Friday, December 26, 2008

Celiac Questions about Pregnancy

I recently had an appointment with a Paranatologist who was fantastic! He was able to answer some of my most burning questions. So I thought I would post them along with his answers for you all to share.

How long should I wait after being GF?
The doctor said it was difficult to give an exact answer. But he suggests that you:
a) be on a gluten free diet successfully - no cheating!
b) have clean and healthy bloodwork
c) have a healthy or normal dexascan
d) find a gluten free prenatal vitamin and DHA supplement
e) be in a healthy weight range
f) meet and work with a nutritionist
f) on top of all this be what you would consider healthy - he said this was the most important. Because you know your body better than any doctor. If you are healthy, chances are you will have a good likelyhood of normal chance of at a healthy pregnancy. If you are sick, ill or unhealthy then the chances for complications skyrocket.

He said that depending on the person, the length of time the disease was undiagnosed and the severity will play more of a time factor than anything else. For some it might be a few months, and for others a few years.

What happens to the baby or fetus if I am glutened while pregnant?

He said that there is no research to prove that it does any damage if it is a one time deal, because not all accidents can be avoided. What is more important is that you are HEALTHY! If you are being glutened on a regular basis and are unhealthy on a regular basis, then that is when there is cause for concern.

If my husband eats gluten, can gluten get in his sperm?
No. Gluten can not get in sperm. Additionally, since you must ingest gluten in your digestive tract, sperm in your uterus does not pose any threat what so ever.

Should my husband be genetically tested for Celiac?
He recommended we both meet with a genetic counselor at the end of this month. I will update it after my appointment.

What tests should I have done once pregnant?
He suggested that whatever tests we feel comfortable with we should do. If I am concerned I can talk to my OBGYN about additional ultrasounds and testing to ensure the baby is healthy. Otherwise, it is really up to us, because as long as I am HEALTHY and CONTROLLING the celiac, then I have the same chances as a non celiac normally healthy woman at a succesful pregnancy.

What are my risk factors while pregnant?
If you are HEALTHY and CONTROLLING your celiac, then you have the same chances as a non celiac normally healthy woman at a succesful pregnancy. The same risk factors for a normal woman for early delivery and such still apply. If you have previously had children, they use those to anticipate how you will preform while pregnant. If it is your first, then it is a wait and see game.

What are possible complications for the baby?
If you are well controlled and healthy and taking daily vitamins and DHA, the same complications risks as a average pregnancy apply.

How long will I need to breastfeed, can I also use formula?
Formula is not recommended. Breastfeeding is recommended up to a year at minimum. And it is suggested to hold off common allegern foods longer than what is recommended, but still introducing them, just at a later time.

How long should I be on prenatals before trying to concieve?
At least 2 weeks, most vitamins will be readily available in your system that same day, but it is important in early pregnancy and through out breatfeeding to be on proper prenatals and a healthy diet.

Sunday, November 23, 2008

The Emotional Connection

It can be toughest sometimes for the ones that are closest to you to fully understand what life is like when you are trying to cope with a new way of life. I know for me it is my husband that does his best to understand, but sometimes no matter how hard he trys, he just misses the mark.

I don't think that it is fair for anyone who is not GF or Celiac to be able to fully understand how much this lifestyle can dominate your day to day activities. Yes, I know...once you get a handle on the new way of doing things it is much easier and with a little of preplanning and forethought you can still do just about anything. But that is not what I am talking about...at least not here.

I am talking about the never ending self control you must exert, or the will to resist the biggest and most emotional temptations. Because lets face it, in our culture we have a HUGE emotional relationship to food. Christmas, Thanksgiving, Birthdays, Halloween, and even Valentine's Day all have certain food for everyone that define the special nostalgia for that specific event. What was the hardest for me was severing my emotional ties to food.

I had to realize that it wasn't the food that I was missing when we went out to eat, it was the fact that once I was diagnosed we STOPPED going out all together. I missed the social aspect of meeting friends for dinner, or the intimacy of a romantic meal at my favorite restaurant. I felt like I was having to give all of that up in the beginning.

Or at Christmas and Thanksgiving, all of my favorite wonderfully delicious family recipies that were staring me down at the kitchen table. My mouth watering, and trying my best to enjoy my gluten free versions that were new, different, and not quite as tasty. Halloween...all of those little individually wrapped candies that everyone brings to work, or you bring home to hand out to all of the little munchkins running rampant through your neighborhood.

It is hard to disconnect yourself emotionally from food during these life occasions. Even Valentines day, My husband asked me last year...what do I get you since you can't eat the chocolate hearts? Initially my answer was, nothing I guess. I know that this may seem a little melodramatic, but think about it. If you are on a diet, you can break that diet and take a "Holiday Vacation" from counting calories. But when you don't have that option, knowing that you can not have it makes you want it that much more. You start to remember how those foods used to taste. Even if they truly are not that delicious your mind remembers it differently.

I told my husband out of desperation one time, when he was having a hard time understanding how difficult it was for me in the beginning, that if I was an Achoholic, NO ONE would ask me to go to the bar, or send me a bottle of vodka in the mail. He wouldn't be bringing me home bottles of wine for a surprise! I told him that it is similar, because when I was first going GF, my body was physically craving Gluten and the reaction I would have. I am sure it is similar to quitting smoking. Denying you body what it wants most! I think the longer you are GF the easier it becomes, just as the longer you are sober or cigarette free the easier it is as well.

But it is those moments of weakness that still sneak up on me. I will be alone in the house, all by myself, no witnesses... maybe it I just take a bite, then I won't get sick, maybe just maybe I can trick myself - telling myself I will be ok...Oreos don't have that much gluten anyways.... RIGHT? WRONG!!!!

The next thing I know I am down for 2 days with horrible stomach pains, and regurgitating everything I have eaten for the last few days including that blessed Oreo. And that is what makes it so hard.

99.99% of the time I have EXCELLENT self control, but there is that small percentage when I think, ok, it won't be so bad.... Unfortunately it never seems to work out for me.

This is the aspect of living GF or Celiac that I think most people have a hard time really grasping. The constant self control and the mild anxiety anytime you try something new, or have gluten around you.

I mean come on, not only do I have to watch my food intake, but what about my husbands... remembering what he has eaten so he won't give me a gluteny kiss, or trying to figure out if those crumbs on your kitchen counter are the enemy or just harmless little crumbs. Or if the waitress who brings your GF food out has touched anything that might contaminate the plate she has just had her hands all over that is now sitting in front of you.

Its the CONSTANT speculation of the risks that what you are about to put in your mouth poses to your health. It never ends. Eventually it does become a normal way of life and you fall into the routine of things, but in the beginning EVERYTHING is so overwhelming anyways, that it just makes it that much harder to deal with the emotional side of food.

I am not trying to just provide a complaint fest in these confessionals, my sincere hope is that someone out there who is going through the same thing, knows that they are not alone, or someone like my husband who is soooo wonderful and loving, can maybe catch a deeper glimmer of what life is like as a GF or Celiac.

Because sometimes things that don't seem like a big deal to Non GF or Celiacs, like a request to have flour tortillas in your pristine GF kitchen, can cause contention unnecessarily. How can they truly understand that they can eat safely ANYWHERE, and this is the ONLY place that you can? That bringing Tortillas into the house, could contaminate your sour cream, cheese, salsa, or other toppings that you use. And no matter how hard they try to be good, mistakes always inadvertently end up happening and then you are the one out for days sick, because of an honest mistake.

It is hard to open up sometimes and be completely honest with the fear of sounding like a complete control freak or a food Nazi, but my husband does understand, and is ok with it. He is wonderful with the whole situation. But we had to talk it through before we could get there. Don't expect people to understand what it is like for you, they can't. So open up and I think you will be pleasantly surprised!

GF Chicken Enchiladas

Ingredients:
2 Chicken Breasts
1 Can Tomatoes
1/2 Sweet Onion
GF Corn Tortillas
Medium Cheddar Cheese (Or your favorite cheese)
McCormick's Original Taco Seasoning

Instructions:
1)Boil chicken breasts in water until completely cooked. Drain water. Shred chicken with a fork. Add tomatoes and onions to the skillet with the chicken. Add taco seasoning, slowly simmer.

2)Microwave corn tortillas until pliable. Fill tortillas with chicken mixture and cheese. Roll and place in a casserole pan.

3) To make enchilada sauce take 4 parts taco seasoning to 1 part water and mix. Then pour over enchiladas. Place in oven on 350 degrees until cheese is melted.

Saturday, November 22, 2008

When is the right time to start trying for a baby?

This is a question that my husband and I have been discussing for the last few months. It is a hard question to answer, first because I think most couples thinking about starting a family consider their financial situations and the stability of where they are in life. You ask yourself...Am I really ready to have kids? Am I doing it for the right reasons? Will we be able to handle anything that comes our way? Are we willing to make the right sacrifices?

But having Celiac added to the equation has only seemed to complicate the matter further for myself and my husband. Of course we asked each other all of the above questions, but then comes the ones that are hard to define. How long do we wait after I have been GF? Am I healthy enough to physically handle the pregnancy? What if we have a miscarriage or a baby with a birth defect from complications? When am I really considered healthy again? What are the risk factors to me and the baby? Should we even consider having kids if we could pass the Celiac gene on?

These questions were much, much harder for us to find answers to. We ended up turning to our parents for guidance. And since I am sure that there are others out there with the same questions to answer, here are the answers my husband and I came up with.

How long do we wait after I have been GF? and Am I healthy enough to physically handle the pregnancy?
I have done alot of research on the Internet, and most forums say or recommend to wait anywhere from 6 months to 2 years before trying to conceive. My husband and I with the advice from my parents decided that the best answer would be found with the consultation of a OBGYN during a pre-pregnancy evaluation. The answer still is not incredibly clear, what came out of my appointment is that the doctor would feel comfortable giving his blessing after I completed the following to do list - pass a full blood work with vitamin panel, dexascan - bone density scan, evaluation by a counselor, consultation appointment with a Paranatologist, and thorough review of my symptoms and current health state. That included making sure I was in the proper BMI range, that I was following the recommendations from my nutritionist, and that I was exercising regularly and learning to manage stress.

I still don't have an answer yet YES or NO, I have another month and a few more tests before I will know for sure. But the one thing that we do know is that we are doing everything we can to be responsible before we make the decision to start conceiving. I think that depending on how well you are recovering and how severe the disease is for you, will determine how long you should wait. So far we have waited a year, I am not sure how much longer we will have to wait, but it is worth it to know that I was responsible about it.

What if we have a miscarriage or a baby with a birth defect from complications?
This was one of the toughest questions that my husband and I talked about. Because of course we would love any child that we created, not matter what. But the issue of miscarriage is an emotional one. We decided that we will only tell our immediate family about the pregnancy once it does happen until we are past the 1st trimester. After 3 months then we will tell our very close friends and extended family. Mainly because I think a miscarriage would be hard enough with out having to involve all the emotions of everyone you love. And secondly because it gives us time to prepare and enjoy the pregnancy with out the added concern of overly cautious friends and family.

As for birth defects, my husband and I had an in depth discussion on whether or not to preform certain tests during pregnancy. We talked to my OBGYN about it and decided that we would do every test that made sense, so we could either try to correct or treat the situation medically or at least have a support system in place to help care for our child once it came. We decided long ago that we would NEVER abort a child. So as long as we are doing everything we can, to do it right then the rest of it is pretty much in God's hands.

One of the issues that my husband did bring up is that if the child had a birth defect from complications with my Celiac Disease would I be ok with it? Would I punish myself forever? He said that he supported me and would accept whatever happened, and that he loves me no matter what....but how did I feel?

I concluded that if I did ABSOLUTELY EVERYTHING I could to make sure I was as 100% medically ready as I could be then, what more could I ask of myself? I decided that for me it was MUCH more important to wait, as hard as it is, until I get the full blessing of my wonderful OBGYN and Paranatologist, since they obviously know way more about pregnancy than I do.

When am I really considered healthy again?
This is a question that I have asked myself even before we decided to pursue trying to start a family. What is Healthy anyways? We decided that it meant that all of my blood work was normal, I maintained a healthy weight for at least 6 months, and was able to exercise regularly 3 times a week. Everything else fluctuates, there are always mistakes, but I seem to bounce back faster the longer I am healthier. I don't know that there is just one test that you can do and say ... YES you are 100% now! Life will now return to normal. Because the reality is that it doesn't! It isn't a destination that I can get to, it is a journey that I will be on for the rest of my life. So for me it is more about being able to maintain healthy habits, weight and blood work.

What are the risk factors to me and the baby?
I have read that you have a 1 in 10 chance of your child developing Celiac Disease if a parent has Celiac. So far I know that there are increased risks in UNTREATED and UNCONTROLLED Celiacs to have a higher rate of miscarriages and full term misscarriages, nerual tube defects, and other vitamin dificiecy complications. I do not know if there are any risk factors yet for TREATED AND CONTROLLED Celiacs, as far as I have been able to find, you have the same chance as a normal person at having a healthy baby and pregnancy. (I will update this after my appointment with the Paranatologist in December!)

Should we even consider having kids if we could pass the Celiac gene on?
My Grandmother asked me this question. I thought to myself, do I wish that my parents never had me? The answer was obviously NO! But if I knew that I would pass it on to my children would that keep me from having them. For my husband and I atleast it is not a good enough reason, to not have them. I feel like it has been a blessing, and his helping me prevent other health issues down the road. The hardest part for me was trying to fiqure out that it was Celiac disease that made me so sick for so long. And as my husband says that I went through it so that our kids won't have to, now we know what it is and how the treat it!

So I guess our answer is YES we will still have kids even if it means we pass it along.

Friendships and Food

Most people when you tell them that you have Celiac their first response is "What is that?". It is challenging to try to explain something that dominates your life in a few short sentences, and how much do you tell them?

I feel like it took me 6 months to figure it out...and I am supposed to provide a summation in just a few minutes! I mean it is pretty personal information once they start asking you "What does it do to you?"

I have come to realize that the best answer is it makes me VERY SICK! IF they press further then I tell them that I am down for days... only one person has continually pressed for more gory details... so I let them have it in all its wonder and disturbing glory, from the abdominal distention, weight gain, and even to the bloody stool before they felt that they had sufficient information and let it drop.

Since it always seems to draw attention every time I eat (which is 3 times a day) it is not surprising that almost everyone I know, or just meet ask me questions about my eating habits. Nothing sticks out like a sore thumb more then not ordering any food when out with friends or bringing your own food and asking the waiter if they could reheat it for you.

Then follows the onslaught of expected questioning. But sometimes it seems that it is all you ever talk about. Not only are you trying to explain something that is already hard enough to deal with, but you are expected to do so publicly. Which can feel very exposing and often leaves me self conscious for the wrong reasons.

I struggled along time with the fact that I was having to share details about my personal struggles that I still had a hard time accepting. Some of my friends were incredibly supportive and fantastic! One of my friends asked me the other day if I missed eating out, while we were at a dinner banquet. I said that it didn't bother me so much anymore as long as I remembered to eat before I came. She said that was good and not to worry because the food sucked anyways! Whether it actually did or not we had a good laugh over it anyways.

There are others that accept it and move on unphased by all of it, which is great and fantastic! And then there are friends that feel uncomfortable when you do not participate with them. If you are not "pigging out" on that glorious chocolate cake with them, then they get uncomfortable with you not partaking in the sinful delight and instead of being able to be confident in their dessert decisions, they make it your problem.

With such comments as - You don't eat enough! I am always worried about you, you never eat anything! Aren't you hungry? No wonder you lost weight, you never eat! Isn't there anything that you can have? It must be so hard for you! I even had a friend tell me that while on a group outing that I was a burden to the whole group because I never said when I was hungry and everyone was worried that I wasn't getting enough to eat, and she was worried that I had a bad relationship with food!!!!!

I couldn't believe it! I wanted to scream and shout! YES!!! I have a bad relationship with food!!!! Gluten hates me! It destroys and attacks my intestines making me sick for days! Why can't it just be more friendly? Like I can talk to the food and hash out a reasonable compromise!!!! (YEAH RIGHT!) TRUST ME if I could eat that chocolate cake with you, I would probably march myself right into the back of the kitchen, not even bothering for a plate and begin to shovel fist fulls of glorious cake into my mouth with out apology! For crying out loud she would probably have to pull me away kicking and screaming!!!!

But I think what really happened is that I made it uncomfortable for those that felt guilty for their choices to eat things they thought they shouldn't. I NEVER spoke a word about food, or said 1 thing that was not upbeat and in the spirit of fun that weekend. But because I had to be so controlled, and restrained it made others who were already self conscious and guilty only more so. It exacerbated the situation. But the girls that were fine with their decisions had no problem with me.

This has been one of the toughest things for me to deal with. Is that on top of having to have self control and an upbeat attitude around friends so that we can have a good time, some of them with already poor relationships with food, place the burden and guilt of their bad feelings on you, and make it seem as if you are the one making them feel that way.

I think the biggest lesson that I have learned is that I am not the only one with a "relationship issue with food" Mine is a medical condition, others seem to stem from emotional issues. And unfortunately instead of being able to find kinship in your issues, they only seem to frustrate and irritate people who already have issues with food. I know that it is hard for them to be supportive, and most of the time I don't want them to, all I want is for them just to not make their issues mine. Rather lets just not talk about it! I have my issues you have yours, no big deal! Instead lets talk about your day, or your the trip you want to go on! Please lets just talk about LIFE, let the food stay on the plate, and we can both have a wonderful time!

I love all of my friends! I don't expect support or even understanding from anyone, just the respect to leave well enough alone and have a great time!

Update!

So it has been a year now since my diagnosis, and soo much has changed! Last year at this time I had to quit work and stay at home. It was all I could do just to make it through the day. Most of the time that meant staying in bed with a heating pad and lots of pain medication.

In February almost 2 months after going gluten free I began to take walks with my husband, they started off slowly 10-15 minutes at a time. I walked everyday that I could, and eventually got brave enough to jog, using a belly suppourt. Last June I finished my first 5k in 32:05. Not incredibly fast, but I made it the whole way running! That was my first big victory!

It took me 6 months of eating nothing but whole foods only prepared by myself and my husband before I started to feel better! Now I am able to eat out at certain resturants and eat some preprocessed foods. What a difference it makes to feel good!

I have maintained my gluten free lifestyle, and exercised 3 times a week, and am working on mangaging my stress levels. I think anytime you change your lifestyle it seems to turn your world upside down for a while.

I am glad that I have made it a year, and in the process have lost 45 pounds and am again at a healthy weight.

It took me a year before I began to feel normal again, and could hold a steady job. It was one of the toughest years of my life, but also one of the best. I wouldn't trade it for anything, because I finally feel normal! :)

Gluten Free Chicken Fried Steak

What you will need:
1 package of Cubed Steaks
1 cup of GF Corn Flake Crumbs (I found them at Albertsons)
2 eggs
1/4 cup of Canola Oil
Milk
GF All Purpose Flour
Salt
Pepper

Instructions:

1)In one bowl crack the eggs and mix with a fork, in a second bowl add the GF Corn Flake Crumbs, add salt to taste.

2)Take a skillet and add the Canola Oil, heat on high.

3)Take the Cubed Steaks and cut in half, take 1 piece and dip it into the beaten eggs. Then place in the Corn Crumb mixture, flipping it over to coat both sides. Make sure to press it into the mixture to flatten out the meat, it will cook in less time this way.

4) Place battered meat into the hot oil, turning the meat occasionally until cooked all the way through and golden brown.

5) Place cooked steaks on a paper towel to drain excess oils.

6) After all your steaks are cooked, add GF All Purpose Flour, 1 spoon full at a time, until the majority of the oil is absorbed. Allow the flour and oil mixture to bubble and simmer, then add the milk slowly. Allow the gravy to simmer until it thickens, if you need to add more GF flour or milk accordingly. Add Salt and Pepper to taste.

7) Serve the GF Chicken Fried Steak with the Gravy, and enjoy!