exactly 24 weeks, I saw my OB and was able to tell him my concerns and symptoms. Of coarse, my manual BP in his office was within normal limits ( 130-something over 75-ish), so he wasn't overly concerned. Then he listened to my heart. Immediately, he said that it was pounding and then informed that I had tachycardia at 120 beats per minute. So this bought me a trip to cardiology later that afternoon, an EKG, many vials of blood, and a follow-up appointment in the next week.

The cardiologist, upon review of my EKG, didn't seem overly concerned. However, he did order an echocardiogram and a 24-hour halter monitor, just to cover our bases. Of coarse my blood pressure was also within normal limits at this appointment, just making me feel a bit crazy.

The following day, one of my nursing co-workers checked my blood pressure twice. The first time it was 168/79 and the second time it was 139/92. I bought a home automatic monitor and the systolic has ranged from the high 120s up to the 150s and the diastolic has ranged from the mid-70s to the low 90s.

At my OB appointment, he didn't seem concerned about the BP because was good when they tested me, but was more concerned about my heart. I am more concerned about my blood pressure given my past history of preeclampsia. I asked if I should continue to monitor it myself and he said this would be okay, but didn't give me a specific guideline (with my first pregnancy, he gave me specific instructions to check 3-4 times per day when it started raising in his office). I asked when/if I should contact him if it got "too high" and he said to call with anything over 140 or 80. When he told me this, I internally rolled my eyes knowing that I would likely be calling him the next day because it seemed like my readings at home were always higher than this.

I haven't called. I am giving myself a higher threshold because I feel like a complete fool to go into the office and have the manual reading be within normal limits. I will call if it escalates, but in the meanwhile I am working on being content that I have a cardiology appointment (for the echo) on Wednesday and see the OB back on Friday. At this point I will have made it 25 weeks. I did not expect to be so focused on "making it" this early on. That part is terrifying.

On a positive note, the baby seems to be doing well. I am measuring on track and her heartbeat was 151 bpm. Now we just need to keep her incubating.

Break. Re-set.

After walking out the door today, I will not return to my office for a full week! My last break of this magnitude was in June and I didn't realize how much I was looking forward to/needing this.

It comes at impeccable timing. In meeting with the therapist last week, we decided collectively to focus on behavioral changes first and keep medication as an option to consider down the road if things don't improve or get worse. I know the behavioral changes that improve mood. I am a psychologist. I just haven't been listening to my own advice. A week off of work is the perfect opportunity to hit the "reset" button and put an emphasis on my health and mood.

Here is the action plan:

1. I have a follow-up therapy appointment in early January. 
2. Focus on sleep hygiene to get enough sleep an feel well-rested. This means turning off the screens before getting to bed, having a relaxing cup of tea or cocoa to down-shift, and taking my heartburn medication as recommended. 
3. Try to get in physical activity every day. Elevate my heart-rate, which is great for endorphin-release and a mood boost. Bonus points if it is outside in the fresh air (but no hard feelings and mentally beating myself up if there is a blizzard and I opt for the treadmill or mall walk!). 
4. Ask for help. Accept that I am growing another human being while working full time and raising a toddler and this is hard work. Don't expect for C to read my mind, but ask to him to assist me completing the first three things on this list or giving me a break from the toddler. 

These are basic, but things that I have not been managing up to this point. Three daily tasks to make my emotional health a priority as we close out the year and I enter the second half of my pregnancy. Now I just need to consistently follow-though. Wish me luck!

Antepartum Depression

I made an appointment with a therapist for later this week.

I am worried about antepartum depression. As a psychologist, you would think a self-diagnosis would be simple. However, mixing in pregnancy symptoms makes it more complex and I decided after calling off work twice last week that I need to be proactive.

Antepartum depression, or depression that occurs during the pregnancy, is more common then most realize, affecting 12 - 20% of women by some estimates. There are many risk factors, including previous history of depression, pregnancy complications, and IVF among others.

Here are the symptoms of depression:

1. depressed/sad mood, 
2. loss of interest in normal activities and relationships (called anhedonia), 
3. fatigue, 
4. concentration difficulties, 
5. sleep disturbance (insomnia or hypersomnia), 
6. psychomotor agitation or retardation (physically feeling agitation or slowed down), 
7. significant weight loss or weight gain, 
8. thoughts of death or suicide, 
9. feelings of worthlessness or guilt.

A diagnosis of depression is warranted when a significant number of these symptoms is present, more often then not, for greater than two weeks, results in impairment in life functioning, and isn't better explained by something else.

This last part complicates things. Pregnancy, combined with a long-lasting respiratory illness that I can't seem to shake from a lowered immune system, also can cause many of these symptoms. It begins with sleep disturbance (in my case, both insomnia and hypersomnia) and fatigue. The fatigue results in concentration difficulties. The fatigue and changing body shape then escalate into psychomotor retardation. Then I am no longer productive and feel like a less-then-adequate mother to my toddler... and now we have feelings of worthlessness and guilt. Significant weight gain clearly doesn't even count in this scenario.

That leaves depressed mood, loss of interest in normal activities, and thoughts of death/suicide. Those are really the only symptoms that can't be explicitly tied to pregnancy. I can clearly rule out the last of these. So how is my mood and my interest? Mostly, "blah".

This is what has me concerned. I haven't felt any lasting joy in this pregnancy. I am too tired to care about much. Objectively, there are some very exciting things going on around me - at work, with family, etc., but I struggling to find enthusiasm for them. Last week, I called in sick two days in a row. The first day was mostly due to illness, but then I realized by the second day that I was really just avoiding work. And I love my job and it is going really well. But I struggle to get there and make an effort. How much of this is due to fatigue versus depression? I can only compare to my last pregnancy, when I don't recall feeling quite this miserable.

So I made an appointment. Because talking to someone and getting another opinion never hurt.